Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: Comparison of bone-patellar tendon-bone and hamstring autografts

Bone tunnel enlargement associated with anterior cruciate ligament (ACL) reconstruction has recently become a topic of interest in the literature. This association was examined, along with the effect of femoral and tibial tunnel enlargement on the clinical results of ACL reconstruction performed with either bone-patellar tendon-bone (BPTB) or hamstring (HST) autografts. Forty-six patients underwent arthroscopic ACL reconstruction (23 receiving BPTB autograft and 23 HST) between March 1999 and July 2001. Thirty patients (13 receiving BPTB autograft and 17 HST) completed the last clinical and radiologic evaluations and were included in the study. The mean age of patients in the HST group was 29.8 years (range 18–39) and that in the BPTB group was 27.6 years (range 20–37). The mean follow-up period was 24.6 months (range 12–36) in HST group and 18.5 months (range 12–40) in BPTB group. The effect of tunnel enlargement on the clinical results was evaluated by comparing preoperative and postoperative Lysholm, Tegner, and International Knee Documentation Committee scores and ligament laxity measurements between and within the groups. Postoperative femoral and tibial tunnel diameters in both groups were significantly larger than their corresponding preoperative tunnel diameters. In an intergroup evaluation, the enlargement of the tibial tunnel was similar in both groups (P=.556), but the femoral tunnel diameter was significantly larger in the HST group than in the BPTB group (P>.001). Preoperative laxity of the knees significantly improved after the operations in both groups, but no difference between the groups was evident at the final follow-up visit. No correlation between tunnel widening and the clinical results of the BPTB and HST procedures was observed.     

分米波防治屈肌腱粘连机制的实验研究

目的　研究分米波对肌腱粘连和愈合的影响。方法　选用 2 8只白色Leghorn鸡 ,随机平均分为A组 (术后分米波治疗组 )和B组 (手术对照组 ) ,将趾深屈肌腱切断、修复 ,术后 1d～ 3周A组足爪局部用分米波治疗 ,B组不行分米波治疗。每组动物分别于术后 3、6周随机处死 7只 ,进行大体和光镜、电镜观察及生物力学检测。结果　大体和组织学观察见A组粘连明显减少 ,电镜检查A组成纤维细胞蛋白合成代谢较B组更旺盛。生物力学检测显示A组肌腱滑动距离、康复顺应性 抗张力强度均大于B组 (P <0 .0 1)。结论　分米波可有效地促进肌腱愈合 ,减少肌腱粘连 ,为肌腱损伤修复术后的早期康复训练提供了必要的条件 ,是防治肌腱粘连理想的辅助措施     

The locomotor system of the ocean sunfish Mola mola (L.): role of gelatinous exoskeleton,horizontal septum,muscles and tendons

Adult ocean sunfish are the heaviest living teleosts. They have no axial musculature or caudal fin. Propulsion is by unpaired dorsal and anal fins; a pseudocaudal fin (‘clavus’) acts as a rudder. Despite common perception, young sunfish are active predators that swim quickly, beating their vertical fins in unison to generate lift‐based propulsion and attain cruising speeds similar to salmon and marlin. Here we show that the thick subcutaneous layer (or ‘capsule’), already known to provide positive buoyancy, is also crucial to locomotion. It provides two compartments, one for dorsal fin musculature and one for anal fin muscles, separated by a thick, fibrous, elastic horizontal septum that is bound to the capsule itself, the roof of the skull and the dorsal surface of the short vertebral column. The compartments are braced sagittally by bony haemal and neural spines. Both fins are powered by white muscles distributed laterally and red muscles located medially. The anal fin muscles are mostly aligned dorso‐ventrally and have origins on the septum and haemal spines. Dorsal fin muscles vary in orientation; many have origins on the capsule above the skull and run near‐horizontally and some bipennate muscles have origins on both capsule and septum. Such bipennate muscle arrangements have not been described previously in fishes. Fin muscles have hinged tendons that pass through capsular channels and radial cartilages to insertions on fin rays. The capsule is gelatinous (89.8% water) with a collagen and elastin meshwork. Greasy in texture, calculations indicate capsular buoyancy is partly provided by lipid. Capsule, septum and tendons provide elastic structures likely to enhance muscle action and support fast cruising.     

从“肝肾-经筋”理论探讨骨性关节炎的综合治疗

目的：依据“肝肾－经筋”理论,探讨骨性关节炎的中医分期综合治疗。方法：通过文献研究方法,以《内经》藏象、经筋理论为指导,根据“治未病”、“杂合以治”为依据,探讨骨性关节炎的分期综合治疗。结果与结论：骨性关节炎早期以局部经筋痛变为主,中后期除经筋病变外,尚有脏腑病变尤其以肝、肾为主。辨证治疗在分期的基础上,采用经筋辨证和脏腑辨证,早期以外治推拿、针灸等方法为主,中后期当辨证论治内服汤药综合配合外治两种方法。通过分期综合治疗,提高治疗该病的临床疗效。     

消肿止痛膏外敷治疗急性踝关节扭伤临床观察

目的：观察消肿止痛膏外敷治疗急性踝关节扭伤临床疗效。方法：98例急性踝关节扭伤患者采用消肿止痛膏治疗。结果：98例急性踝关节扭伤患,治愈82例,显效12例,好转4例,无效0例;有效率100%。结论：消肿止痛膏外敷治疗急性踝关节扭伤临床疗效显著。     

Unusual case of closed rupture of both extensor tendons of the index finger

Extensor tendon rupture is a common condition following penetrating injuries, whereas closed rupture is rare unless in a mallet finger. We describe an unusual case of closed rupture of both extensor tendons to the index finger. The extensor indicis proprius and extensor digitorum longus were avulsed proximal to the extensor retinaculum in a 23-year-old male patient due to forced hyperflexion of his index finger. Investigation was done in the Department of Orthopaedic Surgery at the Notre Dame Des Secours University Hospital, Byblos Lebanon.     

连续腱周缝合对肌腱修复的生物力学影响

目的探讨连续腱周缝合（Running）法在肌腱修复中的生物力学作用,为临床提供理论基础和参考依据。方法成年AA白羽鸡爪50只．按缝合方法随机分为5组。锐刀横断Ⅱ区趾深屈肌肌腱,分别用Running法、单线改良Kessler（MK）法、单线改良Kessler＋Running（K＋R）法、津下双套圈（Tsuge）法、Tsuge＋Running（T＋R）法修复肌腱。缝合后立刻取下肌腱,用冰冻卡具固定两端．在生物力学材料动态力学性能测试仪上进行拉伸——断裂测试。测定极限载荷、应变．记录间隙形成负荷,计算出各组肌腱的韧度、极限拉伸强度、弹性模量和断裂功耗并进行统计学分析。结果在间隙形成负荷、韧度、弹性模量、极限载荷、极限拉伸强度和断裂功耗方面,K＋R法均大于MK法（P〈0．001）,后者分别是前者的58．6％、49．9％、58.4％、56．1％、65．7％、66．3％。T＋R法均大于Tsuge法（P〈0．05）,后者分别是前者的57．8％、52．7％、84．0％、64．7％、91．0％、69．6％。结论Running法操作简单．能为核心缝合增加可观的抗拉强度和抗间隙形成能力,使吻合口对合良好、缝合外观光滑,从而减少肌腱滑动阻力．为术后早期功能锻炼提供有效保证。     

Structure-function relationships of entheses in relation to mechanical load and exercise

Entheses are regions of high-stress concentration that are commonly affected by overuse injuries in sport. This review summarizes current knowledge of their structure-function relationships - at the macroscopic, microscopic and molecular levels. Consideration is given to how stress concentration is reduced at fibrocartilaginous entheses by various adaptations which ensure that stress is dissipated away from the hard-soft tissue interface. The fundamental question of how a tendon or ligament is anchored to bone is addressed - particularly in relation to the paucity of compact bone at fibrocartilaginous entheses. The concept of an "enthesis organ" is reviewed - i.e. the idea of a collection of tissues adjacent to the enthesis itself, which jointly serve a common function - stress dissipation. The archetypal enthesis organ is that of the Achilles tendon and the functional importance of its subtendinous bursa, with its fibrocartilaginous walls and protruding fat pad, is emphasized. The distribution of adipose tissue elsewhere at entheses is also explained and possible functions of insertion-site fat are evaluated. Finally, a brief consideration is given to enthesopathies, with attention drawn to the possibility of degenerative changes affecting other regions of an enthesis organ, besides the enthesis itself.     

关节镜下膝前交叉韧带与后交叉韧带联合重建

[目的]探讨膝关节双交叉韧带损伤的临床特点,评估关节镜下前交叉韧带(ACL)与后交叉韧带(PCL)联合重建的技术和效果。[方法]自2001年9月~2005年2月,13例病人(13膝)经关节镜检查证实ACL和PCL均断裂,其中5膝伴后内侧角(PMC)、内侧副韧带损伤(MCL),4膝伴后外侧角损伤(PLC),2膝伴外侧半月板破裂,1膝伴内侧半月板损伤,3膝伴腘动脉损伤,2膝伴腓总神经损伤。7例病人于损伤后急性期入院,2膝于急性期行腘血管探查修复,4膝行膝后内侧角、内侧副韧带修复。13例病人于伤后4~12周在关节镜下行自体移植物单束ACL和PCL联合重建术,其中4例同期后1/2股二头肌腱重建后PLC,1例同期阔筋膜PMC、MCL重建。[结果]本组术后早期均未发生严重并发症。术后随访10~39个月,平均(21.85±9.28)个月,Lysholm膝关节功能评分为75~95分,平均(86.54±6.89)分。国际膝关节文件编制委员会(IKDC)综合评定由术前显著异常(D级)13例,改进为随访时正常(A级)3例、接近正常(B级)8例、异常(C级)2例。13例病人中,11例恢复至伤前运动水平,2例运动水平较伤前减低。[结论]膝关节双交叉韧带损伤多伴有其它重要结构损伤,需妥善处理合并损伤。关节镜下自体移植物联合单束重建ACL和PCL创伤小、手术操作精细,术后膝关节功能恢复满意。     

辐照氟银肌腱的生物力学和组织形态学变化

目的　探讨辐照氟银肌腱的生物力学性质及形态学变化。方法　肌腱随机分为 3组 :辐照氟银肌腱 (A组 ) ,深低温冷冻肌腱 (B组 )与新鲜肌腱 (C组 )。观察各组生物力学及形态学组织学的变化。结果　辐照氟银组最大载荷和抗张强度明显大于其它各组 (P <0 .0 1) ;组织形态学上各处理组均不同于正常肌腱 ,辐照氟银组光镜下几无细胞 ,纤维呈波浪形 ,深低温冷冻肌腱组细胞很少 ,纤维间距大。结论　辐照氟银肌腱的生物力学和组织形态学改变适合用于异体移植