Clavicular hook plates for acute acromioclavicular dislocations:simultaneous repair of coracoclavicular ligament? / 中国组织工程研究

BACKGROUND:Clavicular hook plates have been used widely to treat acromioclavicular dislocations in recent years. However, it remains controversial whether coracoclavicular ligament should be repaired during the surgery. OBJECTIVE:To study the clinical effect and MRI manifestations after treatment of type III and V acute acromioclavicular Rockwood dislocation with clavicular hook plate, and to discuss the necessity of repairing coracoclavicular ligament during the surgery. METHODS:A total of 44 patients with type III and V acute acromioclavicular Rockwood dislocations were treated with clavicular hook plates without repair of coracoclavicular ligaments, and underwent plate removal operations later. At 24 months after the second surgery, X-rays were taken to measure the width of coracoclavicular joints in both normal and affected limbs, Constant-Murley scores were calculated in both sides, and MR images were used to observe the healing of coracoclavicular ligaments. RESULTS AND CONCLUSION:39 patients (89%) were fol owed up for 36.9±3.1 months (range, 30 to 45 months). The mean duration for retaining clavicular hook plates was 12.9±3.1 months (range, 6 to 21 months). The mean width of coracoclavicular joints was 6.04±1.21 mm (range, 4.3 to 8.8 mm) in normal limb, while 5.09±1.18 mm (range, 3.4 to 7.8 mm) in affected side without significant difference (P>0.05). The mean Constant-Murley score was 98.9±1.2 (range, 96 to 100) in normal limb, while 96.7±3.4 (range, 90 to 100) in affected side without significant difference (P>0.05). MRI showed healing of the coracoclavicular ligaments and the presence of continuous scar tissue in 38 patients, excluding one patient with recurrence of acromioclavicular joint dislocation. The clinical effects after treatment of type III and V acute acromioclavicular Rockwood dislocation with clavicular hook plate are satisfactory, and it is unnecessary to repair coracoclavicular ligament during the surgery. MR images reveal scar healing of the coracoclavicular ligaments without operative repair.

Fixation of proximal clavicle and sternum through the intramedullary cavity for sternoclavicular joint dislocation with wire rope:an anatomic and clinical research / 中国组织工程研究

BACKGROUND:Surgical management of sternoclavicular joint dislocation takes relatively larger risks for its adjacent mediastinal and other important structures. However, the surgical methods are varied and remain controversial. OBJECTIVE:To investigate the feasibility and validity of intramedul ary fixation of the proximal clavicle and sternum for sternoclavicular joint dislocation. METHODS:On 22 adult cadaver upper limb specimens, the anatomical features of the sternoclavicular joints and associated ligaments, the size of articular surface between the medial clavicle and manubrium and the morphology of articular disc, costoclavicular ligament and sternoclavicular ligament were observed and measured. From January 2009 to July 2012, three patients with sternoclavicular joint dislocation received the intramedul ary fixation with wire rope or absorbable suture in figure-of-eight shape. They were males, aged 9, 45 and 62 years, with an average age of 38.6 years. The outcome was evaluated by upper limb function DASH score. RESULTS AND CONCLUSION:Anatomic results demonstrated that the anteroposterior and coronal diameters of the surface of the medial clavicle were greater than that of the sternum, so they did not match each other. The minimum thickness of the manubrium sterni was at the superior margin of articular surface and the largest was at the sternal angle. The minimum width of the manubrium sterni was at the superior margin of articular surface and the largest was at the inferior margin. The articular disc, liked an el ipse and matched with the articulating surface of the manubrium sterni more, whose anteroposterior diameter was greater than its coronal diameter. Central thickness was greater than the edge thickness. The costoclavicular ligament was thicker and denser than the anterior and posterior sternoclavicular ligament. The anterior and posterior sternoclavicular ligaments were close in length, width and thickness. Clinical trial results demonstrated that al cases were fol owed up for 14 to 36 months. DASH score was 10-16, 13.3 in average. Effects of internal fixation were satisfactory. Surgical management of sternoclavicular joint dislocation by the fixation of the proximal clavicle and sternum through the intramedul ary cavity with wire rope or absorbable suture is reliable and effective.

Observations and measurements of Wiltse paraspinal sacrospinalis splitting approach in Chinese people / 中国组织工程研究

BACKGROUND:Application of Wiltse paraspinal sacrospinalis splitting approach can reduce paraspinal muscle injuries caused by operations, but there are stil no precise criteria to determine anatomic locations of longissimus-multifidus cleavage planes. OBJECTIVE:To have an intimate knowledge of structural characteristics of Wiltse paraspinal sacrospinalis splitting approach, to determine specific locations of longissimus-multifidus cleavage planes in different lumbar segments, and to provide experiences and references for its clinical applications by observations and measurements of autopsies and magnetic resonance images in Chinese people. METHODS:Ten embalmed adult cadavers were used for anatomical observations. The natural cleavage planes between longissimus and multifidus were noted and bluntly dissected bilateraly. Measurements were done between these planes and the midline at levels of spinous processes of L2 and L4. 400 patients’ images of lumbar spines were also used for observations. Measurements were taken bilateraly between longissimus-multifidus cleavage planes and the midline at levels of discs from L2/L3 to L5/S1. The correlations between these distances and sex or age were analyzed. RESULTS AND CONCLUSION:No important vessels or nerves were found in the longissimus-multifidus cleavage planes of al 10 cadavers. Superior facets and roots of transverse processes could be exposed at the bottom of the planes. At L2, the mean distance was (2.3±0.3) cm; at L4, (3.4±0.6) cm. Of al 400 images, the mean distances from L2/L3 to L5/S1 were respectively (19.71±1.93) mm, (23.49±2.49) mm, (27.49±2.84) mm and (31.36±3.15) mm. No strong correlation was discovered between sex or age with respect to measured distances. This study provides valuable references for clinical application of Wiltse paraspinal sacrospinalis splitting approach. We suggest routine measurements of magnetic resonance imaging before surgeries to reduce iatrogenic injuries.

Acetabular trabecular direction between different species / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.001

An anatomic study on scalenus minimus muscle / 中国矫形外科杂志

[Objective]To investigate the morphological characteristic of the scalenus minimus. [Methods]Totally 32(64 sides) embalmed adult cadavers were dissected and studied,the morphology of scalenus minimus and its relationship to brachial plexus was observed.Ten scalenus minimus were stained by HE to study membrane of the muscles.Twenty-seven(54 sides) embalmed adult cadavers were dissected carefully to investigate its nerve and blood supply.[Results]Scalenus minimus was found in 84.4% of cadavers(54/64).Its insertion was mainly composed of tendinous tissue,which was spaned by the lower trunk of brachial plexus.Scalenus minimus supply nerve branches was from ventral rami of the cervical seven root,and vascular supply was from:(1) branches of deep cervical artery,(2) branches of subclavia artery.[Conclusion]Scalenus minimus muscle,an independent but inconstant muscle,is existed in most people and sometimes responsible for compression of brachial plexus.It is suggested that scalenus minimus muscle should be resected carefully as well as scalenus anticus and medius during surgical treatment of thoracic outlet syndrome.

Advances in diagnosis and therapy of dislocation of acromioclavicular joint / 中华创伤骨科杂志

The dislocation of acromioclavicular joint is a common type of dislocation in clinic. Non- operative therapy has usually been the main traditional method to deal with it. However, with research on its mechanism and classification going further and further, more and more scholars have been inclined to apply surgical methods in recent years. In this article, we discuss briefly the non- operative and operative methods for dislocation of acromioclavicular joint