Objective: To explore the clinical value of X-ray digital tomosynthesis(DTS)in the diagnosis of knee joint fractures. Methods: A total of 28 cases of thoracic trauma, X-ray film cannot be clearly diagnosed or can conf...Objective: To explore the clinical value of X-ray digital tomosynthesis(DTS)in the diagnosis of knee joint fractures. Methods: A total of 28 cases of thoracic trauma, X-ray film cannot be clearly diagnosed or can confirm the diagnosis but the need for further identification of forensic diagnosis of cases of DTS scan and three-dimensional reconstruction in order to control the study. Results: 1. The reconstructed images after DTS scanning showed that the knee joint fractures were clearly diagnosed, and the detection rate of 28 knee joint fractures was 92.86%. 2. DTS scanning could clearly detect the fresh knee joint fracture's fracture line, corresponding line and broken bones. For the old fracture, DTS scanning could clearly show the condition of the fracture end's healing. Conclusions: The technique is of great value in the diagnosis of knee joint fracture, especially in the examination of complex structure, thick body and review of internal fixation after fracture.展开更多
BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications w...BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.展开更多
BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for ear...BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.展开更多
目的:探讨量化康复训练对胫腓骨平台骨折术后患者膝关节功能恢复及Barthel指数的影响。方法:选择2017年1月-2019年8月在我院接受治疗的胫腓骨平台骨折术后患者1068例,按照随机数表法将其分为两组,各534例。对照组患者接受常规训练干预,...目的:探讨量化康复训练对胫腓骨平台骨折术后患者膝关节功能恢复及Barthel指数的影响。方法:选择2017年1月-2019年8月在我院接受治疗的胫腓骨平台骨折术后患者1068例,按照随机数表法将其分为两组,各534例。对照组患者接受常规训练干预,观察组患者接受量化康复训练干预,对比两组患者的肌力恢复情况、美国特种外科医院(American Hospital of Special Surgery,HSS)评分、Lysholm、巴氏(Barthel)指数、膝关节屈曲角度、伸直受限角度以及关节活动范围。结果:观察组患者的肌力恢复总优良率较对照组高,差异具有统计学意义(P<0.05);观察组干预后的HSS、Lysholm、Barthel指数、膝关节屈曲角度及关节活动范围均较对照组高,伸直受限角度低于对照组,差异具有统计学意义(P<0.05)。结论:量化康复训练应用于胫腓骨平台骨折术后,可以有效恢复膝关节功能,提高自理能力。展开更多
目的探讨关节镜联合C型臂X线机治疗胫骨平台骨折的效果。方法方便选择2017年1月—2022年12月丹阳市人民医院收治的78例胫骨平台骨折患者为研究对象,以随机双盲法分为两组,每组39例。对照组行常规切开复位内固定术,观察组行关节镜联合C型...目的探讨关节镜联合C型臂X线机治疗胫骨平台骨折的效果。方法方便选择2017年1月—2022年12月丹阳市人民医院收治的78例胫骨平台骨折患者为研究对象,以随机双盲法分为两组,每组39例。对照组行常规切开复位内固定术,观察组行关节镜联合C型臂X线机微创内固定术,对两组手术疗效、手术指标、膝关节功能恢复与并发症发生情况进行分析比较。结果观察组手术优良率(97.44%)明显高于对照组(82.05%),差异有统计学意义(χ^(2)=5.014,P<0.05);观察组手术治疗相关指标优于对照组,差异有统计学意义(P均<0.05)。术后6个月两组患者Lysholm、纽约特种外科医院(Hospital for Special Surgery,HSS)评分均升高,且观察组Lysholm、HSS评分明显高于对照组,差异有统计学意义(P均<0.05)。观察组术后并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。结论胫骨平台骨折患者采用关节镜联合C型臂X线机治疗的疗效确切,患者创伤小、术后恢复快、并发症少,且对患者膝关节功能的恢复有着明显的促进作用。展开更多
文摘Objective: To explore the clinical value of X-ray digital tomosynthesis(DTS)in the diagnosis of knee joint fractures. Methods: A total of 28 cases of thoracic trauma, X-ray film cannot be clearly diagnosed or can confirm the diagnosis but the need for further identification of forensic diagnosis of cases of DTS scan and three-dimensional reconstruction in order to control the study. Results: 1. The reconstructed images after DTS scanning showed that the knee joint fractures were clearly diagnosed, and the detection rate of 28 knee joint fractures was 92.86%. 2. DTS scanning could clearly detect the fresh knee joint fracture's fracture line, corresponding line and broken bones. For the old fracture, DTS scanning could clearly show the condition of the fracture end's healing. Conclusions: The technique is of great value in the diagnosis of knee joint fracture, especially in the examination of complex structure, thick body and review of internal fixation after fracture.
基金Supported by the General Cultivation Project of Xi'an Health Commission,No.2021ms08.
文摘BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.
文摘BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.
文摘目的:探讨量化康复训练对胫腓骨平台骨折术后患者膝关节功能恢复及Barthel指数的影响。方法:选择2017年1月-2019年8月在我院接受治疗的胫腓骨平台骨折术后患者1068例,按照随机数表法将其分为两组,各534例。对照组患者接受常规训练干预,观察组患者接受量化康复训练干预,对比两组患者的肌力恢复情况、美国特种外科医院(American Hospital of Special Surgery,HSS)评分、Lysholm、巴氏(Barthel)指数、膝关节屈曲角度、伸直受限角度以及关节活动范围。结果:观察组患者的肌力恢复总优良率较对照组高,差异具有统计学意义(P<0.05);观察组干预后的HSS、Lysholm、Barthel指数、膝关节屈曲角度及关节活动范围均较对照组高,伸直受限角度低于对照组,差异具有统计学意义(P<0.05)。结论:量化康复训练应用于胫腓骨平台骨折术后,可以有效恢复膝关节功能,提高自理能力。
文摘目的探讨关节镜联合C型臂X线机治疗胫骨平台骨折的效果。方法方便选择2017年1月—2022年12月丹阳市人民医院收治的78例胫骨平台骨折患者为研究对象,以随机双盲法分为两组,每组39例。对照组行常规切开复位内固定术,观察组行关节镜联合C型臂X线机微创内固定术,对两组手术疗效、手术指标、膝关节功能恢复与并发症发生情况进行分析比较。结果观察组手术优良率(97.44%)明显高于对照组(82.05%),差异有统计学意义(χ^(2)=5.014,P<0.05);观察组手术治疗相关指标优于对照组,差异有统计学意义(P均<0.05)。术后6个月两组患者Lysholm、纽约特种外科医院(Hospital for Special Surgery,HSS)评分均升高,且观察组Lysholm、HSS评分明显高于对照组,差异有统计学意义(P均<0.05)。观察组术后并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。结论胫骨平台骨折患者采用关节镜联合C型臂X线机治疗的疗效确切,患者创伤小、术后恢复快、并发症少,且对患者膝关节功能的恢复有着明显的促进作用。
