关节液用于关节疾病诊断的意义及未来展望

关节疾病是临床上的常见病及多发病,在临床工作中,其诊断主要依靠询问病史、体格检查、影像学检查及相关血液学检查等。但上述方法诊断价值有限,因不能更早期且准确地诊断关节疾病而导致患者很可能错失早期的有效治疗。近年来在骨关节疾病中关节液的相关研究越来越受到重视,有研究表明关节疾病的早期改变中有关节液成分的变化及关节内环境的改变,所以关节液检查为早期准确诊断关节疾病提供了可能。本文就一些常见的关节疾病,如骨关节炎、假体周围感染、化脓性关节炎、类风湿性关节炎及痛风性关节炎等,介绍了在这些疾病中常见的关节液检查方法、手段及进展,并对关节液检查分析的未来前景及意义进行展望。     

关节液α防御素-1检测在人工关节感染诊断中的应用价值

目的探讨关节液α防御素-1(AD-1)检测在人工关节感染(PJI)诊断中的应用价值。方法选取2013年3月至2015年10月福建省内多家三甲医院骨科45例需行人工关节翻修术患者,男性18例,女性27例,平均年龄(60±14)岁。根据美国肌肉骨骼感染学会(MSIS)诊断标准,纳入标准为全髋及全膝关节置换术后需要进行翻修手术及术后怀疑感染的患者等,排除标准为存在其他身体部位感染病灶等,分为感染组22例,非感染组23例。对45例患者进行关节腔穿刺抽取关节液,采用酶联免疫吸附法(ELISA)检测关节液中AD-1的表达水平。通过受试者工作曲线特征(ROC)曲线计算AD-1、关节液白细胞计数(SF-WBC)、多核比(PMN%)、红细胞沉降率(ESR)、C反应蛋白(CRP)的敏感性及特异性,χ~2检验计算细菌培养的敏感性及特异性。AD-1与各指标间的敏感性及特异性采用χ~2进行比较分析。结果 AD-1诊断PJI的敏感性为86.4%,特异性为91.2%,曲线下面积为0.95。45例患者合并有系统性炎症疾病的患者占31.1%,感染组抽取关节液前有使用过抗生素治疗的患者59%,但AD-1的表达水平并未受到这两项因素的影响。细菌培养、SF-WBC、PMN%、ESR、CRP的敏感性从80%到90.9%,特异性从56.5%到76%。AD-1诊断PJI的敏感性比细菌培养、PMN%、ESR、CRP高,比SF-WBC低;而AD-1诊断PJI的特异性高于各诊断指标。AD-1诊断PJI的特异性与PMN%、ESR、CRP比较差异有统计学意义(P0.05),而与细菌培养、SF-WBC比较差异无统计学意义(P0.05);AD-1诊断PJI的敏感性与细菌培养、SF-WBC、PMN%、ESR、CRP比较差异无统计学意义(P0.05)。结论 AD-1诊断PJI具有较高的敏感性及特异性,可作为诊断PJI的一项潜在诊断指标。     

远端桡尺关节半脱位的CT检查

目的探讨通过 CT检查提高对远端桡尺关节半脱位的诊断率。方法对 56例经 X线检查可疑为远端桡尺关节半脱位的患者（男 36例,女 20例）行双侧远端桡尺关节旋前、旋后位 CT横断扫描。应用 Nakamura的改良桡尺线方法进行测量,经过双侧对比确定尺骨头掌侧或背侧半脱位。结果在 56例 X线检查拟诊为远端桡尺关节半脱位的患者中,尺骨头掌侧半脱位 10例;尺骨头背侧半脱位 15例;另有 2例为尺骨头背侧半脱位,经与健侧对比确定为假阳性。结论通过 CT检查诊断远端桡尺关节半脱位,可减少 X线检查由于难以达到标准投照位置所产生的假阳性,从而提高对远端桡尺关节半脱位的诊断率。对曾有腕关节外伤史或逐渐加重的腕部疼痛及远端桡尺关节活动受限者, CT检查是诊断远端桡尺关节半脱位较为有效的方法。     

下尺桡关节损伤的诊断和治疗

对下尺桡关节(DRUJ)损伤缺乏足够认识和相应的早期处理,是导致DRUJ慢性不稳、尺腕关节撞击、DRUJ关节炎等的主要原因.腕关节X线和CT检查对DRUJ骨折和脱位后关节不稳、尺腕关节撞击有较大诊断价值,腕关节MRI及MR造影主要诊断三角纤维软骨复合体(TFCC)损伤.腕关节镜是目前诊断TFCC损伤的金标准.Ozer等的DRUJ损伤分类对临床手术方式的选择有重要意义.近年治疗DRuJ不稳多是修复重建关节周围稳定结构,关节置换术治疗尺骨矫形术后DRUJ不稳成为研究热点;对早期DRUJ关节炎患者可行尺骨短缩术.对晚期患者宜行关节置换术;对伴TFCC病变的DRUJ损伤多主张在腕关节镜下清理修复,可同时行尺骨矫形术.     

关节液与组织培养在髋膝关节置换术后感染诊断价值的Meta分析

目的 系统评价关节液和组织培养对关节置换术后感染的诊断价值及临床应用前景.方法 计算机检索Cochrane图书馆、Medline、Pubmed、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库[维普（VIP）]等数据库,检索年限均从建库至2013年12月,收集关节液和组织培养对关节置换后感染的诊断试验,手工检索相关会议论文集、学位论文汇编等.根据Cochrane系统评价方法筛选研究并提取数据,采用Meta‐DiSc1.4软件进行Meta分析.结果 5篇文献符合纳入标准纳入本系统评价,总病例数748例.对临床诊断关节置换后感染有指导作用的组织培养总加权灵敏度和特异度分别为85.1%和96.9%;关节液培养的总加权灵敏度和特异度分别为77.4%和96.8%,合并数据中组织培养的敏感度和特异度存在异质性.组织培养在髋膝关节置换术后假体周围感染诊断的灵敏度显著优于关节液穿刺方法,两者比较,差异均有统计学意义（P〈0.05）,两者在阴性似然比及诊断效能比值比没有显著差异性（P〉0.05）.结论 组织培养在在对关节置换术后感染诊断的敏感度上明显优于关节液培养.     

腹腔镜、腹腔穿刺液细胞学和影像学检查对腹部疾病诊断的比较

目的 探讨诊断性腹腔镜对疑难性腹部疾病的诊断价值。方法 对31例临床难以诊断的腹痛、腹水和腹部肿块患者进行电视腹腔镜下检查和活检,并对腹腔镜、腹腔穿刺液细胞学和影像学检查诊断分级进行比较。结果 31例腹腔镜检查均获成功,经活检病理组织学检查30例明确诊断,确诊率达97％。并发现罕见腹部疾病11例（36％）。腹腔镜分级诊断的Ⅰ级诊断率（97％）明显高于腹腔穿刺液细胞学和影像学诊断率（10％和19％）（P均＜0．01）。结论 腹腔镜检查是不明原因腹痛、腹水和腹部肿块病因诊断的一种确诊率最高、安全和快速的方法。     

合并病理性骨折的上肢骨肿瘤穿刺活检结果分析

目的:分析合并病理性骨折的上肢骨肿瘤穿刺活检结果 ,对可能的影响因素进行分析。方法 :分析2015年1月至2019年12月收治的合并病理性骨折的上肢骨肿瘤患者,入选标准为患者行穿刺活检并接受了最终手术治疗,获得了穿刺活检及术后2次病理检查。符合入选标准的共77例,男55例,女22例;年龄5~88岁,中位年龄27岁;肿瘤位于肱骨67例,桡骨8例,尺骨2例。穿刺活检与最终诊断的疾病性质(良恶性)、诊断病名均一致为“正确”,疾病性质正确而诊断病名不一致则为“支持”,穿刺活检诊断的疾病性质错误则定为诊断“错误”。分析穿刺活检的准确性和影响因素。结果:穿刺活检正确63例(81.8%),支持14例(18.2%),错误0例。将患者的性别、年龄、部位、骨折是否移位、肿瘤的骨破坏类型(成骨或溶骨)、有无软组织肿块、病灶内有无液性区域对穿刺活检正确性的影响进行统计学分析,肿瘤有软组织肿块时穿刺活检正确率显著提高(P0.05),病灶内有液性区域时正确率下降(P0.05)。结论:穿刺活检对合并病理性骨折的上肢骨肿瘤诊断准确性高,活检取材时选择有软组织肿块区域能提高诊断准确性。     

腰椎关节突关节内关节鼠1例报告

关节鼠主要是关节内的软骨因创伤、劳损破裂而产生的碎片。经关节液营养形成游离在关节腔内，随着关节的活动而运动。轻者引起疼痛，重者导致关节交锁，活动困难。国内外学者对踝关节、膝关节、肘关节、腕关节、肩关节等大关节的关节鼠均有报道，但腰椎关节突关节鼠尚未见报道。我们遇到1例，报告如下。     

MRI在老年膝骨关节炎患者内侧关节软骨损伤及分级中的诊断价值研究

目的 探讨分析MRI在老年膝骨关节炎（KOA）患者内侧关节软骨损伤及分级中的诊断价值研究。方法 选取2022年1月至2023年3月于本院行膝关节单髁置换术的83例老年膝骨关节炎患者进行回顾性研究。所有患者均完成患侧膝关节的X线、MRI检查，以术中所见关节软骨损伤及分级为“金标准”，分析X线及MRI检查在诊断老年KOA患者内侧关节软骨损伤及分级中的准确性、灵敏度及特异度。结果 所纳入的83例老年KOA患者内侧关节软骨损伤及其分级以术中所见为“金标准”，MRI检查在诊断老年KOA患者内侧关节软骨损伤中的准确率、灵敏度及特异度均显著高于X线检查（P<0.05）。在老年KOA患者内侧关节软骨损伤分级中，X线诊断诊断准确率为73.49%(61/83，例)，与“金标准”的一致性一般（Kappa=0.69,P=0.031）;MRI检查诊断准确率为89.16%(74/83，例)，与“金标准”的一致性较好（Kappa=0.86,P=0.254）。结论 MRI检查在诊断老年KOA患者内侧关节软骨损伤及损伤分级中的效能优于X线检查，且与金标准的一致性更好，能够为临床后续的治疗提供可靠的依据。     

腕关节三腔造影术

本文报告了１４例患者２５腕的腕关节三腔造影检查的结果。证实其阳性诊断率高于传统的桡腕关节腔造影，是一种可取代后者的诊断技术。作者分析讨论了三腔造影失败的原因，并提出了改进的措施。正常人腕中与腕掌关节间的交通为远排腕骨间的三个骨间关节。     

Age‐ and Gender‐Specific Epidemiologic Characteristics of Major Intra‐Articular Fractures: Five‐Year Data from a Level 1 Trauma Center

ObjectiveTo investigate the epidemiological characteristics of major intra‐articular fractures.MethodsThis retrospective study enrolled patients with major intra‐articular fractures who were treated in the Third Hospital of Hebei Medical University from January 2015 to December 2019. A total of 11,084 patients (7,338 [66.20%] males and 3,746 [33.80%] females) meeting the inclusion and exclusion criteria were included. The distribution characteristics of intra‐articular fractures involving shoulder, elbow, wrist, hip, knee, ankle, and subtalar joints were identified.The potential associations between fractures and various other factors, such as age, gender, sites, were explored.ResultsThere were 74 cases (0.67%) of shoulder fractures, 1,941 cases (17.51%) of elbow fractures, 1,155 cases (10.42%) of wrist fractures, 520 cases (4.69%) of hip fractures, 3,118 cases (28.13%) of knee fractures, 2,156 cases (19.45%) of ankle fractures, and 2,120 cases (19.13%) of subtalar fractures. The overall male‐to‐female ratio was 1.96:1. The highest proportion age group of major intra‐articular fractures included the ages 45–54 years. For males, the highest proportion age group was 45–54 years, for females, it was 55–64 years. The knee joint fracture was the most common type, accounting for 28.13%. For male and female patients, knee fractures accounted for 26.19% and 31.93%, respectively, with a male to female ratio of 1.13:1. The proportion of shoulder fractures was the smallest among this investigation, accounting for 0.67%. For male and female patients, shoulder fractures accounted for 0.44% and 1.12%, respectively, with a male to female ratio of 0.76:1. The age group with the highest proportion of shoulder joint fractures was ≥65 year olds (41.89%), with a male to female ratio of 0.76:1. The age group with the highest risk of elbow, wrist, hip, knee, ankle, and subtalar joint fracture was 5–14 year olds (33.59%) with a male to female ratio of 3.29:1, 5–14 year olds (23.98%) with a male to female ratio of 6.91:1, 45–54 year olds (26.92%) with a male to female ratio of 5.67:1, 45–54 year olds (24.60%) with a male to female ratio of 1.68:1, 25–34 year olds (20.36%) with a male to female ratio of 2.30:1, 45–54 year olds (27.41%) with a male to female ratio of 9.02:1, respectively. The most common site of intra‐articular fractures in different age groups was corresponding as follows: 0–4 year olds (elbow), 5–14 year olds (elbow), 15–24 year olds (ankle), 25–34 year olds (subtalar joint), 35–44 year olds (subtalar joint), 45–54 year olds (knee), 55–64 year olds (knee), 65–74 year olds (knee), and ≥75 year olds (knee).ConclusionThe current study revealed the age‐ and gender‐specific epidemiological characteristics of major intra‐articular fractures, providing a basis for clinical evaluation and practices.     

Epidemiological Characteristics of Major Joints Fracture‐Dislocations

ObjectiveTo describe the epidemiological features of major joints fracture‐dislocations between 2015 and 2019.MethodsThis retrospective study enrolled patients with majorintra‐articular fracture‐dislocations who were treated in the third hospital of Hebei Medical University from January 2015 to December 2019. A total of 582 patients (389 [66.84%] males and 193 [33.16%] females) were identified. The distribution characteristics of intra‐articular fracture‐dislocations involving shoulder, elbow, wrist, hip, knee, and ankle joints were included. The potential associations between fractures with concomitant dislocations and related factors, such as age, gender and sites were explored.ResultsThere were 92 cases (15.81%) of shoulder joints, 67 cases (11.51%) of elbow joints, 45 cases (7.73%) of wrist joints, 181 cases (31.10%) of hip joints, 42 cases (7.22%) of knee joints, and 155 cases (26.63%) of ankle joints. The overall male‐to‐female ratio was 2.02:1.The highest proportion age group of the six types intra‐articular fracture‐dislocations included the ages 25‐34 years. For males, the highest proportion age group was 25‐34 years, for females, it was 45–54 years. For male patients, hip was the most common, accounted for 35.48%, but ankle fracture‐dislocation was the most common for females, accounted for 30.57%. The highest proportion age group of shoulder fracture‐dislocation included the ages 55‐64 years(22.83%), with a male to female ratio of 1.24:1. While the age group with the highest risk of elbow, wrist, hip, knee and ankle fracture‐ dislocation was 25‐34 years (28.36%) with a male to female ratio of 2.19:1, 25‐34 years (31.11%) with a male to female ratio of 8:1, 45‐54 years (27.07%) with a male to female ratio of 3.21:1, 15‐24 years (45.24%) with a male to female ratio of 0.75:1, 25‐44 years (43.87%) with a male to female ratio of 1.63:1, respectively. The most common site of joint fracture‐dislocation in different age groups was corresponding as follows, 0‐14 years(elbow), 15‐24 years(knee), 25‐34 years(hip), 35‐44 years(hip), 45‐54 years(hip), 55‐64 years(ankle), 65‐74 years(shoulder), ≥75 years(shoulder).ConclusionMajor joints fracture‐dislocations were most common in the hip and the least common in the knee, and there were more men than women. Hip was the most common affected joint in men while ankle in women. Age and sex factors can significantly affect the location of intra articular fracture and dislocation. The current study could aid orthopaedic surgeons in a better understanding of this injury and help to implement targeted preventive measures.     

膝关节骨关节炎滑液和软骨骨桥蛋白水平与其病变程度的相关性

目的 探讨膝关节骨关节炎(osteoarthritis,OA)患者滑液和关节软骨骨桥蛋白(osteopontin,OPN)水平及其与病变严重程度的关系.方法 随机选取50例膝关节OA患者[男15例,女35例;年龄48～81岁,平均(61.8±7.4)岁]和10名健康对照者[男4例,女6例;年龄59～68岁,平均年龄(63.2±6.0)岁]作为研究对象.采用Mankin评分评价疾病严重程度,Kellgren-Lawrence标准进行放射学分级,酶联免疫吸附法测定关节滑液OPN水平,免疫组化方法测定关节软骨OPN光密度值.结果 OA患者与对照者相比,关节滑液OPN水平[(4519.60±1830.37)pg/ml:(1179.70±303.39)pg/ml)和关节软骨OPN光密度值[(0.60±-0.06):(0.43±0.07)]均明显升高.关节滑液OPN水平与关节软骨OPN表达呈正相关(r=0.411,P=0.003).关节滑液OPN水平与OA病变严重程度(KL分级)呈正相关(r=0.581,P＜0.001).关节软骨OPN表达与OA病变严重程度(Mankin评分)呈正相关(r=0.675,P＜0.001).结论 关节滑液和关节软骨OPN水平与病变严重程度相关.     

The results of the surgical treatment of bone tumors using massive homoplastic grafts

We reviewed our experience as concerns 588 patients treated by resection for bone tumor and reconstructed by massive bank bone implant. The period taken into consideration goes from 1984 to 2001. The mean age of the patients was 24 years with a minimum of 1 and a maximum of 77 years: in 186 cases (31.6%) age was lower by 14 years. Most of the patients were referred for a diagnosis of malignancy (85%), and of these, 70% had undergone antiblastic therapy postoperatively according to the modalities of the protocols. Of the cases that were not treated by chemotherapy there are 16 that had a homoplastic graft after failure of a previous one. In a high number of cases (189) surgery included reconstruction of an intercalar segment of a long bone. Of these, 106 were in the femur, 69 in the tibia, and 14 in the humerus. One joint reconstruction was carried out in 128 cases of which 52 in the knee, 49 in the shoulder, 10 in the elbow, 11 in the wrist, 3 in the ankle, and 3 in the metatarsals. Fusion, which was one of the most frequent indications in the eighties, is used less today; overall it was carried out in 91 cases of which 65 in the knee, 14 in the hip, 9 in the ankle and 3 in the wrist. This type of implant may also be used in the pelves, and this took place in 56 cases using different procedures of reconstruction. The most current method of reconstruction for a joint is composite prosthesis, and this was used in 124 cases of which 67 around a knee, 53 in the hip, 4 in the shoulder. Finally, in 78 cases a vascularized fibula transplant was associated with an intercalar graft, fusion, or osteoarticular graft to increase the mechanical capacity of the implant together with a more rapid integration of the implant, particularly at the osteotomic lines. Despite the excellent results demonstrated in the first 3 years of follow-up, infection, resorption, delay in consolidation and fracture led to 18% failures of the implant. Massive homoplastic graft is still a good means of reconstruction that allows for excellent functional results, but despite this intense research activity is required to improve its mechanical hold in time together with better and complete integration.     

Articular cartilage defects in the knee--basics, therapies and results

Full-thickness defects of the articular cartilage in the knee joint have lower regenerative properties than chondral lesions of the ankle. In order to avoid early osteoarthritis, symptomatic articular cartilage defects in younger patients should undergo biological reconstruction as soon as possible. Various surgical procedures are available to biologically resurface the articular joint line. Numerous animal experiments and clinical studies have shown that early biological reconstruction of circumscribed cartilage defects in the knee is superior to conservative or delayed surgical treatment. This superiority refers not only to defect healing but also to the elimination of changes following secondary osteoarthritis. The various surgical procedures can be differentiated by the range of indications and the final outcome. Additional malalignment, meniscus tears and/or ligament instabilities should be treated simultaneously with the cartilage resurfacing. The mid- and long-term results of the various current techniques are promising, but further modifications and improvements are needed.     

富血小板血浆联合间充质干细胞治疗膝骨关节炎的疗效

目的观察关节腔内联合注射富血小板血浆与脐带间充质干细胞治疗轻中度膝关节骨关节炎患者的近期疗效。 方法收集聊城市人民医院膝关节骨关节炎患者200例,纳入标准：Kellgren-Lawrence分级1～3级膝关节骨关节炎患者;排除标准：Kellgren-Lawrence分级4级骨关节炎患者及炎症性关节炎患者等。根据电脑产生的伪随机数字,将研究对象随机分为富血小板血浆(PRP)与脐带间充质干细胞(MSC)联合注射组(PRP＋MSC)、单纯PRP注射组(PRP组)、单纯脐带MSC注射组(MSC组)、玻璃酸钠(SH)注射组(SH组),每组各50例。PRP ＋ MSC组关节腔内注射5 ml富血小板血浆与脐带间充质干细胞混合液;PRP组关节腔内注射5 ml富血小板血浆;MSC组关节腔内注射5 ml脐带间充质干细胞;SH组关节腔内注射2.5 ml的SH及曲安奈德注射液。分别在治疗后1、3、6、12个月进行随访,通过视觉疼痛模拟评分(VAS),美国膝关节协会评分( AKS )评价治疗后膝关节功能的改善情况;采用酶联免疫吸附法检测治疗前后关节液中细胞因子的变化情况;利用MRI的T2 Map序列评价治疗前后关节软骨的变化情况。患者年龄、病程、VAS评分、AKS评分、细胞因子含量等计数资料分析采用单因素方法分析,患者性别比例、病情程度等计数资料分析采用卡方检验。 结果200例患者中,175例完成随访,PRP ＋ MSC组45例,PRP组44例,MSC组43例,SH组43例。4组患者治疗前VAS、AKS及关节液中细胞因子的表达无统计学意义(P >0.05)。治疗后1个月,4组患者的VAS评分均较前降低,AKS评分较前升高,组内差异具有统计学意义(t ＝6.45,P <0.01),组间差异无统计学意义(P >0.05)。3个月后,SH组VAS、AKS趋向于治疗前状态,其余3组未见反弹,PRP ＋ MSC联合注射组优于单纯PRP与MSC治疗组,4组间的差异具有统计学意义(F ＝7.84/4.35,P <0.01)。治疗后3周,SH组关节液中细胞因子未见明显改变,PRP ＋ MSC组关节液中细胞因子变化水平高于单纯PRP与MSC组,差异具有统计学意义(F ＝39.21,P <0.01)。治疗后6个月,MRI的T₂Map序列显示PRP＋MSC组、PRP组、MSC组、SH组的平均软骨T2值分别为(54.07±2.64)ms、(56.59±1.40)ms、(56.40±1.57)ms、(57.98±1.95)ms,差异具有统计学意义(F＝30.63,P<0.05)。 结论关节腔内联合注射富血小板血浆与脐带间充质干细胞明显改善膝关节骨关节炎患者的症状,延缓骨关节炎的进展。     

Aggrecan and Cartilage Oligomeric Matrix Protein in Serum and Synovial Fluid of Patients with Knee Osteoarthritis

Aggrecan and cartilage oligomeric matrix protein (COMP) which are important degradation products of articular cartilage may be promising diagnostic markers in serum and/or synovial fluid for diagnosis of knee osteoarthritis (OA). Our objective was to measure serum and synovial fluid levels of aggrecan and COMP in patients with OA of the knee joint to find out if they could be of diagnostic value in OA and if their levels correlate with the clinical and radiological manifestations of the disease. Sixty-six patients suffering from primary knee OA with effusion (26 males and 40 females) were studied. Twenty individuals (six males and 14 females) with recent traumatic knee effusion matched for age and sex were chosen to serve as a control group. All subjects had thorough clinical and radiological (X-ray and MRI) evaluation. Aggrecan and COMP in serum and synovial fluid were measured by ELISA. Serum and synovial fluid aggrecan and COMP levels were significantly higher than the control. Serum and synovial fluid aggrecan and COMP levels were positively correlated with age, body mass index, disease duration, plain X-ray and MRI scores. In OA, serum and synovial fluid aggrecan and COMP levels are elevated and represent useful markers in the diagnosis. Moreover, these elevated levels positively correlated with radiological joint damage but not with clinical disease parameters. These markers have the potential to be used for monitoring articular cartilage destruction and response to different therapeutic modalities.     

Linear mixed modeling on the effects of varus knee surgery on the ankle joint weight-bearing axis

BackgroundVarus knee correction may affect the ankle and subtalar joints and impact the prognosis of ankle arthritis because the weight-bearing load on the lower extremity extends from the hip to the foot. We aimed to evaluate the changes in the mechanical axis and the weight-bearing axis of the ankle after varus knee surgery.MethodsPatients with a varus knee were followed up after undergoing high tibial osteotomy or total knee replacement arthroplasty. The inclusion criteria were age (>18 years) and a history of preoperative and postoperative scanograms. The postoperative change to the ankle joint axis point on the mechanical axis and weight-bearing axis according to the hip–knee–ankle angle correction was adjusted by multiple factors using a linear mixed model.ResultsOverall, 257 limbs from 198 patients were evaluated. The linear mixed model showed that the change in the ankle joint axis point on the mechanical axis was not statistically significant after high tibial osteotomy and total knee replacement arthroplasty (p = 0.223). The ankle joint axis point on the weight-bearing axis moved laterally by 0.9% per degree of postoperative hip–knee–ankle angle decrease (p < 0.001).ConclusionsVarus knee correction could affect the subtalar joint and the ankle joint. Our findings require consideration when utilized during pre- and postoperative evaluations using the weight-bearing axis of patients undergoing varus knee correction.     

微型针板内固定治疗10例C型桡骨极远端骨折疗效分析

目的：分析和探讨微型针板内固定治疗C型桡骨极远端骨折的可行性及疗效,以期寻求治疗此类骨折的可靠固定方法。方法：选择从2019年12月至2021年6月进行治疗的10例C型桡骨极远端骨折,男5例,女5例;左侧6例,右侧4例,年龄35~67岁。均以微型针板内固定治疗。结果：所有患者术后获随访,时间6~18个月。所有患者骨折顺利愈合,骨折愈合时间10~16周。随访期间所有患者疗效满意,无切口感染发生,均未发现腕关节慢性疼痛及创伤性关节炎表现。末次随访时腕关节Mayo评分为85~95分,其中优7例、良3例。结论：微型针板能够有效固定C型桡骨极远端骨折,腕关节锻练时间早,具有固定强度高、复位维持好、并发症少、优良率高等优点,是治疗C型桡骨极远端骨折的可靠方法。     

弹性髓内钉治疗儿童四肢长骨骨折

目的探讨弹性髓内钉固定治疗儿童四肢长骨骨折的疗效。方法应用弹性髓内钉固定技术治疗51例儿童四肢长骨干骨折。结果患儿均获随访,时间6~12个月。骨折全部愈合。术后6个月随访时患肢功能均完全恢复正常。采用Flynn评分标准：优46例,良3例,可2例,优良率96.1%。结论弹性髓内钉治疗儿童四肢长骨干骨折,切口小,固定牢固,操作简单,能早期功能锻炼,功能恢复好,临床疗效满意。