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1.
目的为探究踝关节易内翻扭伤的机制,设计一款适用于人体踝关节非对称生理结构、可有效防护内翻的踝护具。方法分析导致踝关节内翻的解剖学因素,基于踝关节解剖的非对称结构,构思一种非对称结构踝护具。运用Kinect系统及Geomagic Studio软件,对成年男子踝关节进行三维扫描并数字建模,通过3D打印技术建立踝关节模型。以EVA膜、硅胶膜和裹边紫铜网为原材料,采用立体裁剪及复合材料加工技术,制备两种非对称结构的踝护具。对踝护具的塑形性能、拉伸性能、疲劳性能、外衬面料透气性和摩擦性等进行表征。结果非对称结构踝护具的外侧具有良好的塑形性能,拉伸弹性回复率低。在小应力长时间作用下,EVA复合材料和硅胶膜复合材料均能保持较好的弹性回复,可有效承受内翻外力。外衬面料的透气性和摩擦性试验结果表明,针织涤纶面料较适合作为外衬材料。结论所设计制备的非对称结构踝护具的力学性能可满足踝关节内翻防护要求。外覆面料可提高踝护具的吸湿透气性能,摩擦性能较好。  相似文献   

2.
唐杰 《医学信息》2019,(12):57-60
踝关节扭伤常见于人们的日常生活,约30%的患者会进展变化成为慢性踝关节不稳,踝关节不稳定导致踝扭伤的反复发作,从而出现踝关节周围软组织肿胀,瘀血,疼痛伴活动受限。随着患者对自我健康的关注需求不断变化以及对生活方式的更高要求,除了部分需要手术的患者,大部分患者越来越倾向于中医疗法治疗慢性踝关节扭伤。中医治疗慢性踝关节扭伤有针刺、药物内服、药物外洗、中药外敷、推拿等多种方法,均有一定疗效,但缺乏统一的中心研究和大样本数据。本文主要就中医治疗慢性踝关节扭伤的疗法进行综述,旨在为中医治疗慢性踝关节扭伤的综合方案提供相应的研究思路。  相似文献   

3.
背景:高位踝关节扭伤容易漏诊导致踝关节功能障碍,关节镜检查可发现隐匿性高位踝关节扭伤,采用Suture-button弹性固定能恢复远端胫腓联合的生物力学稳定性。目的:探讨踝关节镜辅助下采用Suture-button弹性固定治疗高位踝关节扭伤的临床疗效。方法:回顾性分析2019年8月至2021年8月武汉市第四医院足踝外科在踝关节镜辅助下进行Suture-button弹性固定治疗的40例高位踝关节扭伤患者的病历资料。所有患者均采用Suture-button弹性固定,记录患者术前及术后末次随访美国矫形外科足踝协会踝-后足功能评分、目测类比疼痛评分、踝关节活动度,将患者术前影像学数据与术中关节镜下分离程度进行相关性分析,按照Meislin标准进行疗效评估并记录术后并发症发生情况。结果与结论:(1)40例患者术后获16-48个月随访;(2)术后末次随访美国矫形外科足踝协会踝-后足功能评分为(88.95±6.64)分,目测类比评分为(1.78±1.23)分,踝背伸活动度为(33.50±5.79)°,踝跖屈活动度为(34.50±5.97)°,与术前相比差异均有显著性意义(P <0.05);(3...  相似文献   

4.
目的 探讨全踝关节镜下距腓前韧带一期修复术治疗新鲜外踝撕脱骨折的临床疗效。方法 回顾性分析2016年1月—2017年3月徐州市中心医院手足显微外科全踝关节镜下治疗的36例36足新鲜外踝撕脱骨折患者的临床资料。其中男22例、女14例,年龄18~57(29.24±10.37)岁;右侧20例,左侧16例。患者均采用全踝关节镜下距腓前韧带带线锚钉一期修复治疗,术后定期门诊随访,观察踝关节外观、踝关节稳定性及行走步态等;末次随访采用视觉模拟评分(VAS)、美国骨科足踝外科协会(AOFAS)评分及足踝部Olerud-Molander评分对手术治疗效果进行评价。患者术前VAS为5~8(6.35±1.17)分,AOFAS评分为60~85(74.67±8.36)分,Olerud-Molander评分为57~80(68.89±10.70)分。结果 所有患者手术切口一期愈合,无一例出现神经、血管、肌腱损伤等并发症。36例患者获得随访,随访时间12~25(14.63±6.80)个月。末次随访时,患侧踝关节外观恢复满意,无感觉过敏现象及瘢痕触痛,踝关节恢复正常活动,无关节痛及关节不稳情况,均恢复正常行走步态;末次随访时VAS、AOFAS及Olerud-Molander评分分别为(0.31±0.14)、(90.40±9.62)、(88.71±7.38)分,与术前比较差异均有统计学意义(t=30.755、7.405、9.149,P值均<0.05)。结论 采用全踝关节镜下一期修复距腓前韧带,具有安全可靠、疗效确切、创伤小等优点,是新鲜外踝撕脱骨折的有效治疗方法。  相似文献   

5.
目的: 研究新鲜标本下胫腓联合韧带的解剖学特点,为下胫腓联合韧带相关损伤及韧带重建提供解剖学依 据。方法: 选取新鲜胫腓下联合标本,剥离新鲜标本的下胫腓联合的肌、血管及筋膜组织,对下胫腓联合前、后、 横韧带进行解剖学测量,包括胫腓下联合前、后、横韧带的近端长度、远端长度、平均宽度、与水平面的夹角、 冠状面的夹角等相关解剖学数据。结果: 下胫腓联合前韧带近、远端平均长度为(8.51±0.70)mm、(19.03±1.35) mm,平均宽度(15.98±1.17) mm,与水平面、冠状面夹角分别为(42.27±3.43)°、(20.50±4.69)° ;下胫腓联 合后韧带近、远端平均长度为(9.32±0.62)mm、(16.92±1.76)mm,平均宽度(14.36±0.88)mm,与水平 面、冠状面夹角分别为(40.96±3.16)°、(13.10±1.99)°;下胫腓联合横韧带近、远端平均长度为(18.46±2.48) mm、(21.87±2.52)mm,平均宽度(4.56±0.17)mm,与水平面、冠状面夹角分别为(30.60±3.65)°、(13.48±1.60)°。 对左右、男女的下胫腓联合前、后、横韧带的解剖学数据进行对比,差异均无统计学意义。结论: 了解下胫腓联 合韧带各解剖结构及其特点,有助于指导下胫腓联合韧带损伤的修复和重建,帮助外科医生制定手术方案,改善 预后。  相似文献   

6.
目的:探讨全踝关节镜手术治疗陈旧性外踝撕脱骨折并发踝关节不稳的临床疗效及可行性。方法:回顾性分析。纳入2017年1月—2019年1月徐州市中心医院骨科陈旧性外踝撕脱骨折并发踝关节不稳患者21例(21足),其中男12例、女9例,年龄16~63 (31.34±12.17)岁,右侧13例、左侧8例。21足均采用全踝关节镜下修...  相似文献   

7.
踝关节是人体中最为复杂且负重最大的关节,其损伤发生率高、机制复杂、并发症多,一直是骨科领域的研究热点。本文就近年来国内外关于踝关节骨折伴三角韧带损伤、后踝骨折、外踝骨折、旋后内收型骨折、下胫腓联合损伤和Pilon骨折治疗研究的最新研究成果,进行较为全面地论述。临床医生应该不断学习新的技术和理念,在处理踝关节损伤时,争取以最小的手术创伤、最简单的治疗方法和最低的诊疗成本,为患者取得最佳的治疗效果。  相似文献   

8.
目的 探讨全关节镜下改良Broström术治疗慢性踝关节外侧不稳的临床疗效。方法 回顾性研究。纳入2016年1月—2018年6月徐州市中心医院慢性踝关节外侧不稳患者33例(33侧),其中男20例、女13例,年龄16~55(30.3±5.7)岁;右侧22例,左侧11例。病程12~48(25.6±14.2)个月。受伤原因:扭伤28例,车祸伤5例。所有患者进行全关节镜下的改良Broström手术。术后定期随访,观察患者伤口愈合情况,并发症发生情况,观察踝关节活动情况,踝关节内翻应力试验、踝关节前抽屉试验检查踝关节稳定情况及步态。术后12个月采用疼痛视觉模拟评分法(VAS)评价踝关节疼痛情况,采用美国足踝外科协会(AOFAS)踝与后足评分和Karlsson 踝关节功能评分(KAFS)评价踝关节功能。对比患者手术前与术后12个月VAS、AOFAS、KAFS评分改善情况。结果 33例患者均顺利完成手术,手术时间35~80(50.3±12.6)min。术后患者切口均一期愈合,未出现伤口感染、神经损伤、血管损伤、肌腱损伤等并发症。33例患者均获得随访,随访时间12~40(25.0±10.7)个月。末次随访时,患者均无置入物排斥反应或线结反应;踝关节疼痛完全消失,关节活动度良好;踝关节内翻应力试验、踝关节前抽屉试验均阴性,未出现踝关节外侧不稳定,患者均恢复正常步态。术后12个月依据AOFAS评分标准,踝关节功能优27例、良6例;依据KAFS评分标准,踝关节功能优28例、良5例。术后12个月VAS评分由术前(6.02±1.93)分降低到(1.33±0.16)分,AOFAS评分由术前(61.75±13.08)分提高到(92.37±4.15)分,KAFS评分由术前(64.46±10.81)分提高到(93.19±5.58)分,差异均有统计学意义(t=12.765, -13.303, -12.346, P值均<0.05)。结论 全关节镜下改良Broström术,手术创伤小,是一种治疗慢性踝关节外侧不稳的有效方法。  相似文献   

9.
背景:在踝关节扭伤和踝关节韧带损伤中近85%涉及外侧副韧带,损伤的机制为足跖屈时踝关节内翻。急性踝关节外侧扭伤的患者中有20%-40%会出现持续疼痛和慢性踝关节外侧不稳,导致距骨平移和旋转过大,加速软骨磨损,导致关节退化。目的:通过有限元建模探究不同类型的踝外侧副韧带损伤模型对踝关节稳定性以及距骨穹窿软骨接触应变的影响。方法:将1名27岁志愿者足踝CT扫描数据DICOM文件导入有限元软件中,进行三维重建及曲面拟合,再进行网格划分,建立含有骨骼、关节软骨和韧带的完整踝关节有限元模型,对比正常、距腓前韧带损伤、跟腓韧带损伤和距腓前韧带+跟腓韧带损伤4种不同工况下的踝关节稳定性和距骨软骨接触应变的改变。结果与结论:(1)在前抽屉试验中,距腓前韧带损伤和距腓前韧带+跟腓韧带损伤距骨前移距离明显大于正常和跟腓韧带损伤(P <0.05),而距腓前韧带损伤和距腓前韧带+跟腓韧带损伤之间、正常和跟腓韧带损伤之间差异无显著性意义(P> 0.05);(2)在距骨倾斜试验中,跟腓韧带损伤和距腓前韧带+跟腓韧带损伤距骨倾斜角度明显大于正常和距腓前韧带损伤,而跟腓韧带损伤和距腓前韧带+跟腓韧带损伤之...  相似文献   

10.
车晓黎  孙玉萍 《医学信息》2005,18(9):1199-1200
膝关节损伤后功能障碍是常见多发病,尤以半月及韧带损伤最为多见。其次为胫骨平台骨折等。我们对早期和晚期实施康复治疗对膝关节功能障碍的影响作了重点临床观察。  相似文献   

11.
Summary The ligaments of the ankle are superficial and easily accessible at ultrasonography. Suprisingly, the reliability of this technique has never been proven. With this goal in mind, ten ankles were subjected to a ultrasono-anatomic comparison. The five principle ligamentous fascicles (three on the lateral side and two on the medial side) measured at ultrasonography and the values verified after dissection. This study shows that the ligaments of the ankle are analyzed with ultrasonography and that the measures done are valid and have a precision of 2 mm for the anterior fascicle and the lateral fascicle of the lateral ligamentous plane Due to its simplicity and its low price, ultrasonography appears to be an important method in evaluating the ligaments and the degree of seriousness of ankle sprains.
Echo-anatomie des ligaments de la cheville
Résumé Les ligaments de la cheville sont superficiels et aisément accessibles à l'échographie. Par contre, la fiabilité de cette technique pour l'étude de ces ligaments n'a, à notre connaissance, jamais été validée. Dans ce but, dix chevilles firent l'objet d'une corrélation écho-anatomique. Les cinq faisceaux ligamentaires principaux (trois sur le versant latéral et deux sur le versant médial) ont mesurés à l'échographie et les valeurs été vérifiées après dissection. Cette étude montre que les ligaments de la cheville peuvent être analysés en échographie et que les mesures effectuées sont valables et d'une précision de l'ordre de 2 mm pour le faisceau antérieur et le faisceau moyen du plan ligamentaire latéral. L'échographie paraît donc, par sa simplicité et son faible prix, constituer en élément important du bilan ligamentaire et de la gravité des entorses de la cheville.
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12.
CONTEXT: Anterior drawer testing of the ankle is commonly used to diagnose lateral ligamentous instability. Our hypothesis was that changing knee and ankle positions would change the stability of the ankle complex during anterior drawer testing. OBJECTIVES: To assess the effects of knee and ankle position on anterior drawer laxity and stiffness of the ankle complex. DESIGN: A repeated-measures design with knee and ankle position as independent variables. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Bilateral ankles of 10 female (age = 19.8 +/- 1.1 years) and 10 male (age = 20.8 +/- 1.2 years) collegiate athletes were tested. INTERVENTION(S): Each ankle complex underwent loading using an ankle arthrometer under 4 test conditions consisting of 2 knee positions (90 degrees and 0 degrees of flexion) and 2 ankle positions (0 degrees and 10 degrees of plantar flexion [PF]). MAIN OUTCOME MEASURE(S): Recorded anterior laxity (mm) and stiffness (N/mm). RESULTS: Anterior laxity of the ankle complex was maximal with the knee positioned at 90 degrees of flexion and the ankle at 10 degrees of PF when compared with the knee positioned at 0 degrees of flexion and the ankle at 10 degrees or 0 degrees of PF (P < .001), whereas ankle complex stiffness was greatest with the knee positioned at 0 degrees of flexion and the ankle at 0 degrees of PF (P < .009). CONCLUSIONS: Anterior drawer testing of the ankle complex with the knee positioned at 90 degrees of flexion and the ankle at 10 degrees of PF produced the most laxity and the least stiffness. These findings indicate that anterior drawer testing with the knee at 90 degrees of flexion and the ankle at 10 degrees of PF may permit better isolation of the ankle capsuloligamentous structures.  相似文献   

13.
目的研究踝关节外固定防护在模拟半蹲式跳伞着陆中对下肢肌电(Electromyogram,EMG)活动性的影响及其性别差异。方法男女各8名健康成人受试者从0.72m高平台跳落,模拟半蹲式跳伞着陆。实验状态分赤足对照、佩戴护踝和绷带3组。测量其胫骨前肌、外侧腓肠肌、股直肌和股二头肌的肌电图。使用二因素方差分析评价防护和性别对EMG参数的影响。结果使用护踝显著增加男性胫骨前肌触地前EMG幅值(赤足对照:266μV;绷带:368μV;护踝:552μV),防护对其他EMG参数无显著性影响。结论使用护踝仅对男性跳伞者有显著的防护作用;踝关节防护对膝关节EMG活动性无显著性影响。  相似文献   

14.
Disappointing results for total ankle replacement have been explained by poor knowledge of the mechanics of the intact and replaced joints. Dynamic simulation tools have the capacity to simulate dynamic conditions that occur in human joints. The Working Model 2D tool was used to simulate the mechanics of the intact and replaced ankle joints, based on previously validated mathematical models. Elementary objects were used to model ligaments, articular surfaces, retinacula and muscle-tendon units. The performance of several pairs of prosthetic articular surfaces was also analysed. According to the results of these simulations, rolling as well as sliding motion occurs in the natural ankle, governed by a ligamentous linkage. Elongation of the tibiocalcaneal and calcaneofibular ligaments was found to be 1.5% and 4.8%, respectively. A 13% change in lever arm length occurred for both the tibialis anterior and gastrocnemius muscles during ankle flexion. Unlike the currently available three-component designs, the newly proposed convex-tibial ligament-compatible prosthesis was found to be able to restore the original mobility and physiological function of the ligaments. This prosthesis combines freedom from restraint with congruity of the components throughout the range of flexion.  相似文献   

15.
目的 总结高能量踝关节骨折Logsplitter损伤的影像学表现及踝关节周围各解剖结构的损伤特征,探讨Logsplitter损伤的发生机制。方法 回顾性分析2009年4月-2018年12月西安交通大学附属红会医院足踝外科62例Logsplitter损伤患者的影像资料。其中男44例、女18例,年龄21~69(42.3±11.7)岁,左侧27例、右侧35例。提取术前X线和CT影像,分析腓骨损伤、胫骨损伤、下胫腓联合损伤、踝关节内侧损伤及外侧韧带损伤的特征及其不同损伤类型在本组Logsplitter损伤中的占比;结合踝关节骨折的Lauge-Hansen分型,分析不同踝关节骨折类型在本组Logsplitter损伤中的占比。结果 腓骨损伤特征:横行或短斜形骨折占61.3%(38/62),存在蝶形骨块占25.8%(16/62),粉碎性骨折占11.3%(7/62),腓骨无骨折占1.6%(1/62)。胫骨损伤特征:外侧关节面压缩占38.7%(24/62),合并后侧压缩占6.5%(4/62);内侧损伤包括内踝骨折占87.1%(54/62),三角韧带断裂占12.9%(8/62)。下胫腓联合损伤特征:单纯韧带断裂占11.3%(7/62),合并Tillux结节撕脱骨折占8.1%(5/62),合并Volkmann结节撕脱骨折占43.5%(27/62),同时合并Tillux结节与Volkmann结节撕脱骨折占37.1%(23/62);合并踝关节外侧副韧带完全断裂占12.9%(8/62)。根据Lauge-Hansen分型显示,其中旋前外展损伤占87.1%(54/62),旋前外旋损伤占8.1%(5/62),旋后外旋损伤占1.6%(1/62),无法分类的占3.2%(2/62)。结论 Logsplitter损伤的影像学特征多样化,在严重骨折脱位的同时,可合并侧副韧带损伤;损伤机制以外展位垂直暴力最为多见,部分也可为外旋位垂直暴力所致。  相似文献   

16.
脊髓损伤合并截瘫的患者由于体位制动,长期卧床,大小便失禁,极易发生压疮,影响治疗和预后,不恰当的康复方法,更增加压疮的风险,现对1例脊髓损伤患者不当康复锻练致双足跟IV级压疮进行分析。护理人员应综合评估患者情况,循序渐进,早期规范康复介入并配置个体截瘫支具可明显提高日常生活能力及患者步行功能。  相似文献   

17.
Anatomy of the tibiofibular syndesmosis and its clinical relevance   总被引:5,自引:0,他引:5  
The purpose of the present study was to describe the anatomical structure of the tibiofibular syndesmosis. Dissection of the tibiofibular syndesmosis was performed on 30 cadaveric specimens of the ankle in adults. The stability of the tibiofibular mortise is ensured by three ligaments. The interosseous tibiofibular ligament forms a spatial network of fibers of a pyramidal shape filled with fibrofatty tissue. The anterior tibiofibular ligament consists of three parts: the upper one is the shortest, the medial one is the strongest and the lower part is the longest and the thinnest. The posterior tibiofibular ligament is a strong, compact ligament the lower margin of which literally forms the articular labrum for the lateral ridge of the trochlea of the talus. The so-called inferior transverse tibiofibular ligament, as this part of the ligament is sometimes characterized, cannot be considered as a separate ligament. Direct contact between the distal tibia and the fibula was found in 23 cases. Contact facets which were covered with articular cartilage were very small and located in the anterior half of the tibiofibular contact line. In the posterior part of the tibiofibular contact line a vertical V-shaped synovial plica attached by its lateral aspect to the fibula dipped between the two bones. In seven cases where there was no direct contact between the two bones this plica extended anteriorly to the anterior tibiofibular ligament. The findings show that in three quarters of cases the connection of the distal tibia and fibula is not a mere syndesmosis but also a synovial joint. The presented facts change traditional opinions on the structure of the tibiofibular syndesmosis and they should be reflected in the treatment of dislocation-fractures of the ankle as well as in case of so-called anterolateral ankle impingement.

Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at .
Anatomie de la syndesmose tibio-fibulaire et son importance clinique
Résumé Le but du présent travail était de décrire la structure anatomique de la syndesmose tibio-fibulaire. La dissection de la syndesmose tibio-fibulaire a été réalisée sur 30 spécimens cadavériques de chevilles d'adultes. La stabilité de la mortaise tibio-fibulaire est assurée par trois ligaments. Le ligament tibio-fibulaire interosseux forme un réseau spatial de fibres, de forme pyramidale, dont les mailles sont remplies de tissu fibro-adipeux. Le ligament tibio-fibulaire antérieur est formé de trois parties; la partie supérieure est la plus courte, la partie médiale est la plus forte et la partie inférieure est la plus longue et la plus mince. Le ligament tibio-fibulaire postérieur est un fort ligament compact dont le bord inférieur forme littéralement un labrum articulaire destiné à la berge latérale de la trochlée du talus. Ce qui est classiquement appelé " ligament tibio-fibulaire transverse inférieur", comme on le dénomme parfois, ne peut être considéré comme un ligament séparé. Un contact direct entre l'extrémité distale du tibia et de la fibula a été trouvé dans 23 cas. Les facettes en contact, recouvertes de cartilage articulaire, étaient très petites et situées sur la moitié antérieure de la ligne de contact tibio-fibulaire. Sur la partie postérieure de la ligne de contact tibio-fibulaire, un repli synovial vertical en forme de V, attaché par son bord latéral à la fibula, plonge entre les deux os. Dans 7 cas où il n'y avait pas de contact direct entre les deux os, ce repli s'étendait vers l'avant jusqu'au ligament tibio-fibulaire antérieur. Nos constatations montrent que, dans trois quarts des cas, l'articulation entre la partie distale du tibia et celle de la fibula n'est pas une syndesmose pure, mais qu'il s'agit aussi d'une articulation synoviale. Les faits que nous présentons changent les idées traditionnelles sur les structures de la syndesmose tibio-fibulaire et ils devraient trouver des applications, principalement dans le traitement des luxations-fractures de la cheville, ainsi que dans les cas de ce que l'on désigne sous le terme de "conflit antéro-latéral de la cheville".
  相似文献   

18.

Context:

Improving neuromuscular control of hamstrings muscles might have implications for decreasing anterior cruciate ligament injuries in females.

Objective:

To examine the effects of a 6-week agility training program on quadriceps and hamstrings muscle activation, knee flexion angles, and peak vertical ground reaction force.

Design:

Prospective, randomized clinical research trial.

Setting:

Sports medicine research laboratory.

Patients or Other Participants:

Thirty female intramural basketball players with no history of knee injury (age  =  21.07 ± 2.82 years, height  =  171.27 ± 4.66 cm, mass  =  66.36 ± 7.41 kg).

Intervention(s):

Participants were assigned to an agility training group or a control group that did not participate in agility training. Participants in the agility training group trained 4 times per week for 6 weeks.

Main Outcome Measure(s):

We used surface electromyography to assess muscle activation for the rectus femoris, vastus medialis oblique, medial hamstrings, and lateral hamstrings for 50 milliseconds before initial ground contact and while the foot was in contact with the ground during a side-step pivot maneuver. Knee flexion angles (at initial ground contact, maximum knee flexion, knee flexion displacement) and peak vertical ground reaction force also were assessed during this maneuver.

Results:

Participants in the training group increased medial hamstrings activation during ground contact after the 6-week agility training program. Both groups decreased their vastus medialis oblique muscle activation during ground contact. Knee flexion angles and peak vertical ground reaction force did not change for either group.

Conclusions:

Agility training improved medial hamstrings activity in female intramural basketball players during a side-step pivot maneuver. Agility training that improves hamstrings activity might have implications for reducing anterior cruciate ligament sprain injury associated with side-step pivots.  相似文献   

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