Prevention of anterior cruciate ligament injuries in soccer

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained normally and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the control group and 0.15 injuries per team per year in the proprioceptively trained group (P<0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.     

Comparison of augmented and non-augmented anterior cruciate ligament reconstruction combined with high tibial osteotomy

In a follow-up study 27 patients were evaluated after anterior cruciate ligament (ACL-)reconstruction combined with high tibial osteotomy because of chronic rupture of the ACL, cartilaginous lesions of the medial compartment and varus malalignment. They were divided into two groups. In 14 patients (non-LAD group) ACL reconstruction was performed using the central third of the autologous patellar tendon modified according to Eriksson-Trillat. Thirteen patients (LAD group) underwent repair with the same technique, but a Kennedy ligament augmentation device (LAD) in hot dog technique and fixed over the top was added. The postoperative treatment was the same in both groups. All patients were examined according to IKDC criteria. KT-1000 arthrometer testing at maximum manual traction was performed. Although the mean follow-up interval was more than double in the non-LAD group (non-LAD: 127 months vs LAD: 58 months), the subjective and clinical results, IKDC evaluation and KT-1000 arthrometer testing results were similar, showing no statistically significant difference. Further, no complications due to the use of LAD occurred. In this study no evident functional or clinical advantage from the augmentation performed could be shown.Investigation performed at the Department of Orthopaedic and Trauma Surgery, University Hospital Basle, Switzerland. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding sources were SUVA Assurance, Lucerne, and the science fund of the University Hospital Basle     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

乳腺癌术中保护胸前神经对胸大肌功能的意义

目的:提高乳腺癌改良根治术后患侧上肢的运动功能。方法:对1997～2001年间所施行的乳腺癌改良根治术进行回顾性分析,观察两种方法腋窝淋巴结清扫数量,术后患侧胸大肌外缘厚度变化及胸大肌功能,与对照组比较。结果:观察组术后胸肌功能全部良好,胸大肌外缘厚度变化无显著差异(P>0.05),对照组大部分胸肌功能欠佳,胸大肌外缘厚度变化有显著差异(P<0.05),腋窝淋巴结清扫数量两组无显著差异(P>0.05)。结论:保留胸前神经可有效地提高患者术后患侧上肢功能,对手术疗效无不良影响。     

一期前路病灶清除植骨内固定治疗脊柱结核

目的总结一期前路病灶清除植骨内固定治疗脊柱结核的临床效果。方法对13例平均年龄42·3岁,平均病程5·6个月的脊柱结核患者,采用一期病灶清除结合植骨内固定,手术前后配合正规化疗,根据X线片观察脊柱融合时间,手术前后后凸角度变化以及按照Frankel分级的神经功能变化。结果全部病例伤口均一期愈合,未出现严重并发症。平均随访时间17·3个月,植骨界面骨性融合时间平均5·6个月。后凸平均矫正度数为11·7°,7例术前伴有神经损害症状者Frankel分级平均提高1·1级。结论一期病灶清除植骨内固定治疗脊柱结核,骨结构重建可靠,治疗过程相对简化,住院周期缩短,效果肯定。     

联合眼前段重建的二期后房型人工晶体植入术

目的 探讨联合重建眼前段结构及二期后房型人工晶体植入的方法及效果。方法 对36例43眼伴有不同程度眼前段结构紊乱的无晶体眼患者，行眼前段重建和后房型人工晶体植入术。眼前段重建包括虹膜粘连松解、瞳孔成形、瞳孔区机化膜切开、前段玻璃体切除术等。结果 均顺利植入后房型人工晶体。随访6～12个月。术后视力≥0．3者36眼，占83．7％；瞳孔圆形者33眼，占76．7％；人工晶体正位者38眼，占88．4％；无严重并发症。结论 在具备良好的手术条件、熟练的显微操作技术下，联合眼前段重建的二期后房型人工晶体植入术可获得满意的效果。     

Statistical Analysis of Factors Affecting the Outcome of Patients with Ruptured Distal Anterior Cerebral Artery Aneurysms

Summary  The clinical factors affecting the outcome of patients with ruptured distal anterior cerebral artery (ACA) aneurysms were analyzed using multiple logistic regression analysis.  The medical records were reviewed of 52 patients (57 aneurysms) with ruptured distal ACA aneurysms operated on by the same neurosurgeon over 25 years. The standard policy was early surgery for patients in Hunt and Kosnik grades I to IV. Age, sex, Hunt and Kosnik grade, timing of operation, size of aneurysms, number of aneurysms, association of intracerebral haemorrhage (ICH), intraventricular haemorrhage, and azygos ACA, use of temporary clipping , occurrence of premature rupture, and presence of psychiatric change were investigated. Univariant analysis disclosed that clinical grade (P=0.0006), size of aneurysm (P=0.005), and size of ICH (P=0.012) affected the outcome of patients. Multiple logistic regression analysis found that Hunt and Kosnik grade (P=0.010) and timing of operation (P=0.033) affected the outcome. There was no significant relationship between long-term outcome and clinical factors, although a close relationship was found with Hunt and Kosnik grade (P=0.071).  Clinical grade and timing of the operation affected the outcome of patients with ruptured distal ACA aneurysms. Patients harboring ICH of over 3 cm diameter in poor grades should also be carefully treated.     

前路病灶清除一期植骨内固定治疗胸腰椎结核

目的探讨前路病灶清除,一期植骨钛钢板内固定治疗胸腰椎结核的疗效。方法2000-05/2005-06采用前路病灶清除,一期植骨钛钢板内固定治疗胸腰椎结核52例。男32例,女20例,年龄21~65岁,平均38岁。影像学显示单椎体破坏塌陷9例,双椎体破坏塌陷楔形变43例,脊柱后凸畸形35例,cobb’s角14~41°,平均24°。不全截瘫19例。血沉40~110mm/h。术前抗结核药物治疗2~4周。术后继续抗结核药物治疗10~12个月。结果切口均一期愈合,随访1·2~4年,平均2·2年。植骨块6~7月融合,无移位,折断和吸收。19例不全截瘫者术后2~4月恢复到E级。35例脊柱后凸角度平均矫正14°。血沉于术后3~5月恢复到正常。随访期内结核病灶无复发。结论前路病灶清除、一期髂骨植骨钛钢板内固定是治疗脊柱结核较安全有效的治疗方法。     

颈椎前路手术并发症的防治

目的:总结颈椎前路手术并发症,探讨其防治策略。方法:回顾性分析1974年6月～2005年10月行颈椎前路减压植骨固定术的1082例患者发生的并发症,并就与并发症发生有关的原因和处理方法进行探讨。结果:手术相关并发症共出现50例次,占同期治疗病例的4.62%。结论:颈椎前路手术可发生多种并发症,术前准备、术中操作和术后管理是预防并发症发生的关键之处。     

关节镜下半腱肌腱、股薄肌腱重建前交叉韧带

目的总结膝关节镜下半腱肌腱、股薄肌腱重建前交叉韧带的方法及疗效,分析其优、缺点。方法2004年1月～2005年10月应用半腱肌腱、股薄肌腱和微型纽扣钢板重建前交叉韧带22例,术前和术后进行Lachman试验评估膝关节的稳定性,用Lysholm评分方法评定膝关节功能。结果随访6～24个月,平均(16.0±10.3)个月,术前Lachman试验均为阳性,术后20例为阴性,2例为阳性,术前、术后比较差异有统计学意义(χ2=42.50,P<0.01);术前Lysholm评分40～85分,平均(56.36±10.20)分,术后70～100分,平均(92.76±11.20)分。术后膝关节功能有明显改善(t=3.14,P<0.01)。结论半腱肌腱、股薄肌腱和微型纽扣钢板重建前交叉韧带具有移植物强大、操作简单、并发症少、近期疗效满意等优点。