Flexibility does not affect the dorsiflexion of foot and the popliteal angle in young adults

BackgroundThe aim of the study was to assess how flexibility affects the dorsiflexion of foot and the popliteal angle test results in junior high school students.MethodsThe subjects were 142 students from the 2nd, and 3rd year of Poznań junior high schools (age between 13 and 15).Each subject was examined 6 times: there were 3 raters, a specialist in orthopaedics, a resident doctor and a physical therapy student, and each of them performed 2 measurements. Flexibility was also measured using the Beighton scale (score from 0 to 9).ResultsSince the Beighton scale is ordinal in order to evaluate the relationship between flexibility and the range of motion Spearman's rank correlation coefficient was calculated. The statistical analysis showed no correlation between flexibility measured on the Beighton scale and the range of passive foot dorsiflexion and the popliteal angle.ConclusionsThe degree of flexibility does not affect the dorsiflexion of the foot and the popliteal angle in junior high students. At this age the range of dorsiflexion is determined by the length of the triceps surae muscle while the popliteal angle depends on the length of the muscles on the back of the thigh.     

中医微创针刀镜联合常规西药治疗早期类风湿关节炎膝关节滑膜炎100例临床观察

目的:观察中医微创针刀镜联合常规西药治疗早期类风湿关节炎膝关节滑膜炎的临床疗效。方法:将200例类风湿关节炎早期患者随机分为治疗组和对照组,每组100例。治疗组行膝关节中医微创针刀镜滑膜切除术后,口服美洛昔康、甲氨蝶呤治疗;对照组仅口服美洛昔康、甲氨蝶呤治疗。2组疗程均为24周。治疗前后对2组患者进行临床评估和影像评估。结果:治疗组显效49例,有效38例,无效13例,总有效率为87.00%;对照组显效24例,有效20例,无效56例,总有效率为44.00%。2组比较,差异有统计学意义(P<0.05)。治疗后,2组MRI检测情况比较,治疗组较对照组明显好转(P<0.05)。结论:中医微创针刀镜切除早期类风湿关节炎膝关节病变滑膜,后续配合美洛昔康、甲氨蝶呤治疗可有效减轻患者的临床症状,值得临床推广。     

Distraction arthroplasty in osteoarthritis of the foot and ankle

Post-traumatic osteoarthritis(PTOA) is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 joints in the foot and the ankle.Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented.The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle,subtalar,first metatarsophalangeal,and second tarsometatarsal joints,and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty.Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle.Additionally,the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint,and can prolong the need for further,more aggressive surgical interventions such as fusion or arthroplasty.     

Conversion to reverse shoulder arthroplasty fifty-one years after shoulder arthrodesis: A case report

BACKGROUND Patients with a shoulder arthrodesis generally experience restriction in range of motion and limitations in activities of daily living. In addition, up to one-third of the patients deals with serious peri scapular pain. The conversion of a shoulder arthrodesis in a reverse shoulder arthroplasty(RSA) has been described as an effective treatment to achieve better function and decreased pain, although literature is sparse. We present the case of a conversion from a painful shoulder arthrodesis to RSA, after a 51 years interval.CASE SUMMARY A 71-year-old male presented with severe peri scapular pain and limited function 51 years after shoulder arthrodesis. Preoperative workup showed a normal bone stock of the glenoid and an intact axillary nerve, but atrophic posterior part of the deltoid muscle. The shoulder arthrodesis was successfully converted to RSA. Twelve months postoperative the patient was very satisfied. He has no pain at rest, nor with exercise and experienced definite improvements in activities of daily living, despite his limited range of motion.CONCLUSION Conversion from shoulder arthrodesis to a RSA can be performed safely, with a high chance of peri scapular pain relief; even after a longstanding arthrodesis.     

Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty,a five-year Roentgen stereophotogrammetric analysis randomised controlled trial

BACKGROUND Polyethylene(PE) particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty(THA). As highly cross-linked polyethylene(HXLPE) is presumed to give lower wear rates, in vivo studies are needed to confirm this.AIM To compare the wear of REXPOL, a HXPLE, with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis(RSA).METHODS Patients were randomised to receive either a HXLPE(REXPOL) or a conventional PE insert during primary THA. RSA images were obtained directly postoperative and after 6 wk, 12 wk, 6 mo, 12 mo, 24 mo and five years. Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery.RESULTS The HXLPE(REXPOL) showed less wear in the latero-medial direction. Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume, whereas the REXPOL did not show these outcomes over time. Improvement from baseline in functional outcome did not significantly differ.CONCLUSION Total 3 D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years. This study confirms, for the first, that the REXPOL HXLPE inlay is preferred to standard PE.     

关节镜联合胫骨高位截骨治疗伴膝内翻的中老年患者内侧半月板退变性损伤

目的探讨关节镜联合胫骨高位截骨治疗伴膝内翻的内侧半月板退变性损伤的早期疗效。 方法回顾性分析2014年1月至2015年1月,西南医科大学附属医院骨关节外科收治的伴膝内翻的内侧半月板退变性损伤患者26例,采取关节镜联合胫骨高位截骨的手术方式进行治疗。其中男性18例（18膝）,女性8例（8膝）：年龄43~58岁,平均（49±6）岁。所有患者均为内侧半月板退变性损伤且伴有膝内翻,均行内侧撑开胫骨高位截骨,关节镜下半月板部分切除术缓解疼痛。测量下肢机械轴通过胫骨平台的相对位置、股胫角、胫骨平台后倾角;末次随访时评估膝关节各间室骨关节炎进展情况,采用Lysholm评分、美国特种外科医院（HSS）评分和Tegner膝关节运动评分评价膝关节功能,采用视觉模拟疼痛评分（VAS）评价疗效。 结果本组26例患者均获随访,随访时间为1.0~2.8年,平均为（1.6±0.5）年。未发现感染、下肢深静脉血栓形成、骨不愈合或延迟愈合等并发症。下肢机械轴通过胫骨平台的相对位置由术前（21.2±3.8）%改善至（59.5±1.7）%,股胫角由术前的（172±4）°改善至（179±4）°,差异均有统计学意义（t=14.257,P<0.05;t=10.572,P<0.05）。术前胫骨平台后倾角为（7.5±2.2）°,术后为（7.9±1.9）°,差异无统计学意义（t=1.628,P>0.05）。末次随访时,患者Lysholm评分、HSS评分、Tegner评分、VAS评分均较术前明显改善,差异有统计学意义（t=7.684,P<0.05;t=16.521,P<0.05;t=6.284,P<0.05;t=12.359,P<0.05）。 结论关节镜联合胫骨高位截骨治疗伴膝内翻的内侧半月板退变性损伤,能够有效改善下肢力线和缓解关节疼痛,早期临床疗效满意。