The role of periosteal flap in the prevention of femoral widening in anterior cruciate ligament reconstruction using hamstring tendons

Tunnel widening in anterior cruciate ligament reconstruction has been reported for many years, whatever the type of plasty (allo- or autograft) or graft (patellar or hamstring tendons). Recently, the hypothesis has been formulated that widening would be responsible for later laxity of the knees. Micromobility of the graft or biological factors are classically responsible for the enlargement. In order to improve the biological conditions around the graft within the tunnel, we have developed a surgical technique using a periosteal flap. The periosteal flap is harvested at the superior and medial metaphysis of the tibia and wrapped around the proximal part of the four strands of gracilis and semitendinosus tendons near the outlet of the femoral tunnel. Forty-one patients with isolated rupture of the ACL were included in a prospective and randomized study: the first group of 20 patients had femoral fixation by Transfix and resorbable screw, the second group of 21 patients had femoral fixation by Transfix and periosteal flap. The diameters of the tunnel were measured between the sclerotic margins at the tunnel entrance and 1 cm above, and compared to the peroperative drill size. The percentage change in diameter was calculated as: (tunnel diameter–drill size)/drill size. The two groups of patients were comparable as to gender, side, age, KT-1000 side to side difference, femoral tunnel diameter and follow-up. At 2.5 months and 11 months postoperatively on average, there was a significant reduction of enlargement at the outlet of the tunnel with the use of a periosteal flap but widening was constant.     

Skin sensory change after arthroscopically-assisted anterior cruciate ligament reconstruction using medial hamstring tendons with a vertical incision

The purpose of this study was to clarify and document light-touch sensory change of the lower leg after arthroscopically-assisted ACL reconstruction using medial hamstring tendons with a vertical incision. Eighty-six patients were directly followed up during a mean of 32.0 months after surgery. Sixty patients responded to a mailed questionnaire about affect of sensory change on daily living. Forty-seven patients out of 86 (55%) indicated some sensory change of the lower leg, which was usually hypoesthesia with an average verbal score of 6.9. The questionnaire revealed that one patient out of 60 complained that the sensory change adversely affected daily living. A sensory-change area with a mean of 53.2 cm² was located distally from the incision in 40% of the cases; it was located proximally and distally in 56%. Blunt exposure for harvesting the tendons failed to decrease the occurrence of the sensory change. After ACL reconstruction using medial hamstring tendons with a vertical incision, sensory change was frequently found. Daily living was, however, only slightly affected by the sensory change.     

Echocardiographic and morphologic examination of left ventricular false tendons in human and animal hearts

False tendons are thin, fibrous or fibromuscular structures that traverse the cavity of the left ventricle with no connection to the valvular cusps; they may be single or multiple. We retrospectively analyzed echocardiograms for the prevalence of false tendons in the hearts of 368 (231 male, 137 female) newborns, infants, and children (mean age = 6.28 +/- 4.32 years) who were referred for echocardiography because of suspected acquired or congenital heart disease, but in whom no cardiac pathology was found. In addition, we studied the prevalence of false tendons in 90 hearts from three species of animals (dog, sheep, goat) and eight cadaveric human hearts. In our echocardiographic study, false tendons were detected in 97 of 368 hearts (26.4%). In our gross morphologic studies, false tendons were observed in most of the animal and human hearts: they were present in 5 of 8 (62.5%) human hearts, 14 of 20 (70%) dog hearts, 41 of 50 (82%) sheep hearts, and 16 of 20 (80%) goat hearts. The overall prevalence in animal hearts was 71 of 90 (78.8%). Histologic examination showed the false tendons to be composed of cardiac muscle, blood vessels, fibrous tissue, and Purkinje cells. The possible role of false tendons in innocent murmurs, cardiac rhythm disorders, or left ventricular dysfunction is discussed.     

超声心动图诊断左房及左室假腱索多发性粘液瘤1例

老年女性,因脑梗入院,四年前超声心动图检出左房粘液瘤,四年来反复发生全身动脉系统多处栓塞,超声心动图检查发现左室假腱索新发微小粘液瘤。     

Minimally Invasive Extra-articular Anterolateral Reinforcement: A New Technique

Degenerative changes that occur after anterior cruciate ligament (ACL) reconstruction most often are due to poor rotary control with the use of usually 1-bundle intra-articular techniques. For this reason, double-bundle procedures were developed; however, they must be evaluated. The other solution designed to improve rotational stability, which was initiated by MacIntosh in the 1980s, involves extra-articular lateral reinforcement during intra-articular ACL reconstruction. This surgical combination is invasive because of the need for long grafts from the extensor apparatus or the fascia lata, and because anterolateral anatomic stabilizing structures must be dissected. In response to these criticisms, our technique uses the semitendinosus for the usual intra-articular reconstruction procedure and the gracilis in an effort to enhance the original minimally invasive procedure by performing an extra-articular lateral reinforcement procedure. The gracilis is folded to create a free 10-cm-long graft. Interference screws inside bone tunnels are used for femoral and tibial fixation of the graft. The site of fixation adheres to the best isometric principles of Krackow and Draganish. Drilling of the tunnels, insertion of the graft, and its fixation with interference screws are performed through two 1.5-cm-long incisions. Between them, the graft application is completed through Blount dissection under the fascia lata through the distal incision with a pincer.     

两种方法冷冻保存异体髌腱重建膝关节交叉韧带比较

目的 观察程序冷冻液氮保存和-80℃深低温保存方法处理同种异体髌腱后重建膝关节交叉韧带的愈合过程并比较其差异.方法 将兔的1/2骨-髌腱-骨复合体经程序冷冻液氮保存和-80℃深低温保存2周后,观察冻存变化差异并行同种异体移植重建前交叉韧带,分别于术后3周和8周观察细胞毒反应、细胞活性、最大载荷和形态学变化等指标进行比较并与自体移植组对照. 结果 ①经程序冷冻液氮保存方法处理后,髌腱的最大载荷无明显下降,细胞活性得到了较好的保存,组织学观察冷冻损伤较-80℃深低温保存方法轻微.②程序冷冻液氮保存处理的移植物在术后未表现明显的排斥反应,且免疫反应随时间的推移而下降.③移植后3周,各组移植物的最大载荷差异无显著性,移植后8周,程序冷冻液氮保存组移植物的最大载荷优于-80℃深低温保存组,但和自体移植组相近.④和-80℃深低温保存组相比,程序冷冻液氮保存组的移植物在术后的愈合过程和组织学行为更接近于自体移植组.结论 ①经程序冷冻液氮保存和-80℃深低温保存方法冻存的兔异体髌腱重建膝关节交叉韧带后愈合过程和自体韧带移植重建过程相似.②程序冷冻液氮保存法优于传统的-80℃深低温保存法.     

创伤性腓骨肌腱脱位18例回顾性分析

目的 :分析创伤性腓骨肌腱脱位的损伤机制、诊断及治疗方法。方法 :分析研究了 1986年至 2 0 0 0年在我所进行手术治疗的 18例创伤性腓骨肌腱脱位病例的损伤机制及临床表现。 2例急性脱位病例采用直接缝合腓骨肌腱上支持带手术 ,16例复发性脱位病例采用Watson -Jones手术。结果 :16例复发性脱位病例中 ,10例得到随访 ,平均随访时间 6 .2年。 1例因外伤再次脱位 ,其余 9例未再出现脱位 ,踝关节无症状 ,均恢复正常运动或训练。结论 :创伤性腓骨肌腱脱位可因踝背伸、足内翻或外翻损伤及踝跖屈、足内翻损伤引起。踝背伸、足外翻抗阻试验有助于明确诊断。Watson -Jones手术治疗复发性脱位操作简单 ,损伤小 ,效果满意。     

Analysis of relative motion splint in the treatment of zone VI extensor tendon injuries

PURPOSE: Early protected motion after extensor tendon repair is desirable. The low-profile relative motion splint, described previously by Merritt et al, holds the affected digit in 15 degrees of extension relative to the uninjured digits to allow less-cumbersome early protected motion versus dynamic splinting. Although early clinical results have been favorable, formal biomechanic testing of this approach is lacking. We used an in vitro model to assess the effect of the low-profile relative motion splint on the biomechanics of zone VI extensor tendons by measuring tendon elongation with and without the splint. Tendon elongation also was measured after transection and repair of extensor tendons in zone VI with and without splint protection. METHODS: Ten fresh-frozen cadeveric upper extremities were prepared and mounted on a testing apparatus with the wrist in 25 degrees of extension. Alternating applications of extension and flexion loads to the tendons induced a full range of motion for 25 cycles. Differential variable reluctance transducers were applied to zone VI of the index, middle, and ring extensor tendons. Measurements of intact tendon microelongation (or strain) were obtained with and without the relative motion splint. The middle finger extensor tendon then was transected (in zone VI) and was repaired immediately. Measurements were repeated with and without splint protection. Elongation ratios were calculated and analyzed statistically. RESULTS: For the intact tendon of the middle finger splinting reduced the elongation by 1% in extension, by 2% in flexion, and by 3% in neutral position. After the transection and repair of this same tendon, the splint reduced the elongation by 5% in extension, by 7% in flexion, and by 6% in neutral position. Cycling without splint protection caused permanent stretching at the repair site. Reapplication of the splint decreased elongation at the repair site by 2% in extension, by 3% in flexion, and by 3% in neutral position. CONCLUSIONS: The relative motion splint reduces the effective strain on intact and repaired zone VI middle finger extensor tendons and supports its clinical use.     

关节镜下自体腘绳肌腱重建交叉韧带

目的:关节镜下以半腱肌、股薄肌腱重建膝交叉韧带,分析影响疗效的因素。方法:关节镜下可吸收挤压螺钉固定四股绳肌腱修复膝交叉韧带损伤8例8膝,术后即行功能锻炼。结果:8例患者得到随访,随访时间6~30个月,平均14.8个月。术前8例抽屉试验、Lachman征均为阳性,术后检查均为阴性。根据Lysholm评分标准,术前评分平均53.75分,术后平均90.71分,手术前后评分有显著性差异(t=2.21,P<0.05)。结论:半腱肌、股薄肌腱具有良好的抗拉强度和刚度,生物可吸收挤压螺钉固定强度满意,在关节镜下用四股绳肌腱重建膝前交叉韧带是一种疗效可靠的治疗方式。     

中西医结合治疗膝关节骨性关节炎78例

膝关节骨性关节炎是中老年人的常见病、多发病。主要表现为膝关节疼痛、肿胀、功能障碍，严重影响患者的工作和生活。自2000年以来，采用玻璃酸钠注射液膝关节腔内注射配合手法治疗膝关节骨性关节炎78例，取得较好疗效。