Objective To investigate the effect of knee suspension during titanium plate fixation on postoperative posterior tibial slope (PTS) in knee osteoarthritis (KOA) with medial opening-wedge high tibial osteotomy (OWHTO). Methods The clinical data of 47 patients with KOA treated by OWHTO between January 2019 and December 2020 was retrospectively analyzed. In 24 cases, the knee joint was suspended when titanium plate was fixed (research group), and in 23 cases, the knee joint was naturally straightened when titanium plate was fixed (control group). There was no significant difference in gender, age, side, body mass index, disease duration, preoperative visual analogue scale (VAS) score, American Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Lysholm score, and preoperative PTS between the two groups (P>0.05). PTS were measured at 1 day after operation and last follow-up, and were compared with that before operation. Before operation and at last follow-up, VAS score was used to evaluate the knee pain, HSS score, WOMAC score, and Lysholm score were used to evaluate the knee function. Results The patients in both groups were followed up 13-24 months, with an average of 19.9 months. There was no complication such as incision infection, screw fracture, and deep venous thrombosis of lower limbs in two groups. At last follow-up, the VAS score, HSS score, WOMAC score, and Lysholm score in two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference between the two groups in the each score difference of before and after operation (P>0.05). There was no significant difference in PTS at each time point before and after operation in the research group (P>0.05), but PTS in the control group significantly increased at 1 day after operation and last follow-up (P<0.05). PTS of the research group at 1 day after operation and last follow-up were significantly lower than those of the control group (P<0.05). ConclusionOWHTO can effectively relieve knee pain and improve knee function in KOA, and the increase of postoperative PTS can be effectively avoided by suspending knee joint.
摘要:目的:探討地震傷員中膝關節損傷的機制、類型及處理方法。 方法:對我院收入住院的2728例 5·12汶川特大地震傷員傷情特點進行分析,篩選出有膝關節損傷的病例進行分析。 結果: 膝關節損傷前三位分別是髕骨骨折(42.15%)、脛骨平臺骨折(21.05%)、股骨髁骨折(13.16%),這與人們在地震時奔跑摔傷以及被房屋倒塌砸傷有很大關系。結論:地震后膝關節損傷其發病率、受傷機制、損傷類型、合并傷情況及治療處理均有其特點,總結這些特點和規律將對地震傷膝關節損傷患者的處理產生積極作用。Abstract: Objective: To investigate the knee joint injury mechanisms, types and treatment of the earthquake wounded. Methods: Analysis the characteristics of the 2728 cases of West China Hospital from 5.12 Wenchuan earthquake wound, screen out the cases of knee joint injury. Results: Patellar fracture (42.15%),tibial plateau fracture(21.05%), femoral condyle fracture (13.16%), were the top three of knee joint injuries, which have a great relationship with falling down and (or) injured by collapsed houses when people were running in the earthquake. Conclusion: After the earthquake the knee joint damages its disease incidence rate, is injured the mechanism, the damage type, the merge wound situation and treatment processing has its characteristic, will summarize these characteristics and the rule damages patient’s processing to the earthquake wound knee joint to have the positive role.
Objective To analyze the correlation between the morphology of tibial intercondylar eminence and non-contact anterior cruciate ligament (ACL) injury, and provide a theoretical basis for the prevention and risk identification of ACL injury. Methods A retrospective analysis was conducted on the knee radiographs of 401 patients admitted to the Chengdu Second People’s Hospital between January 2017 and October 2021, including 219 males and 182 females. Non-contact rupture of ACL was observed in 180 patients and confirmed by arthroscopy or surgery, while the remained 221 patients were confirmed to have normal ACL by physical examination and MRI. The heights of medial and lateral tibial intercondylar eminence and the width of tibial intercondylar eminence of the 401 patients were measured, and the risk factors of ACL injury were analyzed. Results The height of medial tibial intercondylar eminence was lower and the width of tibial intercondylar eminence was smaller in male patients with ACL fracture than those in the male control group with statistical significance (P<0.05). Logistic regression analysis showed that a narrow width of tibial intercondylar eminence was a risk factor of ACL injury in males (P<0.05). The receiver operating characteristic (ROC) curve showed that the diagnostic threshold was 11.40 mm, the area under the curve (AUC) was 0.851 [95% confidence interval (CI) (0.797, 0.896)], the sensitivity was 72.81%, and the specificity was 84.76%. The height of medial tibial intercondylar eminence was lower and the width of tibial intercondylar eminence was smaller in female patients than those in the female control group with statistical significance (P<0.05). Logistic regression analysis showed that both a low height of medial tibial intercondylar eminence and a narrow width of tibial intercondylar eminence were risk factors of ACL injury in females (P<0.05). For the width of medial tibial intercondylar eminence, the ROC curve showed that the diagnostic threshold was 8.30 mm, and the AUC was 0.684 [95%CI (0.611, 0.751)], the sensitivity and specificity were 63.64% and 72.41%, respectively; for the height of medial tibial intercondylar eminence, the diagnostic threshold was 11.30 mm, and the AUC was 0.699 [95%CI (0.627, 0.756)], the sensitivity was 89.39%, and the specificity was 47.41%. Conclusions The reduced width of tibial intercondylar eminence is a risk factor and effective predictor of non-contact ACL injury in males. Both the reduced height of the medial tibial intercondylar eminence and the reduced width of tibial intercondylar eminence are risk factors and may be predictors for non-contact ACL injury in females.
ObjectiveTo study the difference of femoral condylar twist angle (CTA) measurement in three dimensional (3-D) reconstruction digital models of human knee joint based on the two dimensional (2-D) images of MRI and CT so as to provide a reference for selecting the best method of CTA measurement in preoperative design for the femoral prosthesis rotational position.
MethodsThe CTA of 10 human cadaveric knee joint was measured in 3-D digital models based on MRI (group A), in 3-D digital models based on CT (group B), in the cadaveric knee joint with cartilage (group C), and in the cadaveric knee joint without cartilage (group D), respectively. The statistical analysis of the differences was made among the measurements of the CTA.
ResultsThe CTA values measured in 3-D digital models were (6.43±0.53)° in group A and (3.31±1.07)° in group B, showing significant difference (t=10.235, P=0.000). The CTA values measured in the cadaveric knee joint were (5.21±1.28)° in group C and (3.33±1.12)° in group D, showing significant difference (t=5.770, P=0.000). There was significant difference in the CTA values between group B and group C (t=5.779, P=0.000), but no significant difference was found between group A and group C (t=3.219, P=0.110).
ConclusionThe CTA values measured in the 3-D digital models based on MRI are closer to the actual values measured in the knee joint with cartilage, and benefit for preoperative plan.
ObjectiveTo compare the short-term effectiveness of suture hook suture via double posteromedial approaches and Fast-Fix total internal suture in treatment of Ramp lesions. Methods A clinical data of 56 patients with anterior cruciate ligament rupture combined with Ramp lesions, who met the selection criteria and admitted between December 2021 and February 2023, was retrospectively analyzed. The Ramp lesions were sutured using suture hook via double posteromedial approaches under arthroscopy in 28 cases (group A) and treated with Fast-Fix total internal suture under arthroscopy in 28 cases (group B). There was no significant difference in age, gender, cause of injury, type of injury, time from injury to operation, side of injury, body mass index, and preoperative Lysholm score, visual analogue scale (VAS) score, and Tegner score between the two groups (P>0.05). The patients were followed up regularly after operation, and the clinical and imaging healing of the Ramp lesion was evaluated according to the Barrett clinical healing standard and the MRI evaluation standard. Lysholm score, VAS score, and Tegner score were used to evaluate the function and pain degree of knee joint, and the results were compared with those before operation. ResultsThe incisions of the two groups healed by first intention. All patients were followed up 12-18 months (mean, 14.9 months). Postoperative McMurray tests were negative in both groups. The clinical healing rates of group A and group B were 71.4% (20/28) and 64.3% (18/28) at 6 months after operation, and 92.9% (26/28) and 82.1% (23/28) at 12 months after operation, respectively. The differences between the two groups was not significant (χ2=0.327, P=0.567; χ2=0.469, P=0.225). There was no significant difference in Lysholm score, VAS score, and Tegner score between the two groups at each time point after operation (P>0.05). The postoperative scores in the two groups significantly improved when compared with those before operation, and the scores at 12 months after operation further improved when compared with those at 6 months after operation, showing significant differences between the different time points in the two groups (P<0.05). At last follow-up, MRI examination of the knee joint showed that there were 26 (92.9%), 2 (7.1%), and 0 (0) cases of complete healing, partial healing, and nonunion in the Ramp lesion of group A, and 25 (89.3%), 1 (3.6%), and 2 (7.1%) cases in group B, respectively. There was no significant difference between the two groups (Z=?0.530, P=0.596). ConclusionSuture hook suture via double posteromedial approaches and Fast-Fix total internal suture under arthroscopy are safe and reliable in the treatment of Ramp lesion, and the knee joint function significantly improves after operation.
Objective To summarize the effectiveness of Ilizarov technique in the correction of flexion contracture deformity of the knee after burn. Methods Between April 2012 and July 2017, Ilizarov technique was used to treat 14 cases (17 knees) of knee flexion contracture patients. There were 11 males (13 knees) and 3 females (4 knees), with an age of 20-48 years (mean, 37 years). The duration of scar formation was 8 months to 24 years (mean, 5 years). The scar ranged from the upper part of the thigh, down to the middle part of the leg, from both sides to the inside and outside of the popliteal fossa, without ulceration. The area after scar contracture was 12 cm×10 cm to 30 cm×22 cm. Preoperative total activity of motion (TAM) was 30-115° (mean, 69°). There were 4 cases in wheelchair, 5 cases walking with double crutches, 3 cases with limp, and 2 cases with half squat walking. According to the knee function evaluation criteria by QIN Sihe, the preoperative knee function was fair in 3 knees, poor in 5 knees, and very poor in 9 knees. Results All patients were followed up 6 months to 5 years (mean, 2 years). No local skin necrosis, needle tract infection, limb numbness, and other complications occurred. Knee flexion deformities were all corrected. The postoperative TAM was 70-145° (mean, 125°). All patients were able to walk with plantar weight-bearing, and their gait improved when compared with that before operation. Five cases could walk without a crutch and only slightly claudication after operation. At last follow-up, according to the knee function evaluation criteria, the results were excellent in 9 knees, good in 5 knees, and fair in 3 knees, all were significantly improved when compared with that before operation (Z=–3.677,P=0.000). Conclusion Ilizarov technique has the advantages of minimally invasive, safe, and easy to operate for the treatment of flexion contracture deformity of the knee after burn.
ObjectiveTo compare the patient-reported outcomes regarding function, joint amnesia, and the quality of life after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The clinical data of patients who received UKA or TKA between September 2017 and June 2018 were retrospectively analyzed. After propensity score matching, 40 patients (40 knees) each in TKA group and UKA group were finally included in the study. There was no significant difference between the two groups in gender, age, body mass index, surgical side, preoperative knee range of motion, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, clinical and function scores of knee society score (KSS) (P>0.05). At 2 years after operation, WOMAC score, KSS clinical and function scores were performed on the two groups of patients, and compared with preoperative ones; knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS), short-form 36 health survey scale (SF-36 scale), and forgotten joint score (FJS) were also performed. Results At 2 years after operation, the total score of WOMAC, the clinical and function scores of KSS in the two groups significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in the total score of WOMAC, the individual score of WOMAC, the clinical and function scores of KSS between the two groups (P>0.05). The total KOOS-PS score in the UKA group was significantly lower than that in the TKA group (t=4.243, P=0.000), and the scores of writhing/knee rotation, kneeling, and squatting in the UKA group were significantly lower than those in the TKA group (P<0.05). The total FJS score in the UKA group was significantly higher than that in the TKA group (t=?6.334, P=0.000). In the UKA group, the scores of 7 items were significantly lower than those of the TKA group (P<0.05) including when walking over 15 minutes, when climbing stairs, when walking on uneven ground, when standing for long periods, when doing housework or gardening, when taking a walk or hiking, and when doing your favorite sport. The SF-36 scales of physiological function, energy, social function, emotional function, and mental health in the UKA group were significantly higher than those in the TKA group (P<0.05). Conclusion Compared with TKA, patients treated with UKA may have better knee function recovery, joint amnesia, and higher quality of life.
The injury of the knee joint is usually accompanied with the generation of hydrops. The volume of hydrops can be used as a reference to evaluate the extent of knee joint injuries. Based on the principle of bioimpedance detection, in this paper, a new method is proposed to detect knee joint hydrops. Firstly, a three-dimensional model of the knee joint was established according to the physiological and anatomical structure of the knee joint. Secondly, a knee impedance detection system was constructed based on the four-electrode theory, and the relationship between the knee impedance change and the volume of hydrops was calculated by linear regression. Finally, the model of rat knee joint hydrops was established, and the knee joint impedance was measured under different hydrops content to deduce the relationship between the fluid content and the knee joint impedance. The fluid volume in the joint was calculated by measuring the knee joint impedance, and the error rate was less than 10%. The experimental results show that the method proposed in this paper can establish the relationship between the impedance of the knee and the volume of fluid and realize the detection of the fluid volume.
ObjectiveTo study the effect of intraarticular injection of crosslinked-chitosan in the treatment of knee osteoarthritis in rabbits.MethodsThirty-two New Zealand white rabbits were randomly divided into 4 groups (groups A, B, C, and D; 8 rabbits in each group). The knee osteoarthritis models were prepared by anterior cruciate ligament transection in the left hind in groups A, B, and C. At 4 weeks after operation, the rabbits were received intraarticular injection of 0.6 mL crosslinked-chitosan in group A, 0.3 mL chitosan (once per 2 weeks, for twice) in group B, and 0.3 mL saline (once per 2 weeks, for twice) in group C. The rabbits in group D were treated with sham operation in the left hind, and received intraarticular injection of 0.3 mL saline (once per 2 weeks, for twice). At 8 weeks, the macroscopic observation, histological examination (HE staining, Safranin-fast green double staining, and Mankin score), scanning electron microscopy (SEM) observation, and immunohistochemical staining of collagen type Ⅱ were performed.ResultsMacroscopic and SEM observations showed that the cartilage in group D was basically the same as normal and better than that in groups A and B, and the abrasion of cartilage in group C was the most serious. The histological observation results in groups A and B were slightly similar and better than those in group C, but not up to the structure of group D. The macroscopic score and Mankin score of groups B and C were significantly higher than those of group D (P<0.05), and there was no significant difference between group A and group B (P>0.05). Immunohistochemical staining results showed that the collagen type Ⅱ positive percentage of chondrocytes was significantly higher in group D than that in groups B and C, and no significant difference was found between group A and group B (P>0.05). ConclusionThe crosslinked-chitosan can significantly improve the osteoarthritis of the rabbit knee, delay the pathological changes of osteoarthritis, and decrease the frequency of injection.
This article introduces the basic principles of finite element analysis in biomechanics, focusing on the basic principles of a variety of finite element analysis software, and their respective characteristics. In addition, it also describes the basic stress analysis of UGNX6.0 NASTRAN analysis for artificial knee process, i.e. the choice of the type, material definition, the set of constants, finite element mesh division and the finite element results of the analysis. Finite element analysis and evaluation of the design of personalized artificial knee were carried out, so that the rationality of the geometric design of the structure of the experimental design of artificial knee has been verified.
