不同手术方法治疗复杂胫骨平台骨折临床疗效观察

目的探讨不同手术方法治疗复杂胫骨平台骨折临床疗效。方法选择2016年1月—2018年12月84例复杂胫骨平台骨折患者,随机分组。单侧锁定钢板内固定组选择单侧锁定钢板内固定手术,双侧切口双侧解剖钢板内固定组选择双侧切口双侧解剖钢板内固定。分析手术操作时间、手术失血、平均住院天数以及复杂胫骨平台骨折愈合时间;治疗前后患者视觉模拟评分和Rasmussen膝关节功能评分;膝关节僵硬发生率。结果双侧切口双侧解剖钢板内固定组视觉模拟评分和Rasmussen膝关节功能评分、手术操作时间、手术失血、平均住院天数以及复杂胫骨平台骨折愈合时间、膝关节僵硬发生率和单侧锁定钢板内固定组比较有优势,P<0.05。结论复杂胫骨平台骨折患者实施双侧切口双侧解剖钢板内固定可获得较好效果。     

The effects of increased forward trunk lean during stair ascent on hip adduction and internal rotation in asymptomatic females

BackgroundIncreased hip adduction and internal rotation can lead to excessive patellofemoral joint stress and contribute to patellofemoral pain development. The gluteus maximus acts as a hip extensor, abductor, and external rotator. Improving hip extensor use by increasing one’s forward trunk lean in the sagittal plane may improve frontal and transverse plane hip kinematics during stair ascent.Research questionDoes increasing forward trunk lean during stair ascent affect peak hip adduction and internal rotation?MethodsTwenty asymptomatic females performed five stair ascent trials (96 steps/min) on an instrumented stair using their self-selected and forward trunk lean postures. Three-dimensional kinematics (200 Hz) and kinetics (2000 Hz) were recorded during the stance phase of stair ascent. Biomechanical dependent variables were calculated during the stance phase of stair ascent and included peak forward trunk lean, hip flexion, hip adduction, hip internal rotation angles, and the average hip extensor moment.ResultsDuring the forward trunk lean condition, decreases were observed for peak hip adduction (MD = 2.8˚; 95% CI = 1.9, 3.8; p < 0.001) and peak hip internal rotation (MD = 1.1˚; 95% CI = 0.1, 2.2; p = 0.04). In contrast, increases were observed during the forward trunk lean condition for the peak forward trunk lean angle (MD = −34.7˚; 95% CI = −39.1, −30.3; p < 0.001), average hip extensor moment (MD = −0.5 N·m/kg; 95% CI = −0.5, −0.4; p < 0.001), and stance time duration (MD = −0.02 s; 95% CI = −0.04, 0.00; p = 0.017).SignificanceIncreasing forward trunk lean and hip extensor use during stair ascent decreased peak hip adduction and internal rotation in asymptomatic females. Future studies should examine the effects of increasing forward trunk lean on hip kinematics, self-reported pain, and function in individuals with patellofemoral pain.     

Effect of contralateral cane use on hip moment impulse in the frontal plane during the stance phase

BackgroundRecent reports have shown that the daily cumulative moment in the frontal plane (i.e., product of hip moment impulse in the frontal plane during the stance phase and mean steps per day) is a risk factor for hip osteoarthritis. This study aimed to clarify the effect of contralateral cane use on hip moment impulse in the frontal plane of the stance limb.MethodsThis study included 15 healthy subjects who walked under four experimental conditions: (1) without a cane and (2–4) contralateral cane use with 10%, 15%, and 20% body weight support (BWS), respectively. To maintain the same walking speed in all conditions, the cadence was set to 80 steps/min, and the step length was fixed. The hip moment impulses in the frontal plane (i.e., area under the hip ab-adduction moment waveform) and peak hip adduction moments in all conditions were calculated.ResultsContralateral cane use significantly decreased the hip moment impulse in the frontal plane and peak hip adduction moment compared to non-cane use. Moreover, the hip moment impulse in the frontal plane and peak hip adduction moment decreased significantly with increased cane BWS. There were no significant differences in walking speed, cadence, and step length between the four conditions.ConclusionContralateral cane use decreases the hip moment impulse in the frontal plane and peak hip adduction moment in the stance limb. These findings may help clarify how to delay the progression of hip osteoarthritis.     

关节滑液检测在关节假体周围感染诊断中的研究进展

关节假体周围感染(periprosthetic joint infection,PJI)是人工关节置换术后可能发生的一种严重并发症,其导致的严重后果,无论对于医生还是患者来说,都很难接受。目前,由于多种不确定因素的存在,PJI诊断的准确性较低。传统的血清学检查、影像学检查有一定的价值,但是易受全身情况的影响,导致特异性不高。为了正确诊断关节假体周围感染,不同学科的研究人员采用各种不同的方法进行了大量的诊断研究,并取得了丰富的成果。近年来,关节滑液炎性标志物检测、分子生物学方法等被研究证实具有较高的敏感性和特异性。因此,关节滑液CRP、-防御素、白细胞酯酶、PCR技术等被广泛研究,期望能从中找到诊断关节假体周围感染的特异性指标,提高临床诊断的准确性。     

Identification of the medial femoral safe zone for drilling during dynamic hip screw side plate fixation: A CT angiogram tracing of the profunda femoris artery

Objectives

Iatrogenic injury of the Profunda Femoris Artery (PFA) at time of hip fixation surgery can increase morbidity and mortality and prolong the hospital stay. This is an injury that tends to pass unnoticed as a cause of postoperative deterioration despite being frequently reported in the literature. Our study aims to describe the anatomy of the PFA in relation to the medial femoral cortex with specific emphasis on its orientation relative to the position of a sliding hip screw side plate construct. By doing so we are able to present clear guidance to orthopaedic surgeons on how to avoid iatrogenic PFA injury at the time of hip fracture fixation.

髌周去神经化预防全膝关节置换术后膝前疼痛

目的　依据髌周解剖学特点，探讨全膝关节置换术（total knee arthroplasty，TKA）中应用髌周电灼去神经化的临床效果。 方法　纳入82名诊断为骨性关节炎的患者（91膝），予行双侧或单侧不置换髌骨的TKA，按随机对照原则将病人分为两组，共有41名实验组患者（45膝）在TKA中接受了髌周去神经化处理，41名对照组患者（46膝）未做该处理。手术主刀为同一骨科医师，均使用相同的膝关节假体系统。主要评价项目包括膝关节KSS评分、Western Ontario and McMaster Universities（WOMAC）、Feller髌骨评分及VAS评分。 结果　82名患者术后均获随访，平均随访时间为12个月，两组病人的膝关节KSS评分、WOMAC、Feller髌骨评分及VAS评分均无显著统计学差异（P>0.05）。 结论　在TKA中行髌周电灼去神经化，不能显著改善病人的预后。     

Perception of a Natural Joint After Total Knee Arthroplasty

BackgroundAssessing patients’ functional outcomes following total knee arthroplasty (TKA) with traditional scoring systems is limited by their ceiling effects. Patient’s Joint Perception (PJP) question of the reconstructed joint is also of significant interest. Forgotten Joint Score (FJS) was created as a more discriminating option. The actual score constituting a “forgotten joint” has not yet been defined. The primary objective of this study is to compare the PJP and the FJS in TKA patients to determine the FJS score that corresponds to the patient’s perception of a natural joint.MethodsOne hundred TKAs were assessed at a mean of 40.6 months of follow-up using the PJP question, FJS, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Correlation between the 3 scores and their ceiling effects were analyzed.ResultsWith PJP question, 39% of the patients perceived a natural joint (FJS: 92.9; 95% confidence interval [CI], 89.4-96.4), 12% an artificial joint with no restriction (FJS: 79.5; 95% CI, 65.7-93.3), 36% an artificial joint with minor restrictions (FJS: 70.0; 95% CI, 63.2-76.9), and 13% had major restrictions (FJS: 47.3; 95% CI. 32.8-61.7). PJP has a high correlation with FJS and WOMAC (Spearman’s rho, −0.705 and −0.680, respectively). FJS and WOMAC had a significant ceiling effect with both reaching the best possible score in >15%.ConclusionPatients perceiving their TKA as a natural knee based on PJP have a FJS ≥89. PJP has a good correlation with FJS and may be a shorter, simple, and acceptable alternative.