经骨缝合手术治疗急性髌骨脱位合并髌骨软骨Peeloff损伤早期疗效观察

目的评价经骨缝合手术治疗急性髌骨脱位合并髌骨软骨骨折(Peeloff损伤)的早期临床疗效。方法回顾性分析自2019-05—2020-03诊治的15例急性髌骨脱位合并髌骨软骨Peeloff损伤,膝关节镜检查并确诊髌骨软骨缺损,关节腔内找到与缺损区域吻合的游离软骨片,关节镜下或内侧小切口取出游离软骨片;再作髌内侧切口,将游离软骨片复位并在其边缘选取4个合适进针点,用带孔克氏针在髌骨主体上从内向外垂直钻孔,每两孔之间导入可吸收缝线,经孔道将克氏针抽出时带出缝线并打结。结果 15例均获得随访,随访时间平均8(3~13)个月。术后3个月MRI显示所有患者髌骨关节面软骨骨折均愈合。2例出现早期髌股关节疼痛(1例VAS评分为4分,1例VAS评分为5分),经康复治疗后好转,其余13例疼痛VAS评分平均1.8(1~3)分。末次随访时Tegner运动评级:3级5例,4级9例,5级1例。末次随访时膝关节功能Lysholm评分80~96(88.9±4.7)分,其中优6例,良7例。结论关节镜下探查可确诊急性髌骨脱位合并的髌骨软骨Peeloff损伤,采用可吸收缝线经骨缝合固定髌骨关节面软骨片无需特殊内固定器械及二次手术取出,既能实现软骨稳定固定、正常愈合,又能保证膝关节功能良好恢复。     

膝剥脱性骨软骨病变关节镜下复位固定的疗效

目的:探讨膝剥脱性骨软骨病变关节镜下复位固定的疗效。方法:对2012年12月至2013年12月收治的4例膝关节股骨髁剥脱性骨软骨病变并伴有游离骨块的患者,采用关节镜探查找到剥脱软骨块,行小切口复位、软骨钉固定治疗。男3例,女1例;年龄15、15、20、27岁;病程1 d、5 d、1个月和1年。4例均出现膝关节肿胀积液,浮髌试验阳性,CT检查均可见骨质缺损及游离体。术前应用Lysholm、VAS及Tegner评分评定膝关节功能。结果:所有患者手术顺利,术后CT检查示软骨位置良好,无复位骨软骨脱落,4例平均随访时间12个月(10～13个月).1例术后二次关节镜探查,软骨骨折块与周围软骨连接,内固定物未能吸收。Lysholm、VAS及Tegner评分评定膝关节功能均优于术前。结论:关节镜辅助下软骨块复位联合可吸收螺钉固定治疗膝关节剥脱性骨软骨病变,能重建关节面的完整性和恢复关节稳定性,是一种有效的治疗方式。     

Patellar fracture after total knee arthroplasty

BACKGROUND: Patellar fracture can occur as a complication following total knee arthroplasty. The purpose of this study was to evaluate a large series of patellar fractures to determine the results of different forms of treatment of specific fracture types. METHODS: A retrospective review identified eighty-five fractures (in seventy-seven patients) following 12,464 consecutive total knee arthroplasties performed between 1985 and 1998. Seventy-eight fractures occurred after primary total knee arthroplasty and seven, after revision total knee arthroplasty. Five fractures were treated elsewhere, and two others were lost to follow-up. The results of treatment of the remaining seventy-eight fractures were reviewed. Fractures were classified according to three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone stock. The mean duration of follow-up was 3.6 years. RESULTS: The prevalence of patellar fracture after total knee arthroplasty was 0.68%; fractures were significantly more prevalent among men (1.01%) than among women (0.40%) (p = 0.0004). Thirty-eight fractured patellae had a stable implant and an intact extensor mechanism (Type I). All but one were treated nonoperatively, and there was only one late failure of nonoperative treatment, which required operative intervention. Twelve fractures were associated with disruption of the extensor mechanism (Type II). Eleven were treated operatively; six knees had complications and five had a reoperation. Twenty-eight fractures occurred in association with a loose patellar component (Type III). Twenty were treated operatively; nine knees had complications, and four had a reoperation. CONCLUSIONS: Patellar fractures after total knee arthroplasty are infrequent. Treatment can be guided by three main criteria: integrity of the extensor mechanism, fixation status of the patellar implant, and quality of the remaining bone. Fractures associated with a stable implant and an intact extensor mechanism were usually treated successfully with nonoperative means, with minimal complications. When operative treatment was required, it was associated with a high rate of complications and reoperations.     

Effect of Donor Age on Patellar Tendon Allograft ACL Reconstruction

Anterior cruciate ligament reconstruction with patellar tendon allograft tissue is a common orthopedic procedure. It is unknown what effect, if any, the donor age has on clinical outcomes. Biomechanical studies have shown the strength of cadaveric patellar tendon to be independent of age, but no clinical studies have evaluated patient outcomes related to this variable. The purpose of this study was to evaluate the effect of allograft donor age on clinical outcomes of patients undergoing allograft anterior cruciate ligament reconstruction with patellar tendon allograft.Case logs were reviewed to identify primary anterior cruciate ligament reconstruction with allograft patellar tendon by a single surgeon using a standard endoscopic transtibial technique with interference screw fixation. Revision and multiligamentous surgeries were excluded. Seventy-seven patients who met these criteria were identified. Allografts were fresh-frozen, aseptically harvested patellar tendons from a single tissue bank. The donor age was obtained. Clinical outcomes were obtained by contacting patients by telephone and retrospective chart review. Pre- and postoperative Lysholm and Tegner knee scores were used for comparison.Data from 75 patients with an average follow-up of 24 months were obtained. Average donor age was 44 years (range, 14-65 years), and average patient age was 37 years (range, 18-60 years). Statistical analysis of pre- and postoperative Lysholm scores demonstrated statistically significant improvement (P?.001). Using donor age as a continuous variable, no effect was found on postoperative improvement in Lysholm score or Tegner score (P=.6).     

镍钛聚髌器结合钢丝环扎固定治疗粉碎性髌骨骨折

目的：探讨镍钛聚髌器结合钢丝环扎固定治疗髌骨粉碎性骨折的临床疗效。方法：2004年3月至2007年6月,采用镍钛聚髌器结合钢丝环扎固定治疗38例髌骨粉碎性骨折,男25例,女13例;年龄21—64岁,平均42．5岁：均为粉碎有移位骨折,其中碎骨块3块16例、4块14例、5块及以上8例;合并其他部位骨折8例。随访期间评价患者膝关节功能及并发症情况。结果：经8-24个月（平均15个月）随访,骨折均骨性愈合。术后无内固定松动,发生膝关节创伤性滑膜炎2例。按Lysholm—Gillquist膝关节评价标准：优17例,良19例,可2例。结论：镍钛聚髌器结合钢丝环扎固定具有复位满意、固定可靠、患者可早期进行功能锻炼,是治疗髌骨粉碎性骨折的理想选择方式之一。     

The extended posterolateral approach for split depression lateral tibial plateau fractures extending into the posterior column: 2 years follow up results of a prospective study

ObjectiveTo prospectively study the outcome of surgically treated split depression lateral tibial plateau fractures extending into the posterior column using the extended posterolateral approach.MethodsTwenty-one patients with split depression lateral tibial plateau fractures (AO: 41-B3) with extension into the posterior column were treated with open reduction and internal fixation through an extended posterolateral approach with osteotomy of the fibular neck ± Gerdy tubercle. Follow up radiographs was assessed for quality of articular reduction and limb axis. Functional assessment was performed at last follow up using the Tegner–Lysholm score. Complications pertaining to the surgical approach were recorded.ResultsThe approach was performed in 15 patients with a fibular neck osteotomy alone and 6 patients required a Gerdy's tubercle osteotomy also. All fractures and osteotomies had united. Anatomical articular reduction was achieved in 16 patients. Radiological limb alignment was restored in all patients except for a reversed posterior slope in 1 patient. Arthritic changes were seen in 3 patients. The mean Tegner–Lysholm score was 87.3 (range: 76–95) at last follow up. No specific complications related to the surgical approach like common peroneal nerve injury and lateral instability of the knee was encountered.ConclusionThe extended posterolateral approach offers excellent exposure posterior to the fibular head to perform articular reduction and fixation achieving satisfactory radiological and functional results in split depression lateral tibial plateau fractures extending into the posterior column.     

髌骨钻孔减压改善全膝关节置换术后膝前疼痛

目的探讨通过髌骨钻孔减压术改善全膝关节置换术(TKA)后膝前痛的临床疗效。方法将符合标准的113例行TKA的骨关节炎患者按数字法随机分为两组:54例为减压组,TKA术中联合髌骨钻孔减压术;59例为非减压组,仅施行TKA不联合髌骨钻孔减压术。术后观察两组患者切口愈合情况、相关并发症、KSS评分及膝前痛发生率。结果两组患者切口均一期愈合,无严重并发症发生,113例均获满12个月的完整随访。KSS评分:减压组术后明显高于非减压组;术后膝前痛的发生率明显低于非减压组,差异均有统计学意义(P0.05)。结论 TKA术中联合髌骨减压术可以在一定程度上改善膝关节KSS评分及降低术后膝前疼痛的发生率。     

Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: Results at 15 years follow-up

ABSTRACT: BACKGROUND: If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed.The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique. METHODS: Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs. RESULTS: Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 +/- 18.5 and 4.2 +/- 1.0 preoperatively to 86.4 +/- 5.6 (p = 0.004) and 6.9 +/- 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 +/- 9.2 to 80.2 +/- 8.1 (p = 0.003). According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05). CONCLUSIONS: ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.     

A follow-up study of arthroscopic combined reconstruction of anterior and posterior cruciate ligaments with allograft patellar tendon

Objective： To evaluate the therapeutic effect of combined reconstruction of anterior cruciate ligament （ ACL ） and posterior cruciate ligament （ PCL ） simultaneously by using allograft patellar tendon under arthroscopy. Methods： From May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allograft patellar tendon simultaneously. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales. Results. All patients were followed up for 12-30 months （mean： 18 months ）. At the last follow-up, there was no knee extension limitation and knee flexion was between 120° and 135°, with an average of 128.38°. The Lysholm score of the 10 cases was 66. 5 ± 5. 6 before operation and 89.8 ± 3.4 at last follow up. The difference was statistically significant （ P 〈 0.01 ）. The average Tegner activity score decreased from 6.9 ± 1.7 （ range ： 4-9 ） before injury to 5.5 ± 1. 6 （rang： 2-9） at the follow-up （P=0.53）. At the end of follow-up, IKDC score was graded as A in 4 cases （40.0 % ）, B in 5 （50.0 % ）, and C in 1 （10.0%）. Of the 10 patients, 8 returned to the same sports level as before injury and 2 were under the level. Conclusion. Arthroscopic combined reconstruction of ACL and PCL with allograft patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.     

Partial Lateral Patellar Facetectomy as an Alternative to Lateral Release in Total Knee Arthroplasty (TKA)

This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.     

可吸收软骨钉多点固定治疗髌骨不稳致骨软骨骨折

目的 :观察可吸收软骨钉多点固定治疗髌骨不稳所致骨软骨骨折的疗效。方法 :自2014年8月至2016年9月收治21例髌骨脱位所致骨软骨骨折患者,其中男7例,女14例;年龄12~42岁,平均27岁。采用开放手术找到游离软骨骨折块,行可吸收软骨钉内固定术联合外侧支持带松解内侧支持带紧缩术治疗。术前、术后随访行Lysholm评分评定膝关节功能,对数据进行回顾性分析。结果:所有患者手术顺利,术后随访8~22个月,平均12个月。术后CT及X线检查示骨折块位置良好。21例患者均基本恢复伤前运动水平,膝关节Lysholm评分达86.11±4.97。结论:由髌骨不稳所致骨软骨骨折采用可吸收软骨钉能有效固定游离软骨块,操作简单、疗效满意,具有良好的临床推广意义。     

Tension band fixation for treatment of patellar fracture: Novel technique using a braided polyblend sutures and ring pins

AimTo evaluate a new tension band fixation technique for patellar fracture using braided polyblend sutures (PBSs) and ring pins (RPs).MethodsA total of 13 patients (average: 58.2 years) with transverse or comminuted patellar fractures were treated by this technique. From the 4th week after the surgery, normal activities of daily living were permissible.ResultsBone union was achieved at a mean 3 months from surgery, without any cases of failure, redislocation or postoperative complication. At 12 months after surgery, mean Lysholm score was 93.6, knee motion was extension 0.8° to flexion of 134.6° and visual analogue pain score was 0.5.ConclusionThe new tension band fixation technique using braided polyblend sutures resulted in good outcomes and is considered clinically effective for patellar fracture reduction.     

全膝关节置换术中髌骨置换与髌骨成形对膝关节功能的影响

 目的 探讨髌骨置换与髌骨成形对全膝关节置换术后膝关节功能的影响。方法 对2010年8月至11月拟行全膝关节置换术的48例(69膝)膝关节骨关节炎患者进行随机分组,髌骨置换组24例(35膝)、髌骨成形组24例(34膝)。两组患者年龄、体重、身高、体重指数、美国膝关节协会(Knee Society Score,KSS)膝评分及功能评分、髌骨评分的差异均无统计学意义。比较两组术后6周、3个月、6个月、12个月、24个月的KSS膝评分及功能评分、髌骨评分、术后膝前痛发生率及影像学表现。结果 髌骨置换组20例(30膝)与髌骨成形组20例(29膝)获得随访。术后各时点两组KSS膝评分的差异无统计学意义;6个月以后髌骨置换组KSS功能评分高于髌骨成形组,12个月以后髌骨置换组髌骨评分高于髌骨成形组,差异有统计学意义。术后各时点髌骨置换组膝前痛发生率与髌骨成形组的差异有统计学意义。术后24个月髌骨置换组与髌骨成形组术后胫股角(174.25°±0.97°与173.63°±0.48°)、髌韧带比值(1.01±0.09与1.09±0.07)、髌骨倾斜角(4.58°±0.18°与4.41°±0.19°)、髌骨适合角(2.69°±4.15°与2.56°±3.72°)、髌骨移位距离[(1.53±1.34) mm与(1.68±1.23) mm]的差异均无统计学意义。结论 全膝关节置换术中行髌骨置换可以改善膝关节和髌骨功能,降低术后膝前痛的发生率。     

Vordere Kreuzbandplastik mit proximaler Endobutton-Fixation eines Lig.-patellae-Transplantats

BACKGROUND: Interference screw fixation in ACL reconstruction with bone-patellar tendon-bone graft (BPTB) is a potential source of intraoperative complications such as graft laceration. Further problems are artifacts on MRI and screw removal in revision surgery. These problems can be avoided by using distant fixation with the EndoButton. We designed this study to evaluate the clinical as well as the subjective outcome of ACL reconstruction with BPTB graft and femoral fixation with the EndoButton. METHODS: A total of 51 patients (7 female, 44 male) were examined 2-5 years after ACL reconstruction with BPTB graft and femoral fixation with the EndoButton. We used the IKDC form, Lysholm score, Tegner activity score, and digital radiographs (AP, lateral, axial) for the evaluation. RESULTS: Of all the patients included in the study, 87% showed a "normal" or "nearly normal" knee function according to the IKDC score, Lysholm score 94.2+/-7.9, Tegner score 6.4+/-1.2, and subjective IKDC 89.9+/-11.9. Radiological signs of arthritic changes could be seen in ten cases. CONCLUSION: The clinical outcome of ACL reconstruction with EndoButton fixation is comparable to other studies on ACL reconstruction with interference screw fixation. However, since the EndoButton avoids potential problems of the interference screw fixation, we recommend this fixation technique for ACL reconstruction with BPTB graft.     

A case-control study of spontaneous patellar fractures following primary total knee replacement

Peri-prosthetic patellar fracture following resurfacing as part of total knee replacement (TKR) is an infrequent yet challenging complication. This case-control study was performed to identify clinical, radiological and surgical factors that increase the risk of developing a spontaneous patellar fracture after TKR. Patellar fractures were identified in 74 patients (88 knees) from a series of 7866 consecutive TKRs conducted between 1998 and 2009. After excluding those with a previous history of extensor mechanism realignment or a clear traumatic event, a metal-backed patella, any uncemented component or subsequent infection, the remaining 64 fractures were compared with a matched group of TKRs with an excellent outcome defined by the Knee Society score. The mean age of patients with a fracture was 70 years (51 to 81) at the time of TKR. Patellar fractures were detected at a mean of 13.4 months (2 to 84) after surgery. The incidence of patellar fracture was found to be strongly associated with the number of previous knee operations, greater pre-operative mechanical malalignment, smaller post-operative patellar tendon length, thinner post-resection patellar thickness, and a lower post-operative Insall-Salvati ratio. An understanding of the risk factors associated with spontaneous patellar fracture following TKR provides a valuable insight into prevention of this challenging complication.     

关节镜下改进紧缩髌骨内侧支持带治疗复发性髌骨脱位

目的 探讨关节镜下改进紧缩髌骨内侧支持带治疗复发性髌骨脱位的疗效.方法 我科于2013年7月至2015年7月收治复发性髌骨脱位病人23例,男4例,女19例,年龄为10~25岁,平均为15.8岁.手术在关节镜下操作,用等离子刀常规进行松解髌骨外侧支持带,用ACCU PASS自动连续传递缝合钩将PDS缝线四等分整体跨越髌骨内侧支持带,采用对称集中打结法拉紧缝线,实现对髌骨内侧支持带的有效紧缩.术后鼓励病人在膝关节支具保护下早期进行功能锻炼.比较手术前后Lysholm膝关节评分、Tegner膝关节运动水平评分和髌骨外移度.结果 单膝的关节镜下操作时间为40~55 min,平均为46.4 min.术中实现髌股关节面复位,屈膝关节活动(0°~90°)时髌骨活动轨迹满意,病人没有发生再脱位.随访时间为18~36个月,平均为24.6个月.末次随访时病人髌骨位置满意,膝关节静息位或屈伸活动时未发生髌骨再脱位.术后18个月Lysholm膝关节评分为(79.6±5.4)分、Tegner膝关节运动水平评分为(5.4±0.9)分、髌骨外移度为(3.8±1.1)mm与术前的(51.9±7.9)分、(2.8±1.2)分、(11.8±2.1)mm比较,差异均有统计学意义(均P<0.05).结论 关节镜下采用ACCU PASS自动连续传递缝合钩可以方便对髌骨内侧支持带紧缩的操作,PDS缝线行对称集中式打结能获得坚强的固定紧缩效果,本方法具有操作便捷、固定强度好、膝关节功能恢复快、近期疗效好的特点.     

Patella resurfacing in posterior stabilised total knee arthroplasty: a follow-up study in 56 patients

Patellar resurfacing in total knee arthroplasty (TKA) remains controversial. This study evaluates the results of resurfacing and non-resurfacing of the patella. Fifty-six patients with osteoarthritis (OA) of the knee were enrolled in a prospective randomised clinical trial using a posterior-stabilised TKA. Evaluations were done preoperatively and after 1, 3, 6, 12 and 24 months. Disease specific (Knee Society Score or KSS) and functional (patella-related activities) outcomes were measured. Patient satisfaction and anterior knee pain questionnaires were completed. No patients were lost to follow-up. No significant differences were found between groups with regard to the clinical part of the Knee Society score (KSS) not even in obese patients, the ability of performing daily activities involving the patellofemoral joint, and patient satisfaction. Significant differences were found regarding the functional section of the KSS, passive flexion, anterior knee pain and patellar tilt and subluxation. In conclusion, the authors believe that, for the implant studied, patellar resurfacing can be indicated.     

同种异体骨－髌腱－骨重建后交叉韧带的手术技巧与中期疗效研究

目的探讨关节镜下同种异体骨－髌腱－骨（B—PT—B）重建后交叉韧带（PCL）的手术技巧与临床疗效。方法2002年5月～2004年9月对19例PCL损伤的患者在关节镜下利用同种异体髌腱重建PCL,并按照国际膝关节评分委员会（IKDC）、Lysholm和Tegnar膝关节评分标准评价疗效。结果所有患者术后获50～70个月（平均59个月）的随访。术后无伸膝受限,最后随访时屈膝活动度为125°～140°（平均130．5°）。Lyrsholm膝关节功能评分术前为（67．2±5．9）分,终末随访时为（93．2±5．5）分,手术前后的差异有统计学意义（t=0．021,P〈0．01）。Tegnar运动能力评价表在初次受伤前为（5．2±1．2）分;受伤后术前为（2．1±0．5）分;随访结束时为（5．0±1．5）分。受伤前和随访结束时评分间的差异无统计学意义（t=0．93,P〉0．01）。终末随访IKDC评分：A级11例（57．9％）,B级6例（31．6％）,C级2例（10．5％）。结论关节镜下同种异体髌腱重建PCL手术操作精细、创伤小、结果可靠,术后膝关节功能恢复满意。利用B—PT—B重建PCL需要改良技术以使手术更加顺利地完成。     

Patellar Rebar Augmentation in Revision Total Knee Arthroplasty

BackgroundIn revision total knee arthroplasty, osteolysis, mechanical abrasion, and infection may leave patellar bone stock severely attenuated with cavitary and/or segmental rim deficiencies that compromise fixation of patellar implant pegs. The purpose of this study was to retrospectively review the use of cortical “rebar” screws to augment cement fixation in revision patelloplasty.MethodsFrom 2006 to 2018, dorsal patellar rebar technique was used for patellar reconstruction in 128 of 1037 revision total knee arthroplasty cases (12.3%). Follow-up was achieved with serial radiographs and prospective comparison of Knee Society Scores (KSSs) for clinical outcome. Complications and implant failures requiring reoperation or modified rehabilitation were also assessed.ResultsOf the 128 patellar revisions performed using the rebar technique, 69 patients were women and 59 patients were men. The average age of the group was 69.5 years (range, 32-83 years). The mean follow-up of the cohort was 37 months (range, 13-109 months). The most common causes for revision were kinematic conflict, periprosthetic joint infection, and aseptic loosening. The median number of rebar screws used was 5 (range, 1-13). Preoperative KSSs for the study cohort averaged 50 (range, 0-90) At latest follow-up, mean KSS was 85 (range, 54-100). There were 4 patellar-related complications (3.1%) with no implant failures at study conclusion. Retrieval analysis revealed rigid fixation of the reconstructed patellar component in all cases.ConclusionsPatellar rebar screw augmentation is a useful technique when there are significant cavitary deficiencies and limited segmental rim deficiencies. This technique allows the surgeon to extend indications for patellar revision arthroplasty.     

关节镜下Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱重建膝关节交叉韧带的病例对照研究

目的：探讨关节镜辅助下应用Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱,重建膝关节前交叉韧带（anterior cruciate ligament,ACL）和后交叉韧带（posterior cruciate ligament,PCL）的近期临床疗效.方法：2009年1月至2010年6月在关节镜下采用异体肌腱联合应用Rigidfix交叉钉与Intrafix固定钉治疗ACL或PCL损伤34例,分为两组：ACL重建组（A组）和PCL重建组（B组）.A组24例,男19例,女5例;平均年龄（31.83±9.57）岁;在关节镜下移植同种异体肌腱重建ACL,股骨侧用Rigidfix交叉钉固定,胫骨侧用Intrafix固定钉固定.B组10例,其中男8例,女2例;平均年龄（27.20±7.59）岁;在关节镜下移植同种异体肌腱重建PCL,股骨侧用Intrafix固定钉固定,胫骨侧用Rigidfix交叉钉固定.术后即行前后抽屉试验及Lachman试验检查膝关节稳定性,并随访患者18个月以上,采用膝关节Lysholm评分和Tegner评分进行疗效评估.结果：34例均获随访,时间18～26个月,平均（20.79±2.39）个月.所有患者术后疼痛症状消失,前、后抽屉试验及Lachman试验阴性.A组术前Lysholm评分43.04±7.57,术后6、12、18个月增加至85.41±4.68、92.50±3.05和93.45±2.57;术前Tegner评分2.62±0.92,术后6、12、18个月分别增加至7.45±1.14、8.58±0.77和8.95±0.55.B组术前Lysholm评分46.20±8.27,术后6、12、18个月分别增加至86.40±5.14、90.40±2.67和92.00±3.85;术前Tegner评分2.00-0.66,术后6、12、18个月分别增加至7.10±0.99、8.60±0.84和8.80±0.42.两组患者各时间点Lysholm和Tegner评分差异均无统计学意义.所有患者术前Lysholm评分43.97±7.79,术后6、12、18个月分别增加至85.70±4.76、91.88±3.06和93.02±3.01;术前Tegner评分2.44±0.89,术后6、12、18个月分别增加至7.35±1.09、8.58±0.78和8.91±0.51.随访期间无明显排异反应及严重并发症发生.结论：关节镜下采用Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱重建膝关节交叉韧带方法简?