摘要:目的:探討地震傷員中膝關節損傷的機制、類型及處理方法。 方法:對我院收入住院的2728例 5·12汶川特大地震傷員傷情特點進行分析,篩選出有膝關節損傷的病例進行分析。 結果: 膝關節損傷前三位分別是髕骨骨折(42.15%)、脛骨平臺骨折(21.05%)、股骨髁骨折(13.16%),這與人們在地震時奔跑摔傷以及被房屋倒塌砸傷有很大關系。結論:地震后膝關節損傷其發病率、受傷機制、損傷類型、合并傷情況及治療處理均有其特點,總結這些特點和規律將對地震傷膝關節損傷患者的處理產生積極作用。Abstract: Objective: To investigate the knee joint injury mechanisms, types and treatment of the earthquake wounded. Methods: Analysis the characteristics of the 2728 cases of West China Hospital from 5.12 Wenchuan earthquake wound, screen out the cases of knee joint injury. Results: Patellar fracture (42.15%),tibial plateau fracture(21.05%), femoral condyle fracture (13.16%), were the top three of knee joint injuries, which have a great relationship with falling down and (or) injured by collapsed houses when people were running in the earthquake. Conclusion: After the earthquake the knee joint damages its disease incidence rate, is injured the mechanism, the damage type, the merge wound situation and treatment processing has its characteristic, will summarize these characteristics and the rule damages patient’s processing to the earthquake wound knee joint to have the positive role.
摘要:目的:探討關節鏡微創手術對膝關節色素沉著絨毛結節性滑膜炎的診斷和治療價值。方法:本組12例,男7例,女5例,年齡18～46歲,平均33歲;病史2～60個月,平均16個月;其中左膝8例,右膝4例;初次就診11例,外院開放手術后復發1例。所有病例術前均行MRI檢查,并行關節鏡檢,滑膜切除,記錄該病在關節鏡下的表現形式(局灶型或彌漫型),樣本全部送病理檢查。術后加壓包扎、局部冰敷并按計劃功能鍛煉,術后3～4周行患膝放射治療。結果:本組12例,其中局灶性病例8例,彌漫性4例,術后病理檢查確診;所有病例獲得了3~21個月,平均13個月隨訪,未見復發;術前Lysholm評分(62.3±2.4)分;國際膝關節評分委員會(IKDC)膝關節功能主觀評分(56.4±31)分;術后3月復查Lysholm評分(82.5±3.2)分;IKDC主觀評分(85.3±2.5)分。除1例開放手術后復發病例術后3月膝關節屈曲受限(80°)外,其余患者功能良好。結論:關節鏡手術創傷小,顯露充分,病灶切除徹底,術后功能恢復理想,輔以放射治療可有效降低復發率,對膝關節色素沉著絨毛結節性滑膜炎具有較高的診治價值。Abstract: Objective: To evaluate the role of arthroscopy in the diagnosis and treatment in knee joint pigmented villonodular synovitis. Methods: 12 cases of knee joint pigmented villonodular synovitis with the age of 18 to 46 years old were treated with arthroscopical synovectomy with a combined application of postoperative exercise and radiotherapy. The history of disease was 2 to 60 months, with the mean of 16 months. The clinical data were reviewed when followedup and evaluated by Lysholm score and and IKDC score. Results: 12 patients diagnosed by pathologic examination,including 8 localized and 4 diffused, were followed up for 3 to 21 months(13 months on average)with no relapses at the time of followup. Lysholm score was (62.3±2.4)points preoperatively, but (82.5±3.2) points 3 months later.The International Knee Documentation Committee (IKDC) score was (56.4±3.1) and (85.3±2.5) respectively before surgery and 3 months later. All patient remained good functions of knee joints except one who relapsed after open operation. Conclusion:In case of pigmented villonodular synovitis of the knee joint, arthroscopical synovectomy combined with postoperative radiotherapy and physical exercise is an effective treatment with less invasion and better function than open operation.
ObjectiveTo compare the short-term effectiveness of suture hook suture via double posteromedial approaches and Fast-Fix total internal suture in treatment of Ramp lesions. Methods A clinical data of 56 patients with anterior cruciate ligament rupture combined with Ramp lesions, who met the selection criteria and admitted between December 2021 and February 2023, was retrospectively analyzed. The Ramp lesions were sutured using suture hook via double posteromedial approaches under arthroscopy in 28 cases (group A) and treated with Fast-Fix total internal suture under arthroscopy in 28 cases (group B). There was no significant difference in age, gender, cause of injury, type of injury, time from injury to operation, side of injury, body mass index, and preoperative Lysholm score, visual analogue scale (VAS) score, and Tegner score between the two groups (P>0.05). The patients were followed up regularly after operation, and the clinical and imaging healing of the Ramp lesion was evaluated according to the Barrett clinical healing standard and the MRI evaluation standard. Lysholm score, VAS score, and Tegner score were used to evaluate the function and pain degree of knee joint, and the results were compared with those before operation. ResultsThe incisions of the two groups healed by first intention. All patients were followed up 12-18 months (mean, 14.9 months). Postoperative McMurray tests were negative in both groups. The clinical healing rates of group A and group B were 71.4% (20/28) and 64.3% (18/28) at 6 months after operation, and 92.9% (26/28) and 82.1% (23/28) at 12 months after operation, respectively. The differences between the two groups was not significant (χ2=0.327, P=0.567; χ2=0.469, P=0.225). There was no significant difference in Lysholm score, VAS score, and Tegner score between the two groups at each time point after operation (P>0.05). The postoperative scores in the two groups significantly improved when compared with those before operation, and the scores at 12 months after operation further improved when compared with those at 6 months after operation, showing significant differences between the different time points in the two groups (P<0.05). At last follow-up, MRI examination of the knee joint showed that there were 26 (92.9%), 2 (7.1%), and 0 (0) cases of complete healing, partial healing, and nonunion in the Ramp lesion of group A, and 25 (89.3%), 1 (3.6%), and 2 (7.1%) cases in group B, respectively. There was no significant difference between the two groups (Z=?0.530, P=0.596). ConclusionSuture hook suture via double posteromedial approaches and Fast-Fix total internal suture under arthroscopy are safe and reliable in the treatment of Ramp lesion, and the knee joint function significantly improves after operation.
Objective To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint. Methods A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023. Among them, 11 were male and 2 were female, the age ranged from 23 to 61 years, with an average of 35.7 years. The causes of injury included 10 cases of traffic accident, 2 cases of machine entanglement injury, and 1 case of heavy object crush injury. According to the Gustilo-Anderson classification, 11 cases were type Ⅲ B and 2 cases were type Ⅲ C. Post-injury, 2 cases had wound infection and 2 cases had popliteal artery injury. The time from injury to flap repair was 40-49 days, with an average of 27.5 days. The wound size was 18 cm×13 cm to 32 cm×20 cm, all accompanied by distal femoral bone defects and quadriceps muscle defects. After primary debridement, vacuum sealing drainage combined with external fixation was used for treatment. In the second stage, free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects, with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm. The donor sites of 9 flaps were directly sutured, and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator. At 6-15 months postoperatively, with an average of 10.5 months, 11 patients underwent knee arthrodesis surgery; 2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect. At last follow-up, the recovery of the flap and the donor site was recorded, and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons (ASES) score, and the function of the affected knee joint was evaluated by the Knee Society Score (KSS). ResultsAll the flaps survived after operation, the wounds and donor site incisions healed by first intention. All 13 patients were followed up 15-55 months, with an average of 21.6 months. Four patients who underwent the restoration of the donor site with the thoracodorsal keystone perforator flap had obvious scar hyperplasia around the wound, but no contracture or symmetrical breasts on both sides. At last follow-up, the appearance and texture of the flaps were good; the bony fusion of the knee joint was good, and the range of motion and function recovered well; the shoulder joint function on the flap-harvested side was not significantly affected, and the range of motion was satisfactory. The ASES shoulder joint score of the latissimus dorsi muscle-harvested side was 85-95, with an average of 89.5. The knee joint function KSS score was 75-90, with an average of 81.2. ConclusionFree latissimus dorsi myocutaneous flap transplantation combined with external fixation for the treatment of bone and soft tissue defects around the knee joint caused by high-energy trauma can repair bone and soft tissue defects and reconstruct the stability of the knee joint, effectively preserve the integrity of the limb and soft tissues, and improve the patient’s ability of self-care.
ObjectiveTo study the difference of femoral condylar twist angle (CTA) measurement in three dimensional (3-D) reconstruction digital models of human knee joint based on the two dimensional (2-D) images of MRI and CT so as to provide a reference for selecting the best method of CTA measurement in preoperative design for the femoral prosthesis rotational position. MethodsThe CTA of 10 human cadaveric knee joint was measured in 3-D digital models based on MRI (group A), in 3-D digital models based on CT (group B), in the cadaveric knee joint with cartilage (group C), and in the cadaveric knee joint without cartilage (group D), respectively. The statistical analysis of the differences was made among the measurements of the CTA. ResultsThe CTA values measured in 3-D digital models were (6.43±0.53)° in group A and (3.31±1.07)° in group B, showing significant difference (t=10.235, P=0.000). The CTA values measured in the cadaveric knee joint were (5.21±1.28)° in group C and (3.33±1.12)° in group D, showing significant difference (t=5.770, P=0.000). There was significant difference in the CTA values between group B and group C (t=5.779, P=0.000), but no significant difference was found between group A and group C (t=3.219, P=0.110). ConclusionThe CTA values measured in the 3-D digital models based on MRI are closer to the actual values measured in the knee joint with cartilage, and benefit for preoperative plan.
Objective To investigate the surgical planning and the mid-term effectiveness of four major lower extremity arthroplasties (4JA) in patients with rheumatoid arthritis (RA). Methods A clinical data of 25 patients with RA, who received 4JA and were followed up more than 3 years between June 2012 and September 2018, was retrospectively analyzed. There were 3 males and 22 females, with an average age of 48.6 years (range, 27-80 years). The body mass index ranged from 16.0 to 28.4 kg/m2, with an average of 20.48 kg/m2. The duration of RA ranged from 2 to 35 years (median, 21 years). There were 8 cases (12 sides) of knee valgus, 6 cases (12 side) of acetabular retraction, and 5 cases (10 sides) of hip stiffness. Among them, 20 patients underwent hip surgery first, and 5 patients underwent knee surgery first. Hip joint function was evaluated by Harris score, Hip Disability and Osteoarthritis Outcome Score (HOOS), hip range of motion, and Trendelenburg sign; knee joint function was evaluated by American Hospital for Special Surgery (HSS) score, knee range of motion and muscle strength, and a timed up and go (TUG) test was performed at last follow-up. X-ray films were used to observe whether the prosthesis was loose or displaced. Results All 25 patients completed 4JA. Only 1 patient (1 side) had incision infection after operation, 3 patients (3 sides) had proximal femur fractures during operation. All patients were followed up 3.0-8.8 years, with an average of 5.8 years. At last follow-up, the Harris score, HOOS score, and range of motion of flexion, extension, and abduction of the hip joint significantly improved when compared with those before operation, and the patients with positive Trendelenburg sign decreased. The HSS score and range of motion of flexion and extension of the knee joint also significantly improved when compared with those before operation. There were significant differences in all indexes between pre- and post-operation (P<0.05). The muscle strength was grade V. The TUG test ranged from 7.8 to 15.34 seconds (mean,10.79 seconds). X-ray films showed the prosthesis was not loose or displaced. Conclusion When RA patients receive 4JA, adequate preoperative evaluation, rational selection of the timing and sequence of surgery, and maximal restoration of lower limb alignment can achieve good mid-term effectiveness.
Objective To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prosthesis implanted in the total knee arthroplasty (TKA). Methods Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prosthesis from September 2003 to March 2004. Preoperative KSS knee scores were 16.08±11.58, function scores 13.75±19.79, and the range of motion (ROM) of the knee 75.00±26.46°. Meanwhile, 50 knees of 30 patients (the Scorpio group) werefollowed up, who had undergone TKA with the Scorpio posterior stabilized prosthesis.Preoperative KSS knee scores were 19.48±967, function scores 3.16±19.82,andthe ROM of the knee 80.80±22.82°. The anteroposterior and lateral X-ray filmsof each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. Results The average of the 130 days’ follow-up revealed that the patients implanted with the TC-Dynamic prosthesis had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83±4.04 with improved scores of 72.75±14.47 compared with those before operation; function scores were 79.17±5.15 with improved scores of 65.42±19.47; the ROM of the knee was 107.92±11.57° with increased degrees of 32.92±32.22°.Meanwhile, in the Scorpio group, the KSS knee scores were 85.68±7.36 with improved scores of 66.20±10.44 compared with those before operation; function scores were 71.40±12.70 with improved scores of 68.24±25.35; the ROM of the knee was 109.20±11.13° withincreaseddegrees of 28.40±26.41°.There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups （Pgt;0.01）. All the X-ray films of the knees implanted with both the Scorpio prosthesis and the TC-Dynamic prosthesis were analyzed.No malalignment or lucent line with the prosthesis was seen in all these X-ray films. Conclusion The short-term follow-up indicates that the patients implanted with the TC-Dynamic prosthesis have an excellent result. The TC-Dynamic prosthesis with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prosthesis should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of thebone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the longterm high survivalrate of the knee prosthesis.
Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). ConclusionOWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.
Objective To summarize the effectiveness of Ilizarov technique in the correction of flexion contracture deformity of the knee after burn. Methods Between April 2012 and July 2017, Ilizarov technique was used to treat 14 cases (17 knees) of knee flexion contracture patients. There were 11 males (13 knees) and 3 females (4 knees), with an age of 20-48 years (mean, 37 years). The duration of scar formation was 8 months to 24 years (mean, 5 years). The scar ranged from the upper part of the thigh, down to the middle part of the leg, from both sides to the inside and outside of the popliteal fossa, without ulceration. The area after scar contracture was 12 cm×10 cm to 30 cm×22 cm. Preoperative total activity of motion (TAM) was 30-115° (mean, 69°). There were 4 cases in wheelchair, 5 cases walking with double crutches, 3 cases with limp, and 2 cases with half squat walking. According to the knee function evaluation criteria by QIN Sihe, the preoperative knee function was fair in 3 knees, poor in 5 knees, and very poor in 9 knees. Results All patients were followed up 6 months to 5 years (mean, 2 years). No local skin necrosis, needle tract infection, limb numbness, and other complications occurred. Knee flexion deformities were all corrected. The postoperative TAM was 70-145° (mean, 125°). All patients were able to walk with plantar weight-bearing, and their gait improved when compared with that before operation. Five cases could walk without a crutch and only slightly claudication after operation. At last follow-up, according to the knee function evaluation criteria, the results were excellent in 9 knees, good in 5 knees, and fair in 3 knees, all were significantly improved when compared with that before operation (Z=–3.677,P=0.000). Conclusion Ilizarov technique has the advantages of minimally invasive, safe, and easy to operate for the treatment of flexion contracture deformity of the knee after burn.
OBJECTIVE: Extension stiffness of knee joint is always treated by the quadricepsplasty, but the main deficiency of this method is that patient feels weakness of lower limb and easily kneels down. The aim of this article is to explore the method to resolve the complications after quadricepsplasty. METHODS: Since 1978 to 1997, on the basis of traditional procedures of quadricepsplasty, sartorius muscle was used to reinforce the extension of knee joint. The lower 2/3 of sartorius muscle was fully dissociated only with its insertion intact. A tendon-periosteal-bone flap, about 2 cm in width, was managed on the anterior surface of patella, with its pedicle on the medial edge of patella. The tendon-periosteal-bone flap was used to fix the dissociated sartorious into patella to reinforce the extension of knee joint. The very lower part of sartorius was mainly aponeurosis, with the help of an aponeurosis bundle of iliotibial tract, it was fixed into the insertion of patellar ligament, through a bony tunnel chiseled adjacent to the insertion of patellar ligament. By now the movement of knee joint extension was strengthened by the transferred sartorius muscle. Postoperatively, every patient was required to extend and flex knee joint actively and/or passively. Altogether 12 patients were treated, 9 of them were followed up with an average of 14 months. RESULTS: The average movement was increased from 15 degrees to 102 degrees, and the average myodynamia was improved from grade II to grade IV. CONCLUSION: Traditional quadricepsplasty co-operated with transfer of sartorius muscle can strengthen the myodynamia of knee joint extension. It is simple method and can really achieve good function.