胫骨结节骨软骨炎的X线诊断

目的：探讨X线检查在胫骨结节骨软骨炎诊断中的价值。方法：回顾性分析52个（42例患者）胫骨结节骨软骨炎的膝关节X线摄影图像，观察胫骨结节骨及其周围软组织的改变。结果：所有患病的胫骨结节均示其邻近软组织肿胀，胫骨结节二次骨化中心异常改变有局部骨隆起10个、轮廓不规则8个、密度不均匀15个、碎裂状11个、前方见碎骨片4个和胫骨结节向前上方移位12个。结论：X线检查是诊断胫骨结节骨软骨炎有价值的方法。     

Osteochondrosis of the tibial tuberosity (Osgood-Schlatter's disease)

A case is presented of arthralgia of the left knee associated with osteochondrosis of the tibial tuberosity (Osgood-Schlatter's disease). Orthopedic findings included normal active ranges of knee flexion and extension, but pain with passive flexion and extension movements. Radiographic findings included the presence of slight prominence of the soft tissue overlying the tibial tuberosity. Initially, management of this case consisted of conservative therapy to alleviate pain, inflammation and swelling. Subsequent treatments were designed to result in complete recovery from any discomfort in the knee joint/muscle/ligaments complex.     

Effect of an anterior-sloped brace joint on anterior tibial translation and axial tibial rotation: A motion analysis study

Background

Anterior tibial translation and axial tibial rotation are major biomechanical factors involved in anterior cruciate ligament injuries. This study sought to evaluate a brace prototype designed with an anterior-sloped joint, in terms of its efficacy in attenuating anterior tibial translation and axial tibial rotation during landing, using a motion analysis approach.

Methods

Ten healthy male subjects performed single-leg landing tasks from a 0.6-m height with and without the brace prototype. Ground reaction force and kinematics data were obtained using a motion-capture system and force-plates. Anterior tibial translation and axial tibial rotation were determined based on tibial and femoral marker reference frames. Vertical and anterior–posterior ground reaction forces, hip, knee and ankle joint range-of-motions and angular velocities, anterior tibial translation and axial tibial rotation were compared between unbraced and braced conditions using Wilcoxon signed-rank test.

Findings

We found no significant difference in peak vertical and anterior–posterior ground reaction forces (p = 0.770 and p = 0.332 respectively) between unbraced and braced conditions. Knee joint range-of-motion and angular velocity were lower (p = 0.037 and p = 0.038 respectively) for braced condition than unbraced condition. Anterior tibial translation and axial tibial rotation were reduced (p = 0.027 and p = 0.006 respectively) in braced condition, compared to unbraced condition.

Interpretation

The anterior-sloped brace joint helps to attenuate anterior tibial translation and axial tibial rotation present in the knee joint during landing. It is necessary to test the brace prototype in a sporting population with realistic sports landing situations in order to assess its effectiveness in lowering anterior cruciate ligament injury risk.     

应用骨减压治疗恢复小儿胫骨结节骨软骨病患儿下肢运动功能

Background:Osteochondrosis of tibial tuberosity is common among older children esp.children loving sport.For children with light symptoms,osteochondrosis will recovery voluntarily after a long time.Activity should be restricted in children with severe symptoms.Therapeutic effect of fixation of lower limbers or surgery are ineffective.Children during active phase will be affected psychosomatically.Objective:To introduce application of bone decompression in the treatment of ostochondrosis of tibial tuberosity.     

Operative treatment of greater tuberosity fractures of the humerus--a biomechanical analysis

BACKGROUND: Fractures of the greater tuberosity of the humerus present with increasing frequency. However, no biomechanical data about the optimal fixation technique of greater tuberosity fractures is available. This biomechanical cadaver study compares the stability of three standard fixation techniques used for the treatment of greater tuberosity fractures of the proximal humerus. METHODS: In 21 fresh frozen proximal humeri, standardized fractures of the greater tuberosity were created. The specimens were randomly assigned to one of three operation techniques: wire tension banding, two cancellous screws and transosseous sutures. These constructs were mechanically tested by applying an increasing force to the supraspinatus tendon. Load to 5mm displacement (load to 5mm yield point) and load to failure (maximum stretch strength) were measured in Newton (N). FINDINGS: Load to 5mm yield point values showed no significant differences between tension banding (498 N, SD 153) and two cancellous screws (400 N, SD 174) (P>0.01). Both techniques showed significantly higher values than transosseous sutures (185 N, SD 132) (P<0.01). Load to failure values were significantly higher for tension banding (1054 N, SD 125) than screws (842 N, SD 140) and sutures (480 N SD 101) (P<0.01). The difference between screws and sutures was also significant (P<0.01). INTERPRETATION: Tension banding and two cancellous screws provided the strongest fixation for isolated fractures of the greater tuberosity.     

Osteoid osteoma of the tibial tubercle--an unusual cause of anterior knee pain

This case report describes an atypical cause of anterior knee pain in an adolescent male. The osteoid osteoma was located in the tibial apophysis.     

肌电触发电刺激对偏瘫患者胫前肌康复的作用

本文设计选择２８例偏瘫足下垂患者进行ＥＭＧ－Ｔｉｇｇｅｒｅｄ－ＭＥＳ，刺激强度为３０－６０ｍＡ，频率为２０－３０Ｈｚ。治疗后即刻观察胫前肌１０次最大用力收缩时体表肌电变化。另从本组２８例患者中选出２０例病情较相似的病 并分成２组，９例 接受ＥＭＧ－Ｔｒｉｇｇｅｒｅｄ－ＥＭＳ，１１例接受功能性电刺激（ＦＥＳ）作为对照组，所有病人均参加常规康复训练，然后测定治疗７－２０次后胫前肌收缩时体表最大肌电值及     

The tibialis anterior muscle flap for full-thickness tibial burns

Full-thickness burn wounds to the tibia present a challenging coverage problem. If skin grafting fails, few local options exist, and free tissue transfer may be required for coverage. We report on the use of the tibialis anterior muscle flap to cover longitudinal tibial defects in five extremities in four patients. These patients sustained 80, 55, 40, and 11% total body surface area burns. Postoperatively, all five extremity wounds healed with full coverage of the tibia. Minimal deficits in ankle inversion and eversion resulted, but all patients are fully capable of walking and able to bear weight. We feel that the tibialis anterior muscle flap is a safe, reliable, technically simple alternative for coverage of the burned tibia.     

Tibial shaft fracture after medial open‐wedge distal tibial tuberosity osteotomy: A case report

We report a case of tibial shaft fracture after open‐wedge distal tibial tuberosity osteotomy (OWDTO). The use of a lag screw for a lateral hinge fracture in OWDTO requires careful postoperative rehabilitation and follow‐up. We discuss concerns related to the mechanical strength at the osteotomy site after OWDTO to prevent fracture.     

Increasing posterior tibial slope does not raise anterior cruciate ligament strain but decreases tibial rotation ability

Background

It was investigated whether the strain of the anterior cruciate ligament and tibial kinematics are affected by increasing posterior tibial slope.

Methods

9 human cadaveric knee joints were passively moved between full extension and 120° flexion in a motion and loading simulator under various loading conditions and at 0°, 5°, 10° and 15° posterior tibial slope angles. The anterior cruciate ligament strain and the tibial rotation angle were registered. To assess the influence of posterior tibial slope on the anterior cruciate ligament strain at a fixed flexion angle the anterior cruciate ligament strain was recorded at three different flexion angles of 0°, 30° and 90° while continuously increasing the osteotomy angle from 5° to 15°.

Findings

The anterior cruciate ligament strain was either not affected by the posterior tibial slope angle or, in some load cases, was decreased for increasing posterior tibial slope (P < 0.05). There was a significant decrease of tibial rotation when the posterior tibial slope was increased to 15° for many of the load cases tested (P < 0.05). The mean maximum decrease was from 17.4° (SD 5.7°) to 11.2° (SD 4.7°) observed for flexion-extension motion under 30 N axial load in combination with an internal rotation moment.

Interpretation

The hypothesis that increasing posterior tibial slope results in higher anterior cruciate ligament strain was not confirmed. However, knee kinematics were affected in terms of a reduced tibial rotation. From a biomechanical point of view the data do not support the efficacy of sagittal osteotomies as performed to stabilize anterior cruciate ligament deficient knees.     

关节镜下治疗前交叉韧带胫骨止点撕脱性骨折的护理

目的探讨关节镜下治疗前交叉韧带（ACL）胫骨止点撕脱性骨折的临床护理。方法通过对12例ACL胫骨止点撕脱性骨折的患者采取术前心理护理、术前准备、术前适应性训练,术后一般护理、患肢与疼痛的观察护理和康复护理相结合,并在工作中不断总结护理经验,提高护理水平。结果本组12例患者平均随访16个月,所有骨折均获愈合,未出现骨折移位等并发症。结论科学、系统、细致的护理措施及有效的功能锻炼是确保治疗成功的关键,有利于ACL胫骨止点撕脱性骨折患者关节功能的恢复,减少并发症的发生。     

膝关节镜下前交叉韧带重建的手术配合

目的探讨膝关节镜下前交叉韧带重建的手术配合。方法对19例膝关节前交叉韧带损伤患者,在关节镜下行前交叉韧带重建手术的术前准备和术中护理配合。结果手术进程顺利,无并发症发生,手术效果满意。结论严格的无菌操作,熟练的洗手和巡回护士的配合,提高了手术效率,缩短了手术时间,是手术成功的关键。     

Deep femoral to anterior tibial bypass after failed femoropopliteal reconstructions

Deep femoral to anterior tibial artery bypass is a reconstructive technique occasionally applicable when more conventional attempts at revascularization of the distal portion of the leg have failed. Three such patients, in whom the anterior tibial was the only distal patent branch of the popliteal artery, had severe symptoms of arterial insufficiency. Deep femoral to anterior tibial bypass was done using autogenous The distal portion of the deep femoral artery was exposed through an anteromedial distal thigh approach. The three patients have been followed up for a mean of 20.3 months, and each maintains graft patency and marked symptomatic improvement.