目的 比较3D打印技术辅助后路腰椎椎间融合术与单纯采用后路腰椎椎间融合术治疗峡部裂型腰椎滑脱的临床疗效.方法 回顾性分析自2019-03-2020-04诊治的44例单节段峡部裂型腰椎滑脱症,23例采用3D打印技术辅助后路腰椎椎间融合术治疗(观察组),21例单纯采用后路腰椎椎间融合术治疗(对照组).比较2组手术时间、术中出血量、术中透视次数、置钉准确率.结果 2组均顺利完成手术并获得随访,随访时间4～7个月,平均6个月.对照组出现1例脑脊液渗漏,对症治疗后治愈.观察组手术时间较对照组短,术中出血量较对照组少,透视次数较对照组少,置钉准确率较对照组高,差异有统计学意义(P＜0.05).结论 峡部裂型腰椎滑脱后路腰椎椎间融合术前应用3D打印技术制定手术方案,可以明显提高术中置钉准确率,减少手术时间、术中出血量及术中透视次数.

目的 探讨关节置换治疗老年膝关节退行性骨关节炎的临床效果及患者的生活质量改善情况.方法 选取2018年7月-2019年6月在我院接受治疗的66例老年膝关节退行性骨关节炎患者,对其关节置换治疗疗效及治疗前后患者的生活质量水平进行了分析.结果 通过对66例患者实施关节置换术进行治疗,HSS评分优良率达到了90.91％;而且治疗后,MMSE评分以及ADL评分显著低于治疗前,治疗前后患者的生活质量水平对比差异显著(P<0.05).结论 针对老年膝关节退行性骨关节炎患者,通过采用关节置换术进行治疗临床疗效显著,能够有效改善老人的生活质量,值得临床推广应用.

目的 采用三维有限元方法分析单侧与双侧穿刺PKP对术后伤椎邻近节段生物力学的影响.方法 采集1名正常成人T12L1椎CT扫描数据,经三维有限元软件处理,对处理建立好的T12L1节段模型进行单侧及双侧穿刺PKP操作,比较单侧及双侧穿刺PKP术后T12L1节段模型术前及术后中立、前屈和侧弯状态下伤椎邻近节段(T12)下终板的Von Mises应力、伤椎终板生物力学变化和术后伤椎终板凸起变化.结果 单侧及双侧穿刺PKP术后T12L1节段模型T12下终板在中立、前屈及侧弯状态下应力较术前明显减少,单侧穿刺对T12下终板应力降低程度高于双侧治疗.PKP术强化后的伤椎其刚度和强度都有所增加,且双侧穿刺PKP强化后的伤椎应力明显发生改变.对伤椎进行PKP强化后,脊柱的载荷明显集中在前柱位置,其后柱椎弓根及小关节等接触的压力明显降低.经强化后椎体对T12下终板的生理凸起均有明显改善,且双侧穿刺PKP术后T12下终板生理凸起增加程度高于单侧穿刺.结论 PKP术后伤椎邻近椎体再发骨折与双侧穿刺PKP术后伤椎邻近终板应力的增大、邻近终板凸起的明显增加有关.

目的 采用有限元分析骨质疏松椎体压缩骨折经皮椎体后凸成形(PKP)术后伤椎恢复高度与邻近椎体应力之间的关系.方法 选取1名健康男性志愿者进行胸腰椎CT扫描,建立骨质疏松胸腰段脊柱(T11～L1)有限元模型.对T12椎体进行PKP模拟手术,获得骨水泥强化后的有限元模型,再分别进行不同程度椎体成形,获得T12椎体高度恢复为Geanat 0、1、2、3级的有限元模型.施加垂直、屈曲、左侧屈和右侧屈4种方向的载荷,观察PKP术后伤椎恢复高度与邻近椎体应力之间的关系.结果 对于PKP术后T1,椎体应力,T12椎体恢复高度越接近正常椎体则椎体承受载荷越小,各种状态最小载荷均出现在T12椎体恢复高度为0级时;对于PKP术后L1椎体应力,椎体垂直和右侧屈状态下,T12椎体恢复高度越接近正常椎体则椎体承受载荷越小,T12椎体恢复高度为0级时,垂直和右侧屈状态下承受的载荷最小.结论 骨质疏松性椎体压缩骨折PKP术后为了减少邻近椎体应力,应尽可能恢复伤椎高度.

This study compared the diagnostic accuracy of second-look arthroscopy, clinical assessment, and magnetic resonance imaging (MRI) in evaluating meniscal healing following repair. To explore the application of 3D-MRI sequences with signal-to-noise ratio (SNR) measurements and the analysis of sensitivity and accuracy in evaluating meniscal healing status after meniscal repair.

This study compared knee stability and alterations in the composition of synovial fluid among patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction with either a hamstring autograft or a hamstring allograft. This prospective cohort study enrolled 175 patients. Of these patients, 90 underwent hamstring tendon autograft ACL reconstruction. The remaining patients (n=85) underwent hamstring tendon allograft ACL reconstruction. All of the patients had a minimum of 1 year of follow-up (mean, 2.5 years). Side-to-side differences and the proportion of mononuclear cells in knee joint synovial fluid were measured at 5 time points (preoperatively and at postoperative weeks 1, 3, 6, and 12). During the early postoperative phase, side-to-side knee laxity was greater among the allograft group compared with the autograft group (P<.001). Additionally, among the allograft group, the proportion of mononuclear cells remained high at weeks 6 and 12 (mean, 90.0% and 88.9%, respectively) compared with a normal level in the autograft group (mean, 45.1% and 65.7%, separately). However, no significant difference was found between the 2 groups at final follow-up for range of motion, results of the Lachman test, results of the anterior drawer test, results of the pivot shift test, Lysholm score, bone tunnel enlargement, and graft failure rate (P>.05). These findings showed that, in the early postoperative phase, ACL reconstruction with a hamstring allograft resulted in greater knee laxity and immunologic response compared with the hamstring autograft group. However, at relatively long-term follow-up, both grafts achieved similar objective and subjective outcomes. [Orthopedics. 2017; 40(5):e892-e897.].

Objective To assess the safety and effectiveness of elder carpal tunnel syndrome at the wrist that treated by arthroscopic bush-hook and radio-frequency that monitored by eletroneurophilogy in operation.Methods Fifteen hands of 60 years older patients with carpal tunnel syndrome was enrolled and somatosensory evoked potential(SSEP) and motor evoked potential(MEP)were examined for moni-toring evoked potential of median nerve.2.7 mm-arthroscope was used for observing the procedure of bush-hook and hypothermal radio-fre-quency cut off transverse carpal ligament,flexor retinaculum and thenar fascia for releasing carpal tunnel with medial nerve prevention by can-nula.The safety and effectiveness of operation were assessed,the finger to finger,symptom ssevere scale( SSS) and disability of arm shoulder and hand( DASH) were compared between pre-operation and post-operation.Results The nervous react of the 15 patients with carpal tunnel syndrome were slightly influenced by the procedure of arthroscope,bush-hook and radio-frequency was introduced through carpal tunnel.After 14 months follow-up,the assessments of finger to finger,SSS and DASH were significantly improved in all cases.Tinel sign positive was found in 2 cases that 1 case had Phalen sign positive simultaneously.Conclusions Arthroscopic using bush-hook and radio-frequency for carpal tunnel releasing with prevention by cannula appears to be a safe,trauma less and effective procedure.Also,the symptom restored is more faster after carpal tunnel release.

Objective To examine the multipotent differentiation and immunosuppression of knee synovium-derived mesenchymal stem cells ( SMSCs ) from patients with osteoarthritis ( OA ) .Methods The synovial membranes were obtained with arthroscope and the SMSCs were separated and purified .CCK-8 assay was used to detect cell proliferation ability .Osteogenesis , chondrogenesis and adipogenesis were induced, and the cells were stained with alizarin red , toluidine blue and oil red O respectively .Peripheral blood mononuclear cells ( PBMC) stimulated with anti-human CD3 and anti-human CD28 were co-cultured with SMSCs , and the cell proliferation rate of PBMC was examined with flow cytometry .Results among groups were analyzed by one-factor analysis of variance ( ANOVA ) followed by Bonferroni correction . Results After SMSCs inoculation, the latent phase was 1-2 days, the logarithmic phase was 3-6 days and the stagnate phase began from the 7th day.After osteogenesis, chondrogenesis and adipogenesis inductions , the cells were positive for alizarin red , toluidine blue and oil red O staining .The cell proliferation rate of PBMC at the 5th day without anti-human CD3 and anti-human CD28 stimulation was (3.8 ±0.4)%, while it was ( 80.9 ±8.1 )% with anti-human CD3 and anti-human CD28 stimulation.However, when co-cultured with SMSCs at the 5 th day, the cell proliferation rate of PBMC stimulated with anti-human CD3 and anti-human CD28 was (52.3 ±5.1)%, which was significantly lower than that one with anti-human CD3 and anti-human CD28 stimulation only ( t =8.97, P <0.01).Conclusion Because of multipotent differentiation and immunosuppression , SMSCs from the patients with osteoarthritis could become potentially ideal seed cells for the tissue engineering .

Background: We introduce a novel method of combining the standard anteromedial and anterolateral approaches and dual posterolateral approaches in the arthroscopic treatment of posterior and anterior ankle impingement syndrome and compare the postoperative outcomes with conventional anteromedial/anterolateral and posteromedial/posterolateral approaches. Methods: From January 2013 to January 2015, we treated 28 patients with posterior and anterior ankle impingement syndrome by arthroscopy. The patients were divided into the conventional group (n = 13) and the modified group (n = 15) according to the surgical approaches used in the operation. Preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) score, range of ankle motion, and operation time were recorded. The average follow-up was 16 months (range 6-24 months). Results: Posterior and anterior ankle impingement syndrome was confirmed arthroscopically in all patients. After the operation, the range of ankle motion in all patients was restored. There was no significant difference in postoperative AOFAS score, VAS score, dorsiflexion, and plantarflexion between the conventional group and the modified group. Moreover, the operation time was significantly reduced in the modified group compared with the conventional group. There was no recurrence of osteophyte and no complications such as infection, neurovascular injury, or delayed healing of surgical incision in the modified group. Conclusions: Dual posterolateral approaches combined with standard anteromedial and anterolateral approaches was a novel method for arthroscopic treatment of posterior and anterior ankle impingement syndrome. It proved to be safe and effective, and significantly reduced the operation time. Reposition, repeated prep and drape, and limb distraction were avoided. Level of Evidence: Level IV, retrospective case series.

目的:探讨肩关节镜下应用带线锚钉技术同期修复骨性Bankart损伤合并肩袖损伤的手术策略和术后疗效.方法:2008年6月至2015年1月共收治18例同时合并骨性Bankant损伤和肩袖损伤的患者,其中女性8例,男性10例,患者平均年龄57.9岁(40～72岁).患者均有外伤性肩关节前脱位病史,11例急诊复位后因再脱位就医,7例因存在持续肩关节疼痛就医.18例患者均通过MRI结合X线和三维CT确诊同时存在全层肩袖损伤和骨性Bankart损伤.所有患者均于关节镜下一期修复两种损伤,手术中采用带线锚钉先固定骨性Bankart损伤,再用单排锚钉修复撕裂肩袖.结果:18例患者平均随访时间22.5个月(12～38个月).术后3月、6月随访肩关节前屈上举和体侧外旋活动度较健侧比较差异具有统计学意义(P＜0.05).术后1年两侧活动度差异无统计学意义(P＞0.05).末次随访时,患侧vs健侧ASES肩关节评分为91.6±6.7分vs 93.6±4.8分,Constant-Murley评分为89.9±6.8分vs 92.0±7.9分,Rowe评分为89.3±7.1 vs 91.1±6.7,两侧比较差异无统计学意义(P＞0.05).末次随访外展肌力双侧无显著性差异,VAS疼痛评分较术前显著改善(1.4±1.1 vs 6.2±1.9).随访过程中1例患者曾出现半脱位,3例出现术后僵硬,经肌力和功能训练后改善,无感染、再脱位等并发症.结论:肩关节脱位同时存在骨性Bankart损伤和肩袖撕裂时,全关节镜下修复骨性Bankart损伤后再修复肩袖损伤,治疗全面,疗效肯定.

Objective To discuss the methods and effects of arthroscopic treatment of posterior and anterior ankle impingement syndrome through anterior approach,tarsal sinus approach plus posterolateral approach.Methods The study enrolled 12 patients with posterior and anterior ankle impingement syndrome treated from January 2012 to March 2014.There were 8 males and 4 females,agedl7-65 years (mean,45 years).Left ankle injury was noted in 9 patients and right ankle injury in 3 patients.Eight patients had a history of obvious ankle injury (5 acute and 3 chronic sprains).Arthroscopic surgery was performed to manage the posterior and anterior ankle impingement syndrome through the combined anterior,tarsal sinus and posterolateral approaches,and prone position and posteromedial incision were not used during operation.Postoperative outcome was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score.Results Operation time was 45-80 min (mean,62 min).Arthroscopy confirmed anterior bone impingement in all patients.Three patients suffered from posterior bony impingement of the talus,while nine patients os trigonum injury.Duration of follow-up was 10-18 months (mean,14 months).AOFAS score was (91.4-± 6.5) points after operation,significantly higher (34.4 ± 12.6) points before operation (t =14.607,P ＜0.01).All patients had normal ankle range of motion after operation.There were no complications such as neurovascular injury.All the surgical incisions achieved primary healing.Conclusion The procedure avoids body position shift and posteromedial incision during operation,and attains a good vision to the anterior and posterior portions and satisfactory short-term outcome.

Objective To investigate the results of FasT-Fix technique in repair of degree Ⅲ horizontal meniscus tears.Methods From June 2010 through June 2013,12 patients with degree Ⅲ horizontal meniscus tears underwent arthroscopic vertical mattress suture using the FasT-Fix technique.There were 7 males and 5 females at mean age of 34.7 years.All the patients were diagnosed with combined anterior cruciate ligament (ACL) rupture with preoperative Lysholm score of (64.9 ± 9.4)points.Arthroscopic meniscus repair was performed prior to ACL reconstruction.A second-look arthroscopy examined the healing status of the meniscus at 6 to 18 months postoperatively (mean,12 months).Lysholm score was evaluated during outpatient follow-up.Results All the patients were available to the follow-up of 26 months (range,12-36 months).Second-look arthroscopy showed complete healing in 9 patients and incomplete healing in 3 patients.At final follow-up,Lysholm score was (93.4 ± 5.0) points.Conclusion FasT-Fix technique can repair degree Ⅲ horizontal meniscus tears with vertical mattress sutures and reconstruct ACL,which has advantages of allowing maximal preservation of the horizontally torn meniscus,minor trauma,easy operation and definite efficacy.

INTRODUCTION:This technical note describes a new arthroscopic technique to repair the peripheral attachment lesion of the posterior horn of the medial meniscus. The operation was performed under arthroscopy using a standard anterior portal.SURGICAL TECHNIQUE:A FasT-Fix needle was inserted obliquely close to the tibial plateau and the first implant was inserted into the joint capsule depending on its bending angle underneath the meniscus. The second implant was inserted through 1/3 periphery of the meniscus into the meniscocapsular area. The pre-tied self-sliding knot was tensioned to achieve secure fixation of the posterior meniscal peripheral attachment at the original attachment point.MATERIALS AND METHODS:From August 2011 to February 2014, 23 knees were diagnosed as ramp lesion, underwent meniscal repair using FasT-Fix technique.RESULTS:All patients were followed up for average 14 months. The Lysholm score improved from preoperative 64.4±4.52 to postoperative 91.2±4.60.CONCLUSIONS:We believe that the FasT-Fix technique via the standard anterior portal can be a more convenient and less traumatic alternative for repair of the peripheral attachment lesion of the posterior horn of the medial meniscus in the anterior cruciate ligament deficient knee.

Objective To evaluate the mid-term results of arthroscopic anterior cruciate ligament (ACL) reconstruction using Transfix technique.Methods From August 2002 to December 2003,38 patients (24 left knees and 14 right knees) with ACL ruptures underwent arthroscopic ACL reconstruction with hamstring tendon using Transfix femoral fixation and interference screws tibial fixation.There were 21 males and 17 females,aged from 19 to 48 years (average,28.4 years).The causes of injury included sports injury in 27 cases,traffic injury in 2 cases and fall injury in 2 cases,and 7 patients had no significant injury.There were 6 cases of acute injury and 32 cases of old injury.Anterior drawer test was positive in 35 cases,weak positive in 1 case and negative in 2 cases.Lachman test was positive in 37 cases,and weak positive in 1 case.The Lysholm score was used to evaluate the results.Moreover,X-rays and MRIs were used to observe the conditions of graft and bone tunnel.Results Thirty-six patients were followed up for 6.3 to 7.6 years (average,6.8 years).All patients had normal joint range of motion.The Lysholm score improved from preoperative 64.4±4.52 to postoperative 85.6±4.60,and the difference was statistically significant (P ＜ 0.05).The X-rays and MRIs showed femoral and tibial tunnel enlargement in 3 cases,femoral tunnel enlargement in 5 cases and tibial tunnel enlargement in 3 cases.No joint space narrowing was found in all patients.One patient underwent arthroscopic revision ACL reconstruction with allograft tendon using bioabsorbable interference screws fixation on both tibial and femoral sides for re-rupture of ACL 4 years after operation due to trauma.Conclusion Arthroscopic ACL reconstruction with hamstring tendon using Transfix femoral fixation and interference screws tibial fixation is an effective method,which can provide satisfactory joint range of motion and stability.