Arthroscopic Assisted Fixation of Juvenile Intra-articular Epiphyseal Ankle Fractures

The purpose of this study was to present the long-term follow-up of a case series of arthroscopically assisted fixation of juvenile intraarticular epiphyseal ankle fractures. The functional and radiographic outcomes of 6 patients with a range of follow-up of 1 to 5 years were evaluated. Five of the 6 patients had triplane injuries, whereas the remaining patient sustained a juvenile Tillaux fracture. All of the patients returned to full activity within 14 weeks of surgery, and none of the patients had any restriction in the ankle range of motion at the time of last follow-up. The results of this small series of patients suggest that arthroscopic-assisted, percutaneous fixation of intraarticular juvenile epiphyseal ankle fractures is an effective, less invasive surgical technique. Several surgical maneuvers that are helpful in the consistent execution of this technique are also mentioned.     

关节镜膝关节清理术治疗中重度软骨退变的膝骨关节炎

目的探讨关节镜下膝关节清理术治疗中重度软骨退变的膝骨关节炎的效果. 方法采用关节镜下膝关节清理术联合术后康复训练治疗17例(21膝)中重度软骨退变的膝关节骨关节炎. 结果手术时间55～100 min,平均75 min.无并发症发生.术后住院15～20 d,平均13 d.术中关节被动活动范围0°～120°,术后关节活动度0°～110°.随访5～36个月,平均21个月,良好6例(8膝),尚可9例(11膝),差2例(2膝).关节活动范围0°～120°结论关节镜下膝关节清理术对中重度软骨退变的膝关节骨关节炎有一定的治疗效果.     

胫骨平台骨折非解剖复位对膝关节功能影响的研究

目的分析随访病例关节移位的类型、部位、程度对膝关节功能的影响,探讨影响胫骨平台骨折治疗效果的关键因素。方法对1991年6月～2004年6月间在我院治疗的不同类型胫骨平台骨折进行回顾性分析,对有良好随访的29例未达解剖复位或术后出现复位丢失的病例的X线片进行分析,并进行膝关节功能评分。结果随访6个月～13年,平均3.5年,膝关节功能参照Rasmussen评分法,优11例,良13例,可4例,差1例,优良率达82.75%。结论胫骨平台骨折获得良好治疗效果首先要恢复膝关节的稳定性,其次要恢复膝关节良好的力线,再者要在保护膝关节周围软组织情况下恢复关节面的解剖复位,并要有完善、合理的康复计划。     

Posterior instability near extension is related to clinical disability in isolated posterior cruciate ligament deficient patients

The purpose of this study is to evaluate the relationship between the magnitude of knee laxity and posterior instability at different knee flexion angles and clinical disability in isolated posterior cruciate ligament (PCL) deficient patients. Knee laxity at 20° and 70° of knee flexion were evaluated using KT-2000 arthrometer, and the posterior instability at 20°, 45° and 90° of flexion were evaluated using stress radiography. We assessed the differences in the knee laxity and the tibial translation between isolated PCL deficient knees and normal knees, and between the patients with giving-way during activities of daily living (ADL) and without giving-way. There were statistical differences in the knee laxity and the tibial translation at all knee flexion angles between the PCL deficient knees and normal knees. The magnitude of the knee laxity at 20° of flexion measured with KT-2000 arthrometer was significantly larger in the patients with giving-way than those in the patients without giving-way although there was no significant difference in the tibial translation at 70° between the two groups. The tibial translation in both medial and lateral compartments at 20° and 45° measured with stress radiography were significantly larger in the patients with giving-way than those in the patients without giving-way although there was not significant difference at 90° between the two groups. These results suggested that the magnitude of the knee laxity and the posterior tibial translation at shallow knee flexion angles would be related to giving-way during ADL in isolated PCL deficient patients.     

膝关节后外侧结构的解剖与MRI研究

目的 改进膝关节后外侧结构MRI定位方法，提高后外侧结构损伤的诊断准确率。方法 解剖膝关节标本，辨认后外侧各结构起止点及走行，明确它们之间的解剖关系。以注水的输液器缝合标记各结构进行MRI扫描，测量各结构在矢状面和冠状面上与腓骨颈长轴之间的夹角。按照这些角度定位扫描正常膝关节，观察各结构在MRI中完整显示的情况。结果 （1）测得矢状面上腓侧副韧带和胴肌腱关节囊内部分与腓骨颈长轴的夹角分别为（11．5±1.7）°和（39．5±6，4）°冠状面上胴肌腱关节囊外部分和胴腓韧带与腓骨颈长轴夹角为（39.5±3．9）°和（31．9±3．9）°。（2）腓侧副韧带在11°后斜冠状位1个层面上完整显示占90％，胴肌腱关节囊内部分在40°后斜冠状位1个层面上完整显示占80％，胭肌腱关节囊外部分在内斜40°矢状位1个层面上完整显示占90％，胭腓韧带在外斜30°矢状位1个层面上完整显示占90％。此外，胴腓韧带在11°后斜冠状位1个层面上完整显示的占75％，股二头肌腱和髂胫束在常规冠状面均能够很好显示.结论 选择完整显示腓骨茎突和腓骨颈的冠状面和矢状面为基准面，按照后外侧各结构与腓骨颈长轴所呈角度进行定位，层厚2mm的MR扫描能很好地显示膝关节后外侧解剖结构。     

关节镜辅助下微创髌前“8”字张力钢丝内固定治疗髌骨骨折

目的探讨关节镜辅助下微创髌前＂8＂字张力钢丝内固定治疗髌骨骨折的手术方法及疗效。方法对我科2005年5月～2009年12月髌骨骨折的29例行关节镜辅助下微创髌前＂8＂字张力钢丝内固定治疗,总结手术经验。结果 27例完成微创手术,2例中转开放手术,平均手术时间48min。均获得12个月随访,髌骨骨折均愈合,未形成髌骨关节面＂阶梯＂,无内固定断裂,关节功能优。结论关节镜辅助下髌前＂8＂字张力钢丝内固定治疗髌骨骨折内固定可靠,术中能直观评估关节面复位情况,手术创伤小,有利于早期功能锻炼。     

关节镜下四股半腱肌腱与股薄肌腱重建前交叉韧带

目的　探讨关节镜下应用四股半腱肌腱与股薄肌腱重建前交叉韧带的方法及疗效。方法　对 2 3例前十字韧带 (ACL )损伤患者行关节镜下四股半腱肌腱与股薄肌腱 ACL重建术 ,均取自同侧 ,将两股肌腱分别对折组成 4股 ,编织后预牵张 ,等长点部位钻胫骨骨道、股骨骨道 ,将肌腱拉入骨道 ,分别在屈膝 90°和伸膝位分别将两肌腱收紧 ,两端可吸收扣栓固定。合并损伤同期处理。结果　术后随访 3月～ 4年 ,平均 2 6月。术后 4周关节活动均达正常范围 ,术后抽屉试验除 4例 I度外 ,余 19例均阴性 ;L ysholm评分 ,术后 72～ 10 0分 ,平均 89分 ,较术前 5 4分明显提高 ;Tegner运动评级术后 4～ 8级 ,平均 6级 ,较术前平均 3级有所提高。结论　关节镜下四股半腱肌腱与股薄肌腱重建前交叉韧带 ,可吸收扣栓固定 ,是治疗 ACL断裂的较好方法。