BACKGROUND Since 2006,introducing a tibial intramedullary nail via the suprapatellar approach has been established;however,nail removal must be carried out using classic infrapatellar access,which can lead to complica...BACKGROUND Since 2006,introducing a tibial intramedullary nail via the suprapatellar approach has been established;however,nail removal must be carried out using classic infrapatellar access,which can lead to complications.Here,we report a new method to remove the intramedullary nail through the original suprapatellar incision.CASE SUMMARY A 39-year-old man was hit by a vehicle in 2019.He was immobilized with a 10-mm×330-mm tibial intramedullary nail via the suprapatellar approach due to left middle tibial fracture.Two years later,the patient requested for the implant to be removed.We used a new method to remove the tibial intramedullary nail through the original suprapatellar incision,and the operation went smoothly.CONCLUSION This case report indicates that suprapatellar access can be used to remove the intramedullary nail via the original incision without infrapatellar access,thus avoiding surgical complications.展开更多
In the previous arthroscopic studies, the ratio of presence and type of plica was somewhat different. We arthroscopically investigated and classified suprapatellar plica and medial synovial plica in a Japanese populat...In the previous arthroscopic studies, the ratio of presence and type of plica was somewhat different. We arthroscopically investigated and classified suprapatellar plica and medial synovial plica in a Japanese population. Subjects and Methods: The anatomy of suprapatellar plica and medial synovial plica was studied arthroscopically in 130 knees. Original diagnosis of patients included in this study were 53 meniscal injuries, 51 ACL injuries, 17 osteoarthritis, 5 popliteal cysts, 3 osteochondritis dissecans, and 1 synovial osteochodromatosis. Results: The suprapatellar plica was present 73.8% and classified into 6 types which were arch type, medial type, lateral type, perforated type, pillar type and complete type. The medial synovial plica was present 62.3% and classified into 4 types which were narrow type, medium type, broad type and perforated type. No relationship between age and the pattern of the suprapatellar plica or medial synovial plica could be found. There was no trend to be correlation between the type of suprapatellar plica and medial synovial plica. Conclusion: We classified suprapatellar plica by only location and shape of plica and medial synovial plica by the size of plica.展开更多
目的观察电针透刺和Mulligan动态关节松动术治疗轻中度膝骨关节炎(knee osteoarthfitis,KOA)的临床疗效,探寻安全有效的中西医结合治疗方案。方法将90例来自长沙市中心医院的轻中度KOA患者随机分为电针透刺组、关节松动组和联合组,每组3...目的观察电针透刺和Mulligan动态关节松动术治疗轻中度膝骨关节炎(knee osteoarthfitis,KOA)的临床疗效,探寻安全有效的中西医结合治疗方案。方法将90例来自长沙市中心医院的轻中度KOA患者随机分为电针透刺组、关节松动组和联合组,每组30例。电针透刺组即在透刺基础上连接电针仪,关节松动组采用Mulligan动态关节松动术治疗,联合组即电针透刺结合Mulligan动态关节松动术。各组均每天治疗1次,每周治疗5次,共治疗6周。在治疗前及治疗6周后,通过疼痛视觉模拟评分(visual analogue scale,VAS)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities arthritis index,WOMAC)、Lysholm膝关节功能评估量表、膝关节最大主动关节活动度(active range of motion,AROM)、髌上囊积液及关节间隙角等指标综合评定疗效。结果治疗后,3组患者的VAS、WOMAC评分较治疗前均有下降,Lysholm评分、AROM较治疗前均有提高,关节间隙角较治疗前减小,髌上囊积液量较治疗前减少(P<0.05);联合组的上述指标较电针透刺组、关节松动组改善更明显(P<0.05);电针透刺组在减少髌上囊积液方面优于关节松动组(P<0.05);关节松动组在增加膝关节AROM、缩小关节间隙角方面优于电针透刺组(P<0.05)。结论电针透刺及Mulligan动态关节松动术均能不同程度缓解轻中度KOA患者疼痛症状,降低髌上囊积液量,缩小关节间隙角,改善膝关节整体功能,且二者联合疗效更佳。展开更多
目的探究不同入路胫骨髓内钉内固定治疗胫骨干骨折的疗效。方法将2019年2月~2021年7月本院收治94例胫骨干骨折患者,随机分为观察组和对照组,每组各47例。两组均实施胫骨髓内钉内固定术,观察组予以髌上入路,对照组予以髌下入路。对比两...目的探究不同入路胫骨髓内钉内固定治疗胫骨干骨折的疗效。方法将2019年2月~2021年7月本院收治94例胫骨干骨折患者,随机分为观察组和对照组,每组各47例。两组均实施胫骨髓内钉内固定术,观察组予以髌上入路,对照组予以髌下入路。对比两组手术指标、并发症情况、手术前后炎症免疫指标[高迁徙率族蛋白(HMGB-1)、单核细胞趋化蛋白(MCP-1)、T淋巴细胞(CD4^(+)、CD8^(+))]、膝关节功能(HSS)、疼痛程度(VAS)及关节活动情况。结果观察组术中X线使用次数、手术时间、住院时间优于对照组,差异均有统计学意义(P<0.05);两组并发症总发生率比较差异无统计学意义(P>0.05);观察组术后3 d CD4^(+)、HMGB-1、MCP-1、CD8+优于对照组,差异有统计学意义(P<0.05);观察组术后1、3个月HSS评分、VAS评分优于对照组,差异有统计学意义(P<0.05);观察组术后6个月关节活动优良率93.48%,高于对照组(77.27%),差异有统计学意义(P<0.05)。结论两组入路实施胫骨髓内钉内固定安全可靠,但髌上入路能优化手术情况,减轻免疫功能抑制,缓解疼痛,改善患者膝关节功能。展开更多
目的比较髌上与髌下两种入路行髓内钉固定治疗胫骨干骨折的疗效,探讨不同入路对胫骨骨折治疗的效果差异,分析术后膝前疼痛的原因。方法回顾性分析荆门市人民医院自2019年1月至2022年12月应用髓内针治疗的胫骨干骨折共143例。髌上入路(A...目的比较髌上与髌下两种入路行髓内钉固定治疗胫骨干骨折的疗效,探讨不同入路对胫骨骨折治疗的效果差异,分析术后膝前疼痛的原因。方法回顾性分析荆门市人民医院自2019年1月至2022年12月应用髓内针治疗的胫骨干骨折共143例。髌上入路(A组)74例,其中男39例,女35例;年龄34~55岁,平均(41.56±3.24)岁。髌下入路(B组)69例,其中男35例,女34例;年龄30~56岁,平均(40.56±5.54)岁。比较两组手术时间、术中失血量、术后48 h隐性失血量、住院天数、术中X线透视次数、术后不同时期疼痛视觉模拟评分(visual analogue scale,VAS)、美国特种外科医院(hospital for special surgery,HSS)膝关节评分、Lysholm评分、膝关节活动度(range of motion,ROM)。结果患者术后均获随访,随访时间7~10个月,平均(8.31±1.21)个月。所有患者均顺利完成手术,术中均无血管、神经损伤,术后除3例出现小腿肌间静脉血栓,其余患者均未发生深部组织感染、内固定失效、皮肤坏死骨髓炎等严重并发症。两组患者术中出血、住院时间、骨愈合时间比较差异无统计学意义(P>0.05);术后1、3个月随访HSS评分比较,差异无统计学意义(P>0.05);术后6个月随访HSS评分比较A组优于B组,差异有统计学意义(P<0.05)。手术时间、术中X线透视次数A组明显少于B组,差异有统计学意义(P<0.05)。两组术后1、3、6个月ROM比较差异无统计学意义(P>0.05),术后3、6个月Lysholm评分A组优于B组,差异有统计学意义(P<0.05)。术前、术后1、3个月运动状态VAS评分比较差异无统计学意义(P>0.05),术后第6个月A组VAS评分低于B组,差异有统计学意义(P<0.05)。结论两种入路行髓内钉治疗胫骨骨折均安全、可靠,可取得良好的手术效果,但髌上入路更具优势。术中减少医源性损伤、适度的尾帽突出、术后持续的功能锻炼能降低膝关节疼痛发生率。展开更多
文摘BACKGROUND Since 2006,introducing a tibial intramedullary nail via the suprapatellar approach has been established;however,nail removal must be carried out using classic infrapatellar access,which can lead to complications.Here,we report a new method to remove the intramedullary nail through the original suprapatellar incision.CASE SUMMARY A 39-year-old man was hit by a vehicle in 2019.He was immobilized with a 10-mm×330-mm tibial intramedullary nail via the suprapatellar approach due to left middle tibial fracture.Two years later,the patient requested for the implant to be removed.We used a new method to remove the tibial intramedullary nail through the original suprapatellar incision,and the operation went smoothly.CONCLUSION This case report indicates that suprapatellar access can be used to remove the intramedullary nail via the original incision without infrapatellar access,thus avoiding surgical complications.
文摘In the previous arthroscopic studies, the ratio of presence and type of plica was somewhat different. We arthroscopically investigated and classified suprapatellar plica and medial synovial plica in a Japanese population. Subjects and Methods: The anatomy of suprapatellar plica and medial synovial plica was studied arthroscopically in 130 knees. Original diagnosis of patients included in this study were 53 meniscal injuries, 51 ACL injuries, 17 osteoarthritis, 5 popliteal cysts, 3 osteochondritis dissecans, and 1 synovial osteochodromatosis. Results: The suprapatellar plica was present 73.8% and classified into 6 types which were arch type, medial type, lateral type, perforated type, pillar type and complete type. The medial synovial plica was present 62.3% and classified into 4 types which were narrow type, medium type, broad type and perforated type. No relationship between age and the pattern of the suprapatellar plica or medial synovial plica could be found. There was no trend to be correlation between the type of suprapatellar plica and medial synovial plica. Conclusion: We classified suprapatellar plica by only location and shape of plica and medial synovial plica by the size of plica.
文摘目的观察电针透刺和Mulligan动态关节松动术治疗轻中度膝骨关节炎(knee osteoarthfitis,KOA)的临床疗效,探寻安全有效的中西医结合治疗方案。方法将90例来自长沙市中心医院的轻中度KOA患者随机分为电针透刺组、关节松动组和联合组,每组30例。电针透刺组即在透刺基础上连接电针仪,关节松动组采用Mulligan动态关节松动术治疗,联合组即电针透刺结合Mulligan动态关节松动术。各组均每天治疗1次,每周治疗5次,共治疗6周。在治疗前及治疗6周后,通过疼痛视觉模拟评分(visual analogue scale,VAS)、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities arthritis index,WOMAC)、Lysholm膝关节功能评估量表、膝关节最大主动关节活动度(active range of motion,AROM)、髌上囊积液及关节间隙角等指标综合评定疗效。结果治疗后,3组患者的VAS、WOMAC评分较治疗前均有下降,Lysholm评分、AROM较治疗前均有提高,关节间隙角较治疗前减小,髌上囊积液量较治疗前减少(P<0.05);联合组的上述指标较电针透刺组、关节松动组改善更明显(P<0.05);电针透刺组在减少髌上囊积液方面优于关节松动组(P<0.05);关节松动组在增加膝关节AROM、缩小关节间隙角方面优于电针透刺组(P<0.05)。结论电针透刺及Mulligan动态关节松动术均能不同程度缓解轻中度KOA患者疼痛症状,降低髌上囊积液量,缩小关节间隙角,改善膝关节整体功能,且二者联合疗效更佳。
文摘目的探究不同入路胫骨髓内钉内固定治疗胫骨干骨折的疗效。方法将2019年2月~2021年7月本院收治94例胫骨干骨折患者,随机分为观察组和对照组,每组各47例。两组均实施胫骨髓内钉内固定术,观察组予以髌上入路,对照组予以髌下入路。对比两组手术指标、并发症情况、手术前后炎症免疫指标[高迁徙率族蛋白(HMGB-1)、单核细胞趋化蛋白(MCP-1)、T淋巴细胞(CD4^(+)、CD8^(+))]、膝关节功能(HSS)、疼痛程度(VAS)及关节活动情况。结果观察组术中X线使用次数、手术时间、住院时间优于对照组,差异均有统计学意义(P<0.05);两组并发症总发生率比较差异无统计学意义(P>0.05);观察组术后3 d CD4^(+)、HMGB-1、MCP-1、CD8+优于对照组,差异有统计学意义(P<0.05);观察组术后1、3个月HSS评分、VAS评分优于对照组,差异有统计学意义(P<0.05);观察组术后6个月关节活动优良率93.48%,高于对照组(77.27%),差异有统计学意义(P<0.05)。结论两组入路实施胫骨髓内钉内固定安全可靠,但髌上入路能优化手术情况,减轻免疫功能抑制,缓解疼痛,改善患者膝关节功能。
文摘目的比较髌上与髌下两种入路行髓内钉固定治疗胫骨干骨折的疗效,探讨不同入路对胫骨骨折治疗的效果差异,分析术后膝前疼痛的原因。方法回顾性分析荆门市人民医院自2019年1月至2022年12月应用髓内针治疗的胫骨干骨折共143例。髌上入路(A组)74例,其中男39例,女35例;年龄34~55岁,平均(41.56±3.24)岁。髌下入路(B组)69例,其中男35例,女34例;年龄30~56岁,平均(40.56±5.54)岁。比较两组手术时间、术中失血量、术后48 h隐性失血量、住院天数、术中X线透视次数、术后不同时期疼痛视觉模拟评分(visual analogue scale,VAS)、美国特种外科医院(hospital for special surgery,HSS)膝关节评分、Lysholm评分、膝关节活动度(range of motion,ROM)。结果患者术后均获随访,随访时间7~10个月,平均(8.31±1.21)个月。所有患者均顺利完成手术,术中均无血管、神经损伤,术后除3例出现小腿肌间静脉血栓,其余患者均未发生深部组织感染、内固定失效、皮肤坏死骨髓炎等严重并发症。两组患者术中出血、住院时间、骨愈合时间比较差异无统计学意义(P>0.05);术后1、3个月随访HSS评分比较,差异无统计学意义(P>0.05);术后6个月随访HSS评分比较A组优于B组,差异有统计学意义(P<0.05)。手术时间、术中X线透视次数A组明显少于B组,差异有统计学意义(P<0.05)。两组术后1、3、6个月ROM比较差异无统计学意义(P>0.05),术后3、6个月Lysholm评分A组优于B组,差异有统计学意义(P<0.05)。术前、术后1、3个月运动状态VAS评分比较差异无统计学意义(P>0.05),术后第6个月A组VAS评分低于B组,差异有统计学意义(P<0.05)。结论两种入路行髓内钉治疗胫骨骨折均安全、可靠,可取得良好的手术效果,但髌上入路更具优势。术中减少医源性损伤、适度的尾帽突出、术后持续的功能锻炼能降低膝关节疼痛发生率。
