髌骨环治疗髌骨骨折

目的探讨髌骨环治疗髌骨骨折的疗效。方法对68例髌骨骨折患者应用髌骨环内固定。对骨折愈合情况、膝关节的疼痛及功能、影像学检查等进行评估分析。结果 62例获随访,6例失访,随访时间6~20个月。骨折平均愈合时间为3个月,无骨折再移位和内固定失效发生。根据B stman评分：优39例,良21例,差2例。术后膝关节的屈曲度为126.2°~134.6°（130.4°±2.1°）,患侧与健侧比较差异无统计学意义（P〉0.05）。结论应用髌骨环治疗髌骨骨折操作简单,固定灵活,复位满意;术后并发症少,有利于患膝早期功能锻炼,尤其适合髌骨粉碎性骨折。     

Lateral patellar retinaculum tension in patellar instability

The patellar retinaculum is important in patellar tracking. However, little attention has been paid to the biomechanics of the retinaculum. This study assessed the change in tension of the lateral patellofemoral ligament before and after anteromedial tibial tubercle transfer for patellar instability. Twenty-seven knees in 21 patients were studied and the mean age of the patients at surgery was 19 years. A buckle transducer was clamped on the lateral patellofemoral ligament and the transducer was calibrated to zero with the knee at full extension. The knee then was flexed 30 degrees, 60 degrees, 90 degrees, and 120 degrees, and the transducer recorded changes in tension within the lateral patellofemoral ligament. After anteromedial tibial tubercle transfer, lateral patellofemoral ligament tension was measured in the same manner. Although average lateral patellofemoral ligament tension increased with knee flexion with the maximum at 120 degrees flexion, these changes showed four different patterns measuring variability of patellar instability. An increase of lateral patellofemoral ligament tension after anteromedial tibial tubercle transfer meant that lateral retinacular release should be done concurrently to balance patellar tracking. This information may be useful in deciding the appropriate surgical procedure for each patient.     

Routine patellar resurfacing using an inset patellar technique

The management of the patella in total knee arthroplasty still causes controversy. Whether or not to resurface the patella in primary total knee arthroplasty remains unclear. In this study we examined 220 consecutive total knee replacements, by a single surgeon, where the patella was routinely resurfaced using the inset technique. All patellae were suitable for resurfacing. Patellar thickness was not altered in 54.5% of patellae. In 97.2% the patella was within 2 mm of the original thickness. There were no significant complications. In this study we have found that the inset technique of patella resurfacing in total knee replacement is a simple and safe resurfacing procedure.     

髌骨环治疗髌骨粉碎性骨折

目的 评估髌骨环治疗髌骨粉碎性骨折的治疗结果.方法 对31名髌骨粉碎性骨折的病人应用髌骨环内固定,术后对病人进行至少1年的随访,搜集数据主要包括术后骨折愈合时间,疼痛程度,膝关节的活动范围,并且记录Bstman评分及术后并发症.结果 骨折平均愈合时间为术后3个月,没有骨折再移位和内固定失效的发生.根据VAS(Visu...     

镍钛聚髌器治疗髌骨骨折

1997年5月～2009年6月,笔者采用镍钛聚髌器治疗髌骨骨折86例,取得良好效果. 1 材料与方法 1.1 病例资料 本组86例,男46例,女40例,年龄22～86(54±1.5)岁.右侧骨折52例,左侧骨折34例.粉碎性骨折24例.     

应用抓髌器治疗髌骨骨折的体会

应用抓髌器治疗各型髌骨骨折528例,优良率97%。抓髌器具有不切开皮肤和关节囊,不会加大软组织损伤,有利于骨折整复和固定的优点。生物力学测定证实能够维持加压固定。     

分体式髌骨爪在髌骨骨折治疗中的应用

2006年6月-2008年1月,我院应用分体式髌骨爪内固定治疗35例髌骨骨折患者,临床疗效满意。     

膝关节镜下外侧支持带松解及内侧支持带紧缩治疗急性髌骨脱位

目的探讨膝关节镜下外侧支持带松解及内侧支持带紧缩治疗急性髌骨脱位。方法1999年7月～2003年7月共对11例急性髌骨脱位患者施行膝关节镜手术,松解外侧支持带及外侧髌—股韧带,同时紧缩缝合内侧支持带及内侧髌—股韧带。结果平均随访21.2个月,所有病人均未发生再脱位,亦无残留髌骨不稳。膝关节活动度(ROM)正常。结论本术式疗效确切,具有创伤小、并发症少、功能恢复快等优点。     

交叉克氏针交叉8字钢丝环内固定治疗髌骨骨折

1990年1月～1992年1月,我们采用交叉克氏针交叉“8”字钢丝环内固定,治疗髌骨骨折共32例,经临床观察,疗效满意。现报告如下。     

Factors predisposing to patellar chondropathy and patellar apicitis in athletes

Summary Factors predisposing to patellar chondropathy (the PC group) and inferior patellar apicitis (jumper's knee — the PA group) were sought by means of a questionnaire, detailed quantitative physical measurements and radiological examination in male athletes. There were 20 athletes in the two groups who had typical symptoms and signs of each disorder. A group of 20 high-level athletes without knee symptoms served as a control group.The factors found in the PC group which differed significantly from those in the control group included increased anterior drawer sign (p<0.05), increased passive mediolateral patellar range of movement (p<0.001) and increased hyperextension (p<0.05). More leg length inequality (p<0.001) and patella alta (p<0.05) was observed in the PA group than in the controls.There was statistically significant positive correlation between the different measurements of knee laxity (anterior drawer sign, passive mediolateral patellar movement and hyperextension) in the 60 cases. The correlation coefficient between the length of the patellar tendon and passive mediolateral patellar movement was 0.82 (p<0.001).

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Résumé On a recherché, chez des athlètes de sexe masculin, à l'aide d'un questionnaire détaillant les mensurations physiques quantitatives et les résultats des examens radiologiques, les facteurs prédisposants à la chondropathie de la rotule (groupe CR) et à l'apexite patellaire inférieure (groupe AP). Dans chacun de ces 2 groupes il y avait 20 athlètes qui présentaient des symptômes typiques de l'une de ces 2 affections. Un groupe de 20 athlètes de haut niveau, asymptomatiques, a servi de groupe de contrôle (groupe C).Les facteurs trouvés dans le groupe CR qui différaient significativement de ceux du groupe C, étaient l'augmentation du tiroir antérieur (p<0.05), de la mobilité transversale de la rotule (p<0.001) et de l'hyperextension du genou (p<0.05). Dans le groupe AP, il y avait plus d'inégalités de longueur des membres inférieurs (p<0.001) et de patella alta (p<0.05) que dans le groupe C.Statistiquement, il y avait dans les 60 cas une corrélation positive significative entre les différents tests de laxité du genou. Le coefficient de corrélation entre la longueur du tendon rotulien et la mobilité transversale de la rotule était de 0.82 (p<0.001).

     

Dorsal patellar defect

A case report of a dorsal defect of patella is presented and discussed in comparison with the Osteochondrosis dissecans of the patella.     

国人髌腱长度测量在髌骨不稳诊断中的意义

[目的]比较国人正常膝关节与髌骨不稳膝关节的髌腱长度,探讨国人髌腱长度的测量在髌骨不稳诊断中的意义。[方法]2003年1月~2005年12月诊治的43例髌骨不稳患者共49膝(男15例,女28例,6例为双侧髌骨不稳);平均年龄21.4岁(18~28岁);平均身高163(155~173)cm。正常对照组为50例健康体检者共50膝(男16例,女34例);平均年龄24.2岁(18~35岁);平均身高165(154~177)cm。在屈膝30°X线侧位片上测量髌腱长度、胫骨结节至胫骨平台的距离、Insall-Salvati指数。[结果]髌骨不稳组髌腱长度为(53.3±2.7)mm,对照组为(47.3 3.3)mm,统计学上具有显著差异性(P<0.05)。Insall-Salvati指数在髌骨不稳组(1.33±0.17)和对照组(1.06±0.14)也具统计学差异(P<0.05)。胫骨平台与胫骨结节之间的距离在髌骨不稳组为(27.8±3.6)mm,对照组为(28.9±4.1)mm,统计学上无显著性差异(P<0.05)。[结论]髌腱长度过长是髌骨不稳的重要特点之一。联合测量髌腱长度和Insall-Salvati指数有助于髌骨不稳的诊断。