关节镜下同种异体半月板移植术后疗效观察以及关节镜二次探查报道

目的:探讨18例关节镜下同种异体半月板移植术后效果,并且对其中6例进行术后二次探查以进一步分析移植术后临床效果。方法:对18例2010年1月至2013月12月间半月板切除术后的患者,在关节镜辅助下实施同种异体半月板移植术,对患者进行了平均18.80±0.51(15~26)个月的随访,采用IKDC、Lysholm和Tegner评分进行评估比较,观察分析其恢复效果。其中6例患者术后行关节镜二次探查。结果:18例半月板移植患者行走功能正常,膝关节活动度良好,术后膝关节疼痛不适明显改善,可以完成日常活动和基本体育运动,各项评估指标如IKDC、Lysholm、Tegner评分均较术前有明显提高。其中6例关节镜二次探查见移植半月板周缘关节囊愈合,形态基本正常,稳定性良好。结论:关节镜下同种异体半月板移植安全,半月板移植可有效缓解半月板切除后出现的关节疼痛、肿胀等症状,可获得较好的近期临床效果,临床未见明显的免疫排斥反应。     

自体胭绳肌腱与同种异体胫前肌腱重建前交叉韧带的对照研究

目的观察自体胭绳肌腱与同种异体移植物关节镜下重建膝关节前交叉韧带（ACL）的疗效与差异。方法将54例ACL损伤患者分为2组,自体胭绳肌腱移植组33例,同种异体肌腱移植组21例,均采用美国强生公司生产的Rigidfix及Intrafix系统固定,评价项目包括手术时间、发热天数、大腿周径患健侧比值、Lachman试验、中立位前抽屉试验（ADT）和国际膝关节评分委员会（IKDC）、Lysholm及Tegner评分。结果两组患者术后膝关节稳定性均较术前得到明显好转,除手术时间外,物理检查及功能评分差异均无统计学意义（P〉0．05）。结论关节镜下自体及同种异体肌腱重建ACL都有较好的疗效,可根据患者的病情及主观要求灵活选择。     

同种异体半月板移植和半月板切除术后中期临床效果比较

目的:比较同种异体半月板移植和半月板切除术后中期临床效果。方法:2005年6月至2009年8月,16例半月板切除术后患者接受18个同种异体半月板移植(移植组),其中男12例,女6例,年龄25.7±7.9岁。以同期行半月板切除术的20例患者为对照(切除组),其中男12例,女8例,年龄25.0±7.2岁。采用IKDC评分、Lysholom评分、Tegner评分、VAS评分等比较两组患者临床效果,并通过X线、核磁共振成像(MRI)比较两组患者膝关节退变和软骨损伤进展情况。结果:两组平均随访时间分别为60±20、54.4±6.1个月,术前IKDC评分、Lysholom评分、Tegner评分、VAS评分无显著性差异。术后两组患者的临床评分、单腿跳、关节间隙变化和力线等无显著性差异。切除组Kellgren-Laurence分级术后与术前的差值为1.4(1~2),明显高于移植组的0.3(0~1)(P<0.05)。移植组术后MRI软骨分级和软骨损伤进展程度均明显低于切除组,分别为1.2(0~3)vs 2.0(1~3)(P=0.028),0.7(0~2)vs 1.4(0~2)(P=0.001)。结论:半月板移植术后中期临床效果良好,与半月板切除无明显差异;半月板移植具有保护软骨、减缓关节退变的作用。     

同种异体胫前肌腱和自体腘绳肌腱重建前交叉韧带临床研究

目的:探讨关节镜下同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带(ACL)的临床疗效。方法:回顾了60例陈旧性前交叉韧带损伤重建病例,分为A组30例,B组30例。分别应用同种异体胫前肌腱(A组)和自体半腱肌、股薄肌腱(B组)重建ACL,A组平均随访29.4个月,B组平均随访31.6月。采用Lysholm、Tegner、IKDC、KT2000对患者进行术前和术后膝关节功能测试、评分,并用等速测试仪测量各组术后伸膝、屈膝、内旋和外旋肌力。结果:两组手术前后Lysholm、TegnerI、KDC、KT2000测试结果均有显著性差异(P<0.01);但两组间术后评分无显著性差异(P>0.05)。等速肌力测试结果显示术后B组内旋、屈膝肌力较术前下降(P<0.05),而A组术后肌力较术前无明显下降(P>0.05)。结论:关节镜下采用同种异体胫前肌腱重建前交叉韧带疗效满意,不良反应发生率低。     

关节镜下TightRope环扎固定治疗前交叉韧带胫骨止点撕脱性骨折的疗效评估

目的 探讨关节镜下TightRope环扎内固定治疗前交叉韧带(anterior cruciate ligament, ACL)胫骨止点撕脱性骨折的疗效。方法 回顾性分析2018年5月—2020年6月上海市松江区中心医院骨科收治的ACL胫骨止点撕脱骨折患者26例，男性18例，女性8例；年龄13～37岁，平均18.9岁；运动伤16例，道路交通伤6例，摔伤4例；骨折分型(Meyers-McKeever-Zaricznyj):Ⅱ型8例，Ⅲ型14例，Ⅳ型4例。患者均行膝关节镜下骨折复位TightRope锁扣带袢钛板环扎固定术。手术前后采用Lysholm膝关节评分、国际膝关节评分委员会(IKDC)及膝关节Tegner评分评价膝关节功能，通过Lachman试验及pivot-shift试验评价膝关节稳定性。记录手术时间、膝关节活动度及术后并发症情况。结果 患者均手术顺利，术后随访10～15个月，平均12.5个月。平均手术时长(37.5±6.9)min。末次随访Lysholm、IKDC及膝关节Tegner评分分别为(95.4±4.2)分、(93.5±4.5)分、(7.9±1.5)分，高于术前(45.4±...     

关节镜下自体及同种异体髌韧带移植重建膝前交叉韧带的对比研究

目的观察及比较关节镜下自体及同种异体髌韧带移植重建膝前交叉韧带（anterior cruciate ligament，ACL）的临床疗效。方法自2000年1月至2003年8月，对58例外伤性膝ACL断裂的患者采用关节镜下分别以同种异体骨-中1／3髌腱-骨（B—PT—B）复合物（异体组28例）及自体B—PT—B复合物（自体组30例）进行移植重建，术后随访12个月以上，并对两组患者在肌力恢复、关节稳定性、膝关节功能评分、隧道扩大现象等方面进行对比研究。结果两组患者术后膝关节稳定性、关节症状均有明显好转，早期异体组肌力恢复较自体组为快。12个月时两组肌力恢复、膝关节功能评分、稳定性等比较，差异无统计学意义（P〉0，05）。两组X线片均存在隧道扩大现象，异体组较自体组多见（P〉0．05）。结论关节镜下同种异体韧带移植重建膝ACL疗效满意，应用方便，副作用少，是自体材料的良好替代物。     

同种异体跟腱移植物重建内侧副韧带浅层结构治疗膝关节外翻不稳定的临床研究

目的:评估采用同种异体跟腱重建内侧副韧带(MCL)浅层结构对恢复膝关节外翻稳定性的早期临床疗效。方法:回顾性分析2005年8月至2010年12月我科收治的诊断为陈旧膝关节内侧副韧带损伤并符合重建手术指征的患者19例,均采用同种异体跟腱作为移植物。患者入选标准为:1)陈旧MCL损伤,受伤至手术时间超过3周;2)IKDC膝关节外翻不稳定分级为C级[内侧关节间隙开口程度(侧侧差值)为6～10 mm]或D级(内侧关节间隙开口程度大于10 mm);3)随访时间至少12个月。术前、术后采用Telos装置拍摄膝关节外翻位应力像评估内侧结构稳定性。其他评价指标包括IKDC主观功能评分和Lysholm主观功能评分。结果:19例患者中,16例获得随访,其中男性12例,女性4例;平均年龄31.8岁(19～53岁),受伤至手术时间平均17.6个月(24天～84个月),随访时间平均27.8个月(12～67个月)。患者术前膝关节内侧间隙开口程度平均为(8.9±3.1)mm(6～23.2 mm),术后平均(0.1±1.4)mm(-2～2.4 mm),手术前后比较差异有统计学意义(P<0.05)。IKDC主观功能评分术前平均(49.8±6.7)分(31～57.5分),术后平均(82.8±4.8)分(71.3～93.1分),手术前后比较差异有统计学意义。Lysholm评分术前平均(69.3±5.7)分(55～78分),术后平均(88.3±4.6)分(75～95分),手术前后比较差异有统计学意义。16例患者中,术前膝关节外翻稳定性IKDC分级C级12例,D级4例;术后A级14例,B级2例。结论:采用同种异体跟腱重建内侧副韧带浅层结构能够显著改善膝关节外翻稳定性,术后平均2年的随访表明患者主观功能评分满意。     

自体与深低温冷冻异体髌腱重建前交叉韧带临床疗效比较研究

目的:回顾性观察比较自体与深低温冷冻同种异体骨腱骨(BPTB)组织重建膝关节前交叉韧带(ACL)临床疗效差异。方法:回顾2003年8月~2005年12月共82例ACL损伤患者,其中自体同侧BPTB组织移植59例,同种异体BPTB移植23例。术前、术后行体格检查、膝关节IKDC评定、Lysholm-Tegner评分、VAS疼痛评分及KT-2000检测。采用t检验及χ2检验比较两组间差异。结果:41例自体及17例异体移植物重建患者分别获得平均34.3个月(18~46个月)和平均33.5个月(19~43个月)的最终随访。异体组发生再断裂1例,无感染及排斥反应。自体组4例无明显跪地痛,其余37例患者均极少或未尝试跪地动作,其中髌前取骨处明显压痛5例。5例自体及1例异体移植患者随访时前抽屉试验(ADT)阳性,3例自体及1例异体称植患者Lachman检查阳性。术后两组间关节活动度、膝关节IKDC评定、Lysholm-Tegner评分、KT-2000检测均无显著差异,VAS评分有显著差异(P<0.05)。结论:同种异体与自体髌腱移植物重建ACL临床疗效相近,同种异体移植组织是重建ACL的良好替代物。     

关节镜下应用深低温冷冻异体骨跟腱复合体重建膝前交叉韧带

目的 探讨关节镜下应用深低温冷冻异体骨跟腱复合体重建损伤的前交叉韧带的方法及疗效.方法 回顾了2005年～2006年间我科收治并在关节镜下应用深低温冷冻异体骨跟腱复合体重建损伤的前交叉韧带11例,随访时间12～20个月.对其术前和随访过程中的症状、体征及Lysholm膝关节评分[1]和国际膝关节文献委员会(IKDC)的分级标准评定[2]的情况进行分析.结果 11例术前弹响、交锁和打软腿的症状均消失,无关节不稳的主诉.浮髌试验均为阴性,均无过伸痛,Lachman征、前抽屉试验、轴移试验均为阴性.残留关节轻度疼痛2例.Lysholm评分:术前评分55.26±9.20,术后12个月以上随访评分(90.23±10.55)分(P＜0.01).优秀率81.82%.IKDC评定结果明显优于术前.结论 关节镜下应用深低温冷冻异体骨跟腱复合体重建损伤的前交叉韧带的方法可有效改善膝关节的稳定性;减少了自体肌腱移植所带来的供区损伤;肌腱强度大,供应充足,解决了多根韧带损伤所带来的重建材料匮乏的问题;简化手术步骤,缩短手术时间.未出现明显的免疫反应及关节内感染.     

三种移植物关节镜下重建前交叉韧带的临床疗效比较

目的比较分析膝关节镜下自体骨-髌腱-骨（B-PT-B）、同种异体跟腱和LARS（1igament advanced reinforce．mentsystem,LARS）人工韧带重建前交叉韧带（anterior cruciate ligament,ACL）的临床疗效差异。方法从2008年2月-2010年11月,对156例膝关节ACL损伤患者行关节镜下ACL重建术,其中自体骨-髌腱-骨（B-PT-B）组39例,同种异体跟腱组53例,LARS人工韧带组64例。通过一般情况、前抽屉试验、Lachman试验、轴移试验、Lysholm、IKDC膝关节评分进行临床疗效评价。结果所有患者随访12-38个月,平均21个月,术后3、6个月各组膝关节Lysholm、IKDC评分,LARS组明显高于其余2组（P〈O．05）。异体跟腱组与自体B-PT-B组相比,差异无统计学意义（P〉0．05）。术后12月及最后随访时,LARS组略高于其余2组,但3组间差异无统计学意义（P〉0．05）。结论在关节镜下应用3种不同移植物重建前交叉韧带的近期疗效均较为满意,LARS组可在术后早期进行膝关节功能活动近期效果优于自体B-PT-B组和异体跟腱组。对于年轻患者．尤其是运动员ACL损伤。LARS人工韧带是一种理想移植材料。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.