共查询到20条相似文献,搜索用时 31 毫秒
1.
Objective
Restoration of free knee motion taking into account knee extension, knee flexion, and patella mobility.Indications
Prolonged knee motion restriction after anterior cruciate ligament (ACL) reconstruction, persistent decreased patella mobility, or extension deficit.Contraindications
Existing significant joint irritation or active reflex dystrophy with persistent distinctive pain syndrome.Surgical technique
Arthroscopic arthrolysis possible in most cases. Removal of adhesions in all compartments. Elimination of intraarticular cause of patella infera by removing infrapatellar scar tissue and fibrotic fat pad. In case of severe peripatellar fibrotic tissue, lateral release is useful with partial transection of lateral retinacula. In case of strong capsular contracture, additional medial release indicated to improve patella mobility. Important goal of arthrolysis: full range of knee extension. Arthrolysis for scar tissue removal in the posterior recessus through dorsomedial arthroscopic approach possible. In severe cases posteromedial arthrotomy for posterior capsule release required. Cyclops syndrome makes removal of all tissue adherent to the ACL necessary. An irregular ACL insertion or intercondylar notch stenosis may require notchplasty. Postoperative recurrence of fibrosis may require repeated arthroscopic surgery to improve mobility, such as notchplasty, osteophytes resection, scar removal, and releases.Postoperative management
Immediate postoperative pain-free physical therapy taking into account full range of extension and patella mobility. Passive exercises under traction. Lymphatic drainage. No exercising in pain throughout the entire postoperative physical therapy. Continuous passive motion treatment for 4 weeks postoperatively useful. No muscle strength or equipment training for at least 3 months postoperatively.Results
Based on the observations in our working group, approximately pproximately 78?% of patients develop knee osteoarthritis within 5 years. 相似文献2.
Objective
The goal is early diagnostic arthroscopy with irrigation and, if needed, debridement of all 6 recesses of the infected knee joint to quickly gain control of the infection and a satisfactory functional outcome.Indications
Arthroscopic irrigation without delay is indicated even if a knee joint infection is only suspected.Contraindications
No existing contraindications.Surgical technique
Arthroscopic irrigation of the knee with stage-related debridement. Particularly irrigation and debridement of the two dorsal recesses. In stage IV according to Gächter, open synovectomy and radical debridement is recommended.Postoperative management
In case of persistent infection, early revision. After removement of drainages mobilisation with continous passive motion. Antibiotic therapy is necessary even after the infection has been treated.Results
Arthroscopic irrigation with stage-related debridment of all 6 recesses in combination with antibiotic therapy is the standard procedure for knee joint infections when there is no arthroplasty. Open surgery with debridement of infected bone tissue is indicated in patients with stage IV according to Gächter. Decisive for good results is an early intervention. 相似文献3.
Background
Even in an era of clear improvements in implants and standardized treatment procedures, abortive osteosynthesis after distal radius fractures is not an uncommon complication.Diagnostics
Although not every malunion of the radius leads to complaints, affected patients often suffer from limitations in movement, reduction in strength, pain and aesthetic deficits. Following thorough clinical and imaging diagnostics a selection from the possible treatment options must be made taking the results obtained from the diagnostics into consideration.Therapy
Operative possibilities are available for reconstructing the anatomical features as accurately as possible, functional improvement without correction of the malunion, pain reduction alone and combined procedures.Conclusion
Despite abortive osteosynthesis of distal radial fractures there are possibilities for anatomical reconstruction, retention of mobility and pain reduction. Taking the pathological deformities into consideration, the highest priority should be given to reconstructing the anatomical joint conditions as accurately as possible, even when the conservative treatment options were unsuccessful. 相似文献4.
Christian Alexander Fischer Eva Neubauer Hanne S. Adams Marcus Schiltenwolf Haili Wang 《International orthopaedics》2014,38(3):617-626
Purpose
Low back pain is one of the most common and expensive diseases of Western societies. Psychosocial factors such as low social status, depression, or work dissatisfaction are known to promote chronicity of low back pain. With a multidisciplinary approach, better outcomes can be achieved than with purely biomedical treatment. Optimal patient selection for multidisciplinary therapy reduces costs and labour. This study investigated whether elaborated questionnaires exceed simple items in predicting multimodal therapy success.Methods
In this prospective longitudinal clinical study, 330 patients were followed up for six months after multidisciplinary therapy. We applied the patient questionnaire Heidelberg Short Early Risk Assessment Questionnaire for the Prediction of Chronicity in Low Back Pain (HKF-R10) that is approved and established for predicting chronicity in patients with acute low back pain to forecast the therapeutic outcome. Outcome criteria were QOL, pain reduction and back to work.Results
With regard to outcome criteria, the HKF-R10 was unable to anticipate therapeutic success, but education level, depression, best pain condition, and helplessness predicted therapy success with an 80 % probability for QOL improvement.Conclusions
It is not necessary to confront patients with an extensive and complicated questionnaire to predict the outcome of multidisciplinary therapy. In fact, assessing a few specific items allows better and easier prognosis estimation. 相似文献5.
6.
Paolo Adravanti Stefano Nicoletti Stefania Setti Aldo Ampollini Laura de Girolamo 《International orthopaedics》2014,38(2):397-403
Purpose
It has been reported that even one year after total knee arthroplasty (TKA), a relevant percentage of patients does not attain complete recovery and indicate unfavourable long-term pain outcome. We compared the clinical outcome of 33 patients undergoing TKA randomly assigned to the control or the pulsed electromagnetic field group (I-ONE therapy).Methods
I-ONE therapy was administered postoperatively four hours per day for 60 days. Patients were assessed before surgery and then at one, two and six months postoperatively using international scores.Results
One month after TKA, pain, knee swelling and functional score were significantly better in the treated compared with the control group. Pain was still significantly lower in the treated group at the six month follow-up. Three years after surgery, severe pain and occasional walking limitations were reported in a significantly lower number of patients in the treated group.Conclusions
Advantages deriving from early control of joint inflammation may explain the maintenance of results at follow-up. I-ONE therapy should be considered an effective completion of the TKA procedure. 相似文献7.
Purpose
Various conservative interventions have been used for the treatment of non-specific neck pain. The aim of this systematic review was to investigate the cost-effectiveness of conservative treatments for non-specific neck pain.Methods
Clinical and economic electronic databases, reference lists and authors’ databases were searched up to 13 January 2011. Two reviewers independently selected studies for inclusion, performed the risk of bias assessment and data extraction.Results
A total of five economic evaluations met the inclusion criteria. All studies were conducted alongside randomised controlled trials and included a cost-utility analysis, and four studies also conducted a cost-effectiveness analysis. Most often, the economic evaluation was conducted from a societal or a health-care perspective. One study found that manual therapy was dominant over physiotherapy and general practitioner care, whilst behavioural graded activity was not cost-effective compared to manual therapy. The combination of advice and exercise with manual therapy was not cost-effective compared to advice and exercise only. One study found that acupuncture was cost-effective compared to a delayed acupuncture intervention, and another study found no differences on cost-effectiveness between a brief physiotherapy intervention compared to usual physiotherapy. Pooling of the data was not possible as heterogeneity existed between the studies on participants, interventions, controls, outcomes, follow-up duration and context related socio-political differences.Conclusion
At present, the limited number of studies and the heterogeneity between studies warrant no definite conclusions on the cost-effectiveness of conservative treatments for non-specific neck pain. 相似文献8.
Zoe A. Michaleff Steven J. Kamper Christopher G. Maher Roni Evans Carolyn Broderick Nicholas Henschke 《European spine journal》2014,23(10):2046-2058
Purpose
To identify and evaluate the effectiveness of conservative treatment approaches used in children and adolescents to manage and prevent low back pain (LBP).Methods
Five electronic databases and the reference lists of systematic reviews were searched for relevant studies. Randomised controlled trials (RCTs) were considered eligible for inclusion if they enrolled a sample of children or adolescents (<18 years old) and evaluated the effectiveness of any conservative intervention to treat or prevent LBP. Two authors independently screened search results, extracted data, assessed risk of bias using the PEDro scale, and rated the quality of evidence using the GRADE criteria.Results
Four RCTs on intervention and eleven RCTs on prevention of LBP were included. All included studies had a high risk of bias scoring ≤7 on the PEDro scale. For the treatment of LBP, a supervised exercise program compared to no treatment improved the average pain intensity over the past month by 2.9 points (95 % CI 1.6–4.1) measured by a 0–10 scale (2 studies; n = 125). For the prevention of LBP, there was moderate quality evidence to suggest back education and promotion programs are not effective in reducing LBP prevalence in children and adolescents.Conclusions
While exercise interventions appear to be promising to treat LBP in children and adolescents, there is a dearth of research data relevant to paediatric populations. Future studies conducted in children and adolescents with LBP should incorporate what has been learnt from adult LBP research and be of rigorous methodological quality. 相似文献9.
Neuerburg C Bieger R Jung S Kappe T Reichel H Decking R 《Archives of orthopaedic and trauma surgery》2012,132(8):1183-1189
Introduction
Failed total knee replacement with compromised bone and soft-tissues can be challenging. In these situations, arthrodesis remains a treatment option of a limb-saving procedure.Methods
We investigated the outcome of treatment with an intramedullary cemented knee arthrodesis nail implanted in 22 consecutive patients with forlorn situations after failed total knee replacement.Results
There were three major complications due to re-infection and two minor complications due to wound-healing disturbances that healed with the implant retained after an average follow-up of 3.4?years. Clinical examination, Short Form-36 and Oxford knee scores revealed low pain levels, safe implant anchorage, and improved stability of the knee, whilst autonomous mobility utilizing walking aids was still possible.Conclusion
Bridging knee arthrodesis with an intramedullary nail is a valuable salvage procedure with acceptable clinical results. As recurring infection remains the most challenging complication, regular clinical and radiological follow-up examinations are necessary following implant-related knee arthrodesis to allow timely intervention in case of loosening. 相似文献10.
Prof. em. Dr. R. Baumgartner 《Operative Orthopadie und Traumatologie》2011,23(4):280-288
Objective
To make a transtibial stump as long as possible, free from local and phantom pain with a maximum of terminal load bearing. In order to preserve the knee joint, an ultra-short tibial stump of 5?C6?cm may be indicated.Indications
A hindfoot amputation level is not possible to achieve.Contraindications
In amputations for peripheral vascular diseases, amputations through the distal third of the tibia are not recommended. If they still heal, the level selection might have been too proximal.Surgical technique
According to Verduyn and Burgess, a long posterior muscular flap covering the stump is attached ventrally to a short anterior flap. Modifications: fibular bone bridge (Guedes), resection of the soleus muscle (Baumgartner), Myodesis (Bowker), and Brückner??s procedure. Alternative: rotation plasty according to Borggreve-van Nes-Winkelmann.Postoperative management
Special diagonal elastic bandaging over the knee that must be changed daily. Early prosthetic fitting (in general after 4?C6 weeks) after wound has healed. Physical therapy: gait training with 2?crutches or parallel bars with or without an inflatable ??prosthesis??. Isometric training of the quadriceps. A stump requires several months until it has achieved its final form. During this time, the prosthesis must be adjusted accordingly. Modifications in the home, workplace, and automobile must be made. Sport for the disabled!Results
In order to preserve a maximum of stump length, wound healing problems are to be taken into consideration, requiring surgery and sometimes even reamputation through or above the knee joint. If it is possible to preserve the knee joint, the rehabilitation results, even with an ultra-short transtibial stump, are far superior to any more proximal amputation level. 相似文献11.
PD. Dr. T. Renkawitz S. Winkler M. Weber F. von Kunow J. Grifka C. Baier 《Der Orthop?de》2014,43(5):448-454
Background
The implantation of an artificial knee is one of the most common operative interventions in German hospitals. Navigation procedures have developed into an integral component of such interventions in the operating theatres of many clinics.Methods
For orthopedic surgeons who want to implement an as exact as possible reconstruction of the mechanical leg axis and require intraoperative control of the three dimensional positioning of components and/or the capsular ligament situation, navigation is a well-proven intraoperative tool. The immediate intraoperative control possibility of bone resection and capsular ligament soft tissue balancing means that navigation is a valuable instrument for the biomechanical fundamental understanding in training operations for further education of orthopedic surgeons in training.Developments
The greater precision obtained by the implementation of the procedure has not yet been conclusively reflected in an improved postoperative knee function or an increased durability of prostheses. New developments in navigated knee prostheses are pinless navigation and navigation kinematics. In pinless navigation the conventional reference marker system fixed in the femur and shin bones is replaced by a non-invasive reference system. With the aid of navigation kinematics it is possible to image the tibiofemoral and patellofemoral movement dynamics, intraoperatively.Perspective
The aim of the next generation navigation systems for computer-assisted knee prosthetics is implant positioning aligned to the individual anatomy of patients with high and stable range of movement for optimum patellar guidance and kinematics of the artificial joint. 相似文献12.
Background
Changes of patellar position (height, tilt, and shift) and arthritis of the patellofemoral joint might potentially influence outcome after unicompartmental knee replacement.Objectives
The purpose of this work is to evaluate the influence of the aforementioned parameters on postoperative outcome.Methods
Literature analysis via PubMed.Results
A total of 12 relevant studies (three about Patellar height, two about patellar tilt and shift, seven about patellofemoral osteoarthritis) could be identified. Regarding Patellar height, two out of three studies demonstrated a postoperative decrease. With regard to patellar tilt and shift, only one study identified postoperative lateralization of the patella to be a predictor for poor outcome. The radiological appearance of arthritis of the patellofemoral joint does not significantly influence postoperative knee function except for cases where only the lateral patellar facet is affected. Anterior knee pain has no influence on clinical outcome.Conclusion
Literature data do not allow for a precise statement about the possible influence of patellar position on the outcome after unicompartmental knee replacement. With proper patient selection, good results can be achieved despite patellofemoral osteoarthritis. 相似文献13.
Background
Subscapularis tendon avulsions of the lesser tuberosity are relatively rare and often missed acutely and their characteristic appearance is frequently not recognized or is misinterpreted for an osteochondroma or a neoplastic process.Questions/Purposes
This report reviews our experience with six adolescents who had subscapularis tendon avulsions of the lesser tuberosity.Methods
Six male adolescents (12–15 years) presented with shoulder pain following history of trauma during amateur sport. Clinical notes including range of motion, strength tests, and pain assessment were reviewed along with imaging studies pre- and post treatment. Treatment consisted of either surgical or conservative measures.Results
Two of the six patients had a large avulsion that simulated an exostosis of the proximal humerus that was misdiagnosed as an osteochondroma at two different outside institutions. All six cases were diagnosed with subscapularis tendon avulsion of the lesser tuberosity following clinical and imaging evaluation at our institution. Five of the patients underwent surgical repair and fixation of the tendon and the lesser tuberosity with suture anchors. One patient was treated conservatively. All patients had a good outcome with recovery of full shoulder strength and motion upon follow-up.Conclusion
Clinicians should have a high index of suspicion of lesser tuberosity avulsions in adolescents who present with loss of internal rotation and anterior shoulder pain following traumatic injuries. In addition, an osseous fragment or exostosis along the inferomedial humeral head should suggest a subscapularis tendon avulsion and also should not be confused with an osteochondroma or a neoplastic process. 相似文献14.
E. C. Rodriguez-Merchan 《Journal of orthopaedics and traumatology》2013,14(2):77-81
Background
Patellar tendinopathy (PT) presents a challenge to orthopaedic surgeons. The purpose of this review is to revise strategies for treatment of PTMaterials and methods
A PubMed (MEDLINE) search of the years 2002–2012 was performed using "patellar tendinopathy" and "treatment" as keywords. The twenty-two articles addressing the treatment of PT with a higher level of evidence were selected.Results
Conservative treatment includes therapeutic exercises (eccentric training), extracorporeal shock wave therapy (ESWT), and different injection treatments (platelet-rich plasma, sclerosing polidocanol, steroids, aprotinin, autologous skin-derived tendon-like cells, and bone marrow mononuclear cells). Surgical treatment may be indicated in motivated patients if carefully followed conservative treatment is unsuccessful after more than 3–6 months. Open surgical treatment includes longitudinal splitting of the tendon, excision of abnormal tissue (tendonectomy), resection and drilling of the inferior pole of the patella, closure of the paratenon. Postoperative inmobilisation and aggressive postoperative rehabilitation are also paramount. Arthroscopic techniques include shaving of the dorsal side of the proximal tendon, removal of the hypertrophic synovitis around the inferior patellar pole with a bipolar cautery system, and arthroscopic tendon debridement with excision of the distal pole of the patella.Conclusion
Physical training, and particularly eccentric training, appears to be the treatment of choice. The literature does not clarify which surgical technique is more effective in recalcitrant cases. Therefore, both open surgical techniques and arthroscopic techniques can be used. 相似文献15.
16.
Al-Hadithy N Rozati H Sewell MD Dodds AL Brooks P Chatoo M 《International orthopaedics》2012,36(6):1185-1189
Purpose
Whilst patients undergoing total knee replacements generally have good relief of their symptoms, up to 20% complain of persisting pain. Revision rates have therefore been rising, particularly so for unexplained pain. We reviewed the causes of painful total knee replacements including extrinsic causes.Methods
Forty-five consecutive patients referred to our department with painful total knee replacement were reviewed with our standard protocol, including history and examination, inflammatory markers and radiological studies including radiographs of the hip and knee and computed tomography scan of the knee joint.Results
Of the 45 patients, 15 patients had degenerative hip and lumbar spine disease which resolved after injections of the relevant joints. Nine patients had unexplained pain.Conclusions
Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt. 相似文献17.
Tetsuo Hagino Satoshi Ochiai Yoshiyuki Watanabe Shinya Senga Masanori Saito Masanori Wako Takashi Ando Eiichi Sato Hirotaka Haro 《Archives of orthopaedic and trauma surgery》2013,133(5):669-673
Purpose
To investigate the knee arthroscopic findings of pediatric patients with knee pain.Subjects
Ninety-five knees of 94 patients (46 males and 48 females) aged 15 years or younger who underwent knee arthroscopy during a 4-year period from January 2007 were studied. The mean age at surgery was 13.5 (7–15) years. The mean interval from symptom onset to arthroscopic examination was 6.8 months (5 days to 2 years 10 months).Results
The most common cause of knee pain was sports-related activities (64 knees). Other causes included falling from a moving bicycle (5 knees), while knee pain appeared with no defined reason in 14 knees. The most frequent final diagnosis based on knee arthroscopic findings was anterior cruciate ligament (ACL) injury (35 knees), followed by discoid lateral meniscus (16 knees), lateral meniscal tear (11 knees), and medial plica syndrome (9 knees), while no arthroscopic abnormality was observed in 8 of 95 knees. Among the 95 knees, the diagnosis based on preoperative physical tests and imaging findings was different from the arthroscopic diagnosis in 16 knees, 8 of which were diagnosed preoperatively as medial meniscal tear.Conclusion
ACL injury and discoid lateral meniscus were the predominant conditions in pediatric patients who underwent knee arthroscopic surgery for knee pain. Knee arthroscopy is useful to provide a definitive diagnosis for knee pain in pediatric patients. Preoperative evaluations had a diagnostic accuracy of only 83.2 % and failed to diagnose conditions such as medial plica syndrome and chondral injury. Therefore, diagnosis before knee arthroscopy has to be interpreted with caution. 相似文献18.
19.
PD Dr. I. Rundshagen 《Der Anaesthesist》2013,62(11):914-918