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...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.展开更多
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 s...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.展开更多
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 ...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.展开更多
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 cl...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.展开更多
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 err...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.展开更多
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-Mc...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.展开更多
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 oth...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.展开更多
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 su...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.展开更多
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 m...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展开更多
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 activ...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.展开更多
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 o...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.展开更多
文摘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.
文摘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.
基金Supported by Science & Engineering Research Council of Singapore (052 118 0052)
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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
基金supported by the Science and Technology Innovation Nursery Foundation of Chinese PLA General Hospital, No. 09KMM41
文摘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.
文摘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.
