膝关节镜下髁间棘撕脱骨折的手术治疗

目的 :探究膝关节镜下手术进行髁间棘撕脱骨折复位钢丝内固定治疗的一种新方法 ,介绍微创手术治疗的临床经验。方法 :1999年 4月至 2 0 0 1年 10月间在膝关节镜下手术治疗髁间棘撕脱骨折共 15例 ,其中应用钢丝进行骨折块内固定治疗髁间棘撕脱骨折 12例。手术方法 :膝关节镜监视下 ,应用镜下重建前交叉韧带的定位器确定骨折块的固定位点 ,经导向器钻骨道 ,利用钢丝内固定。术后早期进行康复。结果 :术后随访 6月～ 3年 ,平均 1年 11个月 ,X线片显示骨折复位与愈合良好 ;急性损伤 4例前向不稳均纠正 ,前抽屉试验及Lachman试验阴性 ;陈旧损伤 9例前向不稳纠正 ,其中 2例检查前抽屉及Lachman试验稍松 ,但患者主观稳定性良好。结论 :膝关节镜下手术治疗髁间棘撕脱骨折具有微创的特点。应用该手术方法治疗髁间棘撕脱骨折操作简捷、固定可靠、手术创伤小 ,术后可以早期进行功能康复。同时为关节镜下手术治疗髁间棘撕脱骨折提供了新的方法     

关节镜下双带线锚钉前交叉韧带止点足印重建治疗胫骨髁间嵴撕脱骨折

目的:探讨关节镜下复位、双带线锚钉前交叉韧带(ACL)止点足印解剖重建治疗胫骨髁间嵴撕脱骨折的手术方法及临床疗效。方法:2009年4月～2011年4月,对15例胫骨髁间嵴撕脱骨折患者在关节镜下行骨折解剖复位、双带线锚钉ACL止点足印解剖固定术。胫骨髁间嵴撕脱骨折的Meyers-McKeever分型:Ⅱ型8例,Ⅲ型5例,Ⅳ型2例;男12例,女3例;年龄21～57岁,平均30.6岁。术前前抽屉试验及Lachman试验均呈阳性,Lysholm评分为(49.9±3.7)分,IKDC 2000主观膝关节评分为(53.3±5.3)分。结果:患者均获随访,随访时间9～15个月,平均12个月。术后6个月X线片复查示髁间嵴骨折均愈合,骨折复位良好。末次随访时,患肢膝关节活动范围达0～120°;Lysholm评分为(89.6±3.2)分,IKDC2000主观膝关节评分为(90.8±5.7)分,两项评分与术前比较差异均有统计学意义(t1=22.100,t2=20.700,P=0.000)。结论:关节镜下复位、双带线锚钉ACL止点足印解剖重建治疗胫骨髁间嵴撕脱骨折,有利于实现ACL胫骨止点解剖原点重建,对于恢复ACL正常生理功能有重要意义。     

海军飞行员关节镜下重建前交叉韧带的医学鉴定

目的 介绍海军飞行员前交叉韧带(ACL)损伤患者采用自体4股半腱肌腱+股薄肌腱重建ACL的手术方法 及远期疗效. 方法 关节镜下以自体4股半腱肌腱+股薄肌腱为ACL重建替代物,保留少许ACL残端作为定位标志物,对11例ACL损伤飞行员行重建术. 结果 术后11例飞行员膝关节活动度均恢复至正常范围,无韧带撞击现象,前抽屉试验阴性,Lachman试验均小于I度.Lysholm评分由术前的平均49.1分提高到术后的平均87.5分,差异具有显著性意义(t=8.335,P<0.01).膝关节功能优良率术前与术后比较,差异具有显著性意义(X<'2>=6.793,P<0.01).11例飞行员中8例飞行合格,2例飞行暂不合格,1例飞行不合格. 结论 关节镜下自体4股半腱肌腱+股薄肌腱重建ACL是恢复膝关节稳定性较好的方法 ,关节镜下重建ACL是ACL损伤飞行员较为理想的手术方式,其创伤较小、卧床时间短、远期疗效较好.     

关节镜下空心钉固定胫骨髁间棘骨折20例

传统的胫骨髁间棘骨折常行膝关节切开复位内固定,目前随着关节镜技术的发展,利用关节镜技术可采用不同的固定方式。笔者重点对2004年4月-2005年8月,我院收治胫骨髁间棘骨折20例,行关节镜下空心钉固定胫骨髁间棘撕脱骨折,现报道如下。     

交通伤后胫骨髁间棘撕脱性骨折关节镜下治疗

目的 探讨交通伤后胫骨髁间棘撕脱骨折在关节镜下复位、PDS-Ⅱ线固定的治疗方法.方法 在2005年2月～2009年12月间,我科共治疗36例交通伤后急性胫骨髁间棘撕脱骨折.男性25例,女性7例;平均年龄27.5岁(11～55岁).其中Ⅱ型9例(25%),Ⅲ型20例(56%),Ⅳ型7例(19%).手术采用关节镜下骨折复位...     

关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折

目的:探讨关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折的临床疗效。方法:2008年5月~2010年5月,对10例少年胫骨髁间前棘骨折移位患者,在关节镜下行骨折断端清理、复位,C臂机透视下避开骨骺建立胫骨隧道,自制缝针、钩针导引普通丝线于前交叉韧带前1/3、1/2处镜下两次穿越,普通丝线导引钢丝及PDS-Ⅱ线穿越前交叉韧带。固定物在冠状面两次穿越骨隧道-前交叉韧带-骨隧道,骑跨式三维固定撕脱骨块,有效防止撕脱骨块前后旋转、左右摆动和上下浮动。拉紧钢丝及PDS-Ⅱ线,关节外打结固定。术后下肢支具外固定并早期进行功能康复。术后采用Lysholm评分标准评估疗效。结果:全部病例均获随访,随访时间6～36个月,平均18.2个月。X线片示骨折均愈合。患者膝关节无疼痛,前抽屉试验阴性,Lachman试验阴性。术前Lysholm评分(45.8±7.6)分,术后(97.2±9.1)分,手术前后评分差异有统计学意义。结论:关节镜下骺板近端三维缝合固定治疗少年胫骨髁间前棘撕脱骨折创伤小,不损伤骺板,操作简单,疗效可靠。     

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。     

关节镜下治疗胫骨髁间棘骨折

目的探讨关节镜下复位并内固定治疗胫骨髁间棘骨折的手术方法及疗效。方法对14例Meyers-MckeeverⅡ、Ⅲ、Ⅳ的胫骨髁间棘骨折患者施行关节镜下复位及内固定术。在关节镜监视下,对移位或翻转的粉碎骨折块进行复位,用不可吸收缝合线或自攻空心松质骨螺钉对骨折块行内固定,同时处理合并伤。术后使用支具于伸膝位制动4～6周,术后给予相应阶段的康复指导。结果全部患者术后骨折愈合良好,伤膝关节活动度与健侧一致,关节稳定。结论对于胫骨髁间棘骨折,根据患者年龄、骨折类型、选取适合的内固定方式,在关节镜监视下完全可以做到满意的骨折整复,可靠的内固定,重建前交叉韧带的稳定性。关节镜下复位、内固定手术创伤小,较膝关节开放手术具有明显优越性。     

关节镜下重建膝关节新鲜与陈旧前交叉韧带训练伤疗效对比分析

目的比较部队官兵体能训练所致膝关节前交叉韧带(ACL)损伤手术时机对疗效的影响。方法关节镜下对平均病程(5±0.8)周27例新鲜组和平均病程(76±10.5)周19例陈旧组ACL损伤,均以半腱肌和股薄肌为替代物进行手术重建。结果按Lysholm评分,新鲜组和陈旧组ACL损伤的优良率分别为92.5%和78.9%,两组比较差异有显著统计学意义(P<0.01)。结论体能训练所致膝关节交叉韧带损伤早期关节镜手术重建的疗效优于晚期重建。     

关节镜下“8”字缝线与带线锚钉治疗胫骨髁间棘撕脱骨折的效果比较

目的比较关节镜下胫骨髁间棘撕脱骨折"8"字缝线与带线锚钉固定两种方法的疗效。方法笔者收集2007年1月~2013年9月收治的52例胫骨髁间棘骨折患者,均为Meyers-MckeeverⅡ型、Ⅲ型的患者,28例行"8"字缝线固定(A组),包括男性21例,女性7例;平均年龄24岁;24例行带线锚钉固定(B组),包括男性19例,女性5例;平均年龄22岁。比较两组伸膝功能、屈膝功能、关节稳定性及Lysholm关节功能评分。结果术后平均随访9.2个月。A组与B组伸膝功能有统计学差异(P=0.040.05),两组屈膝功能、关节稳定性及Lysholm关节功能评分无统计学差异。结论关节镜下"8"字缝线固定治疗胫骨髁间棘撕脱骨折的疗效优于带线锚钉固定。     

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.     

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.     

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).     

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.