Clinical study on improving the diagnostic accuracy of adult elbow joint cartilage injury by multisequence magnetic resonance imaging

BACKGROUND Due to frequent and high-risk sports activities,the elbow joint is susceptible to injury,especially to cartilage tissue,which can cause pain,limited movement and even loss of joint function.AIM To evaluate magnetic resonance imaging(MRI)multisequence imaging for improving the diagnostic accuracy of adult elbow cartilage injury.METHODS A total of 60 patients diagnosed with elbow cartilage injury in our hospital from January 2020 to December 2021 were enrolled in this retrospective study.We analyzed the accuracy of conventional MRI sequences(T1-weighted imaging,T2-weighted imaging,proton density weighted imaging,and T2 star weighted image)and Three-Dimensional Coronary Imaging by Spiral Scanning(3D-CISS)in the diagnosis of elbow cartilage injury.Arthroscopy was used as the gold standard to evaluate the diagnostic effect of single and combination sequences in different injury degrees and the consistency with arthroscopy.RESULTS The diagnostic accuracy of 3D-CISS sequence was 89.34%±4.98%,the sensitivity was 90%,and the specificity was 88.33%,which showed the best performance among all sequences(P<0.05).The combined application of the whole sequence had the highest accuracy in all sequence combinations,the accuracy of mild injury was 91.30%,the accuracy of moderate injury was 96.15%,and the accuracy of severe injury was 93.33%(P<0.05).Compared with arthroscopy,the combination of all MRI sequences had the highest consistency of 91.67%,and the kappa value reached 0.890(P<0.001).CONCLUSION Combination of 3D-CISS and each sequence had significant advantages in improving MRI diagnostic accuracy of elbow cartilage injuries in adults.Multisequence MRI is recommended to ensure the best diagnosis and treatment.

Measurement and Analysis Method for Elbow Joint Moments During Walker-Assisted Walking

A new measurement and analysis method was proposed to investigate the changes in elbow joint moments that occur with the use of a front-wheeled walker. A strain gauge-based walker instrumentation system was developed to monitor the hand loads during walker-assisted walking and integrated with an upper extremity biomechanical model, Preliminary system data were collected for 12 subjects following informed consent. Bilateral upper extremity kinematic data were acquired with a six-camera motion analysis system. Internal joint moments at the elbow were determined in the three clinical planes using the inverse dynamics method. Results showed that during a walker-assisted gait elbow joint moments mainly distributed in the walker stance period. There was a noted demand on the elbow extensor in the sagittal plane with the greatest record as 0.381 N.m/（kg.m）, An interesting “bare phase” of mean elbow joint moments was also found in phase angle-240°-340° of gait cycle. Complete description of elbow joint moments of walkerassisted gait may provide insight into walker use parameters and rehabilitative strategies.

Non-traumatic myositis ossificans circumscripta at elbow joint in a 9-year old child

Myositis ossificans circumscripta （MOC） is a kind of self-localized, benign and tumor-like lesions often seen in adults, with approximately 75% of cases caused by trauma. We reported a case of non-traumatic MOC occurred at the elbowjoint in a 9-year old child and it has been excised by surgery. After 18 months follow-up, a favorable outcome has been achieved with the Broberg-Morrey score of 100. We suggest that surgical resection should be done as soon as the diagnosis is confirmed.

Influence of acupotomy loosing on IL-6, IL-10 and TNF-α in synovial fluid of rheumatoid arthritis patients with elbow joint stiffness

Objective： To compare differences of acupotomy loosing combined with medication treatment, electroacupuncture combined with medication treatment and simple medication treatment in effects on rheumatoid arthritis patients with elbow joint stiffness and investigate the anti-inflammatory mechanism of the acupotomy loosing.Methods： A total of 60 cases of rheumatoid arthritis（RA） patients with elbow joint stiffness were randomly assigned into the group receiving acupotomy loosing（group A）, group with electroacupuncture（group B） and the one undergoing medication treatment（group C） with 20 cases for each group. Based on the medication treatment, all patients underwent continuous oral administration with Methotrexate（MTX）, Leflunomide（LEF） and Bitongding capsules for 3 weeks. And no other treatments were given to group C. In addition to medications treatment, the electroacupuncture was performed in group B. The acupoints of Tianzhu（天柱 BL 10）,DAzhui（大椎 GV 14）; Fengchi（风池 GB 20）,Quchi（曲池 LI 11）,Quze（曲泽 PC 3）,Chize（尺泽 LU 5）, Shousanli（手三里 LI 10）, Xiaohai（小海 SI 8）, Shaohai（少海 HT 3）, Tianjing（天井 TE 10）,Qinglengyuan（清冷渊 TE 11） and Hegu（合谷 LI 4） in the affected side were selected. A pair of electrodes were connected to LI 11 and LI 10, and another pair of electrodes were connected to PC 3 and LU 5, and the continuous wave with frequency of 2 Hz was designed, the needle retention for 30 min was performed, and the acupuncture was performed for 6 times per week with 3 weeks for one course,and there was one course totally. Besides the medication treatment, group A underwent the acupotomy loosing therapy. The tender point in lateral elbow joint, etc. were taken as the treatment point, and 6-8 treatment points being taken for each time, and longitudinal dredging and transverse exfoliation were conducted for 2-3 times with the acupotomy. The treatment was given for one time per week with three weeks for one course, and there was one course totally. The changes of maximum angle of active extension position, maximum angle of active flexion position and range of motion were observed, and levels of IL-6, IL-10 and TNF-a in affected synovial fluid of elbow joint were tested before the treatment and 2 weeks after the treatment in the groups.Results： ① Compared with those before treatment, the maximum angle of active extension position were smaller, the maximum angle of active flexion position were larger and the range of motion were wider of the affected elbow joints of the patients in the 3 groups on the 2 weeks after the treatment.There were statistical significances for the differences（All P 0.05）. Two weeks after the treatment,as compared with those in group C, the affected elbow joint for patients in the group B and group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were statistical significances for the differences（All P 0.05）. Comparing with those in the group B, the affected elbow joint for patients in the group A was smaller in maximum angle of active extension position, larger in maximum angle of active flexion position and wider in range of motion and there were the statistical significances for the differences（All P 0.05）. ② Compared with those before treatment, the levels of TNF-a and IL-6 were lower and the level of IL-10 was higher of the 3 groups on the 2 weeks after the treatment. There were the statistical significances for the differences（All P 0.05）. For 2 weeks after the treatment, compared with those in the group C, group B and group A were lower in levels of TNF-α and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）. As compared with those in the group B, group A was lower in levels of TNF-a and IL-6 and higher in level of IL-10 and there were the statistical significances for the differences（All P 0.05）.Conclusions： The combination of acupotomy loosing can improve the maximum angle of active extension position, maximum angle of active flexion position and range of motion in affected elbow joint for RA patients with elbow joint stiffness, whose efficacy was superior to single basic treatment and electroacupuncture combined with basic treatment. Meanwhile, the levels of proinflammatory cytokines,such as TNF-α and IL-6 can be decreased, and the level of anti-inflammatory cytokines, such as IL-10 can be increased, playing a role in regulating the imbalance between proinflammatory cytokines and anti-inflammatory cytokines in RA patients, which may be one of mechanisms regarding treating RA and improving the range of motion for stiff joints.

Bunch-length measurement at a bunch-by-bunch rate based on time–frequency-domain joint analysis techniques and its application

This paper presents a new technique for measuring the bunch length of a high-energy electron beam at a bunch-by-bunch rate in storage rings.This technique uses the time–frequency-domain joint analysis of the bunch signal to obtain bunch-by-bunch and turn-by-turn longitudinal parameters,such as bunch length and synchronous phase.The bunch signal is obtained using a button electrode with a bandwidth of several gigahertz.The data acquisition device was a high-speed digital oscilloscope with a sampling rate of more than 10 GS/s,and the single-shot sampling data buffer covered thousands of turns.The bunch-length and synchronous phase information were extracted via offline calculations using Python scripts.The calibration coefficient of the system was determined using a commercial streak camera.Moreover,this technique was tested on two different storage rings and successfully captured various longitudinal transient processes during the harmonic cavity debugging process at the Shanghai Synchrotron Radiation Facility(SSRF),and longitudinal instabilities were observed during the single-bunch accumulation process at Hefei Light Source(HLS).For Gaussian-distribution bunches,the uncertainty of the bunch phase obtained using this technique was better than 0.2 ps,and the bunch-length uncertainty was better than 1 ps.The dynamic range exceeded 10 ms.This technology is a powerful and versatile beam diagnostic tool that can be conveniently deployed in high-energy electron storage rings.

Experimental study on the irreversible displacement evolution and energy dissipation characteristics of disturbance instability of regular joints

To investigate the disturbance-induced shear instability mechanism of structural catastrophe in the deep rock mass,MTS 815 material testing machine was used to carry out quasi-static loading tests and disturbance shear tests on symmetrical regular dentate joints of two materials at three undulation angles under specific initial static stress,disturbance frequency,and peak value.The test results indicate that:(i)the total ultimate instability displacement is only related to the intrinsic properties of the joints but not to the initial static stress and disturbance parameters;(ii)the cumulative irreversible displacement required for the disturbance instability conforms to the logistic inverse function relationship with the number of disturbances,displaying the variation trend of“rapid increase in the front,stable in the middle,and sudden increase in the rear”;(iii)the accumulation of plastic deformation energy is consistent with the evolution law of irreversible displacement of joints and the overall proportion of hysteretic energy is not large;(iv)the dissipated energy required for the instability of each group of joints is basically the same under various disturbance conditions,and this energy is mainly controlled by the initial shear stress and has no connection with the disturbance parameters.The stability of the total disturbance deformation and the disturbance energy law of the joints revealed in the tests provide data support for reasonably determining the disturbance instability criterion of joints.

Anatomy of the anterolateral ligament of the knee joint

Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.

The review of clinical application of X-shaped balance acupuncture therapy for joint pain and activity disorder

Musculoskeletal diseases such as neck, shoulder, back and leg pain are ext remely common in clinic. Diseases of the joints of the ext remi ti es, especially sputum, wr ist spr ains, and periarthritis of the shoulders, and even lumbar disc herniation, use X-shaped balance acupuncture therapy to relieve pain and improve motor function. The method of obtaining acupoints is simple and easy to operate. Many of clinical comparison shows that this therapy is simple to conventional acupuncture and moxibustion in the treatment of local pain and joint diseases. This review concluded the advantaged about the X-shaped balance acupuncture therapy and it worth to clinical promotion.

Atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability

Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were

不同类型贴布对慢性踝关节不稳患者行走时踝关节运动学的影响

背景:慢性踝关节不稳患者行走时倾向于过度足内翻,这将增加步行周期支撑相踝关节扭伤的风险。临床医生常使用肌内效贴布或运动贴布进行踝关节贴扎。由于肌内效贴布具有弹性,而运动贴布无法拉伸,因此两者技术应用和生理机制存在差异,进而可能产生不同的康复疗效。目的:对比肌内效贴布和运动贴布干预对慢性踝关节不稳患者步行支撑相足额状面和胫骨水平面运动的影响。方法:40名慢性踝关节不稳患者随机分为肌内效贴布组和运动贴布组,肌内效贴布组从后足内侧向外侧粘贴2条贴布,以产生外翻拉力;运动贴布组采用踝关节闭锁式编篮贴扎。分别于贴扎前后在电动跑台上进行行走测试,利用三维运动分析系统获取受试者足部和胫骨运动学参数。结果与结论:肌内效贴布组贴扎后于支撑相早期足外翻角度增加(P<0.05),但对支撑相晚期足的位置无影响(P>0.05);运动贴布组贴扎后于支撑相晚期胫骨内旋增加(P<0.05),而支撑相早期胫骨位置无明显改变(P>0.05)。结果表明:与运动贴布相比,肌内效贴布能够提供灵活的拉力,有利于步态周期中支撑相早期足外翻,同时不限制支撑相晚期的正常足内翻。因此,肌内效贴布可能是慢性踝关节不稳患者的实用康复疗法,在纠正踝关节异常运动的同时不限制其自然运动。

Elbow Dislocation with Ipsilateral Galeazzi Fracture: A Case Report

Elbow dislocation associated with ipsilateral Galeazzi fracture is a rare pattern of injury. Only seven cases were reported in the literature. We reported another case in a 42 years old man. Closed reduction of the dislocated elbow joint was immediately performed under sedation. Because the patient did not want surgery for radius, it was decided to manage the fracture conservatively. The lack of clinical improvement motivated operative treatment for Galeazzi fracture 56 days after injury. We have discussed the treatment option and the result obtained. The prognosis of this associated injury is related to the DRUJ dislocation, which should not be misdiagnosed.

术后早期综合康复对儿童青少年肱骨髁上骨折伴尺神经损伤的效果

目的观察术后早期综合康复对并发尺神经损伤的肱骨髁上骨折儿童青少年的肘关节功能障碍与尺神经损伤的效果。方法2016年1月至2021年12月在中国中医科学院望京医院治疗的并发尺神经损伤的肱骨髁上骨折术后的儿童青少年49例,随机分为对照组(n=24)和治疗组(n=25)。对照组采用蜡敷治疗和针灸治疗,治疗组采用药物熏蒸、关节松动术及肌电生物反馈治疗,治疗12周。治疗前后分别采用美国特种外科医院肘关节评定表(HSS)和英国医学研究院神经外伤学会报告(MCRR)进行评估。结果治疗后,两组HSS评分均显著升高(|t|>8.345,P<0.001),治疗组HSS评分显著高于对照组(t=4.536,P<0.001),治疗组治疗前后HSS评分差值高于对照组(t=3.717,P<0.05)。治疗组尺神经恢复优良率高于对照组(χ^(2)=5.975,P<0.05)。结论术后早期综合康复可改善并发尺神经损伤的肱骨髁上骨折儿童青少年的肘关节功能,促进尺神经恢复。

Simple lateral elbow dislocation:A case report

BACKGROUND Simple lateral elbow dislocation(SLED)is a rare type of elbow dislocation;however,its treatment may be complicated by accompanying soft tissue or neurovascular damage.Herein,we report a rare case of SLED managed secondarily with open reduction and soft tissue repair following failure of closed reduction.CASE SUMMARY A 67-year-old woman suffered SLED after falling on her outstretched left hand with her elbow extended.She developed pain,swelling,and movement restriction in the elbow;there were no neurovascular symptoms,except for numbness in the 4th and 5th digits.Radiologic investigation confirmed the SLED,and a closed reduction under anesthesia was performed.The follow-up radiographs at 1-wk revealed failure of reduction;accordingly,open reduction with lateral collateral ligament and common extensor origin repair were carried out.The patient regained full elbow range of motion by six weeks.CONCLUSION Adequate concentric reduction for SLED,conservatively or surgically,reduces complications and provides a more functional joint.

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。

关节镜联合肘管扩大成型术治疗肘关节骨性关节炎伴肘管综合征疗效观察

目的探讨关节镜联合肘管扩大成型术治疗肘关节骨性关节炎伴肘管综合征的临床疗效。方法选择2020年9月至2023年8月河北省沧州中西医结合医院骨外科收治的101例肘关节骨性关节炎伴肘管综合征患者为研究对象,按照手术方式不同将患者分为观察组(n=51)和对照组(n=50)。观察组患者采用关节镜联合肘管扩大成型术,对照组患者采用常规肘管扩大成型术。观察并记录2组患者的手术时间、术中出血量、住院时间、并发症发生情况。分别于术前、术后6个月时,采用Mayo肘关节功能评分(MEPS)评估2组患者的肘关节功能,采用日常生活活动能力评定表(ADL)评估2组患者的日常生活能力,采用视觉模拟评分(VAS)评估2组患者的疼痛程度;使用关节量角器测量肘关节旋前度数、旋后度数、屈伸度数,评估2组患者的肘关节活动度;使用Keypoint型肌电图仪检测小指展肌的复合肌肉动作电位(CMAP)、尺神经的神经传导速度(NCV)、运动诱发电位潜伏期(MEPLP),评估2组患者神经恢复情况。结果观察组患者的手术时间、住院时间显著短于对照组,术中出血量、并发症显著少于对照组(P<0.05)。术前,观察组和对照组患者的MEPS、ADL、VAS评分比较差异无统计学意义(P>0.05);术后6个月,观察组患者的MEPS、ADL评分显著高于对照组,VAS评分显著低于对照组(P<0.05)。术前,观察组和对照组患者的旋前度数、旋后度数、屈伸度数比较差异无统计学意义(P>0.05);术后6个月,2组患者的旋前度数、旋后度数、屈伸度数显著高于术前(P<0.05),观察组和对照组患者的旋前度数、旋后度数、屈伸度数比较差异无统计学意义(P>0.05)。术前,观察组和对照组患者的CMAP、NCV、MEPLP比较差异无统计学意义(P>0.05);术后6个月,观察组患者的CMAP、NCV显著高于对照组,MEPLP显著低于对照组(P<0.05)。结论常规肘管扩大成型术、关节镜联合肘关节扩大成型术均可改善肘关节骨性关节炎伴肘管综合征患者的肘关节活动度,但后者损伤更小,恢复更快,在提升肘关节功能及日常生活能力、减轻疼痛程度、调节肌电图检查指标等方面效果更佳,且并发症更少。

一例小灵猫肘关节脱位合并掌骨创伤的救护

江西省野生动物救护中心收容救护1只受伤的小灵猫(Viverricula indica),通过一般检查、血液检查和影像学检查,确诊小灵猫右前肢肘关节外侧脱位合并掌部创伤。采用无菌清创、手术整复、科学护理等救护技术,2个月后小灵猫恢复健康,并成功放归野外。

研究测量前脂肪垫与肱骨皮质角度诊断肘关节骨折的意义

目的研究测量肘关节标准侧位片中前脂肪垫与肱骨皮质间角度,探讨诊断肘关节骨折引起的前脂肪垫征阳性角度的临界值,从而帮助骨科医生确定治疗方案。方法从CT检查确诊的肘关节外伤引起的骨折与未骨折患者中,各选取X线片侧位中前脂肪垫征阳性患者50例,进行ROC曲线回顾性分析。结果前脂肪垫与肱骨皮质夹角为15.6°,灵敏度+特异度值最大。讨论前脂肪垫与肱骨皮质夹角≥15.6°为骨折临界值,为基层医院骨科医生治疗提供了清晰、客观的诊断依据。

复合皮移植联合VSD修复碾压伤致肘关节外露

目的:探讨复合皮移植联合负压封闭引流(Vacuum sealing drainage,VSD)在碾压伤伴关节外露创面修复中的临床应用效果及可行性。方法:2020年12月,笔者科室收治1例因左上肢车祸伤致皮肤坏死伴肿胀1 d的患者,入院时查体左上肢肿胀,左前臂、肘部可见约15.0 cm×20.0 cm皮肤坏死,左手感觉功能减退,桡动脉尚可触及,急诊手术探查见肘关节外露、脱位,肱三头肌自肱骨大范围撕脱,尺神经外露、移位,肘关节、尺骨外露范围约3.0 cm×5.0 cm。根据患者病史、临床表现、左上肢X线片及手术探查体征诊断左上肢碾压伤,肘关节外露。应用复合皮移植两步法联合VSD覆盖创面,自体中厚皮片移植修复皮肤缺损。结果:患者左上肢皮肤缺损处愈合良好,术后4个月复查,肘关节屈曲、伸直、旋转功能均恢复良好。结论:对于此例肘关节、骨外露创面,应用复合皮移植后可覆盖骨外露创面,大大降低了手术难度及患者的痛苦,为以后相对小面积骨外露创面的修复提供了新思路。

内侧髌股韧带重建的研究进展

髌股关节不稳是一种常见的膝关节损伤,主要见于年轻患者,明显影响患者的日常生活和运动功能。内侧髌股韧带(MPFL)是髌骨内侧限制髌骨外向脱位的主要稳定结构,也是髌骨不稳发生时必然要损坏的结构。因此,通过MPFL重建恢复髌骨的稳定性为必要措施。虽然MPFL重建在临床上应用较为广泛,但部分手术细节,如股骨隧道和髌骨隧道定位、移植物材料选择、移植物固定角度、移植物张力选择等方面是否影响疗效仍存在争议。近年来,生物力学研究和临床研究的不断深入为术式的优化提供了可靠的循证依据。本文笔者将对MPFL重建的研究新进展进行综述。

外侧柱入路肘关节松解术治疗肘关节僵硬的应用疗效研究

目的探究外侧柱入路手术松解治疗肘关节僵硬的应用及早期临床疗效。方法回顾性分析中国科学技术大学附属第一医院(安徽省立医院)关节外科2022年2月至2023年6月采用外侧柱入路肘关节松解术治疗肘关节僵硬患者的临床资料21例。其中,男15例,女6例;年龄12~61岁,平均(49.4±13.0)岁。采用Mayo肘关节功能(Mayo elbow performance score,MEPS)评分、肘关节活动度(range of motion,ROM)的变化及疼痛视觉模拟评分(visual analogue scale,VAS)对临床治疗效果进行评估。结果术后21例患者均获得随访,随访时间为3~16个月,平均(9.3±3.1)个月,患者的手术时间为39~155 min,平均(84.2±25.5)min,住院时间为3~16 d,平均(8.8±3.0)d,术中无血管、神经损伤。末次随访时所有患者肘关节MEPS评分、肘关节ROM的变化及VAS评分与术前相比均获得显著变化,差异存在统计学意义(P<0.05)。结论采用外侧柱入路肘关节松解术治疗肘关节僵硬可显著改善早期肘关节功能及活动度,为肘关节僵硬患者的手术治疗提供了一种安全且有效的术式选择。