腰椎后缘软骨板破裂症的临床特点及治疗

目的：认识腰椎后缘软骨板破裂症的临床及影象学特点，探讨治疗方法。方法：对52例腰椎后缘软骨板破裂症的资料进行了回顾性的分析。结果：52例经6个月～3年随访，优良率达96％。结论：腰椎后缘软骨板破裂症的发病机制是青少年时期椎体后缘环状骨够陈旧性损伤及其继发改变的结果，CT具有较高的诊断价值。手术治疗效果佳。     

腰椎软骨板破裂症：（附56例报告）

成人腰椎软骨板破裂症很少见，本报告５６例，占我科腰椎手术１７４１例的３．２％。临床主要表现为腰腿痛和下肢间歇肢行及麻木无力。平均发病年龄３２岁，６３％有明确外伤史。描述Ｘ线平片的特有征象，强调ＣＴ扫描，特别是强化ＣＴ扫描在诊断上的重要意义。从生物力学和发育特点方面分析其发生的原因和机理。讨论其基本病理变化、三个病理阶段、四种病理类型。软骨板破裂后突所致椎管狭窄、椎间盘突出和神经组织紧张引起；临床症状。手术必须同时行椎板切除减压、髓核摘除、全部或部分切除破裂后突的软骨板才能取得满意效果。     

腰椎软骨板破裂症的诊治

目的：分析腰椎软骨板破裂症的临床特点，探讨治疗方法。方法：总结回顾手术治疗腰椎软骨板破裂症36例的临床资料。结果：平均随访4．5年，优良率达97．2％，无疗效差者。结论：对症状严重、一旦诊断明确应果断治疗，采用相应椎板开窗术，尽量保留小关节以防造成远期腰椎不稳定。     

腰椎后缘软骨板破裂症15例报告

目的：探讨腰椎后缘软骨板骨板破裂症的病因,诊断和治疗,以及其临床诊断命名。方法：１５全均手术治疗,半椎板切除６例,全椎板切除术９例;基于Ｘ线片、ＣＴ扫描结合手术所见进行总结。结果：随访全部病例,平均随访时间１８个月,优良率达９３．３％。结论：此症多形成于青少年期,软骨板本身发育障碍和外伤是导致软骨板破裂后的主要原因;ＣＴ检查具有重要诊断价值。治疗上不应过分强调保守治疗,手术治疗是重要的治疗方法。诊     

青壮年腰椎软骨板破裂症的临床特征与治疗

发生于青壮年的腰椎软骨板破裂症，目前发病机制尚未完全明了。近5年来，国内文献开始陆续出现报道，但命名不一，如：腰椎间盘突出症并椎体后缘离断症、腰椎椎体后缘骨内软骨结节、腰椎椎后缘离断症等等。但其特殊的CT影象学表现及由于突出物压迫硬膜囊和神经根引起椎管狭窄及类似腰椎间盘突出症的临床表现，已逐渐为临床学者所认识。本文总结近5年来经手术治疗的青壮年腰椎软骨板破裂症患者共56例，对其临床表现、影像学特点、治疗方法进行讨论。     

腰椎后缘软骨板破裂症

近年来，随着影像技术的发展，腰椎后缘软骨板破裂症已引起人们的关注。以往由于诊断技术等诸方面的原因，加之常伴有椎间盘突出，且多有椎间盘突出症的典型征象，很难与椎间盘突出症区别。为明确二者间的关系，我们对1991～1995年本院腰椎CT扫描诊断为腰椎间盘突出症的2236例进行了回顾性分析，发现其中79例为腰椎后缘软骨板破裂。本文将47例住院治疗病人的资料进行总结分析。116床资料1，1一般资料本组男33例，女14例；年龄13～47岁，平均36．1岁。18岁以下3例（6．4％），19～30岁19例（40．4％），31～40岁ZI例（44．7％），41岁以上4…     

有限双开窗法治疗腰椎软骨板破裂症

为保留腰椎后部结构的完整性,又能充分显露,彻底减压,采用根据椎板分型,倒U或V型椎板开窗,扩大侧隐窝治疗腰椎软骨板破裂症12例。手术尽可能地保留腰椎全部结构的完整性,可防止术后腰椎不稳,同时使神经根管代偿间隙明显增大,减低了术后DFC连锁变异现象所引起的椎管狭窄。经1～3.5年随访效果满意。并就12例腰椎软骨板破裂症的特点进行了讨论。     

青壮年腰椎软骨板破裂症的临床特征与治疗

发生于青壮年的腰椎软骨板破裂症 ,目前发病机制尚未完全明了。近 5年来 ,国内文献开始陆续出现报道 ,但命名不一[1 ,2 ] ,如 :腰椎间盘突出症并椎体后缘离断症、腰椎椎体后缘骨内软骨结节、腰椎椎后缘离断症等等。但其特殊的CT影象学表现及由于突出物压迫硬膜囊和神经根引起椎管狭窄及类似腰椎间盘突出症的临床表现 ,已逐渐为临床学者所认识。本文总结近 5年来经手术治疗的青壮年腰椎软骨板破裂症患者共 5 6例 ,对其临床表现、影像学特点、治疗方法进行讨论。1　临床资料1 1　一般资料　本组共 5 6例 ,男 5 0例 ,女 6例 ,年龄 1 8～ 30岁…     

胸椎软骨板破裂症3例

椎体软骨板破裂临床上少见，蒋位庄等［１］１９８２年报告５例，王全平等［２］１９９４年报告５６例，但均发生在腰椎，胸椎软骨板破裂者未见报道，现将我们收治的３例报告如下。例１，王ＸＸ，男，３０岁。搬重物扭伤腰部后出现下肢疼痛、麻木、无力，未作正规治疗，逐渐出现间歇性跛行、步态蹒跚等症状，于伤后５个月来我院。查体：一般情况可，脐以下双下肢皮肤感觉减退，双下肢肌张力增高，腱反射亢进，Ｘ线侧位片示Ｔ１０椎体后下角可见三角形骨块突入椎管，椎管造影显示造影剂通过延迟．ＣＴ增强扫描示Ｔ１０～Ｔ１１椎管狭窄，椎体…     

破裂型腰椎间盘突出症诊断中临床表现及影像学检查的评价

破裂型腰椎间盘突出症(简称破裂型突出,下同),系指腰椎间盘纤维环完全破裂或破碎,并同髓核甚至软骨板脱出于纤维环外,但未完全游离椎管内,该类型突出非手术疗法难以治愈。反复非手术疗法可延误诊治,甚至使病情加重。因此,对破裂型突出应尽早作出诊断,这在提高疗效上具有一定的意义,我科1983年到1995年6月共手术治疗腰椎间盘突出症2167例,作者对资料齐全的162例破裂型突出的病例其临床表现及影像学检查在该型诊断中的意义进行了评价。     

Biomechanical properties (compressive strength and compressive pressure at break) of hyaline cartilage under axial load

INTENTION OF THE STUDY: Explanations concerning the physical properties of hyaline cartilage are different. It was the intention of this study to determine the material parameters of hyaline cartilage under axial load (elasticity, plasticity, elasticity and module pressure stress to break). METHODS: Specimens from the medial femoral condyle (chondro-cortical ships) from adult female domestic pigs (n=28) were used for the experiments. The specimens were completely embedded in plaster to minimize shearing. Axial load was carried out by an universal mechanical testing machine (Zwick Z2.5/TS1S, Ulm, Germany) to determine elastic and plastic deformation and pressure stress to break. RESULTS: Axial load up to 5 MPa produces an almost elastic deformation, an increasing axial load results in a plastic deformation. In the range of 3 to 5 MPa the principle of Hooke is valid. The elasticity module amounted to 39.2 +/- 11.9 N/mm(2), determined under 3.8 MPa axial load. An axial load of 25.8 +/- 5.2 MPa (sigma max ) causes a break of cartilage. A strong correlation between break resistance and thickness of the chondral slice (r=0.71; p < 0.05) was observed. CONCLUSIONS: The low module of chondral elasticity characterizes this tissue as "soft". Moderate axial load causes an ideal elastic, higher axial load a plastic deformation. The medium pressure to break to amounted 25.8 MPa. The medium pressure to break of 25.8 MPa is comparable with the forces produced by an unrestrained limited downfall from a height of 4.3 m. It must be concluded that isolated chondral fractures are rare consequences of a trauma as long as accompanying ligamentous or osseous damages are not found.     

The correlation between osteoarthrosis as seen on radiographs and on arthroscopy

The correlation between arthroscopic and radiographic osteoarthrosis was studied in 63 patients (51 +/- 12 years) with degenerative changes in the medial compartment of the knee involving the medial meniscus with or without chondral damage. Chondral damage on arthroscopy was classified in grades 1-3 modified after Outerbridge. The radiographic evaluation was done according to Ahlb?ck classification. Twenty-eight patients (44%) did not show any significant chondral damage on arthroscopy (grades 0-1). The radiographic findings in this group were usually normal. Three patients, however, showed a slight narrowing of the medial joint space (Ahlb?ck I). All three had severely degenerated menisci, and two of them showed superficial fibrillation of both the tibia and the femur. Twenty-four patients (38%) showed a partial thickness chondral damage with fragmentation of the surface (grade 2). Radiographic findings were usually normal; however, patients with involvement of both the tibia and the femur often showed a joint space narrowing on radiographs. Eleven patients (18%) showed destruction of the cartilage down to subchondral bone (grade 3). The typical radiographic finding was a joint space obliteration (Ahlb?ck II). Involvement also of the lateral compartment as assessed on arthroscopy was significantly more common in patients with 2nd and 3rd degree chondral disease and Ahlb?ck II and III on radiographs than in those with 2nd and 3rd degree chondral damage and normal radiographs. In all but one of the patients with involvement of both compartments, the lateral compartment was considered normal on radiographic examination.     

The microfracture technique to treat full thickness articular cartilage defects of the knee

Full thickness defects of the articular cartilage rarely heal spontaneously. While some patients do not develop clinically significant problems from chondral defects, most eventually develop degenerative changes associated with the cartilage damage over time. Techniques to treat chondral defects include abrasion, drilling, tissue autografts, allografts, and cell transplantation. The senior author has developed a procedure referred to as the "microfracture." This technique enhances chondral resurfacing by providing a suitable environment for tissue regeneration and by taking advantage of the body's own healing potential. This technique has now been used in more than 1400 patients. Specially designed awls are used to make multiple perforations, or "microfractures", into the subchondral bone plate. The perforations are made as close together as necessary, but not so close that one breaks into another. Consequently, the microfracture holes are approximately three to four millimeters apart (or 3 to 4 holes per square centimeter). Importantly, the integrity of the subchondral bone plate is maintained. The released marrow elements form a "super clot" which provides an enriched environment for tissue regeneration. Follow up with long term results of more than 8 years have been positive and very encouraging.     

Innervation of the human knee joint by substance-P fibers.

Anterior knee pain is a frequent musculoskeletal complaint affecting all ages, both sexes, athletes, and nonathletes alike. Numerous theories have been proposed regarding its etiology including patellar malalignment, quadriceps insufficiency, subluxation, quadriceps muscle tightness, and chondral defects. However, the mechanism by which these factors produce this pain is not clear. Knowledge of the distribution of nociceptive nerve fibers around the knee would seem to provide insight in treating these painful conditions. Eleven human patellae--eight specimens from patients with degenerative patellofemoral disease and three normals--were evaluated. Immunohistochemical techniques using monoclonal antibody to substance-P were employed to identify nociceptive fibers. Substance-P is a nociceptive neurotransmitter found in afferent nerve fibers. Substance-P fibers were isolated in the retinaculum, fat pad, periosteum, and subchondral plate of patellae affected with degenerative disease. This study demonstrates that selective tracting of nociceptive pain fibers is possible around the knee both in soft tissue and, in some circumstances, bone. The subchondral plate of normal patellae did not demonstrate erosion channels, but those with chondral defects from degenerative disease did. Nociceptive fibers found in these defects may explain the origin of symptoms in some patients. The distribution of substance-P nerve fibers in the soft tissues around the knee suggests that denervation may be the mechanism by which surgical procedures for anterior knee pain produce favorable results.     

Foot reconstruction in weight bearing area

Summary Multiple reconstructive procedures have been described for replacing skin loss in weight bearing areas of the foot. The reason for this is that the reconstruction of the plantar surface easily breaks down because of the particular structure of the soft tissues of this area. Furthermore, sensation is usually incomplete. For these reasons, stable, functional reconstruction is uncommon, even when using microvascular sensate skin flaps. In order to assess the best reconstructive management, functional long-term results of 13 patients who suffered from soft tissue defects of the weight-bearing areas of their feet were analyzed using gait analysis. The most reliable results were obtained with the Musgrave Footprint^®. It stores the dynamic footprint on a computerized plate allowing to assess qualitatively and quantitatively pressure against time. This non-invasive method simultaneously analyzes pressure data from both feet. Furthermore, it allows the detection of areas about to break down. This may prevent ulcer formation by prophylactic management.     

Oxygen radicals and nitric oxide levels in chondral or meniscal lesions or both

The pathophysiologic mechanism of osteoarthritis is not well known. The importance of reactive oxygen species and nitric oxide in the pathogenesis of osteoarthritis in patients with chondral or meniscal lesions or both and a search for their source were investigated. Synovial fluid samples obtained from 44 patients with osteoarthritis (16 had meniscal lesions, 12 had chondral lesions, and 16 had meniscal plus chondral lesions) were analyzed. Ten control subjects also were included. Reactive species, nitric oxide, and peroxynitrite were measured by the chemiluminescence technique. Patients with chondral lesions had significantly increased levels of O when compared with patients with meniscal lesions and the control group. However, patients with chondral or meniscal plus chondral lesions had significantly higher levels of other reactive oxygen species when compared with the control group. For the patients with meniscal plus chondral lesions, the contribution of nitrogen containing reactive species was evident. Although patients with chondral lesions had a significant increase in nitric oxide, the increase in patients with meniscal plus chondral lesions was more pronounced in peroxynitrite concentration. These reactive species will lead to tissue damage along with the mechanical damage caused by meniscal or chondral lesions or both.(2-)     

Microfracture technique forfull-thickness chondral defects: Technique and clinical results

Articular cartilage defects rarely heal spontaneously. The changes are progressive and they become irreversible if no intervention is applied. Many techniques have been used in the past to include abrasion, drilling, tissue autografts, allografts, and cell transplantation. Physicians have taken a greater interest in treating chondral defects recently in part because of our better understanding of cartilage biology and pathology, and because of advances in imaging and arthroscopy. The senior author has developed a procedure referred to as the “microfracture” technique to enhance chondral resurfacing by providing a suitable environment for tissue regeneration. This technique has now been used in more than 1,200 patients. An arthroscopic awl is used to make multiple holes, or “microfractures,” in the subchondral bone plate of full-thickness chondral defects. The holes are made as close together as necessary, but not so close that one breaks into another, thus damaging the subchondral plate between them. This technique usually results in microfracture holes that are approximately 3 to 4 millimeters apart (or 3 to 4 holes per square centimeter). The arthroscopic awls produce much less thermal necrosis of the bone than would a hand-driven or motorized drill. The released marrow elements form a “super clot” which provides an enriched environment for tissue regeneration. Long-term results, with follow-up covering more than 8 years, have been and continue to be very positive.     

Arthroscopic osteochondral autograft transplantation for chondral lesion of the tibial plateau of the knee

Arthroscopic osteochondral autograft transplantation is often used to treat chondral/osteochondral lesions of the femoral condyle of the knee. However, arthroscopic autologous osteochondral grafting to the tibial plateau has not been reported. We report the surgical technique and the clinical course of a patient who underwent engraftment by this method. A 26-year-old man developed symptoms of pain and catching in his knee. Arthroscopy revealed a deep chondral lesion, 10 × 15 mm in size, down to the subchondral bone on the posterocentral area of the lateral tibial plateau. The injured cartilage was debrided using a curette and an abrader until normal healthy cartilage bordered the debrided defect. An osteochondral plug, 10 mm in diameter and 20 mm long, the chondral surface of which was orientated 25° obliquely, was harvested from the most peripheral and proximal part of the lateral patellar groove. A bony hole was created in the center of the defect through the tibia using a core reamer. The osteochondral plug was inserted from the tibial window through the bony hole. To enhance the stability of the osteochondral fragment, bioactive ceramic fillers were used to fill the space below the plug. A second-look arthroscopy 10 months after surgery showed that the grafted osteochondral plug was well adapted and integrated into the surrounding cartilage on the lateral tibial plateau.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 653–659     

The safety and efficacy of a new adjustable plate used for proximal tibial opening wedge osteotomy in the treatment of unicompartmental knee osteoarthrosis

Twenty opening wedge tibial osteotomies were performed using the Osteotrac plate, which consists of a two-piece plate with a one-way ratcheting mechanism with two degrees of freedom. A variety of concomitant procedures were performed including osteochondral transfer, tibial tubercle medialization, and anterior cruciate ligament reconstruction. The change in tibiofemoral alignment in the coronal plane and the shift in lower extremity mechanical axis were determined. The average lateral shift in the lower extremity mechanical axis was 24% of the tibial plateau width. The average change in the mechanical tibiofemoral angle was 7 degrees of valgus. Union rate at the osteotomy site was 95%. No deep infections, clinical deep venous thrombosis, or device failures occurred. The Osteotrac plate provides safe and effective fixation and intraoperative adjustability to achieve and maintain a lateral shift of the lower extremity mechanical axis and valgus correction of the tibiofemoral alignment in patients with varus knees undergoing proximal tibial opening wedge osteotomy and associated meniscal and chondral procedures.     

Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified With Ankle Arthroscopy Following Rotational Ankle Fracture: A Systematic Review

A systematic literature search was performed using the PubMed, MEDLINE, and the Cochrane Library databases according to the Preferred Reporting Items for Systematic review and Meta-Analyses guidelines on May 20, 2019. The keywords used were: ankle, distal tibia, distal fibula, fracture, arthroscopic, cartilage, and chondral. The objective of this study is to systematically review the characterization of intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following ankle fracture. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures within any timeframe were included. The incidence of intra-articular chondral lesions was recorded, the location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. Fifteen studies with 1355 ankle fractures were included. About 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL). We compared incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < .05 was considered statistically significant. We found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy.