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51.
Femoral attachment of the anterior cruciate ligament 总被引:3,自引:1,他引:2
Francesco Giron Pierluigi Cuomo Paolo Aglietti Anthony M. J. Bull Andrew A. Amis 《Knee surgery, sports traumatology, arthroscopy》2006,14(3):250-256
Endoscopic anterior cruciate ligament (ACL) reconstruction is one of the most popular orthopaedic procedures. Correct tunnel positioning is a prerequisite to success. Current surgical techniques are unable to duplicate the complex anatomy and function of the native ACL. Surgery mainly aims at restoring anteroposterior laxity. The ACL is not isometric and only a few fibers are nearly isometric over the full range of motion. However, a nearly isometric behaviour of the ACL graft is desirable. Isometry is mainly influenced by femoral attachment; thus the femoral tunnel position has a greater effect than the tibial on graft length changes. The purpose of this article is to describe the anatomy of the femoral ACL insertion and to discuss the surgical techniques used to replicate it. 相似文献
52.
Boris A. Zelle MD Andrea S. Herzka MD Christopher D. Harner MD James J. Irrgang PhD PT ATC 《Operative Techniques in Orthopaedics》2005,15(1):76
Clinical outcomes data can be used to facilitate patient management decisions, assess clinician and organizational performance, and to provide evidence for the effectiveness of surgery and rehabilitation. The validity of the inferences made from outcomes data are dependent on the validity of the outcomes measures themselves and the circumstances under which the data were collected, analyzed, and interpreted. Clinical outcomes may include measures of impairment of body structure and function, activity limitation, and participation restriction. However, because the relationship between impairment and the resulting activity limitation and participation restriction is not direct, and because activity limitations and participation restrictions are of the utmost concern to the athlete, the primary clinical outcome should be measures of activity limitation and participation restriction. Activity limitation and participation restriction may be measured either through direct observation of performance or by general or specific measures of health related quality of life. Clinical outcomes data must be collected systematically to ensure valid inferences from the data. 相似文献
53.
The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon 总被引:1,自引:1,他引:0
Shuji Yamazaki Kazunori Yasuda Fumihisa Tomita Akio Minami Harukazu Tohyama 《Knee surgery, sports traumatology, arthroscopy》2006,14(11):1086-1093
The current study was performed to understand the relationship between graft length placed within the bone tunnel and intraosseous graft healing in anterior cruciate ligament (ACL) reconstruction. Twenty-four adult beagle dogs were divided into two groups of 12 animals each. In each animal, ACL reconstruction using a 4-mm diameter autogenous flexor tendon graft was done in the left knee. In groups I and II, the graft having a length of 15 and 5 mm, respectively, was placed within the tibial tunnel. The proximal end of the graft was placed through the over-the-top route in all animals. In each group, five animals were sacrificed immediately after surgery, and the remaining seven were sacrificed at 6 weeks postoperatively. Biomechanical and histologic evaluations were performed. In pull out testing, the ultimate failure load and the linear stiffness of the graft-tibia complex harvested at 6 weeks were significantly greater than those harvested at the time-zero period. There were no significant differences in those parameters between groups I and II at 6 weeks. In each group, the perpendicular collagen fibers connecting the tendon to the bone tunnel wall were observed only in the narrow area located close to the intra-articular tunnel outlet. In conclusion, excessively long placement of the flexor graft within the bone tunnel does not result in an additional increase of anchoring strength and stiffness of the graft in ACL reconstruction. 相似文献
54.
55.
Takanori Kikuchi Naoshi Fukui Tomohiro Sakuta Toshijiro Yamaguchi Hiroya Sakai Hiromi Oda 《Journal of orthopaedic science》1997,2(1):31-39
The midportion of the anterior cruciate ligament (ACL) of rabbits was partially transected, and the effect of hyaluronan (HA) on its healing was determined. A 1% solution of HA (HA group) or physiological phosphate-buffered saline (control group) was administered intraarticularly, at 0.1 ml/kg body weight, once a week from 1 week after the operation. Two, 4, and 6 weeks after the initiation of HA administration, the ACLs were examined grossly, histologically and immunohistochemically. At 2 weeks, the lacerated portions were completely covered with scar-like tissue in both groups. These tissue areas were smaller in the HA group than in the control group. Histologically in the HA group, the regularity of collagen fibers (indicating the maturity of regenerated collagen fibers) had increased compared to findings in the control group, and the number of fibroblastic cells decreased gradually at a significantly faster rate. The number of inflammatory cells and blood vessels decreased gradually in both groups, with these values being lower in the HA group at each time point but not significantly so. Immunohistochemical examination of the repaired tissue revealed strong staining with anti-chondroitin sulfate proteoglycan antibody in the HA group 2 weeks after the first HA administration. The staining gradually became reduced, with the rate of reduction being faster in the HA group than in the control group. The stimulation of chondroitin sulfate proteoglycan production and the faster reduction of it in the HA group suggests that HA facilitated tissue repair and inhibited the formation of scar tissue. 相似文献
56.
下腰痛患者后路手术并发症的防治 总被引:30,自引:0,他引:30
目的:分析下腰痛患者后路手术并发症出现的原因,探讨防治办法。方法:回顾分析我科自1988~1998年6月间采用后路手术治疗下腰痛,即腰椎间盘突出症和/或腰椎管狭窄症患者570例的临床资料。结果:33例发生术后并发症,发生率5.79%,早期(术后2周以内)并发症18例,晚期并发症15例,但无一例并发神经根损伤。结论:除了术中操作技能外,术前严格掌握手术适应证,术后及时观察、早期功能锻炼,都有利于并发症的防治。 相似文献
57.
Yasuhiro Yamaoka Takatomo Mine Hiroshi Tanaka Yoichiro Ishida Tosihiko Taguchi 《Knee surgery, sports traumatology, arthroscopy》2007,15(11):1346-1349
An avulsion fracture of the tibial tubercle is a common injury in traffic accident. If the fracture is closed, then a comparatively
good prognosis can be expected through reinforcement of the bone via osteosynthesis and the use of artificial ligaments. In
this case, an open wound was observed in the tibial tubercle, and the wound was so polluted that the healing process was significantly
delayed. It was therefore difficult to provide simultaneous surgical treatment and so three operations were required to perform
the reconstruction of the extensor mechanism. The reconstruction of extensor mechanism and the frame fixation between the
patella and tibia was performed. Six months after the injury, the patient was able to walk without aid, had a range of movement
from 5°to 130°, and did not show any indications of ADL disorder. Using this method of frame fixation between the patella
and tibia proved to be an effective technique for the reconstruction of the open knee extension mechanism injury. 相似文献
58.
关节镜下可吸收空心界面螺钉固定、四股腘绳肌腱重建前交叉韧带 总被引:9,自引:0,他引:9
目的探讨关节镜下可吸收空心界面螺钉固定、四股自体腘绳肌肌腱重建前交叉韧带(anterior cruciate ligament,ACL)的方法及疗效. 方法关节镜下以四股自体腘绳肌肌腱作为ACL替代物,应用(96L-4D)SR-PLA聚丙交酯生物可降解界面螺钉进行移植物固定, 对42例ACL损伤行ACL重建术. 结果 42例术后随访3~22个月,平均11.4月,膝关节活动度均在正常范围.术后Lachman 试验:37例≤1 ,4例2 ,1 例3 .轴移试验:42 例均为阴性.术后Lysholm 评分(89.7 ±9.6)分较术前(49.4±9.1)分显著提高(t=2.12,P=0.038).术后Tegner 活动评分(5.3±1.1)分较术前(2.3±0.7)分显著提高(t=4.13,P=0.008).术后1年MRI示29例可吸收空心界面螺钉部分被吸收;27例重建的韧带位置良好、形态正常;2例韧带在股骨的止点偏前;3例胫骨止点偏前,有轻度顶撞击现象. 结论四股腘绳肌腱是ACL重建的理想替代材料,可吸收空心界面螺钉是ACL重建的理想内固定材料. 相似文献
59.
Tadeusz F. Wisniewski 《European Journal of Trauma》2004,30(2):120-123
AbstractBackground: Posterior acromioclavicular dislocation is rare.
Dislocation associated with fracture of the clavicle and
simultaneous entrapment of the lateral end of the clavicle by
trapezius muscle has not been reported. Posterior dislocation
occurs frequently owing to forceful move of the scapula
anteriorly and superiorly or from direct force applied to the
lateral end of the clavicle and this may be associated with
clavicular fracture. In acute dislocations, open reduction,
internal joint stabilization and soft tissues reconstruction
have been recommended.Case Study: Acute posterior dislocation occurred in a 32-year-old man.
The lateral end of the clavicle was displaced posteriorly and
inferiorly, and firmly entrapped in trapezius muscle. The
clavicular fracture was undisplaced. The coracoclavicular
ligaments were stretched but intact. Open reduction was secured
with two smooth Kirschner wires. The disrupted soft tissues were
repaired. The clavicular fracture was not explored. Shoulder
movement started at 6 weeks. Wires were removed. 10 years later
he had pain-free, unrestricted shoulder movement, and the
radiographs showed wellreduced, essentially normal
acromioclavicular joint.Conclusion: Open reduction, internal joint stabilization and soft
tissue reconstruction will result in return and long lasting
unrestricted pain-free function of the shoulder. 相似文献
60.
Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis 总被引:2,自引:0,他引:2
Akira Hioki MD Kei Miyamoto MD PhD Hirotaka Kodama MD PhD Hideo Hosoe MD PhD Hirofumi Nishimoto MD Hirofumi Sakaeda MD PhD Katsuji Shimizu MD DMSc 《The spine journal》2005,5(6):600-607
BACKGROUND CONTEXT: Although posterior lumbar interbody fusion (PLIF) for degenerative lumbar diseases is routine, there are few reports on double-level PLIF. PURPOSE: To evaluate the clinical outcomes of double-level PLIF. STUDY DESIGN/SETTING: A retrospective study of operated cases in Gifu, Japan. PATIENT SAMPLE: Nineteen patients (8 men and 11 women, 59.5+/-10.2 years) who underwent double-level PLIF between 1996 and 2001. OUTCOME MEASURES: Operation time, blood loss, complications, the Japanese Orthopaedic Association (JOA) score for back pain and lumbar sagittal alignment were evaluated. METHODS: Patients were examined retrospectively at follow-ups of 3.6+/-1.7 years. Primary diseases were spondylolisthesis, spinal canal stenosis, degenerative scoliosis and herniated intervertebral disc. Fusion areas were L3 to L5 in 15 cases and L4 to S1 in 4 cases. RESULTS: The mean JOA score increased from an initial score of 12.9+/-3.5 to 21.3+/-4.9 at the final follow-up. There was a positive correlation (R=0.718, p<.001) between the increase in lordotic angle and the increase in the JOA score. Several parameters suggested that the surgical invasiveness was not minimal. CONCLUSION: Double-level PLIF provided satisfactory results and preserved lumbar spine lordosis. 相似文献