颈椎三维活动度测定仪的测量稳定性评估

目的对自行设计的颈椎三维活动度测定仪的测量稳定性进行评估。方法由A、B医师分别对30名健康受试者的颈椎屈伸、侧屈、旋转活动度进行2次重复测量,得出本组受试者颈椎三维活动度的平均值和95％可信区间（confidence interval,CI）,得出A医师重复测量的组间相关系数（intraclass correlation coefficient,ICC）和95％CI,得出A医师与B医师间重复测量的ICC和95％CI。结果本组受试者的颈椎活动度均值为：屈伸123．0°±8．3°,侧屈86．3°±8．9°,旋转135．1°±8.3°。观察者内屈伸活动度一致性非常好（ICC=0．87）,侧屈活动度高度一致（ICC=0．92）,旋转活动度高度一致（ICC=0．94）;观察者间屈伸活动度一致性非常好（ICC=0．87）,侧屈活动度高度一致（ICC=0．90）,旋转活动度高度一致（ICC=0．91）。结论本实验证实颈椎三维活动度测定仪具有良好的观察者内信度和观察者间信度,是一种简单实用、稳定精确的颈椎活动度测量工具,适合临床和科研使用。     

Biomaterials,Part I: Symposium organized by the Scandinavian Orthopedic Association

Background and purpose A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused.

Patients and methods The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman’s correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach’s alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37).

Results For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88–0.95), Cronbach’s alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00.

Interpretation SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.     

Analysis of the uninjured tibiofibular syndesmosis using conventional CT-imaging and axial force in different foot positions

BackgroundSyndesmosis measurments and indices have been controversial and showed interindividual variability. The purpose of this study was to analyze, by conventional axial computed tomography images and a simulated load device, the uninjured tibiofibular syndesmosis under axial force and forced foot positions.MethodsA total of 15 healthy patients (30 ankles) were studied using adjustable simulated load device (ASLD). This device allowed to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID) and direct anterior difference (ADD), direct middle difference (MDD) and direct posterior difference (PDD).ResultsIn patients without injury to the tibiofibular syndesmosis, the application of axial load and forced foot and ankle positions showed statistically significant differences on the distal tibiofibular measurements between the stressed and the relaxed position, it also showed interindividual variability : SA (median = 4.12 [IQR = 2.42, 6.63]) (p < 0.001), ADD (0.67 [0.14, 0.67]) (p < 0.001), MDD(0.45, [0.05, 0.9]) (p < 0.001), PDD (0.73 [?0.05, 0.73]) (p < 0.002). However, it did not detect statistically significant differences when the tibiofibular differences between the stressed and the relaxed position in one ankle were compared with the contralateral side: SA (?0.14, SD = 4.33 [95% CI = ?2.53, 2.26]), ADD (?0.42, 1.08 [?1.02, 0.18]), MDD (0.29, 0.54 [?0.01, 0.59]), PDD (?0.1, 1.42 [?0.89, 0.68]). Interobserver reliability showed an Intraclass correlation coefficient of 0.990 [95% CI = 0.972, 0.997].ConclusionsWide interindividual variability was observed in all syndesmotic measurements, but no statistically significant differences were found when comparing one ankle to the contralateral side. Measuring syndesmosis alignment parameters, may only be of value, if those are compared to the contralateral ankle.     

Kinematics before and after reconstruction of the anterior syndesmosis of the ankle

Background We have previously shown that patients with instability of the anterior syndesmosis benefit from an anatomical reconstruction. It is not known whether this is because of restored kinematics.

Methods In a prospective study of 5 patients, we assessed clinical findings and tibiofibular kinematics, evaluated by radiostereometry, before and after reconstruction of a chronic syndesmotic injury.

Results We found no statistically significant differences in tibiofibular kinematics before and after reconstruction. The kinematics of the fibula relative to the tibia during external rotation stress differed from that known in asymptomatic volunteers, but the differences were not typical enough to differentiate between patients and healthy subjects. Clinical examination and ankle scores, however, showed that all patients benefited from reconstruction of the anterior syndesmosis.

Interpretation Radiostereometry is not an adequate technique to diagnose chronic syndesmotic instability or to demonstrate restoration of the kinematics of the ankle as a cause of the beneficial effect of anatomical reconstruction of the syndesmosis.     

Reliability and Validity of the Functional Gait Assessment in Incomplete Spinal Cord Injury

Background:There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI).Objectives:To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI.Methods:Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C (n = 2) or D (n = 10), were included. Participants completed five outcome measures during a single test session including lower extremity motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury, FGA, 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury (WISCI-II), and the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP).Results:Inter- and intrarater reliability for the FGA were excellent. Interrater reliability was excellent with intraclass correlation coefficient (ICC) scores greater than 0.92 (p < .001). Interrater reliability against an expert was also excellent for all raters, with an ICC greater than or equal to 0.92 (p < .01). Intrarater reliability was excellent with an ICC score of greater than 0.91 (p < .002) for all raters. Validity of the FGA with 10MWT was −0.90 (p = .000), FGA with WISCI-II was 0.74 (p = .006), and FGA with SCI-FAP was −0.83 (p = .001).Conclusion:The FGA is a reliable and valid outcome measure to use when assessing gait and balance in individuals with motor iSCI. The FGA provides clinicians with a single tool to utilize across a variety of neurologic diagnoses.     

Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA,Egyptian population radiographic study

BackgroundFemoral component rotational alignment is critical for successful TKA. The primary study objective is to measure the preoperative distal femoral torsion (DFT) of an Egyptian patient’s cohort using a seated posteroanterior (PA) knee radiograph. The secondary objectives are to check the intraoperative reliability of using the posterior condylar line (PCL) as a reference for rotation and to measure postoperative component rotation using the same radiographic technique.Methods100 arthritic knees, 22 males, 78 females, 95 Varus and five valgus. A long anteroposterior radiograph [Hip to knee to ankle (HKA)] for coronal alignment assessment, and the anatomical posterior condylar angle (aPCA) between the anatomical transepicondylar axis (aTEA) and the PCL was measured in the seated PA knee radiographs for evaluating the DFT and component rotation. Intraoperative rotation was adjusted to 3° external rotation to the PCL.ResultsHKA improved from a preoperative mean 170.4° ± 6.2 to a postoperative mean 178.3° ± 1.5 (p < 0.005). DFT was internal in all knees; the mean aPCA was −4.5 ± 2.4 (0° to −9°), femoral component rotation significantly changed to a mean aPCA of −3.6 ± 2.3 (0° to −7°) (p = 0.005). Acceptable intraoperative patellar tracking in 94%, and patellar subluxation needed a lateral retinacular release in 2% (two valgus knees). The preoperative DFT was not affected by sex or direction of coronal deformity; more external DFT noticed in severe varus deformity.ConclusionsAll keens had an internal DFT not affected by sex, or coronal deformity direction. Using PCL as a guide to adjust femoral component rotation is a valid technique in our population.     

The Orthopaedic Research Institute-Ankle Strength Testing System: inter-rater and intra-rater reliability testing

Achilles tendinosis is a degenerative overuse tendinopathy involving the primary ankle plantarflexors, namely the soleus and gastrocnemius muscles forming the tendo Achilles. The Orthopaedic Research Institute-Ankle Strength Testing System (ORI-ASTS) was designed to record objective measurements of force generated with a resisted ankle plantarflexion test. Testing normal subjects (n=6) was used to establish the reliability of the ORI-ASTS for measuring ankle plantarflexion force. Testing patients with Achilles tendonitis (n=5) over time and comparing Achilles tendon analogue pain scores to ankle plantarflexion force measurements was used to assess the validity of the ORI-ASTS for monitoring progression of Achilles tendinopathy. Inter-rater reliability of the ORI-ASTS with normal subjects was excellent, with single measure intraclass correlation coefficients (ICC) for right mean peak force of 0.92, left mean peak force of 0.96, right mean total force of 0.89, left mean total force of 0.91. The ORI-ASTS also had excellent intra-rater reliability for normal subjects with the following single measure ICC scores: right mean force 0.96, left mean force 0.92, right mean total force 0.97, left mean total force 0.92. The relative technical errors of measurement were calculated from these results, and ranged from 1.0% to 2.7%. Testing patients with Achilles tendinosis (n=5), and comparing analogue activity pain scores to ORI-ASTS testing demonstrated a strong negative relationship between the two parameters (Spearman Rho -0.87 to -1.0, Kendall tau b -0.82 to -1.0). The relationship was statistically significant at the p=0.01 level for two of the five patients. The ORI-ASTS shows excellent reliability for testing ankle plantarflexor force, and appears valid for objectively assessing and monitoring patients with Achilles tendinosis.     

The influence of muscle load on tibiofemoral knee kinematics

A comparative kinematics study was conducted on six cadaver limbs, comparing tibiofemoral kinematics in five conditions: unloaded, under a constant 130 N ankle load with a variable quadriceps load, with and without a simultaneous constant 50 N medial and lateral hamstrings load. Kinematics were described as translation of the projected centers of the medial (MFT) and lateral femoral condyles (LFT) in the horizontal plane of the tibia, and tibial axial rotation (TR) as a function of flexion angle. In passive conditions, the tibia rotated internally with increasing flexion to an average of −16° (range: −12/−20°, SD = 3.0°). Between 0 and 40° flexion, the medial condyle translated forwards 4 mm (range: 0.8/5.5 mm, SD = 2.5 mm), followed by a gradual posterior translation, totaling −9 mm (range: −5.8/−18.5 mm, SD = 4.9 mm) between 40–140° flexion. The lateral femoral condyle translated posteriorly with increasing flexion completing −25 mm (range: −22.6 to −28.2 mm, SD = 2.5 mm). Dynamic, loaded measurements simulating a deep knee bend were carried out in a knee rig. Under a fixed ankle load of 130 N and variable quadriceps loading, tibial rotation was inverted, mean TR = 4.7° (range: −3.3°/11.8° SD = 5.4°), MFT = −0.5 mm (range: = −4.3/2.4 mm, SD = 2.4 mm), LFT = 3.3 mm (range: = −3.6/10.6 mm, SD = 5.1 mm). Compared to the passive condition, all these excursions were significantly different (p ≤ 0.015). Adding medial and lateral hamstrings force of 50 N each reduced TR, MFT, and LFT significantly compared to the passive condition. In general, loading the knee with hamstrings and quadriceps reduces rotation and translation compared to the passive condition. Lateral hamstring action is more influential on knee kinematics than medial hamstrings action. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:419–428, 2010     

Technique for in vivo measurement of the three-dimensional kinematics and laxity characteristics of the ankle joint complex

We introduce here a technique to measure the three-dimensional kinematics and laxity characteristics of the ankle joint complex in vivo. The system consists of an optoelectric, kinematic data acquisition system that is used to measure the motion of the ankle joint complex in response to controlled moments applied through a system of pneumatic actuators. As a first step toward development of the method into a quantitative diagnostic tool for injuries of ankle ligaments, we addressed the following questions: (a) What is the reliability for measurement of range of motion and laxity of the ankle joint complex? (b) Are there significant differences in laxity between the left and right joints of a healthy individual? and (c) Are there significant differences in laxity of the ankle joint complex between men and women? To answer these questions, we performed repeated measures of range of motion and laxity of paired ankles in a population of 18 healthy young individuals. The high intraclass correlation coefficients obtained from the statistical analysis indicate that the new experimental system is highly reliable in measurement of total range of motion and total laxity of the ankle joint complex. We further concluded that, within the statistical power available in our experimental design, there are no significant differences in either range of motion or laxity between left and right ankles of healthy individuals or between men and women.     

Intrarater reliability of CROM measurement of cervical spine active range of motion in persons with and without neck pain

STUDY DESIGN: Clinical measurement, intrarater reliability study. OBJECTIVES: To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM). BACKGROUND: Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM. METHODS AND MEASURES: Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized. RESULTS: The intraclass correlation coefficients (ICC3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees . The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees . Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain. CONCLUSION: Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred.     

Comparison of medial distal tibial angle in EOS imaging and weightbearing X-ray

BackgroundThe medial distal tibial angle (MDTA) is used for measurement of ankle alignment. Standard to measure MDTA is weightbearing mortise view. EOS imaging becomes more popular for limb alignment analysis using low-dose radiation. As MDTA might vary in EOS, comparison between both radiographic techniques has been performed.MethodsMDTA was compared between both techniques in 43 cases by defining the mechanical tibial axis in different ways (X-ray low, EOS low, EOS high). For each method MDTA, intra- and interobserver reliability has been compared.ResultsThe correlation between the different methods were measured by ICC (intraclass coefficient) and were ICC 0.86 (X-ray low/EOS low), ICC 0.85 (X-ray low/EOS high) and ICC 0.97 (EOS low/EOS high). Intra- and interobserver reliability were in each case ICC > 0.95.ConclusionICC showed a substantial to excellent agreement between all methods. EOS is appropriate to determine MDTA and can be used for assessment of coronar deformities of the distal tibia.     

Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments’ injury — cadaver study

BackgroundThe lack of consensus on the relevance of the varus talar tilt test (VTTT) might be due to the divergence between the insufficiency vector of lateral ankle instability and the direction of this clinical test. Our hypothesis is that the VTTT is more accurate to diagnose lateral ankle ligaments rupture when it's applied with a pre-positioning of the foot in internal rotation (IR).MethodsWe compared, in 12 cadaver ankles, the varus opening during a classic VTTT with the same test starting in an IR pivot, using a new arthrometer.ResultsThe classic VTTT caused a 13° tilt after ATFL section and 23,8° after ATFL and CFL section. The application of a VTTT with an IR prepositioning caused a 21,2° tilt after ATFL section (p = 0,002) and 29,5° after ATFL and CFL section (p = 0,006).ConclusionThe VTTT is better to identify lateral ankle ligaments' insufficiency when it's applied with a pre-positioning of the foot in internal rotation. The resulting vector is similar to the supination trauma.     

Development and psychometric performance of the French language version of the Manchester-Oxford Foot Questionnaire (MOXFQ)

BackgroundThe Manchester-Oxford Foot Questionnaire (MOXFQ) is a 16-item patient-reported outcome measure (PROM) validated for use in patients with foot and ankle pathologies. It contains three sub-scores for pain, walking/standing and social interaction dimensions. The aim of this study was to develop a French language version of the MOXFQ and to assess its psychometric properties in patients affected by foot and ankle pathologies.MethodsAccording to guidelines, forward and backward independent translations were performed. The final French version was pre-tested in 45 patients. The French MOXFQ and the Short-form 36 Health Survey (SF-36) were filled in by 149 patients. A retest was performed in 39 patients. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by factor analysis, and through correlations of MOXFQ scales with SF-36 scales.ResultsInternal consistency coefficients were high with Cronbach’s alpha ranging from 0.79 and 0.94. Test-retest ICCs were between 0.74 and 0.93. No floor or ceiling effects were observed. The correlations between French MOXFQ and French SF-36 subscales were moderate ranging from −0.33 to −0.71.ConclusionsThe French translation of the MOXFQ revealed good psychometric properties. Our French version proved to be a reliable instrument which can be used for evaluation of patients with foot and ankle disorders.Level of evidenceII.     

Comparison of two-dimensional manual and three-dimensional SurgiCase and BLUEPRINT planning software measurements of glenoid version,inclination, and humeral subluxation

IntroductionVirtual planning for shoulder arthroplasty using preoperative computed tomography (CT) has been gaining popularity, and it is imperative for surgeons to recognize any differences in measurements that may exist amongst software platforms. The purpose of this study is to compare measurements of glenoid version, inclination, and humeral head subluxation between a manual approach and two varying automated software platforms using either a best-fit sphere technique (Wright-Medical BLUEPRINT) or an anatomic landmarks technique (Materalise SurgiCase).MethodsA case control study of 289 CT images from patients preoperatively planned for a total shoulder arthroplasty or reverse shoulder arthroplasty using SurgiCase (v3.0.110.5) were also successfully analyzed by BLUEPRINT (v2.1.6). Glenoid version, inclination, and subluxation were measured manually in a blind fashion by two separate investigators using axial and coronal images oriented to the scapular plane; interobserver and intraobserver reliabilities were measured using intraclass correlation coefficients (ICCs). Concordance correlation coefficients (CCCs), mean differences, and clinically relevant agreement in measurements between the software platforms and with the manual technique were compared. The impact of greater glenoid retroversion on the differences in measurements between the software platforms was further studied by correlation analysis.ResultsThe mean differences between SurgiCase and BLUEPRINT were + 0.5° for glenoid inclination (P = .064; CCC = 0.84), -0.9° for glenoid version (P < .001; CCC = 0.92), and -1.4% for humeral subluxation (P = .002; CCC = 0.88). Agreement within 5 units was 78.9% for inclination, 89.3% for version, and 64.1% for subluxation. Glenoid retroversion had no relation with the degree of variation in measured inclination (P = .59) or version (P = .56). There were significant differences between manual and 3D software measurements for glenoid inclination, version, and subluxation (P < .001). Both software measurements were more inferiorly inclined (average difference, SurgiCase -3.2° and BLUEPRINT -3.9°), more retroverted (average difference, SurgiCase -4.0° and BLUEPRINT -3.2°), and more posteriorly subluxated (average difference, SurgiCase + 3.4% and BLUEPRINT + 4.8%).ConclusionThe SurgiCase and BLUEPRINT preoperative planning software yield clinically similar measurements for glenoid version, inclination, and subluxation. The degree of glenoid retroversion does not impact the variability of inclination or version between the landmark and best-fit sphere software techniques. Compared to the 2D manual technique, both 3D software programs reported greater inferior inclination, retroversion, and posterior subluxation.Level of evidenceLevel III; Retrospective Diagnostic Study     

Impact of fibular torsion and rotation on chronic ankle instability

BackgroundThe fibula is known not to involve in transmission of weight but known simply as an ankle stabilizer. However, its main function in stabilizing the ankle remains obscure. Since the fibula has an impact on torsion and rotation of the ankle, its effect on lateral ankle instability should be investigated.Materials and methodsTwenty patients with lateral ankle instability (Group 1) and 19 healthy volunteers (Group 2) were included in the study. The tibiofibular and talofibular relationships were evaluated using MRI images. Fibular torsion and rotation angles were calculated using a new method. Range of motion of the ankle joint was investigated while the knee was at flexion (90°) and extension (0°). The comparisons performed between the 2 groups and independent from the groups were statistically evaluated and, the p value of <0.05 was considered as statistically significant.ResultsA significant difference was found between the two groups for age (p < 0.05). There were no statistically significant differences between the right and left sides for all measurements in the group 1 and 2 (p > 0.05). There was a statistically significant difference between the two groups in dorsal flexion when the knee is at flexion (90°) and extension (0°) position. There was also a statistically significant difference between the two groups in plantar flexion which was measured while the knee was at extension (0°) position. No statistically significant difference was found between both groups in terms of fibular torsion and rotation. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, in patients with posteriorly localized fibula it was demonstrated that the fibular torsion and rotation was increased significantly.ConclusionWe did not detect any relationship between fibular torsion and rotation and ankle instability. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, we realized that in patients with posteriorly localized fibula, fibular torsion and rotation significantly increased. This finding did not explain the cause of instability. However, it may gain significance with new further studies regarding ankle instability.     

The effects of low arched feet on lower limb gait kinematics in children

BackgroundThe effects of foot posture on the dynamic function of the lower limb during gait remains relatively unknown.ObjectivesThe purpose of this study was to investigate lower limb kinematics between the normal and low arched foot during the gait cycle, particularly in the transverse plane.MethodTwenty-four children, twelve with normal and twelve with low arched feet, aged 11–12 years underwent a lower limb three dimensional gait analysis. Temporo-spatial parameters and patterns and ranges of motion of kinematic data were examined for the pelvis, hip, knee and ankle throughout the gait cycle.ResultsOverall, there were very few differences found in the kinematics of the lower limbs between the normal and low arched group. Increased external hip rotation (6–7°) in the low arched group was the only bilateral significant difference (p < 0.05) between the two foot groups. No significant differences existed in any temporo-spatial parameters between the two groups.ConclusionsThe increased external hip rotation and greater external foot progression angle in the low arched foot highlights the need to examine gait comprehensively to establish cause or effect of these differences observed and hence determine appropriate treatment.     

Second-look arthroscopic findings and clinical outcomes after management of intra-articular lesions in acute ankle fractures with arthroscopy

BackgroundAnatomically surgical reduction of ankle fractures does not always result in a clinically favorable outcome. Arthroscopic examination combined with treatment of intra-articular lesion may related to clinical outcomesObjectivesThe purpose of the present study was to review initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes.ResultsLauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 24), supination-adduction type (n = 3), pronation-external rotation type (n = 7), and pronation-abduction type (n = 6), total 40 ankles. Osteochondral lesions were found in 25 ankles (62%) with an initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in secondary arthroscopy were found in 17 cases. According to the Ferkel and Cheng staging at secondary arthroscopy, 4 of 25 ankles with osteochondral lesions of the talus were deteriorating (more than stage D). In terms of ICRS overall repair grades, 5 ankles (20%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles, respectively, in secondary arthroscopy, and correlations were found between AOFAS scores, VAS and intra-articular lesions.ConclusionSecond-look arthroscopic examination combined with treatment of intra-articular lesion such as arthrofibrosis and osteochondral lesion arising from ankle fracture surgery may consider to improve clinical outcomes.     

髓内钉治疗胫腓骨中下1/3骨折腓骨固定与否的疗效比较

《寰枢椎脱位中西医结合诊疗指南》由中国中西医结合学会脊柱医学专业委员会遵照循证医学原则和专家共识制定,为骨科医师提供AAD临床诊疗的学术性指导意见。主要内容包括AAD的诊断标准、中医辨证、临床分型、治疗策略和方法。     

Stand-to-Sit Kinematics of the Pelvis Is Not Always as Expected: Hip and Spine Pathologies Can Have an Impact

BackgroundStand-to-sit pelvis kinematics is commonly considered as a rotation around the bicoxofemoral axis. However, abnormal kinematics could occur for patients with musculoskeletal disorders, affecting the hip-spine complex. The aim of this study is to perform a quantitative analysis of the stand-to-sit pelvis kinematics using 3D reconstruction from biplanar x-rays.MethodsThirty volunteers as a control group (C), 30 patients with hip pathology (Hip), and 30 patients with spine pathology (Spine) were evaluated. All subjects underwent standing and sitting full-body biplanar x-rays. Three-dimensional reconstruction was performed in each configuration and then translated such as the middle of the line joining the center of each acetabulum corresponds to the origin. Rigid registration quantified the finite helical axis (FHA) describing the transition between standing and sitting with two specific parameters. The orientation angle (OA) is the signed 3D angle between FHA and bicoxofemoral axis, and the rotation angle (RA) represents the signed angle around FHA.ResultsThe mean OA was −1.8° for the C group, 0.3° for Hip group, and −2.4° for Spine group. There was no significant difference in mean OA between groups. However, variability was higher for the Spine group with a standard deviation (SD) of 15.9° compared with 10.8° in the C group and 12.3° in the Hip group. The mean RA in the C group was 18.1° (SD, 9.0°). There was significant difference in RA between the Hip and Spine groups (21.1° [SD, 8.0°] and 16.4° [SD, 10.8°], respectively) (P = .04).ConclusionHip and spine pathologies affect stand-to-sit pelvic kinematics.