目的 观察单侧中央动脉吻合在YamanoⅠ区手指离断伤再植中的临床应用效果.方法 选取2016年1月至2018年12月延安大学附属医院关节外科收治的115例YamanoⅠ区手指离断伤再植患者,按照手术方式不同分为对照组58例(采用指端创面放血法治疗)和观察组57例(术后不放血,仅吻合单侧中央动脉治疗),术后随访6～12个月(平均8.5个月),比较两组患者术后住院天数、换药次数、再植体愈合及成活情况、指甲生长长度、两点辨别觉、远端指间活动度和手指关节活动度优良率.结果 观察组患者的住院天数为(14.86±1.52)d,少于对照组的(15.74±1.67)d,换药次数为(9.02±1.25)次/d,少于对照组的(9.68±1.34)次/d,差异均有统计学意义(P<0.05);术后第6个月,观察组患者再植体溃烂率和部分坏死率分别为1.8％、3.5％,明显低于对照组的12.1％、15.5％,再植体成活率为94.7％,明显高于对照组的82.8％,差异均有统计学意义(P<0.05);术后第6个月,观察组患者的指甲生长长度为(13.8±2.4)mm,明显长于对照组的(11.6±2.2)mm,远端指间活动度为(62.5±4.4)°,明显大于对照组的(46.7±3.8)°,两点辨别觉距离为(4.2±0.5)mm,明显短于对照组的(5.6±0.4)mm,差异均有统计学意义(P<0.05);术后第6个月,观察组患者的手指关节活动度优良率为93.0％,明显高于对照组的79.3％,差异具有统计学意义(χ2=4.487,P=0.034).结论 仅吻合单侧中央动脉再植YamanoⅠ区手指指尖能明显提高再植体的成活率,有效加快指甲生长速度和感觉神经恢复,同时改善关节活动度,临床效果满意.

目的:研究桃叶珊瑚苷在体外对白细胞介素-1β(IL-1β)诱导的软骨细胞凋亡的影响,并探讨桃叶珊瑚苷在体内对小鼠骨关节炎(OA)疾病进展的影响.方法:①将小鼠软骨细胞分为对照组、IL-1β组和IL-1β+AC组.对照组小鼠软骨细胞正常培养36 h.IL-1β组小鼠软骨细胞正常培养12 h后,加入10μg/L IL-1β培养24 h.IL-1β+AC组小鼠软骨细胞加入100μmol/L桃叶珊瑚苷处理12 h后,加入10μg/L IL-1β培养24 h.比较三组软骨细胞活性、凋亡率、凋亡相关基因(Bax和Bcl-2)以及炎症因子[肿瘤坏死因子(TNF-α)、IL-6、前列腺素E2(PGE2)和基质金属蛋白酶-3(MMP-3)]表达情况.②将30只C57小鼠随机分为正常组、模型组和AC组.模型组和AC组小鼠经手术诱导建立OA模型.AC组小鼠按照80 mg/(kg·d)治疗6周,其他两组小鼠给予等量0.9％氯化钠溶液.比较三组小鼠国际骨关节炎研究学会(OARSI)评分、软骨下骨骨量、软骨组织中细胞凋亡率以及血清炎症因子含量.结果:①与对照组相比,IL-1β组软骨细胞活性显著下降,凋亡率显著上升,经桃叶珊瑚苷处理后IL-1β+AC组软骨细胞活性升高,凋亡率下降(均P<0.05).与对照组相比,IL-1β组和IL-1β+AC组软骨细胞内Bax mRNA表达显著升高,而Bcl-2 mRNA表达显著降低(均P<0.05).与IL-1β组相比,IL-1β+AC组软骨细胞内Bax mRNA表达显著降低,而Bcl-2 mRNA表达显著升高(均P<0.05).与对照组相比,IL-1β组和IL-1β+AC组软骨细胞内TNF-α、IL-6、PGE2和MMP-3含量显著升高,且IL-1β+AC组软骨细胞内TNF-α、IL-6、PGE2和MMP-3含量显著低于IL-1β组(均P<0.05).②与正常组小鼠相比,模型组和AC组小鼠软骨OARSI评分、软骨下骨骨量及软骨组织内细胞凋亡率显著升高,且AC组小鼠软骨OARSI评分、软骨下骨骨量与软骨组织内细胞凋亡率显著低于模型组(均P<0.05).与正常组相比,模型组和AC组血清TNF-α、IL-6、PGE2和MMP-3含量显著升高,且AC组血清TNF-α、IL-6、PGE2和MMP-3含量显著低于模型组(均P<0.05).结论:桃叶珊瑚苷在体外显著抑制IL-1β诱导的软骨细胞凋亡,并在体内延缓小鼠OA疾病进展,其机制可能与桃叶珊瑚苷通过抑制炎症因子表达而抑制炎症诱导的软骨细胞凋亡有关.

目的 研究Suture-anchor锚钉修复下胫腓前韧带在Weber C型踝关节骨折合并下胫腓联合损伤中的临床应用效果.方法 回顾性分析延安大学附属医院2017年3月至2021年3月间收治的84例Weber C型踝关节骨折合并下胫腓联合损伤患者的临床资料,根据患者下胫腓前韧带修复方法将其分为锚钉组(Suture-anchor锚钉修复,n=39)与螺钉组(皮质骨螺钉内固定,n=45),比较两组患者围术期相关指标、复位质量以及术后6个月美国足踝外科协会(AOFAS)踝足评分系统和踝关节Baird-Jackson功能得分情况.结果 锚钉组患者的手术耗时和术中透视次数分别为(103.69±17.79)min、(14.49±3.36)次,明显短(少)于螺钉组的(126.41±20.15)min和(18.41±4.15)次,差异均具有统计学意义(P<0.05);锚钉组患者的下胫腓联合前间距(ITFACS)为(1.86±0.26)mm,明显短于螺钉组的(2.79±0.32)mm,差异有统计学意义(P<0.05),但两组患者的下胫腓联合后间距(ITFPCS)比较差异无统计学意义(P>0.05);锚钉组患者的骨折愈合时间及术后恢复正常工作时间分别为(3.26±0.43)个月和(3.43±0.63)个月,明显短于螺钉组的(3.61±0.39)个月和(3.79±0.71)个月,差异均有统计学意义(P<0.05);术后6个月,两组患者的Baird-Jackson功能评分系统得分及AOFAS踝足功能量表得分比较差异均无统计学意义(P>0.05);锚钉组患者术后并发症发生率为2.56％,略低于螺钉组的17.78％,但差异无统计学意义(P>0.05).结论 与皮质骨螺钉内固定比较,带线骨锚钉内固定在治疗Weber C型踝关节骨折合并下胫腓联合损伤中更具优势,其可有效增加下胫腓联合前切迹的解剖复位率,且安全性高.

Background and Objective: Rheumatoid arthritis causes an elevated risk for Osteoporotic Fractures (OP). The present study aimed to investigate the risk for osteoporotic fractures on the combined use of methylprednisolone and Proton Pump Inhibitors (PPIs) among Chinese rheumatoid arthritis patients. Materials and Methods: A total of 4993 RA patients age between 55-75 were administered and exposure with methylprednisolone and proton pump inhibitors were investigated for the risk for osteoporotic fractures (OR). The exposure was stratified by the use of methylprednisolone and PPIs such as omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole and control (non-users). These subjects have been using the drugs for more than 24 months and above. Results: The combined users of methylprednisolone and PPIs had a mean age of 69.22 years compared to the 65.54 years of control. The combined users were linked with a 1.5 fold increased risk for OR compared with the control (OR = 1.56 (95% CI: 1.42-1.93)). It is observed that the OR fracture in the combined users had a 1.5 fold higher risk for hip fracture (OR = 1.52 (95% CI: 1.22-1.87), 3 fold higher risk for vertebral fracture (OR = 2.95 (95% CI: 1.92-4.27)), a 2.5 higher risk for pelvis fracture (OR = 2.51 (95% CI: 1.36-4.27)) and 4.1 higher risk for rib fracture (OR = 4.13 (% CI: 2.24-7.56)) compared to the control. Conclusion: There is an association in the risk for OR fracture between the combined use of methylprednisolone and PPIs due to the biological mechanism of action between methylprednisolone and PPIs on the bone of the RA patients.

Objective To explore the effectiveness of different operative approaches on thoracolumbar multiple level spinal fracture (MSF). Methods Data of 48 patients with thoracolumbar MSF in our hospital from Nov.2009 to Nov.2015 was retrospectively analysed.Twenty-eight cases recievced the posterior operative approach surgery and another 20 cases received anterior approach sugery.There was no significant difference between two groups in age,gender,complicated injury and the type of fracture.Indexes including the perioperative results,bone reduction,spinal nerve function and pain score were compared. Results The cases were followed up for 18 months on average.There were significant differences in bone reduction[(33.14±4.73) in posterior approach and (30.74±3.83) in anterior approach] and Cobb angle [(5.31±2.51) in posterior approach and (5.48±2.41) in anterior approach] when compared with before operation,but had no remarkable difference between two groups.There was no significant difference between two groups in spinal nerve function except for the motional function,with (67.31±2.51) in posterior approach and (78.48±2.41) in anterior approach.The anterior approach was worse than posterior in surgery time and perioperative bleeding but better in pain score. Conclusion Both operative approches are effective interventions for thoracolumbar MSF.There is no significant difference in bone reduction and spinal nerve function.But the anterior approach could do better in motional funtion.We beilive anterior appoarch is suitable in MSF with heavy nerve injury.

Background: The purpose of the present study was to detect the expression level of threonine and tyrosine protein kinase (TTK) in osteosarcoma (OS) and investigate whether TTK could be a biomarker for early diagnosis or even a molecular targeted therapy for OS. Methods: First, by using GEO dataset we analyzed the expression level of TTK in sarcoma. Then, by using immunohistochemistry (IHC) we investigated the TTK expression in tissue microarrays (TMAs) to verify the results. Next, we suppressed TTK expression in MG-63 and U2-OS cell lines, protein expression were analyzed by Western blot respectively as well as cell viability and migration were evaluated by Cell Counting Kit-8 (CCK-8) and transwell chamber assay. Finally, proteins that are associated with MAPK signal pathway were detected by Western blot. Results: GEO dataset revealed that TTK expression in normal bone tissue was significantly lower than that in sarcoma. And the result of IHC verified the higher expression of TTK in OS. In MG-63/siTTK and U2-OS/siTTK cells, the expression levels of TTK down-regulated significantly and the proliferation and migration were decreased with apoptosis increased compared to MG-63 and U2-OS cells. Additionally, MAPK signal pathway related protein expressions were reduced obviously. Conclusions: TTK expression in OS tissue was significantly higher than in normal tissue, it may provide additional help for the early diagnosis or even therapeutic target of OS. In addition, the internal mechanism still needs further investigation.

Objective To observe the effect of different dose of tranexamic acid (TXA) topical application on the postoperative drainage of total hip arthroplasty (THA).Methods 75 patients with primary unilateral THA from January to December 2016 were divided into three groups random number table,25 patients in each group.The group A was treated by retrograde injection of 1.0 g (NS:100 mL) TXA via the drainage tube when incision was sewed up.Group B and group C were injected with 2.0 g (NS:100 mL) TXA and 3.0 g (NS:100 mL) TXA in the same way,respectively.The main observation items were postoperative drainage volume,hemoglobin (Hb) of the third day after operation and number of blood transfusion.The secondary items included operation time,intraoperative blood loss,prothrombin time and activated partial thromboplastin time of the third day after surgery,number of pulmonary embolism,number of deep vein thrombosis and number of infections.Results There was no significant difference among the three groups in the base data (P ＞ 0.05).In the main observation items,the postoperative drainage volume decreased successively;the group A was significantly larger than the group B and the group C respectively (P ＜ 0.05),while the difference between the group B and the group C was not statistically significant (P ＞ 0.05).The Hb of the third day after operation increased successively;group A was significantly lower than group B and group C respectively (P ＜ 0.05),while there was no significant difference between group B and group C (P ＞ 0.05).The incidence of blood transfusion was not statistically significant among the three groups (P ＞ 0.05).There was no significant difference among the three groups in the secondary observation index (P ＞ 0.05).Conclusion The topical application of 2.0 g TXA is superior to 1.0 g TXA in reducing the postoperative drainage volume of THA,but similar to that of 3.0 g TXA.Therefore,it was recommended that 2.0 g TXA is used as a proper dose to decrease the postoperative drainage volume of THA.

Diagnostic physicians during the treatment of patients usually profile a disease into various severity (stages) levels, which gives better picture about the course of the treatment, financial estimate, material needs, time-line of the treatment, further diagnostics and recovery. With the advent of Computational Intelligence (CI), Big Data technologies and with the availability of enormous clinical data, the severity levels prediction by Clinical decision making systems (CDMS) has become ease. Apart from predicting the current severity level of the disease, it is very important to predict the next coming severity level of the disease. The disease severity level transition does not always happen in a predefined sequence on a certain timeline and there are many examples in diseases such as diabetes, cancer, sudden heart attack etc. where there is some sort of randomness in the severity level transition which happens irrespective of the timeline. The severity level jump varies from person to person due to some inexplicable reasons, so if CDMS predicts a possible severity level transition sequence along with the current severity level, it will be very helpful in the treatment phase. This research work provides novel solution for predicting the transition of severity levels using data mining approaches. Cleveland heart data set which has four severity levels is taken from the University of California, Irvine (UCI) machine learning repository and it is used for the analysis of the proposed method.

Objective To investigate regulation mechanism of bone morphogenic protein 2 ( BMP2 ) on chemokine C-X-C motif-ligand-12 ( CXCL12 ) expression in the fracture repair and its clinical significance. Methods Knockout mice of BMP2 ( BMP2cKO/+and BMP2cKO/cKO) were constructed. Immunohistochemistry methods were used to analyze the cells with CXCL12 expression and the timely changes in the controlled, BMP2cKO/+and BMP2cKO/cKO mice bone fracture repair models. Real time-qPCR was used to compare the expression changes of CXCL12, osteocalcin and α-SMA gene in endosteal cells and differential endosteal cells isolated from the controlled, BMP2cKO/+and BMP2cKO/cKOmice. Results The expression of BMP2 was significantly lower in BMP2cKO/+and BMP2cKO/cKOmice than the controlled mice. CXCL12 was expressed in the endosteal cells and some osteocytes during mice fracture repair, and the cells with CXCL12 expression increased at the beginning and then decreased. The endosteal cells and osteocytes which expressed CXCL12 increased gradually in BMP2cKO/+mice. CXCL12 expression in endosteal cells isolated from BMP2cKO/+mice was higher than that cells from the controlled mice. In isolated endosteal cells, rhBMP2, while inducing osteoblastic differentiation, stimulated expression of osteocalcin and α-SMA that was coupled with a decrease of CXCL12 expression significantly. In isolated BMP2cKO/cKOendosteal cells, high CXCL12 expression and low osteocalcin expression were observed. In isolated BMP2cKO/cKOendosteal cells with AMD3100 ( an antagonist of CXCL12 receptor ) treatment, osteocalcin and α-SMA expression increased. Conclusions In fracture repair process, BMP2 leads to the downregulation of CXCL12 expression that would facilitate endosteal cells differentiating into osteoblasts and promote fracture healing.

Objective:To observe Clinical efficacy of Yangxue Shujin Decoction (Tonifying Blood and Stretching Tendon Decoction) cornbined with horizontal supine balance therapy in the treatment of cervical spondylotic arteriopathy and its impact on blood rheology before and after the treatment.Methods:Ninety cases with cervical spondylotic arteriopathy who recieved treatment in Outpatient Cardiology Department of Gansu university of traditional Chinese medicine hospital from March 2014 to March 2015 and met the clinical diagnostic criteria were selected and randomly divided into the experimental group and the control group (n =45) by clinic serial random number table method.The experimental group was given Yangxue Shujin Decoction with hyperbaric oxygen,while the control group was given nimodipine with hyperbaric oxygen.Four weeks was set as one course of the treatment.Clinical symptom integral,clinical effecacy and changes in blood rheology before and after one-course treatment were compared and analyzed.Results:The total efficacy of the experimental group was 95.56％ and that of the control group was 86.67％.Differences in total efficacy showed statistically significant (x2 =3.120,P =0.000 ＜ 0.05).Clinical symptoms integrals of the two groups were compared before the treatment,showing no statistical significance (t =-0.642,P =0.6212 ＞ 0.05),while the difference was statistically significant when compared before and after treatment group in the two groups (P ＜ 0.05).Comparison between the two groups after the treatment also showed statistically significant differences (t =-1.835,P =0.004 ＜0.05).For changes in blood rheology,differences in both the two groups before and after the treatment showed statistically significant (P ＜ 0.05) and comparison between the experimental group and the control group after the treatment also showed statistically significant difference (P ＜ 0.05).Conclusion:The clinical curative effect is satisfied with obvious improvement on patients' whole blood viscosity,plasma viscosity and erythrocyte fibrinogen.This treatment is simple and feasible with good dependency,which is worthy of clinical application.

Background: To compare the clinical effect between early motion and immobilization after arthroscopic rotator cuff repair. Methods: From January 2013 to July 2016, a total of 132 patients underwent arthroscopic repair of a large size rotator cuff tear, the patients were randomly divided into observation group (66 cases) and control group (66 cases). Postoperatively, the observation group received early motion and the control group received immobilization, then the clinical outcomes in two groups were comparatively analysed, including the range of motion, Visual Analogue Scale (VAS) score, muscle strength, University of California-Los Angeles (UCLA) shoulder score and Constant shoulder score, and re-tear rates, and these parameters were performed and assessed at 3, 6, and 12 months after arthroscopic rotator cuff repair. Results: At 12 months after arthroscopic rotator cuff repair, the two groups showed no significant difference in the range of motion (P>0.05). Six patients in the observation group and four patients in the control group appeared re-tear, the differences were not statistically significant (P>0.05). However, the incidence of stiffness in the control group was significantly higher than that in the observation group (36.36% vs. 15.15%, P<0.05). The two groups both obtained significantly better functional score than that before surgery (P<0.05). However, there was no significant difference between the two groups in VAS score, muscle strength, UCLA shoulder score and Constant shoulder score at the final follow-up period (P>0.05). Conclusion: Compared with immobilization, early motion can obtain similar functional outcomes in the later stage and reduce incidence of stiffness, which should be recommended in large size rotator cuff tear after arthroscopy repair.

Objective To investigate the clinical efficacy of the anatomical locking plate fixation and proxi -mal femoral anti-rotation nail for the treatment of intertrochanteric fracture .Methods According to the treatment methods,120 patients with intertrochanteric fractures were divided into the control group ( anatomical locking plate fixation) and the observation group (proximal femoral anti-rotation nail).The surgery-related clinical indicators, postoperative recovery ,clinical efficacy and postoperative complications were compared between the two groups .Re-sults The incision length,operative time,intra-operative and postoperative bleeding volume of the observation group [(7.0 ±1.1)cm,(70.2 ±10.2)min,(136.3 ±43.2)mL and (160.3 ±50.2)mL] were significantly lower than those of the control group[(13.7 ±1.3)cm,(98.5 ±15.3)min,(185.3 ±64.3)mL and (240.4 ±64.3)mL,(P<0.05)];the hospitalization time,bed time,healing time,and early postoperative exercise time of the observation group[(10.3 ±2.3)d,(10.4 ±1.2)d,(10.4 ±1.0)d and (6.3 ±2.3)d] were significantly less than those the control group[(20.1 ±3.2)d,(28.3 ±4.3)d,(14.1 ±1.2) and (11.4 ±5.3)d,(P<0.05)];the clinical effi-cacy rate of the observation group (96.7%) was better than that of the control group (88.3%,P<0.05);the inci-dence of postoperative complications in the observation group (3.3%) was significantly lower than the control group (20.0%,P<0.05).Conclusion The proximal femoral anti-rotation nail in the treatment of intertrochanteric fracture can achieve significant clinical effects ,which has advantages of less invasive ,rapid postoperative recovery , short healing time ,and less complications .It is worthy of clinical application .

Objective To analyze the curative efficacy of posterior short-segment fixation combined with transpedicular intracorporeal grafting in the treatment of thoracolumbar fractures. Methods Eighty patients with thoracolumbar fractures in our hospital were randomly divided into control group (n=40) and treatment group (n=40). Control group was given the treatment of posterior short-segment fixation and treatment group was given posterior short-segment fixation combined with transpedicular intracorporeal grafting, and the curative efficacy of patients in two groups were compared. Results Compared with pre-operation, the compression ratio of anterior vertebral height and the Cobb angle after treatment of both two groups declined, but the compression ratio of anterior vertebral height and the Cobb angle of control group after operation were (15.7±3.6)%and (10.6±3.8)°, which were significantly higher than (8.9±2.5)%and (4.2±1.7)° of treatment group (P<0.05). The postoperative neurological function classification of control group was not significantly different from that of the treatment group (P>0.05). Conclusion Posterior short-segment fixation combined with transpedicular intracorporeal grafting in treatment of thoracolumbar fractures can reconstruct vertebral height and maintain Cobb angle stability and promote bone healing.

目的 分析并探讨椎间盘镜下微创植骨治疗股骨、胫骨骨折术后骨不连临床疗效.方法 选取接受治疗的股骨、胫骨骨折术后骨不连患者120例,根据治疗方案将其分为观察组与对照组,每组60例.观察组采用椎间盘镜下微创植骨进行治疗,对照组采用带锁髓内针附加锁定钢板加压植骨进行治疗,观察二组治疗效果.结果 观察组治疗优良率为83.33％,有效率为100.00％.对照组治疗优良率为66.67％,有效率为100％.观察组治疗优良率明显高于对照组,差异具有统计学意义(P＜0.05).观察组手术时间为(61.33±11.32)min,术中出血量为(101.23±12.32) ml,住院时间为(8.34±2.32)d,骨折愈合时间为(6.34±1.23)个月.对照组手术时间为(83.42±14.53)min,术中出血量为(243.13±30.54)ml,住院时间为(11.32±3.12)d,骨折愈合时间为(15.34±2.43)个月.观察组各项指标明显优于对照组,差异具有统计学意义(P＜0.05).结论 椎间盘镜下微创植骨治疗股骨、胫骨骨折术后骨不连,临床效果显著,且术后恢复快,值得临床推广.

目的：探讨踝关节融合术对创伤性关节炎的临床疗效。方法从2008年6月至2012年6月对23例创伤性踝关节炎患者行踝关节融合手术，男14例，女9例；年龄26~68岁，平均48.6岁。其中既往有踝关节骨折或脱位病史17例，4例继发于距骨骨折，2例患有踝关节不稳。手术采用3~5枚松质骨加压螺钉固定，术后进行石膏固定。评分标准选用美国足踝外科协会（American orthopaedic foot and ankle society，AOFAS）踝-后足评分量表，分别对术前及末次随访进行评分。通过疼痛、功能及 X 线对位情况以及手术优良率分析融合手术对创伤性踝关节炎的疗效。结果23例均获随访，随访时间为1~3年，平均1.9年。所有患者均未出现伤口感染及神经损伤等严重并发症情况，其中18例患者症状基本消失，正常生活，4例患者长时间行走后足弓处出现轻微疼痛，休息后可缓解，1例患者踝关节偶尔发生轻度疼痛，口服药物后可缓解。术后3个月可见骨痂形成，但未将上下关节面完全连接，术后半年所有患者均已达到骨性融合。AOFAS 总体评分由术前（26.0±5.85）分提高至（77.78±10.15）分，P ﹤0.05。优5例，良12例，一般5例，差1例，手术优良率73.91％。结论踝关节融合是治疗创伤性关节炎的有效的手术方式，具有稳定性高，融合成功率高的特点。

Objective To observe the efficiency of arthroscopic percutaneous bone grafting and internal fix-ation in the treatment of SchatzkerⅠ-Ⅲtibial plateau fractures.Methods Forty five cases of lateral tibial plateau fracture of SchatzkerⅠ-Ⅲin our hospital from Mar.2011 to Mar.2013 were divided into the study group(23 cases) and the control group (22 cases) .The study group were treated with arthroscopy assisted percutaneous bone screw fixation and the control group were treated with traditional incision reduction and internal fixation. Intraoperative and postoperative effect of the two groups were compared.Results All patients were followed up for 6 to 12 months and all patients achieved primary healing without infection or delayed healing;healing time,Lysholm score,Yong’ s score of the study group was significantly better than that of the control group( P<0.05 );the distribution of excel-lent and good rate in the study group were significantly better than that of the control group(P<0.05).Conclusion Arthroscopic percutaneous bone grafting and internal fixation in the treatment of tibial plateau fractures have better clinical effect compared with traditional open reduction and shorten the healing time.

目的：比较研究膝关节镜下复位内固定与切开复位内固定治疗胫骨髁间嵴撕脱骨折的疗效。方法：对在我院进行胫骨髁间嵴撕脱骨折手术的28例患者，按照围手术期内的不同治疗方案将其随机分为对照组与实验组各14例，对照组采用切开复位内固定方式给予治疗，实验组则采用关节镜下复位内固定方式给予治疗,手术前均对患者进行X线拍片，手术后每隔3个月对其进行一次X线拍片，并给予Lysholm关节评分，按照Zaricznyj与Meyers&Mekeever的分型标准进行分型，其中，Ⅱ型8例，Ⅲ型11例，Ⅳ型9例。结果：手术后随访二年，两组患者于手术后半年至一年内获得良好的骨性愈合效果，Ⅱ型、Ⅲ型骨折虽在三个月和六个月内的Lysholm关节评分无统计学差异（P＞0.05），但其在术后一年至两年内的比较差异却具有统计学意义（P＜0.05）。结论：膝关节镜下复位内固定技术为治疗胫骨髁间嵴撕脱骨折提供了一种新的治疗方法，其具有创伤小，骨折复位准确以及膝关节功能恢复显著等特点，是一种安全、可行的治疗手段，值得在临床广泛推广及应用。

目的观察自体半腱肌、股薄肌重建术治疗急性膝关节前交叉韧带合并后外侧角损伤的疗效。方法膝关节前交叉韧带合并后外侧角损伤患者13例,在关节镜下采用自体半腱肌、股薄肌一期重建前交叉韧带并加强重建后外侧角韧带。结果术后随访8～18个月,所有患者在站立、行走和上下楼梯时没有与膝关节后外侧不稳相关的过伸位膝关节不稳感,未发现行走时膝关节内甩。术后8个月关节屈曲100°～135°,伸直0°～10°,Lysom评分为(87.79±6.23)分,均较术前明显改善(P均<0.01);国际膝关节文献委员会(IKDC)主观评价正常4例,接近正常8例,异常1例,客观评价平均87分。结论采用自体半腱肌术、股薄肌重建术治疗急性膝前交叉韧带合并后外侧角损伤,能够恢复膝关节后外侧与前、后方的稳定性,重建关节功能。

BACKGROUND: Cruciate ligament and posterolateral corner of the knee can both be reconstructed by semitendinosus and gracilis tendon autograft. OBJECTIVE: To analyse the repairing effects of semitendinosus and gracilis tendon autograft on knee joint combined anterior cruciate ligament and posterolateral corner injury. METHODS: A total of 20 patients of knee joint combined anterior cruciate ligament and posterolateral corner injury were randomly assigned into experiment group and control group. With the aid of arthroscope, one-stage reconstruction of anterior cruciate ligament was performed by semitendinosus autograft and gracilis tendon autograft, and the reconstructed posterolateral corner was strengthened in the experiment group. Patients in control group only underwent one-stage reconstruction of anterior cruciate ligament. RESULTS AND CONCLUSION: Compared with preoperation, there was a significant improvement in Lysom scores of the two groups (P < 0.01). Experimental patients did not show over-extending knee instability related to unstable posterolateral structures of the knee joint when standing, walking, going upstairs and downstairs. There was no inward swing of the knee joint during walking. The ranges of motion were from 100° to 135° of flexion and from 0° to 10° of extension. There were 3 cases in the control group showed no over-extending knee instability related to unstable posterolateral structures of the knee joint when standing, walking, going upstairs and downstairs, and 4 cases showed slight inward swing of the knee joint during walking. The ranges of motion were from 104° to 130° of flexion and from 0° to 10° of extension. These findings demonstrate that the posterolateral, front and rear stability of the knee joint is recovered after the reconstruction of nterior cruciate ligament and posterolateral corner by tendon autograft. The treatment effect is better than the reconstruction of anterior cruciate ligament alone.