Neuromuscular adaptations in older males and females with knee osteoarthritis during weight-bearing force control

Background

Females exhibit significantly greater incidence, prevalence, and severity of osteoarthritis (OA) compared to males. Despite known biological, morphological, and functional differences between males and females, there has been little sex-related investigation into sex-specific biomechanical and neuromuscular responses to OA.

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。     

Repair of Achilles Tendon Rupture Using Autologous Semitendinosus Graft in a Kidney Transplant Recipient

Insertional Achilles tendon injuries can be difficult to treat when minimal tendon tissue remains for anastomosis. Moreover, in the chronic case with tendon shortening, operative repair can be more difficult than acute rupture. It is particularly desirable to reinforce the tendons, in addition to performing primary repair, in patients with renal or systemic diseases because of the accelerated collagen degeneration. Many techniques have been described for the surgical management of Achilles tendon rupture; however, none has shown clear superiority. We report the case of a 50-year-old renal transplant patient with a spontaneous distal Achilles tendon injury that we repaired using the pull-out technique reinforced with an autologous semitendinosus graft. At 2 years postoperatively, the ankle-hindfoot scale score was 92 points, and the postoperative course was without complication. We believe that the free hamstring tendon autograft is advantageous for this repair, because it is easy to handle, has limited donor site morbidity, and preserves the structures around the ankle.     

Is thoracolumbar fascia shear-wave modulus affected by active and passive knee flexion?

The purpose of this study was to examine the effect of passive and active knee flexion efforts on the stiffness of the thoracolumbar (TLF), semitendinosus (STF), and semimembranosus fascia (SMF). Fourteen young healthy males participated in this study. Using ultrasound shear-wave elastography, fascia elastic modulus was measured at rest (passive condition) and during submaximal isometric knee flexion efforts (active condition) with the hip at neutral position and the knee flexed at 0°, 45°, and 90°. Analysis of variance designs indicated that when the knee was passively extended from 90° to 0°, shear modulus of the TLF, SMF, and STF increased significantly (p < 0.05). Similarly, active knee flexion contractions caused a significant increase in TLF, SMF, and STF shear modulus (p < 0.001). Compared to hamstring fascia, the TLF showed greater thickness but a lower shear modulus (p < 0.05) while STF modulus was greater compared that to SMF during active contraction (p < 0.05). These results indicate that exercising the hamstring muscles can remotely influence the stiffness of the fascia which surrounds the lumbar area.     

自体半腱肌复合骨形态发生蛋白和同种异体骨重建前交叉韧带后腱-骨愈合的生物力学研究

目的研究骨形态发生蛋白(BMP)复合同种异体骨(DPB)对自体半腱肌肌腱重建前交叉韧带后腱-骨愈合的影响。方法取64只成年新西兰大白兔,分成4组,建立左侧膝前交叉韧带(ACL)完全断裂模型。重建ACL时,于股骨隧道内分别植入BMP结合DPB、BMP、DPB。结果术后3、6、12及24周BMP结合DPB腱-骨愈合及移植物抗拉强度大于其他各治疗组,P<0.05。结论缓释载体DPB能延长BMP作用时间,提高移植物生物力学特性,拮抗骨吸收因子的负面效应,促进腱-骨愈合。     

腘静脉成形术临床应用研究

目的探讨下肢静脉曲张伴深静脉瓣功能不全的治疗方法。方法在大隐静脉剥脱术同时用半腱肌和股二头肌行一期胭静脉成形术。结果术后症状完全消失17例,明显改善4例;12天水肿消退17例,12～20天水肿消退6例,20天后水肿消退1例;12例胫前溃疡于10～30天逐渐愈合。17例于术后6～8个月随访痊愈无复发。行静脉造影显示膝关节伸直时胭静脉开放,屈曲时受肌袢压迫即闭合,肌袢的瓣膜样功能确切。结论应用胭静脉外肌袢成形术治疗下肢深静脉瓣功能不全。     

下肢节段性神经根刺激H反射

探索理想的诊断腰骶神经根病的神经电生理技术。采用高压短脉冲电刺激技术直接刺激神经根，在比目鱼肌及半腱肌记录Ｈ反射，共检测正常人３０例，Ｓ１及Ｌ５神经根病２０例。（１）测定了比目鱼肌及半腱肌神经根刺激Ｈ反射正常值。（２）半腱肌和经目鱼肌ＮＲＳＨ在正常人可１００％记录到。９３）Ｌ５Ｓ１椎间隙及Ｓ１神经孔刺激，比目鱼肌及 半腱肌ＮＲＳＨ各参数相差均不显著。（４）单纯Ｓ１神经根病仅比目鱼肌ＮＲＳＨ异常，而     

半腱肌血供及肌内血管构筑

应用显微外科解剖学方法,观察了40侧成人半腱肌的血供特点.半腱肌起腱长2.5±1.9cm;肌腹长31.2±3.8cm;止腱长9.2±1.7cm.肌外动脉入肌点主要集中于肌腹的上2/5～4/5区;其分支主要来自穿动脉;在入肌点处动脉直径均在1.3mm以上.半腱肌下端形成扇形腱膜,其附着点处无重要的血管和神经结构.同时用墨汁灌注、组织切片,ABS铸型及扫描电镜观察方法,观察了半腱肌的肌内血管构筑,为临床肌襻成形术提供形态学依据.     

Fetal programming of fat and collagen in porcine skeletal muscles

Connective tissue plays a key role in the scaffolding and development of skeletal muscle. Pilot studies carried out in our laboratory have shown that the smallest porcine littermate has a higher content of connective tissue within skeletal muscle compared with its largest littermate. The present study investigated the prenatal development of intralitter variation in terms of collagen content within connective tissue and intramuscular fat of the M. semitendinosus. Twenty-three pairs of porcine fetuses from a Large White-Landrace origin were used aged from 36 to 86 days of gestation. The largest and smallest littermates were chosen by weight and the M. semitendinosus was removed from each. Complete transverse muscle sections were stained with Oil Red O (detection of lipids) and immunocytochemistry was performed using an antibody to collagen I. Slides were analysed and paired t-Tests revealed the smallest littermate contained a significantly higher proportion of fat deposits and collagen I content compared with the largest littermate. Recent postnatal studies showing elevated levels of intramuscular lipids and low scores for meat tenderness in the smallest littermate corroborate our investigations. It can be concluded that the differences seen in connective tissue elements have a fetal origin that may continue postnatally.     

Reconstruction of the medial patellofemoral ligament with a suture-tie technique of patellar side fixation

Background  Medial patellofemoral ligament (MPFL) reconstruction is the preferred operative treatment for recurrent patellar dislocation. The purpose of this study was to report a novel suture-tie technique of patellar side fixation in medial patellofemoral ligament reconstruction for recurrent patellar dislocation, and to evaluate the intermediate-term results.

Methods  We retrospectively reviewed the results of 22 MPFL reconstructions in 21 patients (6 male and 15 female) with a suture-tie technique performed by a single surgeon between March 2004 and July 2009. All patients had been diagnosed with recurrent patellar dislocation. Outcomes were assessed preoperatively and postoperatively by physical and radiographic examination as well as with Kujala and Lysholm scores.

Results  At the mean follow-up month 37.5 (range: 24–56 months), there was no graft failure. Primary healing was achieved in all cases. At the final follow-up, the mean Kujala score improved from 53.9 (range: 46–62 points) to 84.1 (range: 78–90 points) postoperatively (P <0.05), and the mean Lysholm score improved from 47.2 points (range: 37–57 points) to 82.8 points (range: 76–89 points) postoperatively (P <0.05). To date, no patients have reported redislocation or subluxation; however, there is one patient with a positive apprehension test.

Conclusion  A suture-tie technique in medial patellofemoral ligament reconstruction can restore patella stability without significant complication.