FiberWire is superior in strength to stainless steel wire for tension band fixation of transverse patellar fractures

Background

The metal implants used to achieve fixation of displaced transverse patellar fractures are associated with implant failure, postoperative pain and a significant re-operation rate. Recent studies have examined braided suture as a possible alternative to stainless steel wire to increase patient satisfaction and decrease re-operation rates, but suture has not demonstrated clearly superior fixation strength. FiberWire^® is a reinforced braided polyblend suture that has demonstrated superior characteristics to the previous sutures studied and has not to our knowledge been examined as a material for tension band fixation of transverse patellar fractures.

Methods

Materials testing was performed on repeated samples of No. 5 FiberWire suture and 18-gauge stainless steel wire. The strength and stiffness of each material was measured. The two materials were then used for tension band fixation on a novel transverse patellar fracture model and tested to failure by three-point bending. The constructs included a single stainless steel wire, a single-strand FiberWire tied with a sliding knot, double-strand FiberWire tied with sliding knots and double-strand FiberWire tied with a Wagoner's Hitch. The fixation strength and stiffness of the constructs were measured.

Findings

Unlike stainless steel, FiberWire maintained its initial stiffness until failure. Furthermore, during three-point-bend testing, double-strand FiberWire was found to have a significantly higher failure load than stainless steel wire when the suture was tied and locked under the tension produced by a modified Wagoner's Hitch.

Interpretation

FiberWire is a potentially superior alternative to stainless steel wire in tension band fixation of transverse patellar fractures.     

Management of comminuted patellar fracture with non-absorbable suture cerclage and Nitinol patellar concentrator

PurposeTo evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture using non-absorbable suture cerclage and nickel-titanium patellar concentrator (Ni-Ti PC).MethodsTwenty-nine consecutive patients with displaced comminuted patellar fractures accepted internal fixation procedure using Ni-Ti PC augmented with different types of non-absorbable suture cerclage. During follow-up, the clinical grading scales of Böstman, including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing, were used to evaluate the clinical results. Complications including implant loosening, fragment displacement, bone nonunion, infection, breakage of the implants, painful hardware, and post-traumatic osteoarthritis were also assessed.ResultsPatients were followed up for a mean period of 27 months. The bone union radiographically occurred approximately 2.5 months without implant loosening and fragment displacement. According to Böstman method, satisfactory results were obtained, and the mean score at final follow-up was 28 (range 20–30) points. Twenty-two patients with excellent results had mean score of 29.8 ± 0.5 (range 28–30) and seven patients with good results had mean score of 22.7 ± 3.14 (range 20–27). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed.ConclusionNi-Ti PC fixation with non-absorbable suture cerclage is a feasible approach for comminuted patellar fractures. Firm fixation with this technique resulted in satisfactory outcomes without obvious complications.     

Platelet-Rich Plasma,Mesenchymal Stem Cell,and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

BackgroudWe performed a systematic review on the management of patellar fracture nonunion and report a novel suture-based non-metallic fixation technique associated with platelet-rich plasma and mesenchymal stem cell injections in the management of this injury.MethodsA systematic search was performed up to August 2020 in PubMed and Scopus electronic databases of scholarly articles evaluating different surgical techniques used for nonunion of patellar fractures, with no restrictions on language or year of publication. Furthermore, we describe our novel non-metallic suture fixation technique and a patient in whom this technique was applied.ResultsA total of 9 articles were included in the systematic review. Tension band wiring was the most commonly used procedure (62.7%). Nonoperative procedures (8.1%) resulted in nonunion in all patients. The most common complication after open reduction and internal fixation was infection (7.8%). Our patient at the latest follow-up reported full functional recovery and full extension and flexion of the affected knee with no pain and subjectively normal strength.ConclusionsThe management of patella nonunions is still a challenge. The technique reported here can be used in patellar fracture nonunion, as well as in primary patellar fractures.     

非金属与金属材料对髌骨骨折内固定术后临床疗效影响的Meta分析

目的 :系统评价髌骨骨折内固定术中应用金属与非金属材料的临床疗效。方法 :计算机搜索PubMed、EMBASE、Web of science、中国知网(CNKI)和万方数据期刊全文数据库(Wanfang data)发表的对于金属和非金属材料在髌骨骨折术中应用进行比较的病例对照研究,检索时间从建库至2018年6月。由2名研究员按照纳入和排除标准独立筛选文献,提取资料,采用非随机干预性试验偏倚风险评估工具(risk of bias in non-randomised studies of interventions,ROBINS-I)进行文献质量评价。采用RevMan 5.3软件对两种方法术后再手术率、术后临床康复优良率、术后并发症发生率进行Meta分析。结果:最终纳入9个符合条件的回顾性队列研究,共493例。Meta分析结果显示:非金属植入物和金属植入物之间内固定失败再手术率无显著差异[OR=0.52,95%CI(0.25,1.08),P=0.08]。接受非金属植入物后,患者术后临床康复优良率高于接受金属植入物[OR=3.34,95%CI(1.67,6.71),P=0.000 7],总并发症发生率低于接受金属植入物[OR=0.21,95%CI(0.07,0.60),P=0.003]。当去除钢丝克氏针断裂及其产生的皮肤刺激症状并发症后,非金属相关并发症发生率比较,差异无统计学意义[OR=1.08,95%CI(0.45,2.56),P=0.86]。结论:非金属植物可提供与金属植物相同的内固定成功率,且可通过降低金属植物相关并发症的产生,提高患者术后康复优良率。     

Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures

IntroductionModified tension band wiring has been widely used to treat transverse patellar fractures. However, few studies have evaluated the clinical outcomes using different methods of Kirschner wire bending, location of the tension band, and depths of Kirschner wires. Thus, we tried to clarify these factors according to our clinical outcomes.Patients and methodsThis retrospective cohort study recruited consecutive patients underwent surgical fixation for patellar fractures using modified tension band technique between January 2010 and December 2015. Different factors in this procedure, including the bending manner of the Kirschner wires, their depth, and location of the tension band with respect to the superior and inferior border of the patella were recorded and analysed. The primary outcome was early loss of fixation. The secondary outcomes were minor loss of reduction, implant breakage, deep infection, and the need for implant removal.ResultsThis study included 170 patients with patellar fractures. Regarding the bending method, similar results were obtained with bilaterally or proximally bent Kirschner wires. Regarding length, the tension band was placed closely (within 25% of the patella length) in 124 patients and distantly in 46 patients. The rates of loss of reduction and implant breakage were significantly higher in the distantly placed tension bands. Regarding depth, 37 patellar fractures were fixed with the Kirschner wires at the superficial one third of the patellae while the K- wires at the middle layer of patella were used in the remaining 133 patellar fractures. A significantly higher rate of minor loss of reduction was obtained using the superficial Kirschner wires.ConclusionThe modified tension band technique for transverse patella fractures provides favourable clinical outcomes, with low failure (5%) and infection (2%) rates. Implant irritation is the major complication, and almost half of cases require implant removal. The location of the tension band with respect to the superior and inferior border of the patella plays an important role in clinical outcomes. Placing the wire close to the patella may prevent major loss of reduction and implant breakage. Superficially placed Kirschner wires also affect clinical outcomes by increasing the rate of minor loss of reduction.     

A double button adjustable loop device is biomechanically equivalent to tension band wire in the fixation of transverse patellar fractures—A cadaveric study

IntroductionTension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems. The aim of our study is to compare the fixation rigidity of patella fractures using Tightrope versus conventional tension-band wiring (TBW) in a cadaveric model.Materials and methodsTBW fixation was compared to TightRope fixation of transverse patella fractures in 5 matched pairs of cadaveric knees. The knees were cyclically brought through 0–90° of motion for a total of 500 cycles. Fracture gapping was measured before the start of the cycling, and at 50, 100, 200 and 500 cycles using an extensometer. The mean maximum fracture gapping was derived. Failure of the construct was defined as a displacement of more than 3 mm, patella fracture or implant breakage.ResultsAll but one knee from each group survived 500 cycles. The two failures were due to a fracture gap of more than 3 mm during cycling. There was no significant difference in the mean number of cycles tolerated. There was no implant breakage. There was no statistical significant difference in mean maximum fracture gap between the TBW and TightRope group at all cyclical milestones after 500 cycles (0.3026 ± 0.4091 mm vs 0.3558 ± 0.7173 mm, p = 0.388).ConclusionsWe found no difference between the TBW and Tightrope fixation in terms of fracture gapping and failure. With possible lower risk of complications such as implant migration and soft tissue irritation, we believe tightrope fixation is a feasible alternative in fracture management of transverse patella fractures.     

Long term outcome of patella fractures:open reduction and internal fixation with stainless steel wire vs.non-absorbable braided polyester suture

目的 比较不锈钢钢丝与不可吸收涤纶编织线治疗髌骨骨折的长期疗效.设计 前瞻性对照研究.从2000年至2005年,通过随机抽取密封号码,一组连续的患者被安排收入2组,分别行不锈钢钢丝环扎和不可吸收涤纶编织线缝合治疗髌骨骨折,每组采用相同的手术技术和术后治疗策略.对象 年龄＞ 16岁,有移位的髌骨骨折并适合内固定治疗的患者.同时患者依从性较好,能提供知情同意,可以配合医生行术后康复治疗.干预方法 两组均采用标准的切开复位内固定方法,使用2枚纵形克氏针,“8”字形张力带,18G不锈钢钢丝或者2股5号涤纶编织线环扎固定.结果 评估 主要结果评估为再手术率.次要结果评估包括手术时间、临床和影像学愈合以及末次随访收集的患者膝关节功能评分(膝关节问卷,Euroqol EQ-5D,SF-36).结果 22例患者中有20例达到临床和影像学愈合.不锈钢钢丝环扎组和涤纶编织线缝合组平均随访时间分别为4年和2.3年,再手术例数分别为4例(共11例)和5例(共11例).大多数再手术患者是由于纵向克氏针的疼痛刺激(6/9).不锈钢钢丝环扎组手术时间(44 min)较涤纶编织线缝合组(33 min)少,但差异无统计学意义.长期功能评分显示患者有残留的功能障碍,但并不影响膝关节的总功能.结论 我们认为纵形克氏针过长是髌骨骨折采用张力带固定后发生再手术的一个主要原因.涤纶编织线缝合与不锈钢钢丝环扎均可达到临床和影像学愈合.髌骨骨折患者可以得到较为理想的功能恢复,但康复过程中再手术的几率会较高.     

双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折

目的：探讨双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折的临床疗效。方法 ：2018年1月至2020年6月采用双滑轮结合缝线桥技术治疗15例髌骨下极粉碎性骨折患者,其中男9例,女6例,年龄28～68(42.4±9.6)岁。患者伤后均有明显膝关节疼痛及活动受限,均行膝关节X线和CT检查,明确为髌骨下极粉碎性骨折。术后定期拍摄膝关节X线片了解骨折愈合情况并测量Insall-Salvati指数,记录关节活动度,并采用Bostman评分系统评价术后膝关节功能。结果：15例患者均获得随访,随访时间7～24(11.4±4.2)个月,无明显膝前痛病例。末次随访时患肢膝关节活动度为105°～140°（128.5±12.8）°,Insall-Salvati指数为0.79～1.12 (0.92±0.18)。X线片提示髌骨均骨性愈合,未见锚钉脱落、断裂及骨折块移位等情况。Bostman髌骨骨折功能评分（27.85±2.06）分,优13例,良2例。结论：双滑轮技术结合缝线桥技术治疗髌骨下极粉碎性骨折复位固定可靠,术后患者可早期开始功能锻炼。     

带线锚钉“8”字缝合固定髌骨下极骨折

[目的]介绍带线锚钉“8”字缝合固定髌骨下极骨折的手术技术和初步临床应用效果。[方法]2017年6月-2019年12月采用上述技术固定髌骨下极骨折38例。行膝前正中切口,暴露骨折端。于近髌骨置人1枚5.0 mm带线锚钉。锚钉旁使用2-0克氏针自髌骨前方分别斜向两侧钻孔至髌骨后方关节面,出针点在骨折断端上方约0.1 mm,使用硬膜外导针将锚钉上两股缝线的单边分别自上述钻孔中引出,锚钉线分别从髌骨下极两侧缝合编织在髌韧带上,自行打结收紧。然后将两股缝线上的另一单边自髌骨一侧锚钉处为起点,连续缝合至同侧髌韧带近端,绕髌韧带缝合至对侧,再缝合至起点处自行收紧打结。[结果]38例患者均顺利完成手术。骨折愈合时间14?16周,无内固定失效病例,膝关节稳定性良好。术后12个月Bostman髌骨骨折评级标准,优30例,良7例,优良率97.37%。[结论]带线锚钉治疗髌骨下极骨折,修复了伸膝装置,操作简单安全,术后膝关节功能恢复优良,且无需二次手术取出,疗效满意。     

Patellar Fracture After Total Knee Arthroplasty With Retention: A Retrospective Analysis of 2954 Consecutive Cases

BackgroundTo the best of our knowledge, there have been no large case studies on patellar fracture after total knee arthroplasty (TKA) with patella retention.MethodsFrom 2005 to 2019, 2954 consecutive TKAs with patella retention were retrospectively reviewed. The incidence of patellar fracture was confirmed. Perioperative demographic factors associated with patellar fracture were compared between the nonpatellar fracture control (randomly selected after age and sex matching) and patellar fracture patient groups. To confirm the prognosis of identified patellar fractures, Hospital for Special Surgery knee score, union rates, and complications after treatment were evaluated. Treatment outcomes were compared as per the treatment method, and fracture type was classified by shape.ResultsFor primary TKAs with patella retention, patellar fracture occurred in 32 of 2883 cases (incidence 1.11%). When comparing the preoperative demographic factors between the patellar fracture and control groups, there was a significant difference in knee flexion of the affected limb. Twenty-three cases were treated nonoperatively, and nine cases were treated operatively. Of the 32 patellar fractures, 28 had confirmed union, and the HSS score at the latest follow-up increased significantly from the preoperative score. The only complication noted after treatment was nonunion in three cases. We found no significant differences in treatment results as per the treatment method and fracture type.ConclusionPatellar fracture after TKA with retained patella is infrequent, with relatively improved clinicoradiological results over those of patellar fracture after TKA with resurfaced patella reported in the literature. The improved results did not differ as per the treatment method and fracture type.     

Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.     

Outcome Analysis of Fixed Angle Locking Plate in Patella Fractures: A Single Centre Experience from North India

BackgroundTension band wiring supposedly is the most commonly used technique for displaced patella fractures, but is not effective in comminuted fractures and osteoporotic bones. It often leads to loosening of wires, dislocation of fracture, hardware problem and failure of osteosynthesis, resulting in knee stiffness and post-traumatic osteoarthritis. The aim of the study is to evaluate clinical outcome in patients with acute patella fractures (< 3 week) treated with unidirectional angle fixed low-profile titanium patella locking plate.Materials and methodsTwenty patients who presented with displaced patella fractures, aged between 18–70 years were included in the study. All fractures were reduced and fixed with unidirectional angle fixed stable low-profile titanium patella locking plate. Knee Range of motion and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) was used to evaluate the outcome.ResultsWe were able to achieve union in 19 out of 20 patients. One patient with comminuted patella fracture had failure of fixation, which was revised. Mean flexion at final follow-up was 124° (110°–130°) and none of the patients had extensor lag. The final radiograph revealed complete union in all patients.ConclusionThis technique offers an option of fixation in comminuted patella fracture and in osteoporotic individuals. It provides mechanical stability for fracture fixation resulting in anatomical reduction, good functional outcome, lower incidence of symptomatic implant or failure of osteosynthesis.     

Selective Patella Resurfacing in Contemporary Cruciate Retaining and Substituting Total Knee Arthroplasty: A Matched Cohort Analysis

BackgroundLeaving the patella unresurfaced in total knee arthroplasty (TKA) is increasing due to modern patella-friendly implants, awareness that complications are not uncommon with resurfacing, and knowledge that historical studies were scientifically confounded. This study examined the effect of selective patellar resurfacing on patient-reported outcome measures (PROMs) using modern implants and techniques in cohorts rigorously matched for demographics and osteoarthritis severity.MethodsA total of 166 TKAs performed without patellar resurfacing were case-control matched to 166 TKAs with patella resurfacing. Case-control matching was based on demographics, American Society of Anesthesiology Physical Status, comorbidities, and osteoarthritis severity. No significant differences were observed between cohorts for demographics (P ≥ .347), comorbidities (P ≥ .443), or radiographic osteoarthritis severity (P ≥ .078). Radiographic alignment and prospectively collected PROMs were evaluated preoperatively and at latest clinical follow-up.ResultsPreoperatively, patellar tilt was less for the unresurfaced patella group (3 versus 4°, P = .003); however, postoperative patellar tilt was not different (3 versus 3°, P = .225). At a mean of 2.1 years follow-up (range, 1 to 7), University of California Los Angeles Activity Level was significantly higher for the unresurfaced patella group (6.3 versus 5.5, P = .002), but the mean group difference did not reach a minimal clinically important difference. There were no other significant differences in PROMs or reoperation rates between cohorts (P ≥ .135).ConclusionIn contemporary cruciate retaining and substituting TKA designs, not resurfacing the patella in select patients may achieve comparable PROMs and re-operation rates; and potentially greater activity level compared to patella resurfacing at early follow-up.Level of EvidenceIII.     

Anchor and Krackow‐“8” Suture for the Fixation of Distal Pole Fractures of the Patella: Comparison to Kirschner Wire

ObjectiveThe study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow‐“8” suture fixation (AS) and K‐wire fixation in patients with distal pole patellar fractures.MethodsTwenty‐eight patients with distal pole patella fractures between January 2011 and December 2014 were reviewed retrospectively. The anchor and Krackow‐“8” suture fixation (AS group) was applied in 10 patients and 18 patients underwent K‐wire fixation (K‐wire group). The average age of patients was 46.000 ± 19.476 years in the AS group and 47.556 ± 15.704 years in the K‐wire group, with comparable demographic characteristics. All patients underwent regular follow‐up the operative data and postoperative functional and clinical outcomes were recorded. Complications were recorded by clinical and radiographic assessment. Bostman patellar fracture functional score was used to evaluate knee function after patellar fracture.ResultsA total of 28 eligible patients were included in this study. The mean follow‐up was similar for the AS and the K‐wire groups (P > 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The final follow‐up on the range of motion of the knee: the average extension lag was similar in two groups (P > 0.05); flexion and flexion–extension angle was slightly better in the AS group than in the K‐wire group. The Bostman patella fracture functional score of AS group were better than K‐wire group at 3 and 6 months after operation. Four kinds of postoperative complications in two groups, one patient (10%) in the AS group and two patients (11.1%) in the K‐wire group had infections. Two (11.1%) cases of nonunion in group K and three patients (16.7%) required re‐operation: one due to infection and two due to early implant failure. In the AS group, all distal pole fractures of the patella showed bony union, without loosening, falling, pulling out and nonunion of the fractures 6 months after operation.ConclusionsAnchor and Krackow‐“8” suture fixation is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes than traditional procedures with regard to postoperative complications, knee function and without requiring a second operation. This technique is an effective operation method for the treatment of inferior patellar pole fractures.     

Editorial Commentary: Two Fixation Points Are Better for Medial Patellofemoral Ligament Reconstruction—To Minimize Complications,Bone Tunnels Should Be Avoided

Medial patellofemoral ligament (MPFL) reconstruction has gained in popularity over the past 15 years, with most studies showing a clear advantage over techniques such as MPFL repair or medial imbrication for the treatment of patellar instability. A debate continues as to the type of fixation on the patella, tunnel versus suture anchor, as well as the number of fixation points. In fact, some senior patellofemoral surgeons have opted away from patellar bony fixation altogether to avoid complications associated with patellar fixation such as fracture or penetration of the articular cartilage. In my practice, I prefer to use 2 all-suture suture anchors for patellar fixation as there is minimal risk of fracture or significant cartilage damage compared with tunnel drilling or placement of larger suture anchors. The graft choice for MPFL reconstruction has been shown to be relatively unimportant, and for this reason, I typically choose gracilis allograft to avoid graft-site morbidity and hamstring weakness.     

青少年髌骨骨软骨骨折

目的探讨青少年髌骨骨软骨骨折的临床特征、诊治要点和手术疗效。方法对14例青少年髌骨骨软骨骨折的临床资料进行分析。结果平均随访26.2个月(11个月~4.5年),13例骨折愈合。膝关节功能完全恢复正常12例,膝关节疼痛、活动受限2例。结论青少年髌骨骨软骨骨折易漏诊误诊,详细查体、髌骨轴位X线片及CT薄层扫描是防止漏诊最重要的手段。一经确诊应及早手术,切开复位、应用可吸收螺钉和缝线固定能满足固定要求且不需取内植物,是一种较理想的治疗方法。     

髌胫预压聚髌器固定治疗陈旧性分离髌骨骨折

目的探讨髌胫预压聚髌器固定治疗陈旧性分离髌骨骨折的疗效。方法对18例陈旧性分离髌骨骨折患者术前先行髌骨、胫骨结节间弹性持续加压,待骨折块靠近后切开复位,用聚髌器固定。结果 18例全部获得随访,时间7~48个月。骨折均一期愈合,髌骨的解剖结构得到重建。根据王亦璁改良膝关节功能评分法:优10例,良6例,可2例。结论陈旧性分离髌骨骨折行髌胫预压聚髌器固定治疗方便易行,牵引力线合理,便于护理,聚髌器固定牢靠,更适宜配合术前、术后CPM锻炼,功能恢复满意。     

双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折

目的:观察双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折的临床疗效。方法:自2004年6月至2011年6月,采用双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折86例,其中男48例,女38例;年龄19～75岁,平均42.5岁;左侧52例,右侧34例。86例患者均为粉碎性骨折,3个骨折块者25例,4个骨折块者32例,4个以上骨折块者29例。手术时间40～70 min。所有病例术后根据B觟stman等髌骨骨折疗效评价标准进行评分。结果:86例全部得到随访,时间3个月～6年,平均3.5年。B觟stman评分总平均分(27.65±2.05)分,优78例,良8例。结论:双环10号线环扎并分体式髌骨爪治疗髌骨粉碎骨折具有手术简单、复位良好、固定稳定的优点,可早期进行锻炼,关节功能恢复满意。