临床路径在膝关节置换术病人中的应用

对于80例实施膝关节置换术病人的平均住院日、平均医疗费用、并发症发生率及出院病人的满意度调查进行比较,采用前后对照的研究方法,发现实施临床路径后,病人的平均住院日、平均医疗费用、并发症发生率明显下降,出院病人的满意度明显上升。临床路径是一种科学的工作模式在病种适合的前提下值得在临床实践中推广。     

关节置换治疗膝关节创伤后晚期严重功能障碍

目的探讨膝关节创伤后严重功能障碍的治疗以及人工关节置换治疗这类疾病的手术适应证及手术方法。方法自1997年6月至2004年6月采用人工关节置换治疗严重创伤后晚期膝关节功能障碍18例21膝,对于其中严重创伤性关节炎无明显畸形10例12膝,采用膝关节表面置换。创伤性关节炎合并膝关节20°～40°内外翻或20°～90°固定性屈曲畸形6例7膝,膝关节完全骨性强直2例2膝,患者采用可旋转铰链式膝关节。所有患者均获得随访,时间6个月～7年,平均3.5年,采用美国特种外科医院(HospitalforSpecialSurgery,HSS)评分标准对手术疗效进行评价。结果评定膝关节术后的疼痛、活动功能、关节畸形矫正以及稳定性和肌力。术前评价均为差,术后优12膝,良7膝,可2膝,总优良率90%。患者主观满意率为100%。结论关节置换治疗膝关节创伤后晚期严重功能障碍是一种有效的方法。     

MRT of the unoperated knee joint and the knee joint following alloplastic ligament replacement (polyethylene terephthalate)

When using the spin-echo technique natural, ligament and menisci have practically nearly no signal. Degenerative lesions, lesions of cartilage, and osteochondrosis dissecans are visible. After ligament plastic the bore canal for the alloplastic ligament is visible. The advantages of MRI are pointed out.     

双膝关节置换合并骨劈裂术后5年随访1例

全膝关节置换术适用于治疗各种骨关节炎、关节疼痛、关节强直及屈曲挛缩等疾病。我院2001年5月收治一例双膝关节畸形、行走困难病例,行双膝关节置换术后,经5年随访观察,疗效满意,现报告如下。1病例报告女,65岁,2001年5月8日因双膝关节疼痛、畸形,进行性加重两年余来我院就诊。查体见:双膝内翻畸形,左下肢跛行步态,关节活动无明显受限,左髌骨外侧压痛明显,双膝关节间隙轻压痛,立位踝间距约6 cm,平卧位下肢力线左侧通过髌骨内侧,右侧经髌骨体中部,肢端血运、感觉、活动可,小腿浅表静脉迂曲。X片(CR)示:双膝关节内翻畸形,内翻角度左侧35°,右…     

Radionuclide bone scintigraphy in the detection of significant complications after total knee joint replacement

AIM: Post-arthroplasty knee pain is common and clinically it can be difficult to identify those patients with complications requiring active treatment. The aim of this study was to determine the usefulness of(99)Tc(m)-MDP bone scintigraphy. METHOD: A retrospective study of all patients having a(99)Tc(m)-MDP bone scintigram for a painful knee arthroplasty between 1993 and 1999 was performed. Bone scintigrams were classified as normal or abnormal by a single observer. The results of these investigations were correlated with clinical outcome. RESULTS: Seventy-five patients with painful knee arthroplasties were referred for investigation. A total of 80 bone scintigrams were performed. The average patient age was 66.2 years (42 female and 33 male). The mean time period between surgery and onset of knee pain was 3 years. A final clinical diagnosis based on arthroscopy, open surgery, and extended clinical follow-up was available for all patients. Forty-three (53.8%) of the scintigrams were normal and 37 (46.3%) abnormal. Two patients with a normal bone scintigram has loose prostheses. Thirteen patients with an abnormal study had normal prostheses on follow-up and these tended to be patients scanned less than a year after surgery. The sensitivity, specificity, positive predictive value and negative predictive value of an unequivocally normal or abnormal bone scintigram was 92.3, 75.9, 64.9 and 95.0%, respectively. The pattern of isotope uptake in the abnormal studies was not specific enough to reliably differentiate aseptic from septic loosening. CONCLUSION: Radionuclide bone scintigraphy is useful in the assessment of the painful knee arthroplasty. A negative bone scintigram is reassuring and makes loosening or infection unlikely.     

迭代重建在膝关节置换术后X线数字化断层融合检查中的应用价值

目的：探讨 X 线数字化断层融合（DTS）运用迭代重建技术（IR）,降低膝关节图像金属植入物伪影的可行性和临床应用价值。方法：79例人工膝关节置换术后患者行 DTS 扫描,分别采用滤波反投影重建（FBP）技术和迭代重建（IR）技术对原始图像进行重建。从图像清晰度、假体金属植入物与周围骨相连结构的显示度、金属伪影的多少等方面对两组图像进行分析并评价。根据骨科临床对人工膝关节的分区,在后处理工作站上测量 A1～A7区域内假体与骨之间硬化束金属伪影的长度。结果：对两种重建技术所得到的图像进行主观评价,IR 组优片率为88．6％,FBP 组优片率为62％, IR 组优片率高于 FBP 组,差异有统计学意义（P ＜0．05）。IR 组重建图像在 A1、A3～A7区域无金属伪影,仅3例图像 A2区域见少许金属伪影,A7区域关节间隙内聚氨酸脂软垫显示清晰;FBP 组人工假体在 A1～A7区域均见金属伪影,伪影长度为0．5～2．6 mm。FBP 组图像伪影明显多于 IR 组。结论：有金属植入物的人工膝关节置换术后患者行 DTS 检查,运用 IR 技术可明显减少金属植入物伪影,图像质量明显改善,在术后随访中具有较高的临床应用价值。     

Arthrography of the knee joint with amipaque.

In a double-blind investigation, 30 knee arthrographies were performed by injection of either Amipaque 290 mg I/ml or Urografin 60% (292 mg I/ml). Both contrast media are well tolerated, and give excellent initial contrast quality, which deteriorates rapidly. This occurs more slowly with Amipaque, which has lower osmolality and causes less joint effusion.     

Navigated unicompartmental knee replacement

Computer-aided systems have been developed recently to improve the precision of implantation of unicompartmental knee replacement (UKR) or total knee replacement. Minimal invasive techniques have been developed to decrease the surgical trauma related to the prosthesis implantation. However, there might be a concern about the potential of minimal invasive techniques for a loss of accuracy. Navigation systems might address this issue. We are currently using routinely a nonimage-based navigation for total knee replacement. We developed a modified system for UKR, suitable for either a conventional or a mini-invasive approach. Navigated implantation of a UKR allowed improving the accuracy of the radiologic implantation. Mini-invasive implantation was effective, but the accuracy may not reach that of the conventional navigated technique and should be still improved. Minimal invasive techniques have to be validated because a loss of accuracy will negatively influence long-term outcomes.     

Exercise-induced knee joint laxity in distance runners.

The objectives of this study were to evaluate the effect of exercise on knee joint laxity. If exercise induced laxity is physiological, incorporation of this quality into a ligament replacement material would be indicated. Twenty recreational long distance runners average age 41 (range 24 to 50 yr) were tested before and immediately after 30 minutes of running. Using a computerized goniometer type instrument (Acufex KSS), knee flexion, axial tibial rotation and anterior-posterior tibial displacement were simultaneously recorded, while the runners underwent tests of static as well as dynamic knee joint laxity. At 30 degrees of knee flexion, a maximum increase of 16 per cent in mean total anterior-posterior laxity post-exercise was found. At the examination 30 minutes post-exercise, laxity at 30 degrees of knee flexion was still increased. However, laxity at 90 degrees of knee flexion had decreased to pre-exercise levels or below. Anterior tibial displacement, recorded during eccentric quadriceps activity (0 to 90 degrees of knee flexion) with weights attached to the foot, showed a maximum of 18 per cent increase in total anterior-posterior laxity post-exercise. It is suggested that the laxity increase is caused in part by a true ligamentous laxity increase, and in part by a decreased resting tone of the fatigued muscles.     

Exercise-related knee joint laxity

Knee injuries are the topic of increasingly sophisticated research because of the importance in professional athletics as well as increasing participation in recreational sports. The role of conditioning and fatigue in these injuries remains controversial. Ligaments have high collagen content, and a viscoelastic response to stress would be expected. Because of the postulated relationship between laxity and knee ligament injuries, an experiment was designed using highly motivated athletes to test the hypothesis that exercise to the point of muscular fatigue may cause laxity of the knee and thereby place athletes at risk for ligamentous injury to the knee when fatigued. An exercise protocol was designed to produce muscle fatigue in the hamstring and quadriceps muscle groups. Knee ligament laxity was tested prior to and subsequent to the exercise protocol. To document muscle fatigue, isokinetic testing of right knee flexion and extension power was used several times during the exercise protocol. A knee arthrometer (KT-1000) was used to quantitatively document ligamentous laxity before and after exercise. The results indicated a significant lengthening in knee joint laxity between preexercise and postexercise in the left knee as measured at 15 and 20 pounds of passive displacement force (P less than 0.05). Maximum manual displacement also demonstrated a significant increase in joint laxity (P = 0.02). The right knee, which had undergone isokinetic testing, demonstrated a similar tendency but without a statistically significant difference before and after exercise. There was no significant preexercise side to side difference, but postexercise measurements demonstrated a left-right difference at 15 pounds, 20 pounds, and maximum manual displacement of statistical significance (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

膝关节及周围常见疾病的超声诊断研究

目的：探讨超声检查对膝关节及周围常见疾病的诊断价值。方法：运用超声对膝关节及周围常见疾病进行诊断。结果：对21例胭窝囊肿和20例胭窝脂肪瘤及ll例膝关节腔积液的超声检查结果与手术病例证实,符合率达100％;对74例膝关节共148个半月板超声检查结果与关节镜检查结果进行对照分析,结果148个半月板中,关节镜发现半月板损伤46个,超声检查准确做出半月板损伤诊断38个,漏诊8个,阴性97个,假阳性5个。超声诊断半月板损伤的准确率91．2％,敏感性82．6％,特异性95．1％,阳性结果预测值88．4％,阴性结果预测值92．4％。结论：超声检查无创、方便、诊断膝关节及周围疾病的准确性较高,可作为基层医院一种广泛开展的检查方法。     

Sonography of the knee joint

The results of the ultrasound investigation of 300 patients are described. The procedure and the normal anatomy are demonstrated. Pathological findings are effusion, joint ganglion, chondromalacia, loose bodies in the joint, Baker-cysts and ligamentous lesions. It is probable that future improvement of the equipment will enlarge the diagnostic possibilities.     

Dislocation of the knee joint

Dislocations are the rarest but the most severe injuries of the knee joint. Six patients with traumatic knee joint dislocation were treated at the Clinic for Traumatology and Orthopedics of the Military Medical Academy in the period January 1989-November 1998. Popliteal artery was injured in 3 patients. The injuries required reconstruction and the treatment in 1 patient ended with upper leg amputation. In one case the diagnosis was irreducible lateral dislocation. Surgical reparation--reconstruction of ligamentary apparatus was performed in 4 patients. Concerning the knee joint stability satisfactory results were achieved. Knee joint dislocations are very severe injuries requiring thorough diagnosis of the possible injury of neurovascular bundle and surgical treatment.     

MRI of knee joint injury

Most knee injuries are the result of rotational, varus, valgus, hyperextension, or translational forces or a combination of these. The pattern of abnormalities seen on magnetic resonance imaging depends on the mechanism of trauma and the position of the joint at the time of injury. Knee injuries can be classified under two broad categories of direct and indirect injuries.     

Imaging of joint replacement procedures

Joint replacement procedures have improved dramatically during the past 30 years fueled by the changes in techniques for hips and knees. Joint replacements in other anatomic regions also have become more popular. It is essential to understand the importance of pre- and postoperative imaging for evaluating patients. Preoperative images are used in concert with clinical data to select the appropriate patients and components. Postoperative imaging is critical for evaluating position and potential complications. Appropriate selection of imaging modalities is essential to provide optimal, cost-effective patient care.