Complex knee injuries treated in acute phase: Long-term results using Ligament Augmentation and Reconstruction System artificial ligament

AIM To present the long-term results of complex knee injuries, treated early using the Ligament Augmentation and Reconstruction System(LARS) artificial ligament to reconstruct posterior cruciate ligament(PCL).METHODS From September 1997 to June 2010, thirty-eight complex knee injuries were treated, where early arthroscopic PCL reconstructions were undergone, using the LARS(Surgical Implants and Devices, Arc-sur-Tille, France) artificial ligament. Exclusion criteria were: Late(> 4 wk) reconstruction, open technique, isolated PCL reconstruction, knee degenerative disease, combinedfracture or vascular injury and use of allograft or autograft for PCL reconstruction. Clinical and functional outcomes were assessed with IKDC Subjective Knee Form, KOS-ADLS questionnaire, Lysholm scale and SF-12 Health Survey. Posterior displacement(PD) was measured with the Telos Stress Device. RESULTS Seven patients were excluded; two because of coexisting knee osteoarthritis and the remaining five because of failure to attend the final follow-up. The sample consisted of 31 patients with mean age at the time of reconstruction 33.2 ± 12.5 years(range 17-61). The postoperative follow-up was on average 9.27 ± 4.27 years(range 5-18). The mean average IKDC and KOS scores were 79.32 ± 17.1 and 88.1 ± 12.47% respectively. Average PD was 3.61 ± 2.15 mm compared to 0.91 ± 1.17 mm in the uninjured knees(one with grade 1+ and two with grade 2 +). Dial test was found positive in one patient, whereas the quadriceps active drawer test was positive in three patients. None was tested positive on the reverse-pivot shift test. The range of motion(ROM) was normal in thirty knees, in comparison with the contralateral one. There was no extension deficit. Osteoarthritic changes were found in three knees(9.6%).CONCLUSION Early treatment of complex knee injuries, using LARS artificial ligament for PCL reconstruction sufficiently reduces posterior tibia displacement and provides satisfactory long-term functional outcomes.

Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis:A long-term observational study in Russia

BACKGROUND Oral treatment of glucosamine(GA) combined with chondroitin sulfate(CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clinical trials. While the effectiveness of GA and CS on both clinical and radiological findings has been demonstrated, only a few high-quality trials exist. Therefore, controversy regarding their effectiveness in real-world clinical practice remains.AIM To investigate the impact of GA + CS on clinical outcomes of patients with knee and hip osteoarthritis in routine clinical practice.METHODS A multicenter prospective observational cohort study included 1102 patients of both genders with knee or hip osteoarthritis(Kellgren & Lawrence grades Ⅰ-Ⅲ) in 51 clinical centers in the Russian Federation from November 20, 2017, to March 20,2020, who had started to receive oral capsules of glucosamine hydrochloride 500 mg and CS 400mg according to the approved patient information leaflet starting from 3 capsules daily for 3 wk,followed by a reduced dosage of 2 capsules daily before study inclusion(minimal recommended treatment duration is 3-6 mo). Changes in subscale scores [Pain, Symptoms, Function, and Quality of Life(QOL)] of the Knee Injury and Osteoarthritis Outcome Score(KOOS)/Hip Disability and Osteoarthritis Outcome Score(HOOS) questionnaires during the observational period(up to 54-64wk with a total of 4 visits). Patients’ treatment satisfaction, data on the combined oral use of glucosamine hydrochloride and CS, concomitant use of non-steroidal anti-inflammatory drugs(NSAIDs), and adverse events(AEs) were also evaluated.RESULTS A total of 1102 patients with knee and hip osteoarthritis were included in the study. The mean patient age was 60.4 years, most patients were women(87.8%), and their average body mass index was 29.49 kg/m2. All subscale scores(Pain, Symptoms, Function, and QOL) of the KOOS and HOOS demonstrated clinically and statistically significant improvements. In patients with knee osteoarthritis, the mean score increases from baseline to the end of Week 64 were 22.87, 20.78,16.60, and 24.87 on Pain, Symptoms, Physical Function(KOOS-PS), and QOL subscales(P < 0.001for all), respectively. In patients with hip osteoarthritis, the mean score increases were 22.81, 19.93,18.77, and 22.71 on Pain, Symptoms, Physical Function(HOOS-PS), and QOL subscales(P < 0.001for all), respectively. The number of patients using any NSAIDs decreased from 43.1% to 13.5%(P < 0.001) at the end of the observation period. Treatment-related AEs occurred in 2.8% of the patients and mainly included gastrointestinal disorders [25 AEs in 24(2.2%) patients]. Most patients(78.1%) were satisfied with the treatment.CONCLUSION Long-term oral GA + CS was associated with decreased pain, reduced concomitant NSAID therapy, improved joint function and QOL in patients with knee and hip osteoarthritis in routine clinical practice.

Commentary on“The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in the early phase of cutting maneuvers in female athletes”

1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Consequently,great effort and expense has gone into capturing 3-dimensional kinetics and kinematics from live athletes to drive in vitro and in silico models of ACL injury in order to elucidate the actual mechanism of injury,as these factors have been demonstrated to be surrogates of intraarticular structural loading on the ACL.2,3 The elucidation of injury mechanisms for non-contact ACL injuries is of great medical value as such knowledge consequently permits quantified examination and validation of interventions and their respective effectiveness in both prevention and rehabilitation of these traumatic knee injuries.

Effect of sodium hyaluronate combined with rehabilitation training on knee joint injury caused by golf

BACKGROUND In high-intensity sports like golf,knee joints are prone to injury,leading to pain,limited mobility,and decreased quality of life.Traditional treatment methods typically involve rehabilitation exercises,but their effectiveness may be limited.In recent years,sodium hyaluronate has emerged as a widely used biomedical material in the treatment of joint diseases.AIM To explore the effect of sodium hyaluronate combined with rehabilitation training on pain degree,flexion range of motion and motor function of knee joint injured by golf.METHODS Eighty patients with knee joint injury caused by golf were randomly divided into control(group B)and observation group(group A).The group B was treated with rehabilitation training,and the group A was treated with sodium hyaluronate combined with rehabilitation training.The clinical efficacy,range of motion and function of knee joint,quality of life and inflammatory factors were compared.RESULTS The excellent and good rate of rehabilitation in the group A was raised than group B.At 6 weeks and 3 months after treatment,the range of motion of the two groups was raised than that before treatment,and that of the group A was raised than group B.After treatment,the scores of Lysholm and International Knee Documentation Committee(IKDC)in the group A were raised,and those in the group A were raised than group B.The VAS score of the two groups was reduced than that of the group B,and the SF-36 score of the group A was reduced than group B.The interleukin(IL)-1β,IL-8 and tumor necrosis factor-αin the two groups were reduced,and those in the group A were reduced than group B.CONCLUSION Sodium hyaluronate combined with rehabilitation training has a good clinical effect in the treatment of patients with knee joint injury caused by golf,which relieve pain,maintain knee joint function and improve patients'life quality.

A Mesh Meta-Analysis of the Effectiveness of Different Warm-Up Exercises to Prevent Knee Injuries in Young Child Soccer Players

Objective: A mesh Meta-analysis was used to evaluate the effectiveness of four warm-up exercises to prevent knee injuries in juvenile soccer players. Method: They are a randomized controlled trial (RCT) on FIFA 11+ integrated warm-up, FIFA 11+ Kids integrated warm-up, and neuromuscular training (NMT) warm-up for the prevention of knee joint in juvenile soccer players by a computer search of CNKI, CBMdisc, WanFangdata, Pubmed, Web of science, and SPORTDicus database. The search period was from the establishment of each database to February 2022. Two investigators screened the literature, extracted data, and assessed risk bias for the included studies according to the pre-defined inclusion and exclusion criteria, and finally analyzed the data using Stata 14.0 software and OpenBUGS software. Results: A total of 10 RCT studies with 17,143 subjects, spanning the age range of 7 to 19 years, were included. The results of the reticulated Meta-analysis showed that all three warm-up modalities were effective in reducing the incidence of knee injuries in junior soccer players compared to conventional warm-up, with the optimality in descending order of FIFA 11+ Kids comprehensive warm-up (SUCRA = 85.3), neuromuscular training warm-up (SUCRA = 66.7), and FIFA 11+ combined warm-up (SUCRA = 44). Conclusion: The FIFA 11+ Kids comprehensive warm-up is the most effective warm-up exercise for the prevention of knee injuries in junior and child soccer players, but the above findings need further validation due to the quantity and quality of the literature and the quality of the evidence.

Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non-Operatively

Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Background:Knee examination guidelines in minors are intended to aid decisionmaking in the management of knee instability.Clinical question:A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence.A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children.Key findings:there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary.Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed.Clinical application:In the absence of a strong evidence base,these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible.Following this expert consensus,surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test++,and may include an anterior drawer test+and a Lachman test+.If these conditions are not present,the conservative approach should be chosen,as the anatomical and functional development of children,together with a physiotherapy programme,may improve the evolution of the injury.

Injuries Requiring Surgery in Folk Dancers： A Retrospective Cohort Study of 9 Years

Background： In this study, we examined professional folk dancer injuries which required surgery and if there are any associated factors like age, gender, dexterity, dance style and to evaluate the return to their full capacity. Materials and Methods： Seventy five members of the Fire of Anatolia dance group （mean age： 26.8 ± 5.2; 18-38 years） performers were evaluated. The dancers suffered 14 orthopedic injuries requiring surgery （3 meniscus tears, 2 anterior cruciate ligament tears one of which is with posterolateral corner tear, 1 posterior cruciate ligament tear, 1 patellar dislocation, 1 scaphoid fracture, 1 extensor tendon cut in hand, 1 infrapatellar bursitis, 2 Hoffa’s fat pad syndromes, 2 symptomatic medial plicaes） during a nine-year period. Follow-up time was 51 ± 41.9 （29.5-92） months. Results： Following surgeries, the dancers could restart rehearsals in 12.7 ± 9 （range： 4 to 36） weeks and perform live on the stage in 16.2 ± 12.2 （range： 5 to 52） weeks on average. Conclusion： Males were 8.64 times more likely to suffer an injury requiring surgery compared to the females （p = 0.003） and twelve （85.7%） of these injuries were lower extremity injuries and were all located in the knee in Anatolian folk dancers.

3D Finite Element Model of Human Knee Injuries in the Traffic Accident

Objective To explore the injury mechanism of the human knee in a traffic accident by establishing a 3D finite element(FE) model. Methods The FE model, composed of femur, tibia, fibula, patella, meniscus, knee ligaments and surrounding soft tissues, was reconstructed by CT scanning data from a male volunteer. Validation was performed by the lateral impact simulation, and the stress and strain results were obtained to be compared with those previously reported for injury prediction. Results The results derived from the FE model were found to be similar with those previously reported, most of the ligaments and meniscus wounded at 40 m/s collision, which was readily observed. Conclusion The simulation results generated by FE model can be effectively used for the injury mechanism analysis of initial contact.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Injuries in Spanish female soccer players

Background: Epidemiologic research to learn the incidence, type, location, and severity of female soccer injuries and the risk factors for sustaining a sport injury is the first step in developing preventive policies. The aim of this study was to analyze the incidence of injuries in the population of female soccer players in Spain.Methods: The injuries incurred by 25,397 female soccer players were registered by the medical staff of the Spanish Football Federation during 1 season. A standardized medical questionnaire was used to classify the injury according to type, severity, location, and injury mechanism. A total of 2108 injuries was reported with an incidence of 0.083 injuries per player per season. Most injuries were in the lower limbs(74.0%), mainly affecting knee(30.4%) and ankle joints(17.9%).Results: The proportion of injuries derived from contact with another player was higher during matches(33.7%) than during training(11.4%;p < 0.001). Noncontact injuries were classified as severe more frequently than were contact injuries(51.0% vs. 42.6%; p < 0.001). A higher incidence of injury was found in adult soccer players(≥18 years) vs. their counterparts younger than 18 years(0.094 vs. 0.072 injuries per player per year, respectively; p < 0.001). There were no differences between age groups in any other injury variable(e.g., type, mechanism, location, or severity; p > 0.05).Conclusion: Most female soccer injuries were located at the knee and ankle; the injury mechanism determined the playing time lost; and the player's age did not affect injury characteristics.

RDW、PDW与su-PAR对重度创伤性颅脑损伤患者预后的评估价值

目的 研究红细胞体积分布宽度(RDW)、血小板体积分布宽度(PDW)、可溶性尿激酶型纤溶酶原激活物受体(su-PAR)对重度创伤性颅脑损伤(TBI)患者预后的评估价值。方法 120例TBI患者根据格拉斯哥昏迷评分(GCS)分为重度组64例、轻中度组56例,另选50例健康者为对照组。比较各组血清RDW、PDW及su-PAR水平,ROC曲线分析其在预测重度TBI患者预后中的价值。结果 重度组相较于轻中度组和对照组,RDW和PDW水平均升高,三组su-PAR依次下降(P<0.05)。随访3个月,重度组预后不良33例,预后不良组RDW、PDW及su-PAR均高于预后良好组(P<0.05)。重度组RDW、PDW、su-PAR与入院时GCS评分呈负相关(P<0.05),su-PAR与RDW和PDW呈正相关(P<0.05)。ROC曲线分析发现,三指标联合预测重度TBI患者预后不良的价值最高。结论 重度TBI患者RDW、PDW及su-PAR均异常升高,可作为评估TBI病情及预后的潜在指标。

Perspectives on endogenous and exogenous tissue engineering following injury to tissues of the knee

The knee is a multi-component organ system comprised of several tissues which function coordinately to provide mobility. Injury to any one component compromises the integrity of the system and leads to adaptation of the other components. Over time, such events often lead to dysfunction and degeneration of the knee. Therefore, there has been considerable research emphasis to repair injured components in the knee including cartilage, menisci, and ligaments. Approaches to improving healing and repair/regeneration of knee tissues have included surgery, anti-sense gene therapy, injection of growth factors and inflammatory cytokine antagonists, transplantation of in vitro expanded chondrocytes, enhancement of endogenous cells via microfracture, injection of mesenchymal stem cells, and implantation of in vitro tissue engineered constructs. Some of these approaches have lead to temporary improvement in knee functioning, while others offer the potential to restore function and tissue integrity for longer periods of time. This article will review the status of many of these approaches, and provide a perspective on their limitations and potential to contribute to restoration of knee function across the lifespan.

Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.

关节镜下自体骨软骨移植对膝关节局限性软骨损伤的临床疗效评价

目的探讨关节镜下自体骨软骨移植术对膝关节局限性软骨损伤的临床疗效,并以磁共振成像(MRI)检查对疗效进行评价。方法选取2018年6月至2021年6月诊治的100例膝关节局限性软骨损伤患者,按随机数字表法分为研究组和对照组,每组各50例。研究组采取关节镜下自体骨软骨移植术,对照组采取微骨折术治疗。采用MRI评估其手术疗效,并记录其术后膝关节软骨愈合时间;采用Lysholm膝关节功能评分表、国际膝关节文献委员会(IKDC)膝关节评估表,评估患者治疗前后膝关节功能变化;统计患者术后并发症发生率。结果研究组关节软骨愈合优良率98.00%,高于对照组84.00%(P<0.05)。两组术前和术后3个月的Lysholm评分、IKDC评分比较差异无统计学意义(P>0.05);术后6、12、24个月,研究组Lysholm评分、IKDC评分均高于对照组(P<0.05)。两组患者术后均无严重并发症,且并发症发生率差异无统计学意义(P>0.05)。研究组术后膝关节软骨愈合时间短于对照组(P<0.05)。结论关节镜下自体骨软骨移植术对膝关节局限性软骨损伤的远期治疗效果显著,可有效改善患者术后膝关节功能,缩短膝关节软骨愈合时间,安全性高。

贝母素乙调节RhoA/ROCK信号通路对膝骨关节炎大鼠软骨损伤的影响

目的 探讨贝母素乙调节Ras同源基因家族成员A(RhoA)/Rho相关的卷曲螺旋激酶(ROCK)信号通路对膝骨关节炎(knee osteoarthritis, KOA)大鼠软骨损伤的影响。方法 以碘乙酸钠(MIA)法制备KOA大鼠模型,随机分为模型组、贝母素乙(3.5 mg/kg)组、贝母素乙(3.5 mg/kg)+LPA(RhoA激活剂,1 mg/kg)组,每组10只,另选10只大鼠为对照组。机械刺激法和热辐射法检测大鼠膝关节疼痛症状;检测大鼠关节肿胀度、膝关节宽度并以步态评分评测其关节功能;透射电镜检测大鼠膝关节软骨细胞超微结构;TUNEL染色检测大鼠关节软骨细胞凋亡比;酶联免疫吸附(ELISA)法检测大鼠血清和关节液促炎因子白细胞介素(IL)-18、单核细胞趋化蛋白1(MCP-1)水平;免疫印迹检测各组大鼠关节软骨组织凋亡(Cleaved caspase-3、Bax)和RhoA/ROCK通路相关蛋白表达。结果 贝母素乙可降低KOA大鼠关节肿胀度、膝关节宽度、步态评分、软骨细胞凋亡比、血清及关节液IL-18、MCP-1水平、软骨组织Cleaved caspase-3、Bax、RhoA、ROCK1、ROCK1蛋白表达,升高机械痛阈值、热痛阈值(P<0.05);LPA可减弱贝母素乙对KOA大鼠关节软骨损伤的改善作用。结论 贝母素乙可通过抑制RhoA/ROCK信号激活而抑制KOA大鼠关节炎症反应和关节软骨细胞凋亡,减轻软骨损伤。

CT与MRI在膝关节软骨损伤分级诊断中的效能分析

目的:探究CT与MRI在膝关节软骨损伤分级诊断中的效能。方法:回顾性选取我院2021年1月-2023年1月收治的80例膝关节软骨损伤患者为研究对象,对所有患者行CT、MRI和关节镜检查,通过关节镜检查的结果,评估二者的分级诊断效能,并比较CT与MRI在膝关节软骨损伤分级诊断中的诊断价值。结果:患者经CT检查诊断的分级结果为Ⅰ级28例,Ⅱ级34例,Ⅲ级及以上18例;经MRI检查诊断的分级结果为Ⅰ级31例,Ⅱ级29例,Ⅲ级及以上20例。与关节镜检查的结果对比,CT的分级诊断准确率为81.25%(65/80),MRI的分级诊断准确率为95.00%(76/80)。MRI检查诊断膝关节软骨损伤患者的Ⅰ级诊断准确率、总准确率要高于CT检查,差异有统计学意义(P<0.05)。结论:CT与MRI均可对膝关节软骨损伤进行分级诊断,但MRI对膝关节软骨损伤分级的诊断准确率高于CT,具有更高的诊断效能。

青鹏软膏超声波导入对膝关节军事训练伤的疗效研究

背景膝关节损伤是常见的军事训练伤,严重影响战士的战斗力,近年军事训练伤的防治变得越发重要。超声波治疗和青鹏软膏是常用的运动损伤疗法,但是两者联合应用的研究较少。目的分析青鹏软膏超声波导入治疗军事训练致膝关节损伤的临床效果。方法选取2022年5—7月在中国人民解放军西部战区总医院第五派驻门诊部治疗的膝关节损伤患者56例,利用IBM-SPSS 25.0统计软件产生随机数字后进行随机分组,分为对照组(研究过程中脱落4例,n=24)与治疗组(n=28)。对照组给予普通耦合剂超声波治疗,治疗组给予青鹏软膏超声波导入治疗,1次/d,1个疗程10次,共2个疗程。比较两组治疗前后Lysholm膝关节评分、视觉模拟评分法(VAS)评分、汉密尔顿抑郁量表(HAMD-17)评分、膝关节活动度。结果治疗前,两组患者Lysholm膝关节评分、VAS评分、HAMD-17评分、膝关节活动度比较,差异无统计学意义(P>0.05)。治疗2个疗程,治疗组患者膝关节被动关节活动度优于对照组(P<0.05)。治疗2个疗程后,两组患者Lysholm膝关节评分高于治疗前,VAS评分低于治疗前(P<0.05)。与治疗前相比,治疗组治疗2个疗程膝关节主动关节活动度、被动关节活动度增加(P<0.05);与治疗前比较,治疗组患者治疗2个疗程HAMD-17评分降低(P<0.05)。结论青鹏软膏超声导入治疗与普通耦合剂超声波两种治疗方法均可显著增加Lysholm膝关节评分,改善膝关节功能;降低膝关节损伤患者VAS评分,缓解疼痛。青鹏软膏作为超声波治疗的特殊耦合剂,相比普通耦合剂,具有一定的优势。

MRI检查指标、血清骨钙素、MMP-1及IL-1对膝骨关节炎合并软骨损伤的预测价值

目的探讨磁共振成像(MRI)及血清骨钙素、基质金属蛋白酶(MMP-1)及白细胞介素-1(IL-1)对膝骨关节炎合并软骨损伤的预测价值。方法回顾性分析2021年8月至2023年5月广西贵港市人民医院收治的84例膝骨关节炎患者的临床资料。入院后均行关节镜检查,依据检查结果是否合并软骨损伤分组,分为合并组(n=40)与未合并组(n=44)。比较两组资料[性别、年龄、体重指数、合并疾病(高血压、高脂血症、糖尿病)、病变部位(左膝、右膝)、饮酒史、吸烟史]、MRI不同区域软骨T_(2)值[股骨外侧(LF)、股骨内侧(MF)、胫骨外侧(LT)、胫骨内侧(MT)、髌骨区(P)]以及血清骨钙素、MMP-1、IL-1水平。通过多因素采取非条件Logistic逐步回归分析明确膝骨关节炎合并软骨损伤的危险因素。通过受试者操作特征(ROC)曲线分析MRI不同区域软骨T_(2)值、血清骨钙素、MMP-1、IL-1预测膝骨关节炎合并软骨损伤的价值。结果两组性别构成比、年龄、体重指数、病变部位、合并高血压、高脂血症、糖尿病、饮酒史、吸烟史比较,差异均无统计学意义(P>0.05);合并组MRI不同区域软骨T_(2)值以及血清骨钙素、MMP-1、IL-1水平均显著高于未合并组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,MRI不同区域软骨T_(2)值、骨钙素、MMP-1、IL-1是膝骨关节炎患者合并软骨损伤的危险因素(P<0.05)。经ROC分析证实,LF软骨T_(2)值、MF软骨T_(2)值、LT软骨T_(2)值、MT软骨T_(2)值、P软骨T_(2)值、骨钙素、MMP-1、IL-1最佳截断值分别为39.705 ms、44.250 ms、36.855 ms、35.715 ms、38.005 ms、6.655μg/L、7.335μg/L、389.340 pg/mL,曲线下面积分别为0.796、0.840、0.859、0.882、0.728、0.705、0.763、0.721,均有较高预测价值(P<0.05)。结论MRI不同区域软骨T_(2)值、血清骨钙素、MMP-1、IL-1是膝骨关节炎合并软骨损伤的危险因素;同时LF软骨T_(2)值≥39.705 ms、MF软骨T_(2)值≥44.250 ms、LT软骨T_(2)值≥36.855 ms、MT软骨T_(2)值≥35.715 ms、P软骨T_(2)值≥38.005 ms、骨钙素≥6.655μg/L、MMP-1≥7.335μg/L、IL-1≥389.340 pg/mL可用于预测此类患者合并风险。