A new 3D software for analysis and planning of lower limb and patellofemoral alignment: Reliability and accuracy

BackgroundThe new software, mediCAD® 3D Knee Sport (mediCAD Hectec GmbH, Altdorf/Landshut, Germany), promises to combine automated digital 3D bone model generation, 3D analysis of lower limb geometry including analysis of the patellofemoral joint, and osteotomy planning. The aim of this study was to evaluate its reliability and accuracy.MethodsIn this retrospective multi-observer study, three post-mortem CTs were analysed by three observers at three points in time. Reliability was evaluated by calculating the intraclass correlation coefficient (ICC) of interobserver agreement. Accuracy was evaluated using the mean deviation D from the mean and the standard deviation SD from D.ResultsTen of 18 alignment parameters showed excellent, two good and three moderate interobserver agreement. Poor agreement was found for the mechanical medial proximal tibial angle, the trochlear sulcus angle and trochlea depth. Mean interobserver ICC of all parameters ranged from 0.32 to 0.99. Fifteen of 18 parameters showed a low mean deviation D from the mean of < 2 mm / 2°. Three parameters related to the patellofemoral joint showed medium or high D (patella tilt, trochlear sulcus angle, patellar ridge angle). These parameters also showed the highest values for the SD of D. The trochlear sulcus angle was found to be the only parameter with high mean deviation (D ≥ 5 mm/5°) with D being 5.67 ± 3.23°.ConclusionsThe current version of the software achieves good interobserver reliability and accuracy with the exception of a few measurement parameters.     

髌骨骨折三种内固定方法的疗效比较

目的：探讨3种内固定方法在髌骨骨折治疗中的疗效。方法：选择176例髌骨骨折患者,随机分为3组,形态记忆双向张力钩固定术63例为A组,钢丝粗线环扎术58例为B组,镍钛聚髌器内固定术55例为C组。结果：所有患者均获得随访3～24个月,A、B、C三组的骨折愈合率分别为：95.24%、75.86%、85.45%。结论：形态记忆双向张力钩固定术治疗髌骨骨折具有可靠的生物力学固定效果,疗效满意,值得临床大力推广应用。     

髌骨软化症与髌骨轨迹异常改变相关性调查

目的 调查髌骨运动轨迹的异常改变与髌骨软化症之间是否存在相关性.方法 收集2006年3月至2008年12月在我院临床诊断为髌骨软化症的患者60例,共计79侧膝关节,摄屈膝30°轴位片及侧位片,进行髌骨高度、髌骨指数、髌骨厚度、适应角、髌股关节指数、外侧髌骨角、髌骨倾斜角、股沟角、髌骨外侧偏移率测量,并与对照组(60例膝关节无症状的志愿者)相应数据进行比较.同时进行主成分分析,得出相关性方程.结果 髌骨软化组股沟角、髌股关节指数、外侧髌骨角、髌骨倾斜角与对照组比较,差异均有统计学意义[(137°±6°)比(132°±4°),P ＜0.05;(1.05±0.23)比(1.49±0.22),P＜0.01;(7.6°±2.4°)比(5.3°±2.3°),P＜0.05;(10.8°±2.7°)比(14.6°±3.3°),P＜0.01],主成分分析显示反映髌骨轨迹异常改变的9个指标中第一主成分有5个指标,它们反映髌骨软化症患病程度的系数依次为髌股关节指数、外侧髌骨角、髌骨指数、股沟角和髌骨高度.结论 髌股关节对合关系及髌骨运动轨迹的异常改变与髌骨软化症存在密切相关性,髌骨在屈膝30°位时更易向外侧脱位,对临床上怀疑髌骨软化症的患者应行屈膝30°位轴位片及侧位片拍摄,以便早期作出诊断,及时给予治疗.     

部队战士髌骨软骨软化症与髌骨异常改变相关性调查

目的探讨部队战士髌骨软骨软化症发生与髌骨异常改变的关系。方法选取2005-2008年正常参加部队训练且确诊为髌骨软骨软化症战士50名(观察组)和正常战士50名(对照组),均X线摄髌骨轴位片,测量6个参数并进行对照。结果观察组患者外侧髌股角、髌骨倾斜角、髌股关节指数及适应角与对照组比较差异有统计学意义(P<0.05)。结论部队战士中髌骨异常改变易致髌骨软骨软化症,也是髌骨软骨软化症的发展结果。     

克氏针张力带与髌骨爪治疗髌骨粉碎性骨折临床分析

目的探讨克氏针张力带与髌骨爪治疗髌骨粉碎性骨折的临床疗效。方法 52例髌骨粉碎性骨折患者分为两组,其中克氏针张力带内固定组30例,髌骨爪内固定组22例,比较两组患者在手术时间、骨折愈合时间、膝关节功能评价以及术后并发症方面的差异。结果克氏针张力带组手术时间明显要长于髌骨爪组,差异有统计学意义(P<0.01);两组术后膝关节功能评价,髌骨爪组优良率为90.91%,明显高于克氏针张力带组的66.67%(P<0.05)。结论髌骨爪内固定手术时间短,术后膝关节功能恢复良好,是安全、有效的治疗髌骨粉碎性骨折的方法。     

The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation: An MRI evaluation

The medial patellofemoral ligament (MPFL) and the native trochlear geometry represent two of the most critical components of patellofemoral stability. We sought to define the relationship between trochlear dysplasia and MPFL rupture location in patients with documented patellar dislocations. We hypothesized that patients with lower grades of trochlear dysplasia would have patellar based MPFL ruptures, while patients with higher grade dysplasia would have femoral-sided ruptures.We reviewed post-injury MRIs of 59 patients with documented patella dislocation. Information gathered included: type of trochlear dysplasia in the axial plane MRI, location of MPFL rupture, patellar height ratio, tibial tuberosity to trochlear groove distance (TTTG), number of dislocations prior to MRI, and time between the latest patella dislocation and the MRI.Statistical calculations utilized the Chi-Square-Test.We classified 11 cases as a dysplasia type A, 35 as a type B, 11 as a type C, and 2 cases as a trochlear dysplasia type D. In 7 patients (12%) the MPFL rupture was patella based, in 18 patients (31%) intra-ligamentous, in 33 cases (56%) femoral sided and in one case no MPFL could be identified.In contrast to our original hypothesis, the type of trochlear dysplasia does not appear to be related to the rupture location of the MPFL after patellar dislocation. According to our results, it is not possible to presume the location of the MPFL rupture based on assessment of the trochlear morphology. Therefore, a MRI is mandatory for final indication of any surgery.     

Mesenchymal stem cells and insulin‐like growth factor‐I gene‐enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons

Tendinitis remains a catastrophic injury among athletes. Mesenchymal stem cells (MSCs) have recently been investigated for use in the treatment of tendinitis. Previous work has demonstrated the value of insulin‐like growth factor‐I (IGF‐I) to stimulate cellular proliferation and tendon fiber deposition in the core lesion of tendinitis. This study examined the effects of MSCs, as well as IGF‐I gene‐enhanced MSCs (AdIGF‐MSCs) on tendon healing in vivo. Collagenase‐induced bilateral tendinitis lesions were created in equine flexor digitorum superficialis tendons (SDFT). Tendons were treated with 10 × 10⁶ MSCs or 10 × 10⁶ AdIGF‐MSCs. Control limbs were injected with 1 mL of phosphate‐buffered saline (PBS). Ultrasound examinations were performed at t = 0, 2, 4, 6, and 8 weeks. Horses were euthanized at 8 weeks and SDFTs were mechanically tested to failure and evaluated for biochemical composition and histologic characteristics. Expression of collagen types I and III, IGF‐I, cartilage oligomeric matrix protein (COMP), matrix metalloproteinase‐3 (MMP‐3), matrix metalloproteinase‐13 (MMP‐13), and aggrecanase‐1 (ADAMTS‐4) were similar in MSC and control tendons. Both MSC and AdIGF‐MSC injection resulted in significantly improved tendon histological scores. These findings indicate a benefit to the use of MSCs and AdIGF‐MSCs for the treatment of tendinitis. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1392–1398, 2009     

慢性钙化性冈上肌腱炎的关节镜下治疗

目的：探讨关节镜下治疗慢性钙化性冈上肌腱炎的手术方法与效果。方法：采用关节镜下手术治疗37例钙化性冈上肌腱炎患者,评估其术前、术后的X光片表现,采用视觉模拟法疼痛评分（VAS）,Constant-Murley评分和美国肩肘关节外科医师协会评分系统（ASES）分析患者术后的改善情况。结果：所有患者症状均得以缓解,5例患者术后X光片仍残留部分钙化灶,患者VAS、Constant-Murley及ASES评分均较术前改善（P〈0.05）。结论：关节镜下手术治疗钙化性冈上肌腱炎效果确切,尤其对保守治疗效果不佳的患者,是一种安全有效的治疗途径。     

带血管蒂髌骨移位修复胫骨外侧髁上关节面缺损的研究

目的探讨带血管蒂髌骨移位的方法修复胫骨外侧髁上关节面缺损的可行性。方法用30侧成人下肢标本,解剖研究髌骨的血管,观测30块髌骨和胫骨外侧髁上关节面的形态和面积。结果①供应髌骨血液的各支动脉先在髌骨周围吻合成髌周动脉环,再由该环发出分支进入髌骨 ②于髌尖外下方参与形成髌周动脉环的膝下外侧动脉蒂长、径粗、位置恒定 ③髌骨关节面与胫骨外侧髁上关节面形态大小相似。结论带血管蒂髌骨可移位至胫骨外侧髁,利用其关节面,修复上关节面缺损,以期最大限度地保留膝关节的功能。