Sagittal plane translation of the tibia in anterior cruciate ligament-deficient knees during commonly used rehabilitation exercises

It may be assumed that exercises that provoke high sagittal plane knee translations also induce high stresses on an anterior cruciate ligament substitute and, therefore, these exercises should be limited during the first months after reconstruction. In 18 patients with unilateral anterior cruciate ligament deficiency, sagittal plane knee translations were measured with a goniometer linkage system during common activities. The largest translations were found during low-speed isokinetic exercises. Further, isokinetic and isometric exercises on the Cybex-II dynamometer provoked in more than 40% of the patients larger translations on the injured than on the healthy knee. However, isometric exercises without distally applied load only provoked small translation. During bicycling, translations increased with increasing resistance similarly in both limbs. Except for walking downstairs, load-bearing exercises, such as sitting down and standing up from a chair and walking upstairs, only produced negligible amounts of tibial translation. In conclusion, during the early phase after anterior cruciate ligament reconstruction, activities such as bicycling and some weightbearing exercises seem to be more recommendable than low-speed isokinetic exercises, isometric contractions at a low knee flexion angle with distally applied load or walking downstairs.     

Patellofemoral pain syndrome in young women

Clinical alignment, pain variables, common symptoms and functional activity level associated with patellofemoral pain syndrome (PFPS) were evaluated in 40 women with PFPS and 20 healthy controls. No significant difference could be found neither between the patients' most symptomatic knee and least symptomatic knee, nor between the patients and controls regarding clinical lower extremity alignment, such as Q-angle and leg-heel alignment measurements. There were no radiographic signs of malalignment. The patients were significantly more involved competitively in sports but had a significantly lower pain free activity level than the controls. Pain was associated with increased activity. It is suggested that chronic overloading and temporary overuse of the patellofemoral joint, rather than malalignment, contribute to patellofemoral pain.     

Diagnosis of diaphragmatic rupture utilizing spiral computed tomographic reconstruction

A simple method to diagnose rupture of the diaphragm is described. Spiral computed tomography (CT) of the chest and abdomen, with 5-mm slices through the diaphragmatic region, is performed. Coronal and sagittal reconstruction of the diaphragmatic region clearly demonstrates the diaphragmatic defect.     

假体内旋与初次全膝关节置换术后疼痛因素的分析

疼痛是全膝关节置换术(TKA)后不满意的常见原因,其通常有感染、无菌性松动等因素,但仍有部分患者无法明确病因。近年研究发现术后不明原因疼 痛可能和旋转力线不良相关,作者分析了本院32例初次TKA术后不明原因膝痛患者的旋转力线,并将其和无疼痛患者比较,探讨术后疼痛和旋转力线的关系。发现疼痛组患者胫骨旋转角、股骨旋转角、联合旋转角、胫股失匹配角均较无疼痛组内旋,两组比较差异均有统计学意义(P<0.05)。两组术后VAS评分、KSS功能评分、膝关节活动度比较,差异均有统计学意义(P<0.05)。故假体内旋是初次TKA术后不明原因疼痛的一大因素,应避免假体过度内旋安放,减少术后疼痛发生。     

Computer‐navigated total knee arthroplasty in haemophilic arthropathy

Total knee arthroplasty (TKA) in end‐stage haemophilic arthropathy is complex and challenging due to the altered bony anatomy, arthrofibrosis and muscle contractures. Computer navigation is especially advocated in patients with deformity or altered anatomy to improve alignment and to assist in ligament balancing. The objective of this study was to evaluate the results of computer‐navigated TKA in haemophilic arthropathy. A consecutive series of computer‐assisted TKA for the end‐stage haemophilic arthropathy between February 2007 and December 2009 were evaluated. A total of 27 TKA were performed in 25 patients. Pre‐ and postoperative full‐length weight‐bearing radiographs were assessed for the axial limb alignment. The orientation of the components was measured on anteroposterior radiographs. Clinically, Knee Society score and Short Form‐36 were evaluated. The mechanical axis of the leg was within a range of ±3° varus/valgus in 92% of the TKA. The coronal alignment of the femoral and tibial components was within a range of ±3 degrees in 96% of the knees. The clinical outcomes were significantly improved after the operation. There were no complications specific to the computer navigation. Computer‐navigated TKA helps in restoring the mechanical axis and improves accuracy of orientation of the components in patients with end‐stage haemophilic arthropathy. Potential benefits in long‐term outcome require further investigation.     

Correlation between knee and hindfoot alignment in patients with rheumatoid arthritis: The effects of subtalar joint destruction

Abstract

Objectives. Compensatory hindfoot alignment for deformities at the knee level has been demonstrated in patients with knee osteoarthritis. However, this phenomenon has not been elucidated in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the relationship between knee deformity and hindfoot alignment and the effect of subtalar joint destruction in patients with RA.

Methods. We retrospectively investigated RA patients (110 patients, 205 limbs) using radiographs in the standing anteroposterior knee, standing lateral foot, and hindfoot alignment views. The grade of destruction at the knee and subtalar joints was assigned using Larsen's grading system. The correlation between the femorotibial and tibiocalcaneal angles and the effect of joint destruction on this correlation were analyzed using Pearson's correlation coefficients.

Results. There was moderate correlation between the femorotibial and tibiocalcaneal angles in a group of knees with a Larsen grade of ≥ 4 (r = 0.544, p = 0.0239). This correlation was stronger in a group with less damaged subtalar joints with a Larsen grade of ≤ 3 (r = 0.705, p = 0.0049).

Conclusion. These findings emphasized the importance of examining foot and ankles in patients with RA who undergo total knee arthroplasty.     

Chronobiology,endocrinology, and energy‐ and food‐reward homeostasis

Energy‐ and food‐reward homeostasis is the essential component for maintaining energy balance and its disruption may lead to metabolic disorders, including obesity and diabetes. Circadian alignment, quality sleep and sleep architecture in relation to energy‐ and food‐reward homeostasis are crucial. A reduced sleep duration, quality sleep and rapid‐eye movement sleep affect substrate oxidation, leptin and ghrelin concentrations, sleeping metabolic rate, appetite, food reward, hypothalamic‐pituitary‐adrenal (HPA)‐axis activity, and gut‐peptide concentrations, enhancing a positive energy balance. Circadian misalignment affects sleep architecture and the glucose‐insulin metabolism, substrate oxidation, homeostasis model assessment of insulin resistance (HOMA‐IR) index, leptin concentrations and HPA‐axis activity. Mood disorders such as depression occur; reduced dopaminergic neuronal signaling shows decreased food reward. A good sleep hygiene, together with circadian alignment of food intake, a regular meal frequency, and attention for protein intake or diets, contributes in curing sleep abnormalities and overweight/obesity features by preventing overeating; normalizing substrate oxidation, stress, insulin and glucose metabolism including HOMA‐IR index, and leptin, GLP‐1 concentrations, lipid metabolism, appetite, energy expenditure and substrate oxidation; and normalizing food reward. Synchrony between circadian and metabolic processes including meal patterns plays an important role in the regulation of energy balance and body‐weight control. Additive effects of circadian alignment including meal patterns, sleep restoration, and protein diets in the treatment of overweight and obesity are suggested.     

矢状面弧度准确重建对治疗胸腰段脊柱骨折疗效的对比研究

[目的] 对比研究钛棒折弯角度的个性化设计在手术治疗胸腰段脊柱骨折中的中远期疗效。[方法] 将96例患者随机分为两组,治疗组50例,根据术前标准脊柱侧位片,利用均值法求出患椎运动节段的矢状面成角,所得值与患椎下运动节段矢状面成角、患椎上椎体矢状面成角的和作为所需固定节段的矢状面cobb值,根据此角度值术中钛棒折弯并行后路复位固定,对照组46例,术中凭借经验弯棒,其他治疗均同,治疗组对照组随访6个月以上,平均18个月,96例均术前、术后、末次随访时拍摄腰椎正侧位片,其中42例术前、末次随访均行CT检查,30例末次随访行磁共振检查。[结果] 1. 影像学指标：治疗组末次随访的椎体前、后缘高度及cobb角平均丢失分别为1.06mm、0.42mm、1.57度,对照组矫正的丢失分别为2.73mm、0.79mm、2.49度。治疗组鱼尾现象21例,对照组鱼尾现象25例。治疗组内固定失效率6％,对照组内固定失效率13％,治疗组末次随访22例CT检查10例存在蛋壳现象,对照组20例CT检查9例存在蛋壳现象。2.临床指标：神经系统有神经部分损伤的患者按Frankel分级均有1级以上的恢复。末次随访腰痛根据Oswestry功能障碍指数问卷评分：治疗组17例0分,15例2分,11例4分,2例6分,2例8分,1例56分,1例80分,1例88分,对照组10例0分,15例4分,11例6分,2例8分,2例10分,2例18分,2例50分,2例80分。 [结论] 经后路椎弓根内固定系统治疗胸腰段脊柱骨折时,术前个性化准确折弯钛棒能够较准确恢复矢状面生理弧度,减少椎体高度矫正的丢失,能够减少手术时间,减少内固定失败率,降低术后腰痛发生率,减少相邻节段退变。     

与黄连功能对应的5种药效组分分析

目的：分析与黄连清热燥湿、泻火解毒对应的5种药效组分变化规律,探讨饮片配伍、复方、剂型与药效组分的相关性,为新药的研发和质量评价体系的建立提供科学数据。方法：采用单味药、药对和复方及其制剂对应的方法制备样品并进行对照,采用RP-HPLC法测定黄连5种药效组分的含量。结果：与黄连功能对应的药效组分是盐酸药根碱、盐酸表小檗碱、盐酸黄连碱、盐酸巴马丁、盐酸小檗碱,其含量依次为2.18±0.37、8.81±0.55、18.57±0.35、7.50±0.12、38.41±1.26mg·g-1。结论：黄连药效组分盐酸药根碱-盐酸表小檗碱-盐酸黄连碱-盐酸巴马丁-盐酸小檗碱,其清热解毒组分是1∶3.2∶4.88∶2.72∶12.85;其清热燥湿组分是1∶2.84∶4.62∶2.32∶11.3;其清热泻火组分是1∶4.21∶6.76∶3.39∶16.87;且各药效组分之间有显著性差异（P〈0.01）。黄连的功能与配伍和剂型相关,黄连的功能物质是药效组分。     

矢状窦上开放性凹陷性骨折的临床治疗方法探讨

目的探讨矢状窦上开放性凹陷性骨折的治疗方法。方法收集2006年3月～2011年3月住院的矢状窦上开放性凹陷性骨折12例患者资料,对其临床表现、治疗经过和结局进行回顾性分析。结果本组12例患者中1例观察2个月后摘除骨折片,钛网修补;1例清创摘除骨折片,钛网一期修补;10例摘除骨折片,颅骨缺损后期修补。随访1年,按格拉斯哥后果评定,12例均恢复良好。结论对矢状窦上开放性凹陷性骨折的治疗,应根据损伤污染的程度、临床症状、美观需求等因素综合判断选择治疗方案,按具体情况进行单纯的清创缝合、骨折片摘除或一期修复。