关节镜下应用带跟骨异体跟腱一期联合治疗膝关节脱位合并不稳定

目的：探讨关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位合并不稳定的治疗效果。方法：2008年1月至2010年1月,我们于关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位合并不稳定患者11例,男9例,女2例;年龄17～45岁,平均22.3岁;右膝6例,左膝5例。患者在排除手术禁忌后,分别在关节镜下采用带跟骨异体跟腱一期联合重建后交叉韧带（PCL）、内侧副韧带（MCL）、前交叉韧带（ACL）和外侧副韧带（LCL）。结果：术后所有切口均于2周后I期愈合。10例获得随访,随访时间24～36个月,平均30个月。术后24个月,Lysholm评分由术前的42.2±3.5,升至84.5±6.2分,其中A级9例,B级1例,C级0例;国际膝关节文献委员会（IKDC）评分有术前的41.7±6.5分,升至82.3±10.3分。术前与术后Lysholm评分及IKDC评分有显著差别（P〈0.05）。术后膝关节活动范围,与术前相比具有显著性差异（P〈0.05）。结论：关节镜下应用带跟骨异体跟腱一期联合重建治疗膝关节脱位能够较好的恢复患者膝关节稳定和活动范围,具有令人满意的临床效果。     

关节镜下多种移植物联合重建膝关节前、后交叉韧带

目的:评估关节镜下膝关节前交叉韧带(ACL)与后交叉韧带(PCL)同时重建的技术和临床效果。方法:自2003年6月～2009年10月,27例病人(28膝)经MRI检查及关节镜检查证实ACL和PCL均断裂,其中9膝伴内侧副韧带损伤(MCL),8膝伴后外侧角损伤(PLC),5膝伴内侧半月板破裂,4膝伴外侧半月板损伤。27例患者于伤后3～10周在关节镜下行膝关节前、后交叉韧带联合重建。结果:本组术后早期均未发生严重并发症。术后随访12～88个月,平均(42.67±3.34)个月,Lysholm膝关节功能评分为78～93分,平均(86.67±5.21)分。国际膝关节文件编制委员会(IKDC)综合评定由术前显著异常(D级)28膝,改进为随访时正常(A级)9膝、接近正常(B级)16膝、异常(C级)3膝。结论:关节镜下膝关节前交叉韧带(ACL)与后交叉韧带(PCL)同时重建创伤小、手术操作精细,术后膝关节功能恢复满意。     

关节镜下多种移植物联合重建膝关节前、后交叉韧带

目的：评估关节镜下膝关节前交叉韧带（ACL）与后交叉韧带（PCL）同时重建的技术和临床效果。方法：自2003年6月～2009年10月,27例病人（28膝）经MRJ检查及关节镜检查证实ACL和PCL均断裂,其中9膝伴内侧副韧带损伤（MCL）,8膝伴后外侧角损伤（PLC）,5膝伴内侧半月板破裂,4膝伴外侧半月板损伤。27例患者于伤后3～10周在关节镜下行膝关节前、后交叉韧带联合重建。结果：本组术后早期均未发生严重并发症。术后随访12-88个月,平均（42．67±3．34）个月,Lysholm膝关节功能评分为78-93分,平均（86．67±5．21）分。国际膝关节文件编制委员会（mDC）综合评定由术前显著异常（D级）28膝,改进为随访时正常（A级）9膝、接近正常（B级）16膝、异常（C级）3膝。结论：关节镜下膝关节前交叉韧带（ACL）与后交叉韧带（PCL）同时重建创伤小、手术操作精细,术后膝关节功能恢复满意。     

应用无内固定装置技术双束双隧道重建前交叉韧带疗效分析

目的:探讨应用无内固定装置技术双束双隧道重建前交叉韧带(ACL)的治疗效果.方法:2006年1月至2008年1月,我科应用无内固定装置技术双束重建ACL损伤患者33例,男31例,女2例.患者排除手术禁忌后,分别在关节镜下采用双股半腱肌腱重建前内侧束,双股股薄肌腱重建后外侧束.韧带采用无内固定装置固定,股骨端行悬吊固定,胫骨端行拴桩固定.术后1～3周内指导患者在支具保护下进行康复训练,并逐渐提高训练强度.结果:术后切口均一期愈合,无并发症.病例随访时间24～48个月,平均36个月.术后12月时:Lysholm评分由术前的52.2±2.5,升至96.4±7.2分,IKDC评分55.3±3.7分,升至94.1±5.3分,其中A级19例,B级:11例.术前与术后Lysholm评分及IKDC评分有显著差别(P＞0.05).结论:采用无内固定装置双束ACL重建方法能够较好的平衡患者前内侧束和后外侧束张力,并有利于保留ACL韧带残余结构、节约经费,具有令人满意的临床效果.     

应用无内固定装置技术双束双隧道重建前交叉韧带疗效分析

目的：探讨应用无内固定装置技术双束双隧道重建前交叉韧带（ACL）的治疗效果。方法：2006年1月至2008年1月,我科应用无内固定装置技术双束重建ACL损伤患者33例,男31例,女2例。患者排除手术禁忌后,分别在关节镜下采用双股半腱肌腱重建前内侧束,双股股薄肌腱重建后外侧束。韧带采用无内固定装置固定,股骨端行悬吊固定,胫骨端行拴桩固定。术后1~3周内指导患者在支具保护下进行康复训练,并逐渐提高训练强度。结果：术后切口均一期愈合,无并发症。病例随访时间24~48个月,平均36个月。术后12月时：Lysholm评分由术前的52.2±2.5,升至96.4±7.2分,IKDC评分55.3±3.7分,升至94.1±5.3分,其中A级19例,B级：11例。术前与术后Lysholm评分及IKDC评分有显著差别（P〉0.05）。结论：采用无内固定装置双束ACL重建方法能够较好的平衡患者前内侧束和后外侧束张力,并有利于保留ACL韧带残余结构、节约经费,具有令人满意的临床效果。     

关节镜下前交叉韧带重建术后翻修的临床研究(附14例报告)

目的:探讨关节镜下前交叉韧带(ACL)重建术后翻修手术的开展方式和临床效果。方法:我院2009年1月~2012年9月共收治ACL重建后失稳需翻修的患者14例,均给予关节镜下检查以及翻修手术,术后对患者的治疗情况采用Lysholm评分、Tegner评分、KT-2000及IKDC进行综合评价。结果:患者的KT-2000检查中术前屈曲30°为5.2mm,屈曲90°为3.3mm,术后屈曲30°为3.0mm,屈曲90°为1.6mm;IKDC评分术前为(50±5)分,术后为(72±8)分;Lysholm评分术前为(51±15)分,术后为(77±19)分;Tegner评分术前为(2.6±0.6)分,术后为(4.8±1.2)分。手术前后对比均有显著差异,具有统计学意义(P0.05),表明术后患者的膝关节功能明显增强。结论:对ACL重建术失败患者给予术后的翻修可以有效改善患者膝关节功能。     

关节镜下前交叉韧带重建中保留残端对膝关节功能及本体感觉恢复的影响研究

目的:探讨关节镜下前交叉韧带(ACL)重建术中保留韧带残端对ACL损伤患者膝关节功能及本体感觉恢复的影响。方法:回顾性分析2010年1月~2016年3月解放军第174医院收治的ACL损伤患者266例,所有患者均行关节镜下ACL重建,其中保留韧带残端的163例为保留残端组,术中完全清理韧带残端的103例为非保留残端组,所有患者术后随访12个月以上,评价两组患者的膝关节功能及本体感觉恢复情况。结果:术前、术后9个月、术后12个月两组膝关节患侧Lysholm评分、国际膝关节文献委员会膝关节评估表(IKDC)评分、被动活动察觉阀值、被动角度再生试验结果比较差异无统计学意义(P0.05);两组术后各检测时间点的Lysholm评分、IKDC评分较术前均显著提高,被动活动察觉阀值、被动角度再生试验结果较术前明显降低(P0.05);保留残端组术后3个月、6个月的Lysholm评分、IKDC评分高于非保留残端组,被动活动察觉阀值、被动角度再生试验结果低于非保留残端组,差异有统计学意义(P0.05)。结论:关节镜下ACL重建中保留残端可加快膝关节功能及本体感觉恢复速度,获得满意的临床疗效,值得推广应用。     

双侧自体腘绳肌腱一期重建前后交叉韧带损伤的临床疗效

目的:探讨关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤的方法和临床疗效。方法:内窥镜微创双侧自体腘绳肌腱修复膝关节内韧带,术后用IKDC分级、影像学IKDC分级、Lysholm功能评分和KT2000TM测量进行关节机能打分。结果:11例患者获得3-5年随访,平均随访3.8年。术前Lysholm功能评分平均(46.8±5.7)分,终末随访时平均(81.3±10.5)分,差异有显著性(P<0.05)。术后关节稳定性测量,在20磅时、30磅和最大拉力时健膝和患膝分别是:6.1±0.3和6.8±0.8;6.3±0.5和7.7±1.3;7.5±0.6和9.6±2.4,统计学上差异无显著性(P>0.05)。主观IKDC分级:A级4例,B级6例,C级1例;影像学IKDC分级:A级8例,B级2例,C级1例。结论:关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤是重建膝关节稳定性的良好有效方法。     

双侧自体腘绳肌腱一期重建前后交叉韧带损伤的临床疗效

目的：探讨关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤的方法和临床疗效。方法：内窥镜微创双侧自体腘绳肌腱修复膝关节内韧带,术后用IKDC分级、影像学IKDC分级、Lysholm功能评分和KT2000TM测量进行关节机能打分。结果：11例患者获得3—5年随访,平均随访3．8年。术前Lysholm功能评分平均（46．8±5．7）分,终末随访时平均（81．3±10．5）分,差异有显著性（P〈0．05）。术后关节稳定性测量,在20磅时、30磅和最大拉力时健膝和患膝分别是：6．1±0．3和6．8±0．8;6．3±0．5和7．7±1。3;7．5±0．6和9．6±2．4,统计学上差异无显著性（P〉0．05）。主观IKDC分级：A级4例,B级6例,C级1例;影像学IKDC分级：A级8例,B级2例,C级1例。结论：关节镜辅助下使用双侧自体腘绳肌腱一期修复膝关节前后交叉韧带损伤是重建膝关节稳定性的良好有效方法。     

膝关节镜下自体中1/3骨-髌韧带-骨重建前交叉韧带手术配合

前交叉韧带 ( ACL)的撕裂是膝关节损伤中最常见的严重的韧带损伤 ,ACL损伤后严重影响膝关节功能 ,继发关节软骨、半月板等主要结构损伤 ,导致关节退变和骨关节病的早期发生。由于关节镜技术具有创伤小、操作精细、康复快的优点 ,用来修复 ACL明显提高了 ACL损伤的治愈率。关节镜内自体中 1 /3骨 -髌韧带 -骨 ( B- PT- B)重建 ACL是近几年标准的重建 ACL手术 [1] ,我院自2 0 0 2年 8月至 2 0 0 3年 3月共开展此类手术 5例 ,疗效确切 ,现将手术配合报道如下。1　临床资料　　本组共 5例患者 ,男 4例 ,女 1例 ,年龄最大46岁 ,最小 2 6…     

皮肤成纤维细胞复合纤维修复前交叉韧带的初步研究

目的:本实验采用皮肤成纤维细胞修复原位冻融的前交叉韧带,以探索皮肤成纤维细胞作为构建组织工程前交叉韧带种子细胞的可行性.方法:体外分离培养兔皮肤成纤维细胞(SF),传代培养之后将细胞复合纤维生物蛋白胶,将细胞.纤维蛋白胶复合物植入原位冻融的前交叉韧带处.12周取材切片行HE染色及天狼猩红染色,使用偏振光显微镜观察.并使用图象分析软件对Ⅰ、Ⅲ型胶原含量进行半定量分析.结果:采用皮肤成纤维细胞复合纤维生物蛋白胶修复原位冻融的前交叉韧带的Ⅲ型胶原含量较单纯冻融的前交叉韧带明显减少,而较正常前交叉韧带则无明显统计学差异(P＞0.05).结论:皮肤成纤维细胞可作为构建组织工程前交又韧带的较为理想的种子细胞选择.     

Ligament structure, physiology and function

Ligaments are specialized connective tissues with very interesting biomechanical properties. They have the ability to adapt to the complex functions that each are required to perform. While ligaments were once thought to be inert, they are in fact responsive to many local and systemic factors that influence their function within the organism. Injury to a ligament results in a drastic change in its structure and physiology and creates a situation where ligament function is restored by the formation of scar tissue that is biologically and biomechanically inferior to the tissue it replaces. This article will briefly review the basic structure, physiology and function of normal versus healing knee ligaments, referring specifically to what is known about two of the most extensively studied and clinically relevant knee ligaments, the anterior cruciate (ACL) and medial collateral (MCL) ligaments of the knee. Those readers wishing for more comprehensive sources of information on ligament biology and biomechanics are referred to many excellent reviews on these topics.     

Ligament system of the large intestine

Unconstant ligaments of the large intestine perform the function of its additional fixation. Their number increases as the mobility of the large intestine intensifies. During operative interventions the ligaments of the large intestine should be preserved. If their cutting is necessary, they should be subsequently restored.     

张力带钢丝法治疗髌韧带断裂

目的:探讨张力带钢丝法治疗髌韧带断裂的疗效。方法:回顾分析13例髌韧带断裂的手术治疗情况。结果:1例于术后2月出现钢丝断裂,但韧带连续性和强度恢复良好。其它所有病例功能恢复均达伤前水平,无韧带再断裂。结论:采用张力带钢丝法,以及对合并髌韧带挛缩或者缺损病例,结合半腱肌肌腱重建修复髌韧带断裂效果良好。     

Definition of the To Be Named Ligament and Vertebrodural Ligament and Their Possible Effects on the Circulation of CSF

Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1–C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal.     

Endocannabinoids and Inflammatory Response in Periodontal Ligament Cells

Endocannabinoids are associated with multiple regulatory functions in several tissues. The main endocannabinoids, anandamide (AEA) and 2-arachidonylglycerol (2-AG), have been detected in the gingival crevicular fluid of periodontitis patients, but the association between periodontal disease or human periodontal ligament cells (hPdLCs) and endocannabinoids still remain unclear. The aim of the present study was to examine the effects of AEA and 2-AG on the proliferation/viability and cytokine/chemokine production of hPdLCs in the presence/absence of Porphyromonas gingivalis lipopolysaccharide (P. gingivalis LPS). The proliferation/viability of hPdLCs was measured using 3,4,5-dimethylthiazol-2-yl-2,5-diphenyl tetrazolium bromide (MTT)-assay. Interleukin-6 (IL-6), interleukin-8 (IL-8), and monocyte chemotactic protein-1 (MCP-1) levels were examined at gene expression and protein level by real-time PCR and ELISA, respectively. AEA and 2-AG did not reveal any significant effects on proliferation/viability of hPdLCs in the absence of P. gingivalis LPS. However, hPdLCs viability was significantly increased by 10–20 µM AEA in the presence of P. gingivalis LPS (1 µg/ml). In the absence of P. gingivalis LPS, AEA and 2-AG did not exhibit any significant effect on the expression of IL-8 and MCP-1 expression in hPdLCs, whereas IL-6 expression was slightly enhanced by 10 µM 2-AG and not affected by AEA. In P.gingivalis LPS stimulated hPdLCs, 10 µM AEA down-regulated gene-expression and protein production of IL-6, IL-8, and MCP-1. In contrast, 10 µM 2-AG had an opposite effect and induced a significant up-regulation of gene and protein expression of IL-6 and IL-8 (P<0.05) as well as gene-expression of MCP-1 in P. gingivalis LPS stimulated hPdLCs. Our data suggest that AEA appears to have an anti-inflammatory and immune suppressive effect on hPdLCs’ host response to P.gingivalis LPS, whereas 2-AG appears to promote detrimental inflammatory processes. In conclusion, AEA and 2-AG might play an important role in the modulation of periodontal inflammation.