同种异体半关节移植重建肩膝关节21例报告

观察同种异体半关节移植重建肩膝关节的疗效及并发症。方法：用同种异体半关节重建肿瘤切除后的骨关节２１例；术后石膏托固定６周－３个月，抗炎治疗３个月，抗排异治疗６个月，随访时间２年－２４．８年，平均１０．５年。结果：功能优良中１６例，差５例；并发症种类多且发生率高。     

半膝关节假体置换与半膝骨关节移植保肢治疗膝关节恶性骨肿瘤的124例2组对照比较

2001-07/2007-06昆明医学院第三附属医院(云南省肿瘤医院)骨科纳入膝关节周围恶性骨肿瘤患者12例,骨巨细胞瘤2例,肺癌骨转移癌1例,骨肉瘤9例.根据治疗方案分为2组,同种异体半膝骨关节移植保肢组6例,移植骨段长度12～18锄,平均14.8 cm:移植后随访1.3～5.7年,平均4.2年;疗效优良率为50%.个体化人工半膝关节假体置换保肢组6例,假体体部长度12～15 cm,平均13.6 cm;1例患者失访,其余5例患者置换后随访0.4～5.5年,平均3.9年:疗效优良率为80%.两组患膝关节国际保肢学会功能评分差异无显著性意义(P>0.05).半膝同种异体骨关节移植组患者的术后并发症发生率明显高于人工半膝关节假体置换组(66.7%,20.0%,P<0.05).提示同种异体半膝关节移植和人工半膝关节假体置换是治疗膝关节周围恶性肿瘤的两种较为满意的保肢方法,其中个体化人工半膝关节假体置换优于同种异体半膝关节移植.     

关节镜下同种异体肌腱移植重建交叉韧带60例

背景:目前多采用关节镜下自体肌腱移植治疗膝关节韧带损伤,但取材处并发症严重影响了手术效果.目的:探讨关节镜下同种异体肌腱重建韧带的疗效和应用前景.方法:选择2006-12/2008-12安徽医科大学第一附属医院骨二科膝关节交叉韧带患者60例,男42例,女18例.年龄20～42岁,前交叉韧带损伤46例,后交叉韧带损伤14例,均于关节镜下行同种异体移植肌腱重建.术前进行临床体检及前/后抽屉试验、Lachman试验、膝关节应力X射线片、髌骨轴位片及MRI等相关检查,Lysholm评分.术后6～21个月随访进行评估,包括临床体检和Lysholm评分.结果与结论:60例患者中,57例获得随访,随访时间6～21个月.术后切口愈合良好,无明显免疫排斥反应发生,4例出现关节腔积血,术后1周行关节腔穿刺抽液、加压包扎,出院时关节腔肿胀基本消退.术前出现的不同程度关节疼痛、屈仲活动受限及关节肿胀、急停、急跑困难、打软腿等症状改善显著.术后Lysholm评分较术前明显提高(P<0.05).提示关节镜下应用同种异体移植肌腱重建损伤交叉韧带可重建膝关节稳定性,有效恢复膝关节的功能,减少自体组织移植的供区损伤;同时具有手术损伤小、手术时间短、术后并发症少等优点.     

关节镜下自体肌腱及同种异体肌腱重建膝关节前后交叉韧带

背景:自体肌腱移植重建膝关节前后交叉韧带已广泛应用,但是供区容易出现并发症,同种异体肌腱移植越来越多应用于重建膝关节前后交叉韧带,是一种重要的替代材料.目的:比较关节镜下自体肌腱及同种异体肌腱移植重建膝关节前后交叉韧带的临床疗效差异.方法:40 例前后交叉韧带损伤患者分为2组:自体肌腱组为自体半腱肌及股薄肌重建膝关节前后交叉韧带,异体肌腱组为应用由山西骨组织库提供的同种异体肌腱重建膝关节前后交叉韧带.结果与结论:全部病例均获得6个月以上随访,最长随访时间36个月.重建前后两组大腿周径患健侧差值、Lachman 试验、中立位前抽屉试验(ADT)和国际膝关节评分委员会(IKDC)、Lysholm 及Tegner 评分差异均有显著性意义(P < 0.01),两组间术后各项指标差异均无显著性意义(P > 0.05).结果表明,自体肌腱与单纯深低温冷冻同种异体肌腱移植在重建膝关节前后交叉韧带疗效无明显差异.     

同种异体骨-髌腱-骨移植治疗陈旧性膝关节外侧副韧带损伤

背景:目前同种异体组织移植成为韧带移植重建的一种选择,同种异体骨-髌腱-骨可作为外侧副韧带重建的一种选择。目的:观察采用同种异体骨-髌腱-骨移植重建陈旧性外侧副韧带损伤的临床效果。方法:选择2008-04/2009-12解放军第101医院骨科收治的Ⅲ度陈旧性外侧副韧带损伤患者11例,均采用同种异体髌腱解剖移植重建外侧副韧带。结果与结论:11例患者均获得随访,随访时间12～15个月。切口均Ⅰ期愈合,关节活动范围移植重建后较移植前显著增大(P<0.05)。Lysholm评分末次随访时较移植前显著增加(P<0.05)。移植前内翻应力位X射线平片显示患膝外侧关节间隙较对侧平均增加8～20(12.9±3.5)mm,移植后6个月为-2～3(1.0±1.9)mm,与移植前相比差异有显著性意义(P<0.05),与健侧相比差异无显著性意义(P>0.05)。提示应用同种异体骨-髌腱-骨对陈旧性外侧副韧带损伤进行重建,能够有效恢复膝关节内翻稳定性,对其他软组织重建提供保护作用。     

半膝关节假体置换与半膝骨关节移植保肢治疗膝关节恶性骨肿瘤的12例2组对照比较

2001—07／2007-06昆明医学院第三附属医院（云南省肿瘤医院）骨科纳入膝关节周围恶性骨肿瘤患者12例，骨巨细胞瘤2例，肺癌骨转移癌1例，骨肉瘤9例。根据治疗方案分为2组，同种异体半膝骨关节移植保肢组6例，移植骨段长度12～18cm，平均14．8cm；移植后随访1．3～5．7年，平均4．2年；疗效优良率为50％。个体化人工半膝关节假体置换保肢组6例，假体体部长度12～15cm，平均13．6cm;1例患者失访，其余5例患者置换后随访0．4～5．5年，平均3．9年；疗效优良率为80％。两组患膝关节国际保肢学会功能评分差异无显著性意义（P〉0．05）。半膝同种异体骨关节移植组患者的术后并发症发生率明显高于人工半膝关节假体置换组（66．7％，20．0％，P〈0．05）。提示同种异体半膝关节移植和人工半膝关节假体置换是治疗膝关节周围恶性肿瘤的两种较为满意的保肢方法，其中个体化人工半膝关节假体置换优于同种异体半膝关节移植。     

关节镜下骨-髌腱-骨重建前交叉韧带5年以上随访分析

目的 探讨骨-髌腱-骨(BPTB)在前交叉韧带(ACL)损伤重建后的的远期疗效.方法 1999年1月～2003年6月该院行自体或同种异体BPTB重建ACL韧带123例,采用Lysholm膝关节功能评分法、IKDC评分法及KT1000检测分别评定术后1个月、3个月、6个月、1年、2年及5年等不同时期膝关节功能情况.结果 98例得到5年以上随访,91例患者膝不稳症状消失,关节功能恢复良好.8例合并膝前疼痛,25例感觉伸膝乏力,7例在2年后感觉关节轻度不稳,8例关节功能受限.重建术后6个月Lysholm评分、IKDC评分与术后1个月相比差异有显著性,术后2年与术后6个月相比差异有显著性,但重建术后5年与重建术后2年相比差异无显著性,且术后5年的评分总体满意.结论 自体与同种异体中1/3 BPTB重建ACL远期临床疗效满意.     

同种异体肌腱重建喙锁韧带治疗肩锁关节脱位及锁骨远端骨折23例

背景:临床研究表明,经过消毒和深低温处理的异体肌腱不会引起全身的免疫反应,局部的免疫反应也轻微,其力学性质不受影响,应用异体肌腱移植治疗膝关节韧带损伤的临床效果与自体肌腱移植相比无明显差异.目的:探讨应用异体肌腱重建喙锁韧带治疗肩锁关节脱何及锁骨远端骨折的效果.方法:23例(侧)患者,男17例,女6例;年龄19～45岁,平均30.4岁.其中TossyⅢ型肩锁关节脱位18例,NeerⅡ型锁骨外端骨折5例.右侧15例,左侧8例,均为新鲜脱位或骨折,其中1例肩锁关节脱位合并臂丛牵拉伤.应用同种异体肌腱,通过锁骨远端的两个钻孔,绕过喙突基底部,分别重建锥形韧带和斜方韧带.结果与结论:23例患者均获随访,随访时间12～26个月,平均16.5个月.切口均一期愈合,5例锁骨远端骨折患者,4个月骨折愈合,未见畸形愈合.按Karlsson标准评定优19例,良4例.未发生与材料有关的生物相容性反应,未引起全身和局部免疫反应.结果提示应用同种异体肌腱重建喙锁韧带,手术操作简单、创伤小、疗效满意.     

同种异体半关节加自体红骨髓混合移植的临床研究

目的：分析酒精储备的同种异体半关节加自体红骨髓混合移植的临床疗效。方法：瘤体半关节切除后,应用酒精储备的异体半关节加自体红骨髓混合移植进行重建,采用坚强的内固定。术后１周髂骨穿刺,抽取２０ｍｌ红骨髓,立即经皮注射在异体半关节与受体的骨端处,每周１次,共３次。结果：经８个月～４ａ零２月的随访,术后３个月、４个月、５个月及６个月骨端愈合分别为２例、４例、４例、１例。术后６个月关节间隙均有不同程度的变窄。关节功能恢复优２例,良好６例,尚可２例,差１例。结论：应用酒精储备的同种异体半关节加自体红骨髓混合移植重建近关节部位骨肿瘤切除后半关节缺损,保留了病人肢体及大部分功能,而且提高了异体骨的成活效果,加速了移植骨与宿主骨愈合,效果良好     

关节镜下同种异体韧带移植重建前交又韧带513例

目的:评估膝关节镜下同种异体韧带移植重建前交叉韧带方法的临床疗效.方法:选择1999-02/2008-01行同种异体韧带重建513例前交叉韧带损伤患者,男324例,女189例;平均年龄29岁;异体骨-髌腱-骨272例,异体胫前肌208例,异体股直肌腱13例,异体指屈肌腱8例,异体跟腱-骨12例.移植前后以Lysholm膝关节评分、IKDC评分评估膝关节功能、Lachman试验、轴移试验、KT-1000检测评价关节稳定性及关节活动范围.结果:随访12～76个月,患者移植后Lyshrolm评分较移植前提高(P＜0.01),移植后IKDC评分总体优良率达到92%.Lachman试验阴性458例(89.2%),轴移试验阴性462例(90%).移植后胫骨前移的差别较移植前缩小(P＜0.01).术后部分病例出现持续发热,经过常规对症治疗后完全康复.除部分病例出现局部排斥反应,经少量激素处理后痊愈外,大部分患者未出现明显的排斥反应.58例血沉与C-反应蛋白在术后两三天升高后,14～30 d降至正常,所有患者总活化淋巴细胞、中期活化淋巴细胞均未出现明显升高.2例异体指屈肌腱移植物松弛度增加,关节镜下探查见移植物松弛,1例予紧缩治疗,另一例予前交叉韧带翻修+LARS人工韧带重建.其他病例在二次手术中可见韧带愈合牢固,张力良好,表面有滑膜覆盖,可见小血管长入,刨除少许滑膜后可见活动性出血.结论:中长期随访显示,关节境下同种异体韧带移植重建前交叉韧带能够获得满意的临床疗效,具备有效性和安全性.     

Radiation synovectomy of the rheumatoid knee with yttrium 90.

The use of radioactive yttrium (90Y) in the treatment of rheumatoid knee joints is described. Clinical results in 48 knees after a mean observation period of more than 3 years are reported: 60 percent excellent or good at one year, 46 percent at two years, 33 percent at three years and 17 percent at four years. The number of failures or relapses exceeded 50 percent between 30 and 36 months. The average rate of relapse in successful cases was 12.8 percent per year. The most important factors associated with unsatisfactory result were advanced articular destruction and progression of the systemic disease.     

Proteoglycans from human articular cartilage: the effect of joint location on the structure

Proteoglycan monomers from the articular cartilages of the knee, hip and shoulder of 3 subjects (21, 26 and 45 years old) were isolated and analysed. The proteoglycan monomers from the high weight-bearing knee and hip joints were smaller than those from the low weight-bearing shoulder joints and both had a lower chondroitin sulphate content. The proteoglycan monomers from knee joint cartilage had the lowest intra-individual chondroitin-4-sulphate content in each case. Hyaluronate binding capacity was not found to be dependent on joint location.     

The clinical patterns of arthritis in children with familial Mediterranean fever

We studied the clinical patterns of arthritis in 133 children with familial Mediterranean fever (FMF) over 5.5 years. Six clinical patterns were noted. The commonest was recurrent monoarticular arthritis as seen in 95 children (71%), mainly affecting the knee and ankle joints. This type followed two different courses: acute (< 1 month) and chronic (> 1 month). In 18 (14%) children, both knee or ankle joints were simultaneously and symmetrically involved: here too the course was either acute or chronic. Five (4%) children developed symmetric polyarthritis similar to juvenile rheumatoid arthritis (JRA). Six (4%) children developed asymmetric oligoarticular arthritis similar to acute rheumatic fever (ARF). The small joints of the hands (SJH) were involved in seven (5%) children, and the small joints of the feet in one. One child developed sacroiliitis similar to ankylosing spondylitis (AS). Between attacks, the joints were normal. Overall, outcome was good: residual damage of the hip joint occurred in one patient and of the shoulder in another. Although the clinical presentation and course of FMF arthritis are diverse, delineating these clinical patterns may help with earlier recognition and treatment. The low incidence of residual articular damage in this study may be related to the use of colchicine prophylaxis.      

Anatomic and functional reconstruction of the joint in severe bone and ligamentous knee instability with semi-constrained systems of total knee replacement

Background. The study was made to evaluate efficiency of semi-constrained systems of TKR in correction of severe bone and ligamentous instability in knee joint with degenerative disease. Material and methods. Retrospective investigation of the 50 consecutive TKRs performed in 40 patients (40 women) between 1995-2000 was made. There were following prosthesis implanted: GSB - 45 and Endo-Model - 5. 48 knees were evaluated. Patients' mean age was 65,6 years old. Mean time of follow-up was 32,8 months (range: 1-5 years). Functional status was evaluated according to KSS scale and radiographic results were investigated with standard plain x-ray pictures. Anatomic results were investigated by the computed posturography with the use of Metrecom Systems. Results. In study group there were: 26% excellent, 68% good, 4% fair and 2% poor results respectively in Knee Score (KSS). There are no statistical differences between anatomical and radiological results of TKR in the knee joints with severe deformity. A little poorer efficiency of the semi-constrained system of total knee arthroplasty in functional reconstruction of the knee joint was due to poor general-health status of the patients and multi-joint nature of their disease. Conclusions. 1. Results of TKR with semi-constrained systems in short-term follow-up (1-5 years) are very good. 2. Posturographic and radiographic studies show that with semi-constrained system of TKR allows for reconstruction of proper anatomy of the knee joint even in severe deformed cases. 3. Functional results of TKR with semi-constrained systems are good in severely unstable and deformed knee joints.     

Massive bone allografts for traumatic skeletal defects

Large bone allograft transplants have been successfully used to reconstruct skeletal defects created by tumor resections and failed arthroplasties, but little has been reported on their use in traumatic defects. Of approximately 500 allograft procedures done at the Massachusetts General Hospital from 1979 to 1988, 11 were done for restoration of traumatic bone loss. The average age of the patients was 30 (range 11 to 71 years), and the location of the defect was the tibia or femur in 10 of the 11 patients studied. Eight osteoarticular grafts (six hemicondylar and two total condylar) and three intercalary grafts were used for six open and five closed fractures. The time from injury to reconstruction averaged 17 months (3 to 96 months). Primary reconstruction was done in three cases and a salvage procedure in eight. Patients were assessed by the operating surgeon and a physical therapist using an evaluation system that considers function, life-style, and emotional acceptance. According to the system, nine patients had excellent or good results (six hemicondylar grafts, three intercalary grafts), one patient had a fair result (total elbow graft), and one patient had failure of a total condylar graft and subsequently required an amputation. This study suggests that large bone allografts are of value in reconstructing traumatic skeletal defects, especially those involving an articular surface in a young patient.     

Low Intensity Laser and Phototherapy for Rheumatoid Arthritis

This double-blind randomised and placebo-controlled trial evaluated the effect of low intensity laser light combined with phototherapy on the articular, systemic and functional manifestations of rheumatoid arthritis. Either an active or placebo low intensity laser/phototherapy was given to 35 subjects twice-weekly for four weeks. Only the knee and metatarsophalangeal joints were irradiated and all treated joints showed an active synovitis. The laser/phototherapy device emitted light at six wavelengths in the range 660–950 nm. Each application lasted 240 seconds and delivered an energy density of 8.1 joules/cm². Each subject was assessed at one, three and six months after the initial treatment. Measures of outcome included range of joint movement, articular index, suprapatellar swelling, morning stiffness, walking speed, joint pain, HAQ Disability Index and several haematological and serological indicators. There were no significant differences observed between the active or placebo cohorts although range of movement at the knee improved slightly in the active treatment group. Combined low intensity laser and phototherapy, used under these conditions, does not appear useful for altering the course of rheumatoid arthritis.     

膝关节前交叉韧带重建的生物学及生物力学特性

目的通过总结前交叉韧带重建的生物学及生物力学特性,探讨早期锻炼对膝关节前交叉韧带重建后移植物愈合及膝关节运动功能恢复的作用.资料来源应用计算机检索MEDLINE1970-01/2004-01期间有关膝关节前交叉韧带重建及其生物力学特征的文献,检索词"anterior cruciate ligament,knee ioint,biomechanics",并限定文章语言种类为英文.资料选择对资料进行初审,选择有关膝关节前交叉韧带重建及其生物力学特征的文献,开始查找全文.选择随机对照类文章,当同一作者有多篇文章时,选择病例数最多的予以纳入;排除综述类及Mete分析类文章.质量评价主要考察资料的真实性,调查、实施过程是否严密.资料提炼共检索到46篇有关膝关节前交叉韧带重建及其生物力学特征的文章,29篇符合以上纳入标准,排除的17篇文章中,9篇为小样本分析,8篇为综述类或Mete分析类文章.资料综合通过了解正常前交叉韧带的生物力学特征制定重建措施及康复计划指导.重建后前交叉韧带动物实验提示膝关节运动功能恢复均不理想,而人体实验结果优于动物.随机对照实验表明,前交叉韧带重建后立即持重不增加膝关节的松弛性,反而有利于减轻髌骨疼痛.结论前交叉韧带损伤重建后固定膝关节,限制关节周围肌肉收缩活动,导致韧带、关节及周围肌肉运动功能受限.早期康复锻炼可以减轻疼痛,改善关节软骨代谢,防止关节囊挛缩,有助于重建后膝关节前交叉韧带运动功能的恢复.     

Deficient knee joint biomechanics in bilateral jumping after anterior cruciate ligament reconstruction

BackgroundThe purpose of this study was to analyze sagittal-plane knee biomechanics in individuals with ACL reconstructions in bilateral countermovement jumps. This aimed to determine potential knee compensation strategies during a high-demanding symmetrical movement task from pre to six months post-ACL reconstruction.Methods20 ACL-reconstructed individuals were tested pre-operatively, and then seven weeks, three months, and six months after reconstruction. Additionally, a matched control group was analyzed. Data were sampled with 3D motion capture and two force plates. The following kinematic data were analyzed: peak knee flexion during countermovement, knee angle at toe-off, and knee flexion excursion during landing. The following kinetic data were analyzed: peak knee extension moments during countermovement and landing.FindingsACL-reconstructed individuals showed significant increases in knee flexion during countermovement and knee flexion excursion during landing from six weeks to six months after reconstruction but they remained significantly below the level of the controls. The reconstructed knee joint showed increased flexion at toe-off compared to the non-injured leg at all test sessions. Knee extension moments during countermovement increased up to six months after reconstruction, but remained deficient in ACL-reconstructed individuals during countermovement and landing compared to the controls.InterpretationAlthough ACL-reconstructed individuals showed increases in most kinematic and kinetic variables, they remained below the controls at six months post-ACL reconstruction. The deficits between contralateral legs and compared to the controls show that six months post-ACL reconstruction, knee joint functionality was still not equal between reconstructed and non-injured legs or in comparison to controls.     

胫骨平台骨折合并膝关节损伤的MRI诊断

目的 评估胫骨平台骨折合并膝关节损伤的MRI影像诊断价值。方法 39例胫骨平台骨折病例经X线平片检查后作MRI扫描,MRI扫描序列包括膝关节矢状位、冠状位及横轴位SE T_1WI,矢状位及冠状位SE T_2WI;比较平台骨折的平片与MRI诊断结果;分析骨折合并膝关节损伤的MRI形态表现。结果 MRI可作出正确的骨折分型诊断,还能显示平片不能诊断的平台隐匿性骨折及骨挫伤;MRI能准确显示骨折合并的膝关节损伤性病变,如关节软骨断裂、半月板损伤、韧带撕裂等。结论 MRI是诊断胫骨平台隐匿性骨折、骨挫伤及骨折合并膝关节损伤的有效影像检查手段。     

CT重建人上胫腓骨关节面坡度测量方法及意义

背景:测量上胫腓关节坡度不仅可研究国人上胫腓关节解剖结构与类型,还具有评价上胫腓关节稳定性的作用.目的:通过测量双侧上胫腓关节面X射线平片坡度与利用64排螺旋CT重建后的关节面坡度进行比较,探讨测量方法的优良及关节坡度的临床意义.方法:选取正常成年男女各50名志愿者,年龄18～90岁,分别行双膝关节内旋30°或45°或60°摄片及64排螺旋CT扫描并重建胫腓骨全长(包括膝关节).选用角尺测量上胫腓关节面与腓骨干纵轴的夹角和上胫腓骨关节面与水平线的夹角.结果与结论:X射线及螺旋CT对同一上胫腓骨关节测量数据差别较大.由于X线受摄片位置影响,且关节面倾斜度的确定比较粗略,因此64排螺旋CT重建后的测量方法准确,方便,对于鉴别上胫腓骨关节脱位和关节不稳提供帮助,减少临床误诊.