锁定钢板固定的股骨髁上不全截骨技术治疗膝外翻

目的：通过回顾性研究,评价使用锁定钢板固定的股骨远端内侧髁上闭合楔形不全截骨技术治疗膝外翻的安全性和有效性。方法从2011年8月至2013年2月,共26例膝外翻患者（37膝）接受了股骨髁上内侧闭合楔形不全截骨术,并用 Tomofix 股骨远端内侧锁定钢板固定。患者平均年龄25.6（18～37）岁。膝关节外侧单间室骨关节炎均为Ahlback I期。结果平均随访23.6（13～31）个月。股胫角术前160.2（152～167）°,术后175.6（171～178）°,平均改善14.4（6～22）°;远端股骨外侧角术前股骨角术前68.4（60～74）°,术后82.3（77～84）°,平均改善13.9（7～21）°。差异均有统计学意义（ P＜0.05）。美国特种外科医院HSS膝关节功能评分从术前平均91.7（77～98）分改善至术后平均97.8（84～100）分,但差异无统计学意义（ P＞0.05）。37膝中有2膝出现延迟愈合,均与骨性合页断裂移位有关。1例因出现术后血肿再次手术,2例对术后下肢力线过矫不满,无感染和骨折不愈合发生。结论采用股骨远端内侧闭合楔形不全截骨技术与锁定钢板固定,可以有效地纠正膝外翻,方法安全可靠,截骨时保留外侧骨性和软组织合页是骨折迅速愈合的关键。     

神经训导康复技术对偏瘫膝反张的康复效果和机制

目的 探讨神经训导康复技术对偏瘫膝反张的康复效果,并探讨其作用机制.方法 对60例病程6个月以上、经其他康复方法 治疗不能进一步改善功能的脑卒中偏瘫伴膝反张患者,采用神经训导技术进行康复治疗.对治疗前后膝关节活动范围(ROM)、运动程序信号、Fugl-Meyer下肢运动功能评分和患肢负重时间等进行评定和比较.结果 治疗1个疗程后,患者膝关节ROM、下肢Fugl-Meyer评分、患肢负重时间、股四头肌表面肌电信号、股四头肌与腘绳肌肌电信号差与治疗前比较差异均有统计学意义[(21.6±6.3)°比(3.6±2.3)°;(24±6)分比(15±7)分;(4.02±1.54)s比(0.22±0.13)s;(119±45)μV比(36±12)μV;(76±42)μV比(22±18)μV,P＜0.01],治疗后腘绳肌与股四头肌肌电信号比值明显降低(1.4∶1比1∶4.6,P＜0.01).结论 神经训导康复技术是改善偏瘫患者膝反张的有效康复方法.

Abstract：

Objective To investigate the rehabilitating effect and mechanism of the neurological training of genu recurvatum after hemiparalysis. Methods The neurological training was used to rehabilitate sixty long-term stroke patients with hemiplegia and genu recurvatum. The functional evaluation of range of motion (ROM) of the knee, Fugl-Meyer of the lower leg, the time of weight loading, the intensity and its proportion of the motor program signal of musculus quadriceps fexoris and hamstrings were oserved before and after the treatment. Results After one course of treatment, the differences of all functional evaluation data, including knee ROM, Fugl-Meyer score of the lower limb, weight bearing time, electromyogram (EMG) of the quadriceps, and the EMG difference between the quadriceps and the hamstring muscles were all significantly improved. The ratio of hamstring EMG to quadriceps rehabilitation technique is an effective method of improving the knee extension ability in h.emiplegic patient after stroke.     

The effects of apomorphine and D-amphetamine on striatal c-Fos expression in Sprague-Dawley and Long Evans rats and their F1 progeny

We previously reported that Sprague-Dawley (SD) rats are significantly more sensitive than Long Evans (LE) rats to disruption of prepulse inhibition (PPI) of the startle reflex by the dopamine agonists, apomorphine (APO) and D-amphetamine (AMPH). This susceptibility is inherited through F1 (SD x LE) and N2 backcross (F1 x SD) generations via an orderly pattern (SD>N2>F1>LE). Here we examined systemic APO (0.5 mg/kg) and AMPH (4.5 mg/kg) modulation of neural activity in four regions of the striatum suspected to be involved in the dopaminergic regulation of PPI - dorsolateral (dlCPu) and medial (mCPu) caudate/putamen and core (NACc) and medial shell (NACms) regions of nucleus accumbens - under conditions that mimicked those used to assess PPI. Immunohistochemical quantification of c-Fos protein expression was used as the surrogate measure of neural activity in SD and LE rats and their F1 crosses. Vehicle-treatment showed significant regional differences in Fos expression, particularly between the dlCPu and the other three areas, but no strain-related differences were observed. Three of four brain areas examined (dlCPu, mCPu and NACc) exhibited drug-induced changes in Fos expression--APO decreased and AMPH increased Fos expression in each region. The aggregate effect across these three regions revealed Fos expression to be significantly greater in LE compared to SD rats for both drugs, with F1 rats intermediate. This pattern of inheritance (LE>F1>SD) reveals an inverse relationship between striatal Fos expression and PPI sensitivity for these drugs; and a positive relationship with reported heritable differences in D2-linked G-protein binding in the CPu and NACc, and with locomotor activation/suppression by AMPH and APO.     

Intramedullary insertion of the patellar tendon

This case represents a rare presentation of an intramedullary insertion of the patellar tendon in an otherwise healthy 8-year-old girl. To our knowledge no such phenomenon has previously been reported in the English literature.     

Fiber geometry in the corpus callosum in schizophrenia: evidence for transcallosal misconnection

Background

Structural abnormalities in the callosal fibers connecting the heteromodal association areas of the prefrontal and temporoparietal cortices bilaterally have been suggested to play a role in the etiology of schizophrenia.

Aims

To investigate for geometric abnormalities in these callosal fibers in schizophrenia patients by using a novel Diffusion-Tensor Imaging (DTI) metric of fiber geometry named Shape-Normalized Dispersion (SHD).

Methods

DTIs (3T, 51 gradient directions, 1.7 mm isotropic voxels) were acquired from 26 schizophrenia patients and 23 matched healthy controls. The prefrontal and temporoparietal fibers of the corpus callosum were extracted by means of whole-brain tractography, and their mean SHD calculated.

Results

The schizophrenia patients exhibited subnormal levels of SHD in the prefrontal callosal fibers when controlling for between-group differences in Fractional Anisotropy. Reduced SHD could reflect either irregularly turbulent or inhomogeneously distributed fiber trajectories in the corpus callosum.

Conclusions

The results suggest that the transcallosal misconnectivity thought to be associated with schizophrenia could reflect abnormalities in fiber geometry. These abnormalities in fiber geometry could potentially be underpinned by neurodevelopmental irregularities.     

膝内外翻的体表测量

对30名健康成年人进行了股骨头中点、髂前上棘、股骨粗隆尖点、髌骨下极、踝关节中点的体表标记和测量.所得数据经统计学处理和几何学计算.结果:(1)下肢力学轴与股骨解剖轴夹角7°;(2)膝内外翻时,下肢力学轴线每向内(外)偏离髌骨中点1cm,解剖轴股胫角增(减)3°;(3)髂前上棘至踝关节中点连线,正常情况下通过髌骨中点外侧1.69cm处.当该连线通过髌中点外侧2～2.5cm时,膝生理外翻角7°～9°,因此,在矫正内翻畸形时,下肢对线的理想标准是将髂前上棘、髌骨外缘、第一二趾间三点成一直线.     

Correction of bony genu recurvatum combined with ligamentous instability of the knee: three case reports

We report our experiences for treating the bony genu recurvatum combined with ligamentous instability that needed both osteotomy and ligament reconstruction in three cases. The bony component was corrected according to normal tibial slope, patellar height and limb length. After the osteotomy, we reevaluated the instability of the knee and performed ligament reconstruction if the patients had ligamentous instability even though the osteotomy was done.     

Lateral femorotibial arthritis (LFTA) associated with genu valgum: ethiopathogeny and surgical consequences

The genu valgum is a rare deformation whose frequency does not exceed 15% of our osteoarthritis treatment cases. Despite 30 years of experience in knee arthroplasty, we are still unable to achieve a consensus on both the classification of those deformations, or on the definition of rules pertaining to the appropriate manipulations to establish ligament balance. When it comes to the choice of a prosthetic constraint, this also gives rise to passionate debate among experts. Hence we have felt the importance of reviewing the valgus deformation and its various origins. This will bring us to propose an original classification method based on the deformation cause, the origin of the anomalies, its consequences on the required ligament balance procedures and a precise analysis of the predicted surgical procedures. This classification and this paper will also enable us to isolate the special case of genu valgum in a globally malformative complex which needs to be ascertained before attempting any surgical operation because it constitutes a serious cause of failure in prosthetic surgery.     

腓骨近端截骨与膝关节表面置换治疗膝关节骨关节炎早期疗效的自身对照研究

目的 探讨腓骨近端截骨术和膝关节表面置换术治疗老年膝关节骨关节炎伴膝内翻畸形的早期临床疗效。方法 采用前瞻性自身对照研究方法 ,对2014年11月—2015年2月蚌埠医学院第一附属医院骨科收治的10例双侧膝关节骨关节炎伴膝内翻畸形患者,采用数字表法随机选择术式,每例患者两侧膝分别行腓骨近端截骨术(截骨组)和膝关节表面置换术(置换组)治疗,并对比观察其早期疗效。其中男2例,女8例,年龄55~75岁。应用VAS评分、美国特种外科医院(HSS)膝关节评分、美国膝关节外科协会评分(KSS)评价患者手术前后膝关节疼痛及功能情况,采用SPSS 21.0统计软件进行统计学分析。结果 所有患者顺利完成手术,术后获得随访6~9个月。术前截骨组和置换组在膝关节疼痛与功能评分方面差异均无统计学意义(P值均>0.05)。术后截骨组与置换组的膝关节疼痛及功能均明显改善,至末次随访时双侧VAS评分、HSS评分及KSS临床、功能评分均较术前明显改善,差异均有统计学意义(P值均<0.01);2组术后末次随访各评分差异均无统计学意义(P值均>0.05)。截骨组1例患者术中损伤胫腓间软组织,出现典型的腓总神经麻痹症状,术后6个月恢复正常,其余均无手术相关并发症发生。结论 腓骨近端截骨术可以明显改善膝关节骨关节炎伴膝内翻畸形患者的疼痛及功能情况,与膝关节表面置换术取得同样早期疗效,是一种安全的微创外科手术技术。     

胫骨高位截骨术治疗内翻型膝关节骨关节炎远期疗效观察

为评价应用高位胫骨截骨术治疗内翻型膝关节骨关节炎的远期疗效，对２４例（２９膝）进行平均１０６年的随访。结果显示，８２６％疗效优良或满意。疗效与年龄有关，理想的股胫外侧角度（简称ＦＴＡ）１６８°～１７２°。５０岁以下，ＦＴＡ为１６５°～１７５°者多能获得满意以上结果。术式选用胫骨结节上楔形截骨抑或倒Ｖ截骨，应根据有无髌股关节炎而定。只要选择恰当，疗效与术式无关。本文结论是治疗６０岁以下内翻型膝关节骨关节炎应首选高位胫骨截骨术