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1.
关节镜下半腱肌、股薄肌腱重建前交叉韧带   总被引:2,自引:1,他引:1  
目的关节镜下以半腱肌、股薄肌腱重建膝前交叉韧带,分析影响疗效的因素。方法自2002年12月至2004年6月,关节镜下endobuttonl固定四股腘绳肌腱修复膝前交叉韧带损伤66例72膝。膝前小切口取半腱肌腱、股薄肌腱修整、对折后成四股,分别建立胫骨隧道及股骨隧道,用Endobutton和门形钉固定肌腱,重建ACL的解剖结构和生理功能。术后即行功能锻练。结果66例患者得到随访,随访时间13-30个月,平均22.25个月。术前Lachman征( ),术后Lachman征(-)。术前Lysholm评分从27分到71分,平均53.75分;术后Lysholm评分从70分到99分,平均90.83分,术前、术后评分有显著性差异(t=2.23,P<0.05)。结论腘绳肌腱具有良好的抗拉强度和刚度,在关节镜下用四股腘绳肌腱重建膝前交叉韧带是一种疗效可靠的治疗方式。  相似文献   

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目的 探讨前交叉韧带(ACL)解剖等长重建技术在关节镜下LARS韧带重建前交叉韧带术中应用的可行性及近期疗效.方法 用LARS人工韧带对8例前交叉韧带损伤行关节镜下ACL重建术.采用前交叉韧带解剖等长重建技术钻胫骨、股骨骨道,将LARS韧带拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚界面螺钉固定韧带.结果 手术时间30~80 min,平均56 min.术后无滑膜炎、韧带断裂、活动明显受限等并发症.8例均随访2~6个月,平均4个月.根据Lysholm膝关节功能评分,术前评分为22~65分(40.25±17.07)分;术后评分为80~93分(88.75±4.06)分(t=8.083,P<0.01).结论 前交叉韧带解剖等长重建技术在关节镜下LARS韧带重建前交叉韧带术中操作简便,效果可靠,值得推广.  相似文献   

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目的探讨关节镜下自体腘绳肌肌腱移植重建膝前交叉韧带的临床疗效。方法自2006年12月-2010年1月,对215例膝关节前交叉韧带损伤患者采用关节镜下自体腘绳肌肌腱移植重建(包括单束和双束)。比较患者术前、术后Lysholm膝关节评分和膝关节稳定性改变。结果本组215例中210例获得随访,1例患者在术后6周出现膝关节内感染,予行关节镜下清理、抗感染等处理后治愈。术前和术后1个月、术后6个月、术后1年Lysholm膝关节评分分别比较差异均有统计学意义(P〈0.05)。术前215例患者物理检查均表现为膝关节不稳,术后所有患膝不稳定表现消失。结论关节镜下自体腘绳肌肌腱移植重建膝前交叉韧带疗效可靠,依据病人实际情况个性化合理选择单双束重建。  相似文献   

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关节镜下解剖等长重建技术在重建前交叉韧带中的应用   总被引:5,自引:1,他引:4  
[目的]探讨前交叉韧带(ACL)解剖等长重建技术在关节镜下应用的可行性及近期疗效.[方法]对20例前交叉韧带损伤行关节镜下ACL重建木.采用前交叉韧带解剖等长重建技术钻胫骨、股骨骨道.移植物用LARS人工韧带11例,用四股半腱肌股薄肌腱9例.LARS人工韧带用2枚界面螺钉固定韧带,四股半腱肌股薄肌腱股骨端用Endobutton固定、胫骨端用可吸收界面螺钉固定.[结果]手术时间LARS人工韧带组30~80 min,平均56 min.四股半腱肌股薄肌腱组80~120 min,平均100 min.20例均随访6~12个月,平均9个月.根据Lysholm膝关节功能评分,LARS人工韧带组术前评分22~65分(36.72±15.54)分;术后6个月评分80~98分(90.45±4.68)分(t=10.535,P<0.01).四股半腱肌股薄肌腱组术前评分20~60分(37.11±12.26)分;术后6个月评分75~87分(80.44±4.16)分(t=9.615,P<0.01).术后6个月LARS人工韧带组与四股半腱肌股薄肌腱组评分在统计学上有显著差异(t=10.569,P<0.01).[结论]前交叉韧带解剖等长重建技术在关节镜下重建前交叉韧带术中操作简便,效果可靠,值得推广.LARS人工韧带组近期疗效明显优于四股半腱肌股薄肌腱组.  相似文献   

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关节镜下LARS人工韧带及4股半腱肌肌腱重建前交叉韧带   总被引:1,自引:0,他引:1  
目的评价LARS人工韧带和自体4股半腱肌肌腱关节镜下重建膝前交叉韧带(ACL)的临床疗效。方法对28例膝ACL断裂患者行关节镜下ACL重建术,根据重建材料的来源分为LARS人工韧带组(13例)和自体4股半腱肌肌腱组(15例)。采用ACL解剖等长重建技术建立胫骨、股骨骨道。并对两组的关节稳定性和Lysholm膝关节功能评分进行对比研究。结果术后膝关节稳定性LARS人工韧带组优于4股半腱肌肌腱组(P〈0.05)。移植后两组Lyshrolm膝关节功能评分较移植前提高(P〈0.05)。术后6个月LARS人工韧带组Lysholm评分(90.4分±5.3分)高于4股半腱肌肌腱组(81.2分±4.7分)(P〈0.05)。结论在关节镜下重建ACL术中,LARS人工韧带可作为自体材料的良好替代物。  相似文献   

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关节镜下4股半腱肌肌腱重建前交叉韧带疗效观察   总被引:1,自引:1,他引:0  
目的关节镜下以半腱肌肌腱重建膝前交叉韧带(ACL),分析影响治疗效果的因素。方法关节镜下4股半腱肌肌腱修复膝ACL损伤25例。膝前小切口取半腱肌肌腱对折后成4股,分别建立胫骨隧道及股骨隧道,重建膝ACL的解剖结构和生理功能,术后早期行功能锻练。结果 25例均获随访,时间12~36个月。术前Lachman征(+),术后Lachman征(-)。Lysholm评分从术前27~71(53±13.22)分提高到术后78~94(87±3.42)分。结论半腱肌肌腱具有良好的抗拉强度和刚度,在关节镜下用4股半腱肌肌腱重建膝ACL是一种疗效可靠的治疗方式。  相似文献   

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目的探讨关节镜下应用自体四股胭绳肌腱同时重建膝关节前后交叉韧带的近期临床效果。方法我科自2005年10月至2008年2月对8例前后交叉韧带同时损伤的患者,切取双侧胭绳肌腱折成四股,关节镜下同时重建前后交叉韧带,股骨端应用可吸收界面挤压螺钉固定,胫骨端应用Intrafix固定。应用lysholm膝关节功能评分和膝关节稳定性评价效果。结果术前lysholm膝关节功能评分为(38.5±7.8)分,术后12个月随访,该评分为(90.5±4.2)分。差异具有统计学意义。术前各膝关节前后抽屉试验(+),术后各膝前后抽屉试验(-)。结论关节镜下应用自体四股胭绳肌腱同时重建膝关节前后交叉韧带的近期临床效果良好。  相似文献   

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目的总结关节镜辅助下应用自体半腱肌重建膝关节前交叉韧带手术的体会。方法对30例前、后交叉韧带损伤患者行镜下自体肌腱重建前、后交叉韧带。术后定期随访,按照Lysholm膝关节评分法评价膝关节功能。结果 30例6~24个月获随访,无化脓性关节炎、移植物断裂、螺钉松动及血管神经损伤等并发症发生。患者前抽屉试验均阴性,发生后抽屉试验阳性1例,Lachman试验阳性1例,侧方应力试验阴性。采用Lysholm功能评分标准评估膝关节功能,术前Lysholm评分(22.3±4.6)分,术后(83.2±7.3分),差异具有统计学意义(P<0.05)。患者恢复日常生活和劳动能力功能满意。结论关节镜下自体肌腱重建膝前、后交叉韧带手术损伤小,利于膝关节早期功能锻炼,效果良好。  相似文献   

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目的:探讨关节镜下采用6-8股腘绳肌肌腱单束重建前交叉韧带对恢复膝关节稳定性的临床效果。方法:前交叉韧带损伤患者14例,男9例,女5例;年龄19-51岁,平均32.8岁;病程1-22个月,平均3.7个月。Lachman试验:阳性伴软性终止点12例,阳性伴硬性终止点2例;前抽屉试验:阳性伴软性终止点12例,阳性伴硬性终止点2例;轴移试验阳性12例。合并I度膝关节外翻不稳1例。在关节镜下采用6-8股腘绳肌肌腱单束重建,4孔指骨钢板对移植物行悬吊式固定。结果:术后1年随访,13例患者Lachman试验阴性,1例患者Lachman试验阳性,13例患者轴移试验阴性,1例患者阳性。按照Lysholm膝关节评分标准,评分从术前平均(47.71±1.98)分提高至术后平均(95.36±4.73)分,差异有显著性意义(P<0.01)。结论:关节镜下采用6-8股腘绳肌肌腱单束重建前交叉韧带是恢复膝关节稳定性的可靠方法,具有切口小,对伸膝装置无干扰等优点。  相似文献   

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宋光虎 《中国骨伤》2008,21(10):783-784
目的:探讨以自体骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带的临床效果及应用价值。方法:采用自体骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带断裂20例,男15例,女5例;年龄18~32岁,平均22岁;左、右膝各10例。取自体胭绳肌腱,保留肌腱的胫骨止点,两端编织缝合后预张。建立胫骨、股骨隧道,并制作胫骨骨桥结构,股骨隧道为内窄外宽结构。骨栓肌腱结嵌入股骨隧道内,牵引线带着肌腱结远端的腱束经股骨、胫骨隧道穿出,与胫骨止点上的肌腱交叉,在胫骨骨桥上打结并缝合固定。术后患膝以支具固定在屈曲45。位。结果:20例患者均获得随访,随访时间8—24个月,平均11个月。膝关节功能评估采用Lysholm功能评分标准,术前平均(61.5±4.6)分,终末随访时平均(92.5±3.7)分,差异有统计学意义,P〈0.05。结论:骨栓肌腱结嵌压固定保留胫骨止点的胭绳肌腱重建膝前交叉韧带的方法为生物学固定,避免使用高值耗材,降低了手术费用,且有利于腱-骨愈合。  相似文献   

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This study's purpose was to assess the in vivo effect of auto‐crosslinked hyaluronic acid (HA) gel, a natural HA derivative with increased viscosity and tissue residence time, on adhesions and healing of injured and surgically repaired rabbit digital flexor tendons. The second and third right deep digital flexor tendons from 48 rabbits (n = 96 tendons) were cut and repaired with a modified Kessler and running peripheral suture. Animals were randomized to two groups, receiving either HA gel or saline injected around both freshly repaired tendons. After 2, 3, 6, and 12 weeks, six rabbits in each group were euthanized. Tendon pull‐out force and breaking strength were measured as a value for adhesion formation and tendon healing, respectively. A histological assessment of adhesions and healing was related to the mechanical results. A significantly faster increase in breaking strength was found in HA gel‐treated compared to saline‐treated tendons; this coincided with a significantly accelerated tissue repair response after injury. No significant difference in adhesion formation was found between the two groups at any time. Our results indicate a significant acceleration of in vivo healing of tendons treated with HA gel. Adhesion formation was unaffected. These results could have important clinical value in promoting rehabilitation after tendon injury. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:408–415, 2009  相似文献   

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Postoperative salivary fistulas still remain a serious and potentially lethal problem in head and neck reconstruction particularly if the fistula is large and involving one half or more of the circumference of the pharyngo-oesophagus. Pedicled flaps have traditionally been the flaps of choice for closure of these fistulas, but the results are often disappointing. During the period 1982 to 1995, we have used either a radial forearm free flap or a jejunal free flap to close large and complex pharyngo-oesophageal fistulas after resection for cancer in 15 patients. Although two patients developed major fistulas that required additional operations for closure, successful closure was achieved in all but one case: the success rate was therefore 14/15 (93%). We consider that jejunal flaps are suitable for circumferential pharyngo-oesophageal reconstruction and forearm flaps for non-circumferential defects.  相似文献   

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Cultured tendon fibroblasts (CTFs) from intact explants are widely used to study tendon healing in vitro. The significance of these findings may rely on similarities between CTFs and healing tendon fibroblasts in situ. Our purpose was to compare CTFs with fibroblasts cultured from healing tendons. We cultured CTFs from intact and healing tendons at day 7 and day 14 postinjury in a rat model of patellar donor site injury. The mRNA expression of COL1A1, COL3A1, decorin, and biglycan, with or without supplementation of 1 ng/mL TGF‐β1, was compared by quantitative real‐time RT‐PCR. The expression of proliferation cell nuclear antigen (PCNA) and α‐smooth muscle actin (α‐SMA) was determined by immunostain. COL3A1 and decorin mRNA in CTFs was lower as compared to day 7 healing fibroblasts, but its biglycan mRNA level was higher than day 14 healing fibroblasts. TGF‐β1 increased COL1A1 and decorin mRNA in CTFs, but decreased the mRNA of all four genes in day 7 healing tendon fibroblasts. CTFs exhibited lower PCNA immunopositivity as compared to day 7 and day 14 healing fibroblasts, but a higher α‐SMA immunopositivity than cultured day 14 healing fibroblasts. These findings showed that CTFs did not resemble healing tendon cells with respect to major cellular activities related to tendon healing. Thus, fibroblasts from healing tendon may be a more appropriate model for studying cellular activities in tendon healing. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:374–383, 2008  相似文献   

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PURPOSE: Secure methods of graft attachment ensure safe early motion after flexor tendon grafting. This has been achieved at the proximal graft juncture using Pulvertaft's technique. For secure distal attachment, we investigate the results of flexor tendon grafting using the plantaris tendon with a fragment of attached bone fixed with a screw to the distal phalanx. METHODS: Thirteen digits from 10 patients with longstanding flexor tendon injuries in zone II had surgical reconstruction. A plantaris tendon-bone graft was attached to the distal phalanx using a mini-screw. This was followed by immediate active motion. At 3 and 8 months after surgery, total active motion was calculated as the sum of the degrees of active flexion in the proximal and distal interphalangeal joints minus the sum of the degrees of extension deficits for each of these joints. The results of total active motion were compared to the normal contralateral digit. RESULTS: Three months after surgery, the mean rate of recovery, relative to the normal contralateral finger, was 74%, whereas 8 months after surgery, this value was 70%. This difference was statistically significant. There were no failures or poor results (ie, less than 50% recovery). CONCLUSIONS: The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.  相似文献   

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Abstract

Congenital dislocation of the extensor tendon is extremely rare. We report a case of bilateral dislocations in an 8-year-old boy, which were treated successfully with reconstruction of the sagittal band. We describe the technique and 18 months’ result.  相似文献   

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