[目的]比较两种不同通路保残重建后交叉韧带(posterior cruciate ligament,PCL)重建技术的临床疗效.[方法]回顾性分析本院2012年3月—2020年3月保残重建后交叉韧带损伤50例患者的临床资料.根据术前医患沟通结果,28例采用经ACL腋下通路定位胫骨骨道(腋下组),另外22例采用经ACL与PCL残端间通路定位(常规组).比较两组围手术期、随访及影像资料.[结果]两组均顺利完成手术,术中均无血管、神经损伤等并发症发生.腋下组的术中出血量显著少于常规组(P＜0.05).所有患者均获得2年以上随访,两组恢复完全负重活动时间差异无统计学意义(P＞0.05).随着术后时间推移,两组Lysholm评分、IKDC评分、膝关节屈伸ROM均显著增加(P＜0.05),而VAS疼痛评分和后抽屉试验分级均显著减少(P＜0.05);术后6个月和末次随访,腋下组VAS疼痛评分、Lysholm评分、IKDC评分、后抽屉试验均显著优于常规组(P＜0.05).影像方面,术后腋下组胫骨骨道内口 CT测量冠状位(a/b)比值显著优于常规组(P＜0.05),而两组间胫骨骨道内口 CT测量矢状位(c/d)比值的差异无统计学意义(P＞0.05).与术前相比,两组术后屈膝90.后向应力位胫骨后移显著减少(P＜0.05);术后6个月和末次随访时腋下组显著优于常规组(P＜0.05).[结论]关节镜下经ACL腋下定位胫骨隧道的PCL保残重建术,更有利于精确定位胫骨骨道内口,还可更有效地保留PCL残束,临床疗效更好.

Abstract Background：An accurate method for precise tibial tunnel preparation and preserving remnant are believed as the key technologies of transtibial PCL reconstruction. However, there are technically difficult when creating an accurate tibial tunnel under good visualization without removing the remnant PCL fibers. We found tibial guide could through the path under-the-ACL(between the ACL and lateral femoral condyle) to posterolateral compartment at 45° Knee flexion and varus stress, while tibial guide tip can locate the insertion from the lateral of PCL and get around the PCL remnant and ACL fibers; placing tunnel inferolaterally and preserving remnant intactly will be easily at the same time . Purpose : (1) report a modified technique for tibial tunnel preparation to place the tunnel at inferolateral position easily without remnant’s block in PCL reconstruction with remnant preservation. (2) compare tibial tunnel placement of two guide path by in vivo 3-dimensional computed tomography（3D-CT）:the path under-the-ACL（the guide insertion we recommend）and the path over-the-ACL（the guide insertion we used to）. Methods： Tibial tunnel aperture location was analyzed by postoperative in vivo CT in 50 patients who underwent single-bundle remnant-preserving PCL reconstruction ,22 by over-the-ACL and 28 by under-the-ACL tibial guide insertion techniques by a retrospective study from 2016 to 2020 to our center. Tibial tunnel positions were measured in the medial to lateral and proximal to distal directions of the posterior proximal tibia. Stress radiography of pre- and post-operation were used to evaluate the knee stability. Results：All patients were follow-up above 24 months. In the medial to lateral direction, the center of tibial tunnel aperture was located more laterally in the under-the-ACL group of (0.51±0.01)% than over-the-ACL group of (0.46±0.04)%（P＜0.05）. The tibial tunnel position in the proximal to distal direction, determined by absolute value and relative percentage, were similar in the 2 groups. Two groups were significantly improved the posterior laxity control compared with preoperation by stress radiography at 24 months postoperatively, and posterior tibial translation (4.00±1.03)mm in A group compared with (5.43±1.09)mm in B group（P＜0.05）. Conclusions: Tibial tunnel apertures would be located more laterally after under-the-ACL tibial guide insertion than after over-the-ACL tibial guide insertion. There was, however, no significant difference between these techniques in distance from the joint line to the tibial tunnel aperture. Insertion under-the-ACL to the PCL stump may result in better placement of the PCL in Fanelli area.

[目的]介绍关节镜下"长袖套"保留残迹联合内减张前交叉韧带(anterior cruciate ligament,ACL)重建术的手术技术和初步临床效果.[方法]回顾性分析上述技术ACL重建治疗韧带上体部断裂且部分残端有附着点的95例患者的临床资料.将断裂的ACL残束制成"长袖套",将重建的移植物从中穿出,并联合使用关节内减张术重建ACL.术后行ADT、Lach-man试验评估韧带稳定性,单腿跳跃试验评估膝关节运动功能;并进行IKDC评分和Lysholm评分.术后2年行影像学检查和二次关节镜检,评估韧带生长情况.[结果]所有患者均得到2年以上临床随访,膝关节稳定性均得到了有效恢复,术后膝关节功能较术前有显著提高(P＜0.05).二次镜检评估,韧带生长良好,无明显松弛.[结论] ACL"长袖套"保残重建联合关节内减张技术,手术操作简便有效,能显著促进韧带生长并改善膝关节功能.

[Objective] To explore the risk factors of early deep vein thrombosis in the lower extremity after spinal fusion surgery.[Method] A total of 216 patients who underwent spinal fusion surgery in the People's Hospital of Guangxi Zhuang Autonomous Region from July 2015 to January 2017 were enrolled into this study.According to results of ultrasonography on both lower extremities after surgery,the patients were divided into two groups,the DVT group and the non DVT group.Age,gender,BMI,diabetes,hypertension,blood clotting function,D-dimer,fusion segments,operating time,blood transfusion,anticoagulants,postoperative bed time were recorded.Chi-square test and multivariate logistic regression were used to explore the risk factors of DVT.[Result] Of the 216 patients,including 87 males and 129 females,33 patients (15.3％) developed DVT after surgery with 3 symptomatic patients (1.4％) and 30 asymptomatic patients were classified as the DVT group,whereas the remaining 183 patients without DVT were fallen into non DVT group.Chi-square test showed there were significant differences between the two groups in age,BMI,operation time,blood transfusion and postoperative bed time.In addition,multivariate logistic regression revealed age ≥60,BMI≥24 kg/m2,blood transfusion and postoperative bed time≥5 days were risk factors associated with occurrence of DVT after spinal fusion surgery.[Conclusion] The patients with age ≥60,BMI≥24 kg/m2,blood transfusion and postoperative bed time ≥5 days are more likely to have early deep vein thrombosis of lower extremity after spinal fusion surgery.

Objectives:To investigate and analyze the risk factors of early lower extremity deep vein thrombosis after posterior lumbar interbody fusion.Methods:A total of 165 patients undergoing spinal fusion surgery in the Guangxi Zhuang Autonomous Region People's Hospital from July 2015 to May 2017 were collected.Type-B ultrasonic was perforemed on lower extremities before and after surgery.According to the results of ultrasonography after surgery,these cases were divided into two groups,DVT group and non DVT group.Age,gender,BMI,diabetes,hypertension,blood clotting function,D-dimer,fusion segments,operation time,blood transfusion,anticoagulants,postoperative bed time were recorded.Chi square test was used to analyze the risk factors of early deep vein thrombosis after posterior lumbar interbody fusion,and multivariate logistic regression analysis was applied to explore the main risk factors of DVT.Results:The incidence of DVT after posterior lumbar interbody fusion was 14.5％(24 of 165 cases).Single-factor analysis showed that there were significant differences between the two groups in age,body mass index(BMI),operation time,blood transfusion and postoperative bed time.Multivariate logistic regression analysis showed age≥60 (OR=6.444,95％ CI=2.116-19.628),BMI≥24kg/m2(OR=4.463,95％ CI=1.603-12.426),blood transfusion(OR=3.484,95％CI=1.110-10.932),postoperative bed time≥5 days(OR=3.155,95％ CI=1.027-9.695) were risk factors associated with occurrence of DVT after posterior lumbar interbody fusion.Conclusions:Aged≥60,BMI≥24kg/m2,blood transfusion and postoperative bed time ≥5 days are more likely to have early lower extremity deep vein thrombosis after posterior lumbar interbody fusion.

BACKGROUND:Vertebroplasty system has been proved to be effective for osteoporotic vertebral compressive fracture (OVCF); however, bone cement leakage-related complications occur frequently. Thereafter, high-viscosity bone cement system with high safety and efficacy is developed, but there is stil a lack of large-scale and high quality research. OBJECTIVE:To systematicaly review the efficacy and safety of high viscosityversus common bone cement systems for OVCF. METHODS: PubMed, Embase, Cochrane Library, CNKI, CqVip and WanFang databases were searched to colect the literatures about randomized controled trials (RCTs) or clinical controled trials (CCTs) of high viscosityversus common bone cement systems for OVCF published before January 2016. The quality assessment of included literatures and data extraction were performed by two researchers independently according to the Cochrane system. Data analysis was conducted using RevMan 5. 2 software. RESULTS AND CONCLUSION:Four RCTs and six CCTs were enroled. The results of Meta-analysis indicate that there were no significant differences in the volume of bone cement [MD=0.17, 95%CI(-0.04, 0.38)], visual analogue scale scores [RCT:MD=-0.30, 95%CI(-0.72, 0.11); CCT:MD=-0.05, 95%CI(-0.43, 0.32)] and incidence of second fractures [OR=1.77, 95%CI(0.24, 12.86)] between two bone cements. However, patients undergoing high viscosity bone cement system have significantly lower Oswestry disability index scores [MD=-2.99, 95%CI(-5.85,-0.13)], greater recovery of Cobb angle [MD=-3.19, 95%CI(-5.27,-1.10)] and lower incidence of cement leakage [OR=0.35, 95%CI(0.24, 0.51)]. High viscosity bone cement system in the treatment of OVCF shows good results at recovery of spinal structure and function and reducing leakage. Due to the limited quantity of included literature sand high heterogeneity, more large scale and high quality RCTs are stil needed for further verification.

目的 观察神经肌肉本体感觉促进(proprioceptive neuromuscular facilitation,PNF)技术联合高压氧治疗脊髓损伤合并不完全性截瘫的临床疗效.方法 选取脊髓损伤合并不完全性截瘫患者48例,均行脊髓减压、脊柱内固定手术治疗,均于手术后1～2周开始进行康复治疗.随机分为A组和B组,每组24例.A组采用PNF技术联合高压氧治疗;B组采用常规运动康复训练治疗及针灸治疗,两组均康复治疗6个月.根据中国脊髓损伤协会评分标准对康复治疗前后的感觉及运动进行评分,根据改良巴氏指数(modified Barthel index,MBI)评定表对日常生活活动能力进行评定.结果 两组患者康复治疗后感觉、运动评分及MBI较治疗前显著提高(P＜0.05).A组康复治疗后感觉、运动评分及MBI增加幅度明显大于B组(P＜0.05).结论 PNF技术联合高压氧治疗脊髓损伤合并不完全性截瘫有助于患者脊髓功能恢复,可显著改善患者的运动能力及生活自理能力.

目的:观察PNF技术结合针灸推拿康复治疗胸腰椎骨折并不全瘫患者的临床效果.方法:选取脊髓损伤合并不全截瘫患者60例.随机分为治疗组(30例)和对照组(30例),治疗组采用P N F技术结合针灸推拿治疗,对照组采用针灸推拿治疗,6个疗程后进行疗效比较.患者均做脊髓减压,脊柱内固定手术治疗,手术后2周内开始进行康复治疗.在康复治疗前、后用ASIA评分标准进行感觉及运动评分,改良巴氏指数评定表(MBI)评定日常生活活动能力.结果:两组患者康复治疗后感觉、运动评分及MBI指数较治疗前提高显著(P<0.05).治疗组康复治疗后感觉、运动评分及MBI指数增加幅度明显大于对照组 (P<0.05).结论:PNF技术结合针灸推拿对胸腰椎骨折并不全瘫进行康复治疗有助于患者脊髓功能恢复,可显著改善患者的运动能力及生活自理能力.该治疗方法,具有疗效高、见效快的特点,值得临床推广运用.