关节镜辅助复位内固定治疗SchatzkerⅤ~Ⅵ型胫骨平台骨折疗效分析

【摘要】 目的 探究关节镜辅助复位内固定治疗 Schatzker Ⅴ~Ⅵ型胫骨平台骨折的临床疗效。方法 选取2018 年 3 月至 2020 年 10 月正阳县人民医院收治的 116 例 Schatzker Ⅴ~Ⅵ型胫骨平台骨折患者作为研究对象, 按照随机数表法将其随机分为观察组 (58 例) 和对照组 (58 例), 观察组患者采用关节镜辅助复位内固定治疗,对照组患者采用常规切开复位内固定治疗, 对比观察两组患者术中出血量、手术时间、住院时间、骨折愈合时间等手术相关指标以及膝关节恢复情况与并发症发生情况。 结果 观察组患者术中出血量明显少于对照组 ( t =25.756, P<0.001), 手术时间、住院时间及骨折愈合时间均明显短于对照组 ( t = 2.924、8.643、4.802, P =0.004、P<0.001、P<0.001); 术后随访1年, 观察组患者术后膝关节运动功能恢复情况与对照组无明显差异(Z= -1.721, P= 0.085); 术后 6 个月及术后 1 年, 观察组患者膝关节最大活动度明显大于对照组 ( t = 12.547、16.387, P 均<0.001), 美国特种外科医院 (HSS) 评分与 Rasmussen 评分均明显高于对照组 (术后6个月: t =8.444、8.783, P 均<0.001; 术后 1 年: t = 9.002、9.358, P 均<0.001); 术后随访1年, 观察组患者术后并发症发生率为 12.07%, 明显低于对照组患者的术后并发症发生率27.59% ( χ2 = 4.393, P = 0.036)。 结论 与常规切开复位内固定相比, 关节镜辅助复位内固定治疗 SchatzkerⅤ~Ⅵ型胫骨平台骨折, 创伤更小, 骨折愈合时间更短, 更有利于术后膝关节功能及解剖结构的恢复。     

水疗康复在胫骨平台骨折术后康复中的应用效果分析

目的 研究分析水疗康复在胫骨平台骨折术后康复中的应用效果。方法 选取2021年1月至2021年12月周口市中医院收治的100例胫骨平台骨折患者作为研究对象,按照随机数表法将其随机分为观察组(50例)与对照组(50例),观察组患者术后在常规康复训练的基础上联合应用水疗康复,对照组患者术后单纯采用常规康复训练,对比观察两组患者血清碱性磷酸酶(ALP)与骨形态发生蛋白-2(BMP-2)水平、疼痛评分、最大伸膝角度与屈膝角度、膝关节功能、日常生活活动能力、临床疗效以及并发症发生情况。结果 术后1个月,观察组患者血清ALP、BMP-2水平均明显高于对照组(t=4.181、6.659,P均<0.001),视觉模拟评分法(VAS)评分明显低于对照组(t=9.453,P<0.001);术后3个月,观察组患者最大伸膝角度、最大屈膝角度均明显大于对照组(t=5.007、9.422,P均<0.001),Lysholm评分及日常生活活动量表(ADL)评分均明显高于对照组(t=11.601、12.770,P均<0.001),临床疗效明显优于对照组(Z=-2.835,P=0.005);观察...     

改良Carlson后外侧入路钢板内固定治疗胫骨平台后外侧柱骨折的临床研究

目的探析改良Carlson后外侧入路钢板内固定治疗胫骨平台后外侧柱骨折的临床效果方法选取2016年6月至2018年6月核工业四一七医院外科收治的67例胫骨平台后外侧柱骨折患者作为研究对象,并按照随机数表法将其随机分为治疗组(34例)与对照组(33例),其中治疗组患者采用改良Carlson后外侧入路钢板内固定治疗,对照组患者采用改良膝关节后外侧倒"L"形入路钢板内固定治疗,对比观察两组患者的骨折愈合时间、不良反应发生情况以及术后3、6、12个月的美国特种外科医院(hospilal for special surgery,HSS)膝关节评分与膝关节活动度(range of motion,ROM)结果治疗组患者骨折愈合时间及不良反应发生情况与对照组均无明显差异(t=1.154、χ~2=0.194,P=0.253、0.659);治疗组患者术后3个月的HSS评分及ROM均明显高于对照组(t=3.151、2.123,P=0.003、0.038),术后6个月的HSS评分及ROM也明显高于对照组(t=2.549、2.100,P=0.013、0.040),术后12个月的HSS评分及ROM与对照组无明显差异(t=1.575、0.693,P=0.120、0.491)。结论改良Carlson后外侧入路钢板内固定治疗胫骨平台后外侧柱骨折可明显促进患者的膝关节功能恢复,效果显著,值得临床推广应用。     

股骨近端防旋髓内钉与解剖型锁定钢板治疗股骨转子间骨折疗效对比

目的 对比分析股骨近端防旋髓内钉(PFNA)内固定与股骨近端解剖型锁定钢板(PFLP)内固定治疗股骨转子间骨折的临床疗效。方法 选取2018年6月至2021年6月驻马店段庄孙全贵骨科医院收治的130例股骨转子间骨折患者作为研究对象,按照随机数表法将其随机分为观察组(65例)和对照组(65例),观察组患者采用PFNA内固定治疗,对照组患者采用PFLP内固定治疗,对比观察两组患者手术相关指标、疼痛评分、髋关节功能恢复情况以及并发症发生情况。结果 观察组患者术中出血量、术后引流量均明显少于对照组(t=29.631、22.162,P均<0.001),手术时间、住院时间、术后助行器辅助负重时间、骨折愈合时间均明显短于对照组(t=17.842、12.135、43.875、18.229,P均<0.001);术后3个月,观察组患者视觉模拟评分法(VAS)评分明显低于对照组(t=9.246,P<0.001),Harris评分明显高于对照组(t=12.538,P<0.001);术后随访3个月,观察组患者术后并发症发生率为4.62%,与对照组患者的术后并发症发生率9.23%无明显差异...     

膝关节粘连性僵直36例治疗

膝关节粘连性僵直３６例治疗武警总医院骨科孙炜,姚建祥（北京１０００３９）关键词膝关节粘连性僵直,关节松解术,ＣＰＭ,Ｊｕｄｅｔ术式股骨干骨折、股骨髁上骨折、膝关节周围手＊术、关节内外感染经常会造成膝关节粘连性僵＊直,临床上处理有时较为棘手。一般认为,...     

OWHTO与TKA治疗膝关节内翻畸形的疗效对比

目的探讨内侧开放楔形胫骨高位截骨术(OWHTO)与人工全膝关节置换术(TKA)治疗膝关节内翻畸形的临床效果。方法分析2018年3月-2019年4月收治并完成术后6个月随访的84例膝关节内翻畸形患者的临床资料,依据采取术式不同分为两组,对照组(TKA治疗,42例)和观察组(OWHTO治疗,42例),观察分析两组的临床指标、疼痛程度、膝关节活动程度和功能改善情况。结果观察组手术时间及切口长度均较对照组短,术中出血量均较对照组少,差异有统计学意义(t=7.735、7.751、8.214,P=0.000);术后3 d,观察组和对照组的视觉模拟评分法(VAS)评分分别为(2.21±0.62)分、(2.74±0.61)分,观察组VAS评分较对照组低,差异有统计学意义(t=3.949,P=0.001);术后6个月,观察组的膝关节活动度(ROM)及美国HSS膝关节评分系统评分均较对照组高,差异有统计学意义(t=4.973、2.700,P=0.000、0.008)。结论采用OWHTO与TKA治疗膝关节内翻畸形患者,均可获取一定效果,但OWHTO的治疗效果更为显著,可有效促进患者病情恢复,改善膝功能,利于预后。     

膝关节镜下保留残端单束重建治疗前交叉韧带损伤疗效分析

【摘要】 目的 探讨膝关节镜下保留残端自体腘绳肌腱单束重建在前交叉韧带损伤中的应用效果。方法 选取 2018 年 12 月至 2020 年 12 月商丘市第一人民医院收治的 110 例前交叉韧带损伤患者作为研究对象,按照随机数表法将其随机分为观察组(55例) 和对照组 (55例)。 观察组患者采用膝关节镜下保留残端自体腘绳肌腱单束重建治疗,对照组患者采用膝关节镜下非保留残端自体腘绳肌腱单束重建治疗,对比观察两组患者手术时间、术后引流量、住院时间以及膝关节功能和本体感觉恢复情况。结果 观察组患者手术时间、术后引流量和住院时间与对照组无明显差异 (t = 1.648、1.700、0.332,P = 0.102、0.092、0.741); 术后6个月,观察组患者Lysholm 评分、国际膝关节文献委员会膝关节评估表 (IKDC) 评分、Tegner 评分均明显高于对照组 (t = 3.150、2.927、4.187,P =0.002、P =0.004、P <0.001); 术后 3、6 个月,观察组患者被动活动察觉阈值、被动角度再生试验值均明显低于对照组 (术后3个月: t = 2.951、2.583,P = 0.004、0.011; 术后 6 个月: t = 3.583、19.700,P =0.001、P <0.001)。结论 膝关节镜下保留残端自体腘绳肌腱单束重建可明显改善前交叉韧带损伤患者的膝关节功能,促进膝关节本体感觉恢复,疗效显著,值得临床推广应用。     

红外线照射在下肢骨折患者术后康复中的应用研究

【摘要】 目的 探讨红外线照射在下肢骨折患者术后康复中的应用效果。方法 选取 2020 年 11 月至 2021年 11 月常德市第一中医医院收治的 106 例行手术治疗的下肢骨折患者作为研究对象, 根据术后康复治疗方法将其分为观察组 (53 例) 与对照组 (53 例), 对照组患者术后单纯行常规康复锻炼, 观察组患者术后在常规康复锻炼的基础上联合应用红外线照射, 对比观察两组患者患肢肿胀程度、疼痛程度、膝关节功能及并发症发生情况。结果 观察组患者术后 4 周患肢肿胀程度明显轻于对照组 (Z = - 2.213, P = 0.027)、疼痛评分明显低于对照组 (t = 6.772, P < 0.001), 术后 6 个月膝关节功能评分明显高于对照组 ( t = 6?? 638, P < 0.001), 而并发症发生情况与对照组无明显差异 (χ2= 3.824, P = 0.051)。结论 下肢骨折术后在常规康复锻炼的基础上联合应用红外线照射辅助治疗, 可明显促进下肢骨折患者术后患肢肿胀消退? 缓解疼痛? 提高膝关节功能恢复效果。     

唑来膦酸联合复方骨肽在老年骨质疏松性椎体骨折术后的应用效果分析

【摘要】 目的 探讨唑来膦酸联合复方骨肽在老年骨质疏松性椎体骨折术后的应用效果。 方法 选取2017年7月至2019年4月安阳市人民医院收治的60例老年骨质疏松性椎体骨折患者作为研究对象, 按照随机数表法将其随机分为观察组和对照组, 每组 30 例, 观察组患者采用唑来膦酸联合复方骨肽治疗, 对照组患者单纯采用唑来膦酸治疗, 对比两组患者骨密度以及骨钙蛋白 (BGP)、骨碱性磷酸酶 (BALP) 水平变化情况。 结果 治疗3个月后, 观察组患者腰椎、大转子、髋骨骨密度以及 BGP、BALP 水平均明显高于对照组 ( t = 14.541、8.915、3.995、3.048、3.118, P＜0.001、P＜0.001、P＜0.001、P = 0.003、P = 0.002), 但股骨颈骨密度与对照组无明显差异 (t = 0.286, P = 0.775)。结论 唑来膦酸联合复方骨肽能够明显提高老年骨质疏松性椎体骨折术后患者的骨密度, 改善骨代谢水平, 值得临床推广应用。     

关节镜下后交叉韧带止点撕脱性骨折手术效果分析

目的探讨关节镜下后交叉韧带止点撕脱性骨折闭合复位内定术的疗效及可行性,为临床治疗后交叉韧带止点撕脱性骨折患者的方法选择提供参考依据。方法选取2013年8月~2014年8月佛山市中医院三水医院收治的后交叉韧带止点撕脱性骨折患者40例,随机数字表法分为观察组(n=20)和对照组(n=20)。观察组采用关节镜下后交叉韧带止点撕脱性骨折闭合复位内固定术的方法进行治疗;对照组采用传统的以切开复位内固定为主的手段进行治疗,观察比较两组患者术前、术后6周及术后半年患者Lysholm膝关节功能评分等指标的差异,对关节镜下后交叉韧带止点撕脱性骨折闭合复位内固定术的疗效进行评价。结果 40例均随访6周~6个月。术后6周,观察组只有1例骨折移位,对照组有5例出现骨折移位。观察组无伤口感染,对照组有1例伤口感染。术后6周观察组Lysholm膝关节功能评分(70.32±2.97)分,对照组Lysholm膝关节功能评分(70.12±1.51)分;术后半年观察组Lysholm膝关节功能评分(85.68±3.11)分,对照组Lysholm膝关节功能评分(72.16±2.51)分。观察组Lysholm膝关节功能评分明显高于对照组,差异有统计学意义(P0.05)。结论关节镜下后交叉韧带止点撕脱性骨折闭合复位手术能明显提高手术6周后骨折愈合情况,半年后Lysholm膝关节功能评分明显升高,是一种对治疗后交叉韧带止点撕脱性骨折比较成熟的手术方法,具有实际意义。     

Clinical consequences of bone bruise around the knee

The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derangement and to assess the impact of bone bruise on presentation and short term course of knee complaints. We recorded MR abnormalities in 664 consecutive patients with sub-acute knee complaints. Patients were divided in four groups: patients with and without intra-articular knee pathology, subdivided in patients with and without bone bruise. We assessed function and symptoms at the time of MR and 6 months thereafter. Bone bruises were diagnosed in 124 of 664 patients (18.7%). Patients with bone bruise had significantly more complete ACL, lateral meniscal, MCL and LCL tears. Both with and without intra-articular pathology patients with bone bruise had a significantly poorer function at the time of MR (Noyes score of, respectively, 313.21 versus 344.81 and 306.98 versus 341.19). Patients with bone bruise and intra-articular pathology showed significantly more decrease in activity (decrease of Tegner score from 6.28 to 2.12 versus 5.70–2.55). At 6 months there were no significant differences in clinical parameters between the four groups. We concluded that bone bruise in combination with MCL tear is an important cause of initial clinical impairment in patients with sub-acute knee complaints. Clinical improvement within 6 months is more pronounced than in patients without bone bruise.     

膝关节交叉韧带损伤的MRI诊断

目的 :探讨MRI对膝关节交叉韧带损伤的诊断价值。方法 :回顾性分析 2 5例经手术或关节镜证实的前、后交叉韧带损伤患者 ,MR检查采用SE、TSE矢状位、冠状位及横断位T1WI、T2 WI及STIR。结果 :2 5例交叉韧带损伤中 ,部分性撕裂 16例 ,完全性撕裂 9例。MRI诊断交叉韧带部分性撕裂和完全性撕裂的符合率分别为 87.5 %和 88.9%。结论 :MR能较准确地诊断膝关节交叉韧带损伤及其并发症 ,为临床制订治疗方案提供可靠依据。     

CT Arthrography and Virtual Arthroscopy in the Diagnosis of the Anterior Cruciate Ligament and Meniscal Abnormalities of the Knee Joint

Objective

To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology.

Materials and Methods

Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images.

Results

The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively.

Conclusion

CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.     

Knee loading patterns of the non-paretic and paretic legs during post-stroke gait

BackgroundPost-stoke gait disorders could cause secondary musculoskeletal complications associated with excessive repetitive loading. The study objectives were to 1) determine the feasibility of measuring common proxies for dynamic medial knee joint loading during gait post-stroke with external knee adduction (KAM) and flexion moments (KFM) and 2) characterize knee loading and typical load-reducing compensations post-stroke.MethodsParticipants with stroke (n = 9) and healthy individuals (n = 17) underwent 3D gait analysis. The stroke and healthy groups were compared with unpaired t-tests on peak KAM and peak KFM and on typical medial knee joint load-reducing compensations; toe out and trunk lean. The relationship between KAM and load-reducing compensations in the stroke group were investigated with Spearman correlations.ResultsMean (SD) values for KAM and KFM in the healthy group[KAM = 2.20 (0.88)%BW*ht; KFM = 0.64 (0.60)%BW*ht] were not significantly different from the values for the paretic [KAM = 2.64 (0.98)%BW*ht; KFM = 1.26 (1.13)%BW*ht] or non-paretic leg of the stroke group[KAM = 2.23(0.62)%BW*ht; KFM = 1.10 (1.20)%BW*ht]. Post hoc one sample t-tests revealed greater loading in stroke participants on the paretic (n = 3), non-paretic (n = 1) and both legs (n = 2) compared to the healthy group. The angle of trunk lean and the angle of toe out were not related to KAM in the stroke group.DiscussionMeasurement of limb loading during a gait post-stroke is feasible and revealed excessive loading in individuals with mild to moderate stroke compared to healthy adults. Further investigation of potential joint degeneration and pain due to repetitive excessive loading associated with post-stroke gait is warranted.     

自体中1/3股二头肌腱和股薄肌重建膝关节后外侧角韧带复合体损伤

目的 探讨采用自体中1/3股二头肌腱和股薄肌重建膝关节后外侧角韧带复合体(PLC)的技术及近期的疗效. 方法 本组21例,均为联合型的直向外侧+后外侧旋转＞Ⅱ度不稳定,重建范围:胭肌腱、外侧副韧带、胭腓韧带.术中单独提取健侧或患侧股薄肌重建膕肌腱.切取股二头肌肌腱中1/3部,折叠后对折端拉入股骨外髁骨隧道固定,分出的前束重建外侧副韧带(LCL),后束重建胭腓韧带. 结果 术后随访6～24个月,平均16个月.Lyshohn膝关节功能评分,术前为(43±2)分,术后半年为(90±3)分,有明显改进. 结论 PLC损伤可造成患肢功能受损,采用自体中1/3股二头肌腱和股薄肌修复重建韧带手术可获得良好预后.     

A biomechanical analysis of two reconstructive approaches to the posterolateral corner of the knee

The objective of this study was to evaluate the effects of the biceps femoris tenodesis and popliteofibular ligament reconstruction on knee biomechanics. Ten human cadaveric knees were tested in the intact, posterolateral corner (PLC)-deficient, and PLC-reconstructed conditions using a robotic/universal force moment sensor testing system. The knees were subjected to: (1) a 134 N posterior tibial load, and (2) a 10 Nm external tibial torque applied to the tibia at full extension, 30° and 90° of flexion. External tibial rotation of the intact knee ranged from 18.3±4.6° at full extension to 27.9±4.6° at 30° under the 10 Nm external tibial torque. These values increased after sectioning the PLC by 2.8°–7.5° at 30° and 90° respectively. After the popliteofibular ligament reconstruction, external tibial rotation values were not significantly different from those for the intact knee at any angle tested, while values following the biceps tenodesis were as much as 5.7° greater than the intact knee. Under the 134 N posterior tibial load, there were minimal decreases in posterior tibial translation of up to 0.9 mm with the biceps tenodesis and up to 1.6 mm with the popliteofibular ligament reconstruction compared to the intact knee. The in situ forces in the biceps tenodesis were not significantly different than the intact PLC at full extension or 30°, while the in situ forces in the popliteofibular graft were not significantly different at any flexion angle. Our data suggests that by restoring external tibial rotation the popliteofibular ligament reconstruction more closely reproduces the primary function of the PLC as compared to the biceps tenodesis.     

Spiral CT arthrography of the knee: technique and value in the assessment of internal derangement of the knee

Computed tomography imaging has achieved excellent multiplanar capability and submillimeter spatial resolution due to the development of the spiral acquisition mode and multidetector row technology. Multidetector spiral CT arthrography (CTA) yields valuable information for the assessment of internal derangement of the joints. This article focuses on the value of spiral CTA of the knee in the assessment of the meniscus, anterior cruciate ligament, and hyaline cartilage lesions. Advantages and disadvantages of spiral CTA with respect to MR imaging are presented.     

Recesses along the posterior margin of the infrapatellar (Hoffa’s) fat pad: prevalence and morphology on routine MR imaging of the knee

The objective is to evaluate the prevalence and morphology of recesses along the posterior margin of the infrapatellar fat pad on routine MR imaging of the knee. MR images of 213 knees in 204 consecutive individuals were evaluated with regard to the prevalence and morphology of recesses (a suprahoffatic recess close to the inferior border of the patella and the previously described infrahoffatic recess anterior to the inferior portion of the infrapatellar plica). The recesses were analyzed with regard to synovial effusion and the condition of the anterior cruciate ligament (ACL). Anatomic dissection was made in 29 knees in 16 cadavers to verify the presence of the suprahoffatic recess. The infrahoffatic recess was present in 45% of the knees and mostly linear in shape (44%). The suprahoffatic recess was detected in 71% of the knees (45% in cadavers). Very weak to moderate positive correlation was found between the synovial effusion or the condition of the ACL and the presence and dimensions of the recesses. An awareness of the recesses in the infrapatellar fat pad is important in order to distinguish between pathology and anatomic variants on routine MR imaging of the knee.