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.     

Total knee replacement in severe genu varum deformity

In patients with osteoarthritis (OA) and severe osseous deformity of the knee, total knee replacement (TKR) is a major challenge. If the preoperative deformity exceeds 15°, restoration of the correct mechanical alignment will be difficult to achieve. In the management of medial compartment OA associated with a deformity of more than 15°, there is no agreement on the policy to adopt. The first step to be taken is a detailed analysis of the deformity, to determine where it is articular (wear, laxity) or extra-articular (constitutional or acquired bony deformity). The options open to the surgeon are: isolated valgus osteotomy (with TKR at a later stage), TKR or one-stage opening-wedge tibial valgus osteotomy and TKR. This chapter examines the different options and describes the authors’ preferred strategy.     

Pseudo genu varum ; in true anteroposterior imaging disappearing bowleg

Résumé Les auteurs présentent un dossier de faux genu varum observé chez une patiente de 30 ans porteuse d'un genu recurvatum et d'une hypertorsion fémorale. En position debout, pieds joints, apparaît un écart intercondylien de 7 cm, évoquant un genu varum. En réalité, lorsque les genoux sont repositionnés dans un plan frontal, rotules bien de face, le pseudo varus disparaît et les membres apparaissent normoaxés. Ce même principe de positionnement s'applique `a la mensuration radiographique de l'axe fémoro-tinial.

     

加减羌活胜湿汤主治膝关节创伤性滑膜炎临床观察

目的:观察加减羌活胜湿汤治疗膝关节创伤性滑膜炎的疗效。方法:采用随机、阳性药物对照试验方法进行了对照观察。试验组用羌活胜湿汤,对照组用滑膜炎颗粒;均于治疗1个疗程后进行疗效评价。结果:试验组总有效率89.5%,对照组总有效率78.6%,两组总有效率经统计学处理有显著性差异,P<0.05。结论:加减羌活胜湿汤是治疗膝关节创伤性滑膜炎的有效方药。     

Multiplanar correction of proximal tibial recurvatum deformity with tibial osteotomy and computer assisted fixator

BackgroundSeveral treatment modalities including open wedge osteotomies and Ilizarov reconstruction have been described for treatment of Proximal tibial recurvatum (PTR). However, the literature lacks information regarding the multiplanar correction of PTR using the computer assisted hexapod external fixator. The aim of the study is to present the results of PTR treatment with a computer assisted fixator systems.MethodsThere were three female and three male patients (10 lower extremities) with a mean age of 20.6 years (7.3 to 25.2y) in the study group. The angle of genu recurvatum (aGR), the tibial plateau tilt angle (aTP), the mechanical posterior proximal tibial angle (mPPTA) and sagittal mechanical axis deviation (MADs) was measured for the sagittal plane assessment.ResultsPreoperative sagittal assessment showed that the mean aGR was 28.9°±6.8°, mean aTP was 64.5°±10.2° and mean mPPTA was mPPTA was 114.1° ±10.3°. At the final follow-up there was a significant correction (p < 0.05 for aGR, aTP and mPPTA). Mean MADs was improved from 66.1 ± 14.2 mm to 16.6 ± 5.1 mm (p:0.005). Mean A:B ratio was 0.92 ± 0.13 preoperatively and 0.89 ± 0.14 postoperatively (p:0.37). Nine out of 10 knees had valgus deformity and mean preoperative tibiofemoral anatomic angle (TFA) was improved from 10.8°±3.7° valgus to 6.5°±1.7° valgus.ConclusionThe treatment of PTR deformity with a computer-assisted hexapod external fixator is safe and effective. It provides multiplanar correction of the deformity with a high precision and the patellar alignment remains stable during the correction.     

胫骨高位截骨治疗膝骨性关节炎合并膝内翻

自1995年8月-2001年2月我科对24例(28膝)膝骨性关节炎合并膝内翻的中老年患者进行高位截骨术,其中11例(13膝)应用石膏外固定,13例(15膝)应用Giebel槽式钢板内固定均获得满意疗效,以后者疗效更满意。1 临床资料 本组24例(28膝)均为膝关节单纯内髁骨关节炎。石膏外固定组11例(13膝)中男2例(2膝),女9例(11膝);年龄最小45岁,最大64岁,平均58.3岁;内翻角度最大8°,最小3°,平均5.2°。Giebel槽式钢板固定组13例(15膝),男4例(4膝),女9例(11膝);年龄最小46岁,最大65岁,平均59.2岁;内翻角最大8°,最小4°,平均5.5°。     

膝内翻伴胫骨旋转的治疗

目的 观察胫骨高位截骨，胫骨结节旋转抬高治疗膝内翻伴胫骨旋转畸形的效果。方法 通过膝关节生物力学研究。简化了胫骨高位截骨的测量方法，在胫骨高位截骨的同时进行胫骨结节旋转抬高，恢复胫股关节，髌股关节的生理功能。结果 随访1-8年，通过X线，CT检查及膝关节功能评定，其优良率为88%。结论 胫骨高位截骨，胫骨结节旋转抬高治疗膝关节内侧间隔退行性关节炎，胫骨旋转所致髌股关节炎，符合生物力学要求，长期随访效果满意。     

Spontaneous Correction of Severe Tibiofemoral Deformity in Growing Children

The progress of pronounced varus and valgus deformities of the knees in 20 children were followed. The most pronounced varus deformity was 33 degrees and the most pronounced valgus deformity was 20 degrees. The tibiofemoral angle in growing children was measured on roentgenograms by drawing a longitudinal axis between the femoral and tibial diaphyseal cortices. Spontaneous correction was seen in all cases during the growth period.     

Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment

Coronal plane deformity around the knee, also known as genu varum or genu valgum, is a common finding in clinical practice for pediatricians and orthopedists. These deformities can be physiological or pathological. If untreated, pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis. The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.     

Aggravation of Ankle Varus Incongruency Following Total Knee Replacement Correcting ≥10° of Genu Varum Deformity: A Radiographic Assessment

BackgroundThis study aimed to investigate the change in ankle varus incongruencies following total knee replacement (TKR) in patients with preoperative genu varum deformity of ≥10°.MethodsThe study cohort was composed of patients who underwent TKR in a single institution for knee osteoarthritis with preoperative genu varum deformity of ≥10° and concomitant varus ankle incongruencies. Eight radiographic measurements were evaluated preoperatively and postoperatively: mechanical tibiofemoral angle, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, tibial plafond inclination, talar inclination, tibiotalar tilt angle (TTTA), and tibia-mechanical axis angle. Of these, TTTA represented the quantitative degree of ankle joint incongruency.ResultsA total of 110 patients (male = 2; female = 108) were included in the analysis. The mean patient age was 68.9 (standard deviation [SD] 7.2) years at the time of TKR. All radiographic measurements showed significant changes postoperatively, representing the appropriate correction of genu varum deformity and restoration of the mechanical axis. Nineteen patients (17.3%) showed postoperative decrease in TTTA, 2 (1.8%) remained the same, and 89 (80.9%) showed increase. Overall, mean preoperative and postoperative TTTA were 3.3° (SD 2.2°) and 4.7° (SD 2.9°), respectively (P < .001), representing the aggravation of varus ankle incongruencies.ConclusionVarus ankle incongruencies showed aggravation following TKR despite correction of genu varum deformity and restoration of the mechanical axis. This could be an important cause of postoperative increase or development of ankle pain following TKR. Therefore, patients with preoperative varus ankle incongruencies need to be warned of possible aggravation of ankle symptoms and be evaluated before TKR.Level of EvidencePrognostic level III.