前外侧韧带重建术治疗合并高度轴移的前交叉韧带损伤——手术技术及早期随访结果

目的:探讨联合应用前交叉韧带重建及前外侧韧带重建术治疗合并膝关节高度轴移的前交叉韧带损伤的有效性。方法:2015年5月至2016年4月,共156例患者诊断为前交叉韧带损伤,于我科接受同一医生手术治疗,其中22例高度轴移患者入选本研究。采用KT-1000检查膝关节前向稳定性,采用轴移试验评估膝关节旋转稳定性,使用Lysholm主观功能评分评估膝关节功能。结果:22例患者中男性14例,女性8例,平均年龄29.3岁(15~43岁),平均随访时间8.6个月(3~15个月)。术前KT-1000测量,患侧-健侧差值平均为8.9±3.1 mm(4~16 mm),术后随访时侧-侧差值平均为2.1±0.6 mm(0~3mm),较术前显著改善(P<0.01)。术前轴移检查,20例患者轴移试验2+,2例患者3+。术后即刻检查轴移试验均为阴性。术后随访时,21例患者轴移试验阴性,1例患者1+,与术前相比有显著差异(P<0.01)。患者术前Lysholm评分平均为60.5±12.3(35~90),术后为79.2±7.8(66~90),有显著改善(P<0.05)。结论:前交叉韧带损伤合并高度轴移的患者,联合应用前交叉韧带重建及前外侧韧带重建术可有效恢复膝关节旋转稳定性,术后早期随访结果显示患者膝关节稳定性及功能评分满意。     

同种异体跟腱移植物重建内侧副韧带浅层结构治疗膝关节外翻不稳定的临床研究

目的:评估采用同种异体跟腱重建内侧副韧带(MCL)浅层结构对恢复膝关节外翻稳定性的早期临床疗效。方法:回顾性分析2005年8月至2010年12月我科收治的诊断为陈旧膝关节内侧副韧带损伤并符合重建手术指征的患者19例,均采用同种异体跟腱作为移植物。患者入选标准为:1)陈旧MCL损伤,受伤至手术时间超过3周;2)IKDC膝关节外翻不稳定分级为C级[内侧关节间隙开口程度(侧侧差值)为6～10 mm]或D级(内侧关节间隙开口程度大于10 mm);3)随访时间至少12个月。术前、术后采用Telos装置拍摄膝关节外翻位应力像评估内侧结构稳定性。其他评价指标包括IKDC主观功能评分和Lysholm主观功能评分。结果:19例患者中,16例获得随访,其中男性12例,女性4例;平均年龄31.8岁(19～53岁),受伤至手术时间平均17.6个月(24天～84个月),随访时间平均27.8个月(12～67个月)。患者术前膝关节内侧间隙开口程度平均为(8.9±3.1)mm(6～23.2 mm),术后平均(0.1±1.4)mm(-2～2.4 mm),手术前后比较差异有统计学意义(P<0.05)。IKDC主观功能评分术前平均(49.8±6.7)分(31～57.5分),术后平均(82.8±4.8)分(71.3～93.1分),手术前后比较差异有统计学意义。Lysholm评分术前平均(69.3±5.7)分(55～78分),术后平均(88.3±4.6)分(75～95分),手术前后比较差异有统计学意义。16例患者中,术前膝关节外翻稳定性IKDC分级C级12例,D级4例;术后A级14例,B级2例。结论:采用同种异体跟腱重建内侧副韧带浅层结构能够显著改善膝关节外翻稳定性,术后平均2年的随访表明患者主观功能评分满意。     

深低温保存的异体骨-髌腱-骨重建膝关节前交叉韧带

目的评价深低温保存的异体骨-髌腱-骨(bone-patellar tendon-bone,B-PT-B)重建膝关节前交叉韧带的方法和初步疗效.方法采用异体B-PT-B重建膝关节前交叉韧带共15例,平均年龄25.9岁,平均随访时间23.7个月.手术前后采用Lysholm评分评定关节功能.结果术后恢复均顺利.Lysholm评分,由术前(60.1±5.8)分提高至术后(90.8±5.2)分(P＜0.01),优良率80%.结论采用深低温保存的异体B-PT-B重建膝关节交叉韧带是一种较好的、可供选择的手术方式.     

同种异体骨-髌腱-骨组织移植重建前交叉韧带36例临床分析

目的:回顾性研究并评估采用同种异体骨-髌腱-骨组织移植重建前交叉韧带患者的临床疗效。方法:从2004年12月至2006年8月,对36例ACL损伤病例进行了同种异体骨-髌腱-骨组织移植重建。男性16例,女性20例;平均年龄28岁(15~56岁);急性损伤11例,慢性损伤25例。对所有患者进行了主观评估(包括手术前后Lysholm评分、IKDC评分和症状改善情况)和客观评估(包括Lachman试验、轴移试验、KT-1000测量,以及关节活动范围),并对比了患者术前以及术后的MR影像和关节镜手术探查影像,还对术后发热情况以及并发症进行了记录。结果:本组病例平均随访23.6个月(12~32个月)。主观评估:术前Lyshrolm评分为63.61±13.4分(46~90分),术后最终评分为98.03±3.6分(85~100分),与术前对比差异有统计学意义(P<0.01);术后IKDC评分总体优良率达到91.7%。客观评估:KT-1000测量结果:术前两侧胫骨前移的差别为7.05±2.15mm(2~11mm),术后最终测量值为1.15±1.43mm(0~6mm),与术前对比差异有统计学意义(P<0.01)。所有患者均未出现明显的术后并发症以及病毒和细菌感染。1例患者移植物松弛度增加,给予固缩治疗后好转。另1例部分韧带磨损,但主观评估良好,给予清创和髁间窝成形术处理。结论:短期观察显示,采用同种异体骨-髌腱-骨组织移植重建ACL能够获得满意的临床疗效,具备有效性和安全性。     

同种异体组织重建关节韧带临床疗效的初步观察

目的评价同种异体组织重建膝关节前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)、外侧副韧带(LCL)和肩关节喙锁韧带(CCL)的疗效. 方法回顾调查43例患者,将其分为3组,A组ACL或ACL/MCL损伤34例;B组PCL或PCL/LCL 损伤6例;C组完全肩锁关节损伤3例.分别应用同种异体骨-髌腱-骨(B-PT-B) 、半腱肌腱与股薄肌腱、胫后肌腱、跟腱-骨重建. 结果平均随访19个月, A、B两组术前Lysholm评分63.0±5.6,术后89.0±5.9,手术前后差异有非常显著性意义(P<0.01); 术后国际膝关节文献委员会(IKDC)评分A级3例(8%),B级23例(58%),C级12例(30%),D级2例(5%).KT2000测定A组手术前后胫骨前移分别为(13.10±0.29)mm和(4.70±1.37)mm;B组胫骨后移则分别为(10.53±2.50)mm和(5.74±1.33)mm,手术前后差异有非常显著性意义 ( P<0.01).术后健患侧比较A、B两组健患差异<3 mm 33例(83%);>5 mm 4例(10%);前后抽屉试验36例(90%)由术前3度恢复至术后平均1.3度.合并MCL/LCL损伤患者的侧方应力试验由术前3度恢复至术后平均1.2度,并呈现明显的硬终点;单纯与复合性ACL或PCL损伤,伸屈正常分别占91%和88%.喙锁韧带重建后X线片显示肩锁关节间隙基本正常,肩锁与肩肱关节活动良好. 结论同种异体移植物重建膝关节ACL、PCL、MCL、LCL与肩关节喙锁韧带疗效满意,是自体组织重建的良好替代物.     

急性膝关节前交叉韧带不完全损伤关节镜下诊治方法选择

目的探讨急性膝关节前交叉韧带(ACL)不完全损伤的关节镜下诊断意义和早期临床治疗方案的选择。方法1999年8月-2003年10月收治急性膝关节ACL不完全损伤37例,所有患者均早期行关节镜检查确诊,其中关节镜下射频皱缩术后保守治疗8例,Ⅰ期行ACL加强手术19例,Ⅰ期行ACL重建手术10例,随诊10~23个月,并行临床效果评定。结果获随诊患者34例(92%),治疗康复6个月膝关节Lysholm评分,从术前(43.6±5.2)分提高到(91.8±2.3)分,与术前比较有显著提高(P<0.01)。结论急性膝关节ACL不完全损伤应早期首选关节镜检查以明确诊断,确定损伤程度,选择合理的临床治疗方案;Ⅰ期镜下修复或重建ACL,对早期恢复膝关节稳定有重要的临床意义。     

关节镜下双骨道多股自体腘绳肌腱解剖重建前交叉韧带

目的探讨关节镜下双骨道多股自体腘绳肌肌腱解剖重建前交叉韧带(ACL)的方法和疗效。方法31例ACL损伤患者,年龄18～45岁,平均27岁。在关节镜下应用两组骨道,用多股半腱肌腱在屈膝50°～60°位拉紧并固定重建前内侧束,用多股股薄肌腱在屈膝10°～15°位拉紧并固定重建后外侧束。结果31例患者术后进行3～13个月(平均5.2个月)随访,术后膝关节活动度均在正常范围。术后前抽屉试验和轴移试验均为阴性;Lachman试验:25例“-”,5例“1+”,1例“2+”。术后Lysholm评分为(88.7±9.4)分,较术前(47.4±9.6)分显著提高(t=3.14,P<0.01)。术后Tegner活动评分为(6.9±1.3)分,较术前(3.1±0.9)分显著提高(t=3.13,P<0.01)。结论双骨道多股自体腘绳肌腱重建ACL能够更好地恢复膝关节在不同伸屈角度的稳定性。     

关节镜下前交叉韧带重建术后失败行翻修术的近中期临床疗效

 目的 探讨关节镜下前交叉韧带重建术后失败行翻修术的近中期临床疗效。方法 回顾性分析武警海警总队医院2013-02至2019-02收治的前交叉韧带重建术后失败行翻修术患者30例(30膝)临床资料,术后平均随访时间37个月(6~70个月)。手术前后膝关节功能采用Lysholm评分、Tegner评分、IKDC评分、KT-2000差值进行分析,采用Lachman试验、前抽屉试验对手术前后膝关节前方稳定性进行分析。结果 Lysholm评分术前(48.33±5.43)分,末次随访(82.92±4.13)分;Tegner评分术前(2.18±0.91)分,末次随访(6.52±1.12)分;IKDC评分术前(48.32±5.54)分,末次随访(76.45±3.86)分;KT-2000屈曲90°差值术前(6.95±1.21)mm,末次随访(2.23±0.84)mm,KT-2000屈曲30°差值术前(6.62±1.01)mm,末次随访(2.34±0.42)mm;差异均有统计学意义(P<0.05)。Lachman试验、前抽屉试验术前30例全部阳性,术后全部阴性,膝关节功能术后提高明显。结论 前交叉韧带重建术后失败行翻修术,近中期疗效满意。     

3D打印导向器辅助关节镜下前交叉韧带重建术骨隧道准确性的对比研究

目的依据膝关节影像学定制前交叉韧带重建3D打印定位导向器(专利号:201620246858.0),研究3D打印定制前交叉韧带重建导向器辅助关节镜下行前交叉韧带重建的股骨、胫骨隧道定位可行性及准确性。方法 2015年1月—2017年6月,在陆军军医大学附属大坪医院骨科诊断急性前交叉韧带断裂的患者中,随机数字表法分成3D打印组与传统手术组,两组患者均50例。3D打印组男性38例,女性12例,平均年龄(28.8±7.3)岁,采用自行研制的3D打印前交叉韧带重建定位导向器,辅助关节镜下进行前交叉韧带重建术定位关节内股骨、胫骨隧道口位置;传统手术组男性40例,女性10例,平均年龄(30.0±7.8)岁,采用传统经胫骨隧道重建前交叉韧带方法关节镜下定位关节内股骨、胫骨隧道口位置,胫骨隧道端采用羟基磷灰石挤压螺钉固定,股骨隧道端微孔钢板(Endobutton)悬吊固定。术后常规照射膝关节正侧位X线片,采用Klos测量法评估胫骨隧道,Amis测量法评估股骨隧道,并对两组患者进行平均随访1年,最少随访时间6个月,记录术前及术后膝关节活动范围,术前与术后Lachman试验,评估术前及术后Lysholm评分、Tegner评分,并进行统计学分析。结果 3D打印组中Amis测量法评估股骨隧道位置测量平均值为(45.6±1.5)%,传统手术组测量平均值(41.4±1.4)%;Klos测量法对胫骨隧道位置测量评估,3D打印组测量平均值(62.7±3.3)%,传统手术组测量平均值(57%±2.6)%,差异均有统计学意义(P0.05);Lysholm评分3D打印组由术前(57.36±5.76)分提高至术后(96.42±1.39)分,传统手术组由术前(57.06±5.61)分提高至术后(96.12±1.39)分,Tegner评分3D打印组由术前(3.44±0.5)分提高至术后(5.96±0.8)分,传统手术组由术前(3.5±0.5)分提高至术后(6.1±0.78)分;膝关节活动范围3D打印组由(88.6±14.2)°提高至术后(117.3±5.7)°,传统手术组由(87.4±9.2)°提高至术后(119.3±5.3)°。结论基于CT和磁共振等影像学分析设计的3D打印前交叉韧带重建导向器辅助关节镜下进行前交叉韧带重建定位关节内股骨、胫骨隧道口位置比传统经胫骨隧道进行前交叉韧带重建的隧道内口更接近前交叉韧带止点解剖位置,但两组患者术后临床膝关节活动度及功能评分差异无统计学意义。     

关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折

目的:探讨关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。方法:回顾性分析2008年10月至2011年9月的32例前交叉韧带胫骨止点撕脱骨折患者的病例资料,全部患者采用关节镜下经髌内侧入路导入空心钉进行骨折内固定,采用膝关节功能评分及影像学检查评估术后疗效。结果:术后膝关节侧位片螺钉与胫骨平台夹角平均为(48°±7.3°),随访8~32个月,平均18个月,骨折愈合平均时间为(6.5±0.6)周,术后8周Lysholm膝关节功能评分达到(90.5±1.7)分,随访终末期Lysholm评分达到(94.6±1.5)分。结论:采用关节镜下经髌内侧入路导入空心钉治疗前交叉韧带胫骨止点撕脱骨折,取得了良好的临床效果。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

U50,488H对正常及缺氧心肌细胞L型钙电流的作用

目的 探讨心脏阿片受体和β-受体相互作用的机制。方法 采用全细胞膜片钳技术,观察U50,488H(β-阿片受体选择性激动剂)对正常和缺氧心肌细胞L型钙电流的作用。结果 U50,488H剂量依赖性(0．1～100μmol／L)抑制正常心肌细胞的L型钙电流及异丙肾上腺素(0．1μmol／L)激动的钙电流,而细胞缺氧后,这一抑制作用减弱;U50,488H对Forskolin(10μmol／L)激动的L型钙电流无明显影响。结论 β-阿片受体对β-受体信号的负性调节作用在细胞缺氧后减弱,其作用位点可能发生于β-受体与腺苷酸环化酶环节之间。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.