Knee osteoarthritis in women

Osteoarthritis is a disease that progresses over time and culminates in the destruction of articular cartilage and joints. Thus, with an increasing elderly population the treatment of knee osteoarthritis has become a major healthcare issue. It has been shown that women are more severely impacted by knee osteoarthritis. Differences in knee anatomy, kinematics, previous knee injury, and hormonal influences may play a role. Sex difference with respect to osteoarthritis presentation, treatment, and the allocation of resources also exists. In general, women present for treatment in more advanced stages of osteoarthritis and have more debilitating pain than their male counterparts. In addition, healthcare providers are more likely to recommend total joint arthroplasty for their male patients. Understanding how and why these gender differences occur is instrumental in formulating an inclusive strategy for combating osteoarthritis in the future.     

关节镜下经髌腱入路空心拉力螺钉复位固定治疗胫骨髁间嵴撕脱骨折*

目的探讨在关节镜下经髌腱入路,利用空心拉力螺钉复位固定胫骨髁间嵴撕脱骨折(TEFx)的安全性和有效性。方法选取2014年1月-2015年12月23例TEFx的患者,均在关节镜下经髌腱入路,用空心拉力螺钉复位固定。术前Meyers-McKeever分型:Ⅱ型8例,Ⅲ型10例,Ⅳ型5例;男17例,女6例;年龄16～53岁,平均27.8岁。术前前抽屉试验、Lachman试验均阳性。比较术前术后的视觉模拟评分(VAS)、Lysholm、Tegner和国际膝关节文献委员会(IKDC)评分评价患侧膝关节功能。结果 23例患者均得到随访,随访时间30～40个月,平均36个月。术后即刻X线片示TEFx均复位良好,术后3个月骨折均愈合。无1例感染、关节僵硬、伸直受限、复位丢失及神经血管损伤等并发症。最终随访患侧膝关节活动度均恢复正常,前抽屉试验、Lachman试验均阴性。VAS评分术前(4.8±1.2)分,最终随访为(1.2±0.8)分,术前术后比较,差异有统计学意义(t=18.72,P=0.003);Lysholm评分术前为(50.8±6.2)分,最终随访为(90.8±5.4)分,术前术后比较,差异有统计学意义(t=-42.64,P=0.000);Tegner评分术前为(4.0±1.0)分,最终随访为(5.1±1.2)分,术前术后比较,差异有统计学意义(t=-16.82,P=0.005);IKDC主观评分术前为(52.5±7.4)分,最终随访为(91.5±5.7)分,术前术后比较,差异有统计学意义(t=-40.58,P=0.000)。结论膝关节镜下经髌腱入路空心拉力螺钉内固定治疗TEFx具有微创、操作简捷、固定可靠和恢复快的优点。     

调制中频电疗法对膝骨性关节炎患者疼痛及生存质量的影响

目的:观察调制中频电疗法对膝关节骨性关节炎患者疼痛及生存质量的影响.方法:将60例膝关节骨性关节炎患者随机分为调制中频电治疗组和对照组,每组各30例.治疗组采用调制中频电治疗,两组临床用药及常规康复治疗相同.两组患者分别在入组时及第7次、第14次、第20次治疗结束时,采用简化McGill疼痛问卷和生存质量量表简表进行疼痛和生存质量的评估.结果:在缓解疼痛方面,治疗7次、14次及20次时,治疗组与对照组患者的McGill疼痛量表评分相比差异均有显著性(P＜0.05);在提高生存质量方面,治疗7次时治疗组与对照组患者的生存质量评分相比差异无显著性(P＞0.05):而治疗至14次及20次时,治疗组与对照组患者的生存质量评分相比差异均表现出显著性(P＜0.05).结论:调制中频电疗法能显著缓解膝关节骨性关节炎患者疼痛,并提高患者的生存质量.     

Aseptic knee effusion associated with calcified guinea worms

Reported is a case of aseptic knee effusion associated with the presence of a calcified guinea worm, Dracunculus medinensis, in close proximity to the joint. The patient, a native of Nigeria, presented with chronic right knee pain and swelling. He did well with symptomatic treatment including non-steroidal antiinflammatory drugs, rest, ice, and elevation of the leg. Dracunculiasis is prevalent in parts of Asia and Africa, but has been described only rarely in the United States.     

Osteochondritis dissecans of the patellofemoral groove in athletes: unusual cases of patellofemoral pain

Five athletes who developed osteochondritis dissecans in the patellofemoral groove in the course of sports events at high school and college league level are described. They were male athletes complaining of anterior knee pain. When examining young people engaged in violent sports, it is well to remember that they might have osteochondritis dissecans in the patellofemoral groove. Clinically, four of the five patients under discussion were characterized by tight movements of the patella in a direction parallel to its transversal axis. X-ray studies in lateral projections and CT scans provided useful tools for definitive diagnosis, but AP radiography was no help in diagnosis. Release of a tight lateral retinaculum with or without drilling on the degenerated cartilage was effective in the treatment of osteochondritis dissecans of the patellofemoral groove in three of the four patients.     

椎小关节病的CT诊断：附402例分析

笔者对１０１７例肩背和／或腰腿痛患者的临床、Ｘ线及ＣＴ资料进行了回顾性分析。ＣＴ显示椎小关节异常４０２例，Ｘ线显示１８３例。ＣＴ对本病的显示率比Ｘ线高１２倍。ＣＴ能有效地显示关节突增生肥大、骨赘形成、关节间隙变窄、骨性关节面改变、关节脱位及半脱位、侧隐窝或椎间孔狭窄、关节囊钙化及关节“真空”征等。后二者Ｘ线检查难以显示。ＣＴ易于显示椎小关节病及其并存症，对肩背腰腿痛患者的合理施治有重要意义。     

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft two-incision technique

Anterior cruciate ligament (ACL) reconstruction can be performed with a variety of techniques. Multiple graft sources for reconstruction are also available. The senior author (JRS) has used an arthroscopically assisted technique with 2 incisions that has achieved consistently good results. One incision is made over the patellar tendon, allowing harvest of the bone-patellar tendon-bone graft and tibial tunnel placement and graft fixation. A second lateral incision is used for femoral tunnel placement and fixation. This method has produced predictably good results and avoids some of the potential complications of endoscopic ACL reconstruction.     

Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty

BACKGROUND: After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. METHODS: Thirty-seven patients, scheduled for total knee arthroplasty, were randomly assigned to three treatment groups: in group 1 (EPI) patients received bolus doses of morphine via an epidural catheter; in group 2 (IA) an intraarticular bolus of 1 mg of morphine was applied at the end of the operation with subsequent use of a patient-controlled analgesia (PCA) pump; group 3 (Control), in which only PCA was provided, served as control for both analgesic procedures. Main outcome measures included visual analogue pain scales, total morphine consumption, and stress hormones. RESULTS: No statistically significant differences in visual analogue pain scales could be detected between the three groups. Application of intraarticular morphine did not reduce the amount of analgesics required for postoperative analgesia as compared to intravenous analgesia alone. Application of epidural morphine significantly suppressed beta-endorphine release, but did not significantly influence other stress hormones as compared to the control group. CONCLUSION: Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.     

Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments Short-term results

We describe our experiences with 22 patients who underwent acute surgical intervention for complete combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in our hospital. In all patients, an arthroscopically guided repair of the MCL was performed, while the torn ACL was treated non-surgically. Primary reconstruction of the MCL in patients with complete disruptions of the MCL complex as well as the ACL reduces combined anteromedial instability to an isolated problem of the ACL. As a result of this treatment, the condition of 15 of 22 knees was improved, after an average duration of follow-up of 2 and a half years. In conclusion, our treatment strategy of an immediate repair of the MCL and reconstruction of the ACL when conservative treatment has failed seems safe and effective. Received: 30 January 1997 Accepted: 25 September 1997     

膝关节前交叉韧带损伤及重建后肌肉力量变化的研究

对ACL陈旧性损伤、急性损伤、手术重建以及未损伤对象四个样本组 ,在等长条件下膝关节肌肉屈伸、旋内 ,旋外、内收和外展的力量情况进行了对比测试。共记录了 5 4个研究对象的 80组测试结果。结果表明各样本组肌肉力量比值在不同方向上存在显著性差异。该结果可能有助于解释ACL损伤及重建后神经肌肉系统的补偿机制 ,并提示通过选择性地训练某些肌肉可达到有效的康复效果。