自体四股腘绳肌腱Rigidfix和Intrafix固定重建前交叉韧带

背景：以自体腘绳肌腱rigidfix、Intrafix固定重建前交叉韧带是现在较流行的手术方式,但缺乏中长期临床疗效的评价。 目的：评估股骨端应用Rigidfix、胫骨端应用Intrafix固定自体腘绳肌腱重建前交叉韧带的中期临床疗效。 方法：对39例前交叉韧带损伤患者在关节镜下行自体4股腘绳肌腱Rigidfix和Intrafix固定重建前交叉韧带,进行2年以上中期随访,并应用Lyshlom、IKDC、Tegner评分对治疗后临床疗效进行系统的评价。 结果与结论：经过至少2年的随访发现应用Rigidfix和Intrafix内固定患者在IKDC、Lysholm评分明显高于治疗前(P < 0.01)。证实在关节镜下应用自体4股腘绳肌腱Rigidfix和Intrafix重建前交叉韧带具有良好的中期临床疗效,但若大规模的使用,目前尚缺乏长期的临床随访结果。     

筋伤活血膏治疗慢性筋伤临床观察

目的 观察筋伤活血膏治疗慢性筋伤的临床疗效.方法 将患者随机分为两组,对照组采用奇正消痛贴外用,治疗组采用筋伤活血膏外敷,10d后比较两组疗效.结果 治疗组综合疗效证候积分改善明显优于对照组(P＜ 0.05或0.01).结论 筋伤活血膏治疗慢性筋伤疗效确切.     

Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy

Background Conventional ultrasonography or magnetic resonance （MR） imaging is commonly performed to obtain information about the severity of the disease,location of the injury,and differential diagnosis.The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.Methods A single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients （9 men,19 women; mean age,48.5 years; age range,36-67 years） with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls.Greyscale images were described as normal,tendinosis,partialthickness tear,and full-thickness tear.Sonoelastographic images of the common extensor tendon were analyzed qualitatively （scoring of the elastic spectrum） and quantitatively （based on a color histogram）.Results Both the imaging methods had high sensitivity,specificity,and accuracy for diagnosing lateral elbow tendinopathy.Considering the clinical diagnosis of lateral elbow tendinopathy,sonoelastography showed significantly higher diagnostic accuracy （96.4％） than ultrasonography （89.5％,P ＜0.01）.Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows （P ＜0.01）.Conclusion Sonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.     

Foot posture is associated with morphometry of the peroneus longus muscle,tibialis anterior tendon,and Achilles tendon

The aim of this study was to investigate the association between foot type and the morphometry of selected muscles and tendons of the lower limb. Sixty‐one healthy participants (31 male, 30 female; aged 27.1 ± 8.8 years) underwent gray‐scale musculoskeletal ultrasound examination to determine the anterior‐posterior (AP) thickness of tibialis anterior, tibialis posterior, and peroneus longus muscles and tendons as well as the Achilles tendon. Foot type was classified based on arch height and footprint measurements. Potentially confounding variables (height, weight, hip and waist circumference, rearfoot and ankle joint range of motion, and levels of physical activity) were also measured. Multiple linear regression models were used to determine the association between foot type with muscle and tendon morphometry accounting for potentially confounding variables. Foot type was significantly and independently associated with AP thickness of the tibialis anterior tendon, peroneus longus muscle, and Achilles tendon, accounting for approximately 7% to 16% of the variation. Flat‐arched feet were associated with a thicker tibialis anterior tendon, a thicker peroneus longus muscle, and a thinner Achilles tendon. Foot type is associated with morphometry of tendons that control sagittal plane motion of the rearfoot; and the peroneus longus muscle that controls frontal plane motion of the rearfoot. These findings may be related to differences in tendon loading during gait.     

Ultrashort TE spectroscopic imaging (UTESI): Application to the imaging of short T2 relaxation tissues in the musculoskeletal system

Purpose

To investigate ultrashort TE spectroscopic imaging (UTESI) of short T2 tissues in the musculoskeletal (MSK) system.

Materials and Methods

Ultrashort TE pulse sequence is able to detect rapidly decaying signals from tissues with a short T2 relaxation time. Here a time efficient spectroscopic imaging technique based on a multiecho interleaved variable TE UTE acquisition is proposed for high‐resolution spectroscopic imaging of the short T2 tissues in the MSK system. The projections were interleaved into multiple groups with the data for each group being collected with progressively increasing TEs. The small number of projections in each group sparsely but uniformly sampled k‐space. Spectroscopic images were generated through Fourier transformation of the time domain images at variable TEs. T2* was quantified through exponential fitting of the time domain images or line shape fitting of the magnitude spectrum. The feasibility of this technique was demonstrated in volunteer and cadaveric specimen studies on a clinical 3T scanner.

Results

UTESI was applied to six cadaveric specimens and four human volunteers. High spatial resolution and contrast images were generated for the deep radial and calcified layers of articular cartilage, menisci, ligaments, tendons, and entheses, respectively. Line shape fitting of the UTESI magnitude spectroscopic images show a short T2* of 1.34 ± 0.56 msec, 4.19 ± 0.68 msec, 3.26 ± 0.34 msec, 1.96 ± 0.47 msec, and 4.21 ± 0.38 msec, respectively.

Conclusion

UTESI is a time‐efficient method to image and characterize the short T2 tissues in the MSK system with high spatial resolution and high contrast. J. Magn. Reson. Imaging 2009;29:412–421. © 2009 Wiley‐Liss, Inc.

     

Endoscopic anterior cruciate ligamentreconstruction using doubled gracilis and semitendinosus tendons and endobutton femoral fixation

Donor site complications associated with the use of patellar tendon autografts have resulted in increased interest in the use of multiple-stranded hamstring tendon grafts (semitendinosus and gracilis tendons) for anterior cruciate ligament (ACL) reconstruction. Two major advantages of hamstring tendon grafts are their high initial strength and stiffness, and their harvest results in minimal donor site morbidity. The EndoButton (Smith and Nephew, Andover, MA) provides a quick, simple, strong, and reproducible endoscopic method of securing the femoral end of hamstring tendon grafts. This article describes our technique of endoscopic ACL reconstruction using a doubled semitendinosus and gracilis autograft with EndoButton femoral fixation.     

带血管蒂的自体骨髌腱骨重建前交叉韧带的临床研究

 目的观察"带与不带血管蒂的骨髌腱(PT)骨重建前交叉韧带(ACL)对早中期前交叉韧带完全断裂"的临床疗效.方法治疗组(A组)行带血管蒂骨髌腱骨重建前交叉韧带,对照组(B组)行不带血管蒂骨髌腱骨重建前交叉韧带.结果治疗组较对照组总有效率和显效率、前抽屉试验评分均高,两者间有显著性差异.结论带血管蒂骨髌腱骨重建前交叉韧带对治疗前交叉韧带损伤具有较好的治疗作用,可以明显缩短患者恢复时间,改善患者膝关节功能.     

The frequency and characteristics of ultrasonographic ankle joint involvement in systemic lupus erythematosus: A prospective cross-sectional single-center study

The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0–24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0–2; range 1–10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).     

关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱一期重建膝关节前后交叉韧带

目的 探讨关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱同时重建膝关节前后交叉韧带的近期临床效果.方法 对2004年6月～2005年3月收治的10例膝关节前后交叉韧带同时断裂的患者,切取双侧腘绳肌腱,2条半腱肌腱和2条股薄肌腱分别对折成四束,折端固定同直径EndoPearl.关节镜下利用两组移植物同时分别重建膝前后交叉韧带.股骨端应用可吸收界面螺钉顶压固定EndoPearl与移植肌腱,胫骨端应用Intrafix固定四束肌腱.结果 10例均获得随访,平均7.5个月(6～15个月),切口Ⅰ期愈合,无感染.其中新鲜损伤4例,陈旧性损伤6例,合并后外侧复合体损伤3例,均予同期修复,合并内侧副韧损伤6例,未予特殊处理,5例曾急诊修复腘动静脉.术后3个月膝关节活动范围均超过120°,无伸膝受限,后抽屉试验Ⅰ度阳性2例,其余为阴性;Lyshlom评分(92.6±3.2)分.结论 关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱同时重建膝关节前后交叉韧带方法确切,可有效恢复膝关节功能.     

石学敏经筋刺法治疗带状疱疹后遗神经痛经验浅析

[目的]浅析石学敏院士运用经筋刺法治疗带状疱疹后遗神经痛的经验。[方法]通过整理相关医案,从中医病因病机,经筋刺法理论依据,刺法特点（辨经论治、醒脑调神、经筋排刺与刺络拔罐）等方面,总结石院士运用经筋刺法诊治带状疱疹后遗神经痛的学术经验,并举验案以供参考。[结果]石院士认为,引起带状疱疹后遗神经痛的主要病因病机为患者体弱血虚肝旺,湿热毒邪蕴积,导致“不荣则痛”或“不通则痛”;并认为其以神经病理性疼痛为主的临床表现符合经筋病候特点,故以“疏利经筋”为指导原则,运用经筋刺法治疗该病。所举验案中一患者证属气虚血瘀证,治以益气化瘀、通络止痛;另一患者属气血两虚,治以补气养血、荣养营卫,运用经筋刺法后均取得佳效。[结论]石院士以“不荣”或“不通”为带状疱疹后遗神经痛基本病机,以“疏利经筋”的经筋刺法治疗该病,能有效改善患者症状,其经验值得推广。