RESUMO
PURPOSE: This study aims to determine the outcome of double-bundle anterior cruciate ligament (ACL) reconstruction using an allograft in comparison with ACL reconstruction using a double-bundle autograft or a single-bundle allograft. METHODS: A total of 424 patients who accepted primary ACL reconstructions were divided randomly into three groups: double-bundle technique with autograft (DB-AU group, n = 154), double-bundle technique with allograft (DB-AL group, n = 128), and single-bundle technique with allograft (SB group, n = 142). The KT-1000 arthrometer and pivot-shift tests were performed at 3, 12, and 36 months after surgery, and clinical outcome measurements include the Lysholm score and the IKDC rating scales. Radiological assessments evaluated arthritic changes and tunnel expansion at 36 months postoperatively. RESULTS: The KT-1000 test scores in the DB-AU and DB-AL groups were significantly better than those in the SB group at 12 and 36 months postoperatively (P < 0.05). The pivot-shift tests scores in the DB-AU and DB-AL groups were significantly better than those in the SB group at the 3, 12, and 36 month follow-ups (P < 0.05). Based on the IKDC score and Lysholm score, there were no significant difference between the three groups during follow-up (P > 0.05). At 36 months postoperatively, 42.3 % of patients in the SB group showed a progression in arthritic changes, which was greater than in the DB-AU (29.2 %) and DB-AL (27.3 %) groups (P < 0.05). At 36 months, the rates of tunnel expansion in the DB-AU group and the DB-AL group were lower than in the SB group (P < 0.05). CONCLUSIONS: Double-bundle ACL reconstruction can be used to achieve better anterior and rotational stability and has a lower rate of arthritic progression and tunnel expansion than the single-bundle procedure. LEVEL OF EVIDENCE: I.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/prevenção & controle , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/prevenção & controle , Tendões/transplante , Adulto , Lesões do Ligamento Cruzado Anterior , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Traumatismos do Joelho/complicações , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento , Adulto JovemRESUMO
This study aimed to screen out differentially expressed genes (DEGs) and explore small molecule drugs for Tetralogy of Fallot (TOF). The gene expression profile of TOF GSE26125 was downloaded from the Gene Expression Omnibus database, including 16 idiopathic TOF samples and five healthy controls. The DEGs were identified by the Limma package in R language and underwent functional enrichment analysis via Database for Annotation, Visualization and Integrated Discovery tools. A protein-protein interaction (PPI) network of DEGs was then constructed and the significant clusters were selected for functional analysis. In addition, the DEGs were mapped to the connectivity map (CMap) database to identify potential small-molecule drugs. As a result, a total of 499 DEGs were selected between TOF and healthy controls. Meanwhile, the functional changes of DEGs related to TOF were mainly associated with cellular respiration and energy metabolism. Furthermore, in the PPI network, two clusters were identified via cluster 1 analysis. And only cluster 1 was significantly enriched into gene ontology terms, including respiratory chain, electron transport chain, and oxidation reduction. The hub gene of cluster 1 was NDUFAB1. Additionally, small molecules, such as harmine, solanine, and testosterone, may have the potential to repair the disordered metabolic pathways of TOF.
Assuntos
Biologia Computacional/métodos , Tetralogia de Fallot/genética , Transcriptoma/genética , Feminino , Redes Reguladoras de Genes , Humanos , Masculino , Análise em MicrossériesRESUMO
BACKGROUND: The repair and reconstruction of medial meniscus posterior root tears (MMPRTs) is an important issue in the field of orthopedic sports medicine. This study reports the first application of arthroscopic linear chain fixation for the treatment of MMPRTs. CASE PRESENTATION: A 78-year-old female patient presented with a 1.5-month history of right knee pain accompanied by a locked facet joint. The patient underwent surgery with the new linear chain fixation method. In this method, the suture and the loop part of the buckle-strap titanium plate were combined into a linear chain mechanical complex, and the tension of the posterior root stump was gradually increased by pulling on the two attachment lines at the external mouth of the tibial tunnel. The postoperative Lysholm score was 89, and the visual analogue scale score was 0.9, indicating a significant improvement in knee joint function. At the 7-month and 1-year post-surgery follow-up, physical and MRI examinations confirmed satisfactory healing of the MMPRTs. CONCLUSION: This surgical approach offers several benefits, including a simplified instrumentation setup, preservation of natural anatomical structures, and reliable residual stump fixation. It has the potential for clinical implementation.
Assuntos
Meniscos Tibiais , Lesões do Menisco Tibial , Feminino , Humanos , Idoso , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Artroscopia/métodos , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Articulação do Joelho/cirurgia , Tíbia , RupturaRESUMO
PURPOSE: The purpose of this study was to evaluate the clinical results of medial retinaculum plasty (MRP) and medial patellofemoral ligament reconstruction (MPFLR) with concomitant lateral retinacular release with respect to imaging and functional results. METHODS: Seventy patients with recurrent patellar instability were randomly divided into 2 groups based on their birth years (even/odd), receiving either MRP or MPFLR. Lateral retinacular release was also performed in all patients. Preoperatively, all patients received magnetic resonance imaging to evaluate the injury to the medial patellofemoral ligament. Computed tomography was performed before surgery and at follow-up. The subjective symptoms and functional outcome were evaluated preoperatively and postoperatively with the Kujala score, the Tegner activity score, and a subjective questionnaire. The physical apprehension test was examined, and redislocation was recorded. RESULTS: Patients were followed up for a mean period of 40 months (range, 24 to 55 months). The measurement results for the congruence angle, patellar tilt angle, and patellar lateral shift decreased significantly from the pretreatment measurements to the normal range at the latest follow-up, without a statistically significant difference between the 2 groups (P > .05). The median Kujala score had significantly improved after surgery. However, no statistically significant difference was found between the 2 groups at the latest follow-up (P > .05). In 6 cases in the MRP group (19%) and 3 in the MPFLR group (9%), we found patellar lateral shift that exceeded 1.5 cm but was less than 2.0 cm with a firm endpoint for the apprehension test, without a significant difference between the 2 groups. CONCLUSIONS: This prospective randomized study showed that MPFLR for recurrent patellar instability could achieve good clinical results, with a good congruous patellofemoral joint and good knee function. MRP could yield similar results to MPFLR for recurrent patellar instability in adults with medial patellofemoral ligament injuries from the patella or midsubstance portions. LEVEL OF EVIDENCE: Level II, prospective comparative study.
Assuntos
Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Adulto , Feminino , Humanos , Instabilidade Articular/reabilitação , Masculino , Luxação Patelar/reabilitação , Estudos Prospectivos , Recidiva , Adulto JovemRESUMO
BACKGROUND: Partial atrioventricular septal defect (P-AVSD) is a common congenital heart disease. Because of the presence of left and right atrioventricular valve deformities and the shift in the atrioventricular node and cardiac conduction bundle, the surgical repair of P-AVSD is difficult. This study was performed to compare the effects on the coronary sinus septum in the left versus the right atrium during surgical treatment for P-AVSD and report our experiences regarding the application of on-pump beating heart surgery under mild hypothermia for patients with P-AVSD. MATERIALS AND METHODS: The effects of on-pump beating heart surgery were analyzed retrospectively in 87 P-AVSD patients. Of the 87 total patients, 84 with anterior mitral leaflet cleft underwent valvuloplasty and 3 underwent mitral valve replacement. Seventy-seven patients underwent tricuspid valve annuloplasty, 2 underwent tricuspid valve replacement, and 1 underwent left superior vena cava ligation, and 3 patients with atrial fibrillation were treated with radiofrequency ablation. Patients with an ostium primum atrial septal defect underwent autologous pericardial modified Kirklin repair. Of these, 46 patients had their coronary sinus septum separated into the left atrium and 41 had their coronary sinus retained in the right atrium. Fingertip oxygen saturation was compared between patients in whom the coronary sinus was separated to the left atrium and those in whom the coronary sinus was retained in the right atrium. RESULTS: There was 1 postoperative early death (1.15%) due to respiratory failure, and 1 patient had a III degree atrioventricular block (1.15%) and underwent implantation of a permanent pacemaker. The fingertip oxygen saturation levels of the left atrium group were 96.81 ± 3.17 preoperatively, 95.37 ± 4.62 at 7 days postoperatively, and 94.53 ± 4.95 at 3 months postoperatively. Those of the right atrium group were 98.53 ± 2.84 preoperatively, 97.19 ± 3.57 at 7 days postoperatively, and 96.89 ± 4.19 at 3 months postoperatively. During the follow-up period, which ranged from 3 months to 7 years, the cardiac function was adequately restored. CONCLUSIONS: On-pump beating heart surgery under mild hypothermia is a safe and feasible method. The retention of the coronary sinus in the right atrium might maintain oxygen saturation.
Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Defeitos dos Septos Cardíacos/mortalidade , Defeitos dos Septos Cardíacos/cirurgia , Coração Auxiliar/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: The objective of present study was to propose a new classification for acute MPFL injury, which can help choose optimal treatment method for certain injury type. METHODS: Eighty-five patients with acute patellar dislocation treated non-surgically were retrospectively reviewed. They were assigned into two groups according to the newly introduced classification scheme, which classified MPFL injury into three types: injury in overlap region, injury in non-overlap region and combined injury of both regions. For study purpose, patients with combined injury were not included. Of 85 patients, 33 were in the overlap-region group (Group 1) and 52 in the non-overlap-region group (Group 2). Clinical patellar instability rate and patellofemoral score were measured and recorded at 2-year follow-up. RESULTS: The patellar instability rate was 15.2 % in Group 1 and 38.5 % in Group 2, with statistically significant difference between the two groups (P = 0.022). The mean visual analogue scale for Group 1 and Group 2 was 15.6 points and 28.3 points, respectively (P = 0.026). The mean Kujala score was 91.1 points and 82.6 points (P = 0.009), with a good or excellent subjective result recorded for 27 of 33 patients (81.8 %) in Group 1 compared with 30 of 52 patients (57.7 %) in Group 2 (P = 0.021). CONCLUSIONS: Non-surgical treatment achieves better clinical outcomes with respect to a lower patellar instability rate and better subjective function for the overlap-region injury of MPFL than for the non-overlap-region injury, and can be considered as treatment of choice for overlap-region injury of MPFL. The optimal choice for the non-overlap-region injury still requires further researches. LEVEL OF EVIDENCE: Therapeutic, Level IV.
Assuntos
Traumatismos do Joelho/classificação , Traumatismos do Joelho/terapia , Ligamentos Articulares/lesões , Luxação Patelar/classificação , Luxação Patelar/terapia , Articulação Patelofemoral/lesões , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Instabilidade Articular/terapia , Traumatismos do Joelho/diagnóstico , Masculino , Luxação Patelar/diagnóstico , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to present a novel medial collateral ligament (MCL) reconstruction technique and investigate the clinical outcomes of this surgical procedure. METHODS: From July 2006 to June 2009, 56 patients with medial instability of the knee were treated with MCL reconstruction and followed up for 33 months on average. These patients were divided into 2 groups based on whether anterior cruciate ligament (ACL) injury was present: 27 patients had isolated MCL injury, whereas 29 patients had combined MCL-ACL injury. All patients underwent reconstruction of the MCL with triangular double-bundle allograft, and we evaluated International Knee Documentation Committee (IKDC) scores, anteromedial rotatory instability (AMRI), and excessive knee medial opening (EKMO) both preoperatively and at follow-up. RESULTS: EKMO was significantly reduced to 2.9 mm at follow-up compared with 10.1 mm preoperatively. The incidence of AMRI was reduced to 9.4% (5 patients) compared with 67.9% (36 patients) preoperatively. Of the patients, 58.9% (33 patients) had a grade A IKDC subjective score and 35.7% (20 patients) had a grade B IKDC subjective score. Most patients had normal or nearly normal range of motion of the knee joint, whereas 4 patients (7.1%) lost more than 6° of range of motion in extension and 2 (3.6%) lost more than 25° in flexion. In 47 patients (83.9%) the symptoms were graded as normal or nearly normal according to IKDC symptom scores. No significant differences in IKDC subjective score, IKDC symptom score, flexion deficit score, AMRI, and EKMO were found between the isolated MCL injury group and the MCL-ACL injury group; however, a significant difference was found in knee extension deficit between groups. CONCLUSIONS: We have presented a new technique for reconstruction of the MCL with a triangular shape. This technique improved both valgus and rotational stability at short-term outcome. The clinical outcomes using IKDC evaluation indicate that no major difference exists in isolated MCL injury and combined MCL-ACL injury treated with this new technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Assuntos
Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Humanos , Masculino , Ligamento Colateral Médio do Joelho/lesões , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica , Transplante Homólogo , Adulto JovemRESUMO
INTRODUCTION: The purpose of this study was to evaluate the clinical effect of medial patellar retinaculum plasty for children and adolescent patients with patellar dislocation. MATERIALS AND METHODS: A prospective study was performed between October 2005 and December 2009. Sixty-one cases of children and adolescent patients with patellar dislocation were admitted to our study. Twenty-nine patients received medial capsule reefing, of which 13 patients also received lateral retinacular release (LRR) (Group I). Thirty-two patients received medial patellar retinaculum plasty, of which 12 patients also received LRR (Group II). Preoperatively, all patients received magnetic resonance imaging (MRI) to evaluate the injury of medial patellofemoral ligament. And all patients received computed tomography (CT) scans on which the congruence angle (CA) and patellar lateral shift (PLS) could be evaluated with 30° knee flexion. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean period of 50 months (25-75 months). For the comparison between the preoperative and postoperative results, the Kujala score improved significantly from 52.3 ± 2.9 to 78.1 ± 3.6 in Group I and from 53.5 ± 3.4 to 82.2 ± 3.4 in Group II (P < 0.05). There was significant difference of CA on CT scans and PLS with a statistical difference between the two groups (P < 0.05). Results of the apprehension test showed that nine patients had patellar lateral shift exceeding 1.5 cm with a soft end point in Group I and two patients had patellar lateral shift exceeding 1.5 cm with a hard end point in Group II (P < 0.05). Moreover, the subjective questionnaire revealed a significant difference of subjective effects between two groups (P < 0.05), including 7 excellent, 10 good and 12 fair in Group I and 18 excellent, 9 good, and 5 fair in Group II. CONCLUSION: The medial retinaculum plasty was better than medial capsule reefing in improving the subjective effects and decreasing the rate of patellar instability postoperatively in children and adolescent patients.
Assuntos
Procedimentos Ortopédicos/métodos , Luxação Patelar/cirurgia , Ligamento Patelar/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To study the therapeutic effect of chitosan-coated basic fibroblast growth factor (bFGF) slow-releasing microspheres on the knee osteoarthritis in the rabbit. METHODS: From November 2008 to July 2009, 54 New Zealand rabbits were divided into 6 groups at random, which were the control group, the model group, the PBS-M group, the bFGF-S group, the 10-bFGF-M group and the 100-bFGF-M group, respectively. The model of knee osteoarthritis was induced by the injection of papain in the rabbit. Except the control and model groups, all the experimental groups were implanted 1 ml intervention solution at the third and sixth weeks, including the PBS microspheres, bFGF solution, 10 µg bFGF microspheres and 100 µg bFGF microspheres, respectively. The rabbits were sacrificed at the ninth week after operation, and then articular cartilage was conducted the morphological and histopathological evaluation. RESULTS: The damage of articular cartilage in the model group was more serious than that in the control group, with statistical differences according to the Ink score (t = 8.22, P = 0.00) and Mankin score (t = 17.20, P = 0.00). The damage of articular cartilage in the PBS-M and bFGF-S groups were similar with that in the model group, according to the Ink score (t = 0.26, P = 0.79; t = 0.80, P = 0.45) and Mankin score (t = 1.51, P = 0.17; t = 0.56, P = 0.60). The Ink and Mankin scores in the 10-bFGF-M and 100-bFGF-M groups were better than that in the model group (Ink score: t = 3.58, P = 0.01; t = 6.82, P = 0.00; Mankin score: t = 3.41, P = 0.01; t = 5.00, P = 0.00), with the 100-bFGF-M group much better (t = 5.29, P = 0.00; t = 2.80, P = 0.02). CONCLUSIONS: The bFGF slow-releasing microsphere can keep its effective intra-articular concentration, which may accelerate the synthesis of proteoglycan and inhibit its decomposition to reverse the damage of articular cartilage.
Assuntos
Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Osteoartrite do Joelho/terapia , Animais , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/uso terapêutico , Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Injeções Intra-Articulares , Microesferas , CoelhosRESUMO
OBJECTIVE: To compare the outcome of arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction with six-strand hamstring tendon and patellar tendon allograft. METHODS: From October 2006 to December 2009, 108 patients with arthroscopic single-bundle ACL reconstruction were retrospectively reviewed, with 58 patients with six-strand hamstring tendon (Group H), and 50 patients with patellar tendon allograft (Group P). Patients were available for clinical evaluation with KT-1000 arthrometer measurements, Lachman and pivot-shift test, and knee function with the International Knee Documentation Committee (IKDC), Lysholm scores. RESULTS: All the patients were followed up at an average of 28.6 months (range 12 - 38 months). The average side-to-side difference was lesser for group H (1.2 ± 1.2) mm than group P (1.8 ± 1.5) mm (P < 0.05). On the pivot-shift test, 55 (94.8%) patients were negative and 3 (5.2%) were positive in group H, whereas 41 (82.0%) were negative and 9 (18.0%) were positive in group P, with significant difference between two groups (P < 0.05). All knee function scores were improved postoperatively, without statistically significant difference between the two groups (P > 0.05). CONCLUSION: Arthroscopic single-bundle ACL reconstruction with six-strand hamstring tendon will achieve better knee stability than patellar tendon allograft.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Artroscopia , Tendões/transplante , Adulto , Feminino , Humanos , Masculino , Ligamento Patelar/transplante , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To discuss a new technique about reconstruction of medial collateral ligament (MCL) with double bundle allograft and to evaluate the short-term clinical efficacy. METHODS: All 53 patients who suffered from valgus instability of the knee were selected. All cases were diagnosed of MCL injury because the medial gap of the knee widened more than 5 mm compared with collateral knee by the stress X-ray, MRI displayed discontinuity of MCL and valgus stress test was positive. All patients were accepted arthroscopic evaluation through inferomedial and inferolateral arthroscopy portal incisions to ascertain whether there were intra-articular injuries. An 8 cm incision was made from 1 cm superior adductor tubercle to 5 cm proximal medial tibia joint line in a longitudinal fashion. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm under the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm under the medial tibia joint line. We used 5 mm or 6 mm reamer to drill the tibia tunnel along with guide pin, and then drill the femur tunnel with 6 mm or 7 mm drill in the top of the adductor tubercle about 25 mm or 30 mm length. The allograft was pulled into the tunnel from tibia to the femur and fixed with absorbable interference screw. Patients carried out active rehabilitation program after operation. One year after the operation, IKDC score, Lysholm score were used to evaluate the clinical effect. RESULTS: The IKDC score (A or B, 86.78% vs. 0), Lysholm scores (89.7 ± 3.4 vs. 51.8 ± 4.9, t = -79.724, P < 0.05) were significantly improved compared with preoperative in all patients. Medial joint widened gap decreased from (10.4 ± 2.4) mm preoperative to (2.8 ± 1.5) mm postoperative from X ray and the differences were significant (t = 41.727, P < 0.05). Among these patients, the medial joint widened gap of 46 cases were less than 3 mm, 7 cases were from 3 mm to 5 mm. The range of motion was 135.4° ± 2.5° preoperative and 132.7° ± 3.7° postoperative. The 9 patients still had medial tenderness 1 year after operation. CONCLUSION: Application double bundle allograft technique to reconstruct MCL can significantly improve the stability of the knee and the short-term clinical efficacy was sure.
Assuntos
Ligamento Colateral Médio do Joelho/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Ligamento Colateral Médio do Joelho/lesões , Pessoa de Meia-Idade , Transplante Homólogo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To investigate the contribution of genetic polymorphisms of vitamin K epoxide reductase complex subunit 1 gene VKORC1-1639G>A, cytochrome P450 2C9 gene (CYP2C9), EPHXI, and clinical factors to warfarin sensitivity in southwest Chinese Han patients with mechanical heart valve prostheses. METHODS: A total of 127 patients with mechanical heart valve prostheses who have been followed up at our department during the past 23 years were enrolled in this study and compared to a control group that consisted of 133 randomly selected healthy blood donors. These Chinese patients met stable warfarin dosage requirements and had reached the target international normalized ratio (INR) of 1.5-2.0. PCR and direct sequencing were carried out to identify the polymorphisms of VKORC1-1639G>A (rs9923231), CYP2C9*3 (rs1057910), CYP2C9 IVS3-65G>C (rs9332127), and EPHX1691A>G (rs4653436). In addition, total and free (non-protein-bound) warfarin concentrations were analyzed. RESULTS AND CONCLUSIONS: There were great interindividual differences in warfarin maintenance dosage (ranging from 0.6 to 8.4 mg/day) among the 127 patients with mechanical heart valve prostheses. VKORC1-1639G>A, CYP2C9, EPHX1691A>G polymorphism, body weight, and age were found to affect the dose demands. Multiple linear regression models incorporating genetic polymorphisms of VKORC1, CYP2C9, EPHX1691A>G, and the nongenetic factors of age and body weight were developed, and explained up to 76.8% of the total variation (adjusted R (2) of 0.743) in warfarin maintenance doses in southwest Chinese patients with mechanical heart valve prostheses.
Assuntos
Próteses Valvulares Cardíacas , Oxigenases de Função Mista/genética , Varfarina/uso terapêutico , Adulto , Fatores Etários , Idoso , Hidrocarboneto de Aril Hidroxilases/genética , Povo Asiático/genética , Peso Corporal , China , Cromatografia Líquida de Alta Pressão , Citocromo P-450 CYP2C9 , Epóxido Hidrolases/genética , Feminino , Genótipo , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único , Espectrometria de Massas por Ionização por Electrospray , Espectrometria de Massas em Tandem , Vitamina K Epóxido Redutases , Varfarina/administração & dosagemRESUMO
Echocardiography detected a giant mass on the lateral wall of the right ventricle in a 13-year-old boy. The mass extended into the cavity of right ventricle without attachment to adjacent structures. We resected the mass under cardiopulmonary bypass. Histology showed it to be a primary leiomyoma of the right ventricle.
Assuntos
Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Leiomioma/cirurgia , Adolescente , Ponte Cardiopulmonar , Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Masculino , Resultado do TratamentoRESUMO
The purpose of this study was to explore the anatomy and evaluate the function of the medial patellofemoral ligament (MPFL). Anatomical dissection was performed on 12 fresh-frozen knee specimens. The MPFL is a condensation of capsular fibers, which originates at the medial femoral condyle. It runs transversely and inserts to the medial edge of the patella. With the landmark of the medial femur epicondyle (MFE), the femoral origination was located: just 8.90 ± 3.27 mm proximally and 13.47 ± 3.68 mm posteriorly to the MFE. The most interesting finding in present study was functional bundles of its patellar insertion. Approximately from the femoral origination point, fibers of the MPFL form two relatively concentrated fiber bundles: the inferior-straight bundle and the superior-oblique bundle. The whole length of each was 71.78 ± 5.51 and 73.67 ± 5.40 mm, respectively. The included angle between bundles was 15.1° ± 2.1°. Although the superior-oblique bundle and the inferior-straight bundle run on the patellar MPFL inferiorly and superiorly, respectively, as their name indicates, the two bundles are not entirely separated, which make MPFL one intact structure. The inferior-straight bundle is the main static soft tissue restraints where the superior-oblique bundle associated with vastus medialis obliquus (VMO) is to serve as the main dynamic soft tissue restraints. So this finding may provide the theoretical foundation for the anatomical reconstruction of the MPFL and shed lights on the future researchers.
Assuntos
Articulação do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/anatomia & histologia , Procedimentos de Cirurgia Plástica/métodos , Artroscopia , Fenômenos Biomecânicos , Cadáver , Dissecação , Feminino , Humanos , Masculino , Ligamento Colateral Médio do Joelho/cirurgia , Ligamento Patelar/anatomia & histologia , Ligamento Patelar/cirurgia , Resistência à TraçãoRESUMO
OBJECTIVE: To develop a surgical technique using a periosteal flap wrapped autologous hamstring tendons in ACL reconstruction and to examine its short-term outcome. METHODS: A total of 110 patients (110 knees) were included. The experimental group (n = 52) received ACL reconstruction with hamstring tendons wrapped in periosteum. In the other 58 patients, ACL was reconstructed with autologous hamstring tendons. The mean post-operative follow-up was 19 (12 - 25) months. All patients were assessed at 12 months post-operation. The parameters of efficacy evaluation included IKDC score, Tegner score, modified HSS score, KT-1000 arthrometer reading and a radiographic assessment using anteroposterior and lateral radiographs. The incidence of femoral and tibial bone tunnel enlargement between two groups was compared with chi(2) test. RESULTS: Clinical outcomes in experimental group (periosteum-wrapped grafts) were dependent on the wrap-up of periosteum, bone tunnel, graft fixation and postoperative rehabilitation. The good or excellent outcomes were reported in approximately 90% of the experimental group. And 44 patients showed normal or nearly normal knee function according to IKDC criteria. KT-1000 tests showed an average maximal manual side-to-side difference of 1.7 +/- 1.1 mm. Forty patients showed the outcomes of KT-1000, Lachman's knee ligament test and pivot-shift testing. The evaluation of the level of activity using the Tegner score revealed that 40 patients regained their pre-injury activity level. And 44 patients showed full knee extension and 42 patients showed full knee flexion after surgery. The average HSS score showed no significant difference between experimental group (90.6 +/- 0.57 points) and control group (89.9 +/- 0.8 points) (t = 0.714, P > 0.05). The KT-1000 measurement (133N) was larger in control group (2.3 +/- 1.0 mm) than in experimental group (1.7 +/- 1.1 mm). There was significant difference in laxity between two groups (t = 6.427, P < 0.05). At 12 months post-operation, tunnel enlargement could be observed in both groups. The average enlargement of femoral tunnel was less in experimental group (17.3%) than control group (34.5%) (chi(2) = 4.17, P < 0.05). And the enlargement of tibial tunnel was less in experimental group (19.2%) than control group (36.2%) (chi(2) = 3.90, P < 0.05). CONCLUSIONS: The surgical technique using a periosteal flap wrapped with autologous hamstring tendons in ACL reconstruction has definite clinical efficacies. It can enhance the stability of knee and prevent the enlargement of bone tunnel.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Articulação do Joelho/cirurgia , Periósteo/transplante , Adulto , Lesões do Ligamento Cruzado Anterior , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo , Cicatrização , Adulto JovemRESUMO
OBJECTIVE: to investigate if the cartilaginous surface and corresponding osseous contour of the patellofemoral joint match in the axial plane for providing theoretical basis with evaluating alignment of patellofemoral joint and designing the part of patellofemoral joint in knee prosthesis. METHODS: from January 2009 to March 2010, 9 human cadaver knees were prepared, which chandra of patellofemoral joint didn't degenerate. Each specimen was sectioned in the axial plane at 20° to 30° knee flax. The cross-sections revealed characteristics in the bony anatomy and corresponding articular surface geometry of the patellofemoral joint in the axial plane. Evaluating parameters included osseous patella congruence angle (OPCA), chondral patella congruence angle (CPCA), patella chondral convex point parameter (PCCPP), patella subchondral osseous convex point parameter (PSOCPP), the parameters of the deepest (chondral or osseous) point of the intercondylar sulcus. After that, the osseous and cartilaginous contours and subchondral osseous contours of the patella in the axial plane were analyzed through MRI data of 11 patients who didn't degenerate in patellofemoral joint cartilage. Parameters as same as cadaver knees were compared. RESULTS: data from specimens of OPCA was (-4.5 ± 1.1)°, CPCA was (0.5 ± 0.8)°, PCCPP was 1.13 ± 0.11, PSOCPP was 1.67 ± 0.14, PCDPIS was 1.35 ± 0.28, PODPIS was 1.38 ± 0.33. Date from MRI of OPCA was (-3.8 ± 1.4)°, CPCA was (0.7 ± 1.0)°, PCCPP was 1.05 ± 0.21, PSOCPP was 1.73 ± 0.18, PCDPIS was 1.41 ± 0.21, PODPIS was 1.37 ± 0.27. The patella exhibited significant differences in the bony vs. chondral anatomy (P < 0.05), but the intercondylar sulcus nearly match in the bony vs. chondral anatomy. CONCLUSIONS: the cartilaginous surface and corresponding osseous contour of the patella don't match in the patellofemoral joint axial plane, but that of the trochlea nearly matches. This is very important for accurately evaluating alignment of patellofemoral joint because the normal osseous alignment of patellofemoral joint don't represent the normal alignment and helpful for designing the part of patellofemoral joint in knee prosthesis.
Assuntos
Cartilagem Articular/anatomia & histologia , Articulação Patelofemoral/anatomia & histologia , Fenômenos Biomecânicos , Fêmur/anatomia & histologia , Humanos , Patela/anatomia & histologiaRESUMO
OBJECTIVE: To compare the clinical results of single-stranded isometric with double-stranded anatomic reconstruction of medial patellofemoral ligament (MPFL) for recurrent patellar dislocation. METHODS: Retrospective analysis of 60 consecutive patients (72 knees) with recurrent patellar dislocation underwent medial patellofemoral ligament reconstruction between August 2004 and October 2008, 22 cases (27 knees) with single-stranded isometric reconstruction, 38 cases (45 knees) with double-stranded anatomic reconstruction. Postoperatively patellar stability was examined, and recurrent rate was recorded. Patellar lateral shift ratio and tilt were measured on CT scans. Knee function was evaluated with subjective questionnaire and the Kujala score. RESULTS: All patients were followed up for more than 12 months without recurrent redislocation. (1) Recurrent instability rate was 18.5% in single-stranded group and 2.2% in double-stranded group, with statistical difference (P < 0.05). (2) The patellar tilt and lateral shift ratio returned to normal, without statistical difference between groups (P > 0.05). (3) The Kujala score were 59 ± 9 and 62 ± 9 preoperatively and 87 ± 4 and 94 ± 6 postoperatively in single- and double-stranded group, with statistical difference (P < 0.05). (4) The excellect rate was 85.2% in single-stranded group, 97.8% in double-stranded group, with statistical difference(P < 0.05). CONCLUSION: Both reconstruction can improve patellar stability and knee function significantly, with double-stranded anatomic reconstruction better in clinic evaluation.
Assuntos
Ligamento Colateral Médio do Joelho/cirurgia , Luxação Patelar/cirurgia , Ligamento Patelar/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Alkaptonuria is a rare disease in which the body does not have enough of an enzyme called homogentisic acid oxidase. Osteoarthritis is the most common degenerative joint disease. Ochronotic arthritis which resulting from the deposition of oxidized homogentisic acid within the connective tissues of peripheral joints has clinical feature that resembles those of osteoarthritis, but it has a unique manifestation. We reported a case of a patient of ochronotic arthritis, arthroscopic findings showed large areas of darkly pigmented full-thickness cartilage defects in the right knee, the whole meniscal parenchymatous tissue was also darkly pigmented. Histological investigation proved to be ochronosis.
Assuntos
Alcaptonúria/complicações , Articulação do Joelho , Ocronose/diagnóstico , Osteoartrite do Joelho/diagnóstico , Artroscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Ocronose/etiologia , Ocronose/patologiaRESUMO
OBJECTIVE: To evaluate the safe zones of screw fixations of Jumbo cup and reinforcement rings in acetabular revision surgery. METHODS: From December 2006 to January 2008, 11 fresh frozen human cadaver pelvises were prepared by removing all soft tissues except the medial neurovascular structures, each specimen was held in supine position with clamps. The anteroposterior radiographs were taken after the Jumbo cups or reinforcement rings were fixed in places. Left sides of acetabulum were used to create the models to evaluate the safe zones of the high hip center and Jumbo cups. Right sides were used to evaluate the safe zones of 3 different designs of acetabular reinforcement rings (Müller, Ganz, Burch-Schneider cage). RESULTS: Jumbo cups: screws in the superoanterior and anteroinferior quadrants could cause neurovascular injuries. High hip center: neurovascular injuries could be expected in all quadrants except the inferoposterior and posterior half of superoposterior quadrant. Müller ring: screws placed in the intra-acetabular and extra-acetabular areas of the superoanterior quadrant could cause neurovascular injuries. Ganz ring:the screws placed in superoanterior quadrant and apex area were dangerous. The insults were confirmed in all of the specimens. Burch-Schneider cage: the medial nervous and vasculature structures were injured in all of the specimens if the screws placed in the superoanterior (intra-acetabular and extra-acetabular) quadrant. Screws for ischial fixation could cause sciatic nerve injury. CONCLUSIONS: In revision acetabular surgery, the superoanterior quadrant, the anterior half of the superoposterior quadrant and the implant's central area are unsafe for screw fixation, especially when the exposed thread is longer than 15 mm.
Assuntos
Acetábulo/anatomia & histologia , Artroplastia de Quadril , Parafusos Ósseos , Acetábulo/cirurgia , Feminino , Prótese de Quadril , Humanos , Técnicas In Vitro , MasculinoRESUMO
OBJECTIVES: To introduce the technique of arthroscopic simultaneous reconstruction of posterior cruciate ligament (PCL) using double femoral tunnel, single-bundle transtibial tunnel PCL technique and anterior cruciate ligament (ACL) with achilles allograft, and to evaluate the clinical outcome. METHODS: Fourteen patients with PCL and ACL injuries after a minimum follow-up 18 months were received. Arthroscopically assisted simultaneous ACL/PCL reconstruction with achilles allograft were performed using the single-incision endoscopic ACL technique and the double femoral tunnel, single-bundle transtibial tunnel PCL technique. The Lysholm and Tegner knee score scale were used for functional evaluation. All patients were evaluated with physical examination and KT-1000 arthrometer testing. The mean knee flexion was (123.6 +/- 2.5) degrees preoperatively. The Lysholm score was 52.8 +/- 2.2. The Tegner score was 5.9 +/- 0.5 before injury, 1.2 +/- 0.9 preoperatively. RESULTS: The mean time from injury to the reconstructive procedure was 19.5 d. The mean knee flexion was (117.9 +/- 2.8) degrees postoperatively( t = 1.54, P = 0.14). As to the Lachman test for 14 patients, the results of 13 patients (92.9%) was negative. As to posterior drawer test, the results of 12 patients (85.7%) was negative. The Lysholm score was 92.9 +/- 3.3 at final evaluation (t = 17.009, P < 0.001). KT-1000 arthrometer testing at 25 degrees knee flexion showed that the side-to-side difference was below 2 mm in 9 cases, 3-5 mm in 4 cases, 6 mm in 1 case. At 75 degrees knee flexion the difference was below 2 mm in 10 cases, 3-5 mm in 3 cases, 6 mm in 1 case. The Tegner score was 5.4 +/- 0.8 at final evaluation. The difference between the preoperative score and the postoperative was statistically significant (F = 4.2, P < 0.01). CONCLUSIONS: Combined ACL and PCL injuries can be successfully treated with arthroscopic simultaneous reconstruction of PCL using double femoral tunnel technique and ACL with achilles allograft. The double femoral tunnel technique more closely approximates the anatomic insertion the native PCL. Most patients recover a functionally stable knee.