两种内固定方法治疗髌骨骨折术后关节面对合情况的比较

目的：比较改良张力带钢丝内固定和传统张力带钢丝内固定治疗髌骨横行骨折术后关节面对合的效果。方法：2007年3月至2011年9月,分别采用胥氏张力带钢丝内固定和改良张力带钢丝内固定且随访超过1年的髌骨横行骨折的患者64例,术中分别采用胥氏张力带钢丝内固定和改良张力带钢丝内固定治疗,随访时行膝关节X线摄片检查,观察关节面对合情况,比较两种治疗方法所致关节面台阶样错位是否大于2mm的差异。结果：64例患者均获得随访,随访时间8~18个月,平均13.2个月,骨折端均愈合,两组Lysholm评分比较无统计学意义（P=0.665）;胥氏张力带钢丝内固定组和改良张力带钢丝内固定组分贝出现1例（3.1%）和7例（21.9%）关节面台阶征,两组关节面台阶征的发生率比较差异有统计学意义（P=0.036）。结论：胥氏张力带钢丝固定法使髌骨骨折术后固定作用加强,关节面对合更好,能有效预防因台阶征引起的创伤性关节炎的发生。     

两种方法治疗尺骨鹰嘴骨折发生异位骨化的分析

目的:比较张力带钢丝和解剖钢板治疗尺骨鹰嘴型骨折术后异位性骨化的发生率。方法:运用两种方法治疗尺骨鹰嘴骨折48例,其中张力带钢丝治疗组28例,解剖钢板治疗组20例,均无肘关节脱位,为闭合骨折。结果:术后随访4周和8周复查肘关节x线,张力带组术后8周x线表现出异位骨化3例,解剖钢板组术后4周x线可见异位骨化2例,术后8周复查x线出现异位骨化5例,尺骨鹰嘴骨折解剖钢板治疗组发生异位骨化发生率大于张力带钢丝治疗组。结论:使用尺骨鹰嘴骨折解剖钢板治疗尺骨鹰嘴型骨折有比较满意的效果。     

三种不同内固定法治疗髌骨骨折82 例临床疗效的分析

目的:观察三种不同内固定法治疗髌骨骨折82例临床疗效及安全性。方法:将82例髌骨骨折患者随机分成三组,其中30人接受双克氏针钢丝环绕法治疗,髌骨周缘环形缝扎处理21例,31人应用镍钛聚髌器治疗。从手术时间、优良率、愈合时间、手术费用及并发症等指标进行评价。结果:三种内固定方法治疗髌骨骨折组的手术时间差异无统计学意义(P>0.05),镍钛聚髌器组的愈合时间、手术费用及术后并发症与双克氏针钢丝环绕法组及髌骨周缘环形缝扎处理组相比,差异具有统计学意义(P<0.05);镍钛聚髌器治疗髌骨粉碎性骨折的优良率与其它两组相比,差异具有统计学意义(P<0.05);三种方法治疗髌骨横断性骨折的优良率相互比较差异无统计学意义。结论:双克氏针钢丝环绕法、髌骨周缘环形缝扎法及镍钛聚髌器法都可以被采纳治疗髌骨横断性骨折;在治疗髌骨粉碎性骨折优先采用镍钛聚髌器法。     

针刀干预对膝骨关节炎兔髌韧带拉伸、蠕变及应力松弛等生物力学特性的影响

针刀干预对髌韧带生物力学特性可以产生一定的影响,故针刀对膝骨关节炎具有一定的治疗作用.本研究采用左后肢伸直位固定制动法造成膝骨关节炎模型兔(Leporidae),并应用针刀进行治疗,治疗结束后,通过对膝关节髌韧带进行应力松弛、蠕变及拉伸等力学测试,研究针刀干预对髌韧带生物力学的影响.结果显示,针刀干预可以明显改善髌韧带的生物力学特性,激发髌韧带的拉伸、蠕变、应力松弛特性的恢复,维护膝关节的平衡与稳定.     

空心钉张力带钢丝联合内固定治疗髌骨骨折的临床疗效

目的:探讨空心钉张力带钢丝联合应用内固定在髌骨骨折患者中的临床疗效及安全性。方法:收集于我院就诊的150例髌骨骨折患者,随机分为实验组和对照组,各75例。对照组患者行钢丝环扎内固定术,实验组患者给予空心钉张力带钢丝内固定术。观察并比较两组患者骨折愈合时间、手术时间、临床治疗优良率以及患者的并发症的发生情况。结果:与对照组相比,实验组患者的骨折愈合时间显著缩短,但手术时间较长,治疗优良率较高,并发症发生率较低,差异均具有统计学意义(P0.05)。结论:与钢丝环扎内固定术比较,空心钉张力带钢丝联合应用治疗髌骨骨折的临床疗效较好,安全性更高。     

空心钉加钢丝张力带固定治疗髌骨横行骨折的体会

目的探讨空心钉结合张力带钢丝治疗髌骨横行骨折的优势。方法 2009年1月~2012年12月我科对17例新鲜髌骨横行骨折患者采用空心加压螺钉结合钢丝张力带固定治疗,并于术后12个月进行Neer评定。结果 17例患者均获得12个月以上的随访。骨折均获得骨性愈合,术后12个月Neer评分,优15例,良2例,优良率为100%。结论空心钉及张力带钢丝内固定治疗髌骨横行骨折,内固定稳定,可早期进行膝关节功能康复训练;钉头暴露少,且髌骨周围软组织刺激症状轻,无并发症发生,近、远期效果好。     

关节镜下前交叉韧带重建术后早期康复训练研究

目的:探讨关节镜下前交叉韧带重建术后早期进行康复训练的康复疗效。方法:回顾性分析单侧膝关节前交叉韧带断裂患者60例治疗康复情况,通过对比手术前后膝关节稳定性、活动范围、Lysholm评分及IKDC评分来评估疗效。结果:术后60例患者均获随访,早期康复训练组患者术后6月膝关节稳定性与活动度均良好,本体感觉得到恢复,可进行正常生活、工作。结论:关节镜下前交叉韧带重建术后早期进行康复训练可以恢复膝关节满意稳定性及活动度,疗效可靠。     

应用缝合锚结合联合腱外侧半肌腱重建喙锁韧带治疗肩锁关节脱位

目的:观察治疗肩锁关节脱位的不同手术方式的治疗效果,以确定最佳的手术方法。方法:将60例肩锁关节脱位病人随机分为治疗组和对照组,分别采用缝合锚结合联合腱外侧半肌腱反转移位重建喙锁韧带辅助颈腕吊带制动的治疗方法及克氏针张力带内固定方法,术后3个月及6个月对患者进行JOA总体情况评定、JOA评分比较、肩锁关节疼痛VAS评定情况比较及安全性评价。结果:应用缝合锚结合联合腱外侧半肌腱反转移位重建喙锁韧带辅助颈腕吊带制动治疗肩锁关节脱位3个月及6个月后JOA总体评定情况结果及.JOA评分结果优于克氏针张力带治疗方法;应用缝合锚结合联合腱外侧半肌腱反转移位重建喙锁韧带辅助颈腕吊带制动治疗肩锁关节脱位3个月及6个月后肩锁关节疼痛程度均轻于同时期克氏针张力带治疗方法。结论:缝合锚结合联合腱外侧半肌腱反转移位重建喙锁韧带辅助颈腕吊带制动治疗肩锁关节脱位是一种安全有效的临床治疗方法。     

ADT、Lanchman试验与MRI对于诊断前交叉韧带断裂的可靠性研究

目的:回顾性分析因怀疑前交叉韧带断裂而住院行膝关节镜检查治疗术的患者当中,术前前抽屉试验(ADT)、Lanchman试验、核磁共振成像(MRI)检查提示韧带断裂的阳性率、敏感性以及特异性,讨论前交叉韧带断裂的最敏感非手术检查方法。方法:通过搜集近10年内我院骨科关节镜术中确诊的前交叉韧带损伤患者的临床病例资料,分析术前ADT、Lanchman试验及MRI检查数据,统计各种检查结果的阳性率、敏感性和特异性,比较各种检查方法的差异。结果:本次研究共搜集到210个关节镜手术病例,术前相关检查的确诊前交叉韧带断裂的阳性率依次为:ADT:61.4%;Lanchman试验:69.5%;MRI:87.1%。敏感性依次为:ADT:61.5%;Lanchman试验:69.5%;MRI:91.4%。特异性依次为:ADT:60.9%;Lanchman试验:69.6%;MRI:52.2%。结论:ADT、Lanchman试验、MRI对于诊断前交叉韧带断裂均存在偏差,临床诊疗过程中应将三种检查结果联合参考作为前交叉韧带断裂的诊断依据。     

两种不同内固定手术对髌骨骨折患者术后膝关节功能恢复的影响

目的:探讨两种不同的手术方式(钛制空心钉结合张力带内固定手术)对髌骨骨折患者的临床疗效和安全性比较。方法:选择2016年6月-2017年10月治疗的髌骨骨折患者72例作为对象,使用随机数字表,随机分为对照组(n=36)和观察组(n=36)。对照组给予常规的克氏针张力带内固定进行手术,观察组则使用空心钉张力带进行固定。治疗后对患者效果进行统计和评估,比较两组患者的术后骨折的愈合时间,功能恢复(最大屈曲角度),髌骨评分以及并发症等指标。结果:根据不同的治疗方式后,观察组(空心钉张力带固定组)在骨折的愈合时间,功能恢复,髌骨评分以及并发症等比较指标中较对照组均有显著优势,其结果具备统计学意义(P<0.05)。结论:将钛制空心钉结合张力带内固定手术用于髌骨骨折与传统的克氏针张力带固定方法相比较,具有操作简便,骨折愈合率高,功能恢复确实,并发症发生率低等诸多优点,值得在临床中进一步推广应用。     

Results of the surgical reconstruction of the anterior cruciate ligament

Results of the surgical reconstruction of the anterior cruciate ligament (ACL), using as a graft fourfold hamstring tendons (gracilis and semitendinosus) and middle third of the patellar ligament, were compared. In all patients that were participating in this study clinical examination and magnetic resonance showed ACL rupture, and apart from the choice of the graft, surgical technique was identical. We evaluated 112 patients with implemented patellar ligament graft and fourfold hamstring tendons graft six months after the procedure. Both groups were similar according to age, sex, activity level, knee instability level and rehabilitation program. The results showed that there was no significant difference between groups regarding Lysholm Knee score, IKDC 2000 score, activity level, musculature hypotrophy, and knee joint stability 6 months after the surgery. Anterior knee pain incidence is significantly higher in the group with patellar ligament graft (44% vs. 21%). Both groups had a significant musculature hypotrophy of the upper leg of the knee joint that was surgically treated, six months after the procedure. Both grafts showed good subjective and objective results.     

Toronto scientists using wire mould to treat malignant melanomas of the choroid

The quadriceps tendon and patellar ligament rupture rarely, even when under great stress or trauma, but can rupture spontaneously in patients with chronic diseases such as gout, rheumatoid arthritis and renal disease. Several factors probably combine to weaken the tendon, including an impoverished local vascular supply, repeated microtrauma and secondary hypoparathyroidism with osteodystrophy. In the three cases reported here, one of which was bilateral, the patients were being treated for chronic renal disease; surgical repair of the tendons led to sound healing and a return to normal function of the joints.     

A planar model of the knee joint to characterize the knee extensor mechanism

A simple planar static model of the knee joint was developed to calculate effective moment arms for the quadriceps muscle. A pathway for the instantaneous center of rotation was chosen that gives realistic orientations of the femur relative to the tibia. Using the model, nonlinear force and moment equilibrium equations were solved at one degree increments for knee flexion angles from 0 (full extension) to 90 degrees, yielding patellar orientation, patellofemoral contact force and patellar ligament force and direction with respect to both the tibial insertion point and the tibiofemoral contact point. The computer-derived results from this two-dimensional model agree with results from more complex models developed previously from experimentally obtained data. Due to our model's simplicity, however, the operation of the patellar mechanism as a lever as well as a spacer is clearly illustrated. Specifically, the thickness of the patella was found to increase the effective moment arm significantly only at flexions below 35 degrees even though the actual moment arm exhibited an increase throughout the flexion range. Lengthening either the patella or the patellar ligament altered the force transmitted from the quadriceps to the patellar ligament, significantly increasing the effective moment arm at flexions greater than 25 degrees. We conclude that the levering action of the patella is an essential mechanism of knee joint operation at moderate to high flexion angles.     

A mathematical model of the patellofemoral joint

A mathematical model of the patellofemoral joint taking into account movements and forces in the sagittal plane is described. The system parameters of the model are the locations of the attachments of the quadriceps muscle and the patellar ligament, the length of the patellar ligament, the dimensions of the patella and the geometry of the articulating surfaces. They were obtained from ten autopsy knees. The model enables calculation of the relative position of the patella, patellar ligament and quadriceps tendon, the location of the patellofemoral contact point and the magnitude of the patellofemoral compression force and the force in the patellar ligament as a function of the location of the tibial tuberosity at different flexion-extension angles of the knee. The model is validated by comparing model data with experimentally determined data.     

The orientation of the distal part of the quadriceps femoris muscle as a function of the knee flexion-extension angle

Lateral view radiographs of ten autopsy knees were used to determine the orientation of the patellar ligament, patella and quadriceps tendon relative to tibia and femur at different flexion-extension angles (0-120 degrees) of the knee. The results show a linear relationship between the angle of flexion and the movement of the patellar ligament relative to the tibia and of the movement of the patella relative to tibia and femur. There is a non-linear relationship between angle of flexion and the movement of the quadriceps tendon relative to the patellar ligament, patella and femur. The angular changes between patella and patellar ligament are negligible. The complicated movements of the distal part of the quadriceps femoris muscle may significantly influence biomechanical parameters such as the forces acting at the patella and tibial tuberosity.     

Some aspects of rat femorotibial joint microanatomy as demonstrated by high-resolution magnetic resonance imaging

High-resolution magnetic resonance images (MRI) of the right femorotibial joint of normal Han:Wistar rats were acquired using a 4.7 Tesla magnet and a single-turn solenoid radio frequency coil (built in-house). Some anatomical findings of the rat femorotibial joint, which have not been reported previously using MRI, are described. The separation of patellar ligament and crural fascia was feasible on MRI. This separation would not be seen on images of lower resolution and its presence on high-resolution images could be mistaken for artefact due to the magic angle effect. Band-like fibrous structures exist in the infra-patellar fat pad, which might be mistaken as ligaments within the femorotibial joint. On sagittal MRI a vessel was seen inserted on the central part of the caudal surface of the patellar ligament. Subcutaneous fascia/cutaneous muscles (panniculus carnosus) could also be demonstrated with MRI in the femorotibial joint area.