关节镜下双束腘绳肌腱股骨双隧道和微型钢板纽扣重建后交叉韧带

目的探讨应用双束腘绳肌腱股骨双隧道和微型钢板纽扣固定法重建后交叉韧带(PCL)的临床效果。方法对13例单纯PCL断裂的患者在关节镜下用腘绳肌双束股骨双隧道和微型钢板纽扣固定法进行重建。其中男9例,女4例;年龄20-53岁,平均36岁;新鲜损伤9例,陈旧性损伤4例。全部取自体半腱肌腱和股薄肌腱作为移植物。根据PCL的解剖特点,将肌腱编织成"Y"形的两束。PCL两束股骨附着点分别钻孔,成双隧道。用微型钢板和纽扣分别固定股骨和胫骨端。结果术后3个月,所有患者均无伸膝受限,膝关节屈膝活动度均>120°。术后1年,屈膝70°时后抽屉试验Ⅰ度阳性1例,其余均为阴性;屈膝30°时后抽屉试验Ⅰ度阳性2例,其余均为阴性;膝关节功能Lysholm评分为(92.51±2.40)分。结论在关节镜下利用腘绳肌腱股骨双隧道和微型钢板纽扣法重建PCL能够更可靠地恢复膝关节功能。     

关节镜治疗前交叉韧带陈旧损伤29例临床体会

目的探讨前交叉韧带(ACL)陈旧损伤采用关节镜下单束自体四股腘绳肌腱重建ACL的临床价值。方法自2010年1月—2011年12月采用关节镜下单束自体四股腘绳肌腱重建ACL 29例,男20例,女9例,年龄18～46(31.6±4.2)岁;观察术后Lysholm评分及关节前向松弛度差值变化。结果所有病例均获得随访,随访时间7～24(12.5±2.7)个月,无感染、血管神经损伤、内固定物松动及深静脉血栓等并发症;术前Lysholm评分42～64(53.2±7.2)分,关节前向松弛度差值3.4～4.3(3.72±0.42)mm;术后Lysholm评分88～96(93.2±2.5)分,关节前向松弛度差值1.2～2.4(1.64±0.38)mm。结论关节镜下自体四股腘绳肌腱重建ACL是一种治疗ACL陈旧损伤可靠的方法,术中在治疗关节失稳的同时,需对关节内软骨、半月板等结构损伤进行修复,以增强膝关节的稳定性,缓解患者的症状。     

关节镜下自体四股腘绳肌腱重建膝前交叉韧带

目的评估关节镜下自体四股腘绳肌腱重建膝前交叉韧带(ACL)的技术和效果方法1999年10月-2003年12月共56例患者经关节镜检查证实为ACL断裂,26例伴半月板破裂,7例伴内侧副韧带损伤,12例伴后交叉韧带断裂。均于关节镜下行自体四股腘绳肌腱ACL重建术,采用Bionx生物可吸收挤压螺钉或钛挤压螺钉解剖位固定重建韧带。结果本组术后早期均未发生严重并发症。术后随访6-48个月,平均20个月,Lysholm膝关节功能评分由术前45-80分(平均58.36分),提高至随访时70-100分(平均92.77分)(P<0.01)。国际膝关节文件编制委员会(IKDC)综合评定由术前异常(C级)14例、显著异常(D级)42例,改进为随访时正常(A级)23例、接近正常(B级)29例、异常(C级)4例(P<0.01)。56例患者中,52例恢复伤前运动水平,4例运动水平较伤前降低。结论关节镜下自体四股腘绳肌腱重建膝ACL具有手术损伤较小、术后膝关节功能恢复良好的优点,值得采用。     

自体骨-髌腱-骨和腘绳肌腱单束重建陈旧性断裂前交叉韧带后移植物愈合形态学和前向稳定性比较

目的:探讨陈旧性前交叉韧带(anterior cruciate ligament,ACL)断裂患者,采用自体骨-髌腱-骨(bone-patellar tendon-bone,B-PT-B)和自体腘绳肌腱(hamstring tendon,HT)单束重建后移植物愈合的形态学表现以及前向稳定性是否存在差异。方法:2000年12月～2003年8月,我所77例受伤病史>12个月的ACL断裂患者,分别采用自体B-PT-B和HT作为移植物,接受了膝关节镜下ACL单束重建,因去除金属内固定进行二次手术,并接受关节镜探查(术后10～32个月,平均14.7个月)。根据移植物种类将其分为B-PT-B组(n=27)和HT组(n=50)两组,比较关节镜下移植物愈合形态学表现,采用膝关节韧带位移测量仪(KT-2000),分别在屈膝30°和90°时测量前向松弛度。结果:B-PT-B组和HT组移植物愈合形态学表现分别为:①韧带完整的分别占96.3%(26/27)和98.0%(49/50),部分断裂占3.7%(1/27)和2.0%(1/50)(χ2=0.000,P=1.000);②滑膜完整的分别占77.8%(21/27)和82.0%(41/50)(χ2=0.119,P=0.655);③滑膜内有明显血管形成的分别占63.0%(17/27)和76.0%(38/50)(χ2=1.460,P=0.227);④有分股表现的分别占22.2%(6/27,此6例均无完整滑膜覆盖)和32.0%(16/50)。屈膝30°时,两组前向松弛度分别为1.5±1.8 mm和2.2±1.3 mm(t=1.949,P=0.055),90°时分别为1.1±1.4mm和1.4±0.9 mm(t=1.467,P=0.147)。结论:采用自体B-PT-B和HT单束重建陈旧性ACL断裂,术后短期肉眼观察移植物愈合形态学表现无显著性差异,前向稳定性均满意,且无显著性差异。     

自体半腱和股薄肌腱移植双束重建膝关节后外侧角

目的:观察采用自体半腱和股薄肌腱移植双束重建膝关节后外侧角韧带结构的近期临床效果。方法:对21例膝关节后外侧角韧带结构损伤患者(23个膝关节),采用自体半腱和股薄肌腱移植,双束重建膝关节后外侧角韧带结构。自体半腱肌腱移植物经胫骨骨道和腓骨骨道返折分别重建腘肌腱和腘腓韧带,于腘肌腱股骨外侧髁解剖止点处钻孔固定重建的腘肌腱和腘腓韧带;股薄肌腱移植物经腓骨骨道返折重建腓侧副韧带,于腓侧副韧带股骨外侧解剖止点处钻孔固定重建的腓侧副韧带。对于合并交叉韧带损伤者,同期行关节镜下韧带重建术。术后对患者膝关节内翻稳定性和外旋活动度进行至少1年(12~31个月,平均26.7个月)随访,通过Lysholm膝关节评分法评价膝关节术前、术后功能。结果:术后1年以上的回顾性随访中,膝关节完全伸直位无膝内翻不稳定者;屈膝30°位,无膝内翻不稳定者19例,膝内翻Ⅰ度不稳定伴硬性终止点者2例;俯卧位膝关节屈膝30°,所有患者小腿外旋活动均与对侧相同;Lysholm膝关节评分术前平均54.3分,术后平均89.2分。结论:自体半腱和股薄肌腱移植双束重建膝关节后外侧角韧带结构具有移植腱割取创伤小、移植材料理想、解剖等长重建及固定强度高的特点,近期疗效理想。     

关节镜下单骨道双束和单骨道单束重建前交叉韧带疗效的初步对比研究

目的:前瞻性对比研究单骨道双束和单骨道单束腘绳肌腱重建前交叉韧带的疗效差异。方法:2011年10月至2012年3月,共48例初次前交叉韧带断裂患者入选本研究,随机分为单骨道双束组(n=24)和单骨道单束组(n=24),分别采取关节镜下单骨道双束和单骨道单束重建前交叉韧带手术技术,移植物均使用自体腘绳肌腱。两组胫骨骨道均用Tibial Intrafix固定,单骨道双束组股骨骨道用Femoral Intrafix固定,而单骨道单束组股骨骨道用Endobutton固定。术后随访分别采用IKDC、Lysholm和Tegner评分进行主观膝关节功能评价,采用KT-2000测量客观评估稳定性。结果:48例患者均获随访,平均随访时间(14.71±1.69)个月。两组功能评分显示,术后IKDC、Lysholm和Tegner评分较术前均显著改善,但组间无显著性差异。两组术后客观稳定性评估较术前均显著提高,但组间无显著差异。在134N拉力下KT-2000测量侧侧差值:单骨道双束组屈膝30°时为(1.44±1.28)mm,屈膝90°为(1.15±1.30)mm;单骨道单束组屈膝30°时为(1.63±1.15)mm,屈膝90°为(1.31±1.26)mm。结论:单骨道双束腘绳肌腱重建前交叉韧带能够很好恢复膝关节前向稳定性,手术操作简便,固定牢固,近期疗效满意;但与单骨道单束重建前交叉韧带相比,膝关节主观功能评分和客观稳定性评估均无明显差别,需进一步研究。     

关节镜下运用4股腘绳肌腱同期重建前后交叉韧带损伤

目的 关节镜下运用Intrafix和可吸收界面螺钉固定自体4股腘绳肌腱，同期重建前交叉韧带（anterior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL），评估其疗效。方法 ACL、PCL同时损伤的患者16例，关节镜下以自体4股胭绳肌腱作为重建移植物，应用可吸收界面螺钉固定移植物股骨端，Intrafix钉鞘和可吸收锥形钉固定胫骨端，同期行ACL和PCL损伤重建术。7例行内侧副韧带修补，4例行外侧副韧带复合结构修复，2例行内外侧同时修复。所有患者按照国际膝关节评分委员会（International Knee Documentation Committee，IKDC）评分标准进行术前评估，均为D级。术前Lysholm评分为（36．5±3．7）分。结果 随访时间为12～18个月，平均14．6个月。终末随访时，IKDC总体评价：A级6例（38％），B级9例（56％），C级1例（6％），无D级患者。Lachman试验0～2mm8例；3～5mm6例；6～10mm2例（P〈0．05）。屈70°前后总位移0～2mm10例；3～5mm5例；6～10mm1例（P〈0．05）。屈70°后位移0～2mm12例；3～5mm4例（P〈0．05）。术后2个月Lysholm功能评分为（90．4±2．9）分，终末随访时为（93．4±3．5）分，与术前相比差异均有统计学意义（P〈0．05）。结论 关节镜下以自体4股胭绳肌腱作为移植物，应用可吸收界面螺钉、Intrafix钉鞘和可吸收锥形钉固定股骨胫骨端同期重建ACL和PCL损伤，有利于早期积极的功能康复，膝关节功能恢复满意。     

半腱肌股薄肌腱打结骨栓嵌入固定镜下重建前交叉韧带的初步观察

目的　探讨自体半腱肌、股薄肌腱中间打结、骨栓嵌入挤压固定法在关节镜下重建前交叉韧带 (ACL)的可行性。　方法　 15例前ACL损伤 ,采用自体半腱肌、股薄肌腱中间打结 ,骨栓嵌入挤压固定法镜下重建ACL。半腱肌腱和股薄肌腱预张力后 ,肌腱中间打结嵌入 12mm×6mm骨栓。经ACL导向器打入导针 ,用环钻建立股骨和胫骨隧道。胫骨和股骨隧道下 1 3的直径为 5～ 7mm ,股骨隧道近 2 3为 11mm。将肌腱从股骨隧道的近端经关节腔牵入胫骨隧道 ,将肌腱拉紧、膝关节屈伸活动 2 0次 ,使肌腱结和骨栓完全嵌入瓶颈状股骨隧道内。将 4股肌腱从胫骨隧道和其下方 10mm处分别穿出 ,交叉打结并缝合固定在骨桥上。　结果　 15例患者得到随访 ,关节稳定 ,功能恢复正常。按膝关节疗效评定标准 ,优 11例 ,良 2例 ,可 2例 ,优良率 86.7%。　结论自体肌腱打结骨栓嵌入固定法重建ACL为生物固定 ,创伤小 ,固定可靠 ,费用低 ,有利于愈合 ;可免除金属内固定物 ,术后不影响MRI检查     

同种异体胫前肌腱和自体腘绳肌腱重建前交叉韧带临床研究

目的:探讨关节镜下同种异体胫前肌腱与自体腘绳肌腱重建前交叉韧带(ACL)的临床疗效。方法:回顾了60例陈旧性前交叉韧带损伤重建病例,分为A组30例,B组30例。分别应用同种异体胫前肌腱(A组)和自体半腱肌、股薄肌腱(B组)重建ACL,A组平均随访29.4个月,B组平均随访31.6月。采用Lysholm、Tegner、IKDC、KT2000对患者进行术前和术后膝关节功能测试、评分,并用等速测试仪测量各组术后伸膝、屈膝、内旋和外旋肌力。结果:两组手术前后Lysholm、TegnerI、KDC、KT2000测试结果均有显著性差异(P<0.01);但两组间术后评分无显著性差异(P>0.05)。等速肌力测试结果显示术后B组内旋、屈膝肌力较术前下降(P<0.05),而A组术后肌力较术前无明显下降(P>0.05)。结论:关节镜下采用同种异体胫前肌腱重建前交叉韧带疗效满意,不良反应发生率低。     

关节镜下横杆悬挂法重建膝前交叉韧带临床研究

目的:介绍关节镜下横杆悬挂固定法(ArthrexTransFixⅡ法)固定移植的半腱肌腱、股薄肌腱重建膝关节前交叉韧带的方法,并对其中期临床疗效进行了分析。方法:从2003年6月至2005年9月,采用横杆悬挂固定法固定移植的半腱肌、股薄肌腱重建膝关节前交叉韧带123例。其中,男性100例,女性23例。年龄16～57岁,平均年龄28.5岁。左膝60例,右膝63例。平均病程12.3个月。取患膝半腱肌腱、股薄肌腱并修整、编织缝合后植入骨道,股骨骨道的移植物行横杆悬挂法固定,胫骨端用生物可吸收挤压钉加门形钉固定。结果:123例患者中,112例获得随访,随访时间6～27个月,平均18.5个月。随访病例术前Lysholm评分为53.2±3.2分,随访时Lysholm评分为93.4±2.3分,两者相比有显著性差异(P<0.05)。结论:关节镜下横杆悬挂法绳肌移植重建膝前交叉韧带是一种微创、疗效确切的方法。     

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.