关节镜下同种异体髌腱组织重建膝前交叉韧带的初步临床研究

目的　探讨关节镜下应用异体髌腱 (骨 腱 骨组织 ,BPTB)重建膝关节前交叉韧带 (an teriorcruciateligament,ACL)的方法及初步临床疗效。 方法　关节镜下应用深低温冷冻异体BPTB移植重建ACL 8例。对手术时间、手术切口及术后体温恢复、ACL体征、X ray检查分析手术疗效 ;术后关节屈曲度及Lysholm Ⅱ评分评定膝关节功能。结果　关节镜下应用异体BPTB重建ACL切口小 ,手术时间短 ,术后 5d内体温恢复正常 ,无一例感染及免疫排斥现象。平均随访时间 4个月 (2～ 6个月 ) ,所有患者症状均有缓解 ,前抽屉试验 ( ) (anteriordrawertest,ADT) ,Lachman( ) ,X ray检查界面螺钉在位 ,未见骨道异常 ;术后 2周平均屈曲度可至 10 5°(80°～ 130°) ,术后 2个月膝关节平均屈曲度可达 12 0°(10 0°～ 130°) ,术前Lysholm Ⅱ评分平均 38 5分 (2 4～ 5 0分 ) ,术后 2个月Lysholm Ⅱ评分平均 88分 (76～ 97分 )。结论　应用深低温冷冻异体髌腱重建ACL可减少手术创伤 ,早期即可有效改善膝关节功能 ,是一种可行的重建ACL的方法 ,远期疗效尚需进一步的观察。     

同种异体肌腱修复膝关节韧带损伤2年随访报道

目的探索应用同种异体肌腱修复膝关节韧带损伤的临床疗效,避免取自体肌腱造成的膝关节周围组织再损伤和并发症。方法采用经深低温冷冻加γ射线照射处理的同种异体骨-髌腱-骨移植,关节镜下修复膝关节交叉韧带损伤30例,前交叉韧带16例、后交叉韧带9例,前、后交叉韧带一期修复5例。其中1例镜下行半月板缝合,15例行半月板部分切除或完全切除,1例合并胫腓骨骨折,交锁髓内钉固定术后3周行交叉移植修复,3例合并髌骨骨折,与交叉韧带在关节镜下同时修复。结果29例患者获得2年以上随访,采用Lysholm膝关节功能评分法评估患膝手术前后的功能,术前平均36分,术后平均85分,优良率86%。客观检查,前抽屉试验阳性,术前21例,术后弱阳性2例,后抽屉试验阳性,术前14例,术后弱阳性3例,Lachman试验阳性,术前21例,术后弱阳性4例,术后遗留膝关节运动后疼痛2例,可忍受,膝关节屈曲活动受限(5°～20°)2例。其中7例术后1～2年取内固定或镜下行韧带固缩过程中,取少许异体髌腱活检,结果已全部转变为正常腱性组织。结论应用同种异体骨-髌腱-骨组织修复膝关节韧带损伤,术后通过系统的康复治疗,能有效恢复膝关节功能。     

Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.     

Comparison of supraspinatus tendon and glenohumeral joint axes in MR imaging of the shoulder

Objective. In magnetic resonance (MR) imaging of the shoulder, oblique coronal images are used for evaluating the supraspinatus tendon (SST) of patients with suspected rotator cuff tear or impingement. This study aimed to compare orientation of the SST long axis with planes perpendicular to the glenohumeral joint (GHJ). Design and patients. The axial scans of 100 consecutive patients referred for MR imaging or MR arthrography of the shoulder were reviewed. Using the electronic cursors of a computer workstation, the angle of the SST long axis was measured and compared with the angle obtained through the GHJ utilizing three different landmarks: perpendicular to the joint (GHJ-90), joint–humeral head center axis (GHJ-H) and joint–scapular body axis (GHJ-S). Results. Differences in angulation between axes of the SST and the three GHJ axes averaged only about 5° [range of means 4.5–5.3°, range of standard deviation (SD) 3.8–4.6°]. In the majority of shoulders, angular differences measured 4 or less for all SST/GHJ comparisons. Similarly, small angular differences in the three GHJ axes were found: 4.5° (SD 3.3°) for GHJ-90/GHJ-S, 5.0° (SD 4.0°) for GHJ-S/GHJ-H and 2.9° (SD 3.0°) for GHJ-90/GHJ-H. Correlation between the GHJ-90 and GHJ-H axes was particularly good, with differences of 4° or less in 84% of shoulders. The orientations of the GHJ axes and that of the SST long axis are comparable. Conclusion. The GHJ may potentially be used as a landmark for obtaining oblique coronal images of the SST. Received: 19 November 1999 Revision requested: 18 January 2000 Revision received: 27 March 2000 Accepted: 5 April 2000     

可调节带袢锁扣钛板-自体半腱肌肌腱全内重建前交叉韧带断裂的效果

 目的 探讨可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节前交叉韧带(anterior cruciate ligament,ACL)断裂的可行性、优缺点及并发症。方法 选择2014-07至2015-07应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL断裂47例。2～6周,关节镜下应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL断裂,伴发内侧副韧带损伤,用股薄肌肌腱修复或直接缝合。取同侧半腱肌肌腱,修整后将肌腱移植物对折成4股,并与可调节带袢锁扣钛板相连,移植物长度为6～6.5 cm,直径为7～9 mm。在ACL胫骨侧、股骨侧印迹定位并用倒打钻钻孔,制作骨隧道,经前内侧入路将肌腱移植物牵入骨道,并两侧逐步锁紧线环,将胫骨向后复位,将钛板固定在骨皮质上。根据重建手术前、后膝关节前抽屉实验、Lachman 试验、侧方挤压实验、IKDC 膝关节功能评价表、 Lysholm 评分对患者进行主观和客观评分,以评定疗效。结果 本组47例随访2～3年,平均随访时间为2.1年。末次随访时,患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善,前抽屉实验(-),Lachman试验(-),IKDC膝关节功能评分、Lysholm评分较重建前明显提高。膝关节屈曲达115°～130°;膝关节IKDC评分结果:正常41例(87.2%),接近正常4例(8.5%),异常2例(4.3%);膝关节功能Lysholm评分:术前(51.4±5.4)分,术后(92.2±4.6)分,差异有统计学意义(P<0.05)。结论 应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL,创伤小,能恢复膝关节的稳定性,功能恢复良好,疗效确切。     

Long-term outcome of superficialis-to-profundus tendon transfer in patients with clenched fist due to spastic hemiplegia

Background. Spastic hemiplegia is a common feature after stroke, which can result in a clenched fist deformity with secondary hygienic problems and pain. Operative treatment can improve these problems, although literature about its long-term effects is lacking.

Purpose. To determine whether Superficialis-to-Profundus tendon (StP-) transfer procedure leads to permanent improvement of hygiene and reduction of pain in patients with clenched fist due to spastic hemiplegia following stroke.

Method. Patients who underwent a StP-transfer in 2003 – 2005 were evaluated on skin condition, upper extremity joint mobility, resting position and muscle tone and with VAS scores on hygiene maintenance and pain in the hand.

Results. Six patients (mean age 54 years; duration after stroke 10 years) were included. Indications to operate were hygienic problems only (3) or combined with pain (3). The average follow-up period was 19 months. After 6 weeks of post-operative splinting, no standard follow-up was applied. Serious post-operative complications were not reported. At follow-up no hygienic problems were present and pain was decreased in all except one patient. All hands could passively be fully opened. In resting position, flexion was seen in the MCP-joints (60 – 90°). Muscle tone was raised in flexors of the wrist and fingers and m. adductor pollicis (Ashworth 1 – 2). Given the same pre- and post-operative circumstances, all patients would agree to have the surgery over again.

Conclusion. Even 19 months after the StP-transfer for clenched fist, all operated hands could still be fully opened and there was a permanent improvement of hygiene and pain reduction.     

Arthrodesis for chronic lateral subtalar joint dislocation caused by posterior tibial tendon dysfunction: A case report

IntroductionAdult acquired flatfoot deformity (AAFD) caused by posterior tibial tendon dysfunction (PTTD) can lead to the development of peritalar subluxation (PTS) and much more rarely to lateral subtalar dislocation.Presentation of caseA 75-year-old woman was referred to our hospital with an approximately 15-year history of pain in her right foot without obvious trauma. The lateral shifting foot deformity had worsened in the previous 5 years. On presentation, she had tenderness over the talonavicular joint, and the skin overlying the talar head on the medial foot was taut. Imaging revealed lateral displacement of the calcaneus with simultaneous dislocation of the talonavicular and talocalcaneal joints. We diagnosed lateral subtalar dislocation including the talonavicular and talocalcaneal joints caused by PTTD, which we treated by reduction and fusion of the subtalar joint complex. The foot and ankle were immobilized with a cast for 6 weeks.DiscussionAt the 1-year follow-up visit, the patient reported no pain during daily activities, although flatfoot persisted.ConclusionWe report a rare case of chronic lateral subtalar dislocation caused by PTTD that was treated by fusion of the talonavicular and talocalcaneal joints.     

False Tendon‐Related Polymorphic Ventricular Tachycardia

A 39‐year‐old woman showed nonsustained polymorphic ventricular tachycardia (PVT) during light physical activity. Cardiac multidetector row computed tomography demonstrated false tendons, one of which proved to be the focus triggering premature ventricular contraction (PVC) in electrophysiological studies. The triggered PVC arose during the diastolic period, which might have caused tension in the false tendon. Radiofrequency catheter ablation targeting the triggered PVC by pace mapping was performed and proved partially effective against PVT. (PACE 2012;35:e341–e344)