高低位髌骨测量方法比较及其与膝关节骨性关节炎的相关性

目的通过对一定量样本的正常膝关节正侧位X线片进行骨形态学测量及相关比值分析研究,并利用计算机作为辅助测量技术,得出膝关节相关参数的正常范围,明确高、低位髌骨与膝关节骨性关节炎(KOA)之间的相关性。方法将标准体位正常膝关节及KOA患者的X线片影像导入装有Image Proplus软件的电脑中,利用Image Proplus软件测量工具进行膝关节测量。测量指标:髌韧带长度/髌骨纵径,髌骨关节面下缘距胫骨平台距离/髌骨关节面长度,髌骨下缘距间隙距离/股骨髁宽度,髌骨纵径/髌骨关节面高,髌骨厚度/髌骨纵径。采用SPSS 17.0软件对各有关比值数据进行处理和分析,采用90%医学参考范围为正常参考范围描述。结果 Insall-Salvati法正常髌骨位置90%医学参考范围0.840 194~1.361 644,Blakburne-Peel法正常髌骨位置90%医学参考范围0.684 783~1.216 607。481例KOA中,Insall-Salvati法以正常值0.8~1.2为标准,正常382例(79.42%),低位髌骨18例(3.74%),高位髌骨81例(16.84%),检出异常率20.58%;Blakburne-Peel法以正常值0.8~1.0为标准,正常206例(42.83%),低位髌骨189例(39.29%),高位髌骨86例(17.88%),检出异常率57.17%。Blakburne-Peel法检出异常率较Insall-Salvati法高,差异有统计学意义(χ2=164.058,P0.001)。结论Blakburne-Peel法对高位髌骨、低位髌骨的检出率较Insall-Salvati法高。     

膝关节骨性关节炎的X线影像学分析

为了详细了解膝骨性关节炎的病理进程,应仔细分析Ｘ线片,从影像学角度评价膝关节的退变。1　临床资料根据《矫形外科学》对本病的定义[1],本组病例除外继发性膝骨性关节炎,共90例、150个膝关节。其中女性66例,男性24例;年龄35～76岁。双侧发病者60例,单侧发病30例,其中左膝16例,右膝14例,共150个膝关节;发病时间最短者一周,最长者21年。2　Ｘ线影像学资料90例150膝均拍摄膝关节正、侧、轴位Ｘ线片,观察测量有关数据。21　膝关节正位片(1)股骨角:股骨下端关节面连线与股骨下段轴线所成外侧夹角,正常值为75°～85°[3](如图1所示),小于75°为…     

膝骨关节炎病因、X线片及临床表现分析

目的探讨国人膝骨关节炎病因,临床表现和Ｘ线片的相关性,为临床诊治提供依据。方法对骨科门诊膝骨关节炎患者进行病因,临床表现调查,摄单腿站立位膝关节正侧位、髌骨轴位片,分析Ｘ线征象并作骨关节炎分级、分型。结果膝骨关节炎原发性占８７％,继发性占１３％,膝骨关节炎分型：初期型３８％,股型２８．５％,内侧－髌股型２３．２％。随关节炎分类程度的加重,稞症状向严重发展（Ｐ〈０．０１）。胫股角越大,Ｘ线分级趋向病     

术前负重位双下肢全长数字化X线测量在全膝关节置换术中的应用

目的 探讨术前负重位双下肢全长数字化X线片(Digital radiography,DR)测量截骨参数在全膝关节置换术中的应用情况及对手术效果的影响.方法 回顾性分析自2019-10-2020-10完成的104例单侧全膝关节置换术,其中58例根据术前负重位双下肢全长DR片测量结果截骨(DR组),46例以股骨外翻角5°和...     

膝关节损伤影像比较

目的探讨传统的影像检查方法（X线、CT）及MR成像技术对膝关节外伤性骨损伤的诊断价值。方法对85例因外伤临床膝关节有疼痛及功能障碍的患者进行X线、CT及MRTIWI／TSE,T2wI／TSE,STIR序列扫描,并作结果比较。结果46例X线平片明确诊断有骨折;11例x线平片检查未见异常,CT显示骨皮质断裂;28例X线及CT骨结构均未见异常,MRI表现：T1WI呈不规则网状、地图状低信号,T2WI呈片状高信号改变,STIR序列呈明显高信号,并与其病理改变相符合。同时MRI还能反应出合并的半月板、韧带损伤及关节腔（囊）内积血情况。结论X线是常规检查方法,CT检查是常规X线检查方法的补充,可发现细小骨皮质及骨小梁改变,MR检查明显优于传统影像学检查,它有助于提高诊断敏感性,增加临床对外伤性骨损伤的认识,为临床得到及时有效的治疗方案提供影像依据,有利于关节损伤后功能的恢复。     

膝关节周围截骨术治疗膝关节骨关节炎

膝关节骨关节炎(KOA)的手术治疗方式有多种,膝关节周围截骨术作为可保留膝关节的一种术式,近来逐渐受到重视,尤其是对年轻、活动量较大的患者,可有效缓解骨关节炎症状,并为后期可能的膝关节置换等手术保留一定骨量。膝关节周围截骨术包括胫骨近端内侧开放楔形截骨术、胫骨近端外侧闭合楔形截骨术、股骨远端内侧闭合楔形截骨术、股骨远端外侧开放楔形截骨术、腓骨上段截骨术等,适用于治疗不同类型的KOA。该文就近年膝关节周围截骨术治疗KOA研究进展作一综述。     

髌骨骨-软骨骨折诊治分析

髌骨骨-软骨骨折因骨折块较小,X线片不易显示,容易漏诊。其骨折块于关节腔内形成游离体,若不及时处理对膝关节危害较大。我们2000年5月～2004年6月治疗髌骨骨-软骨骨折55例,疗效良好。     

全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位

目的评估全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位患者的临床疗效。方法对6例膝骨关节炎合并固定性髌骨脱位的患者(8膝)行全膝关节置换术。采用标准内侧髌旁入路,并行“+”形松解外侧支持带,常规髌骨置换,使用非限制性后稳定假体。比较手术前后的HSS评分和疼痛VAS评分,测量股骨胫骨角(FTA)和伸膝迟滞。结果患者均获得随访,时间1~8年。HSS评分从术前25~63分提高到术后1年75~94分。VAS评分从术前5~8分下降至术后1年0~3分。FTA从术前161°~173°改善至术后1年173°~175°。术前有10°~25°的伸膝迟滞,术后基本消失。结论采用标准内侧髌旁入路结合外侧结构的松解作全膝关节置换术治疗膝骨关节炎合并固定性髌骨脱位可获得良好的临床疗效。     

膝关节骨关节炎43例的核素骨显像分析

膝关节骨关节炎(OA)是老年人的常见病和多发病.以往对此病主要依靠X线诊断.自2005年1月～2006年6月,笔者共收治43例,发现核素骨显像对其诊断有其独特的价值.现报告如下.     

The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection

BackgroundIt remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI.MethodsTwo-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively. All original patellar components and cement were removed during resection and the patella was resurfaced whenever feasible during reimplantation. PROMs, implant survivorship, and radiographic measurements (patellar tilt and displacement) were compared between knees reimplanted with a patellar component versus those without a patellar component.ResultsA total of 103 patients met the inclusion criteria. Forty-three patients (41.7%) underwent reimplantation with, and 60 patients (58.3%) without a patellar component. At a mean follow-up of 33.5 months, there were no significant differences in patient demographics or PROMs between groups (P ≥ .156). No significant differences were found in the estimated Kaplan-Meier all-cause, aseptic, or septic survivorship between groups (P ≥ .342) at a maximum of 75 months follow-up. There was no significant difference in the change (pre-resection to post-reimplant) of patellar tilt (P = .504) or displacement (P = .097) between the groups.ConclusionPatellar resurfacing during knee reimplantation does not appear to meaningfully impact postoperative PROMs or survivorship. Given the risk of potential extensor mechanism complications with patellar resurfacing, surgeons may choose to leave the patella without an implant during total knee reimplantation and expect similar clinical outcomes.Level of EvidenceLevel III.     

The Subchondral Bone in Osteoarthritis and Rheumatoid Arthritis of the Knee: A Histological and Microradiographical Study

Specimens of the joint surfaces of the tibia from patients with OA and RA were examined for bone mineralization, bone formation, osteoid tissue and bone resorption. Judging from the appearance of the osteoblasts in OA the sclerotic changes are mainly focal with relatively little osteogenesis. No osteoclasia was seen, in the sclerotic areas. Breakdown of the mineralized cartilage is followed by the development of cysts with highly cellular connective tissue with high osteoblastic activity and osteoclasia. Osteoid tissue is relatively sparse. The changes in RA are more diffuse with a more active osteoblastic activity and widespread zones of osteoid tissue as well as resorption by osteoclasts. It appears as if the increased uptake of ⁸³Sr in OA is more dependent on the occurrence of relatively inert osteosclerosis than on a rapid turnover of the bone tissue.     

The Knee Osteoarthritis Grading System for Arthroplasty

Background

The aim of this study is to validate the Knee Osteoarthritis Grading System (KOGS) of progressive osteoarthritic degeneration for the tri-compartmental knee. This system defines the site and severity of osteoarthritis to determine a specific knee arthroplasty.

放射性核素骨显像在老年性膝关节骨性关节炎诊治中的应用

目的：研究放射性核素骨显像在老年性膝关节骨性关节炎诊治中的应用价值。方法：通过对29例老年性膝关节骨性关节炎（osteoarthritis,OA)99mTc-MDP(亚甲基二磷酸盐）骨动态三相显像,结合临床线及关节镜分组分期对比研究。结果：发现29例患者核素骨显像中的血流相、血池相及静态相病变处摄处均较健侧明显增高,有显著性差异。结论：放射性核素骨三相显像是诊断老年性膝OA非创伤性和灵敏的手段,且对于指导治疗、预测预后具有较大的临床价值。     

The Subchondral Bone of the Proximal Tibial Epiphysis in Osteoarthritis of the Knee

The trabecular bone of the proximal end of the tibia was assessed as an endoprosthesis-bearing structure. The mass and mineral content as well as the activity of subchondral trabecular bone were determined in osteoarthritic knees with varus or valgus deformity.

Bone specimens were taken from the lateral condyle, the medial condyle, and centrally from the intercondylar area of seven varus and four valgus knees. The percentage volume of trabecular bone was determined by histomorphometry. On an additional nine knees, five with varus and four with valgus deformity, as well as ten knees from a normal autopsy material, photon absorptiometric determination of the mineral content of the same areas was performed. On average, the loaded condyle had twice the percentage volume of trabecular bone, and accordingly twice the mineral content, of the unloaded condyle. It was remarkable that the mineral content of the latter was of the same order as the condyles of the normal material.     

Osteoarthritis of the hip and Knee Joint in Retired Football Players

The possible relationship between football playing and osteoarthritis in the hip and knee joints has been examined. the results of clinical and radiographic examinations of 57 retired football players and a corresponding control group were compared. Osteoarthritis of the hip joint was found to occur significantly more often in the football players than in the controls. Such a relationship could not be found regarding the knee joint.     

The Subchondral Bone of the Proximal Tibial Epiphysis in Osteoarthritis of the Knee

The trabecular bone of the proximal end of the tibia was assessed as an endoprosthesis-bearing structure. The mass and mineral content as well as the activity of subchondral trabecular bone were determined in osteoarthritic knees with varus or valgus deformity.

Bone specimens were taken from the lateral condyle, the medial condyle, and centrally from the intercondylar area of seven varus and four valgus knees. The percentage volume of trabecular bone was determined by histomorphometry. On an additional nine knees, five with varus and four with valgus deformity, as well as ten knees from a normal autopsy material, photon absorptiometric determination of the mineral content of the same areas was performed. On average, the loaded condyle had twice the percentage volume of trabecular bone, and accordingly twice the mineral content, of the unloaded condyle. It was remarkable that the mineral content of the latter was of the same order as the condyles of the normal material.     

Size of Medial Knee Osteophytes Correlates With Knee Alignment But Not With Coronal Laxity in Patients With Medial Knee Osteoarthritis

The severity of osteoarthritis (OA) has been related to osteophyte size. However, the effects on osteophyte size of repeated and increased loading associated with joint laxity and varus misalignment remain unclear. We investigated these relationships in patients with medial knee OA and compared the performances of computed tomography (CT) and radiography for assessing osteophyte parameters. We examined knee joint alignment on radiographs and knee laxity using arthrometry in 191 patients with medial knee OA who were undergoing total knee arthroplasty. We also measured femur and tibia osteophyte distance (largest perpendicular distance from the cortical line to outer margin of the osteophyte) using radiography and CT, osteophyte areas (largest area surrounded by the outer margin of an osteophyte) by CT and determined the locations of the osteophytes in the femur and tibia by CT. We then analyzed the correlations between the variables using Spearman's rank correlation tests. Osteophyte sizes in the femur and tibia as determined by radiography (distance) or CT (distance and area) were positively correlated with the degree of varus alignment but not with medial or lateral laxity. There was also a significant correlation between maximum osteophyte distances measured by radiography and CT. The greatest number and the largest osteophytes were located in the posterior third of the femur and middle third of the tibia, respectively. Osteophyte size was correlated with preoperative knee alignment but not with knee laxity in patients with medial knee OA. Osteophyte size can be evaluated using conventional radiography, without the need for CT. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:639–644, 2020     

骨性关节炎全膝关节置换术中切除滑膜对失血量及膝关节功能的影响

目的:探讨骨性关节炎全膝关节置换术中切除滑膜对失血量和膝关节功能的影响。方法:选取初次骨性关节炎全膝关节置换术患者180例,随机分成观察组和对照组各90例。观察组在全膝关节置换手术中切除滑膜,对照组保留滑膜,观察两组手术失血量、手术时间、和手术前后的疼痛情况以及术后膝关节临床和功能评分。结果:观察组手术显性失血量(750.9±253.7)mL、隐性出血量(722.8±213.3)mL、理论总出血量(1557.2±346.8)mL和手术时间(111.3±23.9)min均明显高于对照组显性失血量(543.2±223.6)mL、隐性失血量(536.1±192.4)mL、理论总失血量(1086.7±242.9)mL和手术时间(90.6±20.2)min(P0.05);两组手术后3 d、12周和1年时的VAS评分均明显低于手术前,差异均有统计学意义(P0.05);但两组间比较差异无统计学意义(P0.05);两组术后12周和术后1年美国膝关节协会评分标准(AKSS)临床评分和功能评分比较,差异无统计学意义(P0.05);观察组术后不良反应和感染发生率为11.11%,对照组3.33%(P0.05)。结论:骨性关节炎全膝关节置换术中切除滑膜,可明显增加失血量和感染风险,但未能显著促进膝关节功能改善的作用。     

人工单髁膝关节置换术治疗膝骨关节炎

目的探讨人工单髁膝关节置换术治疗单间室膝关节骨关节炎的临床效果。方法2009年1月至2011年12月共收治15例膝关节内侧间室骨关节炎患者,术前关节平均屈曲角度127°（95°～135°）,术前美国纽约特种外科医院膝关节功能评分为48．06分（42～58分）。采用人工单髁膝关节置换术进行治疗,术后早期进行膝关节功能锻炼。结果手术时间75～110min,平均（85±9．89）min;出血量50～300mL,平均（149±45．74）mL。有1例术后7个月出现感染。其余14例均获随访,时间3～30个月。按照美国纽约特种外科医院膝关节评分标准进行疗效评估,优10例,良4例,中0例,差1例,优良率93．3％,膝关节功能评分平均82．8分（42～94分）,膝关节活动范围115°（90°～130°）。末次随访时未发现假体位置不良、假体松动,对侧间室和髌股关节无进行性病变和髌股关节疼痛等并发症。结论在严格适应证的选择下,人工单髁置换术治疗单间室膝关节骨关节炎是创伤小、出血少、效果好的治疗方法。