渐变形面膝关节假体设计及接触应力分析

目的研究膝关节假体形面轮廓对假体关节面间接触应力的影响。方法基于MRI(magnetic resonance imaging)图像采集建立多角度正常膝关节模型。依据自然膝关节的解剖结构,从中提取出个体膝的结构尺寸及形面特征,设计出渐变形面的膝关节假体,按照全膝关节置换手术的规范流程建立植入渐变形面假体后的全膝三维模型,并通过有限元分析,比较植入假体后对股骨/胫骨关节面等效应力的影响。结果植入渐变形面的假体膝在屈曲角度0°~60°时对于髁面的应力分布影响不大,但大于60°,尤其是80°时,应力分布变化明显;另外,对内/外侧髁面的最大等效应力有较大的改变。结论在膝关节假体的设计建模中,尽量重现人体关节构造,益于保证置换后整个膝关节的协调运作。整个设计过程及方法对于完善和改进假体的设计具有重要的参考意义。     

单髁置换术治疗膝关节内侧间室骨性关节炎的疗效观察

目的 观察膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)治疗膝关节内侧间室骨性关节炎的临床疗效.方法 选取自2013年5月至2018年11月期间收治病变累及膝关节内侧间室的膝关节骨性关节炎的患者85例,随机分为两组,观察组42例,行膝关节单髁置换术(UKA),对照组43...     

人工全膝关节置换术股骨截骨方法改良及效果

目的对人工全膝关节置换术股骨截骨方法进行改良,通过截骨厚度的测量和临床随访对改良截骨方法的手术效果进行评估。方法改良股骨截骨模板,股骨后髁截骨厚度增加3mm。对81例人工全膝关节置换术中的各向截骨厚度进行测量,分为膝内翻和膝外翻两组,对截骨厚度和假体厚度进行比较分析。术后平均随访27.1个月。结果全组患者屈膝间隙和伸膝间隙平均截骨厚度均小于假体厚度。膝内翻和膝外翻组间除股骨后髁内侧截骨厚度外,各项测量值间差异均存在显著性意义(P<0.01)。膝内翻组内侧屈伸膝间隙截骨厚度和假体厚度差异最大;膝外翻组,外侧屈伸膝间隙截骨厚度和假体厚度差异最大。膝内翻组,外侧屈膝间隙存在过度截骨(0.57mm);膝外翻组,内侧屈膝间隙存在过度截骨(0.92mm)。术后关节活动度良好,仅7%的患者存在轻度屈膝不稳,无中重度不稳。结论对股骨截骨模板的改良是可行的,股骨后髁截骨厚度增加3mm不会出现过度截骨和屈膝不稳的情况。     

点对点图像配准技术虚拟膝关节单髁置换术后三维模型的构建

目的:探讨使用点对点图像配准技术虚拟膝关节单髁置换术的可行性,为该方法的拓展应用及优化手术提供试验依据。方法:选取在本院行膝关节单髁置换术(UKA)的膝关节内侧间室骨性关节炎患者为研究对象,基于膝关节MRI及CT扫描数据构建单髁置换术后膝关节三维模型,使用点对点配准技术完成虚拟假体置换操作及建立有限元模型,分析虚拟置换术后膝关节运动学变化。结果:使用点对点图像配准技术建立了完整的单髁置换术后膝关节三维模型,其运动学变化趋势与传统分析法相似。结论:点对点图像配准技术可准确完成虚拟手术,较传统方法更为简便,值得推广应用。     

全膝关节置换术与膝关节单髁术置换患者住院费用构成比较

目的比较3年内行全膝关节置换术及膝关节单髁置换术住院患者的住院费用结构比例,分析两种手术方式的疗效和住院费用的差异。方法收集北京积水潭医院矫形骨科自2013年3月至2016年6月间行全膝关节置换术及膝关节单髁置换术的3 096例患者的临床资料和具体住院费用,对住院费用结构进行统计分析。结果行膝关节单髁置换患者的人均总费用、卫生材料费、手术费、药费、治疗费、麻醉费、床位费、检查费、输血费以及平均住院日,均显著低于行全膝关节置换术患者。两种术式膝关节评分和活动度均较术前有显著性提高。结论全膝关节置换及膝关节单髁置换是治疗终末期膝关节骨关节炎的主要手术方式。合理选择手术方式有助于控制围手术期医疗费用,减轻患者经济负担。     

关节镜下清理术联合开放楔形胫骨高位截骨术治疗骨性关节炎的经验及文献回顾

<正>膝关节骨性关节炎是中老年患者临床常见疾病,根据发病部位分为全关节型、髌骨型、内侧间室型和外侧间室型四种类型^[1]。临床最常见的类型为内侧间室骨关节炎,约占74%。早期膝骨关节炎患者首选保守治疗,可以缓解患者的临床症状,减缓疾病的进展。手术是治疗晚期膝骨关节炎的有效方法。手术治疗包括膝关节置换术、胫骨截骨术、关节镜清理术等。其中胫骨高位截骨术是治疗膝关节骨关节炎的重要方法之一,     

股内斜肌负载变化影响髌腱近端受力的生物力学研究

目的:探讨股内斜肌不同负载情况下髌腱近端内、外侧拉伸应力的变化。方法:6例新鲜膝关节尸体标本在屈膝0°、30°和60°时,分别将股内斜肌负载从0N增加到30N、60N、100N。测量髌腱近端内、外侧的拉伸形变。然后取下髌腱内、外侧部分,置于万能实验机上进行拉伸测试至断裂。根据所得到的髌腱拉伸应变和材料特性测试结果计算髌腱内、外侧受到的拉伸应力。结果:在膝关节屈曲0°、30°和60°时,股内斜肌加载在0N和30N情况下,内侧髌腱拉伸应力差别无显著差异(P>0.05)。在其它加载状态下,屈膝同一角度时,各相邻工况的拉伸应力差异均有显著性差异(P<0.05),表现为随着股内斜肌负载增加,内侧髌腱拉伸应力减小,外侧髌腱拉伸应力增大。结论:在股内斜肌负载增加时,髌腱近端外侧拉伸应力增加,内侧拉伸应力减小,在膝关节屈膝0°、30°和60°时均存在这种趋势。     

人工全膝关节置换术治疗严重畸形膝关节临床研究

目的：探讨人工全膝关节置换术（total knee arthroplasty, TKA）治疗严重畸形膝关节的手术方法和临床疗效。方法对人工全膝关节置换术916例（1031膝）,严重畸形膝关节置换术80例,其中56例（70膝）成功随访。严重内翻畸形19例（23膝）、严重外翻畸形21例（27膝）、严重屈曲畸形16例（20膝）。术后平均随访时间60个月（6个月～10年）。对膝关节屈伸活动度、HSS、KSS膝关节评分系统对手术前后进行回顾性研究。结果膝关节屈伸活动度由术前平均80°（伸直0°～屈曲120°）提高到术后115°（伸直0°～屈曲130°）,膝关节评分系统 HSS、KSS术前及随访时比较差异有统计学意义（P＜0．05）,KSS评分：临床评分由术前平均33分（10～68分）提高到术后平均81分（70～100分）,HSS临床评分由术前平均43分（27～68分）提高到术后平均86分（72～100分）。膝内外翻、屈曲挛缩畸形得到较好矫正。结论严重畸形膝关节通过关节置换术同样能恢复正常的关节功能,提高了患者生活质量,获得满意的临床疗效。     

多间室和内侧单间室严重骨关节炎内侧半月板突出及后根撕裂的特点分析

目的：探究多间室和内侧单间室严重骨关节炎（OA）患者内侧半月板突出（MME）及内侧半月板后根撕裂（MMPRT）的特点。方法：回顾性分析2020年6月至2021年11月我科收治的117例终末期OA患者的基线资料、X线和磁共振（MRI）图像,其中多间室严重OA患者60例67膝（M-OA组）,均行全膝关节置换;内侧单间室严重OA患者57例68膝（mU-OA组）,均行内侧单髁置换。在MRI上测量患膝MME程度,判定是否存在MMPRT,并在X线片上测量髋膝踝角（HKA）、胫骨近端内侧角（MPTA）、机械轴股骨远端外侧角（mLDFA）、胫股关节线夹角（JLCA）,在MRI上测量内侧胫骨平台后倾角（mPTS）。对基线资料、病理性MME和MMPRT发生率、MME程度、HKA、MPTA、mLDFA、JLCA和m PTS进行统计学分析。结果：两组患者年龄、体质指数（BMI）和患膝侧别等无显著性差异（P>0.05）,M-OA组患者女性比例高于mU-OA组（78.33%vs 56.14%,P<0.05）。M-OA组病理性MME发生率高于m U-OA组（79.1%vs52.94%,P<0.01...     

C反应蛋白在4种不同关节置换手术后变化趋势

目的 通过记录4种不同人工关节置换手术后C反应蛋白（CRP）的变化趋势及相关水平来研究这4种不同手术对机体造成的创伤反应.方法 研究96例不同关节置换（全膝关节置换、单髁膝关节置换、表面髋关节置换、全髋关节置换）患者,分别记录其术前、术后2d、术后7d的CRP水平.结果 CRP的峰值在术后第2天出现,表面髋关节置换组峰值低于全髋关节置换组,单髁膝关节置换组峰值低于全膝关节置换组,全髋关节置换组峰值低于全膝关节置换组.结论 术后CRP的反应程度是由手术过程中骨髓组织的破坏程度决定的,不是由手术部位或软组织的损伤程度决定的.     

Responsiveness of the International Knee Documentation Committee Subjective Knee Form

Background and PURPOSE: The International Knee Documentation Committee Subjective Knee Form was developed to measure change in symptoms, function, and sports activity in patients treated for a variety of knee conditions. Although previous research has demonstrated reliability and validity of the form, its responsiveness has not been evaluated. The purpose of this study was to determine responsiveness of the International Knee Documentation Committee Subjective Knee Form. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: Patients who participated in the original validation study for the International Knee Documentation Committee Subjective Knee Form completed the form and a 7-level global rating of change scale that ranged from greatly worse to greatly better after a mean of 1.6 years (range, 0.5-2.3 years). Analyses included calculation of the standardized response mean and mean change in International Knee Documentation Committee Subjective Knee Form score compared to the patient's perception of change on the global rating of change scale. In addition, a receiver operating characteristic curve was plotted to determine the change in score that best distinguished patients who improved from those who did not. RESULTS: The overall standardized response mean was 0.94, which is considered large. With the exception of those who were slightly worse or unchanged, the mean change in the International Knee Documentation Committee Subjective Knee Form score compared to the patients' perceived global ratings of change was as expected (greatly worse, -15.1; somewhat worse, -8.4; slightly worse, 20.6; no change, 10.7; slightly better, 5.9; somewhat better, 18.1; greatly better, 38.7). The receiver operating characteristic curve analysis revealed that a change score of 11.5 points had the highest sensitivity, and a change score of 20.5 points had the highest specificity to distinguish between those who were or were not improved. CONCLUSION: The International Knee Documentation Committee Subjective Knee Form is a responsive measure of symptoms, function, and sports activity for patients with a variety of knee conditions.     

Runner's Knee

A systematic approach to knee problems by anatomical location of symptoms helps the physician make a specific diagnosis. The aim is to keep the runner running, so treatment is conservative whenever possible.     

Ultrasonography of the Knee

Musculoskeletal ultrasonography (MSUS) is a radiologic modality that can help in the evaluation of the knee and its lesions. Both soft tissue and surface bony structures can be sonographically visualized. The extra-articular structures of the knee can be evaluated, specifically the ligaments, bursae, and tendons. Collateral ligaments and the extensor mechanism, especially quadriceps and patellar tendons, are readily visualized. The diagnosis of a Baker's cyst and its complications is a common indication. The intra-articular structures of the knee, with proper maneuvers and transducers, can also be evaluated. The femoral condylar and patella cartilage can be examined for traumatic or degenerative lesions. The anterior and posterior cruciate ligaments can be partially visualized directly, or evaluated indirectly. Loose bodies are readily detectable whether intra-articular or extraneous in a Baker's cyst. Synovial disease can be characterized without the use of radiographic contrast. MSUS can be used as a screening, diagnostic or follow-up radiologic tool in the diseases of the knee.     

Acute Knee Injuries

An athlete who has an acute knee injury should be assessed rapidly on the field and then more thoroughly on the sideline or in the training room. On-the-field assessment includes questions about the mechanism of injury and any similar previous injuries, a visual check for knee deformities and skin injuries, a neurovascular exam, and, ideally, tests for flexion and hyperextension. On the sideline or in the training room, standard physical tests are likely to reveal any significant injuries. These include the patellar apprehension, Lachman, posterior sag, quadriceps active, posterior drawer, posterolateral drawer, valgus and varus stress, pivot-shift, and dial tests.