带血管蒂髌骨移位修复胫骨内侧髁上关节面缺损的应用解剖

为探索用带血管蒂髌骨移位的方法，修复肛骨内侧髁上关节在缺损，采用经动脉灌注的成人下肢标本３７侧，经解剖，厚切片或铸型研究髌骨的血管。观察３０块髌骨和胫骨内侧髁上关面的形态和面积。供应髌骨血液的各支动脉先有髌骨周围吻合成髌动脉环，再由该环发支进入髌骨，膝下内动脉和膝降动脉关节支的髌下支在髌骨内下方合并与参与形成髌周动脉环。髌骨的关节面与胫骨内侧髁上关节形态大小相似，根据研究结果，提出用带血管蒂髌骨移     

膝降血管为蒂股骨内侧髁瓣移位修复股骨中下段的应用解剖

在３０侧经动脉红色乳胶灌注过的下肢标本上，解剖观测了膝降血管的起始、走行位置、分支和分布。膝降动脉于股骨内侧髁下缘上方１１．５±１．６ｃｍ处起于股动脉，外经２．３±０．４ｍｍ。膝降动脉关节支或直接发自股动脉的关节支是股骨内侧髁前内侧面３ｃｍ×６ｃｍ区域的主要供血动脉。根据解剖结果，设计了带膝降血管蒂股骨内侧髁骨（膜）瓣，用以移位修复股骨中下段骨不连或骨缺损。     

隐血管蒂逆行股骨内侧髁骨(膜)皮瓣的解剖和临床意义

目的　为隐血管蒂股骨内侧髁骨 (膜 )皮瓣逆行移位修复小腿中上段损伤提供应用解剖学基础。方法　在 3 2侧经动脉灌注红色乳胶的成人下肢标本上 ,解剖观察了隐血管的起源、走行、分支、分布和吻合情况。结果　在 84.3 3 %的情况下隐动脉起源于膝降动脉 ,膝降动脉发出关节支后主干延续为隐动脉。隐动脉终末支在小腿内侧胫骨粗降水平与膝下内侧动脉皮支和胫后动脉肌间隙支有恒定的吻合。结论　隐血管蒂股骨内侧髁骨 (膜 )皮瓣逆行移位可以修复小腿中上段骨与软组织缺损。     

带掌背动脉远侧穿支蒂掌骨骨膜瓣移植治疗指间关节面缺损

介绍治疗食、中、环、小指近节关节面－侧缺损的手术方法。方法用带掌背动脉远侧穿支蒂掌骨骨膜瓣翻转治疗一侧关节面缺损１５例。结果本组病例在临床应用中，经３－３６个月的随访，取得了满意疗效。结论第二 动脉远侧穿支骨膜瓣位置恒定，血管蒂长，口径较粗，游离容易，血供充分，能有效地促进手指近节关节面的修复。     

膝降动脉穿支蒂股内侧皮神经营养血管皮瓣的应用解剖

目的 为膝降动脉穿支蒂股内侧皮神经营养血管皮瓣提供解剖学基础.方法 在40侧动脉内灌注红色乳胶的成人下肢标本上,以股骨内侧髁为观测标志解剖观测:股内侧皮神经走行与分布;膝降动脉穿支与股内侧皮神经营养血管间的吻合关系.另1侧新鲜标本进行摹拟手术.结果 股内侧皮神经体表投影为腹股沟韧带中点与股骨内侧髁的连线;膝降动脉(髌下支)穿支于股骨内侧髁下缘上约4 cm,在股内侧肌、大收肌腱与股骨内侧髁所围成的三角形凹陷内穿过深筋膜至皮下,并分出众多的细小血管与股内侧皮神经的神经旁和神经干血管链(网)密切吻合,在大腿内侧形成顺沿股内侧皮神经纵轴的血管丛.结论 根据膝降动脉穿支与股内侧皮神经营养血管吻合关系,可形成膝降动脉穿支蒂股内侧皮神经营养血管皮瓣转位修复膝部软组织缺损.     

带掌背动脉远侧穿支蒂掌骨骨膜瓣移植治疗指间关节面缺损

目的　介绍治疗食、中、环、小指近节关节面一侧缺损的手术方法。方法　用带掌背动脉远侧穿支蒂掌骨骨膜瓣翻转治疗一侧关节面缺损 15例。结果　本组病例在临床应用中 ,经 3～ 36个月的随访 ,取得了满意疗效。结论　第二掌背动脉远侧穿支骨膜瓣位置恒定 ,血管蒂长 ,口径较粗 ,游离容易 ,血供充分 ,能有效地促进手指近节关节面的修复。     

不同术式的指动脉逆行岛状皮瓣修复指腹缺损及术后感觉功能评价

我院自１９９２年到今，采用三种术式的指动脉逆行岛状皮瓣；（１）吻合神经的：（２）不带神经支的；（３）带指神经血管束的；共急诊修复６８例８２指的手指未节指腹缺损。通过术后２年的随访，对其感觉功能按英国医学研究会标准作了评价。通过比较认为吻合神经的指动脉蒂塑行岛状皮瓣因其解剖方便，血供可靠，术后感觉功能恢复好等优点而成为急诊修复手指未节指腹缺损的最佳术式。     

以膝降血管为蒂的股骨内侧髁骨膜(骨)瓣移位术

目的：为股骨中、下段骨不连、骨缺损提供一种新的疗法。方法：应用膝降血管关节支为蒂的股骨内侧髁骨膜（骨）瓣移位术予以修复。结果：临床应用１１例，效果满意。结论：本骨膜（骨）瓣移位术具有操作简便、手术安全、疗效可靠和易于推广等优点。     

以膝降血管为蒂的肌骨内侧髁骨膜（骨）瓣移位术

目的：为股骨中、下段骨不连、骨缺损提供一种新的疗法。方法：应用膝降血管关节支为蒂的股骨内侧髁骨膜（骨）瓣移位术予以修复。结果：临床应用１１例，效果满意。结论：本骨膜（骨）瓣移位术具有操作简便、手术安全、疗效可靠和易于推广等优点。     

指动脉终末背侧支逆行皮瓣

目的：介绍用指动脉终末背侧支逆行皮瓣修复指端软组织缺损及覆盖裸骨的疗效。方法：应用指动脉终末背侧支血管蒂的中节指背皮瓣逆行转移修复指端软组织缺损5例。结果：术后皮瓣全部存活，外形满意。结论：该术式是目前临床上以最纤细血管分支命名的血管蒂皮瓣之一，可避免损伤指固有血管，手术简便。     

Patellar tracking and patellofemoral geometry in deep knee flexion.

Patellar tracking and femoral condylar geometry in deep knee flexion were evaluated using magnetic resonance imaging. The patellar tilting angle, patellar shift, and patellar anteroposterior translation from 0 degrees to 135 degrees flexion were measured. The depth of the femoral condylar articular surface and the curvature of the femoral condylar articular surface also were measured at 135 degrees flexion. The patella shifted laterally, tilted medially, and sank deeply into the intercondylar notch during deep knee flexion. The articular surface of the lateral condyle, existing deep within the intercondylar notch, began to curve steeply at a point farther from the center of the intercondylar notch than did the medial condyle. The geometry of the femoral condyle is adequate to fit the patellar geometry. Results of the current study suggest that the geometry of the lateral femoral condyle allows the patella to track smoothly with a larger patellofemoral contact area and less patellofemoral pressure during deep flexion.     

髌骨形态异常与膝关节骨关节炎之间相关性

目的利用计算机辅助测量技术,对一定样本量的甘肃省中医院影像科膝关节X线片进行骨形态测量和相关比值分析研究,得出膝关节相关参数的正常范围,确立膝关节发育缺陷与膝关节骨关节炎之间相关性,找出导致髌股关节骨关节炎的骨性致病因素。方法测量指标:股骨髁宽度、胫骨髁宽度、髌骨宽度、髌骨纵径、髌骨关节面高度、髌骨厚度、髌骨下缘与关节间隙距离、股骨内髁前后径、胫骨平台前后径、髌骨关节面距胫骨平台距离、髌骨中点距股骨纵轴距离,采用SPSS 17.0软件对各有关比值进行处理和分析,采用90%(p5~p95)医学参考范围为正常参考范围描述;计数资料采用χ2检验,设检验水平为0.05,P0.05为差异有显著性意义。结果通过测量136例正常膝关节X线片各骨形态数据及相关比值,以90%医学参考范围为正常范围,得出髌骨厚度/股骨内髁前后径:0.162 362~0.335 135,髌骨纵径/髌骨关节面高度:1.217 105~1.643 902为正常范围。以此标准在481例膝关节骨关节炎病例中,髌骨厚度/股骨内髁前后径异常率6.4%,髌骨纵径/髌骨关节面高度异常率23.5%。结论髌骨偏厚、髌骨偏薄等形态异常在膝骨关节炎中占有一定的比例且女性发病率高于男性。     

带血管蒂股骨外侧髁骨膜(骨)瓣移位术的应用解剖

目的　为修复股骨中、下段提供一新的骨膜（ 骨）供区。方法　在４０ 侧成人下肢标本上,解剖观测股骨外侧髁和股骨下段前面的血管来源、走行、分支和吻合情况。结果　膝外上动脉起自月国动脉,经外侧髁上方穿股二头肌腱与股外侧肌间隔至骨面发骨膜支分布于外侧髁的外侧面并参与股骨前面骨膜血管网。股动脉直接骨膜支约在股骨中下１／３ 交界处,发自股动脉,斜向外下行分布于股骨下段前面。结论　以膝外上动脉为蒂的股骨外髁骨膜（ 骨） 瓣移位可修复股骨髁上部;以股动脉直接骨膜支为蒂可修复股骨中段。     

Factors associated with acute articular cartilage lesions of the patella and lateral femoral condyle in acute first-time lateral patellar dislocation: A prospective magnetic resonance imaging study

ObjectivesTo identify risk factors of acute articular cartilage lesions of the patella and lateral femoral condyle in acute first-time lateral patellar dislocation (LPD).MethodsMagnetic resonance images were prospectively analyzed in 115 patients in an acute first-time LPD. Factors included gender, skeletal maturity, trochlear dysplasia, patellar height, and tibial tuberosity–trochlear groove (TT-TG) distance. Binary logistic regression analysis was carried out to identify the independent risk factors for the incidence of acute articular cartilage lesions of the patella and lateral femoral condyle in acute first-time LPD.ResultsThe incidence of acute articular cartilage lesion of the patella and lateral femoral condyle were 46.1% and 27% in acute first-time LPD, respectively. Univariate analysis revealed significantly higher incidence rate of acute articular cartilage lesion of the patella in male (P = 0.027), skeletally mature (P = 0.035), normal TT-TG distance (P = 0.043) and normal femoral trochlea (P = 0.031). Risk factors for the incidence of acute articular cartilage lesion of the patella were skeletally mature (odds ratio (OR): 2.324), normal TT-TG distance (OR: 2.824) and normal femoral trochlea (OR: 3.835). Univariate analysis revealed significantly higher incidence rate of acute articular cartilage lesion of the lateral femoral condyle in skeletally mature (P = 0.027) and normal femoral trochlea (P = 0.031). Risk factor for the incidence of acute articular cartilage lesion of the lateral femoral condyle was normal femoral trochlea (OR: 3.347).ConclusionsFor patients in acute first-time LPD, compared with other parameters, the normal femoral trochlea, normal TT-TG distance and skeletally mature are independent risk factors for the incidence of acute articular cartilage lesion of the patella, and the normal femoral trochlea is an independent risk factor for the incidence of acute articular cartilage lesion of the lateral femoral condyle.     

Vertical axis patellar dislocation with ipsilateral femoral fracture: use of a closed percutaneous technique for reduction of the dislocation

Intra-articular vertical axis dislocations are rare injuries, which mostly occur after blunt trauma. In this type of dislocation, the patella rotates along its vertical axis, bringing the articular surface to face medially or laterally. A 13-year-old boy sustained an intra-articular lateral patellar dislocation with a 90 degrees vertical axis medial rotation, which resulted in the articular surface facing laterally, the medial edge of the patella pointing posteriorly, and the lateral edge of the patella pointing anteriorly. As a result, the patella was wedged between the medial and lateral femoral condyles. He also sustained an ipsilateral closed distal femoral shaft fracture. Closed reduction of the dislocation was not successful. Subsequently an A-O reduction clamp was used percutaneously to reduce the patellar dislocation. The femoral fracture was then stabilized by internal fixation using a dynamic compression plate. Isolated vertical and horizontal dislocations have been previously described, but the presence of an ipsilateral femoral shaft fracture makes this a unique case. The percutaneous method used for reduction of the patella has not been previously described. A focused review of the literature, pathoanatomy, and methods of treatment of this condition are presented.     

Chondral and osteochondral injuries associated with acute patellar dislocation

Purpose: The purpose of this study was to evaluate the frequency and precise pathology of articular cartilage injuries after acute patellar dislocation. Type of Study: Case series. Methods: In 39 consecutive knees with initial lateral patellar dislocation, the articular cartilage injuries were examined using arthroscopy or macroscopic observation. Results: Thirty-seven knees (95%) had articular cartilage injuries of the patellofemoral joint and 2 knees (5%) had no cartilage injury. In all 37 knees (95%), articular cartilage injuries were observed in the patella. The appearances were categorized into 3 groups: cracks alone (9 knees), cartilage defect caused by osteochondral or chondral fracture (7 knees), and cartilage defects caused by osteochondral or chondral fracture associated with cracks (21 knees). The main site of osteochondral fracture was the medial facet, and the main site of cracks was the central dome. Twelve knees (31%) had cartilage injury of the lateral femoral condyle. Conclusions: From this study, articular cartilage injuries, especially of the patella, seem to be common occurrences after acute patellar dislocation. Chondral and osteochondral injuries of the patella were classified into 3 groups.     

Analysis of the sonographic patterns in Traumatic Patellar Dislocation]

The diagnosis of osteochondral fractures and medial patellar retinaculum injuries that originate as a result of Traumatic Patellar Dislocation (TPD) appears to be crucial for establishing the treatment strategy. Those injuries may be efficiently recognized by means of ultrasonography (USG). MATERIAL AND METHODS: The analysis of the USG patterns in 22 knees after TPD in 21 patients treated between 2004 and 2007 was proceeded. In all children knee USG examination followed its clinical examination and X ray imaging. The standard USG knee assessment was supplemented by patellar articular cartilage assessment according to the author's technique and dynamic examination of the functional efficiency of the Medial Patello-Femoral Ligament (MPFL). 15 patients were treated surgically and 7 conservatively. RESULTS: The following USG patterns of TPD--concomitant injuries were observed: avulsion fracture of the patellar insertion of MPFL (16), injury of MPFL fibres (17), injury of MPFL femoral insertion (4), intramuscular hematoma of the quadriceps muscle (3), osteochondral fracture with presence of the intraarticular loose body and corresponding fracture-site leasion of the articular surface of the lateral femoral condyle or patella (12), and non-full thickness articular cartilage injury (8). The sonographic diagnoses were confirmed in 20 out of 22 knees (91%), including 13 out of 15 patients operated. CONCLUSIONS: TPD may result in numerous injuries of the knee extensor apparatus and articular cartilage. The authors' experiences displayed usefulness of the USG in diagnosis of these damages. Using dynamic assessment the patellar articular cartilage as well as a function of the MPFL can be examined.     

髌内侧滑膜皱襞综合征为主的膝关节内紊乱

目的:通过临床病例观察,探讨膝内侧滑膜皱襞综合征的诊断、类型及与半月板损伤、软骨损害的关系,分析膝内侧滑膜皱襞综合征的特点及在骨性关节炎发病中所起的作用。方法:关节镜下治疗内侧滑膜皱襞综合征患者48例(53膝),其中男13例(13膝),女35例(40膝);年龄16~71岁,平均56岁;病程1个月~10年,平均26个月。48例于关节镜直视下观察并手术切除滑膜皱襞,处理相应病变。采用Lysholm膝关节量表记分法评价疗效。观察症状体征与实际病损的关系,计算术前与术中诊断的符合率。关节镜下观察症状性滑膜皱襞的部位、性状、分型及软骨磨损的部位和分级,分析增生的滑膜皱襞与半月板损伤、软骨损害的关系。对术前后Lysholm评分采用SPSS13.0统计软件进行统计学处理。结果:常见的软骨缺损有股骨内髁内侧的沟槽状缺损及股骨内侧滑车的类圆形缺损。软骨退变以股骨内髁非负重区为主,占总数的54.29%;以股骨滑车内侧次之,占40.00%;以髌骨内侧关节面为主的缺损居第3位,占5.71%。术后48例53膝均获随访,随访时间17个月~4年,平均28个月。Lysholm膝关节评分:术前平均(41.00±7.03)分,术后平均(85.00±8.01)分(t=-26.17,P<0.001),证明关节镜治疗效果显著。本组优(>90分)12膝,良(80~90分)37膝,可(70~79分)4膝,优良率92.45%,无复发及二次手术者。结论:通过关节镜下特征性改变可以对内侧滑膜皱襞综合征做出明确诊断,股骨内髁及滑车软骨的沟槽状及类圆形磨损是2种典型的皱襞引起的软骨缺损。镜下切除滑膜皱襞疗效满意,对防止软骨进一步损害有积极的意义。