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1.
糖皮质激素在成人呼吸窘迫综合征救治中的合理应用 总被引:5,自引:0,他引:5
采用放射配体结合法测定28例成人呼吸窘迫综合征(ARDS)病人外周血白细胞糖皮质激素受体(GCR),结果(1018.3±825.2)位点/细胞,显著低于正常人(4634.1±436.5)位点/细胞(P<0.01)。而其血浆皮质醇浓度为(289±151)ug/L,高于正常人(124±47)ug/L(P<0.05)。结合病人APACHEⅡ评分,并根据GCR指导地塞米松的用法,使ARDS的病死率由88.3%下降至36。4%。 相似文献
2.
神经节苷酯对低氧大鼠脑钙,钙调素及蛋白激酶Ⅱ的影响 总被引:3,自引:1,他引:2
观察了神经节苷酯对急性低氧组大鼠(A组:模拟海拔700m,5h;B组:给神经节苷酯)和常氧对照组大鼠(C组:常氧;D组:给神经节苷酯)脑组织Ca ̄(2+)、钙调素(CaM)及CaM依赖性蛋白激酶Ⅱ(CaMPKⅡ)活性的影响。用Fura-2测得Ca ̄(2+)水平分别为722.1±81.2.640.6±74.4、258。7±39.2和263.8±41.3nmol/L,A组明显高于常氧对照组(P<0.01);B组明显低于A组(P<<0.05)。用流式细胞仪(FACS)所测CaM平均荧光强度分别为40.2±4.7、44.3±4.8.46.1±5.1和45.9±5.0道;A组明显低于常氧对照组。用同位素(r ̄(32)-ATP)液闪计数法所测CaMPKⅡ活性分别为182.9±7.9、192.3±8.2、197.9±9.2和198.2±9.3pmolpi.min ̄(-1)mg ̄(-1)protein,A组明显低于其它三组,急性低氧B组与常氧对照组比无明显差别。表明,低氧时神经节苷酯可以减少胞内Ca ̄(2+)蓄积和稳定CaM和CaMKinaseⅡ的变化. 相似文献
3.
G-CSF减轻大鼠下肢缺血再灌注致肺功能损伤的实验研究 总被引:1,自引:0,他引:1
目的:研究重组粒细胞集落刺激因子(G-CSF)对大鼠下肢缺血再灌注所致肺功能损伤的治疗作用。方法:雄性SD大鼠随机分3组,手术组及给药组麻醉后开腹解剖口主动脉.在肾动脉水平远端阻断120min,开放、再灌注 120 min;假手术组不阻断腹主动脉,余同手术组。3组均于术前经舌静脉注入伊文氏蓝(Evan’s blue dge) 30 mg/kg;给药组术前经尾赢脉注入G-CSF 20μg/kg.余二组给予生理盐水1ml。术后取肺组织测定丙二醛(malonrldiadehyde,MDA)及伊文氏蓝含量。结果:给药组MDA含量为(1.71±0.34)nmol/mg,假手术组为(l.73±0.65)nmol/mg,均显著低于手术组〔(2.54±0.39)nmol/mg]。 给药组伊文氏蓝含量为(1.50±0.29)μg/mg.假手术组为(0.13±0.07)μg/mg,均显著低于手术组[((3.07±1.18)μg/mg].结论:G-CSF有减轻大鼠下肢缺血再灌注所致肺功能损伤的作用。 相似文献
4.
心肌肌凝蛋白轻链放射免疫分析及临床初步应用 总被引:1,自引:0,他引:1
为提供急性心肌梗塞(AMI)早期血清学诊断法,用改进后的Schoβ法提取狗肌凝蛋白轻链(CM-LC),免疫兔获得抗血清。氯胺T法标记抗原,建立血清CM-LC RIA。结果:该方法标准曲线测量范围1-100μg/L,批内、批间(CV分别是3.2%和9.1%,平均回收率95.3%。正常人30例血清CM-LC为3.5±1.5μg/L,20例AMI患 者血清CM=LC为20.2±8.6μg/L,两组间差异 相似文献
5.
ApoE基因敲除鼠12周游泳运动前后纤溶激活功能的改变 总被引:3,自引:0,他引:3
目的:探讨ApoE在长期有氧运动中影响纤溶激活作用中的有关机制。方法:以ApoE基因敲除(ApoE-/-)鼠为实验组、以相同遗传背景的C57BL/6J鼠为对照组建立运动模型。结果:12周游泳后,对照组鼠TG(0.96±0.30vs0.54±0.070mmol/L,P<0.01)和PAI(0.92±0.07vs0.80±0.09AU/ml,P<0.05)降低,tPA升高(0.60±0.12vs1.04±0.23IU/ml,P<0.01);而ApoE-/-鼠的TG(1.28±0.34vs1.29±0.32mmol/L,P>0.05)和PAI(0.74±0.10vs0.79±0.04AU/ml,P>0.05)均没有显著变化,tPA(0.71±0.15vs0.97±0.17IU/ml,P<0.01)升高。结论:长期有氧运动使对照小鼠纤溶激活作用明显改善,其机制与TG和含ApoE脂蛋白水平降低导致LRP清除tPA-PAI作用加强、PAI抑制作用减弱及tPA合成水平增加有关。Ap oE-/-鼠运动后,PAI水平稳定而tPA活性增加,提示tPA合成作用增强。 相似文献
6.
本文报告了1例母子间外周血干细胞移植病例。供受者HLA表型完全相合.但供者CMV—IgG(+),IgM(+)。预处理为全身照射(TBI)加环磷酰胺(CY)方案,环孢素A(CSA)加甲氨喋呤(MTX)方案预防GVHD。输入MNC 3.3×103/kg,CD34+CD38—11.8×106/kg。WBC下降到最低点(0.1×109/L)为移植后第7天,血小板下降到最低点(7×109/L)为第8天。WBC超过1.0×109/L为第19天,血小板达到20×109/L上下为第25天。移植后第30天、58天两次行细胞遗传学检查,结果均为46(X,X)。移植后产生了IV度aGVHD和CMV间质性肺炎,经积极治疗后均得到控制。移植后已近2年,现血象基本正常,有局限性cGVHD表现。仍在服用环胞素A胶囊中。本文对二代间移植的相关问题进行了讨论。 相似文献
7.
为探讨急性脑梗塞时患者体内 脂质过氧化及纤溶状况,以指导临床诊疗。用硫代巴比妥酸比色法和酶联免疫吸附双抗体夹心法分别测定了患者丙二醛( M D A) 及 D 二聚体( D dim er) 水平,结果在急性脑梗塞时 M D A 为(71 ±1 .4)nm ol/ L,较正常人(6 .0±1 .3)n mol/ L 明显地升高( P< 0 .01) , D dimer 在急性脑梗塞时为(1 .72 ±0 .98) m g/ L 较正常人(0 .26 ±0 .13) mg/ L 也明显地升高( P< 0 .01) 。提示脑梗塞时机体内存在脂质过氧化及纤溶活性的增强,适当予以抗氧化及溶栓治疗是降低病人死亡率,提高治愈率的一项有效措施。 相似文献
8.
高原低氧性肺动脉高压的多普勒超声研究 总被引:1,自引:0,他引:1
应用脉冲式或连续式多普勤超声技术,对18例海拔3200m高原正常人及25例高原性心脏病(HAHD)患者测定其肺动脉压。正常组及HAHD无瓣膜返流组10例(40%)应用Haham回归方程,PAMP分别为2.84±0.4及3.73±0.57(lkPa=7.5mmHg);HAHD有三尖瓣返流组8例(32%)用TRPG法测得PASP为6.13±1.73kPa;HAHD有肺动脉瓣返流组7例(28%)用PRPG法测得PADP为4.0±0.73kPa。表明多普勒超声技术的不同方法可用于不同病理状态上高原低氧性肺动脉高压的测定,并揭示了出现瓣膜返流改变时高原低氧性肺动脉高压的程度。 相似文献
9.
采用Seldinger技术锁骨下动脉穿刺插管的解剖学基础及临床应用研究 总被引:5,自引:0,他引:5
经皮锁骨下动脉(SCA)穿刺是导管药盒系统植入术的难点之一。对12例成人尸体标本双侧SCA走行及毗临关系解剖学观察表明,SCA的体表投影点(D点)位于胸锁关节与喙突连线中点偏外约1cm处。当动脉的穿刺靶点为D点内1.5cm上约1cm处时,在锁骨中外1/3下2~3cm处进针,角度额状面为(20~30)°,横断面为(10~20)°,深度为4~5cm。20例患者穿刺成功并送入导丝后的X线照片测量显示左SCA位于第一肋外缘中点处,可作为透视下定位点和靶点。SCA穿刺先按体表标志进行,困难时按透视下骨性标志进行,不成功则采取经股动脉插管,入左SCA,透视引导下穿刺。 相似文献
10.
目的 比较直接经皮冠状动脉腔内成形术( 直接PTCA) 和静脉溶栓疗法在急性心肌梗死(AMI) 治疗中的效果。方法 124 例AMI患者( 直接PTCA组60 例,溶栓组64 例) 均于发病2 周时和12 周后行99Tcm甲氧基异丁基异腈(MIBI)心肌断层显像,将左室心肌分为20 个节段,并对心肌摄取99TcmMIBI的程度进行打分,分别计算发病2 周时心肌显像的总积分(S2WS) 、发病后12 周心肌显像的总积分(S12WS)和两者相减的积分(SDS)。直接PTCA组和溶栓组分别有38 人和35 人于心肌显像后行平衡法门控心室显像。结果 直接PTCA 组与溶栓组比较:S2WS为18-3±6-9 和28-6 ±7-3(t=7-3,P< 0-001),S12WS为11-2 ±4-2 和24-4 ±6-2(t= 11-7,P< 0-001),SDS为7-6 ±3-2 和4-3 ±1-1(t= 5-4,P< 0-001)。直接PTCA组和溶栓组入院2 周时的左室射血分数(LVEF) 分别为(41-4 ±6-5) % 和(39-5 ±7-2)% (t= 1-5 ,P> 0-05),出院12 周后的LVEF 分别为(62-6 ±7-8)% 和(51-4 ± 相似文献
11.
Carlo Camathias Geert Pagenstert Ulrich Stutz Alexej Barg Magdalena Müller-Gerbl Andrej M. Nowakowski 《Knee surgery, sports traumatology, arthroscopy》2016,24(9):2811-2817
Purpose
The purpose was to measure the effect of flexion and additional rotation of the femur relative to the tibia on the tuberosity–trochlear groove distance (TT–TG) in the same subject in 20 cadaveric knees joint.Methods
In 20 human adult cadavers, formal fixed knees (age: 81.9 years, SD 12.3; 10 female) CT scans were performed in extension and 30° of flexion as well as in neutral, maximal possible internal (IR), and external rotation (ER). On superimposed CT scan images, TT–TG was measured in each position. TT–TG measurements were correlated in all knee positions.Results
TT–TG in full extension/neutral rotation was 7.8 mm (SD 3.4, range, 2.4–15.3). TT–TG in full extension and IR was significantly lower, and TT–TG in full extension and ER was significantly higher than in neutral rotation (5.4 ± 2.3 vs. 10.9 ± 4.8 mm; P < 0.001). IR and ER varied between 1.0°–7.6° and 0.2°–9.2°, respectively. TT–TG in 30° flexion/neutral rotation was 3.9 mm (SD 1.8, range, 1.3–7.8), which was significantly lower than in full extension and neutral rotation (P < 0.001). TT–TG in 30° flexion and IR was significantly lower, and TT–TG in 30° flexion and ER was significantly higher than values obtained in neutral rotation (2.7 ± 1.2 vs. 6.5 ± 3.4 mm; P < 0.001). IR and ER in 30° flexion varied between 0.6°–10.7° and 1.9°–13.0°, respectively.Conclusion
Flexion as well as rotation of the knee joint significantly alters the TT–TG. These results may have wider clinical relevance in assessing TT–TG and further decisions based on it.12.
Shigetoshi Okamoto Ken Okazaki Hiroaki Mitsuyasu Shuichi Matsuda Hideki Mizu-uchi Satoshi Hamai Yasutaka Tashiro Yukihide Iwamoto 《Knee surgery, sports traumatology, arthroscopy》2014,22(12):3174-3180
Purpose
In total knee arthroplasty (TKA), a high soft-tissue tension in extension at the time of operation would cause a post-operative flexion contracture. However, how tight the extension gap should be during surgery to avoid a post-operative flexion contracture remains unclear. The hypothesis is that some laxity in the intraoperative extension gap is necessary to avoid the post-operative flexion contracture.Methods
A posterior-stabilized TKA was performed for 75 osteoarthritic knees with a varus deformity. The intraoperative extension gap was measured using a tensor device that provides the gap length and the angle between the femoral component and the tibial cut surface. The medial component gap was defined as the gap calculated by subtracting the selected thickness of the tibial component, including the polyethylene liner, from the extension gap at the medial side. Then, the patients were divided into three groups according to the medial component gap, and post-operative extension angle measured 1 year after the surgery was compared between each groups.Results
One year post-operatively, a flexion contracture of more than 5° was found in 0/34 patients when the medial component gap was more than 1 mm, in 2/26 (8 %) patients when the gap was between 0 and 1 mm, and in 3/15 (20 %) patients when the gap was <0 mm. Three factors were associated significantly with the post-operative extension angle: age, preoperative extension angle, and medial component gap.Conclusion
The intraoperative extension gap is related to the post-operative extension angle. Surgeons should leave more than 1-mm laxity after the implantation to avoid the post-operative flexion contracture. As a clinical relevance, this study clarified the optimal extension gap to avoid the post-operative flexion contracture.Level of evidence
Prospective comparative study, Level II. 相似文献13.
不同跖屈角度对踝三角韧带损伤X线诊断的影响 总被引:1,自引:0,他引:1
目的 评估踝关节不同跖屈角度对踝三角韧带损伤X线诊断的影响,提高踝三角韧带损伤诊断的准确率.方法 自2010年2月至2010年12月收治踝关节旋后-外旋型骨折患者24例,均为腓骨远端骨折但无内踝骨折.所有患者外翻应力下分别取中立位0°、跖屈位15°、30°、45°拍摄踝穴位X线片,并行患侧踝关节MRI检查.对不同跖屈角度下四组患者X线片内侧踝穴宽度(medial clear space,MCS)及胫距上关节宽度(superior clear space,SCS)进行测量.测量结果采用单因素方差分析LSD-t检验,分别以(1)MCS≥4 mm,且MCS> SCS,(2)MCS≥5 mm,且MCS> SCS作为踝三角韧带损伤X线诊断的标准,踝关节MRI检查结果作为诊断“金标准”,进行诊断性试验研究.结果 外翻应力下踝关节中立位0°、跖屈位15°、30°、45°时,MCS测量结果分别为(4.10±0.79)mm、(4.55±0.72)mm、(4.99±0.56)mm、(5.71 +0.86)mm,组间比较差异有统计学意义(P<0.05);SCS测量结果分别为(3.56±0.41)mm、(3.50±0.43)mm、(3.71±0.44)mm、(3.93±0.51)mm,组间比较差异无统计学意义(P>0.05);以MCS≥4 mm,且MCS>SCS作为诊断标准时,中立位0°、跖屈位15°、30°、45°时,出现假阳性率分别为50.0%、66.7%、88.9%、94.4%.以MCS≥5 mm,且MCS> SCS作为诊断标准时,中立位0°、跖屈位15°、30°、45°时,出现假阳性率分别为5.6%、11.1%、38.9%、77.8%.结论 不同跖屈角度是影响踝三角韧带损伤X线诊断的重要因素,随着踝关节跖屈角度增加,踝三角韧带损伤X线诊断的假阳性率亦随之升高. 相似文献
14.
Tobias J. Dietrich Michael Betz Christian W. A. Pfirrmann Peter P. Koch Sandro F. Fucentese 《Knee surgery, sports traumatology, arthroscopy》2014,22(1):214-218
Purpose
Increased tibial tuberosity-trochlear groove distance (TTTG) is one potential correcting parameter in patients suffering from lateral patellar instability. It was hypothesized that end-stage extension of the knee might influence the TTTG distance on MR images.Methods
Transverse T1-weighted MR images of the knee were acquired at full extension, 15° and 30° flexion of the knee in 30 asymptomatic volunteers. MRI parameters: slice thickness: 3 mm, matrix: 256 × 384, FOV: 150 × 150 mm. Two observers independently measured the TTTG at all positions.Results
Mean TTTG for observer 1 was 15.1 ± 3.2 mm at full extension, 10.0 ± 3.5 mm at 15° flexion and 8.1 ± 3.4 mm at 30° flexion. Mean TTTG for observer 2: 14.8 ± 3.3 mm at full extension, 9.4 ± 3.0 mm at 15° flexion, 8.6 ± 3.4 mm at 30° flexion. Mean values were significantly different (p < 0.001) between full extension and 15° as well as 30° flexion for both observers. Mean values were significantly different (p < 0.001) between 15° and 30° for observer 1, but not for observer 2 (n.s.). Interobserver agreement was very good (intraclass correlation coefficient: 0.87–0.88; p < 0.001).Conclusions
The TTTG increases significantly at the end-stage extension of the knee. Therefore, the comparability of published TTTG values measured on radiographs, CT and MRI at various flexion/extension angles of the knee are limited.Level of evidence
Development of diagnostic criteria in a consecutive series of patients and a universally applied ‘gold’ standard, Level II. 相似文献15.
M. Ettinger M. Petri D. Guenther C. Liu C. Krusche E. Liodakis U-V Albrecht C. Krettek M. Jagodzinski 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2057-2062
Purpose
Double-bundle ACL reconstruction has been demonstrated to be at least as effective as single-bundle reconstruction in terms of restoring knee rotational and translational stability. Until now, the influence on knees with hyperextension has not been evaluated. It was the purpose of this study to evaluate whether double-bundle ACL reconstruction restricts extension in hyperextendable knees.Methods
Hamstring tendon reconstructions of 10 human cadaveric knees with the ability of hyperextension (age: 48 ± 14 years) were performed as single bundle (SB) on one side and double bundle (DB) on the other side. A surgical navigation system (BrainLab, Germany) was used to assess the kinematics of each knee at the intact and reconstructed state. A difference with regard to the anterior-to-posterior translation (AP) and rotational stability at 30° of knee flexion, 90° of flexion and the hyperextension capability of each specimen was analysed.Results
The difference in AP translation before and after the reconstruction was not significantly different in 30° and 90° of flexion (n.s). Both single- and double-bundle reconstructions restored the preoperative kinematics at 30° and 90° of knee flexion (n.s). The knee extension was 4° ± 1.8° with the intact ACL and 4° ± 1.7° after reconstruction in the SB group (n.s). The knee extension was 5° of hyperextension ± 1.1° with the intact ACL and 0° ± 0.4° after reconstruction in the DB group; the limitation of the extension was significantly larger in this group (p = 0.013).Conclusion
Both single- and double-bundle ACL reconstruction techniques are capable of restoring knee anteroposterior and rotational stability. Double-bundle reconstructions significantly reduce knee extension in knees with hyperextension capability. Care must be taken when using double-bundle techniques in patients with knee hyperextension as this procedure may limit the knee extension after double-bundle ACL reconstruction. 相似文献16.
《Gait & posture》2021
BackgroundAdults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice.Research QuestionWhat are the main alterations in gait kinematics of ASD and their radiological determinants?Methods52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored.ResultsASD had increased sagittal vertical axis (SVA:34 ± 59 vs −5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (−3 ± 10 vs −7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (−11 ± 12 vs −15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis.SignificanceStatic compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment. 相似文献
17.
《Journal of Science and Medicine in Sport》2022,25(8):684-689
ObjectivesTo compare biceps femoris long head (BFlh) muscle tendon unit and fascicle function during Nordic hamstring exercise (NHE) variations with different hip range of motion.DesignCross-sectional.MethodsTwelve healthy volunteers (age: 24 ± 4 years; mass: 77 ± 6 kg; height: 177 ± 4 cm) performed two NHE variations: NHE with hips in neutral (fixed) position (conventional NHE); and NHE with hip flexion/extension. BFlh fascicle length behaviour was assessed using a dual transducer ultrasound configuration. BFlh and semitendinosus muscle electromyography, lower limb kinematics and knee flexion moment were also recorded. A biomechanical model was used to estimate BFlh muscle-tendon unit (MTU) length. Statistical Parametric Mapping was used to assess timing differences in outcome variables across the movement.ResultsIn both variations, during much of the exercise (~30–80% of movement phase), BFlh fascicles undergo little length change (isometric) while the MTU lengthens. Fascicles stretched considerably just in the last ~20% of the exercise, and changes in fascicle length (<2 cm stretch) were smaller in comparison to changes in MTU length (<4 cm stretch). Hip flexion resulted in the muscle tendon unit and fascicles operating at longer lengths until approximately 80% of the movement phase.ConclusionsThe decoupling between fascicle and MTU length seen during the NHE variations suggests that stretch of the elastic tissue of the MTU has an important role in absorbing energy during Nordic hamstring exercises. This may be important when considering adaptations to BFlh muscle and connective tissues that might occur from NHE training. 相似文献
18.
Dae-Hee Lee Young-Soo Shin Jin-Ho Jeon Dong-Won Suh Seung-Beom Han 《Knee surgery, sports traumatology, arthroscopy》2014,22(8):1793-1798
Purpose
The aim of this study was to investigate the mechanism underlying the development of gap differences in total knee arthroplasty using the navigation-assisted gap technique and to assess whether these gap differences have statistical significance.Methods
Ninety-two patients (105 knees) implanted with cruciate-retaining prostheses using the navigation-assisted gap balancing technique were prospectively analysed. Medial extension and flexion gaps and lateral extension and flexion gaps were measured at full extension and at 90° of flexion. Repeated measures analysis of variance was used to compare the mean values of these four gaps. The correlation coefficient between each pair of gaps was assessed using Pearson’s correlation analysis.Results
Mean intra-operative medial and lateral extension gaps were 20.6 ± 2.1 and 21.7 ± 2.2 mm, respectively, and mean intra-operative medial and lateral flexion gaps were 21.6 ± 2.7 and 22.1 ± 2.5 mm, respectively. The pairs of gaps differed significantly (P < 0.05 each), except for the difference between the medial flexion and lateral extension gaps (n.s.). All four gaps were significantly correlated with each other, with the highest correlation between the medial and lateral flexion gaps (r = 0.890, P < 0.001) and the lowest between the medial flexion and lateral extension gaps (r = 0.701, P < 0.001).Conclusion
Medial and lateral flexion and extension gaps created using the navigation-assisted gap technique differed significantly, although the differences between them were <2 mm, and the gaps were closely correlated.Clinical relevance
These narrow ranges of statistically acceptable gap differences and the strong correlations between gaps should be considered by surgeons, as should the risks of soft tissue over-release or unintentional increases in extension or flexion gap after preparation of the other gap.Level of evidence
III. 相似文献19.
Jae-Hyuk Yang Anshul Dahuja Jin-Kak Kim Se-Hyeok Yun Jung-Ro Yoon 《Knee surgery, sports traumatology, arthroscopy》2016,24(8):2422-2429
Purpose
The aim of this study was to demonstrate the lower limb alignment in knee flexion position after navigation-assisted total knee arthroplasty using the gap technique and to identify the correlative factors.Methods
One hundred and twenty consecutive osteoarthritic knees (120 patients) were prospectively enrolled for intraoperative data collection. All TKA surgeries were performed using the navigation system (OrthoPilot?, version 4.0; B. Braun Aesculap, Tuttlingen, Germany). Before and after final prosthesis implantation, the lower limb navigation alignment in both knee extension (0°) and knee flexion (90°) position was recorded. The knee flexion alignment was divided into three groups: varus, neutral and valgus alignment. To determine the factors of the alignment in knee flexion position, preoperative demographics, radiologic and intraoperative data were obtained. Pearson’s correlation (r) analysis was performed to find the correlation. The Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were compared between groups.Results
Although all postoperative extension alignment was within neutral position (between ?2° and +2°), postoperative knee flexion alignment was divided into three groups: varus (≤?3°), 24 cases (20 %); neutral (between ?2° and +2°), 85 cases (70.8 %) and valgus (≥+3°) alignment, 11 cases (9.2 %). There were a good correlation of alignment in knee flexion position with the rotation of femoral component relative to posterior condylar axis (r = ?0.502, p = 0.000) and weak correlations with posterior femoral cut thickness (lateral condyle) (r = 0.207, p = 0.026), medial flexion (90°) gap after femoral component rotation adjustment (r = 0.276, p = 0.003). Other variables did not show correlations. There were no statistical clinical differences between varus, neutral and valgus knee flexion alignment groups.Conclusion
About 30 % of the cases showed malalignment of more than 3° in knee flexion position although with neutral alignment in extension position. The knee flexion alignment had a good correlation with the rotation of femoral component relative to posterior condylar axis. Neutral alignment in knee flexion position may be adjusted by femoral component rotation especially by the use of navigation system.Level of evidence
IV.20.
《Scandinavian journal of medicine & science in sports》2018,28(3):947-960
Effects of resistance training are well known to be specific to tasks that are involved during training. However, it remains unclear whether neuromuscular adaptations are induced after adjacent joint training. This study examined the effects of hip flexion training on maximal and explosive knee extension strength and neuromuscular performance of the rectus femoris (RF , hip flexor, and knee extensor) compared with the effects of knee extension training. Thirty‐seven untrained young men were randomly assigned to hip flexion training, knee extension training, or a control group. Participants in the training groups completed 4 weeks of isometric hip flexion or knee extension training. Standardized differences in the mean change between the training groups and control group were interpreted as an effect size, and the substantial effect was assumed to be ≥0.20 of the between‐participant standard deviation at baseline. Both types of training resulted in substantial increases in maximal (hip flexion training group: 6.2% ± 10.1%, effect size = 0.25; knee extension training group: 20.8% ± 9.9%, effect size = 1.11) and explosive isometric knee extension torques and muscle thickness of the RF in the proximal and distal regions. Improvements in strength were accompanied by substantial enhancements in voluntary activation, which was determined using the twitch interpolation technique and RF activation. Differences in training effects on explosive torques and neural variables between the two training groups were trivial. Our findings indicate that hip flexion training results in substantial neuromuscular adaptations during knee extensions similar to those induced by knee extension training. 相似文献