全膝关节置换术治疗骨关节炎

目的 探讨人工全膝关节置换术治疗骨关节病的临床疗效。方法 对31例人工全膝关节置换术进行临床分析和总结,并应用HSS膝关节评分系统进行分析。结果 手术优良率为93．6％,患者术后在疼痛、功能及关节活动度等方面都有明显改善。结论 全膝关节置换术是治疗骨关节病的有效方法。     

UKA与TKA治疗膝关节内侧单间室骨性关节炎的临床对比

目的:探究膝关节单髁置换术(UKA)与全膝关节置换术(TKA)治疗膝关节内侧单间室骨性关节炎的临床治疗效果。方法:将2011年4月-2015年7月期间因膝关节单间室骨性关节炎入院接受治疗的89例患者纳入本研究,随机分为研究组和对照组,研究组44例,行UKA手术,对照组45例,采用TKA手术方式治疗。对两组患者进行术后随访,对比临床治疗效果。结果:两组术前均有明显膝关节疼痛,术后膝关节疼痛均明显改善,组间差别无显著统计学意义(X2=1.323,P=0.2500.05);术后膝关节屈曲角度、HSS评分相对于术前均显著改善,研究组术后膝关节屈曲角度(111.2±18.8)度高于对照组的(98.6±14.7)度,差异有统计学意义(P0.05);HSS评分(87.6±13.7)分高于对照组的(73.2±16.8)分,差异有统计学意义(P0.05);研究组膝关节屈曲至90度时间比对照组短,数据差异有统计学差异(t=-2.303,P=0.0240.05)。结论:膝关节内侧单间室骨性关节炎采用UKA与TKA均能取得一定临床效果,减轻患者痛苦,改善膝关节功能,但UKA临床疗效较好,手术创伤较小,术后恢复较快。     

不同手术方式治疗老年膝内侧间室骨关节炎的疗效对比分析

摘要 目的：比较单踝关节置换术（UKA）和全膝关节置换术（TKA）治疗老年膝内侧间室骨关节炎的疗效。方法：选取2020年1月~2022年6月本院收治的100例老年膝内侧间室骨关节炎患者为研究对象,随机（随机数字表法）分为UKA组（n=50）和TKA组（n=50）,采取相应手术方法治疗。比较两组手术相关指标、美国特种外科医院（HSS）膝关节功能评分、膝关节屈伸活动度（ROM）、疼痛视觉模拟评分法（VAS）、健康调查12条简表（SF-12）评分及假体情况。结果：与TKA组相比,UKA组切口长度更短,术中出血量及术后引流量更少,手术时间、下地行走时间及住院时间更短,组间比较差异均有统计学意义（P<0.05）。UKA组术后2周、3个月及6个月时HSS评分均明显高于TKA组（P<0.05）。UKA组术后2周、3个月ROM均明显高于TKA组（P<0.05）。UKA组术后3个月VAS评分明显低于TKA组（P<0.05）。两组SF-12评分中生理及心理维度评分在术后6个月后均明显提高（P<0.05）;但组间比较差异均无统计学意义（P>0.05）。两组均无假体翻修病例。结论：UKA相比于TKA具有创伤更小、患者术后恢复更快、膝关节功能恢复更好的优势。     

全膝关节置换术与单髁置换术治疗老年膝关节骨关节炎的疗效比较

目的:探讨全膝关节置换术与单髁置换术对老年膝骨关节炎患者的临床疗效及术后恢复情况。方法:收集我院就诊的94例膝骨关节炎患者,随机分为UKA组和TKA组,每组各47例。UKA组采用单髁置换术治疗,TKA组采用全膝关节置换术治疗。观察并比较两组患者治疗前后膝关节功能评分(KSS)、疼痛视觉模拟评分(VAS)以及手术时间、术中出血量及术后并发症的发生情况等。结果:与治疗前相比,治疗后两组患者KSS评分均升高,VAS评分均下降,差异具有统计学意义(P0.05);与TKA组相比,UKA组VAS评分水平较低,KSS评分水平较高,差异具有统计学意义(P0.05);与TKA组相比,UKA组手术时间短,术中出血量少,差异具有统计学意义(P0.05);两组患者治疗后的并发症发生率差异无统计学意义(P0.05)。结论:在掌握适应证的前提下,与全膝关节置换术相比,单髁置换术创伤小、出血量少,关节功能恢复较好。     

Quantification of plantar soft tissue changes due to aging in various metatarsophalangeal joint angles with realistic tissue deformation

The nonlinearity of plantar soft tissue is seldom examined because of the small extent of deformation induced during indentation for measurement purposes. Furthermore, in most indentation experiments, the metatarsophalangeal joint (MTPJ) angle is not well controlled, although it has been proven to have a significant stiffening effect on sub-metatarsal head (MTH) pads. Hence, the study aims to quantify changes in the mechanical properties of plantar soft tissue due to aging under an experimental condition which is similar to walking. This is done by subjecting the tissue to an appropriate level of deformation at various MTPJ angles. A custom-made in vivo tissue indenter was used to measure directly the force-indentation response of the plantar tissue of two healthy groups: “Young” (n=25, mean age 22) and “Elderly” (n=25, mean age 67) subjects. Tests were performed on the 2nd sub-MTH pad at angles of 0°, 20°, 40° MTPJ dorsiflexion, as well as at the hallux and heel pad at 0° MTPJ angle. At all three plantar sites tested, elderly subjects showed significantly higher tissue stiffness than the young (p<0.05). However, the stiffening effect of MTPJ angle was not notably influenced by aging. In this work, tissue stiffness is quantified in stiffness constant (K) based on the proposed indentation technique. It is hypothesized that the increase in stiffness with age observed is probably due to compositional change in the plantar soft tissue.     

A biomechanical analysis of finger joint forces and stresses developed during common daily activities

The problem of modelling stresses incurred at the finger joints is critical to the design of durable joint replacements in the hand. The goal of this study was to characterise the forces and stresses at the finger and thumb joints occurring during activities such as typing at a keyboard, playing piano, gripping a pen, carrying a weight and opening a jar. The metacarpal and proximal phalanx were modelled using a COMSOL-based finite element analysis. Analysis of these activities indicates that joint forces in excess of 100 N may be common at the metacarpophalangeal joint (MCP) due to carrying objects such as groceries or while opening jars. The model predicted that stresses in excess of 2 MPa, similar to stresses at the hip, occur at the MCP with the properties of cancellous bone playing a significant role in the magnitude and distribution of stress.     

Development of an image-based technique to examine joint congruency at the elbow

Identifying joint contact in articular joints is important for both the biomechanical investigation of joint mechanics and the study of osteoarthritis. The purpose of this study is to develop a proximity mapping technique to non-invasively determine joint congruency, as a surrogate of joint contact. To illustrate the capabilities of this algorithm, a cadaveric upper extremity was positioned at varying degrees of elbow flexion. This technique was validated using a gold standard experimental casting technique. The pattern of the cast showed an excellent agreement with the generated proximity map using the inter-bone distance algorithm. The results from this study agree with the results of previous studies examining joint contact at the elbow both in the location and in the tracking of the joint contact throughout elbow flexion. Ultimately, this technique will lead to an increased understanding of the effect of malalignment and instability of the joint on contact mechanics.     

Shear and pressure under the first ray in neuropathic diabetic patients: Implications for support of the longitudinal arch

ObjectiveTo assess dynamic arch support in diabetic patients at risk for Charcot neuroarthopathy whose arch index has not yet shown overt signs of foot collapse.MethodsTwo indirect measures of toe flexor activation (ratios: peak hallux pressure to peak metatarsal pressure – Ph/Pm; peak posterior hallux shear to peak posterior metatarsal shear – Sh/Sm) were obtained with a custom built system for measuring shear and pressure on the plantar surface of the foot during gait. In addition, the tendency of the longitudinal arch to flatten was measured by quantifying the difference in shear between the 1st metatarsal head and the heel (S_flatten) during the first half of the stance phase. Four stance phases from the same foot for 29 participants (16 control and 13 neuropathic diabetic) were assessed.ResultsThe peak load ratio under the hallux (Ph/Pm) was significantly higher in the control group (2.10±1.08 versus 1.13±0.74, p=0.033). Similarly, Sh/Sm was significantly higher in the control group (1.87±0.88 versus 0.88±0.45, p=0.004). The difference in anterior shear under the first metatarsal head and posterior shear under the lateral heel (S_flatten) was significantly higher in the diabetic group (p<0.01). Together these findings demonstrate reduced plantar flexor activity in the musculature responsible for maintaining the longitudinal arch.ConclusionsWith no significant difference in arch index between the two groups, but significant differences in Ph/Pm, Sh/Sm and S_flatten the collective results suggest there are changes in muscle activity that precede arch collapse.     

活动半月板单髁关节置换术治疗膝骨性关节炎早期疗效分析

目的：分析活动半月板单髁关节置换术治疗膝关节骨关节炎的早期临床效果。方法：2009年6月至2010年2月,采用OXFord活动半月板单髁关节治疗膝骨性关节炎患者23例25膝。结果：23例患者（25膝）随访3-8个月,无感染、假体位置不良及松动等并发症。HSS评分由术前56.9分提高至术后93.3分。结论：活动半月板单髁关节置换术治疗膝骨性关节炎短期疗效优良,成功的关键在于适应证的把握和手术技术的掌握,其远期疗效仍需观察。     

活动半月板单髁关节置换术治疗膝骨性关节炎早期疗效分析

目的:分析活动半月板单髁关节置换术治疗膝关节骨关节炎的早期临床效果。方法:2009年6月至2010年2月,采用OXFord活动半月板单髁关节治疗膝骨性关节炎患者23例25膝。结果:23例患者(25膝)随访3-8个月,无感染、假体位置不良及松动等并发症。HSS评分由术前56.9分提高至术后93.3分。结论:活动半月板单髁关节置换术治疗膝骨性关节炎短期疗效优良,成功的关键在于适应证的把握和手术技术的掌握,其远期疗效仍需观察。     

关节灌洗术联合透明质酸钠注射治疗颞下颌关节骨关节炎的疗效观察

目的:评价关节腔灌洗联合透明质酸钠注射治疗颞下颌关节骨关节炎(TMJOA)的疗效及安全性。方法:选取我院2014年5月-2015年5月收治颞下颌关节骨关节炎患者68例作为研究对象,根据入院时间先后顺序按照随机数字表法随机分为实验组和对照组各34例。所有患者在颞颌关节区域局麻下建立关节上腔的双通道灌洗系统,实验组用生理盐水反复冲洗关节腔后注射透明质酸钠,对照组只进行关节腔灌洗术,术后随访对比两组治疗前、治疗后4周、6个月时患者非辅助最大开口度、侧向运动幅度、咀嚼时疼痛感;同时采用酶联免疫吸附法(ELISA)测定两组治疗前、治疗后4周血清中白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平并进行比较。结果:实验组患者治疗后4周、治疗后6个月时颞下颌关节最大张口度和侧向活动距离明显增大,而咀嚼时疼痛感明显减轻,且优于同期对照组,差异具有统计学意义(P0.05);实验组患者治疗后4周时血清IL-6、TNF-α水平较术前及同时期对照组均明显降低,差异具有统计学意义(P0.05)。结论:关节灌洗术联合透明质酸钠注射是治疗颞下颌关节骨关节炎的简单、安全有效治疗方法,治疗效果明显优于单纯关节腔灌洗,值得临床推广应用。     

Development of software for human muscle force estimation

Muscle force estimation (MFE) has become more and more important in exploring principles of pathological movement, studying functions of artificial muscles, making surgery plan for artificial joint replacement, improving the biomechanical effects of treatments and so on. At present, existing software are complex for professionals, so we have developed a new software named as concise MFE (CMFE). CMFE which provides us a platform to analyse muscle force in various actions includes two MFE methods (static optimisation method and electromyographic-based method). Common features between these two methods have been found and used to improve CMFE. A case studying the major muscles of lower limb of a healthy subject walking at normal speed has been presented. The results are well explained from the effect of the motion produced by muscles during movement. The development of this software can improve the accuracy of the motion simulations and can provide a more extensive and deeper insight in to muscle study.     

Design of a cylindrical brachytherapy implant applicator for the irradiation of an intestinal segment in mice

YingExperimental determination of the RBE of new isotopes for brachytherapy implants (e.g. iodine-125 and palladium-103) remains a very difficult problem, especially in small animals, where the seeds cannot be implanted easily in the planned geometry in a reproducible way. This technical note describes an original device that makes it possible to irradiate a segment of the intestine in mice for the purpose of determining the RBE for crypt regeneration. The device is a length of tube (3.4 mm and 7 mm internal and external diameter, respectively) whose external surface has been longitudinally grooved and into which the seeds can be squeezed (each groove holds either one or two seeds). The tube is composed of two sections. This seed container can be surgically positioned around an intestinal ansa while the mice are anesthetized. The mean dose rates in the intestine (for eight seeds) were found to be 86.3 +/- 5.9 and 79.0 +/- 5.4 cGy/h for 29.2 MBq (1 U) iodine and 28.6 MBq (1 U) palladium seeds, respectively. So far, more than 100 mice have been irradiated successfully. Full dose-effect relationships can be obtained using the same seeds and applying them successively in different groups of animals (which ensured the accuracy of the relative doses).     

双极人工股骨头置换治疗老年不稳定股骨粗隆间骨折的临床研究

目的:通过观察我院老年不稳定股骨粗隆间骨折患者临床治疗资料,探讨分析采用双极人工股骨头置换治疗该疾病的临床效果.方法:将我院收治的100例该疾病患者按照手术方法平分为A组与B组两组,分别进行双极人工股骨头置换术与动力髋螺钉手术治疗,对比分析使用两种方法手术时间、出血量情况、术后并发症以及治疗效果等.结果:两组患者经各自手术治疗后,临床症状均有改善,A组患者在手术时间、出血量情况与B组患者相比,差异不显著(P＞0.05),而在术后并发症、髋关节功能对比方面,A组优于B组,差异具有显著性(P＜0.05).结论:采用双极人工股骨头置换手术治疗老年不稳定股骨粗隆间骨折患者,手术并发症少,安全可靠性高.有效改善患者髋关节功能,临床效果显著,值得临床上推广与进一步研究.     

Experimental and computational analysis of micromotions of an uncemented femoral knee implant using elastic and plastic bone material models

It is essential to calculate micromotions at the bone-implant interface of an uncemented femoral total knee replacement (TKR) using a reliable computational model. In the current study, experimental measurements of micromotions were compared with predicted micromotions by Finite Element Analysis (FEA) using two bone material models: linear elastic and post-yield material behavior, while an actual range of interference fit was simulated. The primary aim was to investigate whether a plasticity model is essential in order to calculate realistic micromotions. Additionally, experimental bone damage at the interface was compared with the FEA simulated range.TKR surgical cuts were applied to five cadaveric femora and micro- and clinical CT- scans of these un-implanted specimens were made to extract geometrical and material properties, respectively. Micromotions at the interface were measured using digital image correlation. Cadaver-specific FEA models were created based on the experimental set-up. The average experimental micromotion of all specimens was 53.1 ± 42.3 µm (mean ± standard deviation (SD)), which was significantly higher than the micromotions predicted by both models, using either the plastic or elastic material model (26.5 ± 23.9 µm and 10.1 ± 10.1 µm, respectively; p-value < 0.001 for both material models). The difference between the two material models was also significant (p-value < 0.001). The predicted damage had a magnitude and distribution which was comparable to the experimental bone damage. We conclude that, although the plastic model could not fully predict the micro motions, it is more suitable for pre-clinical assessment of a press-fit TKR implant than using an elastic bone model.     

人工股骨头置换与动力髋螺钉内固定用于老年股骨头转子间骨折治疗的疗效比较

目的：比较人工股骨头置换术与动力髋螺钉内固定治疗老年股骨头转子间骨折的临床疗效。方法：选择我院74例老年股骨头转子间骨折患者作为观察对象,随机分为A组（人工股骨头置换术）和B组（动力髋螺钉内固定术）,每组37例。比较两组患者的手术时间、术中出血量、术后卧床时间、术后Harris评分及术后并发症和死亡率。结果：手术时间和术后卧床时间A组明显短于B组（P〈0．05）,A组术中出血量较B组明显减少,差异显著（P〈0．05）。术后1、3个月Harris评分A组均高于B组（P〈0．05）;术后6个月Harris评分两组无明显差异（P〉0．05）。结论：与动力髋螺钉内固定术相比,人工股骨头置换术术后可更早负重、恢复好,而且并发症少,是较为理想的治疗老年股骨头转子间骨折的治疗方法。     

Validation of radiostereometric analysis in six degrees of freedom for use with reverse total shoulder arthroplasty

A phantom study was conducted to determine bias in motion and bias at zero motion of radiostereometric analysis (RSA) for evaluating implant relative displacement in reverse total shoulder arthroplasty (RTSA). A Sawbones shoulder phantom was fitted with a RTSA implant set and 13 tantalum markers. The model was fixed to a manual micrometer, providing controlled movements though fifteen known increments in translation and twelve increments in rotation (0.02–5.00 mm and 0.1–6.0°), along each translation and rotation axis. Movement between the glenoid and humerus was assessed using beads vs. beads (B/B), model vs. beads (M/B), and model vs. model (M/M) measurement methods in a model-based RSA environment. Bias in motion and bias at zero motion were defined as the difference between measured and accepted reference values, and the difference between double examinations with a theoretical displacement of zero, respectively. Bias in motion ranged from 0.054 ± 0.010 to 0.129 ± 0.014 mm and 0.076 ± 0.025 to 0.126 ± 0.025° (B/B), 0.023 ± 0.009 to 0.126 ± 0.016 mm and 0.111 ± 0.033 to 0.794 ± 0.251° (M/B), and 0.029 ± 0.010 to 0.135 ± 0.030 mm and 0.243 ± 0.088 to 0.384 ± 0.153° (M/M). Bias at zero motion ranged from 0.120 to 0.156 mm and 0.075 to 0.206° (B/B), 0.074 to 0.149 mm and 0.067 to 1.953° (M/B), and 0.069 to 0.259 mm and 0.284 to 1.273° (M/M). This is the first RSA for RTSA study, with results comparable to those validating the use of RSA for hip and knee arthroplasties (accepted as 0.05–0.50 mm and 0.15–1.15°), justifying the potential use of RSA as a tool for measuring implant displacement in the shoulder.     

万古霉素- 脂质体对兔股骨头置换感染模型预防作用的实验研究

目的:制备万古霉素脂质体抗生素缓释系统,研究该缓释系统在治疗兔人工股骨头置换术后感染中的作用,为临床的进一步应用提供理论基础和实验依据。方法 :建立兔人工股骨头置换术后感染模型,将配置好的万古霉素-脂质体药物释放系统、万骨霉素于术中即分别放入关节腔及髓腔内,同时设对照组。大体观察左侧髋关节及观察右髋关节的活动度。实验动物于人工股骨头置换术后即刻、第4、8周,分别行髋关节X线摄片检查。实验动物建立感染模型6周后,分别取关节腔内肉芽组织或假膜组织,观察细菌生长情况,计数细菌菌落。并用4%的甲醛溶液固定组织,石蜡包埋(骨组织先用EDTA脱钙处理),HE染色,光镜观察组织炎细胞浸润状况。实验动物建立感染模型术前和术后第1、3、6周后,测定血清C-反应蛋白和血沉的变化。结果:成功建立了兔人工股骨头置换术后感染模型,各组兔人工股骨头置换术后股骨头均在位,经万古霉素-脂质体药物释放系统治疗后,万古霉素-脂质体组翻修术后8周X线结果提示关节间隙清晰,无明显骨缺损即透亮线形成,而万古霉素-骨水泥组置换术前后对比片,无明显变化。对照组感染未控制者术后6周X线结果显示,关节间隙模糊,假体及股骨结合部出现轻度骨吸收。细菌培养结果显示,空白对照组中实验动物细菌感染率为100%,而加入万古霉素后,万古霉素-PMMA组的实验动物细菌感染率为33.3%,显著降低;万古霉素-脂质体组实验动物细菌感染率为16.7%,与万古霉素-PMMA组相比,感染率显著降低(P<0.05);联合应用万古霉素-PMMA和万古霉素-脂质体,与其它组相比较,感染率显著降低(P<0.05),提示这种模式具有良好的抑菌效果。病理组织切片,发现实验动物建立感染模型6周后,空白对照组中实验动物感染人工股骨头周围股骨组织明显充血及炎性细胞浸润,万古霉素-PMMA组、万古霉素-脂质体组和万古霉素-脂质体组+万古霉素-PMMA的实验动物,炎性细胞浸润明显减少,提示术后关节周围细菌感染得到了有效的抑制。与术前相比较,各组CRP均显著升高(P<0.01),而经过万古霉素-PMMA组、万古霉素-脂质体组和万古霉素-脂质体组+万古霉素-PMMA治疗的实验动物,CRP均显著低于空白对照组中实验动物(P<0.05)。结论:本实验中首先建立兔人工股骨头置换术后感染模型,并观察了万古霉素-脂质体药物释放系统对兔人工股骨头置换术后感染的效应,通过X线检查、细菌培养、病理组织切片观察以及血清C-反应蛋白和血沉变化的测定,结果表明,通过上述方法制备的万古霉素脂质体对于人工股骨头置换术后感染具有良好的预防和治疗作用,为临床的进一步应用提供了初步的实验基础和理论依据。