下肢力学轴线改变与膝关节骨性关节炎的关系

目的 探讨下肢力学轴线改变与膝关节骨性关节炎关系。方法 选择健康人群56例(112只下肢，年龄13～40岁，平均24．8岁)和膝关节骨性关节炎患者50例(87只下肢，年龄54～83岁，平均67岁)。根据FTA角的不同，将膝关节骨性关节炎分成4组。拍摄下肢全长S线片，测定FTA角、颈干角、股骨干倾斜角、胫骨干倾斜角、关节间隙角和股骨力学轴偏位角。结果 正常人群组FTA角、颈干角和关节间隙角与OA第l组比较有差异(P&;lt;0．01)，股骨干倾斜角与OA第一组比较有差异(P&;lt;0．05)。胫骨干倾斜角和颈干角与OA第2组比较有差异(P&;lt;0．05)。结论 初期OA人群组颈干角、关节间隙角和股骨干倾斜角发生了明显的改变，OA中后期的改变主要是关节间隙角和胫骨倾斜角减少。     

两种不同矫形器对早期内侧间室膝关节骨性关节炎步态的影响

摘要 目的: 比较早期内侧间室膝关节骨性关节炎（OA）患者在佩戴膝关节外翻矫形器与外侧楔形角矫形鞋垫后所产生的下肢生物力学变化及差异,探讨不同矫形器在早期内侧间室膝关节骨性关节炎患者康复中的应用价值。 方法: 采用Vicon三维步态分析系统及Kislter测力台分别测评32例早期内侧间室型膝关节骨性关节炎患者在佩戴定制外侧楔形角矫形鞋垫（倾斜角5°）、膝关节外翻矫形器及无佩戴任何矫形器（测试期间均穿标准鞋）三种条件下的下肢关节运动学、动力学及时间空间参数。 结果: 相较于未佩戴任何矫形器情况,佩戴2种矫形器后膝关节内侧间室压力（膝关节内翻力矩,膝关节内翻角冲量）均明显降低（P<0.05）,此外佩戴外侧楔形角矫形鞋垫后患者踝关节外翻角度明显增加,足底压力中心明显向外侧偏移（P<0.05）。 结论: 两种不同的矫形器均有助于降低早期内侧间室型膝关节骨性关节炎患者在步行过程中膝内侧间室所产生的压力,两者治疗效果未见明显差异。     

半月板突出在膝骨性关节炎关节间隙狭窄中的作用

目的:探讨膝关节半月板突出在膝骨性关节炎(osteoarthritis,OA)的关节间隙狭窄中作用。方法:2003-01/2004-06对65骨关节炎膝及36正常自愿者膝在复旦大学附属华山医院骨科进行正侧位X射线检查和MRI扫描,根据X射线片进行内侧关节间隙Kellgren-Lawrence(K-L)分级,同时在MRI冠状面上评估内侧半月板突出程度。比较膝关节OA和正常膝关节半月板突出程度差异,并分析膝关节OA关节间隙狭窄和半月板突出的关系。结果:膝OA组K-L分级:Ⅰ级狭窄13膝、Ⅱ级狭窄19膝、Ⅲ级狭窄22膝、Ⅳ级狭窄8膝,对照组均为0级;膝OA组半月板突出:正常3膝,轻度突出16膝,中度突出20膝,重度突出23膝。对照组半月板突出:正常11膝,轻度突出20膝,中度突出5膝。OA组内侧半月板突出程度与正常对照组比较差异有显著性意义(P<0.01);骨关节炎组内不同K-L分级与内侧半月板突出程度有关系r=0.461,P<0.01)。(结论:内侧半月板突出是膝关节OA的一个重要特征,并且与关节间隙狭窄有关。     

下肢全长负重位X线检查在膝关节炎内外翻畸形中的临床价值

目的:探讨膝关节炎患者下肢全长负重位X线片对膝内、外翻畸形诊断的临床价值。方法:选取32例临床诊断为膝关节炎51膝分别拍摄下肢全长负重X线片,测量下肢力线和机械轴偏距(mechanical axis offset distance,MAD),解剖学股胫骨角(anatomical femor-tibial angle,aFTA),股骨远端力学外侧角(mechanical lateral distal femoral angle,mLDFA),胫骨近端力学内侧角(mechanical medial proximal tibial angle,mMPTA),对图像数据进行分析,对膝关节炎进行X线K/L分级,通过SPSS 17.0统计对下肢力线各参数与关节炎的相关性进行分析。结果:①膝关节下肢全长负重位X线片显示,关节有不同程度骨质增生,关节间隙变窄。②51膝骨关节炎中确诊膝内翻畸形38膝(74.51.%)和膝外翻畸形8膝(10.42%),5膝均无内外翻畸形。③膝关节炎X线K/L分级显示,0级:5膝(9.8%),I级:12膝(23.5%),II级:22膝(43.1%);III级:9膝(17.6%);IV级:3膝(59%)。④膝内翻组中股骨内翻7膝(18.42%),胫骨内翻18膝(47.36%),股骨、胫骨均内翻13膝(34.21%);膝外翻组中股骨外翻6膝,股骨、胫骨均外翻2膝。⑤在膝内翻组中,aFTA与骨关节炎X线K/L分级呈正相关(B值=0.132,t=2.648,P=0.012,P<0.05)。结论:下肢全长负重X线显示下肢结构清晰、完整,通过测量下肢力线参数评估,可全面诊断膝关节炎的内翻畸形或外翻畸形,膝内翻中以胫骨内翻显著,膝外翻中则以股骨外翻显著。因此,膝关节骨性关节炎的下肢全长负重X线检查具有较高的临床价值。     

胫骨近端双平面截骨结合关节镜技术治疗合并内侧半月板损伤的膝关节内翻性骨性关节炎*

目的探讨胫骨近端双平面截骨结合关节镜技术治疗膝关节内翻性骨性关节炎(OA)的初步临床效果。方法纳入2016年11月-2018年9月30例进行内侧胫骨近端撑开截骨结合关节镜治疗的膝关节内翻畸形OA患者,并采用美国膝关节协会评分(KSS)、疼痛视觉模拟评分(VAS)和股胫角(FTA)等指标对疗效进行评估与分析。结果 27例患者获得随访,随访时间12～34个月,平均随访时间20.6个月,X线片复查示所有患者的膝内翻畸形得到纠正,截骨均愈合,愈合时间3～8个月,平均3.5个月。所有患者切口均Ⅰ期愈合,无伤口感染。末次随访术后KSS评分(88.42±3.27)分、FTA(176.88±3.36)°和VAS评分(1.48±0.89)分与术前比较,差异均有统计学意义(P 0.05)。结论胫骨近端双平面截骨结合关节镜技术能有效纠正力线,缓解关节疼痛,改善关节功能。     

本体感觉强化训练对骨性关节炎患者平衡能力的影响

正骨性关节炎(osteoarthritis,OA)最常见的一种关节病变,尤其是60岁的老年人口中,发病率达到20%,其中膝关节骨性关节炎(knee osteoarthritis,KOA)发病占到OA发病率的78.5%。KOA主要功能障碍包括关节活动度障碍,下肢肌力下降和平衡能力差,增加老年人跌倒风险,严重影响老年人     

腓骨截骨术联合关节镜下膝关节清理术治疗膝骨性关节炎的临床效果

目的探讨腓骨截骨术联合关节镜下膝关节清理术治疗膝骨性关节炎(KOA)的临床效果。方法选取鹤壁市人民医院2016年10月至2019年10月收治的KOA患者93例,按随机数字表法分为2组:对照组46例行关节镜下膝关节清理术,观察组47例行腓骨截骨术联合关节镜下膝关节清理术,观察2组疼痛程度[视觉疼痛模拟(VAS)评分],膝关节功能(股骨胫骨角、胫骨关节间隙角、膝关节活动度)以及不良情绪[焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分]。结果与对照组比较,观察组治疗后VAS评分显著升高,股骨胫骨角显著增大、胫骨关节间隙角显著减小、膝关节活动度显著增大,SAS、SDS评分均显著降低,差异有统计学意义(均P<0.05)。结论腓骨截骨术联合关节镜下膝关节清理术治疗KOA效果确切,通过减轻腓骨重力以及增强周边软组织重建等途径,有效地提高临床疗效、缓解疼痛程度及其对膝关节功能的影响。     

兔膝关节骨性关节炎的模型制作及组织病理学

目的探讨骨性关节炎(OA)的发病机制及组织病理学基础。方法20只健康雄性白兔随机分为正常组和模型组各10只。模型组采用管型石膏伸直位制动方法复制出膝关节OA模型。6周后处死白兔并观察软骨的大体改变及Mankin评分;并取血清及关节灌洗液标本检测超氧化物歧化酶(SOD)及丙二醛(MDA)的含量。结果模型组白兔膝关节滑膜均存在不同程度增生、肥厚、水肿;光镜及电镜下关节软骨呈明显退行性变;Mankin评分模型组显著高于正常组(P<0.05);关节灌注液中SOD和血清中MDA含量模型组显著升高(P<0.01)。结论滑膜组织的炎症、关节软骨的退变以及自由基的改变是导致OA发生的病理学基础,如何阻断这些病理环节是防治OA的关键。     

中药熏蒸治疗膝关节骨性关节炎疗效观察及护理

骨性关节炎(OA)是一种以关节软骨完整性破坏以及关节边缘软骨下骨板病变为主,导致的一系列关节症状和体征的一组特异性疾病[1]。膝关节骨性关节炎多发于50岁以上中老年人。症状可见膝关节疼痛、肿胀、僵硬、骨摩擦音、活动受限、膝内翻     

胫骨高位截骨术治疗膝内翻骨性关节炎临床研究

目的评价胫骨高位截骨术在膝关节骨性关节炎中的临床疗效。方法选取2017年6月至2019年1月在该科住院的膝关节骨性关节炎患者共34例患者作为研究对象,均采用胫骨高位截骨术治疗,记录截骨手术并发症、愈合时间,采用胫骨近端内侧角(MPTA)、视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)评估临床疗效。结果所有患者获得了6~24个月随访,术后3~4个月截骨处达到骨性愈合,无伤口感染及骨不愈合,术前与术后3个月MPTA、VAS评分及HSS评分比较,差异有统计学意义(P<0.05),患者术后临床症状及下肢力线均较术前明显改善。结论掌握好适应证,采用胫骨高位截骨术可有效治疗膝内翻骨性关节炎。     

T2*mapping辅助MRI技术对差异性膝关节骨性关节炎软骨损伤程度的诊断价值

目的探讨T2*mapping辅助MRI技术对差异性膝关节骨性关节炎软骨损伤程度的诊断价值。方法选取我院2016年6月~2019年6月收治的膝关节骨性关节炎患者作为病变组,共46例,其中男性32例,女性14例,年龄22~69岁(41.19±15.53岁);另将7名健康志愿者作为对照组,其中男性5例,女性2例,年龄23~64岁(42.05±15.28岁)。两组均行膝关节MRI常规扫描及T2*mapping序列扫描,分别比较两组不同区域软骨T2*值,分析病变组软骨损伤程度、各区域浅深层软骨以及股骨内侧髁、外侧髁负重区与非负重区的T2*值。结果病变组股骨内侧髁、股骨外侧髁、内侧胫骨平台、外侧胫骨平台T2*值均高于对照组(P < 0.05)。重度患者股骨内侧髁、股骨外侧髁、内侧胫骨平台、外侧胫骨平台T2*值均高于轻度患者(P < 0.05)。病变组股骨内侧髁、股骨外侧髁、内侧胫骨平台、外侧胫骨平台浅层软骨的T2*值均高于深层软骨(P < 0.05)。病变组股骨内侧髁、外侧髁负重区的T2*值均高于负重区(P < 0.05)。结论T2*mapping辅助MRI技术在诊断差异性膝关节骨性关节炎软骨损伤程度中具有较高的价值,可为患者病情的判断提供可靠依据。      

Remodelling and congruency of the hip joint in children with Perthes' disease treated with varus-derotation subtrochanteric osteotomy

Background. Dislocation of the femoral head to the front and to the side during the course of Perthes' disease is the main threat to the development of the hip. Containment of the femoral head into the acetabulum is the main goal of conservative and operative treatment. The spherical shape of the acetabulum is used as the modelling factor for the femoral head during the regeneration period, which enables the femoral head to rebuild its spherical shape. The aim of the study is to present the changes occurring within the hip joint during the course of Perthes' disease, before and after operative treatment with varus-derotation subtrochanteric osteotomy, based on objective radiological measurements. Material and methods. 53 patients, aged from 5 to 10 years, were treated operatively. The necrosis period was assessed on radiographic examination according to Reiberg and Catterall. All patients were treated with varus-derotation subtrochanteric osteotomy, decreasing the neck-shaft angle to an average value of 111 degrees . During the follow-up period of 6 years, a control examination was performed every 12 months. Measurements were compared with norms published in the literature. Various parameters were assessed in this study to assess the proximal end of the femur bone (neck-shaft angle, epiphyseal head index of Heyman and Herndon) and the position of the femoral head inside the acetabulum (centre-edge angle, distance angle, acetabular head index of Heyman-Herndon). Results. During the 6-year follow-up period, the value of the neck-shaft angle remained within the range of norms for the age and group, and for operated limbs the value was lower than the norm. The other assessed parameters showed substantial improvement, which led to the preservation of the correct shape of both the femoral head and acetabulum and improved the congruency of the joint. Conclusion. The value of parameters assessed post-operatively show a substantial improvement compared with preoperative measurements. Good results are obtained as a result of varus-derotation subtrochanteric osteotomy in patients with Perthes' disease type III and IV according to Catterall, and lead to improvement in the congruency of the joint.     

The prognostic importance of congruity of the hip joint in the reduction of residual dysplasia after successful conservative treatment of developmental luxation

Background. Conservative treatment of developmental hip dislocation aims for stable reposition. However, after treatment a significant number of joints are not completely remodeled. The aim of our study was to determine which factors influence the direction of remodeling of the hip joint during growth. Material and methods. The remodeling of 78 dysplastic hips in 66 patients was analyzed, from the end of treatment to the end of the growth period. The remodeling of the hip joint was evaluated based on 5 radiographic parameters. The final assessment at the end of the growth period was performed using Severin's classification, and also our own classification. Results. The best outcome was obtained in hips which after conservative treatment had a normal neck-shaft angle, and the centering of the femoral neck improved quickly, reaching normal values before the age of 5 years. Slower remodeling (good final outcome) was observed in hips with increased neck-shaft angle which reached correct centering of the femoral neck before age 7. Those hip joints in which the centering of the femoral neck was incorrect at age 5-7 years had unsatisfactory outcomes. The condition of the acetabular roof in the first years after the end of conservative treatment did not affect outcome. Conclusion. The remodeling of the dysplastic hip after conservative treatment of developmental dislocation depends exclusively on the congruity of the joint. Early unsatisfactory remodeling of the acetabular roof resolves later, if the congruency of the joint is normal by age 5-7, depending on the neck-shaft angle.     

全膝关节置换术前应用双下肢全长摄影对不同体位下肢负重轴线的影响

目的探讨全膝关节置换术前应用双下肢全长摄影对不同体位下肢负重轴线的影响。方法选择在我院接受全膝关节置换术患者138例,均拍摄两组双下肢全长正位片,一组以骨盆正中,下肢呈中立位为标准,另一组以膑骨正中,胫骨覆盖腓骨小头内1/3为标准方案。比较两种体位下的股骨胫骨机械轴夹角等数据,并评估两者图像质量。术后随访,比较术前术后膝关节功能。结果骨盆正中以及髌骨正中下摄影获得的股骨侧弓角(FBA)、机械股骨远端外侧角(mLDFA)以及近端内侧角(mMPTA)比较,差异均有统计学意义(P<0.05),且前者明显高于后者,但机械股胫角(mFTA)比较差异无统计学意义(P>0.05);两种体位下患者摄影图像质量比较差异无统计学意义(P>0.05);患者术后疼痛、功能、活动度、屈曲畸形和稳定性评分较术前均显著上升(P<0.05)。结论骨盆正中体位的双下肢全长摄影在全膝关节置换术的应用可正确展示患者本身该有的下肢力线,减小人为操作不当引起的误差,同时可以优化下肢力线在不同摄影体位的角度测量。     

股骨颈骨折患者与正常体检者骨矿物质含量的对照观察(英文)

目的:探讨股骨颈骨折与骨质疏松之间的关系。方法:1990/2000从34例髋关节骨折患者中选择20例作为研究对象,选择年龄,性别相匹配的20例正常人群作为对照组,分别测量骨矿含量、尿羟脯氨酸含量。结果:对照组男性、女性骨皮质(BC1、BC2)、骨矿含量、骨密度的差异有显著性(t=5.33,6.47,3.44,1.65,P<0.01),股骨颈骨折男性人群与对照组男性人群骨矿含量比较差异有显著性(t=3.52,P<0.01),股骨颈骨折女性与对照组女性比较骨矿含量,骨密度差异有显著性(t=4.21,3.68,P<0.01)。骨折妇女与对照组尿羟脯氨酸含量差异有显著性(t=5.0,P<0.01),骨折的男女人群之间比较差异有显著性(t=11.1,P<0.01)。结论:股骨颈骨折患者骨矿物含量较正常体检者低。     

Comparison of the prevalence of myofascial trigger points of muscles acting on knee between patients with moderate degree of knee osteoarthritis and healthy matched people

IntroductionTrigger points have been implicated in the development of several musculoskeletal disorders. Trigger points harbored in lower limb muscles might represent a ubiquitous source of pain in patients with knee osteoarthritis (OA). This study was carried out to evaluate the prevalence of Myofascial Trigger Points (MTrPs) in muscles acting on the knee in patients with OA.MethodsThirty-seven patients aged at least 55 years old with a moderate degree of OA (grade III of Kellgren and Lawrence scale) were recruited. Thirty asymptomatic people, matched on age and body mass index, were considered as the control group. Ten muscles acting on the knee joint were selected. Taut bands were also identified using a skin rolling method. A pressure of 3 kg/cm² was used to identify myofascial trigger points in all muscles except the popliteus (8 kg/cm²).ResultsChi-square was performed to compare the prevalence of trigger points between the groups. The McNemar test was administered to compare the prevalence of trigger points in the right and left sides of participants. Prevalence of the trigger points was significantly higher in patients with knee OA compared with asymptomatic people in all muscles except for right (p = 0.17) and left (p = 0.41) rectus femoris, right (p = 0.61) and left (p = 0.22) sartorius and left biceps femoris (p = 0.08). Comparison of the prevalence of MTrPs bilaterally revealed that only the right and left sartorius differed significantly (p = 0.008).ConclusionsThe prevalence of MTrPs in the muscles acting on the knee joint is higher in patients with a moderate degree of knee OA compared with asymptomatic subjects.     

抗生素骨水泥结合股前外游离皮瓣治疗创伤性胫骨骨髓炎伴皮肤软组织缺损的效果

目的探讨抗生素骨水泥结合股前外游离皮瓣治疗创伤性胫骨骨髓炎伴皮肤软组织缺损的效果。方法选取2016年5月至2018年6月收治的78例创伤性胫骨骨髓炎伴皮肤软组织缺损患者进行研究,随机将其分为对照组和观察组,各39例。对照组采用局部抗生素灌注结合股前外游离皮瓣治疗,观察组采用抗生素骨水泥结合股前外游离皮瓣治疗。比较两组的治疗效果。结果观察组的治疗总有效率为97.44%,高于对照组的84.62%(P<0.05)。治疗后,观察组的CCL11水平、ESR、NF-κB水平均低于对照组(P<0.05)。治疗后,观察组的Lysholm评分及AOFAS踝-后足评分均高于对照组(P<0.05)。结论临床采用抗生素骨水泥结合股前外游离皮瓣治疗创伤性胫骨骨髓炎伴皮肤软组织缺损,能够明显提高治疗效果,减轻炎症反应,促进膝、踝关节功能改善。     

Worse Functional Status Among Old People When Admitted for Arthroplasty

The aim of this study was to investigate whether there is a difference in functional status between younger and elderly people referred to an orthopaedic clinic for total joint replacement. A total of 709 patients with osteoarthritis of the hip or knee (aged 27–91 years) and 42 healthy controls (aged 42–83 years) were examined with a new Functional Assessment System (FAS) for lower extremity dysfunction. Age effects were explored by one-way analysis of variance. Older people showed higher dysfunction scores in almost all variables, with the exception of pain, where there was an inverse relationship, i.e, old people had lower disability scores. This age-related increase in disability scores was not observed in the control group. Old people seem to be referred for joint replacement on different grounds from those of younger people, despite the fact that age was not included in the criteria for arthroplasty. The results may indicate a hidden, age-related criterion in the selection of patients for arthroplasty. Different interpretations are discussed.     

开放楔形胫骨高位截骨术治疗膝关节内侧间室骨性关节炎对髌骨参数及关节功能的影响

目的 探讨开放楔形胫骨高位截骨术(OWHTO)治疗膝关节内侧间室骨性关节炎对髌骨参数及关节功能的影响.方法 回顾性分析2018年7月—2020年6月收治的膝关节内侧间室骨性关节炎98例的临床资料,按照术式分为研究组45例和对照组53例.研究组给予OWHTO治疗,对照组给予单髁置换术(UKA)治疗.比较两组手术前后膝关节...