The geometry of patella and patellar tendon measured on Knee MRI

This study provides the geometry of patella and patellar tendon measured on sagittal and axial magnetic resonance images of 172 knees (142 males, 30 females) of 163 subjects (135 males, 28 females) whose mean age was 26.7. The gender difference and the relationship with anthropometry were also given. As for patella, the longitudinal lengths of the whole and articulating surface were 44.6, 32.9 mm, and the thickness was 22.3 mm. The mediolateral width was 45.8 mm, and the central ridge was located 19.9 mm or 43% lateral from the medial border. As for patellar tendon, the longitudinal length was 40.2 mm. The widths of proximal and distal part were 30.3, and 24.0 mm. The thicknesses of proximal and distal part were 3.2, and 5.0 mm. The geometry of the patella and patellar tendon was larger in male than in female (P < 0.001). Anthropometry including weight, height, body mass index corresponds well with the thickness of patella but poorly with the length of patellar tendon. These data can provide useful information in the field of knee surgery and sports medicine.     

Reconstruction of a patellar tendon with Achilles tendon allograft for severe patellar infera — A case report

Severe patellar infera accompanied by pathologic shortening and fibrosis of the patellar tendon is relatively an uncommmon condition but can cause recalcitrant joint stiffness and limited range of motion after knee surgery or injury. This report presents a case of a 49-year-old male with severe patellar infera and limping due to joint stiffness after three-time knee surgeries. We report a successful outcome along with a finding of the well-healed allograft after the reconstruction of a patellar tendon using Achilles tendon-bone allograft.     

Patellar tendon lengthening and augmentation with quadriceps tendon graft for treatment of severe patella infera

BackgroundPatella infera represents a permanent abnormally low position of the patella with three characteristics: distal position of the patella in the femoral trochlea, permanent shortening of the patellar tendon, and decreased distance between the inferior pole of the patella and the articular surface of the tibia. Several surgical techniques have been described to resolve this disabling condition with varying outcomes.HypothesisLengthening of the shortened patellar tendon with augmentation using a quadriceps tendon graft in combination with excessive intra-articular release improve knee function in patients presenting with severe and permanent patella infera.MethodsNine patients (four males, five females) with significant patella infera were treated between 2004 and 2020. The low position of the patella was documented using the Caton–Deschamps index. The Tegner Lysholm knee scoring scale and the Numerical Rating Scale (NRS) for pain were used as outcome measures before surgery and at follow up. Complete data were available in 100% of cases at 12 months follow up, and in 78% at final follow up.ResultsThe average follow up was 4.2 years (range, 1–16 years). The Tegner Lysholm score improved from a mean preoperative score of 43.8 to a mean postoperative score of 80.5. The median NRS status decreased from an average of 6.7 (range, 5–8) to 2.3 (range, 1–7). The median preoperative flexion was 103.3° (range, 40–125°), rising to 126.6° (range, 40–145°). The median preoperative Caton–Deschamps ratio of 0.32 (range, 0–0.6) improved to 0.99 (range, 0.9–1.1) at final follow up. Two patients needed additional surgical treatment (arthroscopic scar tissue removal and proximalisation of the tibial tuberosity).ConclusionLengthening of a shortened patellar tendon with augmentation using a quadriceps tendon graft combined with excessive intra-articular release is an individually adapted surgical salvage procedure to treat permanent patella infera. It improves knee function and yields good to excellent results in most cases.     

大脑性瘫痪患者的体感诱发电位和运动诱发电位分析

目的；观察大脑性瘫痪（脑瘫，CP）患者体感诱发电位（SEP）和运动诱发电位（MEP）的表现。方法：对15例CP患者作四肢SEP和磁刺激MEP测试，并与对照组进行比较。结果：14例CP患者SEP中有3例异常，异常率21％，15例CP患者中MEP有14例异常，异常率93％，与临床表现相一致。结论：SEP和MEP可检测神经感觉和运动通路功能状况，对CP的诊断可提供客观依据。     

短期负荷下p38抑制剂对兔髌腱及止点炎症因子的影响

背景:p38抑制剂干预治疗相关疾病已经取得了很好的成效,但是关于短期大强度负荷下p38抑制剂对兔髌腱及髌骨髌腱结合部中炎性反应的影响仍有许多疑问。目的:在实验室建立的定量跳跃动物模型上,观察短期内大强度运动负荷下,p38抑制剂对兔髌腱及髌骨髌腱结合部中主要炎性因子白细胞介素1β、白细胞介素6和转化生长因子β1表达的影响。方法:34只18周龄新西兰大白兔,随机分为对照组(n=4)、跳跃组1,3,5 d(n=5)及跳跃+p38抑制剂组1,3,5 d(n=5)。各跳跃组进行电刺激跳跃训练,每次电刺激引发兔向前上方跳跃,跳跃高度达到10 cm定义为合格,每次训练共进行150次合格跳跃。跳跃+p38抑制剂组在每次训练后腹腔注射SB203580(0.5 mg/kg),对照组不训练,预适应过程及饲养时间相同。各组训练结束后麻醉处死取材,采用SABC法对组织进行免疫组织化学染色,并通过Metamorph图形处理软件对各炎症因子的阳性细胞密度进行定量计算。结果与结论:①髌腱及髌骨髌腱结合部中白细胞介素1β、白细胞介素6和转化生长因子β1的免疫组化结果显示,短期大强度负荷运动下髌腱及髌骨髌腱结合部的炎症因子变化情况不一致;②与跳跃组相比,跳跃+p38抑制剂组髌腱与髌骨髌腱结合部中3个炎症因子白细胞介素1β、白细胞介素6和转化生长因子β1的表达水平均没有显著变化(P>0.05);③结果提示大强度运动后急性期p38抑制剂可能不会影响髌腱及腱止点的炎症反应。     

The knee kinematic pattern associated with disruption of the knee extensor mechanism in ambulant patients with diplegic cerebral palsy

Failure of the knee extensor mechanism is a potentially disastrous complication of diplegic cerebral palsy and if left undiagnosed may lead to a cessation of independent walking. The disruption of the extensor mechanism usually occurs through or distal to the patella. The aim of this article is to describe the knee kinematic pattern associated with such knee pathology. We also present a mathematical model of knee crouch that leads to this problem. In a retrospective review of patients with radiographically proven disruption, we compared the postfailure clinical and kinematic data to premorbid data. All patients included in this study had attended our clinical Gait Analysis Laboratory on two occasions. In the patients with disruption of the extensor mechanism, the kinematic pattern changed from crouch with shock absorption to one of increased crouch and loss of shock absorption. Clinical characteristics included knee flexion contracture and increased hamstring tightness. We demonstrate how the prefailure crouch position of the knee increases the flexor moment arm about the knee. We suggest that this knee crouch position during walking is the primary cause of pathology. Failure of the knee extensor mechanism is associated with a distinctive knee kinematic pattern. Regular gait analysis can help identify this pathology and enable treatment to be planned accordingly. Clin. Anat. 23:586–592, 2010. © 2010 Wiley‐Liss, Inc.     

Soft tissue surgery for equinus deformity in spastic hemiplegic cerebral palsy: effects on kinematic and kinetic parameters

The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.     

Kinect v2 based system for gait assessment of children with cerebral palsy in rehabilitation settings

Abstract

Cerebral palsy (CP) describes a group of disorders of movement, posture and balance caused by a non-progressive brain injury in the immature brain. It is the most prevalent cause of chronic motor disability in childhood, and although two thirds of CP children are able to walk, they show gait limitations. In this context, rehabilitation therapy can improve muscle balance and gait. Previous studies showed the importance of gait analysis as part of multidisciplinary tools for effective rehabilitation treatment. However, the high cost and the infrastructure required for the implementation of commercial gait analysis systems as well as the time-consuming preparation procedures, limit the access to this service. A low cost, non-restrictive, portable and of simple operation and installation system was developed based on Kinect v2 sensor. This study aims to validate it for capturing and analysing gait parameters in children with cerebral palsy. Several gait parameters from eleven CP patients with different levels of disability classified as a function of the Gross Motor Function Classification System (GMFCS) from II to III were recorded while they walked on a flat surface. The Kinect-based gait analysis system was compared with video-recording that yielded the same results. These results show the potential of Kinect to analyse gait in frail patient populations unobtrusively and with very low cost. More importantly, regarding to spatial parameters, the Kinect system was useful even for the worst case of GMFCS III that show a large gait variability with abnormal patterns.     

100例脑性瘫痪患儿的临床分析

目的从年龄、病因、诊断及治疗等方面综合观察和分析脑瘫患儿,确定其疗效结果。方法将我院脑瘫门诊康复诊治就诊的100例患儿进行回顾性研究分析,综合治疗以三个月为一疗程,参照婴幼儿运动功能评定量表(GM-FM)作为评估指标,探讨其疗效。结果患儿年龄越小,治疗时间越长,临床治疗效果越好。结论小儿脑病要早期诊断、早期干预、坚持治疗,以提高脑瘫患儿的生存质量。     

The role of the patellar tendon angle and patellar flexion angle in the interpretation of sagittal plane kinematics of the knee after knee arthroplasty: A modelling analysis

Background

Many different measures have been used to describe knee kinematics. This study investigated the changes of two measures, the patellar tendon angle and the patellar flexion angle, in response to variations in the geometry of the knee due to surgical technique or implant design.

Eye hand coordination in children with cerebral palsy

Reaching to grasp an object of interest requires complex sensorimotor coordination involving eye, head, hand and trunk. While numerous studies have demonstrated deficits in each of these systems individually, little is known about how children with cerebral palsy (CP) coordinate multiple motor systems for functional tasks. Here we used kinematics, remote eye tracking and a trunk support device to examine the functional coupling of the eye, head and hand and the extent to which it was constrained by trunk postural control in 10 children with CP (6–16 years). Eye movements in children with CP were similar to typically developing (TD) peers, while hand movements were significantly slower. Postural support influenced initiation of hand movements in the youngest children (TD & CP) and execution of hand movements in children with CP differentially depending on diagnosis. Across all diagnostic categories, the most robust distinction between TD children and children with CP was in their ability to isolate eye, head and hand movements. Results of this study suggest that deficits in motor coordination for accurate reaching in children with CP may reflect coupled eye, head, and hand movements. We have previously suggested that coupled activation of effectors may be the default output for the CNS during early development.     

髌韧带与膝交叉韧带的血供及其在交叉韧带损伤重建中的意义

目的　探讨髌韧带和膝交叉韧带的血供特点,为临床韧带重建提供形态学依据。 方法　通过成人和胎儿股动脉红色乳胶灌注并解剖剥离、胎儿墨汁灌注组织透明和组织切片等方法,观察髌韧带和膝交叉韧带的动脉分布特点并测量胎儿韧带内微血管密度。 结果　髌韧带的动脉来自膝下外动脉、胫前返动脉、膝降动脉和膝下内动脉的分支;胎儿髌韧带不同区域微血管密度不同,且以韧带中心部为最低。前、后交叉韧带的动脉分别来源于膝中动脉、髌下脂肪垫以及膝下外动脉的分支。多数韧带内血管沿长轴走行,同时也有横向交通的小血管,血管网呈梯状或平行的丛状。近侧端和远侧端较密而中间部相对稀疏。 结论　①髌韧带和膝交叉韧带均存在中心部乏血管区;②韧带两端血供最丰富,且近侧段好于远侧段;③髌韧带血供优于膝交叉韧带,髌韧带重建交叉韧带具有血供基础。     

脑性瘫痪儿童红外热成像特点观察研究

目的　探讨脑瘫儿童热像特点,为临床应用热像观察脑瘫患儿提供参考。 方法　选取广州市社会儿童福利院中符合入选标准的脑瘫儿童（n=42）和正常儿童（n=42）分别作为观察组和对照组,使用TMI-BX1便携式红外线热影像测温系统采集儿童全身热像,通过计算机抓取额头、前胸、上腹、下腹、脊椎T4、脊椎T12、脊椎L4、左手心、右手心、左足背、右足背共11个点的平均温度值,并统计分析。 结果　两组的左右侧肢端温度差异无统计学意义（P>0.05）,两组的头面及躯干温度均高于四肢肢端温度（P<0.01）;最高温度与最低温度的极差,观察组大于对照组（P<0.05）;两组的头面温度分别低于其腹部温度,两者差异均有显著意义（P<0.01）;观察组腹部温度高于背部温度,对照组反之,两组间比较差异有显著意义（P<0.01）。 结论　脑瘫儿童腹部温度高于背部温度,正常儿童均反之,此热像特点可为临床研究提供参考。     

The relationship between breast milk intake and speech in children with cerebral palsy

Background/aimCerebral palsy (CP) is a nonprogressive neurodevelopmental disorder that cause damage to the developing brain (0–3 years) for various reasons. Children with CP commonly have speech disorders due to impairment in neuromuscular control of oro-motor coordination. We focused on the relationship between breast milk intake and speech functions in children with CP.Materials and methodsThe gross motor function classification system (GMFCS) was used to categorize the gross motor function. The viking speech scale (VSS) was used to classify the speech in children with cerebral palsy. Children were subdivided into two groups as term and preterm based on gestational age. The duration of exclusive breast milk intake was defined as the period when the infant received breast milk alone. We used Spearman’s correlation coefficient to evaluate the relationship between the duration of breast milk intake, GMFCS, and VSS.Results The median level of viking speech scale was 2 in preterm-born children and 4 in term-born children. There was no correlation between age and VSS levels.We observed a statistically significant difference in terms of preterm- or term-born status among children with different VSS levels. There was a weak positive correlation between birth weight and VSS level, indicating better speech function in children with lower birth weight. There was a moderate negative correlation between the duration of exclusive breast milk intake, the total duration of breast milk intake, and the corrected age of weaning completion with VSS level.Conclusion The duration of breast milk intake may reflect the oromotor function and predict speech performance in children with cerebral palsy. We wanted to emphasize that speech language therapy is as important as motor rehabilitation.     

脑瘫患儿头颅MR与病因、智能发育相关性研究

对１５０例脑瘫患儿的头颅ＭＲ及智能发育进行了检测,结果表明：ＭＲ１４例正常,１３６例异常,将ＭＲ成像结果与ＤＱ及病因分别进行对比研究,发现ＭＲ异常者ＤＱ发育明显落后于正常者。ＤＱ异常率由高到低排列次序依次为脑发育畸形,脑室周围白质软化（ＰＶＬ）,脑萎缩,脑软化。     

Long-term follow up of extensor tendon ruptures of the knee using electromyography and three-dimensional gait analysis

BackgroundThe aim of this study was to analyze the long-term outcomes of extensor tendon ruptures of the knee using exact measuring tools.MethodsThe results of patients treated for extensor tendon rupture with a minimum follow up of 10 years were reviewed. Electromyography (EMG) and three-dimensional (3D) gait analyses were performed and compared with the healthy side of each patient and with the gait patterns of 20 healthy controls. Functional outcome scores were assessed using the Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS).ResultsAfter a mean of 13.4 ± 3 years, 23 patients were available for follow up. The mean Lysholm score was 86.6, and the KOOS averaged 78.1. Gait analysis showed no major kinematic differences between these patients compared with healthy controls. In the squat test, the mean peak amplitude of the rectus femoris muscle was significantly smaller on the injured side than on the healthy side (140.21 ± 66.13 μV vs. 168.25 ± 91.77 μV; P = 0.01). The mean peaks of the vastus lateralis and medialis EMG signals were also lower on the injured side (P = 0.63; P = 0.08). Correspondingly, the thigh girth at 20 cm and 10 cm above the knee was significantly lower on the injured side. One patient had re-rupture after patella tendon repair.ConclusionAt long-term follow up the patients reached good clinical outcomes and exhibited mainly physiological gait patterns after rupture of knee extensor tendons. However, the thigh muscles showed hypotrophy and a significantly smaller EMG signal amplitude during a high-intensity task on the formerly injured side.     

神经节苷脂治疗婴幼儿大脑性瘫痪临床研究

目的：探讨神经节苷脂治疗婴幼儿大脑性瘫痪（脑瘫）的临床疗效。方法：将84例脑瘫患儿随机分为治疗组和对照组,各42例。两组性别、年龄、临床分型、伴随疾病、头颅CT及发病因素等对比差异均无显著意义（P〉0．05）。两组均采用支持、对症、脱水和降颅压等常规治疗,并予以物理疗法、针灸、按摩、高压氧等综合治疗,治疗组患儿同时加用神经节苷脂2ml（20mg）,加入5％葡萄糖注射液250m1中静脉滴注,每日1次,10d为1个疗程。停药20d后进入下一个疗程,连续治疗6个疗程。结果：与对照组相比,洽疗组治疗后发育商评分明显上升,头颅CT阳性率显著降低。治疗组总有效率为95％（40／42）与对照组的79％（33／42）相比差异有显著意义（P〈0．05）。结论：神经节苷脂治疗婴幼儿脑瘫的临床疗效确切。     

关于先天性聋哑脑瘫遗传咨询效果的研究

目的研究先天性聋哑、脑瘫患者病残儿鉴定后生育第二胎发病情况。方法对连续6年政策允许批复生育二胎后生育状况调查1104人,对第二胎患先天聋哑脑瘫患者有专家组织复诊并统计分析。结果二组比较第二胎患病率明显降低,先天性聋哑较脑瘫组明显增高。结论病残儿鉴定的遗传咨询、生育指导效果明显,但遗传病得到完全控制尚有一定难度。建议生育过先天性聋哑等遗传病的夫妇最好不要生育二胎。     

10例以脑发育不良为主要特征的脑瘫患儿的遗传学病因分析

目的探讨脑瘫患儿的遗传学病因。方法对表型存在差异的1对双胞胎脑瘫患儿进行全基因组测序,对另外8例脑瘫患儿进行全外显子组测序,用自定义的过滤流程对所发现的基因变异进行筛选,探讨可能与脑瘫相关的生物学通路和基因。结果共发现3个与脑瘫相关的生物学通路,分别为轴突导向通路(axon guidance)、化学突触传播(transmission across chemical synapses)和突触处蛋白相互作用(protein-protein interactions at synapses),同时发现25个脑瘫易感基因。结论对脑瘫相关的分子机制进行了初步探讨,可能为脑瘫的药物开发提供新的线索。     

Diffusion tensor imaging demonstrates focal lesions of the corticospinal tract in hemiparetic patients with cerebral palsy

The purpose of this study was to use diffusion tensor imaging (DTI) with fiber tractography (FT) to demonstrate focal lesions of the corticospinal tract (CST) in hemiparetic patients with cerebral palsy (CP) who showed no specific focal lesions on conventional brain MRI. Four hemiparetic patients with CP (three left hemiparesis, mean age: 2.5 years, range: 0.9–7.0) and four age-matched controls were recruited. DTI was performed using a 1.5-T system with a synergy-L Sensitivity Encoding head coil. Fractional anisotropy (FA) and apparent diffusion coefficients (ADC) were measured using the region of interest (ROI) method. We estimated the asymmetric anisotropy index (AA) and asymmetric mean diffusivity index (AD) to evaluate the asymmetry between right and left CSTs. All four patients showed interrupted FT at the affected periventricular white matter (PVWM) level compared to that of the opposite side; this was not detected on conventional brain MRI and explained the hemiparesis of these patients. Compared to the data of controls, all patients showed significant AA and AD only at the PVWM level. DTI with FT demonstrated focal lesions at the PVWM level. We conclude that DTI with FT may be a useful modality for investigating focal lesions in hemiparetic patients with CP.