ObjectiveTo discuss the effectiveness of Poking reduction with shoulder arthroscopy-assisted surgery for displaced scapular neck fracture. MethodsBetween January 2009 and January 2012,9 cases of displaced scapular neck fracture underwent shoulder arthroscopy-assisted surgery for Poking reduction treatment.Of 9 cases,6 were men,and 3 were women,aged 21-54 years (mean,39 years).The causes were traffic accident injury in 7 cases,falling injury from height in 1 case,and hurt injury in 1 case.The shoulder abduction,flexion,and external rotation were obviously limited.X-ray films showed all cases had obvious displaced scapular neck fracture.Three-dimensional reconstruction of CT showed a grossly displaced of fracture.The time of injury to surgery was 4-27 days (mean,11 days). ResultsPatients obtained healing of incision by first intension,without infection,neurovascular injury,or other surgery-related complications.All patients were followed up 19-31 months (mean,23 months).X-ray films showed scapular neck fractures healed from 7 to 11 weeks (mean,8 weeks).At last follow-up,the shoulder abduction,flexion,and external rotation activity were improved significantly when compared with ones at preoperation (P<0.05);the shoulder Constant score,American Shoulder and Elbow Surgenos (ASES) score,and Rowe score were significantly better than preoperative scores (P<0.05). ConclusionThe reduction of displaced scapular neck fracture is necessary,and arthroscopic Poking reduction and fixation for displaced scapular neck fracture can reconstruct the shoulder stability and reduce complications
ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.
ObjectiveTo study the effectiveness of transverse carpal ligament release for carpal tunnel syndrome (CTS) with arthroscopic "two-portal" technique under local anesthesia. MethodsTransverse carpal ligament was released with arthroscopic "two-portal" technique in 31 patients with CTS between November 2002 and August 2008. There were 4 males and 27 females, aged 24-71 years (mean, 52 years). The disease duration was 1 month to 14 years (mean, 42 months). According to the guidelines of Bin Tian, 20 sides were rated as grade I, 16 sides as grade Ⅱ, and 5 sides as grade Ⅲ before operation. The sensation was S2+ in 7 cases, S3 in 19 cases, and S3+ in 5 cases. The muscle strength of the abductor pollicis brevis and opponens pollicis muscles was grade 2 in 5 cases, grade 3 in 14 cases, and grade 4 in 7 cases. Michigan hand function scoring system (MHQ) was used to evaluate the function of the hand before and after operation. ResultsAll incisions healed primarily, and no complications of median nerve injury and adhesion occurred. All of the 31 patients were followed up 6-11.8 years (mean, 9.6 years). After operation, numbness and paresthesia of fingers were relieved (S4); the muscle power returned to grade 4 in 8 cases, and to grade 5 in 23 cases. The MHQ scores of function, daily life, work, pain, appearance, and satisfaction were improved significantly at 6 months postoperatively when compared with preoperative ones (P<0.05). There was no relapse. ConclusionArthroscopic "two-portal" technique is an effective surgical procedure for relieving the compression symptoms on the median nerve from carpal canal, so it is helpful to functional recovery of the median nerve. The long-term effectiveness is definite.
ObjectiveTo study the biomechanical stability of neckwear-knot-loop-ligature fixation for tibial eminence avulsion fractures by comparing with cannulated screw fixation and suture anchor fixation. MethodsTwenty-four fresh porcine knee joints were selected. After the model of tibial eminence avulsion fracture (type Ⅲ) was made, 24 samples were randomly divided into 3 groups: neckwear-knot-loop-ligature group (group A), cannulated screw group (group B), and suture anchor group (group C), 8 samples in each group. The Universal electromagnetic and mechanical testing machines were used for the biomechanical tests. After 200 cyclic tests, pull-out test was done until fixation failure. The maximum failure load, yield load, stiffness, and displacement were measured. ResultsFailure mode: the displacement was beyond limit in 8 samples of group A; screws extraction (5 samples) and bone fragment re-fracture (3 samples) were observed in group B; and suture anchor extraction (4 samples), suture rupture (3 samples), and suture thread cutting (1 sample) were found in group C. Biomechanical test: From groups A to C, the maximum failure load and yield load showed significant decreasing tendency (P<0.05), but the displacements showed significant increasing tendency (P<0.05). The stiffness also gradually decreased, but differences was not significant (P>0.05). ConclusionCompared with cannulated screw and suture anchor, neckwear-knot-loop-ligature fixation for tibial eminence avulsion fracture has good biomechanical performance and the advantages of firm fixation and simple operation.