Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

Use of Ilizarov technique for bilateral knees flexion contracture in Juvenile-onset ankylosing spondylitis: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic rheumatic disease that primarily affects the spine and the sacroiliac and peripheral joints.Juvenile-onset AS(JoAS)patients will likely present with peripheral joint symptoms.Knee flexion contracture(KFC)and hip flexion contracture(HFC)are common in these patients due to subchondral bone inflammation.The Ilizarov technique is the most commonly used technique for treating KFC.However,its use to treat JoAS-associated KFC has not been reported.CASE SUMMARY This report presents a case study of a 31-year-old male patient with a squatting gait due to severe bilateral KFC and HFC.The patient had a normal walking pattern until the age of eight,after which he experienced knee and hip pain,leading to the gradual development of KFC and HFC.The patient’s primary complaint was an inability to walk upright.The patient was diagnosed with JoAS and under-went hip dissection and release,limited soft tissue release of the hamstring,and gradual traction using the Ilizarov method.Ultimately,the patient was able to walk upright.CONCLUSION The incidence of squatting gait due to KFC in individuals diagnosed with JoAS was low.Utilizing the Ilizarov technique has proven to be a secure and effective method for managing KFC in JoAS patients.Although the Ilizarov technique cannot substitute for total knee arthroplasty(TKA),its application can delay the need for primary TKA in JoAS patients and alleviate the intricacy and potential complications associated with the procedure.

Activation of brain areas following ankle dorsiflexion versus plantar flexion Functional magnetic resonance imaging verification

Changes in activated areas of the brain during ankle active dorsiflexion and ankle active plantar flexion were observed in six healthy subjects using functional magnetic resonance imaging. Excited areas of ankle active dorsiflexion involved the bilateral primary motor area and the primary somatosensory area, as well as the bilateral supplementary sensory area, the primary visual area, the right second visual area, and the vermis of cerebellum. Excited areas of ankle active plantar flexion included the ipsilateral supplementary motor area, the limbic system, and the contralateral corpus striatum. Fine movements of the cerebral cortex control the function of the ankle dorsiflexion to a larger extent than ankle plate flexion, and the function of ankle plate flexion is more controlled by the subcortical area.

Tracking of Thigh Flexion Angle during Gait Cycles in an Ambulatory Activity Monitoring Sensor Network

An accelerometry-based gait analysis approach via the platform of sensor network is reported in this paper. The hardware units of the sensor network are wearable accelerometers that are attached at the limbs of human body. For the specific task of gait analysis, flexion angles of the thighs during gait cycles are computed. A Kalman filter is designed to estimate the flexion-extension angle, angular velocity of the thigh using the output of the wearable accelerometers. The proposed approach has been applied to four subjects and the performance is compared with video-based approach. Comparative results indicate that with the proposed Kalman filter, the sensor network is able to track the movement of the thighs during gait cycles with good accuracy and simultaneously detect major gait event of foot contact from the waveform of the angular velocity.

Serial elongation-derotation-flexion casting for children with early-onset scoliosis

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis(JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion(EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and- in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois.

Errors in visual estimation of flexion contractures during total knee arthroplasty

AIM: To quantify and reduce the errors in visual estimation of knee flexion contractures during total knee arthroplasty(TKA).METHODS: This study was divided into two parts: Quantification of error and reduction of error. To quantify error, 3 orthopedic surgeons visually estimated preoperative knee flexion contractures from lateral digital images of 23 patients prior to and after surgical draping. A repeated-measure analysis of variance was used to compare the estimated angles prior to and following the placement of the surgical drapes with the true knee angle measured with a long-arm goniometer. In an effort to reduce the error of visual estimation, a dual set of inclinometers was developed to improve intraoperative measurement of knee flexion contracture during TKA. A single surgeon performed 6 knee extension measurements with the device during 146 consecutive TKA cases. Three measurements were taken with the desired tibial liner trial thickness, and 3 were taken with a trial that was 2 mm thicker. An intraclass correlation coefficient(ICC) was calculated to assess the testretest reliability for the 3 measurements taken with the desired liner thickness, and a paired t test was used to determine if the knee extension measurements differed when a thicker tibial trial liner was placed.RESULTS: The surgeons significantly overestimated flexion contractures in 23 TKAs prior to draping and significantly underestimated the contractures after draping(actual knee angle = 6.1°± 6.4°, pre-drape estimate = 6.9°± 6.8°, post-drape estimate = 4.3°± 6.1°, P = 0.003). Following the development and application of the measurement devices, the measurements were highly reliable(ICC = 0.98), and the device indicated that 2.7°± 2.2° of knee extension was lost with the insertion of a 2 mm thicker tibial liner. The device failed to detect a difference in knee extension angle with the insertion of the 2 mm thicker liner in 9/146 cases(6.2%).CONCLUSION: We determined the amount of error associated with visual estimation of knee flexion contractures, and developed a simple, reliable device and method to improve feedback related to sagittal alignment during TKA.

Report of a Case of Genu Recurvatum Following Tibial Eminence Avulsion Treated by Proximal Tibial Flexion Osteotomy and Review of the Literature

We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.

Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population

BACKGROUND Sagittal alignment of the spine,pelvis,and lower extremities is essential for maintaining a stable and efficient posture and ambulation.Imbalance in any element can result in compensatory changes in the other elements.Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis(OA).The correction of knee flexion deformity(KFD)by total knee arthroplasty(TKA)can lead to complementary changes in the sagittal spinopelvic parameters(SSPs).AIM To determine the SSP changes in patients with knee OA,with or without KFD undergoing TKA.METHODS The study was conducted in 32 patients who underwent TKA.A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients.Subjects were divided into two groups(Group 1 obtained>10°corrections in KFD;group B obtained<10°correction).The pelvic tilt(PT),pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),and sagittal vertical axis(SVA)were measured.RESULTS The median of change in PT,PI,SS,LL,and SVA was 0.20 mm,1.00 mm,2.20 mm,−0.40 mm,and 6.8 mm,respectively.The difference in the change in SSPs between the two groups was statistically non-significant.CONCLUSION SSPs,such as PI,PT,SS,LL,and SVA,do not change significantly following TKA in end-stage knee OA despite a significant correction(>10°)in KFD.

New Ideas of Treatment for Cerebral Palsy I Capital Flexion of the Neck： The Key Link in Prematurity Treatment

In a human, the head and spine work together in any kind of posture and movement. Any movement starts from the head through neck flexion and specifically capital flexion. Capital flexion initiates the straightening of the cervical spine which causes the connection of the head on the C1-C2 suboccipital part to the thoracic and lumbar parts. With this, the spine starts to move and postural tone increases. Without construction of the neck or alteration of the axis, as seen with cases of prematurity, postural tone becomes low. Typical features of children with prematurity include low postural tone, altered axis of the head and neck which generates incorrect or ineffective vestibular information and poor cortical movement caused by poor development of capital flexion. Therefore, the most important aspect to consider is the lack of capital flexion causing the absence of some initiation of movements of the spine which leads to further weakness of the neck and trunk.

Comparative Study of Surgical Approaches for Distractive Flexion Injuries of Sub-Axial Cervical Spine

Distractive flexion injuries (DFI) of subaxial cervical spine are common after motor car accident or falling from height. The ideal surgical approaches to DFI are still unclear. A retrospective comparative study of surgical approaches for DFI of sub-axial cervical spine involved 60 patients throughout the years 2014 to 2016 at Al-Azhar University Hospitals. All patients were undergoing initial routine resuscitative measures, full general and neurological examinations. Neurologic function was assessed according to modified Frankel’s grading. All patients were received cervical plain antero-posterior, lateral and oblique X-ray, CT with 3D and MRI of cervical spine. Severity of DFI injury was assessed according to Allen and Ferguson’s classification. The most common level involved was C5-6 and most common grade was grade 3. The patients operated through anterior approach were 36 patients and through the posterior approach were 24 patients. Restoring cervical alignment was achieved in 29 patients (80.56%). The mean time of bone fusion was 5.454 months in anterior approach while it was 9.876 months in posterior approach. The extend of bone fusion was good in 30 patients (83.33%) after anterior approach and in 8 patients (33.33%) after posterior approach, while poor fusion was observed in 6 patients (16.67%) after anterior approach and 16 patients (66.67%) after posterior approach. We can conclude that anterior cervical approach is better in DFI stage 3 and 4 where there are associated ruptured intervertebral disc. Posterior approach is better in DFI stage 1 and 2 with or with presence of posterior compressing lesion.

INFLUENCE OF FLEXION POSITION OF THE KNEE ON LIMB ALIGNMENT

Objective To verify the influence of flexion position of the knee on limb alignment,the change of the standing femorotibial angle(FTA)with knee flexion was radiologically investigated. Methods Radiographs were taken on each left knee of 47 volunteers with seldom complaints in a one-leg standing position,The standing femorotibial angles(FTA)in full knee extension were compared with the corresponding ones in different angles of knee flexion,and the relationship between the FTA and the flexion angle was investigated. Results Standing FTAs in knee flexion were always smaller than the corresponding ones in full knee extension.With the increment of the flexion angle,the FTA decreased.Positive correlation was found between the difference(△FTA)of the standing FTA in full extension and in flexion and the flexion angle of the knee. Conclusion In the preoperative planning of knee surgeries such as high tibial osteotomy and arthroplasty,the influence of flexion contracture on limb alignment should be taken into consideration to avoid overcorrection or undercorrection.

Clinical study of correction of finger flexion deformity in Dupuytren's disease

Objective To explore surgical technique and its result in correcting finger contracture in Dupuytren’s disease. Methods Seventeen cases of Dupuytren’s disease with 58 years mean age were studied in this group ( 15 males and 2 females) . Among them,8 sides were with flexion eontracture of little finger,8 sides with flexion contracture of little and ring fingers,1 side with

Coactivation Does Not Contribute to Fatigue-Induced Decreases in Isokinetic Forearm Flexion and Extension Torque

Purpose The present study examined the effects of a reciprocal,slow velocity forearm flexion and extension task on fatigue-induced changes in isokinetic torque,agonist and antagonist muscle activation,and coactivation ratios at slow and moderate velocities.Methods Nine women(mean±SD:age=21.0±1.7 years;body mass=68.1±8.2 kg;height=167.4±7.2 cm)completed pre-testing for forearm flexion and extension isokinetic peak torque at 60 and 180°/s,a fatiguing task of 50 maximal,recip-rocal,isokinetic muscle actions at 60°/s,and post-testing.The amplitude(AMP)of the electromyographic(EMG)signals from the biceps and triceps were simultaneously recorded.Torque and EMG AMP were normalized to the corresponding values from the pre-testing peak torque movements.Repeated measures ANOVAs and pairwise comparisons were used to identify mean changes in torque,EMG AMP,and coactivation ratios.Results The torque analyses indicated significant decreases from pre-to post-testing for forearm flexion(14.1%±5.0%;P<0.001)and extension(25.4%±12.2%;P<0.001)at 60°.At 180°/s there was a significant decrease,collapsed across the forearm movements(24.7%±11.7%;P<0.001).For EMG AMP and coactivation ratios,there were no changes(P>0.05)from pre-to post-testing for either velocity or movement.Conclusions The torque responses were velocity-specific,with greater fatigability exhibited for forearm extension versus flexion at 60°/s,but no differences at 180°/s.The parallel EMG AMP responses between the agonist and antagonist muscles for both velocities supported the lack of fatigue-induced changes in coactivation ratios.Thus,our results demonstrated that fatigue-induced decreases in torque were not attributable to increases in antagonist activation or coactivation.

Functional muscle transfer for restoration of elbow flexion:a review

Elbow flexion is essential to help position the hand in space and for functional use of the upper extremity.Loss of elbow function can be secondary to many etiologies,including but not limited to brachial plexus injury,traumatic muscle loss,oncologic treatment,poliomyelitis or congenital absence of motor function.The end result is a significant functional limitation of the upper extremity.One method to address the loss of elbow flexion is the use of a functional muscle transfer.These transfers can be performed as pedicled rotational transfers or free functional muscle transfers.This article reviews functional muscle transfers for restoration of elbow flexion as a treatment option for patients with an otherwise unreconstructable extremity.

肘关节后囊损伤后愈合不同阶段的生物力学

目的评估关节后囊损伤愈合过程中不同阶段,肘关节内部软组织的力学行为。方法建立考虑肌肉主动行为的肘关节有限元模型,模拟肘关节在无损伤和关节后囊损伤后2、4、6、8周时屈曲运动,分析关节囊、尺骨软骨和韧带von Mises等效应力变化。结果无损伤以及损伤后2、4、6、8周时,关节囊在肘关节屈曲60°时应力分别为8.23、7.87、8.27、8.99、10.5 MPa。在肘关节屈曲30°时,与无损伤相比,损伤后2、4、6、8周时尺骨软骨应力分别为增加13.0%、28.3%、41.3%和45.7%。与损伤后2周相比,损伤后4周时桡侧副韧带在屈曲15°、30°、45°、60°、75°时应力分别减少12.5%、22.2%、13.6%、3.2%和10.6%。结论肘关节后囊损伤愈合过程中,骨与软组织生物力学特征变化显著。研究结果可为关节囊挛缩的预防和治疗以及康复辅具的开发提供理论依据。

固定平台单髁置换联合髁间窝成形术治疗中度屈曲畸形膝内侧间室骨关节炎的疗效分析

目的观察固定平台单髁置换加髁间窝成形术治疗中度固定屈曲畸形膝内侧间室骨关节炎的临床效果。方法选取2021年11月至2023年6月青岛市市立医院收治的合并有中度固定屈曲畸形的膝内侧间室骨关节炎患者50例,其中男24例,女26例,年龄64~75岁,平均(69.69±3.53)岁。按手术方式分为研究组(采用固定平台单髁置换加髁间窝成形术)和对照组(采用全膝关节表面置换术)各25例。对比两组手术前后Lysholm评分、美国特种外科医院(the hospital for special surgery,HSS)膝关节评分及疼痛视觉模拟评分(visual analogue scale,VAS),测量术前及术后12个月膝关节屈曲角度,对比两组伸膝角度改善情况。结果患者均获得12个月完整随访。术后2周、6周、3个月研究组Lysholm评分、HSS评分及VAS均优于对照组,差异有统计学意义(P<0.05);两组术后6个月、12个月Lysholm评分、HSS评分及VAS差异均无统计学意义(P>0.05);研究组术后12个月残留畸形角度大于对照组,差异有统计学意义(P<0.05)。结论对老年骨关节炎合并中度固定屈曲畸形患者采取固定平台单髁置换加髁间窝成形手术可以有效地减轻疼痛,改善膝关节功能,但对屈曲畸形的矫正能力小于全膝关节置换。

专业训练中篮球鞋对下肢关节的运动生物力学影响研究综述

篮球运动员在专业训练时会进行各式各样的技术动作,尤其是急停起跳、迅速移动等,需时刻转变步伐,会明显增加下肢关节负荷,这就需要运动员穿着合适的运动鞋,以确保其稳定性可以充分支撑与保护足部而避免下肢关节损伤。据此,为保障运动员在篮球训练及比赛中的安全性与技术发挥实效性,本文全面综述了专业运动训练中篮球鞋对下肢关节的运动生物力学影响研究成果,并进一步做了相关研究展望,以期能够为篮球鞋整体结构优化设计,有效应对运动员下肢关节损伤提供有利帮助。

改良股骨颈截骨术在伴严重屈曲畸形强直性脊柱炎患者手术治疗过程中的疗效

目的:评估改良股骨颈截骨术(modified femoral neck osteotomy, mFNO)在合并严重脊柱后凸和髋关节屈曲强直的强直性脊柱炎(ankylosing spondylitis, AS)患者手术治疗过程中的疗效。方法:回顾性分析2019年1月1日至2023年11月15日期间进行经椎弓根椎体截骨矫形术(pedicle subtraction osteotomy, PSO)和人工全髋关节置换术(total hip arthroplasty, THA)手术治疗的合并脊柱后凸和髋关节屈曲强直的AS患者资料,总共61例患者,103髋。记录患者mFNO的手术时间、手术失血量、术前和术后下肢体干角(angle of the trunk and lower limb, ATL)度数、髋关节被动活动度(range of motion, ROM)、视觉模拟评分(visual analogue scale, VAS)和院内并发症的发生率,并采用配对样本t检验进行统计学分析,P<0.05为差异有统计学意义。结果:最终纳入病例10例,其中男性9例,女性1例,平均年龄(41.30±9.03)岁。10例患者总接受手术次数为52次,其中接受mFNO和THA各19髋,接受PSO 14次。9例双侧mFNO手术的平均手术时间为(133.11±34.81) min,失血量为(433.33±187.10) mL;1例单侧mFNO手术时间为60 min,出血量200 mL。19髋的mFNO术前ATL度数为40.37°±13.66°,术后ATL度数为88.47°±12.46°,差异有统计学意义(P<0.05)。mFNO术前VAS评分为0,术后VAS评分为5.95±1.51,差异有统计学意义(P<0.05)。髋关节被动伸直ROM在mFNO术前为37.37°±18.13°,术后为-4.95°±21.24°,差异有统计学意义(P<0.05);髋关节被动屈曲ROM在mFNO术前为37.37°±18.13°,术后为50.79°±20.36°,差异有统计学意义(P<0.05)。院内并发症共有3次(3/52,5.67%),其中1次为PSO术后肺不张(1/52,1.92%), 1次为THA术中发现大粗隆骨折(1/52,1.92%), 1次为THA术后早期脱位(1/52,1.92%)。结论:mFNO能够明显改善合并严重脊柱后凸和髋关节屈曲强直的AS患者的ATL角度,为PSO和THA提供可行性。

肌肉能量技术对非特异性腰痛患者动态姿势控制和腰神经肌肉功能效果的随机对照试验

目的 探讨肌肉能量技术(MET)对非特异性腰痛患者动态姿势控制能力以及腰部神经肌肉功能的影响。方法 2022年3月至6月,于山东体育学院招募非特异性腰痛在校大学生30例,随机分为对照组(n=15)和干预组(n=15)。对照组进行健康宣教,干预组采用MET进行干预,共4周。干预前后,采用疼痛视觉模拟量表(VAS)、腰部功能障碍指数(ODI)、Y平衡测试和躯干屈曲-放松测试评定腰部神经肌肉功能的变化。结果 干预后,两组VAS评分(|t|> 2.449,P <0.05)均下降,干预组VAS评分显著小于对照组(t=-5.068,P <0.001);干预组ODI评分下降(t=4.785,P <0.001),干预组ODI评分明显小于对照组(t=-2.895,P=0.007);干预组Y平衡测试成绩明显提高(t=-3.662,P=0.003);干预组多裂肌屈曲放松比增加(t=-2.460,P=0.029)。结论 MET能有效改善非特异腰痛患者的疼痛、腰部功能障碍、动态姿势控制和腰部多裂肌屈曲功能。

不同角度下护膝紧度对膝关节影响的有限元分析

为了探讨不同角度下护膝紧度对膝关节半月板及胫股软骨应力和位移的影响,首先利用MRI获取一位志愿者的人体膝关节数据,构建膝关节有限元模型,通过与前人研究结果对比验证该模型有效。然后在仿真软件中建立屈膝角度分别为0°、30°、60°的膝关节模型并通过改变膝关节外部软组织12个参考点的压力,模拟护膝在不同屈膝角度下对膝关节的压迫。进而以胫股关节软骨、半月板的最大Mises应力和最大位移两个维度作为研究指标,分析不同屈膝角度及不同护膝紧度下半月板和胫股关节的力学特征。结果表明,在应力维度上,不同角度下不同的护膝紧度对半月板和胫股关节的影响趋势不同;在位移维度上,不同角度下紧度越大,对膝关节各部位都呈现较好的防护效果。