There is more to the knee joint than just the quadriceps:A systematic review with meta-analysis and evidence gap map of hamstring strength,flexibility,and morphology in individuals with gradual-onset knee disorders

Background:Impairments in hamstring strength,flexibility,and morphology have been associated with altered knee biomechanics,pain,and function.Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation.This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength,flexibility,and morphology in individuals with gradual-onset knee disorders.Methods:Five databases(MEDLINE,Embase,CINAHL,SPORTDiscus,and Web of Science)were searched from inception to September 2022.Only studies comparing hamstring outcomes(e.g.,strength,flexibility,and/or morphology)between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included.Meta-analyses for each knee disorder were performed.Outcome-level certainty was assessed using the Grading of Recommendations Assessment,Development,and Evaluation,and evidence gap maps were created.Results:Seventy-nine studies across 4 different gradual-onset knee disorders(i.e.,knee osteoarthritis(OA),patellofemoral pain(PFP),chondromalacia patellae,and patellar tendinopathy)were included.Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric(standard mean difference(SMD)=-0.76,95%confidence interval(95%CI):-1.32 to-0.21)and concentric contractions(SMD=-0.97,95%CI:-1.49 to-0.45).Individuals with PFP presented with reduced hamstring strength compared to painfree controls during isometric(SMD=-0.48,95%CI:-0.82 to-0.14),concentric(SMD=-1.07,95%CI:-2.08 to-0.06),and eccentric contractions(SMD=-0.59,95%CI:-0.97 to-0.21).No differences were observed in individuals with patellar tendinopathy.Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls(SMD=-0.76,95%CI:-1.15 to-0.36).Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders.Conclusion:Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.

下肢生物力学调整治疗髌骨软化症的临床效果

目的:探讨下肢生物力学调整治疗髌骨软化症(CP)的临床效果。方法:选择2021至2022年门诊康复科治疗的60例CP患者为研究对象,按随机数字表法分为对照组和观察组各30例,对照组给予膝关节功能训练,观察组在对照组基础上给予下肢生物力学调整,对比两组的膝关节疼痛程度、膝关节功能和Q角。结果:治疗1周后,两组患者VAS评分、LKSS评分均较治疗前显著改善(P<0.05),而观察组上述评分虽优于对照组,却无统计学差异(P>0.05)。治疗8周后,两组患者VAS评分、LKSS评分均显著优于治疗1周后(P<0.05),且观察组上述评分显著优于对照组(P<0.05)。在治疗结束后6个月随访时,观察组VAS评分、LKSS评分显著优于治疗8周后(P<0.05),而对照组上述评分显著劣于治疗8周后(P<0.05)。对照组治疗1周、8周及6个月随访时Q角与治疗前比较,差异均无统计学意义(P>0.05)。对照组治疗1周Q角与同期观察组比较,差异无统计学意义(P>0.05),而治疗8周、6个月随访时Q角显著劣于同期观察组。观察组治疗1周Q角与治疗前比较,差异无统计学意义(P>0.05),而治疗8周Q角显著优于治疗1周,而显著劣于6个月随访时。结论:与单纯膝关节功能训练相比,下肢生物力学整体调整治疗CP的远期疗效更好,值得临床推广应用。

Clinical effect of traditional Chinese spinal orthopedic manipulation in treatment of chondromalacia patellae

OBJECTIVE: To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation(TCSOM) in treating chondromalacia patellae(CP).METHODS: Sixty cases of CP patients were randomly assigned to a TCSOM group and a Celecoxib group according to the random number table method. All patients in the TCSOM group were treated with a maximum of 10 spinal manipulations and rehabilitation training of quadriceps femoris. The symptoms before and after treatment were assessed with visual analog scale(VAS) and Kujala functional knee scoring system(KFKSS). A symptom improvement rate(SIR) was implemented in order to evaluate the effects of the treatments.RESULTS: The symptoms of 16 patients in the TC-SOM group quickly resolved after the first spinal manipulation and 8 cases were significantly improved. The VAS scores in the TCSOM group after 4weeks of treatment were significantly lower than those in the Celecoxib group. The KFKSS scores in the TCSOM group after 4 weeks of treatment were significantly higher than those in the Celecoxib group. Side effects of the treatment were not reported. Symptom improvement rate based on the VAS in the TCSOM group indicated more significant improvements than the Celecoxib group.CONCLUSION: TCSOM has greater efficacy than Celecoxib capsules for relief of the symptoms of CP.

髌骨软化症中医证型分布规律及危险因素分析

目的:探讨髌骨软化症(chondromalacia patellae, CMP)中医证型的分布规律及危险因素。方法:收集2018年1月至2023年6月在天长市中医院收治的CMP患者的病例资料,提取中医证型、年龄、性别、体质量指数(body mass index, BMI)、饮食偏嗜、吸烟情况、饮酒情况、合并症等信息。按照中医证型不同将纳入的CMP患者分为肝肾亏虚组、痰湿痹阻组和气滞血瘀组。先对3组患者的相关信息进行单因素对比分析,然后将其中组间差异具有统计学意义的因素作为自变量,将CMP中医证型作为因变量,进行多因素Logistic回归分析。采用Hosmer-Lemeshow检验判断模型拟合优劣。结果:共纳入122例CMP患者,其中肝肾亏虚组60例、痰湿痹阻组45例、气滞血瘀组17例。3组患者年龄、吸烟情况、饮食偏嗜、体质量指数、是否合并腰椎病、是否合并甲状腺功能减退的组间差异均有统计学意义,其余各因素的组间差异均无统计学意义。多因素Logistic回归分析结果显示,以气滞血瘀证为对照,年龄>65岁、合并腰椎病、合并甲状腺功能减退是CMP肝肾亏虚证的危险因素(β=2.366,P=0.000,OR=20.544;β=3.479,P=0.003,OR=28.328;β=1.371,P=0.030,OR=3.936),饮食偏咸、BMI>28 kg·m^(-2)是CMP痰湿痹阻证的危险因素(β=2.234,P=0.000,OR=9.341;β=1.845,P=0.046,OR=6.896)。Hosmer-Lemeshow检验显示回归模型对数据拟合度较好(χ^(2)=2.372,P=0.726)。结论:肝肾亏虚证和痰湿痹阻证是CMP的主要中医证型;相对于气滞血瘀证,年龄>65岁、合并腰椎病、合并甲状腺功能减退是CMP肝肾亏虚证的危险因素,饮食偏咸、BMI>28 kg·m^(-2)是CMP痰湿痹阻证的危险因素。

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for chondromalacia patellae

Objective To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid.Methods Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group,with 34 cases in each group.The control group was treated with intra-articular injection of sodium hyaluronate,while the observation group was given additional warm needling moxibustion treatment.Before and after treatment,the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and visual analog scale(VAS),examined by magnetic resonance imaging(MRI)and determined for the levels of nuclear factor-KB(NF-kB),tumor necrosis factor(TNF)-αand interleukin(IL)-1βin knee joint fluid.Clinical efficacy was estimated after treatment.Results The effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the scores of pain,stiffness and daily activities,as well as the general score of WOMAC declined significantly in both groups(all P<0.05),and were lower in the observation group than in the control group(all P<0.05);the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups(all P<0.05),and were shorter or lower in the observation group than in the control group(both P<0.05);the MRI grading showed no significant change in the control group after intervention(P>0.05),while the grading in the observation group showed notable improvement(P<0.05),and was better than that in the control group(P<0.05);the levels of NF-kB and IL-1βin knee joint fluid dropped significantly in the control group after treatment(both P<0.05),while the levels of NF-kB,TNF-αand IL-1βin knee joint fluid all decreased significantly in the observation group(all P<0.05)and were lower than those in the control group(all P<0.05).Conclusion Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae;it can mitigate the clinical symptoms,improve the lesion extent of chondromalacia and down-regulate the levels of NF-kB,TNF-αand IL-1βin knee joint fluid.

毫针结合股四头肌筋结点放血拔罐治疗髌骨软化症的疗效观察

目的观察毫针结合股四头肌筋结点放血拔罐治疗机务人员髌骨软化症的疗效。方法将患有髌骨软化症的60例机务人员随机分为观察组与对照组,各30例。观察组采用毫针结合股四头肌筋结点放血拔罐治疗,毫针治疗1次/d,放血拔罐1次/3 d,9 d为1个疗程;对照组采用毫针治疗,1次/d,9 d为1个疗程。2组治疗前后均行疼痛视觉模拟评分(visual analogue scale,VAS)、膝关节功能Lysholm评分,并观察临床疗效。结果对比2组临床疗效,治疗髌骨软化症疗效差异有统计学意义(Z=2.003,P=0.045)。2组VAS评分治疗后较治疗前均降低(t=15.597、17.000,P均<0.001),治疗后2组差异有统计学意义,且观察组疼痛程度优于对照组(t=3.459,P=0.001);2组Lysholm评分治疗后较治疗前均增加(t=11.462、8.104,P均<0.001),且治疗后观察组膝关节功能优于对照组,差异有统计学意义(t=4.285,P<0.001)。结论毫针结合股四头肌筋结点放血拔罐治疗机务人员髌骨软化症的临床疗效优于毫针治疗。

通络活血散对木瓜蛋白酶致炎大鼠髌骨的影响

目的:探讨通络活血散对木瓜蛋白酶致炎大鼠髌骨的影响。方法:使用木瓜蛋白酶诱导大鼠髌骨软化症动物模型,通过红外热成像、显微镜检和免疫组化技术研究大鼠体温、髌骨表面形态、髌骨组织,以及滑膜中肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)和转化生长因子(Transforming Growth Factor,TGF)-β1的变化。结果:①红外热成像显示,通络活血散高剂量组、通络活血散中剂量组红色最深,空白组、双氯芬酸二乙胺乳胶剂组、通络活血散低剂量组红色次之,模型组红色最浅。②金相显微镜观察发现,空白组大鼠髌骨表面平滑,凹凸排列均匀;模型组大鼠髌骨表面粗糙,多裂隙,排列不规则;双氯芬酸二乙胺乳胶剂组大鼠髌骨表面粗糙,多细小裂隙,排列不规则;通络活血散高剂量组、通络活血散中剂量组、通络活血散低剂量组大鼠髌骨表面平滑,可见凹凸,稀疏,排列不均匀,有少量细小裂隙。③空白组大鼠滑膜组织表面被覆单层滑膜细胞,髌骨组织分层清晰。模型组大鼠滑膜增生合并慢性炎症,髌骨表面不规则,有血管翳形成,表层储备细胞退变,增生层细胞明显增生,分层结构紊乱。通络活血散高剂量组、通络活血散中剂量组滑膜表面被覆单层滑膜细胞,有轻微增生,髌骨表面表层储备细胞增生,分层基本清晰。通络活血散低剂量组和双氯芬酸二乙胺乳胶剂组大鼠滑膜组织增生合并少量炎细胞浸润,髌骨表面表层储备细胞局部退变,增生层细胞明显增生。④在TNF-α免疫组化染色阳性率方面,模型组、双氯芬酸二乙胺乳胶剂组,以及通络活血散高剂量组、通络活血散中剂量组、通络活血散低剂量组均高于空白组(P<0.05);模型组高于双氯芬酸二乙胺乳胶剂组以及通络活血散高剂量组、通络活血散中剂量组、通络活血散低剂量组(P<0.05);通络活血散低剂量组高于双氯芬酸二乙胺乳胶剂组以及通络活血散中剂量组、通络活血散高剂量组(P<0.05);双氯芬酸二乙胺乳胶剂组、通络活血散中剂量组、通络活血散高剂量组之间的差异无统计学意义(P>0.05)。在TGF-β1免疫组化染色阳性率方面,模型组、双氯芬酸二乙胺乳胶剂组、通络活血散高剂量组、通络活血散中剂量组及通络活血散低剂量组均高于空白组(P<0.05);模型组低于双氯芬酸二乙胺乳胶剂组、通络活血散高剂量组、通络活血散中剂量组及通络活血散低剂量组(P<0.05);双氯芬酸二乙胺乳胶剂组低于通络活血散中剂量组、通络活血散高剂量组(P<0.05),与通络活血散低剂量组之间的差异无统计学意义(P>0.05);通络活血散低剂量组低于通络活血散中剂量组、通络活血散高剂量组(P<0.05),通络活血散中剂量组、通络活血散高剂量组之间的差异无统计学意义(P>0.05)。结论:通络活血散可促进大鼠血液循环,明显减轻木瓜蛋白酶致炎引起的炎症反应,促进大鼠髌骨表面细胞与组织的修复与再生。

Detection of Chondromalacia Patellae by Analysis of Intrinsic Mode Functions in Knee-Joint Vibration Signals

This paper presents the knee-joint vibration signal processing and pathological localization procedures using the empirical mode decomposition for patients with chondrom alacia patellae.The artifacts of baseline wander and random noise were identified in the decomposed monotonic trend and intrinsic mode functions (IMF) using the modeling method of probability density function and the confidence limit criterion.Then, the fluctuation parts in the signal were detected by the signal method turning for count. The results demonstrated that the quality of reconstructed signal can be greatly improved, with the removal of the baseline wander(adaptive trend) and the Gaussian distributed random noise. By detecting the turn signals in the artifact-free signal, the pathological segments related to chondrom alacia patellae can be effectively localized with the beginning and ending points of the span of turn signals.

肌内效贴联合经筋疗法治疗髌骨软化症的临床疗效

目的探讨肌内效贴联合经筋疗法治疗髌骨软化症的临床效果。方法选取2019-06至2021-12在武警福建总队医院就诊的髌骨软化症患者90例,随机分为肌贴组、经筋组和联合组,在治疗前,治疗后1 d、1周、2周和4周时对各组患者进行疗效评定。肌贴组按照髌股关节周围足阳明经筋、足少阳经筋、足太阴经筋、足厥阴经筋循行路线进行贴扎;经筋组采用对髌股关节周围足阳明经筋、足少阳经筋、足太阴经筋、足厥阴经筋循行路线上的穴位“病灶”依次进行手法放松疏理治疗;联合组采用肌贴组和经筋组联合治疗。最终疗效采用疼痛程度视觉模拟评分法(VAS)、Kujala髌股关节评分(KPST)、Lysholm膝关节评分(LKSS)的改善情况和Y平衡测试(YBT)进行评定。结果治疗后1 d,联合组VAS评分和YBT较肌贴组和经筋组改善更显著(P<0.05)。治疗后1周,联合组VAS、LKSS评分和YBT较肌贴组和经筋组改善更显著(P<0.05)。治疗后2周和4周,联合组VAS、LKSS、KPST评分和YBT较肌贴组和经筋组改善更显著(P<0.05)。组内比较中,治疗后1 d VAS较治疗前有显著改善(P<0.05),治疗后1周、2周和4周VAS、LKSS、KPST和YBT评分均较治疗前有显著改善(P<0.05)。结论肌贴联合经筋疗法技术对髌骨软化症患者的疼痛和膝关节功能的短期效果优于单独应用肌贴或经筋疗法技术。

薛爱国以“少阳为枢”理论指导经筋刺法治疗髌骨软化症经验

总结薛爱国教授治疗髌骨软化症(CP)的理论观点及疗法应用。薛爱国教授指出“筋骨失衡”和“少阳枢机不利”是本病关键病机,治疗以“通少阳枢,筋骨并治,形神同调”为原则,其治疗方案是在“调形”(体态评估、体格检查)的基础上,采取经筋恢刺法针刺“足少阳经筋穴”(风池、肩井、带脉、环跳、阳陵泉)及膝后结筋病灶点,再依据以上针刺点施以揿针埋针,对于肌力不足导致的膝前疼痛配合运动康复训练,从而提高临床疗效。

磁共振弥散加权成像多序列图像及定量参数对髌骨软化症的诊断价值

目的探讨磁共振弥散加权成像多序列图像及定量参数对髌骨软化症的诊断价值。方法选取2020年1月—2022年1月收治的髌骨软化症120例,均经关节镜检查确诊。所有患者行磁共振弥散加权成像多序列检查,分析三维翻转稳态自由进动(3D-DWPSIF)、磁共振扩散加权成像-平衡稳态自由进动(DW-bSSFP)、磁共振扩散加权成像-平面回波成像(DW-EPI)序列与关节镜诊断的一致性,比较不同分级患者表观弥散系数(ADC)、信噪比(SNR)、对比噪声比(CNR),分析DW-bSSFP序列ADC、SNR、CNR与髌骨软化症分级的相关性。结果DW-bSSFP序列诊断髌骨软化症分级与关节镜检查结果的一致性最高(P<0.01)。Ⅰ~Ⅱ级髌骨软化症患者3D-DWPSIF、DW-EPI序列检测ADC低于Ⅲ~Ⅳ级,DW-bSSFP序列检测ADCⅠ级<Ⅱ级<Ⅲ级<Ⅳ级(P<0.05)。不同分级髌骨软化症患者DW-bSSFP序列检测SNR高于3D-DWPSIF序列、DW-EPI序列(P<0.01);Ⅰ级髌骨软化症患者3D-DWPSIF序列、DW-EPI序列检测SNR低于Ⅱ、Ⅲ、Ⅳ级,Ⅱ、Ⅲ级低于Ⅳ级,DW-bSSFP序列检测SNRⅠ级<Ⅱ级<Ⅲ级<Ⅳ级(P<0.05)。不同分级髌骨软化症患者DW-bSSFP序列检测CNR高于3D-DWPSIF序列、DW-EPI序列(P<0.01);Ⅰ级髌骨软化症患者3D-DWPSIF序列、DW-EPI序列检测CNR高于Ⅱ、Ⅲ、Ⅳ级,Ⅱ、Ⅲ级高于Ⅳ级,DW-bSSFP序列检测CNRⅠ级>Ⅱ级>Ⅲ级>Ⅳ级(P<0.05)。结论磁共振弥散加权成像3D-DWPSIF序列、DW-EPI序列、DW-bSSFP序列均对髌骨软化症具有一定诊断价值,尤其DW-bSSFP序列与关节镜诊断结果一致性最高。

针灸按摩治疗肾阴亏虚型髌骨软骨软化症的有效性分析

目的探讨通过给予肾阴亏虚型髌骨软骨软化症患者针灸按摩治疗模式的临床效果。方法随机选取2022年1-12月山东省济南市章丘区人民医院收治的肾阴亏虚型髌骨软骨软化症患者60例为研究对象,依据治疗方式的不同分为两组,对照组(n=30)实施常规西医治疗,观察组(n=30)在对照组的基础上实施针灸按摩治疗,对比两组临床治疗效果、膝关节疼痛情况、膝关节活动度、各组生活质量评分。结果观察组治疗总有效率(100.00%)高于对照组(80.00%),差异有统计学意义(χ^(2)=4.630,P<0.05)。治疗后,观察组生活质量各项评分高于对照组,差异有统计学意义(P<0.05)。治疗后第3天,观察组膝关节疼痛评分以及膝关节活动度优于对照组,差异有统计学意义(P<0.05)。结论给予肾阴亏虚型髌骨软骨软化症患者常规西医治疗的基础上增加针灸按摩治疗,能够快速缓解疾病症状,提升其生活质量。与此同时,还能够缓解膝关节疼痛,促使膝关节活动恢复正常。

髌骨软化症的病因、诊断和治疗探索

总结近年来我科对髌骨软化症研究的初步结果。髌骨软化症的普查结果发现，患病率高达 36.2％。对病变区的软骨及软骨下骨标本进行超微结构研究和免疫组化分析，发现关节软骨坏死与所受到的不正常压力负荷的大小成正比，而局部软骨细胞的修复能力则与病变程度及所受压力大小成反比。髌骨软化症是由于髌股关节顺列的生物力学关系紊乱，髌骨半脱位或侧倾，髌股外侧小关节压力过度集中和磨损，而内侧则缺乏应力刺激，从而导致髌股关节面的软骨水肿、软化，进而碎裂；软骨逐渐脱落，软骨下骨质裸露、增生硬化。晚期软骨结构遭到完全破坏，无自身修复能力。因此，应早期诊断和治疗。采用的膝关节轴位“胫骨结节定位”投照法准确、易操作，有助于早期诊断。研制成功的 JKY-肌肉康复仪，通过选择性电刺激股四头肌内侧头使肌力增强，可缓解症状及矫治髌骨半脱位。该法用于髌骨软化症的保守治疗，其有效率达 90％（优良率 63％）。对晚期患者则应采用人工髌股关节置换术，治疗优良率达 86.3％。

选择性股内侧肌电刺激治疗髌骨软化症的疗效分析

采用选择性股内侧肌电刺激方法治疗了３６４例髌骨软化症患者。通过对其中２１１例随访结果表明，选择性股内侧肌电刺激能够明显改善ＣＡ角（ｃｏｎｇｒｕｅｎｃｅａｎｇｌｅ）（Ｐ＜０．０１），显著地改善ＬＰＡ角（ｌｅｔｅｒａｌｐａｔｅｌｌｏｆｅｍｏｒａｌａｎｇｌｅ）（Ｐ＜０．００１），对临床症状缓解的有效率达９５％，从而为髌骨软化症的非手术治疗提供了一个有效的方法。

玻璃酸钠治疗髌骨软骨软化症

背景:玻璃酸钠本身特殊的理化性质决定了其非常重要的生理作用,如构成细胞基质、润滑关节、促进组织损伤修复等。目的:观察玻璃酸钠注射治疗不同病程髌骨软化症的疗效。方法:76例髌骨软化症患者关节腔内注射玻璃酸钠2 m L(以髌骨内侧缘为进针点,每周1次,5周为1个疗程),根据病程分两组,病程<3个月32例,病程>3个月44例,随访1年观察远期疗效。结果与结论:随访1年发现病程<3个月组的优良率达94%,远期疗效优于病程>3个月组(优良率73%)。治疗期间无明显毒副作用,其中有5例注射后疼痛加重,可能与髌下积液未抽尽和早期穿刺技术不熟练有关,休息后一两天均得到缓解,未发生感染。结果可见玻璃酸钠是治疗髌骨软化症的有效药物,早期治疗及合理的进针点是保证疗效的关键。

髌骨与髌股关节表面置换

自１９８３年始开展髌骨软化症和髌股关节骨性关节炎的手术治疗。先采用单纯塑料人工髌骨表面置换术，平均随诊４４．９月，结果表明该法只能收到短暂效果，最终因塑料髌骨磨损股骨髁部骨质而失败。为克服这一问题，于１９８９年５月开始研制Ｙ－Ｌ－Ｑ型人工髌股关节及相应手术器械，经测试合乎要求后于１９９１年１月用于临床，为１６个膝（１３例患者）作了髌股关节表面置换术，髌骨表面用高分子聚乙烯假体置换，于相对应股骨髁间侧放置钴铬钼合金的轨道，供人工髌骨在其上滑行，从而改善了膝关节的屈伸功能，并克服了骨质磨损问题。术后膝部疼痛缓解及功能改善，优良率达８７．５％（１４／１６膝）。早期随诊疗效满意，远期效果有待进一步观察。

关节镜辅助下经皮髌骨外侧支持带松解术治疗髌骨软骨软化症

目的：报告关节镜辅助下经皮髌骨外侧支持带松解术治疗２１例髌骨软骨软化症的治疗效果，并探讨了影响疗效的因素。临床资料：本组２１例（２８膝）髌软骨软化症患者均经关节镜确诊，根据Ｏｕｔｂｒｉｄｇｅ软骨退变分级标准，Ⅰ级髌骨软骨退变８膝，Ⅱ级１３膝，Ⅲ级４膝，Ⅳ级３膝。采用屈膝４５°位 Ｍｅｒｃｈａｎｔ髌骨轴位Ｘ线摄片结合关节镜检查诊断髌股排列错乱，发现髌骨倾斜１６膝，髌骨半脱位６膝，髌骨倾斜与半脱位并存６膝。本组患者２８膝均在关节镜辅助下实施经皮髌骨外侧支持带松解术。结果：随访平均１７．２月，按照Ｃｒｏｓｂｙ和Ｉｎｓａｌｌ疗效评定标准，优１２膝，良１２膝，一般４膝，优良率达８５．７％。结论：本术式治疗伴有髌股排列错乱的髌骨软骨软化症疗效确切，具有创伤小、并发症少、功能恢复快等优点。软骨退变的程度是影响疗效的重要因素。

髌骨倾斜导致髌骨软骨软化实验研究

为了研究髌骨倾斜是否为髌骨软骨软化（ＣＰ）的病因，髌骨软骨软化的发生与何种异常应力有关，选用２４只雌性新西兰兔，随机分４组，每组６只。右膝为实验侧，将髌外侧支持带紧缩造成髌骨外侧倾斜，左膝实施假手术为对照侧，定期处死动物，分别进行髌骨倾斜角Ｘ线测量、髌骨软骨面的接触压力测量、软骨组织切片观察以及软骨组织Ｍａｎｋｉｎ评分。结果显示：实验侧髌骨倾斜角明显大于对照侧。术后６周至１２周时，实验侧髌骨内侧软骨面接触压力明显较对照侧减低（ｐ＜０．０５）。光镜下，术后６周时髌骨内侧面软骨中层与深层轻度变性，１２周至１８周时软骨明显变性，软骨细胞坏死或Ｃｌｏｎｅ状增生，中层与深层软骨基质较多纵行裂隙以及片状苏木素深染的纤维网，表面溃疡形成，ＳａｆｒａｎｉｎＯ染色提示蛋白多糖严重丢失。软骨组织Ｍａｎｋｉｎ评分，实验侧髌骨内侧面软骨得分高于髌骨外侧面软骨（ｐ＜０．０５），说明髌骨内侧面软骨退变较外侧面明显。结论：髌骨倾斜造成髌骨内侧面应力减低导致髌骨软骨软化。

髌股关节软骨退变的临床MRI研究

目的：以关节镜为标准，比较多序列MRI对髌股关节软骨退变的诊断价值。材料与方法：48个膝关节行关节镜检查及3D-Volume-FFE-T1WI矢状位、SE-T1WI横断位、FFE-T1WI横断位扫描。3D-Volume-FFE-T1WI矢状位行多平面重建（MPR）处理。10例无症状志愿者仅行MRI扫描。MRI图像每个髌股关节分内、外侧髌骨面、股骨滑车面与关节镜图像逐一对照分析。统计各序列诊断软骨病变的敏感性、特异性。结果：关节镜下发现102个病变软骨面，3D-Volume-T1WI敏感性、特异性高于SE-T1WI（P＜0.01）。3D-Volume-FFE-T1WI对软骨病变的分级和关节镜分级间有显著正相关性（P＜0．01）。结论：3D-Volume-FFE-T1WI结合MPR评价髌股关节软骨退变明显优于SE-T1WI、FFE-T1WI。关节镜和MRI评价关节软骨有很好的相关性、互补性。

排球运动员髌骨软骨软化症与Q角关系的研究——Ⅰ.临床流行病学研究

本文用临床流行病学方法调查了我国111名优秀男子排球运动员髌骨软骨软化症(CP)的患病情况及与Q角的关系,发现CP患病率达39.6%,占膝伤首位。111名男排队员的平均Q角为13°±3°,其中44例患者的Q角为14°±3°,较未患CP者的Q角12°±3°明显为大。CP患病率与Q角大小密切正相关,r=0.825。认为Q角在发育成熟的个体较恒定,建议作为运动员选材的指标之一。同时也探讨了Q角测量方法、认为体表定位Q角测量是一种简单易行,精确可靠的方法。选取髌骨中点是保证精确测量的关键。