MRI 对一过性髌骨外侧脱位的诊断价值

【目的】探讨一过性髌骨外侧脱位(TLPD)患者的 MRI 影像特征。【方法】回顾性分析本院收治的56例 TLPD 患者的临床 MRI 资料,对有无骨或软骨损伤、关节内游离体、内侧髌股韧带损伤、关节积液、髌骨半脱位和外倾、解剖异常等进行判断分析,并结合临床资料、X 线片及关节镜图像分析,总结该类患者影像学特征。【结果】初次就诊时被误诊、漏诊有26例(46.4%)。MRI 显示56例(100%)患者均存在“对吻征”所致不同程度的骨软骨损伤,其中股骨外髁外侧前缘有10例(17.9%)软骨骨折,骨软骨骨折6例(10.8%);髌骨下极内侧缘有16例(28.6%)软骨骨折,10例(17.9%)骨软骨骨折。关节内游离体20例(35.7%);50例(89.3%)有不同程度的内侧髌股韧带损伤和关节积液;髌骨半脱位和外倾36例(64.3%);56例患者中存在股骨滑车发育不良者 16例(28.6%),高位髌骨者14例(25.0%),TT-TG>20 mm 者6例(10.7%)。【结论】TLPD 患者误诊、漏诊率较高,MRI 能准确地显示各解剖结构的损伤及程度,有助于明确诊断,应作为该病的首选检查方法。     

复合软组织手术对儿童习惯性髌骨脱位髌股关节适应性的影响

目的 研究复合软组织手术治疗不同年龄段儿童习惯性髌骨脱位后,髌股关节适应性的变化情况.方法 回顾性分析2000至2007年收治的习惯性髌骨脱位患儿73例.男24例,女49例;平均年龄7.1岁(3～15岁);单侧47例,双侧26例.按照年龄分为A、B两组:A组年龄3～8岁(包括8岁),24例(30膝);B组年龄8～15岁,49例(69膝).复合软组织手术包括膝关节外侧充分松解、内侧紧缩、髌腱半腱上点移位(Roux-Goldthwait手术)和股内侧肌止点下移术.术前及随访中分别行髌骨轴位和侧位X线检查,测量股骨滑车角、髌骨高度、髌骨-滑车适配角及髌骨倾斜角(Laurin角)的变化情况,以评价髌股关节适应性.结果 73例患儿均获随访,平均随访38个月(25～98个月).末次随访时髌骨脱位均无复发,其中2例发生髌骨内侧脱位.股骨滑车角:A组由术前的150.1°±5.1°改善为144.3°±6.0°,手术前后差异有统计学意义(P＜0.05);B组手术前后差异无统计学意义(P＞0.05).其余测量指标在两组均无显著变化.结论 复合软组织手术对儿童习惯性髌骨脱位髌股关节的塑型有影响,对于手术年龄在8岁以下儿童可以明显促进股骨髁的发育,降低股骨滑车角,改善髌股关节适应性;8岁以上儿童在随访期内股骨滑车角的变化不显著,髌股关节适应性改变不明显.     

Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone-patellar tendon-bone autograft

We prospectively studied knee proprioception following ACL reconstruction in 40 patients (34 men and six women; mean age 31 years). The patients were allocated into two equal groups; group A underwent reconstruction using hamstrings autograft, and group B underwent reconstruction using bone-patellar tendon-bone autograft. Proprioception was assessed in flexion and extension by the joint position sense (JPS) at 15°, 45° and 75°, and time threshold to detection of passive motion (TTDPM) at 15° and 45°, preoperatively and at 3, 6 and 12 months postoperatively. The contralateral healthy knee was used as internal control. No statistical difference was found between the ACL-operated and the contralateral knees in JPS 15°, 45° and 75° at 6 and 12 months, in both study groups. No statistical difference was found between the ACL-operated and the contralateral knees in TTDPM 15° at 6 and 12 months, nor regarding TTDPM 45° at 3, 6 and 12 months, in group A. No statistical difference was found in JPS and TTDPM between the two grafts, at any time period. Knee proprioception returned to normal with ACL reconstruction at 6 months postoperatively, without any statistically significant difference between the autografts used.     

Effectiveness of goosestep training or its modification on treating patellar malalignment syndrome: clinical, radiographic, and electromyographic studies

Introduction  Imbalanced soft tissue tension between medial and lateral para-patellar structures is the most common pathogenic cause of patellar malalignment syndrome. Despite the fact that an effective technique has not been developed, this disorder is usually treated conservatively. This prospective study tried to identify an effective alternative treatment for patellar malalignment syndrome. Materials and methods  Forty female patients (age, 20–40 years) with bilateral patellar malalignment syndrome were randomly divided into two groups. Forty knees in 20 patients were treated with goosestep training without forcefully striking the ground, and 40 knees in other 20 patients were treated with goosestep training with forcefully striking the ground. Results  After 1 month, significant clinical improvement was observed in 72.5% of all patients (P < 0.001). Congruence or lateral patellofemoral angles and VMO/VL (vastus medialis obliquus/vastus lateralis) ratio significantly improved within 1 or 3 months in both groups (P < 0.001 for each comparison). Conclusion  Goosestep training with or without forcefully striking the ground is a feasible method for treating patellar malalignment syndrome. The main advantages include its convenience, simplicity, lack of cost, and demonstrated effectiveness.     

Histological and molecular analysis of the biceps tendon long head post‐tenotomy

Tendinopathy is a vexing clinical problem as its onset and development is often asymptomatic and unrecognized until tendon rupture. While extensively studied in the rotator cuff, Achilles, and patellar tendons, no study to date has examined the histological and molecular characteristics of the tendinopathic biceps long‐head (LHB). The anatomy of the LHB is unique in that it comprises intra‐ and extra‐articular portions, each exposed to differing loading patterns. Eleven LHBs post‐tenotomy were sectioned, fixed in formalin, and stained (H&E; Alcian Blue), and gross structural organization of collagen measured using polarized light microscopy. Protein expression of intra‐ and extra‐articular portions of the tenotomized biceps for IGF‐I, collagen III, and MMP‐1, ‐2, ‐3, and ‐13 was determined with Western blot analyses. The intra‐articular LHB exhibited significantly greater histological evidence of tendinopathy inclusive of increased proteoglycan (p < 0.05) and decreased organization as measured by polarized light microscopy (p < 0.01). The intra‐articular LHB also had significantly increased expression of collagen type III (p < 0.01) and of MMP‐1 and 3 (p < 0.01, p < 0.05 respectively). No significant differences were found for IGF‐I or for MMP‐2 and ‐13. The intra‐articular LHB exhibited histological characteristics of tendinopathy. Protein expression of the intra‐articular LHB did not universally display signs of tendinopathy in comparison to the extra‐articular portion of the tendon. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1379–1385, 2009     

单髁膝关节置换术后髌腱长度的变化

目的 研究单髁膝关节置换(UKA)术后的髌腱是否存在有意义的短缩(大于10%),术后髌腱长度变化与膝关节活动度、疼痛、僵硬及功能的关系.方法 自2005年3月～2008年1月,对34例41个膝关节行UKA手术.测量术前及术后8个月以后的髌腱长度和膝关节活动度,进行WOMAC评分.对测量测量数据进行组内及相关性统计学分析.结果 手术前后髌腱长度差异无统计学意义(P<0.01),关节活动度、WOMAC疼痛、僵硬及功能评分有显著性差异(P<0.01).髌腱的长度变化与术后关节活动度、疼痛、僵硬及功能无直线相关关系(P<0.01).结论 UKA手术损伤小,对膝关节生物力学机制干扰轻,值得推广.     

Neglected Achilles tendon rupture with central insertional plantaris tendon hypertrophy: two cases

A neglected Achilles tendon rupture is often characterized by muscle weakness and an overlengthened repair by scar tissue. Reconstructive surgery is usually performed taking into account the patient’s required level of function. Two surgical cases of neglected Achilles tendon rupture are presented in this article. In both instances it was expected that central fibrosis, possibly after neglected tendon rupture, would be found. However, after longitudinal opening of the tendons, a thickened plantaris tendon was evident at the insertion on the calcaneus in both cases. This hypertrophic tendon occupied most of the diameter of the Achilles tendon. Due to partial or complete rupture of the Achilles tendon, there was notable weakening and tendon transfer-augmentation was performed. A thickened plantaris tendon as a reaction to a neglected rupture of the Achilles tendon is a rare presentation. It can be detected preoperatively by MRI and subsequently preoperative planning can be optimized.     

电针对大鼠跟腱病影响的实验研究

目的：探讨电针治疗方法对跟腱病组织修复的影响,为电针治疗跟腱病提供科学依据。方法：从36只2月龄雄性SD大鼠中选出6只,设为空白对照组（A组,n=6）,对其余大鼠行跟腱病造模后随机分为阳性对照组（B组,n=18）、电针患侧组（C组,n=12）,B组随机分为‰组、B,组和B,组,各6只,C组随机分为C1组和C2组,各6只。造模3周后,C组取患侧的阳陵泉、足三里、承山以及太溪,给予电针治疗,每日1次,每次15min,10天为1疗程,共2个疗程,2疗程间隔2天,A组和B组大鼠不予任何干预,均自由饮食。造模3周后分别处死民组和A组大鼠,第一疗程和第二疗程后分别处死B1、C1、组和B2、C2、组大鼠,标本用H．E染色观察组织学结构改变,作跟腱内成纤维细胞计数后用Microsoft Excel统计软件进行统计分析。用免疫组织化学染色法检测TGF-β1表达情况,并与组织学观察及统计结果作比较,以评价跟腱病组织学恢复情况。结果：①细胞计数：第一疗程后C．组成纤维细胞数量显著高于B1组,差异具显著;第二疗程后C2组成纤维细胞数量显著低于B2组,差异具显著。②TGF-β1：A组未见TGF-β1表达,各期阳性对照组有弱阳性表达,而C组有TGF-β1阳性表达。结论：电针能改善跟腱病组织胶原纤维结构排列,有效地促进跟腱病的修复,其机制可能是电针刺激了TGF-β1的合成,进而促进了成纤维细胞数量增殖与胶原合成。