Objective To evaluate an improving operative procedure and the cl inical results of arthroscopically assisted treatment for acute patellar dislocation. Methods Between April 2006 and March 2009, 22 patients (25 knees) with primary acute complete dislocation of the patella underwent an improving arthroscopic operation, release of lateral retinaculum and suture of medial capsule and retinaculum structure. There were 5 males and 17 females with an average age of 23.6 years (range, 14-34 years). Three patients had bilateral procedure. Eleven left knees and 14 right knees were involved. The disease duration was 1-10 days with an average of 5.9 days. All patients had lateral dislocation; of them, 14 patients showed reduction without treatment, and 8 patients showed dislocation at admission and were given close manipulative reduction. The results were positive for apprehension test in all patients with the l imitation of passive motion and for Ballottable Patella Sign in 15 cases. Lysholm score, visual analogue scale (VAS) score, and Insall scale were adopted to evaluate the effect. Results All incisions healed by first intention. All the patients were followed up 12-36 months (17 months on average). During the first 3 months after operation, sunken skin in the puncture point medial to the patella was observed in 12 knees; 10 knees suffered pain of the soft tissue lateral to the patella; 15 knees felt tense in the soft tissue medial to the patella, however, all these problems disappeared or recovered gradually after rehabil itation and conservative treatment. No recurrence of dislocation was observed during the follow-up. Lysholm score was significantly improved from preoperative 67.3 ± 5.7 to postoperative 96.6 ± 4.5 (t=3.241, P=0.003) and VAS score from 6.5 ± 0.5 to 1.8 ± 0.4 (t=2.154, P=0.040). According to Insall scale, the results were excellent in 18 knees, good in 5 knees, and fair in 2 knees at 1 year after operation with an excellent and good rate of 92%. Conclusion The improving procedure of arthroscopically assisted treatment for acute patellar dislocation is a minimally invasive operation and has a number of benefits. Its short-term cl inical outcome was satisfactory.
【摘要】 目的 观察全喉全下咽切除术后空肠游离移植术二次手术时同时保留动静脉血管蒂或仅保留动脉血管蒂时对移植组织的影响。 方法 回顾分析2002年1月-2009年12月4例下咽癌行全喉全下咽切除术空肠游离移植术术后8~18个月因颈部转移灶出现而需再行手术患者的临床资料，其中3例行根治性颈清扫，1例行局部包块扩大切除术。2例同时保留动静脉蒂，2例仅保留动脉蒂。 结果 4例术后临床Ⅰ期愈合。保留动静脉蒂者吞咽功能与术前无异。仅保留动脉蒂者术后1个月仍有颈中份的明显隐痛，胃肠造影移植空肠段的蠕动明显减弱，吞咽固体食物时自觉较术前缓慢。 结论 再次手术时保留血管蒂对于保持空肠移植段的活力具有重要的意义。【Abstract】 Objective To observe the effect of keeping arteriovenous or venous pedicles during the second free jejunal transplantation after total laryngopharyngectomy on the transplanted tissues. Methods From January 2002 to December 2009,four patients underwent total laryngopharyngectomy and free jejunal. But 8-18 months later, the patients underwent another operation because of recurrent metastatic mass in the ipsilateral neck side of anastomosis; in whom three underwent radical neck dissection and one underwent local enlarged mass resection. In the four patients, two had arteriovenous pedicles remained and another two kept only venous pedicles. Results All of the four patients experienced first-stage healing. The deglutitive function in the two patients who had received the arteriovenous pedicles preservation didn’t differ much from that before the operation. While vague anguish in the anterior region of the neck, weak peristalsis of the transplanted jejunum, a little discomfort and slow swallowing were found in another two patients. Conclusion Keeping vascular pedicles during re-operation helps make the activity of the transplanted jejunum.