前交叉韧带损伤膝关节侧副韧带长度的变化

背景:侧副韧带对膝关节的稳定性起着重要的作用,通过2D/3D图像配准技术可以实现膝关节的运动还原并获得前交叉韧带损伤后生理屈曲过程中内侧副韧带和外侧副韧带长度变化规律.目的:对前交叉韧带损伤膝关节侧副韧带长度变化进行运动还原体内稳定性研究.方法:选择单侧膝关节前交叉韧带断裂而对侧正常的8例患者,在生理负重屈曲采集0°,15°,30°,60°和90°时的相互垂直的2D图像,与CT(3D)图像在虚拟X射线投射系统进行2D/3D图像配准,还原膝关节不同角度时的股骨和胫骨相对3D位置关系,并通过韧带止点还原的方法对内侧副韧带、外侧副韧带进行韧带长度分析,并对比两侧.结果与结论:内侧副韧带损伤后在0°,15°和30°患膝内侧副韧带长度较健膝增加;内侧副韧带损伤后在0°、15°和30°患膝外侧副韧带长度较健膝减少,差异均有显著性意义(P＜0.05).结果提示,在0°、15°和30°,前交叉韧带损伤后患膝内侧副韧带长度较健膝增加,而外侧副韧带长度较健膝缩短.     

64层CT多种成像后处理技术在急诊膝关节创伤诊断中的应用

目的：探讨64层螺旋CT多种图像后处理技术在急诊膝关节创伤诊断中的价值。材料与方法：利用64层CT对26例急诊膝关节损伤患者行快速扫描,将获得的原始数据分别通过不同算法得出骨窗及软组织窗（显示膝关节周围软组织及膝关节韧带）薄层图像,然后行多种图像后处理技术功能成像（包括MPR、MIP以及VRT成像,必要时辅以SSD图像）。结果：26例急诊行64层螺旋CT检查的急诊膝关节创伤患者,其中发现骨折39处（包括隐匿性骨折7处）;髌及胫腓侧韧带、前后交叉韧带损伤34处,此外25例患者伴有软组织损伤及23例合并有关节腔积液,所有病例最终经过临床证实。结论：64层螺旋CT在急诊膝关节创伤诊断中有非常重要的意义和实际应用价值,可以作为急诊膝关节创伤的首选手段。     

低场磁共振成像对膝关节损伤的诊断

目的 探讨低场磁共振在膝关节损伤的诊断价值.方法 对85例X线及CT检查未见异常的外伤患者进行常规SE序列T1WI、脂肪抑制T2冠状位、和T2WI、T2WI矢状位扫描.结果 骨挫伤42例,前交叉韧带撕裂12例,后交叉韧带撕裂10例,胫侧副韧带损伤23例,腓侧副韧带损伤8例;半月板撕裂35例.结论 MRI对肌肉、肌腱等软组织有较高的分辨率,可以发现膝关节隐匿性骨折,韧带、半月板损伤,滑膜囊和关节腔积液(血)等,为临床治疗提供可靠的依据.膝关节外伤X线及CT检查未见异常时,MRI是最为理想的进一步检查方法.     

高频彩色多普勒超声在膝关节胫、腓侧副韧带损伤诊断中的价值

膝关节内、外侧各有强大的支持结构．分别为胫侧副韧带和腓侧副韧带。膝关节胫、腓侧副韧带损伤在骨科并不少见，以往依靠损伤病史和体征，临床诊断韧带损伤并不困难．有时难以判断损伤的程度、我院2000年6月～2006年1月应用高频超声对正常膝关节侧副韧带和膝关节侧副韧带损伤的患者进行观察研究．旨在探讨高频超声在诊断膝关节侧副韧带损伤中的价值．     

低场MRI诊断急性膝关节韧带损伤的应用效果分析

目的 观察低场核磁共振成像(MRI)在诊断膝关节侧副韧带和交叉韧带损伤程度的准确性,并与手术探查结果比较.方法 2007年6月至2009年6月期间因膝关节外伤来本院就诊接受MRI检查并接受手术治疗的患者186例,分析比较患者的MRI检查和手术探查结果.结果 186例患者MRI检查显示侧副韧带损伤患者169例(90.7%)、交叉韧带损伤患者119例(64.0%),均经手术探查证实,灵敏度为100%;MRI诊断侧副韧带和交叉韧带严重度与手术所见符合率分别为93.8%和94.1%.结论 MRI可以准确地诊断内外侧副韧带损伤和前后交叉韧带损伤,并能准确诊断其严重程度,为临床治疗方案的选择提供可靠依据.     

低场MRI诊断急性膝关节韧带损伤的应用效果分析

目的 观察低场核磁共振成像(MRI)在诊断膝关节侧副韧带和交叉韧带损伤程度的准确性,并与手术探查结果比较.方法 2007年6月至2009年6月期间因膝关节外伤来本院就诊接受MRI检查并接受手术治疗的患者186例,分析比较患者的MRI检查和手术探查结果.结果 186例患者MRI检查显示侧副韧带损伤患者169例(90.7%)、交叉韧带损伤患者119例(64.0%),均经手术探查证实,灵敏度为100%;MRI诊断侧副韧带和交叉韧带严重度与手术所见符合率分别为93.8%和94.1%.结论 MRI可以准确地诊断内外侧副韧带损伤和前后交叉韧带损伤,并能准确诊断其严重程度,为临床治疗方案的选择提供可靠依据.     

三维CT对前交叉韧带重建术后早期效果的评价

目的 探讨三维CT评价膝关节前交叉韧带重建术后早期效果的技术要点和临床应用价值.方法 关节镜下行前交叉韧带重建术患者22例,术后1至10天行多层螺旋CT扫描,并行三维重建,观察骨隧道、移植物、内固定物、关节腔及周围软组织等显示情况.结果 三维CT显示移植物形态连续完整、密度均匀,关节腔内有少量气体、液体及点片状高密度影,周围软组织有不同程度肿胀.骨隧道管径(10.02±1.26) mm,管径均匀20例,边缘光滑19例,开口位置准确20例;内固定物位置准确19例.结论 三维CT能清晰显示膝关节前交叉韧带重建术后移植物形态、骨隧道情况和内固定物位置,为临床提供重要信息,可以成为膝关节前交叉韧带重建术后早期随访的重要方法.     

MRI在膝关节损伤中的诊断价值

目的:探讨MRI检查对膝关节损伤的诊断价值。方法:利用GE公司1.5TMRI对手术、关节镜或临床证实的116例122个膝关节半月板、韧带损伤的MRI表现进行回顾性分析。结果:MRI能清楚地显示膝关节半月板、交叉韧带、侧副韧带撕裂和损伤的改变,具有特征性的影像学表现。结论:MRI是诊断膝关节副结构损伤的最佳检查方法,为临床医生选择合适的治疗方案提供了依据。     

螺旋CT多平面重建对膝交叉韧带MR扫描方式的指导价值

目的：通过螺旋CT多平面重建技术探寻膝关节交叉韧带成像的最佳方位,指导交叉韧带MR扫描方式,提高交叉韧带MR图像的显示程度。方法：随机选取2009年1月~2010年3月50例成人膝关节螺旋CT检查阴性者,调取双侧膝关节薄层横断面重建图像,利用多平面重建技术进行任意角度矢状面重建,分析所得图像交叉韧带的显示程度。结果：膝关节自然伸直位,当定位线平行于股骨髁间窝层面的外侧髁内缘时,所得矢状面图像膝关节交叉韧带显示完整（一个层面以上）,前交叉韧带显示率为98%,后交叉韧带显示率为100%,明显优于其他方位。依上述方位做矢状面定位,20例MR检查阴性者图像示前、后交叉韧带显示完整,显示率为100%。结论：利用螺旋CT多平面重建技术探寻膝关节交叉韧带成像的最佳方位,操作简单,结论准确,对膝关节交叉韧带MR扫描方式具有明确的指导价值。     

低场MRI在膝关节损伤中的诊断价值

目的探讨磁共振成像（MRI）检查对膝关节损伤的诊断价值。方法利用西门子公司0．2TMRI回顾性分析76例膝关节损伤的MRI资料。结果MRI能清楚地显示膝关节半月板、交叉韧带、侧副韧带撕裂和损伤的改变,具有特征性的影像学表现。结论MRI是诊断膝关节副结构损伤的最佳检查方法,为临床医生选择合适的治疗方案提供了依据。MRI对于膝关节损伤的诊断具有重要的临床价值。     

髌支持带MR成像的初步研究

目的　观察髌支持带中各结构在不同方位成像上的MRI表现 ,明确其最佳MRI显示方法。方法　对 2 0例 40侧正常膝关节进行冠状、矢状、横轴及斜位T1WI扫描 ,观察髌支持带在不同方位成像上的MRI表现。结果　髌支持带包括髌内、外侧支持带 ,又可分为浅、深两层。髌内侧支持带深层包括内侧髌股韧带、内侧髌胫韧带和内侧髌半月板韧带 ;髌外侧支持带深层包括横韧带、外侧髌胫韧带和上髁髌韧带。在MRI上 ,内侧髌股韧带和横韧带在横轴像显示最佳 ;内侧髌胫韧带在冠状像或矢状像显示最佳 ;内侧髌半月板韧带和外侧髌胫韧带分别在 70 °内斜和 70 °外斜矢状斜位像显示较好。上髁髌韧带显示不佳。结论　MRI多方位成像可较好地显示髌支持带的解剖结构。     

Influence of a mono-centric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament--an in vitro study

OBJECTIVE: To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency. DESIGN: The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model. BACKGROUND: Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the knee joint. Therefore knee braces should reduce that tension increase. However, that effect has never been proven quantitatively. METHODS: After anterior cruciate ligament-transection, the forces of the medial (anterior/posterior part) and lateral collateral ligament were measured in ten fresh human cadaver knees at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees and 100 degrees of flexion, with and without application of a mono-centric knee brace. To quantify the ligament forces, strain gauges were fixed at the bony origins of the ligaments. RESULTS: Bracing led to a significant decrease of ligament forces (20-100 degrees: P < 0.0001) in the anterior part of the medial collateral ligament in all joint positions. In the posterior aspect, this effect was observed only at 40 degrees (P < 0.0001) and 80 degrees (P = 0.001) of flexion. In the lateral collateral ligament, bracing caused a strain reduction from 60 degrees to 100 degrees of flexion (P < 0.0001). Therefore a flexion angle dependent effect of knee bracing on the strain was seen in the posterior aspect of the medial and in the lateral collateral ligament in anterior cruciate ligament deficient knee joints. CONCLUSIONS: Application of a mono-centric knee brace leads to a significant position dependent reduction of collateral ligament tension after anterior cruciate ligament-rupture.     

Das alternde Knie

Of all peripheral joints the knee is most often affected by degenerative alterations. Visible signs on X-ray examinations are often preceded by clinical symptoms. When complaints occur a distinction must be made between therapy of acute (arthritic attack) and chronic pain. The therapy of acute pain in degenerative diseases of the knee includes temporary immobilization, local application of cooling, administration of non-steroidal anti-inflammatory drugs, puncture of the effusion when needed and possibly local application of corticosteroids (possibly in combination with a local anesthetic). For chronic complaints the results of the manual clinical examination are decisive for the therapeutic approach. This includes treatment via the skin (receptors) but especially the local influence of painful extracapsular structures of the joint, such as ligaments or their attachments, the quadriceps tendon, patellar ligament, patellar retinaculum, collateral ligaments, in particular the coronary ligament, the meniscus retaining ligament. Also important is an area of the medial tibial head, the??tibia head point?? according to Tilschner, an entry point of vessels into the head of the tibia. These structures are predominantly treatable with topical injections but also with dry needling. Functional limitations are indications for manual therapy techniques. Further advice for patients is essential.     

正常成年人膝关节的MR测量及其成像

目的通过对正常成年人膝关节MRI的半月板及韧带的测量,为膝关节损伤性疾病的诊断提供参考值.方法 53例正常对照组成人膝关节MRI检查资料,选择矢状位及冠状位PDWI成像序列,分别测量正常成年人半月板、前、后交叉韧带、内、外侧副韧带、胫骨平台的有关数据,并与解剖文献的大体测量结果进行比较.其中13例同时做了矢状位及冠状位的T2WI及PDWI压脂序列扫描,分析、比较压脂序列对显示半月板及韧带的优势.结果半月板的MR测量值较大体解剖测量值大,外侧半月板后角较半月板的其余部分厚.内侧半月板体部横径与胫骨平台宽径及体重呈线性相关.前交叉韧带与Blumensaat线的夹角小于15°,后交叉韧带的角度约为(120.89±5.63)°.结论膝关节的MR测量值较大体解剖测量值更能反映活体的真实情况,为临床膝关节损伤性疾病的诊断提供正常参考值,外侧半月板后角较前角及内侧半月板厚;内侧半月板体部横径与胫骨平台宽径及体重间可建立多元线性回归方程,体重对内侧半月板体部横径的作用稍大于胫骨平台的作用;MR特别是T2WI及PDWI压脂序列对显示膝关节结构具有较高的价值.     

基于Mimics软件虚拟人膝关节三维图像融合实验

背景：国内外已有学者利用不同的方法对人体膝关节进行三维建模,根据各自研究侧重点不同,在方法和最终效果上各有不同。目的：根据不同模态中膝关节影像的特点,将膝关节建模结果进行配准、融合,为进一步生物力学研究提供一种方便的方法。方法：采用MimicsV10.0软件根据膝关节在CT和MR断层图像的特点,选择不同分割算法进行膝关节解剖组织分割,并对不同的分割图像进行三维重建。结果与结论：基于逆向工程原理,利用虚拟人膝关节连续CT断面图像分别重建出膝关节的骨性结构如股骨、胫骨、腓骨、髌骨;并利用膝关节的连续MRI断面图像重建出半月板、髌韧带、内侧副韧带、前交叉韧带、后交叉韧带等结构,并成功对上述结构进行融合,融合后的三维膝关节模型可以任意角度或单独观察,并可以进行体视学测量。说明通过不同模态图像融合的方法可以建立膝关节的三维模型,为计算机辅助膝关节损伤康复研究奠定基础。     

Three-week joint immobilization increases anterior-posterior laxity without alterations in mechanical properties of the anterior cruciate ligament in the rat knee

BackgroundAlthough knee immobilization may deteriorate the mechanical parameters of the anterior cruciate ligament, such as stiffness and failure strength, it is unknown whether it induces laxity in the whole joint. We examined the effects of immobilization on anterior-posterior joint laxity and mechanical properties of the anterior cruciate ligament, as well as histological and gene expression profiles of the joint capsule in rat knee joints.MethodsUnilateral rat knees were immobilized using an external fixator. Non-immobilized contralateral knees were used as controls. After 3 weeks, anterior-posterior laxity in the whole joint (i.e., a complex of bones, ligaments, and capsule) and stiffness and failure strength in the anterior cruciate ligament were examined using a universal testing machine. Moreover, the knee joint capsule was histologically analyzed, and the expression levels of genes related to collagen turnover in the posterior joint capsule were examined.FindingsJoint immobilization slightly but significantly increased anterior-posterior laxity compared with the contralateral side. Unexpectedly, the stiffness and failure strength of the anterior cruciate ligament were not altered by immobilization. There was no correlation found between anterior cruciate ligament stiffness and anterior-posterior joint laxity. In the posterior joint capsule, thinning of the collagen fiber bundles accompanied by a decrease in COL3A1 gene expression was observed after immobilization.InterpretationThese results suggest that 3 weeks of joint immobilization alters the biomechanical integrity in the knee joint without altering the mechanical properties of the anterior cruciate ligament. Changes in the joint capsule may contribute to the immobilization-induced increase in anterior-posterior laxity.     

Komplexe Bandläsion des Kniegelenks

Combined injuries of the main knee ligaments have a broad spectrum, ranging from typical combinations like anterior cruciate ligament (ACL) and medial collateral ligament (MCL) ruptures up to knee luxations with severe combinations of both cruciate ligaments and at least one collateral ligament. Isolated injuries of the MCL and the posterior cruciate ligament (PCL) can be treated conservatively. Indications for surgical repair are mainly combined injuries of cruciate ligaments and ruptures of the lateral structures. Knee luxations are often complex injuries with neurovascular complications. Careful and early detection of these complications can avoid endangering the extremity and therefore prevent massive damage to the patient. Surgical repair of ligament injuries is superior to conservative treatment.     

Quantified kinematics of the injury to the posterior cruciate ligament: a computer-aided design simulation study

OBJECTIVE: To quantify the kinematics of the injury to the posterior cruciate and the other major knee ligaments as a function of the knee flexion angle at the moment of impact. DESIGN: Computer-aided design modelling was used to investigate the strain response of all major knee ligaments during antero-posterior abnormal tibio-femoral translation at 0-90 degrees knee flexion. BACKGROUND: It is generally believed that the likelihood of injury to the posterior cruciate ligament following anterior impact is higher in the flexed knee. However, there are no kinematical studies to quantify this clinical observation or investigate the role of the other knee ligaments in the above situation. METHODS: Computer calculations of the individual ligament strain were plotted against the magnitude of posterior tibial translation. Additionally, the strain rate for each ligament (defined as the ligament strain produced per mm of posterior tibial linear translation) was calculated as the slope of the strain-displacement curve for all tested degrees of knee flexion. RESULTS: The posterior cruciate ligament has been shown to be the primary restraint to posterior tibial translation in all degrees of knee flexion. However, at 90 degrees of knee flexion the strain rate of the posterior cruciate ligament is approximately half that in the fully extended knee and the posterior cruciate ligament is the only ligament to resist posterior tibial translation. CONCLUSIONS: The strain behaviour of the posterior cruciate ligament during injury is highly dependent on the knee flexion during the moment of impact. Forced posterior tibial translation in the 90 degrees flexed knee may result in isolated posterior cruciate ligament deficit rather than a complex ligament disruption. The strain rate of a ligament as introduced in the present study is a quantified parameter related to the resistance that the ligament imposes to an abnormal joint movement. Relevance. This study provides insight into the differential strain of the knee ligaments during impacts that result in posterior cruciate ligament injury. Studies that quantify the strain behaviour of individual knee ligaments are important to the understanding, diagnosis and prevention of injuries sustained during contact sports and high-energy road traffic accidents.     

宝石能谱成像分析膝关节痛风中沉积尿酸盐

目的探索宝石能谱成像(GSI)评价痛风患者双膝关节尿酸盐沉积规律的临床价值。方法对32例痛风患者行双膝关节GSI扫描,分析双膝尿酸盐沉积分布规律,同时统计分析尿酸盐与周围各组织定量分析指标:有效原子序数(Eff-Z)、能谱曲线斜率、尿酸(钙)[UA(ca)]含量、钙(尿酸)[CA(ua)]含量及UA(ca)/CA(ua)值。结果 32例患者均检测到尿酸盐,分布于213处沉积区,且内外侧副韧带处(74/213,21.13%)>交叉韧带(35/213,16.43%)>股四头肌肌腱(18/213,8.45%)。尿酸盐Eff-Z、曲线斜率、UA(ca)含量、CA(ua)含量和UA(ca)/CA(ua)值分别为8.10±0.26、1.06±0.55、(1260.30±50.65)mg/cm3、(18.93±6.26)mg/cm3和68.31±24.96,与周围骨皮质、肌肉、骨松质比较差异均有统计学意义(P均<0.05)。结论尿酸盐在膝关节周围易沉积于受力较大的肌腱及韧带处。GSI多参数分析有助于尿酸盐的定性诊断,UA(ca)/CA(ua)值对尿酸含量变化可能更敏感。