锚钉缝合术修复治疗副韧带前束撕脱的疗效

目的评价锚钉缝合术对于全膝关节置换术(TKA)术中膝关节内侧副韧带(MCL)前束撕脱屈膝位不稳的临床效果。 方法回顾性分析了2011年1月至2017年12月在东莞市中西医结合医院骨科接受TKA的患者3 922例,确定术中MCL前束撕脱屈膝位不稳的病例48例(1.2%),所有患者接受锚钉缝合术。所有患者在术后6周内使用铰链式护膝,术后每次随访时,测量膝关节的运动范围。在术后6周、3个月、1年,及之后每年接受1次X线检查,以评估美国特种外科医院(HSS)膝关节评分,并以t检验行统计学分析。 结果在3 922例全膝关节置换术中,48例(1.2%)发生术中MCL损伤。其中,1例患者术后两年内死亡,2例患者失访,共有45例患者纳入了本研究。其中24例MCL中段撕裂,21例MCL附着点断裂。35例发生在十字韧带保留的TKA术中和10例发生在后稳定型TKA术中。患者末次随访时最大屈膝(111.2±18.8)°、最大伸膝(1.5±1.5)°以及活动范围(110.2±30.2)°明显高于治疗前(107.5±22.5)°、(5.5±4.5)°、(102.2±27.8)°(t ＝ 2.822、5.026、3.670,均为P<0.05)。平均随访时间(99.2±5.7)个月,没有1例患者发生膝关节不稳定。其中5例患者因为膝关节僵硬而接受了干预(4例手法推拿和1例翻修术),2例患者因为人工膝关节无菌性松动接受了翻修术。 结论TKA术中MCL前束撕脱可以通过锚钉缝合术修复治疗,然后进行铰链式护膝支撑。膝关节僵硬是一种常见的并发症。     

半腱肌重建膝关节陈旧性内侧副韧带损伤

对于陈旧性膝关节内侧副韧带损伤手术治疗方式临床报道较多,如陆景华等、“的带骨瓣髌韧带移植修复膝内侧副韧带陈旧性损伤。2003年至2008年共收治因漏诊、误诊或误治的膝关节内侧副韧带（medial collateral ligament,MCL）陈旧性损伤9例,行半腱肌重建膝关节陈旧性内侧副韧带损伤手术治疗,术后取得满意疗效,现报告如下。     

锚钉固定治疗膝关节内侧副韧带附着点断裂

膝关节内侧副韧带（medial collateral ligaments,MCL）是膝关节内侧的主要稳定结构,膝关节外侧暴力常常导致其损伤,MCL损伤在膝关节韧带损伤中常见,其中股骨内上髁及胫骨内髁附着点的断裂又占相当比例。自2004年8月至2007年8月用锚钉治疗膝关节内侧副韧带附着点断裂,取得显著疗效,报告如下。     

膝内侧副韧带损伤治疗现状及进展

<正>内侧副韧带(MCL)损伤是膝部最常见的韧带损伤之一。随着运动伤和交通伤等增多,内侧副韧带损伤的发病率不断增高。膝MCL损伤后由于误诊或未采取适当治疗(如休息或石膏固定),损伤的内侧副韧带在被拉长的状态下愈合,使膝关节内侧结构松弛,继而导致韧带对胫骨的制导和限制作用功能缺     

TKA术中原位修复医源性内侧副韧带损伤效果观察

目的探讨全膝关节置换(TKA)术中医源性内侧副韧带损伤原位修复的方法及康复策略。方法回顾性分析自2014-01—2016-01行TKA治疗的12例重度膝关节骨性关节炎,术中出现医源性内侧副韧带损伤,原位缝合修复后采用非限制性后稳定型膝关节假体置换。结果 12例均获得平均12.5(11~24)个月随访。术前KSS评分为(52.3±4.5)分,末次随访时提高至(89.3±3.2)分,差异有统计学意义(P0.05)。术前膝关节活动度为(92.0±5.2)°,末次随访时提高至(106.0±4.1)°,差异有统计学意义(P0.05)。结论在获得良好下肢力线的前提下,原位缝合修复TKA术中医源性内侧副韧带损伤后可使用非限制性后稳定型膝关节假体,术后规范康复训练后可获得良好的膝关节稳定性及临床效果。     

半腱肌腱和股薄肌腱转移修复人工全膝关节置换术中内侧副韧带损伤

目的探讨应用半腱肌腱和股薄肌腱转移修复人工全膝关节置换术(total knee arthroplasty,TKA)中内侧副韧带(medial collateral ligament,MCL)损伤的临床疗效。方法回顾分析2009年3月-2014年5月采用半腱肌腱和股薄肌腱转移治疗的11例(11膝)TKA术中MCL损伤患者临床资料(损伤组),并与同期18例(21膝)TKA术中无MCL损伤患者(对照组)进行比较。两组患者性别、年龄、侧别、病程、体质量指数、膝关节内翻畸形程度及术前膝关节学会评分系统(KSS)评分比较,差异均无统计学意义(P0.05),具有可比性。比较两组术后临床疗效,以KSS评分评价关节功能。结果术后两组患者切口均Ⅰ期愈合,未出现关节不稳、疼痛等并发症。两组患者均获随访,损伤组随访时间6~29个月,对照组7~34个月。末次随访时,损伤组KSS临床评分及功能评分分别为(89.82±3.76)分和(89.54±3.50)分,对照组分别为(90.19±3.39)分和(90.00±3.53)分,均显著高于术前,差异有统计学意义(P0.05);两组末次随访时KSS临床评分及功能评分比较,差异均无统计学意义(t=0.158,P=0.877;t=0.820,P=0.432)。X线片复查示,随访期间两组假体均无松动、下沉发生。结论对于TKA术中MCL损伤,可选择半腱肌腱和股薄肌腱转移修复,半腱肌腱和股薄肌腱止点接近MCL止点,移位后解剖重建MCL,膝关节功能恢复满意。     

重度膝内侧副韧带断裂的手术治疗

目的探讨重度膝内侧副韧带断裂的手术治疗。方法对12例内侧副韧带严重断裂采取手术治疗,损伤程度均是Ⅲ度,即内侧副韧带的浅、深层完全断裂,部分患者伴有内侧关节囊韧带或前、后交叉韧带断裂。手术方法按解剖对合内侧副韧带采用直接缝合法或U形钉内固定。术后随访6～24月。结果12例患者按Lysholm膝关节评分法评分,比较术前(平均为35分)、术后(平均为78分)得分,P<0.05。结论重度膝关节内侧副韧带断裂的早期手术疗效佳。     

有关膝关节复合韧带损伤诊治中的一些问题

膝关节复合韧带损伤最常见的为膝关节前交叉韧带(ACL)合并内侧副韧带(MCL)损伤,其次是后交叉韧带(PCL)合并MCL损伤;ACL合并外侧副韧带(LCL)和ACL合并PCL及MCL损伤。随着目前交通事故的增多和竞技体育运动的普遍开展,膝关节复合韧带损伤亦日趋常见。然而,复合韧带损伤的诊断与治     

缝合锚钉固定半腱肌重建膝关节内侧副韧带治疗Ⅲ度内侧副韧带损伤的疗效分析

正膝关节内侧副韧带(MCL)是膝关节内侧稳定的重要结构之一。MCL损伤是较为常见的膝关节损伤,其中Ⅰ度和Ⅱ度MCL损伤通常采取非手术治疗可以获得较好的治疗效果~([1]),然而Ⅲ度MCL损伤常常合并其他韧带损伤,严重影响膝关节的稳定性,常需手术治疗~([2])。笔者回顾性分析自2017-05—2018-05诊治的64例膝关节Ⅲ度MCL损伤,旨在探讨缝合锚钉固定半腱肌重建膝关节MCL治疗Ⅲ度MCL损伤的临床疗效,报道如下。     

全膝关节置换术与单髁置换术治疗内侧间室膝骨关节炎疗效对比的meta分析

背景:全膝关节置换术(TKA)及单髁置换术(UKA)均为治疗内侧间室膝骨关节炎终末期的有效方法,然而目前对于两种术式的治疗效果并没有统一结论。目的:对TKA和UKA治疗内侧间室膝骨关节炎的随机对照试验(RCT)进行meta分析。方法:检索PubMed、EMbase、Cochrane、中国知网、万方数据以及维普数据库,筛选比较TKA及UKA治疗内侧间室膝骨关节炎的RCT,检索时间截至2019年12月。由两名检索员严格按照纳入标准筛选文献并提取数据,所得数据均采用Review Manager 5.1.4进行meta分析。结果:最终20篇文献纳入本研究,其中英文文献3篇,中文文献17篇;共有患者1473例(1493膝):UKA组725例(733膝),TKA组756例(760膝)。在膝关节HSS评分、膝关节活动度、术后屈曲90°所需时间、手术时间、术中出血量及术后并发症方面,UKA组均优于TKA组(P<0.05);在膝关节KSS评分和疼痛缓解优良率方面,两组无明显统计学差异(P>0.05)。结论:相对于TKA治疗内侧间室膝关节骨关节炎,UKA能有效提高膝关节功能评分、膝关节活动度,降低术后屈曲90°所需时间、手术时间、术中出血量及术后并发症。     

An Anatomic Study on Whether the Patella is Centered in an Ideal Anteroposterior Radiograph of the Knee

BackgroundCurrently, an anteroposterior radiograph of the knee is judged based on a centered position of the patella between the femoral condyles. We are not aware of any anatomic literature supporting this recommendation.Questions/PurposesOrthogonal images are required for accurate assessment of knee deformity. Although an image with the patella centered at the distal femur is generally accepted as a true anteroposterior (AP) radiograph of the knee, there is minimal anatomic data to support that this view is orthogonal to a true lateral view of the knee where the condyles are overlapped. We designed an anatomical study to test the relationship between these two radiographic views.MethodsWe studied 428 well-preserved cadaveric skeletons ranging from 40 to 79 years of age at death. Centering of the patella was calculated based on distal femoral and patellar widths. Multiple regression analysis was then performed to determine the relationship between patellar centering and age, gender, ethnicity, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), femoral anteversion, and contralateral centering.ResultsAverage patellar centering was 0.13 ± 0.04, indicating that the average patella was laterally positioned in the distal femur. Only mLDFA and contralateral centering showed statistically significant independent correlations with patellar centering with modest standardized beta coefficients of 0.10 and 0.23, respectively.ConclusionsIn the average specimen, the patella is laterally deviated by 13% of the condylar width. Clinicians should be aware that a lateral view with the femoral condyles overlapped is not always orthogonal to a patella-centered AP view when planning and implementing deformity correction.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-014-9419-3) contains supplementary material, which is available to authorized users.     

单髁置换术与全膝关节置换术治疗膝单间室骨性关节炎近中期疗效的对比研究

目的探讨膝单髁置换术(UKA)和全膝关节置换术(TKA)治疗膝单间室重度骨性关节炎(KOA)的近中期临床疗效。方法随访本研究中因患膝单间室重度KOA接受单髁置换术的患者23例(23膝),同时期同术者施行的全膝关节置换术50例(56膝)。UKA组23位患者22名获得到了较为完整的临床随访,1例死亡。平均时间为28.6个月(4个月～7年),TKA组50位患者均获得随访,平均时间为32.9个月(2个月～7年)。对手术前后HSS评分,疼痛缓解,术中出血量及术后3d血红蛋白下降量,关节屈曲大于90°时间及屈曲大于120°膝关节数进行比较。结果UKA组与TKA组均获得满意疗效,两组患者均无假体松动,无关节翻修等严重并发症,HSS评分UKA组术前(64±5.75)分,术后末次随访(86±7.85)分(t=11.53,P0.001);TKA组术前(61±6.53)分,术后末次随访(84±7.92)分(t=18.64,P0.001)。与TKA组比较,UKA组术中出血(t=12.47,P0.001)及术后3d天血红蛋白下降少(t=13.61,P0.001),疼痛缓解相似(2=0.007,P0.05),术后膝关节屈曲到90°时间短(t=3.97,P0.05),术后能屈曲到120°的比率高。结论在严格掌握适应证的前提下,对于膝单间室重度KOA患者的手术治疗,UKA的近中期疗效可与TKA相媲美,而且UKA具有创伤小,出血少,患者耐受性好,术后恢复快的优点。     

膝关节单间室置换术的研究进展

膝关节单间室置换术（单髁置换术,unicompartmental knee arthroplasty,UKA）已沿用30多年,被认为是治疗膝关节单间室骨性关节炎及骨坏死的一种有效术式。此术式有很多成功病例的报道,也有引发灾难性后果需要再次手术的情况。由于UKA多采用微创手术方式,因而在术后恢复及患者病死率等方面优于全膝关节置换;并且有学者经过10年的随访,发现关节存活率令人满意。随着手术技术日趋成熟、关节假体制造工艺越来越精细、     

Preclinical Evaluation Method for Total Knees Designed to Restore Normal Knee Mechanics

The objective was to develop a simple, rapid, and low-cost method for evaluating proposed new total knee arthroplasty (TKA) models and then to evaluate 3 different TKA models with different kinematic characteristics. A “desktop” knee testing rig was used to apply forces and moments over a full flexion range, representing a spectrum of positions and activities; and the positions of the femur on the tibia were measured. The average neutral path of motion (for compressive force only) and the laxities about the neutral path (for superimposed shear and torque) were determined from 8 knee specimens to be used as a benchmark for the TKA evaluations. A typical posterior-stabilized TKA did not display the normal external femoral rotation with flexion and also showed abnormal anterior sliding on the medial side. A medial-pivot type of guided-motion design showed medial stability comparable to anatomical but still did not produce external femoral rotation and posterior lateral displacement with flexion. The addition of a central cam-post produced the rotation and displacement but only after 75° of flexion. It was concluded that the test method satisfied the objective and could be used as a design tool for evaluating new and existing designs, as well as for formulating a TKA with anatomical characteristics.     

Management of the painful knee

The painful knee is one of the most common musculoskeletal presentations to primary and secondary care. It is important to distinguish between acute and chronic causes of knee pain, since the urgency of diagnosis and management can be vastly different. This short review covers the common diagnoses that are frequently encountered, with a systematic approach to confirming the diagnosis, and a management strategy.     

Restoration of the joint line in total knee arthroplasty

The purpose of the study was to assess the effect of the joint line position in a posterior cruciate ligament–retaining, mobile-bearing total knee arthroplasty (TKA). Seventy-six consecutive TKAs performed by 1 surgeon were prospectively assessed for a minimum of 2.5 years. Posterior cruciate ligament–retaining, mobile-bearing TKA was performed in all cases. The joint line was elevated 1 mm on average (range, −11 to +10). There was no correlation between joint line position and range of motion, knee function scores, knee pain scores, or patellar height. The joint line position in a posterior cruciate–retaining, mobile-bearing (LCS AP Glide; DePuy, Leeds, United Kingdom) TKA did not affect the early clinical results.     

人工全膝关节置换治疗膝关节骨关节炎

目的探讨人工全膝关节置换术(TKA)治疗终末期膝关节骨关节炎的临床疗效。方法对行TKA治疗的181例终末期膝关节骨关节炎患者(226膝)分别于手术后40、120、180、360 d进行定期随访观察,对患者HSS膝关节功能评分及膝关节最大活动度进行比较。结果患者均获得随访,时间1~2年。膝关节功能HSS评分:优209膝(92.5%),良13膝(5.8%),可3膝(1.3%),差1膝(0.4%),优良率98.2%。术后各时间段的HSS评分及膝关节最大活动度均较术前显著提高,差异均有统计学意义(P0.05)。结论 TKA是治疗终末期膝关节骨关节炎的有效方法,正确的手术操作和合理的功能锻炼是取得满意临床效果决定性因素。     

Extension Deficit and Lateral Instability in Degenerative Disease of the Knee

During the period October 1975-June 1977, 70 Marmor knee arthroplasties were performed. the operative procedure provided a good opportunity to study the anatomical conditions in vivo. the causes of extension deficit and lateral instability of the knees were analysed in a prospective investigation. Thirty-seven out of 69 knees had an extension deficit exceeding 10° preoperatively. At operation a bony impediment to extension was found in 32 of these 37 knees, and by removal of this obstruction the extension deficit was relieved in 31 of the knees. At radiography a bony impediment was demonstrated preoperatively as a cause of an extension deficit in 29 of the 32 knees. No false positive diagnosis was made radiographically. Varus or valgus instability exceeding 5° was observed preoperatively in 42 of the 70 knees. Lateral stability was achieved in all knees at operation by compensating for the intra-articular loss of cartilage and bone with the Marmor module system. Macroscopically intact collateral ligaments were found in all knee joints even in those severely affected by rheumatoid arthritis. All knees except three showed lateral stability 1 year postoperatively.