后交叉韧带胫骨止点撕脱骨折的早期诊断与手术治疗

目的　探讨后交叉韧带胫骨止点撕脱骨折的早期诊断与手术治疗。方法　回顾性分析 1 995年 1月～ 2 0 0 1年 1 0月共收治 1 8例后交叉韧带胫骨止点撕脱骨折的诊断与治疗情况。训练伤 1例 ,车祸伤 1 6例 ,机器卷伤 1例。新鲜骨折 1 6例 ,陈旧性骨折 2例。 1 0例行三维CT重建检查。 1 8例手术均用腓肠肌内侧斜切口显露。采用可吸收钉内固定 1 0例 ,钢丝 2例 ,螺钉6例。结果　 1 8例均得到随访 ,时间 6个月～ 2年 ,平均 1 8年。优 1 0例 ,良 6例 ,中 2例 ,差 0例。结论　三维CT重建有利于后交叉韧带胫骨止点撕脱骨折早期诊断 ;腓肠肌内侧斜切口有利于该损伤的手术显露     

关节镜下Suture-Bridge线桥技术止点足印重建前交叉韧带撕脱骨折

目的 :探讨关节镜下复位、Suture-Bridge线桥技术止点足印重建前交叉韧带撕脱骨折的手术方法及临床疗效。方法:2010年3月至2012年9月,对6例膝关节前交叉韧带(ACL)胫骨端止点撕脱骨折患者,在关节镜下行撕脱骨块解剖复位、Suture-Bridge线桥技术ACL止点胫骨端足印重建术。ACL止点撕脱骨折Meyers-Mc KeeverZaricznyj分型:Ⅲ型2例,Ⅳ型4例;其中男2例,女4例;年龄14~52岁,青少年2例,分别为男14岁和女15岁)。术前患膝前抽屉试验及Lachman试验均呈阳性。结果:所有患者获随访,时间均超过2年。术后患膝前抽屉试验及Pivotshift均阴性,无伸膝受限。术后影像学复查示ACL止点撕脱骨折均愈合,骨折复位良好,ACL走行正常。术后3个月及1、2年的Lysholm及IKDC评分均较术前改善。结论 :关节镜下复位、Suture-Bridge线桥技术止点足印重建前交叉韧带撕脱骨折的手术方式安全有效,实现ACL胫骨止点解剖重建,尤其适用于撕脱骨块碎裂严重或胫骨骨骺未闭合的青少年患者。     

后内侧入路治疗后交叉韧带胫骨止点撕脱骨折

目的探讨后交叉韧带胫骨止点撕脱骨折的手术入路和固定方法。方法2007年6月至2009年6月对17例后交叉韧带胫骨止点撕脱骨折患者,采用膝关节后内侧入路切开复位,11例用1～2枚空心钛钉固定,6例用钢丝固定。结果17例患者术后随访12-24个月,平均16．4个月,骨折均骨性愈合,术后12个月膝关节功能评定按Hohl评分标准评定,优12例,良3例,可2例,优良率88．2％。结论膝关节的后内侧人路为骨折的直视复位和固定提供了良好的操作空间,结合空心钉或钢丝内固定是治疗后交叉韧带胫骨止点撕脱骨折的一种有效方法。     

钢丝结合空心加压钛螺钉或界面可吸收螺钉内固定治疗后交叉韧带胫骨止点撕脱骨折

目的探讨后交叉韧带胫骨止点撕脱骨折的治疗方法与疗效。方法对我科在2001年5月～2009年5月收治62例单纯后交叉韧带胫骨止点撕脱骨折,采用钢丝结合空心加压钛螺丝钉或界面可吸收螺钉内固定治疗进行回顾性分析。结果本组患者术后无切口机关节内感染,亦无明显关节积液和积血。62例患者术后均获得随访,随访时间为6～16个月,平均10个月。所有患者膝关节功能恢复满意。结论钢丝结合空心加压钛螺钉或界面可吸收螺钉内固定治疗后交叉韧带胫骨止点撕脱骨折,方便简单,疗效优。     

认知周痹

自2002年1月-2006年1月分别采用小切口与传统切口后入路治疗后交叉韧带胫骨止点撕脱骨折35例。我们对比分析2种切口手术时间、术中出血量、伤口长度以及疗效结果,报告如下。1资料与方法1·1纳入标准有外伤史,具有腘窝部压痛、肿胀等一般症状,后抽屉试验与健侧对比差别大于10 mm以上,或骨折块较大、后抽屉试验与健侧对比5~10 mm之间者。经拍X线片、CT扫描除外后交叉韧带股骨止点撕脱骨折,明确为后交叉韧带胫骨起点撕脱骨折,不伴有膝关节其他部位骨折者,同时MR检查除外半月板损伤、前交叉韧带及侧副韧带断裂。1·2临床资料本组均为2002年1月…     

关节镜下缝线固定修复膝前交叉韧带胫骨止点撕脱骨折

目的 探讨关节镜下修复膝前交叉韧带胫骨止点撕脱骨折的固定方法及临床效果.方法 自2004年1月至2007年1月,对18例膝前交叉韧带胫前止点撕脱骨折患者在关节镜下复位,使用不可吸收缝线8字形联合可吸收缝线2次平行穿越膝前交叉韧带基底部,胫骨隧道外打结固定,完成缝线修复固定.术后对其疗效评定采用Rasmussen评分标准进行评估.结果 18例患者均获得随访,随访时间6～30个月,平均12个月.术后16例为优,1例为良,1例为可,优良率为94.4%.结论 缝线固定方法修复膝前交叉韧带胫骨止点撕脱骨折创伤小,固定可靠,关节功能恢复好.     

小切口微创治疗单纯后交叉韧带胫骨止点撕脱骨折

目的探讨小切口微创治疗后交叉韧带胫骨止点撕脱骨折的手术方法及疗效。方法对32例后交叉韧带胫骨止点撕脱骨折,采用膝关节后内侧小切口入路治疗。结果术后骨折均一期愈合,1例有Ⅰ度后抽屉试验阳性,2例有10°～15°的屈膝受限,Lysholm膝关节功能评分(91.6±3.6)分。结论采用膝关节后内侧小切口入路治疗后交叉韧带胫骨止点撕脱骨折,避开了膝关节后方神经、血管,有安全,创伤小,术后功能恢复快等优点。     

膝后侧入路治疗后交叉韧带止带撕脱骨折

1997年 2月～ 1999年 2月 ,我院采用膝后侧入路治疗 9例后交叉韧带胫骨撕脱骨折患者 ,效果满意。1　材料与方法1.1　病例资料　本组 9例 ,男 8例 ,女 1例 ,年龄 17～ 5 0岁 ,均为车祸伤。孤立性后交叉韧带止点撕脱骨折 7例 ,1例伴前交叉韧带及内侧副韧带断裂 ,1例合并有前交叉韧带、内侧副韧带断裂、内侧半月板边缘撕裂及腓骨小头撕脱骨折。手术均于伤后 3天内施行。1.2　手术方法　麻醉后 ,取俯卧位 ,在气囊止血带下 ,取横纹中 1/ 3为中心 ,作“Ｓ”形切口 ,长约 12ｃｍ。在腓肠肌内外侧头之间显露胫神经及血管 ,并显露腓肠肌内侧头…     

后交叉韧带胫骨止点撕脱骨折的早期诊断与手术治疗

目的：探讨后交叉韧带胫骨止点撕脱骨折的早期诊断与手术治疗。方法：回顾性分析1995年1月－2001年10月共收治18例后交叉韧带胫骨止点撕脱骨折的诊断与治疗情况。训练伤1例，车祸伤16例，机器卷伤1例。新鲜骨折16例，陈旧性骨折2例。10例行三维CT重建检查。18例手术均用腓肠肌内侧斜切口显露。采用可吸收钉内固定10例，钢丝2例，螺钉6例。结果：18例均得到随访，时间6个月－2年，平均1．8年。优10例，良6例，中2例，差0例。结论：三维CT重建有利于后交叉韧带胫骨止点撕脱骨折早期诊断；腓肠肌内侧斜切口有利于该损伤的手术显露。     

施乐辉双固定螺钉治疗ACL胫骨止点撕脱骨折17例

目的观察总结应用双固定螺钉治疗前交叉韧带胫骨止点撕脱骨折的方法和临床效果。方法选择本院2009年1月至2012年3月,收治的前交叉韧带胫骨止点撕脱骨折患者17例,采用膝前内侧微创小切口进入,应用双固定螺钉进行治疗,观察骨折愈合及膝关节功能恢复情况。结果对17例患者进行6～24月随访,平均随访时间18个月,未见明显骨折端移位,无膝关节伸屈受限。Lysholm膝关节评分为（93.2±1.9）。结论应用双固定螺钉治疗前交叉韧带胫骨止点撕脱骨折操作简便,固定牢靠,疗效确切,并发症少。     

Hybrid Anterior Cruciate Ligament Reconstruction: Introduction of a New Technique for Anatomic Anterior Cruciate Ligament Reconstruction

Recently, anatomic or double-bundle reconstruction of the anterior cruciate ligament (ACL) has been presented in an effort to more accurately restore the native anatomy. These techniques create 2 tunnels in both the femur and tibia to reproduce the bundles of the ACL. However, the increased number of tunnels, particularly on the femoral side, has raised some concerns among authors and surgeons. We describe a technique to reconstruct the 2 distinct bundles of the ACL by using a single femoral tunnel and 2 tibial tunnels, the “hybrid” ACL reconstruction. The femoral tunnel is drilled through an anteromedial arthroscopy portal, which allows placement in a more anatomic position. Fixation in the femur is achieved with a novel device that separates a soft-tissue graft into 2 independently functioning bundles. Once fixed in the femur, the anteromedial and posterolateral bundles of the graft are passed through respective tunnels at the anatomic footprint on the tibia. These bundles are independently tensioned, which creates a reconconstruction that is similar to the native ACL. The technique presented provides surgeons with an alternative to other double-bundle techniques involving 4 tunnels.     

The posterior cruciate ligament arthroscopic evaluation and treatment

The posterior cruciate ligament (PCL) is an anatomically and biomechanically complex structure. PCL injuries are reported to occur in 1–40% of acute knee injuries, with isolated PCL tears less common that PCL tears combined with other ligament injuries. Diagnosis of PCL injuries requires a high index of suspicion, careful physical examination, imaging studies, and systematic arthroscopic evaluation. Surgical reconstruction is recommended for acute PCL tears combined with other ligament or structural injuries, and when there is a negative tibial step off in an isolated PCL tear. Isolated acute PCL tears with a positive tibial step off or flat tibial step off may be treated with rehabilitation and observation and reconstructed later if symptomatic. Arthroscopic techniques of PCL reconstruction are becoming more refined and reproducible and may increase the predictability of this surgery. Carefully documented pre- and postoperative evaluations are required to judge the effectiveness of PCL reconstructive procedures.     

膝关节镜手术专用导向器的试制及临床应用

目的：探讨我院自行试制的膝关节镜专用滑臂式导向器用于前交叉韧带(ACL)和后交叉韧带(PCL)重建的临床效果。方法：回顾分析1996年7月--2000年2月应用滑臂式导向器定位，在关节镜下行ACL、PCL重建，随访超过18月患52例，其中ACL重建组33例，PCL重建组19例，重建材料均用深低温冷冻异体跟腱移植，术前及术后18月用Lysholm-Ⅱ评分评定膝关节功能及患运动水平。结果：根据膝关节功能评分(Lysholm-Ⅱ评分)ACL重建组：术前平均48分(36--62分)，术后18月平均86分(58--98分)，优良率90．9％(30／33)。PCL重建组：术前平均56分(42--64分)，术后18月平均84分(56--94分)，优良率89．5％(17／19)。结论：滑臂式导向器定位准确，使用方便，用于关节镜下ACL、PCL重建可获得良好的临床效果。     

A follow-up study of arthroscopic combined reconstruction of anterior and posterior cruciate ligaments with allograft patellar tendon

Objective： To evaluate the therapeutic effect of combined reconstruction of anterior cruciate ligament （ ACL ） and posterior cruciate ligament （ PCL ） simultaneously by using allograft patellar tendon under arthroscopy. Methods： From May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allograft patellar tendon simultaneously. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales. Results. All patients were followed up for 12-30 months （mean： 18 months ）. At the last follow-up, there was no knee extension limitation and knee flexion was between 120° and 135°, with an average of 128.38°. The Lysholm score of the 10 cases was 66. 5 ± 5. 6 before operation and 89.8 ± 3.4 at last follow up. The difference was statistically significant （ P 〈 0.01 ）. The average Tegner activity score decreased from 6.9 ± 1.7 （ range ： 4-9 ） before injury to 5.5 ± 1. 6 （rang： 2-9） at the follow-up （P=0.53）. At the end of follow-up, IKDC score was graded as A in 4 cases （40.0 % ）, B in 5 （50.0 % ）, and C in 1 （10.0%）. Of the 10 patients, 8 returned to the same sports level as before injury and 2 were under the level. Conclusion. Arthroscopic combined reconstruction of ACL and PCL with allograft patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.     

Mucoid Degeneration of Both ACL and PCL

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient''s magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.     

腘绳肌腱结嵌压固定法重建交叉韧带的临床应用与生物力学研究

目的探讨腘绳肌腱结嵌压固定法重建交叉韧带的可行性。方法对52例陈旧性前、后交叉韧带损伤患者在关节镜下行双股腘绳肌腱中间打结,嵌入瓶颈状股骨隧道内固定,胫骨端采用肌腱编织缝合在骨桥上打结固定,重建交叉韧带。其中前交叉韧带25例,前、后十字韧带同时重建15例,后交叉韧带12例。生物力学实验采用猪膝关节。股骨端固定分为肌腱结嵌入组(n=13)和骨髌腱骨(B PT B)介面螺钉固定组(B PT B介面钉组,n=11)。胫骨端固定分为肌腱编织缝合线在骨桥打结组(n=7)、肌腱编织缝合介面螺钉组(n=8)。进行最大拔出强度、最大位移和固定刚度等力学实验。结果术后随访49例,平均14 6个月,Lanchman试验阴性46例,阳性3例。术后Lysholm评分由术前56 7分提高到92 8分。按膝关节疗效评定标准,优46例,良3例。生物力学实验最大拔出强度肌腱结嵌入组高于B PT B介面钉组;固定刚度肌腱结嵌入组小于B PT B介面钉组;最大位移肌腱结嵌入组大于B PT B介面钉组。胫骨端固定抗拉强度和刚度骨桥打结组优于介面螺钉组。结论腘绳肌腱结嵌压固定重建交叉韧带生物力学抗拉强度能满足生理需求,方法可行;可克服位移因素,降低韧带松弛率,提高疗效。     

257 ankle arthroplasties performed in Norway between 1994 and 2005

Background and purpose?There have been few reports on the long-term outcome of ankle replacements. The Norwegian Arthroplasty Register has been registering ankle replacements since 1994, but no analysis of these data has been published to date. Here we report data on the use of total ankle replacements and the revision rate in the Norwegian population over a 12-year period.

Methods?We used the Norwegian Arthroplasty Register to find ankle arthroplasties performed between 1994 and 2005. Patient demographics, diagnoses, brands of prosthesis, revisions, and time trends were investigated.

Results?There were 257 primary ankle replacements, 32 of which were cemented TPR prostheses and 212 of which were cementless STAR prostheses. The overall 5- year and 10-year survival was 89% and 76%, respectively. Prosthesis survival was the same for the cementless STAR prosthesis and the cemented TPR prosthesis. There was no significant influence of age, sex, type of prosthesis, diagnosis, or year of operation on the risk of revision. The incidence of ankle replacements due to osteoarthritis, but not due to inflammatory arthritis, increased over the years.

Interpretation?The revision rate was acceptable compared to other studies of ankle arthroplasties, but high compared to total knee and hip arthroplasties. The overall incidence of ankle replacements increased during the study period.     

Biomechanics of the anterior cruciate ligament:Physiology,rupture and reconstruction techniques

The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.     

Posterior cruciate ligament injuries

We have studied 48 patients with posterior cruciate ligament injury and 14 knees from fresh frozen cadavers. A diagnosis of posterior cruciate ligament injury was made by the sag and posterior drawer signs and stress x-ray films, the latter being useful in the grossly swollen and multiple ligament-injured knee. For avulsion injury, surgical management gave the best results. Other isolated posterior cruciate ligament injuries did well conservatively. When posterior cruciate injury is part of a multiple ligament injury, the nature of the associated ligament injury and that of the posterior cruciate determine the type of treatment; the posterior cruciate ligament is not more important than other knee ligaments.