从生物力学角度评价单髁置换术与腓骨截骨术

膝关节单间室骨性关节炎引起的膝内翻是常见病症之一,目前手术方法主要有胫骨高位截骨术、单髁置换术以及最新推广的腓骨截骨术。单髁置换术自开展以来已有60余年历史,相比全膝关节置换术具有可保留膝关节正常运动、手术创伤小、保留骨量多以及术后关节活动度大等优点,故单髁置换术已成为治疗内侧间室骨关节炎一种可靠的治疗方式。腓骨截骨术是一种治疗膝内翻的新治疗手段,具有手术简单、费用低、恢复快等优点,目前正在被大力推广,但其治病机制尚不很清楚。综述单髁置换和腓骨截骨两种临床手术方式,并从生物力学角度推论腓骨截骨术治疗内侧间室骨性关节炎的可能机制,提出腓骨截骨术后外侧收缩肌力下降导致关节合力矩再平衡,故关节接触位置改变、关节接触力下降可能是腓骨截骨术能够缓解疼痛治疗骨性关节炎的原因。     

Dynamic function of the fibula. Gait analysis evaluation of three different parts of the shank after fibulectomy: proximal,middle and distal

The purpose of this case study was to investigate the dynamic features of fibular movement to gait pattern by analyzing the gait of individuals with three different parts of the fibula resected. Gait analyses revealed that proximal fibula resection impaired knee stability, whereas distal fibula resection disturbed ankle kinematics significantly. Except a mild secondary quadriceps weakness, middle fibula resection did not cause a significant biomechanical disturbance on gait.     

The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: A prospective study

Background:

Isolated tibial shaft (ITS) fracture with intact fibula is a common injury but records often fail to mention it. Our primary aim was to study the effect of the intact fibula in ITS fractures in closed and open injuries and that these fractures can unite without a primary fibulectomy.

Materials and Methods:

56 patients who sustained an ITS fracture with an intact fibula who underwent closed or open reduction and reamed intramedullary interlocking nailing (IM IL nail) for closed and open fractures between August 2008 and April 2014 were included in this study. Four patients were lost to followup. One patient died due to causes not related to the surgery. At the time of final followup, 51 patients with 51 ITS fractures were available for the analysis. There were 33 closed and 18 open fractures. Patients were followed up at 4 weekly intervals until radiological signs of union were noted. They were assessed for functional outcome using the IOWA knee and ankle score systems at the time of final followup.

Results:

The average time to union was 19.7 weeks. Closed fractures united in 17.7 weeks as compared to 23.5 weeks for open fractures (P < 0.05). A delay in union occurred in 6 patients (4 open) and in 3 patients fractures failed to unite (2 open). The functional outcome as per the knee score and ankle score evaluation system was 93.13 and 92.54, respectively. The knee scores were 93.81 and 91.8 for closed and open ITS fractures, respectively (P > 0.05). Similarly, the ankle scores were 94.96 and 88.1 for closed and open ITS fractures, respectively (P < 0.05).

Conclusion:

ITS fracture with intact fibula is a common occurrence, and they can be treated safely with reamed IM nailing that provides good union rates and the excellent functional result even in open fractures.     

从生物力学角度评价单髁置换术与腓骨截骨术

膝关节单间室骨性关节炎引起的膝内翻是常见病症之一,目前手术方法主要有胫骨高位截骨术、单髁置换术以及最新推广的腓骨截骨术。单髁置换术自开展以来已有60余年历史,相比全膝关节置换术具有可保留膝关节正常运动、手术创伤小、保留骨量多以及术后关节活动度大等优点,故单髁置换术已成为治疗内侧间室骨关节炎一种可靠的治疗方式。腓骨截骨术是一种治疗膝内翻的新治疗手段,具有手术简单、费用低、恢复快等优点,目前正在被大力推广,但其治病机制尚不很清楚。综述单髁置换和腓骨截骨两种临床手术方式,并从生物力学角度推论腓骨截骨术治疗内侧间室骨性关节炎的可能机制,提出腓骨截骨术后外侧收缩肌力下降导致关节合力矩再平衡,故关节接触位置改变、关节接触力下降可能是腓骨截骨术能够缓解疼痛治疗骨性关节炎的原因。     

从生物力学角度评价单髁置换术与腓骨截骨术

膝关节单间室骨性关节炎引起的膝内翻是常见病症之一，目前手术方法主要有胫骨高位截骨术、单髁置换术以及最新推广的腓骨截骨术。单髁置换术自开展以来已有60余年历史，相比全膝关节置换术具有可保留膝关节正常运动、手术创伤小、保留骨量多以及术后关节活动度大等优点，故单髁置换术已成为治疗内侧间室骨关节炎一种可靠的治疗方式。腓骨截骨术是一种治疗膝内翻的新治疗手段，具有手术简单、费用低、恢复快等优点，目前正在被大力推广，但其治病机制尚不很清楚。综述单髁置换和腓骨截骨两种临床手术方式，并从生物力学角度推论腓骨截骨术治疗内侧间室骨性关节炎的可能机制，提出腓骨截骨术后外侧收缩肌力下降导致关节合力矩再平衡，故关节接触位置改变、关节接触力下降可能是腓骨截骨术能够缓解疼痛治疗骨性关节炎的原因。