简介：客观：探索multiple-ligamentinjured膝的临床的特征并且为multiple-ligamentinjured膝评估处理的协议，技术和结果。方法：从2001年10月，到在9的2005年3月，有联合前面的十字形的系带(ACL)的9膝和以后的十字形的系带(打印机控制语言)眼泪，病人们被识别与临床并且arthroscopic考试。他们，5膝与破裂ofposteromedial角落(PMC)和中间的并行的系带(MCL)被相结合，4与混乱ofposterolateral角落(PLC)，2与腿弯部的脉管的损害并且1与小腿侧的神经损害。六个病人在损伤的尖锐阶段被就医，腿弯部的动脉and4的2个收到的修理举办了PMC和MCL的修理。有在arthroscope下面的自体移植的ACL和打印机控制语言的重建在损伤以后在4～10个星期在所有病人被执行，包括有在4个病人的二头肌femoris腱tenodesis的以后的一半的PLC的重建和PMC和MCLwith的重建在1个病人的大腿骨的扁带。结果：没有严重复杂并发症在9个病人在手术以后发生在早舞台。所有他们被跟随在上面为有23的一般水准的10-39月。00months±9。46个月。Lysholm分数是有85.00±的一般水准的70-958.29。InternationalKnee文档委员会(IKDC)分数从严重地反常(等级D)在在到在2膝的正常(等级A)的起始的检查的9膝，将近在6膝的正常(等级B)并且在在最后后续的1knee反常。9个病人，7在损害前回到了一样的活动水平，2在水平下面。结论：有严重不稳定性的多重系带的受伤的膝通常与另外的重要结构损坏被相结合。因此，对联合损害的小心的评价和治疗是必要的。在arthroscope下面的ACL和打印机控制语言的重建，同时或在阶段与额外的关节的系带的修理或重建结合了，在外科和令人满意的结果有最小的损伤的优点。

简介：推拿颈项部，并用梅花针扣刺大椎穴，在大椎穴拔罐，治疗了120例项韧带劳损患者。14天后观察疗效，其中治愈87例，好转28例，无效5例，总有效率95．8％。

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简介：AbstractPurpose:Iatrogenic coracoid and clavicle fracture is a known complication of drilling bone tunnels during anatomic coracoclavicular ligament reconstruction (ACCR). This study aims to measure the dimensions of coracoid process and clavicle in an Asian population to evaluate the suitability of drilling coracoid and clavicle tunnels for ACCR in Asians.Methods:Width measurements of 196 coracoids and 189 clavicles were obtained after reviewing all computed tomography (CT) scans of the shoulder performed over a 6 years period. Coracoid measurements were made on the CT slice which showed the maximum cross sectional width of the coracoid base. Medial to lateral measurements of the coracoid width were taken on an axial view, 4 mm above the identified junction of the coracoid base and glenoid base. Antero-posterior clavicle width was measured through a point directly above the midpoint of the coracoid and perpendicular to the long axis of the clavicle.Results:The overall mean coracoid width was 14.8 mm ± 2.54 mm (range 9.2-23.3 mm) and clavicle width was 17.1 mm ± 2.72 mm (range 11.1-25.3 mm).Conclusion:The Asian coracoid process is smaller than its Western equivalent. More research is required to validate this conclusion as no cadaveric studies with equivalent measurement techniques have been performed on Asians. Given the potentially narrower dimensions of the Asian coracoid process, extra precautions are required to minimize the risk of iatrogenic coracoid and clavicle fractures.

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简介：Background:Apreviousstudyhasreporteda50%reductionindisuseatrophyofthequadricepsduringthefirst14daysafteranteriorcruciateligament(ACL)reconstruction.Afollow-uptrialisneededtoconfirmthesepromisingresults.ThepresentstudyaimstoinvestigatetheeffectofanocclusionstimulusonquadricepsatrophyafterACLreconstruction.Methods:Atotalof24subjectsparticipatedinthestudy.Theywererandomizedintotwogroups.Startingthe2nddayaftersurgery,theocclusiongroupreceivedanocclusionstimulusfor5min,followedbyremovaloftheocclusivepressurefor3min.Thiswasrepeatedfivetimesinonetrainingsession,twicedaily.Duringtheperiodofocclusivestimulus,thesubjectsperformed20lowloadexercisesforthequadriceps.Thecontrolgroupfollowedthesameexerciseprotocol,butwithouttheocclusionstimulus.Changesinquadricepsanatomicalcrosssectionarea(ACSA)weremeasuredusingaxialmagneticresonance(MR)imagesat40%and50%ofthelengthofthefemur.Results:BothgroupshadasignificantreductionofquadricepsACSAfrom2daysbeforesurgeryto16daysaftersurgery.Duringtheinterventionperiod,theocclusiongrouplost13.8%±1.1%(mean±SEM)andthecontrolgrouplost13.1%±1.0%oftheirquadricepsACSA,respectively.Therewasnosignificantdifferencebetweentheocclusionandcontrolgroupswithregardstoatrophyofthequadricepsmuscles.Conclusion:Inconflictwithotherstudiesusingasimilarprotocol,applicationofbloodflowrestrictionthefirst14daysafterACLreconstructiondidnotreducequadricepsACSAmuscleatrophymeasuredbyMRinapopulationofathletes.

简介：客观：为了介绍posteromedial，从胫骨为以后的十字形的系带(打印机控制语言)的多骨的撕裂的减小和附件通过gastrocnemius的中间的头的中间的边阶来临。方法：通过posteromedial的起作用的减小和内部固定从1998年2月在我们的部门gastrocnemius走近到2000年3月的有PCL的胫骨的附件经历了的avulsed的十一个病人。皮切口被颠倒沿着gastrocnemius和以后的囊的中间的头的中间的边阶塑造L被把暴露中间的边阶和侧面的收回，避免腿弯部的神经与血管的结构的损坏。在那以后，以后的囊垂直地有点中间地被把到以后的intercondylarsulcus并且就在手指触诊放的以后的中间的胫骨的著名上。当时，PCL和它的胫骨的附件是容易温和的。在推迟的盒子中，打印机控制语言外设释放是必要的克服系带收回并且为最佳的减小并且多骨的愈合使破裂床清醒。最后，一或二个可被细菌破坏的螺丝钉被用来修理avulsed骨头片断和30°屈曲膝灰浆在创伤被关上以后，演员组固定定期被使用。评估包括了X光检查，以后下垂符号和以后的抽屉与相反地侧面的方面相比测试。因为伴随物损害，对低手足的功能的评价不是可得到的。结果：在PCL的胫骨的附件avulsed损害的修理使用的gastrocnemius的Theposteromedial途径能提供清楚的解剖暴露的利益，很少血损失(20ml平均)，对任何结构的分开或附件的没有需要。病人被跟随在上面为一般水准上的11个月(从6个月到2年)。它证明多骨的愈合在推迟的损害的情况下在新鲜损害和7-9星期的情况下在4-6星期以内被完成。六从8fresh盒子出现了完全否定以后下垂符号或以后的抽屉测试但是为1-2公里的2有的额外的松弛。在3个推迟的盒子中，为3-4公里的额外的松弛与thecontralateral膝相比被介绍。结论；gastrocnemius的pos

简介：AbstractPurpose:To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair.Methods:From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant.Results:Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both).Conclusion:The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

简介：AbstractPurpose:To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR.Methods:Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software.Results:Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years.Conclusion:MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.

简介：Objective:Toanalyzethehistologicalresultsandthebiologicalremodelingofligamentousinsertionafterthereconstructionofanteriorcruciateligament(ACL)withautograftorallografttendon.Methods:ExtensordigitorumtendonwasharvestedfromhindlimbasgraftmaterialandtransplantedtoreconstructtheresectedACLin12mongreldogs.Eachfreetendonendwassecuredbyholdingsuturesandthenthesuturesweretiedtothepostscrewatthefemoralandtibialbonytunneloutletaftertransplantationrespectively.Autograftwasrandomlyperformedononesideofkneewhileallograftontheothersideofknee.Aftertransplantation,thehistologicalanalysiswasundertakenatthe6th,12thweeksandthe6thmonthusinghematoxylin-eosin(HE)stainunderlightmicroscope.Results:TheinsertionstructureofnormalACLtypicallyconsistedoffourlayers,i.e.,denseconnectivetissue,fibrocartilage,mineralizedfibrocartilageandbone.Therewasadistinctregulartidemarklinebetweenfibrocartilageandmineralizedfibrocartilage.Atthe6thweekpostoperativcly,looseconnectivetissuepresentedintheinterspacebetweengraftandbonytunnelwallinbothautograftandallograftgroups.Atthe12thweekpostoperatively,thecollagenousfibersbetweenautograftandtunnelwallbecamewellorganizedandthefourlayersofinsertionwithdiscontinuoustidemarklineweredemonstratedindistinctlyinautograftgroupbutnotinallograftgroup.Atthe6thmonthpostoperatively,bothofaclearandcontinuoustidemarklineanddistinctfourlayerscouldbeseeninautograftgroup.Inallograftgroup,onlyawaveddiscontinuoustidemarklinewasshownandeithertheanatomicmorphologyorthematurityofinsertionwasinferiortothatofautograftgroup.Conclusions:Atthe6thmonthpostoperatively,althoughtheligament-cartilageinsertionisprimarilyformedafterACLreconstructionwithautograftorallografttendon,thehistologicalmorphologyandthematurationofinsertionofautografttendonar

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简介：AbstractBackground:Multiple techniques are commonly used for posterior cruciate ligament (PCL) reconstruction. However, the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable. The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.Methods:Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups: the interference screw fixation (IS) group, the transtibial tubercle fixation (TTF) group, and TTF + IS group (n = 12 in each group). The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure. The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.Results:After 1000 cycles of cyclic testing, no significant difference was observed in graft slippage among the three groups. For load-to-failure testing, the TTF + IS group showed a higher ultimate failure load than the TTF group and the IS group (876.34 ± 58.78 N vs. 660.92 ± 77.74 N [P < 0.001] vs. 556.49 ± 65.33 N [P < 0.001]). The stiffness in the TTF group was significantly lower than that in the IS group and the TTF + IS group (92.77 ± 20.16 N/mm in the TTF group vs. 120.27 ± 15.66 N/m in the IS group [P = 0.001] and 131.79 ± 17.95 N/mm in the TTF + IS group [P < 0.001]). No significant difference in the mean stiffness was found between the IS group and the TTF + IS group (P = 0.127).Conclusions:In this biomechanical study, supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.

简介：目的将创造膝系带并且到压力在不同的膝屈曲侧面的并行的系带(LCL)改变与或没有代替的运动的分析的有限元素模型调节的3-dimensional。four-major-ligament从一个成年人包含了膝标本的方法死于颅骨损害为与精确预先标记的可检测的系带插入脚印，地点和取向扫描的CT作好准备。扫描图象的CT与3-dimensional重建技术被变换成膝的一个3-dimensional模型并且由ANSYS的软件转变了成有限元素模型。模型用另外的科学家获得的试验性、数字的结果被验证。在五个不同的膝屈曲角度的LCL的自然压力变化(0

简介：AIM:Toevaluatetheeffectofreleasingtheorbicularisretainingligament(ORL)complexoftheteartroughcombinedwiththetransconjunctivalblepharoplastyinthesurgicalmanagementofteartroughdeformitycomparedwiththeeffectofblepharoplastyalone.METHODS:Aprospective,randomized(byclosedenvelopetechnique),controlledsurgicaltrialwhichincluded50patients(100eyes)withbilateralvisibleteartroughdeformityandlowereyelidfatbulging,wasdividedintotwogroupswhere25patients(50eyes)hadteartrough-ORLreleasewithblepharoplastyand25patients(50eyes)didn’t.Qualitativeandquantitativeassessmentsofteartroughdeformityweredoneat6mopostoperatively,achievinggrade0or1ofBarton’sclassificationwasconsideredasuccess.Standardizedphotographicdocumentationofeachpatientwasdonepreandpostoperatively,alsoassessmentofthepatients’satisfactionpostoperativelywasdoneandrankedasexcellent,verygood,goodorfair.RESULTS:Therewasstatisticallysignificantdifferencebetweenthetwogroupsintheoverallaestheticresultspostoperativelyregardingthequalitativeandquantitativeanalysisoftheteartroughdeformity,wherepatientswhohadteartrough-ORLcomplexreleasehadmoresuccessfuloutcomesthanthoseofthesecondgroup.CONCLUSION:ORLreleaseshouldbedoneinpatientswithteartroughdeformityinordertoreleasethetetheringeffectofthisligamentwhichcausestheprominenceofthenasojugalgroove.

简介：Injuryofankleisthemostcommoninathleticinjury.Becauseofanatomicparticu-larityofanklejoint,i.e.lateralmalleolusislongandthinandislocatedattheposteriorandlowerthanmedialmalleolus.Themedialmalleolusisbroadandflatandislocatedattheanterior.Lateralligamentisthinnerandweakerthanmedialligamentandthemusclegroupssupportingstrephexopodiaisfarinferi-ortothemusclegroupssupportingstrephenopodiainstrength,injuryofanklejointhappensmoreatinversionsprainandin-juryofanteriortalofibularligamentisinducedoften.Thus,rapidandeffectivetreatmentofanteriortalofibularligamentinjurycanelevatebetterathleticsofsportsman.Wheneverthediseasehappenedinstudentstoexercise,theauthorsoftenusedacupunctureofQiuxu（GB40）-through-Zhaohai（KI6）pointwithstrongstimulativemanipulation,whichcouldrelievemoreremakedlypainoftheanklejointcausedbyanteriortalofibularligamentinjuryasre-portedinthe