Neurotomy of the rectus femoris nerve: Short-term effectiveness for spastic stiff knee gait: Clinical assessment and quantitative gait analysis

BackgroundStiff knee gait is a troublesome gait disturbance related to spastic paresis, frequently associated with overactivity of the rectus femoris muscle in the swing phase of gait.ObjectiveThe aim of this study was to assess the short-term effects of rectus femoris neurotomy for the treatment of spastic stiff-knee gait in patients with hemiparesis.Patients and methodsAn Intervention study (before-after trial) with an observational design was carried out in a university hospital. Seven ambulatory patients with hemiparesis of spinal or cerebral origin and spastic stiff-knee gait, which had previously been improved by botulinum toxin injections, were proposed a selective neurotomy of the rectus femoris muscle. A functional evaluation (Functional Ambulation Classification and maximal walking distance), clinical evaluation (spasticity – Ashworth scale and Duncan-Ely test, muscle strength – Medical Research Council scale), and quantitative gait analysis (spatiotemporal parameters, stiff knee gait-related kinematic and kinetic parameters, and dynamic electromyography of rectus femoris) were performed as outcome measures, before and 3 months after rectus femoris neurotomy.ResultsCompared with preoperative values, there was a significant increase in maximal walking distance, gait speed, and stride length at 3 months. All kinematic parameters improved, and the average early swing phase knee extension moment decreased. The duration of the rectus femoris burst decreased post-op.ConclusionThis study is the first to show that rectus femoris neurotomy helps to normalise muscle activity during gait, and results in improvements in kinetic, kinematic, and functional parameters in patients with spastic stiff knee gait.     

基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究

目的　探讨基于活体造影数据重建股深动脉穿动脉穿支皮瓣血供三维数字化模型的可行性,为临床股深动脉穿动脉穿支皮瓣的应用提供解剖学依据。 方法　选择8例需行皮瓣移植的患者作为研究对象,采用DSA结合CT血管成像技术获取一侧大腿二维断层图像数据,应用 Mimics 软件对股深动脉穿动脉及其穿支进行三维可视化重建,利用软件自带测量工具筛选合适穿支。 结果　利用 Mimics 软件成功重建了股深动脉穿动脉及其穿支的三维可视化模型,能清晰显示股深动脉穿动脉及其穿支的分布、走行及穿支穿出深筋膜位置。8例患者中6例发现3支穿动脉,2例发现4支穿动脉。这些穿动脉共发出66支皮肤穿支（以大于0.5 mm为标准）,穿支在穿深筋膜平面内径(0.9±0.26)mm, 穿支浅出深筋膜点主要分布于坐骨结节与股骨外上髁的连线附近。 结论　基于活体造影数据可以重建清晰股深动脉穿动脉及其穿支血管的3D立体影像,可为临床股深动脉穿动脉穿支皮瓣的术前设计与皮瓣切取提供解剖学依据。     

股深动脉穿支供血的横半月形股薄肌肌皮瓣的解剖研究及在乳房再造中的应用

目的为股深动脉穿支供血的横半月形股薄肌肌皮瓣在乳房再造中的应用提供解剖学依据,并探讨将其做成穿支皮瓣的可能性及大隐静脉属支在该皮瓣的分布规律。方法在4例8侧灌注红色乳胶的成人尸体下肢标本上对股薄肌上股深动脉穿支的出现率及其在股薄肌内的走行、血管外径、血管蒂长度以及伴随静脉和神经情况等进行解剖学观测。结果股深动脉股薄肌支在股薄肌肌皮瓣中的出现率为100%,其中75%来自于股深动脉,25%来自于旋股内侧动脉。穿支入肌点距股薄肌起点为(13.21±1.03)cm,入肌处动脉外径(1.35±0.30)mm,沿途发出2~3只皮支,血管蒂动脉起点外径(2.77±0.54)mm,蒂长为(74.14±9.42)mm。伴随静脉终点外径(2.83±0.63)mm,大隐静脉属支在皮瓣范围内出现率87.5%,除1例无大隐静脉属支分布外,其余7例标本均有1支属支,外径为(2.60±0.64)mm。闭孔神经外径(1.85±0.53)mm。结论①股深动脉穿支在股薄肌中上1/3处出现率高,分布具有规律性,可以作为乳房再造的可靠供区;②皮瓣范围内存在较为恒定的大隐静脉的属支,可以作为皮瓣的第二套静脉系统予以保留以获得更好的静脉回流;③存在将横半月形股薄肌肌皮瓣做成穿支皮瓣的可能,在适合的病例中可以考虑减少肌肉的携带量以减少供区损伤;④股深动脉穿支供血的横半月形股薄肌肌皮瓣经标本手术模拟,证明切实可行;⑤供区关闭后切口瘢痕隐蔽,患者更易于接受;⑥根据胸部乳腺切除后缺损大小设计皮瓣,皮瓣宽度以供区能直接拉拢关闭为准,不仅可用于整个乳房的再造,而且适合于保乳术后乳房局部缺损的修复,对于双侧缺损的患者可以提供双侧皮瓣作为供区。     

Variability and reliability of the vastus lateralis muscle anatomy

Purpose: The aims of this study are to investigate the variability of the morphological and neurovascular anatomy of the vastus lateralis (VL) muscle and to describe the relationships among its intramuscular partitions and with the other muscles of the quadriceps femoris. Clinical implications in its reliability as a flap donor are also discussed.

Methods: In 2012, the extra- and intramuscular neurovascular anatomy of the VL was investigated in 10 cadaveric lower limbs. In three specimens, the segmental arterial pedicles were injected with latex of different colors to point out their anastomotic connections. The morphological anatomy was investigated with regard to the mutual relationship of the three muscular partitions and the relation of the VL with the other muscles of the quadriceps femoris.

Results: The VL has a segmental morphological anatomy. However, the fibers of its three partitions interconnect individually and with the other bellies of the quadriceps femoris, particularly, in several variable portions with the vastus intermedius and mainly in the posterior part of the VL. The lateral circumflex femoral artery and its branches have variable origin, but demonstrate constant segmental distribution. Intramuscular dissection and colored latex injections show a rich anastomotic vascular network among the three partitions.

Conclusions: Moderate variability exists in both the myological and the neurovascular anatomy of the VL. Despite this variability, the anatomy of the VL always has a constant segmental pattern, which makes the VL a reliable flap donor. Detailed knowledge of the VL anatomy could have useful applications in a broad clinical field.     

空心钉内固定联合股方肌骨瓣移植对青壮年股骨颈 骨折患者血液流变学及骨代谢指标的影响

目的 探讨空心钉内固定联合股方肌骨瓣移植术对青壮年股骨颈骨折患者血液流变学及骨代谢指 标的影响。方法 选取2015 年10 月—2016 年12 月徐州市中心医院收治的96 例青壮年股骨颈骨折患者作为 研究对象,根据病历单双号随机分为观察组和对照组,每组48 例。对照组采用闭合复位空心钉内固定治疗; 观察组采用空心钉内固定联合股方肌骨瓣移植术治疗。比较两组手术相关指标、血液流变学、骨代谢指标、 临床疗效及并发症。结果 观察组手术时间高于对照组（P <0.05）,术中出血量高于对照组（P <0.05）,骨折愈合 时间低于对照组（P <0.05）;随访6 个月,观察组Harris 髋关节功能评分高于对照组（P <0.05）;术后3 个月,观 察组全血高切、全血低切、血浆黏度及红细胞比容均低于对照组（P <0.05）,血清碱性磷酸酶（ALP）、骨保护 素（OPG）及骨钙素（BGP）含量高于对照组（P <0.05）;随访6 个月,观察组有效率（95.37%）高于对照组（79.17%） （P <0.05）,股骨头坏死等并发症发生率（18.75%）低于对照组（37.50%）（P <0.05）。结论 空心钉内固定联合股 方肌骨瓣移植术有助于促进青壮年骨颈骨折患者术后康复,提高临床疗效,降低并发症发生率,可能与改善患 者血液流变学、调节骨代谢指标等因素有关。     

He-Ne激光联合超短波疗法、股四头肌训练治疗膝关节骨关节炎的临床观察

目的观察He-Ne激光联合超短波、股四头肌训练治疗膝关节骨关节炎（knee osteoarthritis,KOA）的疗效。方法膝关节OA患者80例,分为两组,每组40例患者。对照组,采用超短波联合股四头肌功能训练治疗;激光组,采用HeNe激光联合超短波、股四头肌功能训练治疗,对照组和治疗组均治疗50 d。两组患者治疗前、后分别采用视觉模拟评分（visual analogue scale,VAS）评价疼痛和Lysholm功能评分量表（Lysholm knee scoring scale,LKSS）进行疗效评定。结果两组患者治疗后VAS疼痛评分和Lysholm膝关节评分均较治疗前好转,有显著性差异（P〈0.01）,两组治疗后组间比较,激光组的VAS疼痛评分低于对照组,差异有显著性意义（P〈0.01）;激光组的Lysholm膝关节评分高于对照组,差异有显著性意义（P〈0.01）。结论 He-Ne激光联合超短波疗法、股四头肌训练治疗对改善患者的膝骨关节功能、缓解关节疼痛优于单纯超短波联合股四头肌训练治疗。     

聚丙烯补片预防游离腹直肌皮瓣术后切口疝的作用

目的 探讨聚丙烯补片（Prolene)预防游离腹直肌皮瓣术后切口疝发生的作用。方法 1999年11月9日-2000年10月22日对26例患者行游离腹直肌皮瓣移植术时,采用聚丙烯补片作腹直肌前鞘修补,分析聚丙烯补片植入后的组织反应及创口愈合情况,以及切口疝发生的情况。结果 25例患者腹部创口均Ⅰ期愈合,1例术后腹部创口出现局部积液,经保守治疗好转,未出现排异和感染等并发症,术后随访1-12个月,全部患者聚丙烯补片愈合良好,无排出或取出,腹部不适,切口疝及腹壁膨隆。结论 聚丙烯补片具有较好的生物相容性,其植入体内后不会发生排异和增加创口感染的机会,用于腹直肌前鞘的修补安全可靠,能有效预防游离腹直肌皮瓣术后切口疝的发生,值得进一步观察和应用。     

“养肝柔筋方”对大鼠耐运动性疲劳能力和血清、股四头肌AChE活性的影响

目的探讨"养肝柔筋方"抗运动性疲劳作用的现代机制.方法选用游泳训练导致大鼠运动性疲劳模型,用生化检测方法,研究运动大鼠血清和股四头肌中胆碱酯酶(AChE)活性的变化,及"养肝柔筋方"对其变化的影响.结果与安静对照组比较,运动性疲劳组大鼠血清和股四头肌中AChE活性均降低(P<0.01),而灌胃"养肝柔筋方"组大鼠血清和股四头肌中AChE活性均提高(P<0.01).结论"养肝柔筋方"可显著提高大鼠运动状态下血清和股四头肌中AChE活性,这可能是该方抗运动性疲劳的机制之一.