Objective To study the diagnosis and treatment of the acute medial collateral ligament ruptures of the knee.Methods From August 1998 to August 2003, 87 cases of acute medial collateral ligament ruptures were examined with physical method and MR imaging. Out of them, 35 cases of Ⅰdegree and Ⅱ degree ruptures were treated with non-surgery and 52 cases of Ⅲ degree ruptures were treated surgically. The torn medial collateral ligaments were mended, 21 of which were strengthened with the anterior partial gracilis muscle tendon after the arthroscopy. Results In 35 cases of Ⅰ and Ⅱ degree ruptures, 32 were followed up 13 months on average. According to Lysholm scoring system, the clinical results were classified as excellent or good in 93.7% of the cases. In 52 cases of Ⅲ degree ruptures, 50 were followed up 16 months on average. The excellent or good result was 90%.Conclusion For Ⅰ and Ⅱ degree ruptures, MR imagimg is an important way to definitely- diagnose medial collateral ligament ruptures. Abduction stress test of knee extension shows that the medial direct instability is a main way to definitely diagnose Ⅲ degree ruptures. The results of conservative treatment of Ⅰ degree and Ⅱ degree ruptures are excellent. Surgical therapy are fitfor the cases of Ⅲ degree ruptures.
ObjectiveTo investigate the effect of glenohumeral ligament(GHL） in static stabilizing structure of shoulder joint. Methods Fifteen upper limbs specimen from fresh adult corpse were made shoulder jointbone ligament specimen and divided in 5 groups (n=3). The loadshift curve of the following specimen was measured respectively at the shoulder joint in abductive angles of 0°,45° and 90°,influenced by 50 N posterioranterior load to evaluate anterior stability of shoulder joint. According to different selectivecutting test, 5 groups were divided subgroups:group A (A1-A4), respectively normal group, superior GHL (SGHL) injury group；SGHL/middle GHL (MGHL) injury group and SGHL/MGHL/inferior GHL (IGHL） injury group； group B（B1-B3），respectively normal group，MGHL injury group，MGHL/IGHL injury group； group C（C1-C2），respectively normal group,IGHL-anterior band(IGHL-AB) injury group； group D（D1-D2），respectively normal group, IGHL-posterior band(IGHL-PB) injury group; and group E（E1-E2），respectively normal group, IGHL injury group. Results For complete shoulder joint(A1 group), there was verysmall average shift (15.00±4.99 mm), for A4 group, there was the worst stability of shoulder joint，the average shift was 22.34±5.70 mm. For B2 group，the stability of shoulder joint had no obvious decrease. For B3 group, the stability of shoulder joint was worst at abduction angleof 45° and 90°. For C2 group, the stability of shoulder joint at abduction angle of 45° (23.19±4.58 mm) and 90°(15.32±1.30 mm) was worse than that of A1 group （P＜0.05）; halfdislocation or dislocation could be seen. For D2 group(17.30±4.93 mm), there was less effect on anterior stability of shoulder joint than that of A1 group(P＜0.05).For E2 group(20.26±4.75 mm), the effect on anterior stability was similar toC2 group. Conclusion GHL is a key static stabilizing structure of shoulder joint. SGHL has no obvious effect on anterior stability of shoulder joint. MGHL and IGHL together holds anterior stability of shoulder joint, and IGHL plays the most important role.
Objective To analyze the effect of the posterior cruciate ligament (PCL) retaining or not on knee-joint proprioception by comparing the proprioceptive difference between PCL retaining and no PCL retaining in total knee arthroplasty (TKA). Methods Between June 2009 and June 2010, 38 osteoarthritis patients meeting the inclusion criteria were divided into PCL retaining group (group A, n=19) and PCL-substituting group (group B, n=19) according to the random number table. There was no significant difference in gender, age, disease duration, the range of motion of the knee between 2 groups (P gt; 0.05). The effectiveness and the knee-joint proprioception were separately assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and the passive angle reproduction test (30, 60, and 90° of knee flexion) preoperatively and 12 months postoperatively. Results All incisons healed by first intention, without complications of infection, fracture, and deep vein thrombosis of lower limb. The patients were followed up 12-17 months (mean, 14.1 months). The knee function after operation was obviously improved when compared with preoperative one; significant differences were observed in the WOMAC scores and the results of passive angle reproduction test between at preoperation and at 12 months after operation (P lt; 0.05), but no significant difference was found between group A and group B (P gt; 0.05). Conclusion Whether PCL retaining or not in TKA both can improve knee-joint proprioception, and no obvious difference between them.
OBJECTIVE: To observe the strength of thigh muscles after reconstruction of anterior cruciate ligament by autogenous bone-patellar tendon-bone graft. METHODS: Twenty-three patients, 9 males and 14 females, were followed up one year after reconstruction of the anterior cruciate ligament with autogenous bone-patellar tendon-bone graft. Through arthroscope, no intra-articular derangement was found. The strengths of isometric and isotonic contractions of the quadri ceps and the hamstrings muscles of the affected and contralateral thighs were recorded. RESULTS: The donor side for autogenous bone-patellar tendon-bone graft showed significant decrease (P lt; 0.01), but no effect on that of the hamstrings muscle(P gt; 0.05). CONCLUSION: To reconstruct the anterior cruciate ligament, harvest of the bone-patellar tendon-bone graft as a reparative material may markedly lower the strength of the quadriceps femoris muscle.
OBJECTIVE: To study the characteristics of, morphology histology and ultrastructure of anterior cruciate ligament(ACL) autograft and two-step cryopreserved ACL allograft after transplantation. METHODS: Sixty New Zealand rabbits and sixty Japanese rabbits were randomly divided into two groups: ACL autograft group and two-step cryopreserved ACL allograft group. Immunosuppressant were not used after transplantation. The histology and ultrastructure of the ACL of transplantation and normal knee were observed after 4 weeks and 12 weeks, respectively. RESULTS: The rate of remodeling process was faster in ACL autograft than in two-step cryopreserved ACL allograft, but there was similar remodeling process between two groups 12 weeks after transplantation. The proportions of large-diameter fibers(gt; or = 80 nm) of ACL autograft and cryopreserved ACL allograft were 6% and 24% in the 4th week, and were 0 and 2% in the 12th week, respectively. The proportions of small-diameter of fibers(lt; 80 nm) of ACL autogrft and cryopreserved ACL allograft were 94% and 76% in the 4th week, and 100% and 98% in the 12th week, respectively. Histologic incorporation in ACL autograft was similar to that in cryopreserved ACL allograft. CONCLUSION: Two-step cryopreserved bone-ACL-bone allograft were similar to bone-ACL-bone autograft cryopreserved in remodeling process and histology. The rate of remodeling process was faster in ACL autograft than in cryopreserved ACL allograft.
Objective To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal(MP) joints. Methods Twenty-four preserved human No.2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut inopposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence.From 1994 to 2000,11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligamentscut in 9 cases. Results The angle of flexion of the MP joint before operation in group A is 37.30±5.42°, it increased 11.29±2.36° and to 48.60±2.98° when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30±1.59° and to 53.35±2.76°. Both have an increasing trend for the angle of flexion of the MP joint (Plt;0.01). While in group B, the angle of flexion of the MP joint before operation is 34.59±5.32°, it increased 6.29±2.98° and to 40.89±2.36° when the plantar plate were cut, laterthe cut of the bilateral collateral ligaments increased another 9.71±1.94° and to 50.60±2.01°. Both had an increasing trend for the angle of flexion ofthe MP joint (Plt;0.01). The bilateral collateral ligaments had more influence than the plantar plate (Plt;0.01). There was the same effect in different sequence (Pgt;0.05). In 2 cases with plantar section, the flexion angle of MP joint could achieve 15° to 45° in 2 monthes. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3° to 58.4° in 26.3 months. Conclusion The flexion angle of the MP joint can be increasedby cutting the bilateral collateral ligaments and the plantar plate.
Objective To evaluate the short-term effectiveness after static anatomical reconstruction of posterolateral complex (PLC) in the treatment of traumatic multi-ligament injury of the knee. Methods Between June 2007 and July 2011, 23 cases of multi-ligament injury of the knee were treated. There were 15 males and 8 females with an average age of 41 years (range, 19-56 years). The injury was caused by traffic accident in 9 cases, sprain in 7 cases, bruise in 3 cases, and falling from height in 4 cases. The time between injury and operation was 13-78 days (mean, 32 days). The results of posterior drawer test and Lachman test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 43.4 ± 5.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli typing, all were classified as type C. The X-ray films showed that load-induced posterior motion of the knee was (13.3 ± 4.2) mm; the lateral joint space was (15.1 ± 2.4) mm. Anterior cruciate ligament/posterior cruciate ligament and PLC were reconstructed simultaneously with auto-semitendinosus, gracilis tendon, and allogeneic tendon. Results All incisions healed by first intention, and no complication occurred. All patients were followed up 12-56 months (mean, 28 months). At last follow-up, the results of posterior drawer test and Lachman test were negative; 3 cases had varus instability, and 2 cases had external rotation instability. The Lysholm score of the knee was 85.6 ± 16.7, showing significant difference when compared with preoperative score (t=11.469, P=0.000). According to IKDC scoring, 7 cases were rated as grade A, 12 as grade B, and 4 as grade C; significant difference was found when compared with preoperative value (Z=4.285, P=0.000). The load-induced posterior motion of the knee was (5.1 ± 4.4) mm, the lateral joint space was (3.2 ± 2.8) mm, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion In the treatment of traumatic multi-ligament injury of the knee, the anatomical reconstruction of the PLC using auto-semitendinosus, gracilis tendon, or allogeneic tendon can obtain good short-term effectiveness.
Objective To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment. Methods The literature about the surgery for cervical OPLL involving C2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. Results For cervical OPLL involving the C2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. Conclusion OPLL involving the C2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C2 segment.
【Abstract】 Objective When knee medial collateral ligament (MCL) rupture, the upper surface of medial meniscus is exposed totally, like the gulf panoramic, which is called “panoramic views of the bay sign” or the “bay sign”. To investigate the reliability and significance of the “bay sign” in diagnosis of knee MCL rupture under arthroscope. Methods Between March 2007 and March 2011, 127 patients with knees injuries were divided into the observation group (n=59) and control group (n=68) based on the MRI results. In the observation group, 59 patients had MCL rupture by MRI, including 12 cases of MCL injury alone, 16 cases of MCL injury with lateral meniscus torn, 27 cases of MCL injury with anterior cruciate ligament (ACL) injury, 3 cases of MCL injury with ACL and posterior cruciate ligament (PCL) injury, and 1 case of MCL injury with patellar dislocation; there were 38 males and 21 females with an average age of 23.2 years (range, 16-39 years). In the control group, 68 patients had no MCL rupture by MRI, including 38 cases of ACL injury, 4 cases of ACL and PCL injury, and 26 cases of ACL and lateral meniscus injury; there were 45 males and 23 females with an average age of 31.8 years (range, 25-49 years). The “bay sign” was observed under arthroscope in 2 groups before and after operation. Results The positive “bay sign” was seen under arthroscope in the patients of the observation group before MCL repair; the “bay sign” disappeared after repair. No “bay sign” was seen in patients of the control group before and after ACL reconstruction. Conclusion The “bay sign” is a reliable diagnostic evidence of MCL injury. It can be used as a basis to judge the success of MCL reconstruction during operation.
ObjectiveTo explore the effect of spinal dural release on the effectiveness of expansive cervical laminoplasty for treating multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament. MethodsA retrospective analysis was made on the clinical data of 32 patients with multi-segmental cervical myelopathy with cervical ossification of posterior longitudinal ligament who underwent expansive cervical laminoplasty and spinal dural release between February 2011 and October 2013 (group A); and 36 patients undergoing simple expansive cervical laminoplasty between January 2010 and January 2011 served as controls (group B). There was no significant difference in gender, age, disease duration, affected segments, combined internal disease, preoperative cervical curvature, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score between 2 groups (P>0.05). Postoperative JOA score and improvement rate, VAS score, posterior displacement of the spinal cord, and the change of cervical curvature were compared between 2 groups. ResultsSpinal dural tear occurred in 3 cases (2 cases in group A and 1 case in group B) during operation. Cerebrospinal fluid leakage occurred in 3 cases (2 cases in group A and 1 case in group B) after operation. The patients were followed up 12-46 months (mean, 18.7 months). At last follow-up, the JOA score and VAS score were significantly improved in 2 groups when compared with preoperative scores (P<0.05). JOA score and improvement rate of group A were significantly higher than those of group B (P<0.05), but VAS score of group A was significantly lower than that of group B (P<0.05). At last follow-up, no significant difference in cervical curvature was found between 2 groups (P>0.05); posterior displacement of the spinal cord of group A was significantly larger than that of group B (P<0.05). No reclosed open-door was observed during follow-up. ConclusionFor patients with multi-segmental cervical myelopathy with ossification of posterior longitudinal ligament, full spinal dural release during expansive cervical laminoplasty can increase the posterior displacement of spinal cord, and significantly improve the effectiveness.