Evaluation of clinical outcomes in anterior cruciate ligament surgery

Clinical outcomes data can be used to facilitate patient management decisions, assess clinician and organizational performance, and to provide evidence for the effectiveness of surgery and rehabilitation. The validity of the inferences made from outcomes data are dependent on the validity of the outcomes measures themselves and the circumstances under which the data were collected, analyzed, and interpreted. Clinical outcomes may include measures of impairment of body structure and function, activity limitation, and participation restriction. However, because the relationship between impairment and the resulting activity limitation and participation restriction is not direct, and because activity limitations and participation restrictions are of the utmost concern to the athlete, the primary clinical outcome should be measures of activity limitation and participation restriction. Activity limitation and participation restriction may be measured either through direct observation of performance or by general or specific measures of health related quality of life. Clinical outcomes data must be collected systematically to ensure valid inferences from the data.     

The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon

The current study was performed to understand the relationship between graft length placed within the bone tunnel and intraosseous graft healing in anterior cruciate ligament (ACL) reconstruction. Twenty-four adult beagle dogs were divided into two groups of 12 animals each. In each animal, ACL reconstruction using a 4-mm diameter autogenous flexor tendon graft was done in the left knee. In groups I and II, the graft having a length of 15 and 5 mm, respectively, was placed within the tibial tunnel. The proximal end of the graft was placed through the over-the-top route in all animals. In each group, five animals were sacrificed immediately after surgery, and the remaining seven were sacrificed at 6 weeks postoperatively. Biomechanical and histologic evaluations were performed. In pull out testing, the ultimate failure load and the linear stiffness of the graft-tibia complex harvested at 6 weeks were significantly greater than those harvested at the time-zero period. There were no significant differences in those parameters between groups I and II at 6 weeks. In each group, the perpendicular collagen fibers connecting the tendon to the bone tunnel wall were observed only in the narrow area located close to the intra-articular tunnel outlet. In conclusion, excessively long placement of the flexor graft within the bone tunnel does not result in an additional increase of anchoring strength and stiffness of the graft in ACL reconstruction.     

出血性玻璃体混浊行玻璃体切除术后假性前房积脓分析

目的介绍一种发生于玻璃体切除术后的非感染性前房积脓现象，即假性前房积脓。方法收集我中心收治的需行玻璃体切除术的连续病例１２５０例，其中各种原因引起的玻璃体积血４１８例。术后发生假性前房积脓者７例，均为玻璃体积血者。主要治疗方法是前房冲洗及其自然吸收。结果假性前房积脓发生于术后３～５天，呈泥沙样沉积，局部抗生素及激素加强治疗无效。眼内穿刺行涂片、细菌和真菌培养未发现病原体。患者无疼痛等自觉症状及刺激征。随访时３例视力在０．０５以上。结论玻璃体积血行玻璃体切除术后可能出现假性前房积脓，须与眼内感染相鉴别。     

Effect of hyaluronan on the healing of partially ruptured anterior cruciate ligament of rabbits

The midportion of the anterior cruciate ligament (ACL) of rabbits was partially transected, and the effect of hyaluronan (HA) on its healing was determined. A 1% solution of HA (HA group) or physiological phosphate-buffered saline (control group) was administered intraarticularly, at 0.1 ml/kg body weight, once a week from 1 week after the operation. Two, 4, and 6 weeks after the initiation of HA administration, the ACLs were examined grossly, histologically and immunohistochemically. At 2 weeks, the lacerated portions were completely covered with scar-like tissue in both groups. These tissue areas were smaller in the HA group than in the control group. Histologically in the HA group, the regularity of collagen fibers (indicating the maturity of regenerated collagen fibers) had increased compared to findings in the control group, and the number of fibroblastic cells decreased gradually at a significantly faster rate. The number of inflammatory cells and blood vessels decreased gradually in both groups, with these values being lower in the HA group at each time point but not significantly so. Immunohistochemical examination of the repaired tissue revealed strong staining with anti-chondroitin sulfate proteoglycan antibody in the HA group 2 weeks after the first HA administration. The staining gradually became reduced, with the rate of reduction being faster in the HA group than in the control group. The stimulation of chondroitin sulfate proteoglycan production and the faster reduction of it in the HA group suggests that HA facilitated tissue repair and inhibited the formation of scar tissue.     

人子宫内膜植入兔眼前房模型的研究

本实验成功地将人子宫内膜植入到１５只去卵巢新西兰雌兔的眼前房，并给每只兔外源补充雌二醇（Ｅ２）１００μｇ／ｄ和孕酮（Ｐ）８ｍｇ／ｄ。在内膜植入期间每只兔皮下注射总量为９ｍｇ的霉酚酸（ｍｙ－ｃｏｐｈｅｎｏｌｉｃａｃｉｄ）以防免疫排斥反应。在眼前房的人子宫内膜存活了２８．４４±８．６５天，兔血清Ｅ２和Ｐ的平均值分别为１６１．７１±１５．１３和３８．８８±７．４５ｐｍｏｌ／Ｌ。前房液中Ｅ２和Ｐ浓度在植入人子宫内膜前后分别为２４．８０±１６．５３和１７０９．２５±４７５．１０ｐｍｏｌ／Ｌ，２．００±０．５３和１２．２２±３．８１ｎｍｏｌ／Ｌ。树脂切片验证人子宫内膜植入兔眼前房第５天就能与虹膜附贴并有血管发生。来自巩膜的血管分布在子宫内膜周围。扫描电镜观察人子宫内膜分化成分泌细胞和纤毛细胞。植入人子宫内膜后，前房液的蛋白浓度高于植入前。可以证明该模型可用来研究人子宫内膜对药物的反应和通过对前房液的测量研究子宫内膜的分泌功能。     

Periarticular heterotopic ossification: A complication of arthroscopic anterior cruciate ligament reconstruction using a two-incision technique

Extra-articular heterotopic bone formation was recognized as a postoperative complication of arthroscopic anterior cruciate ligament reconstructions in four knees around the femoral drill hole. Although laxity of the reconstructed anterior cruciate ligament was not observed in these patients, local pain, swelling, and deformity at the site of heterotopic ossification required surgical intervention. The ectopic bone can be successfully excised with restoration of function. The incidence rate of this complication is less than 1%.     

The “Biplanar” forehead lift

A new technique of forehead rhytidectomy is presented that combines the best features of the coronal incision with those of the anterior hairline incision. The plane of dissection is formed by an anterior subcutaneous plane dissecting a lateral subgaleal plane. This approach is particularly valuable in patients with high foreheads, severe static wrinkling, and asymmetrical eyebrows.Presented in part at the Annual Meeting of the American Society of Aesthetic Plastic Surgeons, Boston, MA, 1984     

The use of frame fixation in the management of open distal extensor mechanism avulsion fracture in a dislocated knee

An avulsion fracture of the tibial tubercle is a common injury in traffic accident. If the fracture is closed, then a comparatively good prognosis can be expected through reinforcement of the bone via osteosynthesis and the use of artificial ligaments. In this case, an open wound was observed in the tibial tubercle, and the wound was so polluted that the healing process was significantly delayed. It was therefore difficult to provide simultaneous surgical treatment and so three operations were required to perform the reconstruction of the extensor mechanism. The reconstruction of extensor mechanism and the frame fixation between the patella and tibia was performed. Six months after the injury, the patient was able to walk without aid, had a range of movement from 5°to 130°, and did not show any indications of ADL disorder. Using this method of frame fixation between the patella and tibia proved to be an effective technique for the reconstruction of the open knee extension mechanism injury.     

关节镜下可吸收空心界面螺钉固定、四股腘绳肌腱重建前交叉韧带

目的探讨关节镜下可吸收空心界面螺钉固定、四股自体腘绳肌肌腱重建前交叉韧带(anterior cruciate ligament,ACL)的方法及疗效. 方法关节镜下以四股自体腘绳肌肌腱作为ACL替代物,应用(96L-4D)SR-PLA聚丙交酯生物可降解界面螺钉进行移植物固定, 对42例ACL损伤行ACL重建术. 结果 42例术后随访3～22个月,平均11.4月,膝关节活动度均在正常范围.术后Lachman 试验:37例≤1 ,4例2 ,1 例3 .轴移试验:42 例均为阴性.术后Lysholm 评分(89.7 ±9.6)分较术前(49.4±9.1)分显著提高(t=2.12,P=0.038).术后Tegner 活动评分(5.3±1.1)分较术前(2.3±0.7)分显著提高(t=4.13,P=0.008).术后1年MRI示29例可吸收空心界面螺钉部分被吸收;27例重建的韧带位置良好、形态正常;2例韧带在股骨的止点偏前;3例胫骨止点偏前,有轻度顶撞击现象. 结论四股腘绳肌腱是ACL重建的理想替代材料,可吸收空心界面螺钉是ACL重建的理想内固定材料.