腓肠豆骨的解剖学观察及其临床意义

目的:对国人腓肠豆骨进行解剖观察,为临床腓肠豆骨相关疾病诊治提供解剖学参考依据.方法:对61侧成年膝关节标本进行解剖,观察腓肠豆骨的出现率、形态及其与周围相关结构的关系.结果:外侧腓肠豆骨的出现率为86.89%,且以骨性多见(55.74%),而内侧出现较少(9.84%),且均为软骨性.腓肠豆骨与腓总神经毗邻,20.8%的腓总神经从其表面通过.腓肠豆骨的存在与腓肠豆韧带的出现并不相关,不能作为判断腓肠豆韧带是否存在的标志.结论:国人腓肠豆骨以外侧多见,与腓总神经关系密切,临床医生需要对此结构有一定的认识,以利腓肠豆骨相关疾病的诊治.     

腓肠神经营养血管远端蒂腓骨复合组织瓣的临床应用

目的：探讨腓肠神经营养血管远端蒂腓骨复合组织皮瓣的临床应用.方法：在对腓肠神经营养血管与周围组织血供关系进行解剖研究的基础上设计了带腓肠神经营养血管腓骨复合组织瓣并应用临床.结果：腓肠神经-小隐静脉营养血管远端蒂腓骨复合组织瓣成活,经随访观察皮瓣外观、质地及功能良好.骨折愈合情况正在随访中.结论：对严重的外伤造成的骨不连、骨缺损病例,应用腓肠神经-小隐静脉营养血管远端蒂腓骨复合组织瓣进行修复是比较理想的.     

脉络膜前动脉解剖及其临床意义的研究进展

目的：综述脉络膜前动脉的解剖特点及其临床意义的研究成果。方法：广泛查阅近期脉络膜前动脉解剖及相关临床方面的研究文献，分析其临床意义。结果：脉络膜前动脉常起源于颈内动脉后侧壁，其供血范围广、管径细，易阻塞引起严重的临床后果。结论：脉络膜前动脉虽然细小，却是具有重要临床价值的一支脑血管，应当引起相关学者的高度重视。     

中国西北地区汉族人群胫骨近端截面线性参数的测量与分析

背景：用于国人膝关节置换的膝关节假体多由欧美国家进口或以之为蓝本制作,而欧美人种的膝关节界面与国人不同,国人的各人群之间亦有不同,制造适合于国人各人群的膝关节假体对于取得良好的置换效果至关重要。 目的：明确中国西北地区汉族人群胫骨上端截骨面的几何特点。 方法：135例中国西北地区汉族人群的膝关节CT扫描影像学资料来源为近段时期在CT扫描机上进行过膝关节检查人员的CT扫描数据,将膝部CT扫描数据导入图像工作站建立数字化模型,在模型中距内侧平台之下3 mm与6 mm处后倾3°截骨,测量两截骨平面中前后径线与内外侧径线等各径线的数值。 结果与结论：测得两截骨平面中各径线数值,进一步得出各主要径线之间的相关系数与回归方程,结果显示中国西北地区汉族人群与欧美人种及亚洲各人群相比,胫骨近端截面有其独自特点,建议据其特点设计与选择适合于西北汉族人群的膝关节胫骨侧假体。     

人工韧带修复膝关节交叉韧带损伤

背景：以往治疗膝关节交叉韧带损伤的主要手段是移植重建,最常用的移植材料为自体的骨髌腱骨、半腱肌腱和股薄肌腱。但由于此类移植物存在取材区并发症及韧带化过程中的各种问题,近年来人工韧带的研究受到重视。 目的：认识膝关节交叉韧带的结构及血供特点,以及膝关节交叉韧带损伤后人工韧带重建治疗机制与临床应用特点。 方法：①分析膝关节前、后交叉韧带的组织结构,功能学特点以及血供差异。②分析膝关节前、后交叉韧带损伤的类型及生物力学机制。③分析修复膝关节交叉韧带损伤的材料学分类及特点。④分析人工韧带修复后影响关节稳定性的因素。 结果与结论：修复膝关节前、后交叉韧带损伤时,应首先考虑到前、后交叉韧带的功能及血供情况,选择合适的重建物,使重建时过程简化,操作简单,重建材料的组织相容性较好,达到修复后的解剖与功能的双重建。     

人工膝关节常用假体材料及其生物相容性

背景：理想的假体材料对人工膝关节的功能、预后至关重要。 目的：评价各种人工膝关节生物材料的性能、应用及其生物相容性,寻找合理的膝关节替代物。 方法：采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索1999-01/2009-12有关生物材料应用于人工膝关节的研究文章,关键词为“组织工程,人工膝关节,生物材料”。排除重复研究、普通综述或Meta分析类文章,筛选纳入17篇文献进行评价。 结果与结论：传统的金属和骨水泥材料仍广泛运用于人工膝关节假体中,随着医学和组织工程技术的发展,各种合成生物材料相继出现。近来出现了生物相容性较好的生物陶瓷及高分子复合材料,但存在易磨损的缺点,改进上述材料的缺点,寻求理想的人工膝关节假体材料是当前生物医学工程研究的热点之一。虽然传统的金属、骨水泥、生物陶瓷及高分子复合材料均在临床上大量应用于人工膝关节,但由于其存在各自不可避免的缺点,理想的人工膝关节假体材料仍需进一步开发。     

应用逆向工程技术测量人膝关节内外侧间室间隙和体积

背景：膝关节是人体骨骼中形态及结构最为复杂的部分,临床上常使用X射线片反映膝关节间隙狭窄程度。但X射线片是将三维的关节结构进行二维投射,因此关节拍摄定位的不同会影响测量结果,很难保证重复测量的准确性。 目的：建立膝关节间隙三维模型并测量其距离和体积,为后续的模型、生物力学及相关临床研究提供基础。 方法：基于逆向工程原理,采用膝关节CT断层图像,使用Mimics进行膝关节和内侧间室三维结构重建,最后导入Geomagic Studio对模型进行光滑处理并计算膝关节内、外侧间室体积。 结果与结论：利用膝关节CT断层图像分别重建出膝关节三维模型的骨性结构如股骨、胫骨、腓骨,并成功构建出膝关节间隙模型。构建的膝关节三维模型和间隙模型可以任意角度或单独观察,并可以进行体视学测量。发现膝关节内外侧间隙虽然距离有差异,但体积接近,说明通过计算膝关节内、外间室的体积,可以全面的反映膝关节间隙的狭窄程度。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

膝关节剥脱性骨软骨炎MRI诊断

目的 总结膝关节剥脱性骨软骨炎的MRI影像特点,为临床早期诊断提供参考。方法 回顾性分析2012年6月~2017年5月在我院接受MRI检查并经过临床及关节镜证实的17例膝关节剥脱性骨软骨炎患者的MRI影像资料。结果 17例患者中发生于膝关节股骨内侧髁9例,股骨外侧髁3例,胫骨内侧髁3例,髌骨2例,关节腔内游离骨块8例;17例患者均有不同程度膝关节积液。结论 采用合理的MR检查序列,膝关节剥脱性骨软骨炎的MRI表现有明显特征性,为首选检查。     

股骨髁部复杂骨折内固定后膝关节功能受限的多元逐步回归分析

背景：股骨髁部复杂骨折内固定治疗后常出现膝关节功能受限,但对其发生机制及影响因素也各说不一。 目的：筛选分析股骨髁部复杂骨折内固定后膝关节功能受限的相关因素。 方法：回顾性总结121例股骨髁部复杂骨折患治疗后6及12个月回访信息,依Merchan标准评价患者膝关节功能恢复程度。对患者的性别、年龄、致伤原因、合并伤情况、皮肤软组织损伤情况、骨折类型、固定方式、手术时机、内固定后石膏固定情况、切口愈合情况、骨愈合情况及功能锻炼情况等12项因素进行多元逐步回归分析。总结出影响因素。 结果与结论：以内固定后是否发生膝关节功能受限作为因变量Y,将上述单因素分析中有统计学意义的因素作为自变量X,选择多元逐步回归分析统计方法进行多因素分析,结果表明患者的性别(X1)、是否合并伤(X3)和软组织损伤情况(X4)及手术时机(X6)共4个因素不能引入模型,说明上述4个因素与内固定后是否发生膝关节功能受限无显著相关。其他8个因素则进入多因素分析模型,表明患者内固定前致伤原因(X2)、内固定前骨折类型(X5)、内固定方式的选择(X7)和植骨与否(X8)、内固定后石膏固定与否(X9)、内固定后膝关节功能锻炼与否(X10)及伤口愈合情况(X11)、骨愈合程度(X12)等8个危险因素与股骨髁部复杂骨折内固定后膝关节功能受限有较密切的关系。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

膝关节人工交叉韧带材料的运动力学特征及临床应用评价

背景：交叉韧带损伤是膝关节常见的运动损伤,可引起膝关节的疼痛和关节不稳,常伴有关节松弛、半月板损伤等症状出现。 目的：分析膝关节人工交叉韧带的特点以及在膝关节交叉韧带损伤治疗中的效果评价。 方法：膝关节交叉韧带发生断裂时,需要通过外科方法重建韧带功能,应用生物材料进行交叉韧带的重建,可以使患者获得较少的病废,并且允许患者膝关节在治疗后立即活动,有利于患者的康复。交叉韧带的移植材料包括自体韧带材料、同种异体韧带材料和人工韧带材料。 结果与结论：膝关节交叉韧带修复重建的自体材料有骨-髌腱-骨和半腱肌移植,骨-髌腱-骨移植的并发症较多,半腱肌与股薄肌腱取材后会影响关节的功能。异体韧带材料主要包括骨-髌腱-骨和股四头肌腱-骨,异体材料的不足之处是杀灭细菌和病毒不完全。人工交叉韧带材料分为永久性韧带材料、支架韧带材料和框架韧带材料,LARS人工韧带移植治疗交叉韧带损伤的疗效较为理想,与自体韧带移植的近期疗效相比,差异有显著性意义(P < 0.05),与自体韧带移植的远期疗效比较无差异。无论是自体、同种异体还是人工韧带材料,每种材料都有各自的优缺点,需要根据患者的自身情况和病情来决定,人工韧带材料为交叉韧带移植提供了新的材料选择,随着生物材料学和生物医学工程学的发展,人工韧带材料一定会成为韧带材料的良好替代物。     

Dislocation of an enlarged fabella as uncommon cause of knee pain: a case report

The fabella is a sesamoid bone that can very occasionally act as a source of atypical knee pain, often mistaken for a more common cause of clinical symptoms, such as an intra-articular loose body or an osteophyte. We report a case of symptomatic dislocation of an osteoarthritic, enlarged fabella, 4 years after total excision of the patella for a comminuted fracture, that was primarily overlooked and led to repeated diagnostic arthroscopy of the knee. A thorough history and physical examination of the joint as well as appropriate roentgenographic studies could have spared this patient an unnecessary arthroscopy and indicated the correct therapy.     

Fabella prevalence rate increases over 150 years,and rates of other sesamoid bones remain constant: a systematic review

The fabella is a sesamoid bone located behind the lateral femoral condyle. It is common in non‐human mammals, but the prevalence rates in humans vary from 3 to 87%. Here, we calculate the prevalence of the fabella in a Korean population and investigate possible temporal shifts in prevalence rate. A total of 52.83% of our individuals and 44.34% of our knees had fabellae detectable by computed tomography scanning. Men and women were equally likely to have a fabella, and bilateral cases (67.86%) were more common than unilateral ones (32.14%). Fabella presence was not correlated with height or age, although our sample did not include skeletally immature individuals. Our systematic review yielded 58 studies on fabella prevalence rate from 1875–2018 which met our inclusion criteria, one of which was an outlier. Intriguingly, a Bayesian mixed effects generalized linear model revealed a temporal shift in prevalence rates, with the median prevalence rate in 2000 (31.00%) being ~ 3.5 times higher than that in 1900 (7.64%). In all four countries with studies before and after 1960, higher rates were always found after 1960. Using data from two other systematic reviews, we found no increase in prevalence rates of 10 other sesamoid bones in the human body, indicating that the increase in fabella prevalence rate is unique. Fabella presence/absence is due to a combination of genetic and environmental factors: as the prevalence rates of other sesamoid bones have not changed in the last 100 years, we postulate the increase in fabella prevalence rate is due to an environmental factor. Namely, the global increase in human height and weight (due to improved nutrition) may have increased human tibial length and muscle mass. Increases in tibial length could lead to a larger moment arm acting on the knee and on the tendons crossing it. Coupled with the increased force from a larger gastrocnemius, this could produce the mechanical stimuli necessary to initiate fabella formation and/or ossification.     

腓肠肌外侧头纤维化钙化与膝及小腿后外侧疼痛

目的：探讨腓肠肌外侧头纤维化、钙化引起膝后及小腿后外侧疼痛的临床特点及治疗方法。方法：收集腓肠肌外侧头纤维化、钙化导致膝及小腿后外侧疼痛病例25例（28侧）,其中侧位X线片于股骨外侧髁后部可见明显的小豆骨22侧,仅见小钙化点6侧;均行钙化或纤维化组织包块切除,腓总神经探查松解术。结果：全部病例随访6-24个月,平均12个。术后静态及动态一过性足下垂及小腿下段与足背麻木症状消失,膝关节后外侧疼痛消失或明显缓解。结论：腓肠肌外侧头纤维化钙化是膝后外疼痛的重要原因,大多伴有腓总神经受损症状,目前对其认识欠缺,误诊率高,手术切除纤维化钙化包块、选择松解受累的腓总神经效果确切。     

Anatomical study of the fabella, fabellar complex and its clinical implications

The fabella has been mainly studied using imaging methods but there are less research reports on the gross anatomical studies. We performed this anatomical study of the fabella and its surrounding structures with functional implications using 150 heads of the gastrocnemius muscles of 75 knees from 39 Japanese cadavers. This study is the direct representation of the human fabella and its functional implications. We observed 99 fabellae (66.0%) including 44 complete bony fabellae (29.3%). Of these bony fabellae, 43 (97.7%) were located in the lateral head of the gastrocnemius muscle with its surrounding structures and were positioned only on the lateral condyle of the femur. Moreover, the cartilage and bony fabellae, especially on the lateral side, contributed to the fabella complex with its surrounding muscles and ligaments and formed small articular cavity by cooperating with the femoral condyle. Although the human fabella is considered as appearing in the fabella complex with ageing and it possibly induces clinical symptoms, the fabella may play an important role as a stabilizer between the fabella complex and the femoral condyle.     

Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects

The fabella is a sesamoid bone located in the proximal tendon of the gastrocnemius muscle. In rare cases, its presence may lead to a variety of clinical problems, including fabella syndrome and common fibular (CF) nerve palsy. The purpose of this study was to analyze the morphology of the fabella and CF nerve and discuss the influence of any existing fabellae on the size of the CF nerve. The morphology of the fabella and CF nerve in the popliteal region of the lateral head of the gastrocnemius muscle was investigated in 102 knees of 51 Japanese cadavers. The maximum circumference of the thigh, knee, and calf and the frequency, position, and size of the fabella were measured. In addition, the CF nerve width and thickness were measured proximal to the fabellar region and again as the CF nerve passed posterior, lateral, or medial to the region. A fabella was observed in 70 knees (68.6%). The CF nerve adjacent to the fabella was significantly wider and thinner than in the region proximal to the fabella (P < 0.001). In cases in which a bony fabella was present, there was a significant relationship between the thickness of the CF nerve and the circumference of the thigh and knee. The following factors were observed to contribute to the presence of a fabella causing alterations in the size of the CF nerve: a bony fabella, a CF nerve path posterior or lateral to the fabella, and subjects with a thin physique and bony fabella. Clin. Anat. 26:893–902, 2013. © 2012 Wiley Periodicals, Inc.     

Anatomic study of fabella and its surrounding structures in a Chinese population

Purpose  

To explore the anatomic features of the fabella and its relationship with the common peroneal nerve and the fabellofibular ligament, so as to provide anatomical evidence for clinical diagnosis and treatment of fabella diseases in a Chinese population.     

Intra-articular osteoid osteoma simulating a painful fabella syndrome

We present a case of an intra-articular osteoid osteoma in the knee that was mistaken for a painful fabella syndrome after unsuccessful knee arthroscopy for the treatment of postero-lateral knee pain. In this case both the initial clinical presentation and the imaging proved to be deceiving. The diagnosis of intra-articular osteoid osteoma was considered only once typical clinical features appeared and a Computerized Tomography scan was performed. We discuss the difficult of diagnosing an intra-articular osteoid osteoma and the imaging of choice.     

Human biological variation in sesamoid bone prevalence: the curious case of the fabella

The fabella is a sesamoid bone located in the gastrocnemius behind the lateral femoral condyle. In humans, fabellae are 3.5 times more common today than they were 100 years ago, with prevalence rates varying between and within populations. In particular, fabellae have been assumed to be more common in Asians than non-Asians, equally common in men and women, potentially more common in older individuals, and bilateral cases (one per knee) appear to be more common than unilateral ones. The roles of genetic and environmental factors in this phenotypic variation have been hypothesized, but not rigorously investigated. Given its clinical and evolutionary significance (i.e. being associated with several knee ailments, causing medical issues on its own, interfering with medical devices, and being less common in humans than in other mammals), it is important comprehensively to understand prevalence rate variation, and the roles of genetics and environmental factors in that variation. To address these questions, we performed a meta-analysis on data from studies published from 1875 to 2018 to investigate possible variation in sexual dimorphic (n = 22 studies, 7911 knees), ontogenetic (n = 10 studies, 4391 knees), and global (n = 65 studies, 21 626 knees) fabella prevalence rates. In addition, we investigated what proportion of cases are bilateral (n = 37 studies, 900 individuals), and among unilateral cases (n = 20 studies, 204 individuals), if fabellae are more common in the left or right knee. Our results show that, today, fabellae are 2.47–2.60% more common in men than women, and prevalence rates increase ontogenetically in old age (i.e. 70 years old), implying that fabellae can ossify early (i.e. 12 years old) or late in life. Approximately 72.94% of cases are bilateral, and among unilateral ones, fabellae are equally common in right and left knees. There is marked regional variation in fabella prevalence rates, with rates being highest in Asia, followed by Oceania, South America, Europe, Middle East, and North America, and lowest in Africa. Worldwide, an average of 36.80% of knees has ossified fabellae detectable by dissection. These results imply that, while the ability to form a fabella may be genetically controlled, the mechanisms that trigger fabella ossification may be environmentally controlled. What these environmental factors are, can only be speculated.     

脂肪来源干细胞的研究及临床应用前景

目的：总结脂肪干细胞的研究进展及在临床上的应用。方法：查阅国内外相关文献,对脂肪干细胞的分化能力及临床应用前景进行汇总分析。结果：脂肪干细胞具有多向分化潜能,在动物模型中进行组织修复、细胞移植等方面有成功报道。结论：作为种子细胞的脂肪干细胞有着广阔的临床应用前景,其研究有待进一步深入。