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31.
肌腱结嵌压固定法重建前交叉韧带生物力学实验研究 总被引:4,自引:4,他引:0
目的探讨绳肌腱结嵌压固定法重建前交叉韧带(ACL)影响初始固定效果的相关因素及对策。方法采用猪膝关节模拟重建ACL不同术式,即绳肌腱结股骨隧道嵌压固定和胫骨端肌腱编织缝合骨桥打结固定法,与骨-髌腱-骨两端界面螺钉固定法,比较其生物力学初始固定最大拔出载荷、抗拉刚度和位移等生物力学指标。结果最大抗拉载荷肌腱结组与正常ACL组接近,无显著性差异;肌腱结组大于骨-髌腱-骨界面螺钉固定组。抗拉载荷在100N和400N时的位移两组无显著性差异。胫骨端肌腱编织缝合骨桥上打结固定组最大抗拉载荷大于BPTB界面螺钉固定组和肌腱编织缝合后界面螺钉固定组。抗拉刚度正常ACL组>骨-髌腱-骨组>绳肌腱结组。最大位移正常ACL<髌腱骨组<肌腱结组。结论绳肌腱结嵌压固定法抗拉强度和刚度完全可以满足重建后ACL的生理需求;术中克服位移因素,是有效防止ACL重建术后松弛的关键。 相似文献
32.
33.
本文用30例成人尸体观察了动脉韧带和左喉返神经,动脉韧带长1.2.97±4.53mm,圆索状动脉韧带23例(77%),直径为3.92±1.12mm。动脉韧带的主动脉端附着于主动脉弓(80%)或降主动脉(20%),肺动脉端附着于左肺动脉,6例肺动脉端位于心包内。19例(63%)左喉返神经绕主动脉弓,11例(37%)绕动脉韧带的主动脉端。 相似文献
34.
兔膝关节持续被动活动对前交叉韧带重建术后切口局部组织血氧饱和度的影响 总被引:5,自引:0,他引:5
目的 探讨膝关节持续被动活动(continuous passive motion, CPM)对兔前交叉韧带重建术后切口局部组织血氧饱和度的影响. 方法 20 只八月龄雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建前交叉韧带手术,术后随机分为2组:自由活动组(n=10)和CPM组(n=10).自由活动组笼内自由活动;CPM组应用兔膝关节持续被动活动器运动.术后第2天,近红外光技术装置ODISseyTM 局部组织血氧监护仪测量每一来回(屈曲30°~110°)不同CPM速度(分别为2.35°/s、3.2°/s 、8°/s)时的切口局部组织血氧饱和度(tissue oxygen saturation ,StO2)变化,选择最好的CPM范围和速度.分别在术前和术后第2、4、6、8、10、14天观察膝关节CPM不同角度时切口局部组织StO2的变化. 结果 与自由活动组相比,3种速度的CPM在不同屈曲角度下均保持较高的StO2,且有显著性差异(P<0.05),不同CPM速度之间StO2有显著性差异(P<0.05).每一来回(屈曲30°~110°)运动速度为3.2°/s时保持最高的StO2.在术前和术后第2、4、6、8、10、14天等各时间点,膝关节屈曲30°、60°、90°、110°时StO2均无显著性差异(P>0.05),不同的时间点(术前和术后第2、4、6、8、10、14天)切口的StO2差别均有显著统计学意义(P<0.05).术后第2~4天最低,然后逐渐上升.术后第2周拆线后,切口愈合良好,没有感染、血肿和切口裂开. 结论 兔膝前交叉韧带重建术后第2天开始进行膝关节CPM(屈曲30°~110°),可增加切口局部组织血氧饱和度,以3.2°/s的CPM速度最佳. 相似文献
35.
目的 研究保留胫骨止点的自体腘绳肌肌腱移植重建交叉韧带的优缺点。方法 自2001年7月至2005年3月间我院收治交叉韧带断裂患者33例,前交叉韧带断裂17例,后交叉韧带断裂10例,前后交叉韧带断裂并外侧副韧带断裂3例,前后交叉韧带并内侧副韧带断裂3例。其中男性28例,女性5例。平均年龄28.2岁(18-45岁)。平均随访时间3.9年(范围0.5~5年)。使用特制取腱器将半腱肌腱和股薄肌腱从肌腹中抽出,回折锁边缝合成四股,穿过胫骨和股骨隧道。远端经过骨孔以界面钉固定或经过骨桥固定。结果 按照JOA膝关节韧带损伤疗效判定标准,手术前后评分分别为46.0分和79.8分,Lysholm膝关节评分标准手术前后分别为54.4分和80.3分(P〈0.001)。胫骨前移:术前平均10.9mm(范围9~13mm),术后平均3.6mm(范围0~7mm)(P〈0.001)。结论 保留胫骨止点的腘绳肌肌腱移植,可以适用于前后交叉韧带重建,其优点是取材方便,并发症少,胫骨隧道不再需要内固定。 相似文献
36.
Young-Mo Kim Sung-Jae Kim Jun-Young Yang Kyung-Cheon Kim 《Knee surgery, sports traumatology, arthroscopy》2007,15(7):847-850
We describe a firm, effective suture-tying method using a tensioner for reattaching tibial avulsion fractures of the anterior
cruciate ligament. Our simple method achieves strong, firm reattachment of the fracture. In addition, it prevents fixation
loosening during suture tying effectively. Since pullout repair using nonabsorbable sutures is commonly used to fix various
avulsion fractures, the tensioner helps attain strong, firm reattachment of avulsion fractures simply and effectively. 相似文献
37.
目的 观察等距和非等距前交叉韧带(anterior cruciate ligament,ACL)重建对膝关节功能的影响。方法 采用新鲜尸体观察等距ACL的解剖结构,在尸体和模型上重建等距和非等距ACL,分别观察重建后ACL长度和胫骨平台表面压强的变化。结果 等距ACL的重建在膝关节的全范围活动中长度的变化值最小,胫骨平台所受的压强也最小。结论 只有等距的ACI。的重建才能恢复膝关节的正常生理功能,而非等距重建的ACL会造成膝关节的不稳定(或活动受限),或者使膝关节表面的压强增加。 相似文献
38.
Objective: To evaluate the technique and outcome of arthroscopic sipy, le-bundie reconstruction of posterior crudate ligament (PCL) with quadrupled hamstring tendon. Methods: From April 2001 to October 2004, 49 knees with PCL tears in 49 patients were verified with arthroscope in this department. Of them, 13 were combined with anterior cruciate ligament tears, 14 with disruptions of the posterolateral comer, 6 with ruptures of the posteromedial corner and medial collateral ligament, 9 with lateral meniscus tears, 5 with medial meniscus tears and 2 with popliteal vascular tears. All the damaged PCLs were reconstructed with single-bundie of autogenous quadrupled hamstring tendons under arthroscope. Biodegradable interference screws or blunt titanium interference screws were used for direct anatomic fixation of the reconstructed ligament. Results: After operation, no severe complications occurred at early stage in the 49 patients. All of them were followed up for 10-52 months with an average of 22. 0 months + 10. 7 months. Lysholm score was remarkably improved from 30-60 ( mean: 47.96 + 8. 16) preoperatively to 70-95 ( mean: 89. 08 + 6. 10 ) at the last postoperative follow-up ( P 〈 0.01 ). Furthermore, there was a significant improvement in International Knee Documentation Committee (IKDC) score from abnormal ( Grade C) in 10 knees and severely abnormal (Grade D ) in 39 preoperatively to normal ( Grade A ) in 20, nearly normal ( Grade B) in 24 and abnormal in 5 at the last follow-up. Of the 49 patients, 40 returned to the same activity level as before and 9 were under the level. Conclusions: Single-bundle reconstruction of PCL with quadrupled hamstring tendons has the advantage of minimal trauma in surgery and satisfactory outcome. 相似文献
39.
G G Varela A López-Loredo J F García León 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):127-130
BACKGROUND AND OBJECTIVE: We present the case of a female patient 29 years of age with antecedents of laparoscopic laser ablation for endometriosis, laparoscopic appendectomy, and umbilical hernioplasty. METHODS: The patient was admitted to the hospital's emergency room for abdominal pain in the epigastrium, transfixing, irradiating to both upper quadrants and to the lumbar region, accompanied by nausea and gastrobiliary vomiting. Lipase determination was 170 mg/dL. Other laboratory findings were normal. Plain abdominal films on the patient's admission were normal, and computed tomography (CT) showed data compatible with acute pancreatitis. Without improvement during the patient's hospital stay, pain and vomiting increased in intensity and frequency. RESULTS: New abdominal x-rays revealed dilatation of small bowel loops. Management was begun for intestinal obstruction, with intravenous hydration and placement of a nasogastric tube without a good response. At 48 hours, a diagnostic laparoscopy was performed, revealing a 3-cm internal hernia in the left broad ligament in which a 20-cm segment of terminal ileum was encased. We performed liberation of the ileal segment and closed the hernial orifice by using the laparoscopic approach. CONCLUSION: The patient's evolution was excellent. 相似文献
40.
Shinichiro Iwata Yasunori Suda Takeo Nagura Hideo Matsumoto Toshiro Otani Yoshiaki Toyama 《Knee surgery, sports traumatology, arthroscopy》2007,15(4):343-349
The purpose of this study is to evaluate the relationship between the magnitude of knee laxity and posterior instability at
different knee flexion angles and clinical disability in isolated posterior cruciate ligament (PCL) deficient patients. Knee
laxity at 20° and 70° of knee flexion were evaluated using KT-2000 arthrometer, and the posterior instability at 20°, 45°
and 90° of flexion were evaluated using stress radiography. We assessed the differences in the knee laxity and the tibial
translation between isolated PCL deficient knees and normal knees, and between the patients with giving-way during activities
of daily living (ADL) and without giving-way. There were statistical differences in the knee laxity and the tibial translation
at all knee flexion angles between the PCL deficient knees and normal knees. The magnitude of the knee laxity at 20° of flexion
measured with KT-2000 arthrometer was significantly larger in the patients with giving-way than those in the patients without
giving-way although there was no significant difference in the tibial translation at 70° between the two groups. The tibial
translation in both medial and lateral compartments at 20° and 45° measured with stress radiography were significantly larger
in the patients with giving-way than those in the patients without giving-way although there was not significant difference
at 90° between the two groups. These results suggested that the magnitude of the knee laxity and the posterior tibial translation
at shallow knee flexion angles would be related to giving-way during ADL in isolated PCL deficient patients. 相似文献