Radiographical definition of the proximal tibiofibular joint – A cross-sectional study of 2984 knees and literature review

BackgroundProximal tibiofibular joint (PTFJ) injuries are not uncommon but relatively understudied. This study evaluates the effectiveness of 2 radiographic methods in assessing the integrity of the PTFJ.Study designThis is a cross-sectional study of 2984 consecutive patients with knee X-rays done in a single institution over a 4-month period. A total of 5968 knee X-rays were assessed using 2 methods–[1] The direction in which the fibula points to in relation to the lateral femoral epicondyle on anteroposterior view and Blumensaat line on lateral view. [2] The degree of tibiofibular overlap as percentage of widest portion of the fibula head. Sensitivity and specificity of these methods in diagnosing a disrupted PTFJ are calculated. Variables including quality of X-rays, weight-bearing status of AP views and degree of knee flexion on lateral views are also recorded. Univariate analysis was carried out to investigate the association between variables using chi-square test for nominal data and student t-test for continuous data.ResultsThe fibular points towards the lateral femoral epicondyle on AP view in 94.4% of the patients and points towards the posterior half of the Blumensaat line on lateral view in 98.1% of the patients. Using this method, weight-bearing X-rays are significantly associated with the direction the fibula is pointing (p < 0.01) on the AP view and the degree of knee flexion is associated with the direction the fibula is pointing (p < 0.01) on the lateral view.The AP tibiofibular overlap ranges from >0% to <75% in 94.1% of the patients and the lateral tibiofibular overlap ranges from >0% to <75% in 84.5% of the patients.This method is associated with whether true orthogonal X-rays of the knees are taken (p = 0.048).ConclusionThe direction in which the fibula is pointing and the percentage of tibiofibular overlap are highly specific radiographic methods useful in defining the PTFJ. The first method requires a weight-bearing view on AP assessment and >20 degrees of flexion on lateral assessment. True orthogonal AP and lateral views are required for the second method to be used.     

Influence de la gestion posturale de la hanche sur l’indice de Reimers,dans les installations assises des enfants paralysés cérébraux avec un système de classification de la fonction motrice globale (III–V)

Introduction

Hip excentration is a very common orthopedic problem in children with cerebral palsy, especially in non-ambulatory quadriplegics. Prevention plays a vital key, with early clinical and radiological monitoring to try to maintain the walking quality, the possibility of sitting in no walking patients and avoiding pain. Some of the resources available today in order to try to prevent or not enlarge hip problems is postural management. The purpose of this analysis is to evaluate the influence of postural hip management on the Reimers index, in the seating systems of cerebral palsy children with a gross motor function classification system III–V.

高渗葡萄糖关节上腔注射治疗颞下颌关节囊松弛（半脱位）和复发性脱位的临床应用

目的：探讨高渗葡萄糖硬化治疗颞下颌关节囊松弛（半脱位）和复发性脱位的效果。方法：采用50%葡萄糖注射剂行关节上腔注射治疗6例颞下颌关节半脱位的患者和7例复发性颞下颌关节脱位的患者,观察疗效;并对其治疗前后Fricton颞下颌关节紊乱指数进行评分,评价患者颞下颌关节功能的变化。结果：13例患者临床疗效满意,随访2月至半年无复发,治疗后患者的颞下颌关节紊乱指数明显改善。结论：采用50%葡萄糖注射剂行关节上腔注射治疗颞下颌关节半脱位和复发性脱位具有良好的效果。     

超声乳化吸出治疗晶状体半脱位白内障

目的探讨超声乳化白内障吸出联合人工晶状体植入术在晶状体半脱位白内障手术中的应用。方法对15例（15眼）行超声乳化白内障吸出联合人工晶状体植入术。结果术后视力0．4～0．8者9眼,0．1～0．3者5眼,0．08以下者1眼。结论超声乳化白内障吸出联合人工状体植入术,是晶状体半脱位白内障的有效的手术方法。     

先天性晶状体半脱位手术治疗临床研究

目的 比较囊袋内张力环(CTR)植入术和人工晶状体(IOL)巩膜缝合固定术治疗先天性晶状体半脱位的有效性及安全性.方法 将2008年6月至2009年10月就诊的27例(45只眼)年龄3～50岁的先天性晶状体半脱位患者,随机分为两组,分别采用CTR植入并二期CTR固定术(24只眼)与IOL巩膜缝合固定术(21只眼)治疗,术后观察视力、最佳矫正视力(BCVA)、散光等指标,术后3个月行前节OCT及晶状体后照法测量IOL的倾斜及偏心值,记录手术并发症.结果 术后3个月,最佳矫正视力CTR组为0.75,IOL固定组为0.54;散光度数CTR固定后为1.47D,IOL固定组为2.35D;CTR固定后IOL倾斜为5.48°,IOL固定组IOL倾斜为7.37°;两组术后BCVA、散光、IOL倾斜度数的差异均有统计学意义(P<0.05):CTR固定后IOL偏心为1.09mm,IOL固定组IOL偏心为0.88mm,差异无统计学意义(P>0.05).IOL固定组4只眼IOL夹持.结论 超声乳化晶状体吸除联合囊袋内CTR和IOL植入、二期CTR巩膜缝合固定术是治疗先天性晶状体半脱位的更好选择.     

先天性晶状体半脱位手术治疗临床研究

Objective To compare the efficacy and safety of two surgical options in treating congenital subluxated lenses,one is capsular tension ring(CTR)and intraocular lens(IOL)implantation,and the other is IOL scleral fixation.Methods This study comprised 45 eyes of 27 congenital subuxated lenses patients,who were randomly divided into two groups.In Group 1(n=24 eyes),a CTR and IOL was implanted and in Group 2(n=21 eyes),a single-piece,scleral-fixated IOL.For group 1,CTR was sutured to sclera at a secondary surgery two months after CTR and IOL implantation.The postoperative visual acuities and best corrected visual acuities(BCVAs),astigmatism were analyzed.IOL tilt and decentration were measured with AC-OCT system and IOL post-photo system 3 months after surgery.Results Three months after surgery,Compared to group 2,group 1 had better BCVA(0.75 vs 0.54,P<0.05),lower astigrnatism(1.4D vs 2.3D,P<0.05).smaller IOL tilt(5.48°vs 7.37°,P<0.05).IOL decentration was 1.09mm in group 1 and 0.88mm in group 2 but without significant differences statistically (P>0.05).IOL pupillary capture occurred to 4 eyes of group 2.Conclusions Phacoemulsification with CTR and IOL implantation combined with secondary CTR scleral fixation iS a better surgical option for congenital subluxated lenses.     

虹膜拉钩辅助的超声乳化联合囊袋内人工晶状体缝襻固定术治疗晶状体半脱位

目的评价虹膜拉钩辅助的超声乳化联合囊袋内人工晶状体缝襻固定术治疗合并晶状体半脱位的白内障的安全性及手术效果。方法选取2010年1月至2011年1月间在我院接受手术治疗的合并晶状体半脱位的白内障患者13例(14只眼),术中不使用囊袋张力环,进行虹膜拉钩辅助的超声乳化联合囊袋内人工晶状体缝襻固定术治疗。随诊至术后6个月,观察术后视力及并发症的发生情况等。结果所有患者手术中均无晶状体后囊破裂、晶状体核块下沉或明显玻璃体脱出,人工晶状体均位于囊袋内,人工晶状体及囊袋位置良好、居中。所有患者术后视力均有明显提高,随访至6个月时,裸眼视力0.3～0.4者7例(7只眼)0,.5～0.6者5例(6只眼),0.8～1.0者1例(1只眼),无低于0.3者。人工晶状体位置良好,无特殊并发症发生。结论虹膜拉钩辅助的超声乳化联合囊袋内人工晶状体缝襻固定术对合并晶状体半脱位的白内障进行治疗安全、可靠、经济,效果良好。     

Tibial subluxation in anterior cruciate ligament–deficient knees: Implications for tibial tunnel placement

Purpose: This study was performed to determine whether subtle anterior subluxation occurs in anterior cruciate ligament (ACL)–deficient knees with the knee in full extension. Type of study: Radiographic evaluation of tibial position in ACL-intact and ACL-deficient knees. Methods: Twenty-four subjects with arthroscopically documented ACL-deficient knees were compared with 20 subjects with arthroscopically documented ACL-intact knees. A previously reported method was used to evaluate the tibial position relative to the femur. Results: Measurements on standing lateral radiographs revealed asymptomatic but significant anterior subluxation of the tibia compared with the ACL-intact subjects. Conclusions: The possibility of anterior tibial subluxation with the knee in full extension should be taken into account when deciding on tibial tunnel placement or when evaluating for postoperative graft impingement by the intercondylar notch.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 960–962     

玻璃体切除人工晶状体植入术治疗晶状体脱位

目的：评价玻璃体切除联合人工晶状体植入术治疗晶状体脱体的效果。方法：对各种原因所致的晶状体半脱位或全脱位28例（32眼）进行玻璃体切除,同时植入人工晶状体。统计术后视力并进行随访观察。结果：术后视力增进30眼（93.8％）,不变2眼（6.2％）,术后随访1至19月,严重并发症少。结论：玻璃切除联合人工晶状体植入治疗晶状体脱位术后视力恢复快,是完全有效的方法。     

超声乳化吸除术治疗晶状体脱位白内障的临床观察

目的 探讨超声乳化吸附术治疗晶状体不全脱位白内障的疗效。方法 对18例（19只眼）晶状体不全脱位白内障患者行超声乳化白内障吸附联合人工晶状体植入术,其中2只眼联合玻璃体切除、视网膜复位术。结果 18只眼术后视力有不同程度提高,1只眼因术前黄斑挫伤,视力无改善。结论 采用超声乳化吸附术治疗晶状体不全脱位白内障患者,有效避免了其他手术方法并发症的发生,取得了良好疗效。