  1. 前交叉韧带重建是否需要同时处理Segond骨折 2. 年龄40岁以上患者半月板修复术失败的风险5年内无明显增加 3. 一种新型旋转支撑板对胫骨平台外侧骨折支撑效果的有限元分析 4. 改良缝线桥技术治疗后交叉韧带胫骨止点撕脱骨折:生物力学比较 5. MRI和CT分析提示Schatzker IV型胫骨平台骨折存在内翻应力之外其他潜在的损伤机制 6. 胫骨平台后外侧压缩性性骨折的严重程度与前外侧复合性损伤相关，并对前交叉韧带重建后的功能结果产生影响 7. 小腿静脉血栓形成中轴向静脉和肌间静脉血栓形成预后的比较   前交叉韧带重建是否需要同时处理Segond骨折 译者：冯斌 徐炜 背景：指导前交叉韧带（ACL）撕裂联合Segond骨折治疗的临床相关信息十分缺乏。 目的：在至少2年的随访中，比较有和没有Segond骨折的ACLR患者的临床效果、移植物失败率和活动水平。 研究设计:队列研究，证据等级：3 方法:本研究包括一组ACL撕裂联合Segond骨折的患者（未处理Segond骨折），并根据年龄、性别、BMI和移植物类型匹配对照组患者（ACL撕裂且无Segond骨折）。2000年至2015年间所有接受ACLR的患者，由X线来诊断Segond骨折或前外侧复合体撕脱骨折。记录初始损伤、手术治疗和体格检查结果。临床和功能结果通过体格检查、IKDC主观评分和Tegner活动水平获得。 结果：20例(男性16例，女性4例)ACL撕裂合并Segond骨折，骨折未治疗的患者，平均年龄26.3岁(范围13-44岁)，与40例(男性32例，女性8例)ACL撕裂且无Segond骨折的患者相匹配，平均年龄26.4岁(范围13-47岁)。研究组随访时间平均为59.1个月(范围24-180个月)，对照组随访时间平均为55.5个月(范围24-120个月)。研究组的平均IKDC评分为86.5(范围54-100)，而对照组的平均IKDC评分为93.0(范围54-100)(P
=0 .03)。两组移植物再发断裂率均为10% (P =0 .97)。研究组移植物撕裂平均时间为术后33.0个月(21-45个月)，对照组移植物撕裂平均时间为术后63.5个月(39-88个月)(P =0
.24)。研究组患者术前Lachman试验的前后不稳定性明显高于对照组(对照组:0例正常，3例1+，37例2+级，0例3+级；研究组:0例正常，1例1+，10例2+级，9例3+; P = .0001)。而两组术后的Lachman试验无统计学差异（对照组: 35例正常 ，3例 1+, 2例2+, 0例3+; 研究组:17例正常, 3例1+, 0例2+,0例3+; P =
0.31）。研究组患者术前轴移试验不稳定性明显高于对照组(对照组:0例正常、7例1+、33例2+、0例3+;研究组:1例正常、1例1+、11例2+、7例3+;P = .0003)。两组患者术后轴移试验差异无统计学意义(对照组36正常, 2例1+, 2 grade 2+, 0 grade 3+; 研究组: 18 正常；1例1+, 1例 2+, 0 例3+; P = 0.61)，最终Tegner活动水平(中位数为6)。 结论：在中期随访中，伴有和不伴有Segond骨折的ACLR患者有相似的轴移测试结果、移植物失败率和活动水平。ACL撕裂合并Segond骨折未治疗患者的IKDC评分在统计学上较差，但其差异小于IKDC评分的最小重要临床差异值。这些结果表明，ACL撕裂合并Segond骨折未治疗的患者与ACL撕裂无Segond骨折的患者在ACLR的预后相当。 Is Treatment of Segond
Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? Background: There is a paucity of clinical information
to guide the treatment of a combined anterior cruciate ligament (ACL) tear and
Segond fracture. Purpose: To compare clinical outcomes, graft
failure rates, and activity levels between patients undergoing ACL reconstruction
(ACLR) with and without an untreated Segond fracture at a minimum 2-year
follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a group of patients
with a combined ACL tear/untreated Segond fracture that was matched based on
age, sex, body mass index, and graft type to a control group of patients with
an ACL tear and no Segond fracture. All patients were treated with ACLR alone
between the years of 2000 and 2015. The diagnosis of a Segond fracture, or bony
avulsion of the anterolateral complex, was made by radiographic analysis. Data
regarding the initial injury, surgical intervention, and physical examination
findings were recorded. Clinical and functional outcomes were obtained using
physical examination results, International Knee Documentation Committee (IKDC)
subjective scores, and Tegner activity levels. Results: Twenty patients (16 male, 4 female) with a
combined ACL tear/untreated Segond fracture with a mean age of 26.3 years
(range, 13-44 years) were matched to a control group of 40 patients (32 male, 8
female) with an ACL tear and no Segond fracture with a mean age of 26.4 years
(range, 13-47 years). The study group was followed for a mean of 59.1 months
(range, 24-180 months) and the control group for a mean of 55.5 months (range,
24-120 months). The mean IKDC score was 86.5 (range, 54-100) for the study
group compared with 93.0 (range, 54-100) for the control group (P = .03). The
graft rupture rate was 10% for both groups (P = .97). The mean time to rupture
was 33.0 months (range, 21-45 months) in the study group and 63.5 months
(range, 39-88 months) in the control group (P = .24). Patients in the study
group had significantly more anteroposterior instability by preoperative
Lachman testing than those in the control group (control group: 0 normal, 3
grade 11, 37 grade 21, 0 grade 31; study group: 0 normal, 1 grade 11, 10 grade
21, 9 grade 31; P = .0001). There was no significant difference between the 2
groups in regard to postoperative Lachman testing (control group: 35 normal, 3
grade 11, 2 grade 21, 0 grade 31; study group: 17 normal, 3 grade 11, 0 grade
21, 0 grade 31; P = .31). Patients in the study group had significantly more
instability by preoperative pivot-shift testing than those in the control group
(control group: 0 normal, 7 grade 11, 33 grade 21, 0 grade 31; study group: 1
normal, 1 grade 11, 11 grade 21, 7 grade 31; P = .0003). No significant
difference was found between the 2 groups for postoperative pivot-shift testing
(control group: 36 normal, 2 grade 11, 2 grade 21, 0 grade 31; study group: 18
normal, 1 grade 11, 1 grade 21, 0 grade 31; P = .61) or final Tegner activity
level (median, 6). Conclusion: At midterm follow-up, patients undergoing
ACLR with and without a Segond fracture had similar pivot-shift test results,
graft failure rates, and activity levels. The IKDC score was statistically
worse in the patients with a combined ACL tear/untreated Segond fracture, but
the difference was less than the minimal clinically important difference for
the IKDC score. These findings suggest that patients with a combined ACL
tear/untreated Segond fracture can have comparable outcomes to patients with an
ACL tear and no Segond fracture when treated with ACLR alone. 文献来源：Aaron J Krych, Heath P Melugin, Nick R Johnson, Isabella T Wu, Bruce A Levy, Michael J Stuart；Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction? The American Journal of Sports Medicine；2018 Apr；PMID: 29601235 doi: 10.1177/0363546518764417. 年龄40岁以上患者半月板修复术失败的风险5年内无明显增加 译者：夏飞镖 徐炜 目的:比较40岁及以上患者与40岁以下患者半月板修复术的失败率。 方法:在2006年至2012年期间，共276名患者由同一位运动医学专业的外科医生进行半月板修复手术，且均符合研究纳入的条件。随访患者半月板修复术的失败，手术的失败定义为再次半月板切除术、半月板再次修复或全膝关节置换术。使用Logistic回归分析来确定失败的风险，同时控制潜在的混杂变量，包括体重指数、性别、前交叉韧带状态、半月板损伤到手术的时间、植入物的数量、撕裂模式和修复时的软骨状态。 结果:在276例符合条件的患者中，221例(80%)在术后平均5年成功随访。在这些患者中，56例年龄在40岁或以上(平均47.2岁;标准差[SD]， 5.3岁)，165例年龄小于40岁(平均24.7岁;SD, 6.7年)。5年的半月板修复失败率为20%。在40岁及以上的患者中，失败风险为18%，而40岁以下的患者为21%。在对混杂变量进行调整后，年龄在40岁或以上与失败风险增加无关(调整后优势比，0.83;95%置信区间，0.36-1.81;P＝0.65)。40岁及以上的患者的平均失败时间较短，为16.9个月(SD, 10.2个月)，而40岁以下患者的平均失败时间为28.5个月(SD, 23.3个月)(P＝0.04)。 结论:年龄在40岁以上半月板修复失败的风险5年内无明显增加无关，尽管在这一年龄组中半月板修复术失败的时间相对较短。 Age of 40 Years or Older Does Not Affect
Meniscal Repair Failure Risk at 5 Years Purpose: To compare meniscal
repair failure rates in patients aged 40 years or older versus patients younger
than 40 years. Methods: A total of 276 patients
underwent meniscal repair surgery by a single sports medicine
fellowshipe-trained surgeon between 2006 and 2012 and were eligible for study
inclusion. Patients were followed up for meniscal repair failure, defined as
meniscectomy, repeated meniscal repair, or total knee arthroplasty. Logistic
regression analysis was used to determine the risk of failure while controlling
for potential confounding variables including body mass index, sex, anterior
cruciate ligament status, time from injury to surgery, number of implants used,
tear pattern, and chondral status at the time of the repair. Results: Among the 276 eligible
patients, 221 (80%) were successfully contacted for follow-up at an average of
5 years after surgery. Of these patients, 56 were aged 40 years or older (mean,
47.2 years; standard deviation [SD], 5.3 years) and 165 were younger than 40
years (mean, 24.7 years; SD, 6.7 years). The overall meniscal repair failure
rate over a 5-year period was 20%. Among patients aged 40 years or older, the
failure risk was 18% versus 21% in patients younger than 40 years. After
adjustment for confounding variables, age of 40 years or older was not
associated with increased failure risk (adjusted odds ratio, 0.83; 95%
confidence interval, 0.36-1.81; P ＝0 .65). The mean time to
failure tended to be shorter in older patients, at 16.9 months (SD, 10.2
months) versus 28.5 months in the group younger than 40 years (SD, 23.3 months)
(P ＝0.04). Conclusions: Age of 40 years or
older is not associated with an increased risk of meniscal repair failure at 5
years, although a shorter time to failure was noted in this age cohort. 文献出处：Poland S, Everhart JS, Kim W, Axcell K, Magnussen RA, Flanigan DC. Age
of 40 Years or Older Does Not Affect Meniscal Repair Failure Risk at
5 Years. Arthroscopy. 2019 May;35(5):1527-1532. doi:
10.1016/j.arthro.2018.11.061. Epub 2019 Apr 15. PMID: 31000396. 一种新型旋转支撑板对胫骨平台外侧骨折支撑效果的有限元分析 译者：胡正辉
李柳炳 背景:胫骨平台骨折(TPFs)是骨科创伤学中一种具有挑战性的骨折类型。我们之前设计了一种用于后外侧TPF合并后外侧塌陷的钢板。本研究采用有限元分析比较两种内固定方法治疗后外侧TPF的生物力学特性。我们研究了新型钢板对外侧和后路TPFs的支撑作用。 方法:建立两种复合TPF模型。型号A采用新型钢板固定，型号B不采用钢板固定。对两种断裂模型(A和B)采用有限元分析方法，分别施加500、1000和1500 N的轴向载荷来分析数据。 结果:模型A在500、1000、1500 N处最大位移分别为0.085797、0.17043、0.25465
mm;骨块的最大应力分别为11.285、20.648、29.227 MPa;骨块的最大应变分别为0.0012474、0.007435、0.0035769 mm。内固定最大位移分别为0.096932、0.18682、0.27655
mm;最大应力分别为69.54、112.1和155.71 MPa;最大应变分别为0.00066228、0.0010676和0.0014829 mm。模型B中，500、1000、1500 N处裂缝最大位移分别为0.15675、0.29868、0.44017 mm;骨块的最大应力分别为6.5519、12.575、18.842
MPa;骨块的最大应变分别为0.0032554、0.0074357和0.012146 mm。螺钉最大位移分别为0.14177、0.27109、0.39849 mm;最大应力分别为48.916、92.251、135.27
MPa;最大应变分别为0.00046608、0.00087893和0.0012887 mm。 结论:该钢板和螺钉固定方法可替代其他双钢板固定复杂TPF的方法。
A finite element analysis of the supportive
effect of a new type of rotary support plate on lateral tibial plateau
fractures Background: Tibial
plateau fractures (TPFs) are a challenging type of fracture in orthopedic
traumatology. We previously designed a plate for posterolateral TPF combined
with posterior lateral collapse.. In this study, finite element analysis was
used to compare the biomechanical characteristics of two internal fixation
methods for posterolateral TPF. We investigated the support effect of the new
steel plate on lateral TPFs combined with posterior TPFs. Methods: Two models
of complex TPF were established. Model A was fixed with the new type of plate,
and model B was fixed without the plate. Three axial loads of 500, 1,000, and
1,500 N were applied using FEA on the two fracture models (A and B) to analyze
the data. Results: In model A,
the maximum displacement at 500, 1,000, and 1,500 N was 0.085797, 0.17043, and
0.25465 mm, respectively; the maximum stress of the bone block was 11.285,
20.648, and 29.227 MPa, respectively; and the maximum strain of the bone block
was 0.0012474, 0.007435, and 0.0035769 mm, respectively. The maximum
displacement of the internal fixation was 0.096932, 0.18682, and 0.27655 mm,
respectively; the maximum stress was 69.54, 112.1, and 155.71 MPa,
respectively; and the maximum strain was 0.00066228, 0.0010676, and 0.0014829
mm, respectively. In model B, the maximum displacement of fractures at 500,
1,000, and 1,500 N was 0.15675, 0.29868, and 0.44017 mm, respectively; the
maximum stress of the bone block was 6.5519, 12.575, and 18.842 MPa,
respectively; and the maximum strain of the bone block was 0.0032554,
0.0074357, and 0.012146 mm, respectively. The maximum displacement of the screw
was 0.14177, 0.27109, and 0.39849 mm, respectively; the maximum stress was
48.916, 92.251, and 135.27 MPa, respectively; and the maximum strain was
0.00046608, 0.00087893, and 0.0012887 mm, respectively. Conclusions: The fixation
method using this type of plates and screws can replace other methods using two
plates to fix complex TPF. 文献出处：Shijie Gao, Quan Cheng Yao, Lindan Geng, Jian Lu , Ming Li, Kai An, Guowei Ren , Federico Canavese, Seok Jung Kim , Chukwuweike Gwam , Pengcheng Wang , Dong Ren /Eur J Trauma Emerg Surg /DOI: 10.1007/s00068-022-02113-8 . Epub 2022 Sep 28 改良缝线桥技术治疗后交叉韧带胫骨止点撕脱骨折:生物力学比较 译者：周钊鑫
佘昶 目的:移位明显的胫骨后交叉韧带止点撕脱骨折需要手术固定，让骨折块愈合用以避免膝关节后稳定性的损失。本研究的目的是比较最近建立的改良缝线桥技术和成熟的双隧道缝线技术的生物力学性能。我们假设缝线桥技术与双隧道缝线技术固定相比具有较低的延伸率和较高的失效载荷。 方法:采用单轴流体力学材料测试系统对12具新鲜冰冻人体尸体膝关节进行生物力学测试。根据文献报道制作胫骨PCL止点的标准骨性撕脱骨折。采用两种不同的固定方式:(A)改良缝线桥式固定;(B)双隧道缝线固定。在90°屈曲膝关节，进行循环试验和疲劳试验，测定延展度、初始刚度和失效载荷。 结果:缝线桥技术的延长率为(4.5±2.1)mm，显著低于双隧道缝线技术的(12.4±3.0)mm (p < 0.001)。循环加载开始时，A组的初始刚度为46.9±3.9 N/mm, B组为40.8±9.0 N/mm (p = 0.194)。A组的失效载荷为(286.8±88.3)N, B组为(234.3±96.8)N (p = 0.377)。 结论:缝线桥技术在循环载荷下可显著降低结构延伸率。但术后康复必须审慎考虑两种技术的低结构强度，因为两种固定技术都没有显示出足够的固定强度来允许更积极的康复。
a为改良缝线桥技术，b为缝线内固定技术
胫骨后交叉韧带止点撕脱骨折缝合桥技术与双隧道缝线固定技术的生物力学性能比较 Modified suture‑bridge
technique for tibial avulsion fractures of the posterior cruciate ligament: a
biomechanical comparison Purpose Displaced tibial
posterior cruciate ligament (PCL) avulsion fractures require surgical fixation
in order to provide an adequate bone healing and to avoid a loss of posterior stability.
The purpose of this study was to compare the biomechanical properties of a
recently established modified suture bridge technique to a well-established
transtibial pullout technique.It was hypothesized that the suture bridge
technique shows lower elongation and higher load to failure force compared to a
transtibial pullout fixation. Methods Twelve fresh-frozen
human cadaveric knees were biomechanically tested using an uniaxial hydrodynamic
material testing system. A standardized bony avulsion fracture of the tibial
PCL insertion was generated. Two different techniques were used for fixation:
(A) suture bridge configuration and (B) transtibial pullout fixation. In 90° of
flexion elongation, initial stiffness and failure load were determined. Results The suture-bridge
technique resulted in a significant lower elongation (4.5 ± 2.1 mm) than
transtibial pullout technique (12.4 ± 3.0 mm, p < 0.001). The initial
stiffness at the beginning of cyclic loading was 46.9 ± 3.9 N/mm in group A and
40.8 ± 9.0 N/mm in group B (p = 0.194). Load to failure testing exhibited 286.8
± 88.3 N in group A and 234.3 ± 96.8 N in group B (p = 0.377). Conclusion The suture bridge
technique provides a significant lower construct elongation during cyclic
loading. But post-operative rehabilitation must respect the low construct
strength of both techniques because both fixation techniques did not show a
sufficient fixation strength to allow for a more aggressive rehabilitation. 文献出处：Forkel P, Lacheta L, von Deimling C, Lang J,
Buchmann L, Imhoff AB, Burgkart R, Willinger L. Modified suture-bridge
technique for tibial avulsion fractures of the posterior cruciate ligament: a
biomechanical comparison. Arch Orthop Trauma Surg. 2020 Jan;140(1):59-65. doi:
10.1007/s00402-019-03278-5. Epub 2019 Sep 26. PMID: 31559489. MRI和CT分析提示Schatzker IV型胫骨平台骨折存在内翻应力之外其他潜在的损伤机制 译者：肖家正 佘昶 背景:Schatzker
IV型胫骨平台骨折(IV型TPFs)具有复杂的骨折形态伴有高频率的膝关节半脱位。内翻应力被认为是IV型TPFs的原因，但无法解释MRI观察到的胫骨外侧平台粉碎和股骨外侧髁骨挫伤。本研究的目的是通过综合分析一组患者的MRI和CT，进一步探讨IV型TPFs损伤的机制。 方法:2010年至2019年，我院共手术治疗IV型TPFs
49例。纳入完成术前CT和MRI的患者。分析测量骨折形态后，根据OTA/AO和罗从风提出的三柱分型(uTCC)进行分类。然后对交叉韧带/副韧带损伤和骨挫伤进行MRI观察。比较分析uTCC组间明显骨折和隐匿性骨挫伤/软组织破裂的差异。 结果:30例患者符合条件，纳入本研究。在uTCC系统下，所有病例根据胫骨平台角判断均由内翻力引起，分为三组:过伸-内翻组4例，伸直-内翻组21例，屈曲-内翻组5例。在伸直-内翻组中，骨折形态分析发现有两个明显的亚组:OTA/AO 41B1.2(内柱+后柱断裂)和41B3.3f
(41B1.2 +后外侧柱断裂)。MRI显示，30例患者中有28例韧带损伤超过2处。前后交叉韧带损伤的发生率分别为96.7%和43.3%，内侧副韧带(MCL)损伤的发生率为70%。30例中有18例显示有明显的股骨外侧髁骨挫伤。卡方分析发现，伸直-内翻组后外侧柱粉碎与股骨外侧髁挫伤(p < 0.05)和MCL损伤(p < 0.05)密切相关。这一发现和股骨内侧髁挫伤的缺失不太可能是由uTCC提出的内翻应力引起的。 结论:与内翻力相反，IV型TPFs可能是外翻或旋转所致。
图B 仅在外侧股骨髁（白色箭头所示位置）发现骨挫伤信号 Magnetic resonance
imaging (MRI) and Computed topography (CT) analysis of Schatzker type IV tibial plateau fracture revealed possible mechanisms of injury beyond varus deforming force Background:Schatzker type IV tibial plateau fractures (type IV TPFs) are known for complex
fracture morphology and high frequency of knee subluxation. Varus deforming
force has been believed to be the cause but which fails to explain the lateral
tibial plateau comminution and the lateral femoral condyle bone edema observed
on injury MRI. The purpose of this study is to further explore the mechanisms
of injury of type IV TPFs by synthetically analysing the information obtained
from MRI and CT of a cohort of patients. Methods: Between 2010
and 2019, 49 type IV TPFs were surgically treated in our hospital. The patients
with complete preoperative CT and MRI were enrolled. They were classified
according to OTA/AO and Luo’s updated three-column classification (uTCC) after
fracture morphology analysing and measuring.Then the injuries of
cruciate/collateral ligaments and bone contusion were studied on MRI. The
discrepancy between obvious fracture and occult bone contusion/soft tissue
disruption among the groups of uTCC were compared and analysed. Results: Thirty
patients were eligible for this study. Under uTCC system, all the cases were
caused by varus force according to the tibial plateau angle and were classified
into three groups of uTCC referring the posterior tibial slope angle: 4 were
into hyperextension-varus, 21 into the extension-varus and 5 into the
flexion-varus group. Fracture morphology analysis found in the extension-varus
group, there were two distinct subgroups: OTA/AO 41B1.2 (medial + posteromedial
columns disruption) and 41B3.3f (41B1.2 + posterolateral column disruption).
Injury MRI revealed 28 of the 30 cases had more than 2 ligamentous injuries.
The incidences of anterior and posterior cruciate injury were 96.7% and 43.3%
respectively while 70% for medial collateral ligament (MCL). Eighteen out of 30
demonstrated apparent lateral femoral condyle bone contusion sign. Chi-square analysis
found in the extension-varus group, the posterolateral column comminution was
closely associated with lateral femoral condylar contusion ( p < 0.05) and
MCL injuries ( p < 0.05). This finding and the absence of medial femoral
condylar contusion was unlikely caused by uTCC proposed varus deforming force. Conclusion: In
contrast to varus impaction, some type IV TPFs was probably caused by valgus or
rotation force. 文献出处：Zhang Y, Wang R, Hu
J, Qin X, Chen A, Li X. Magnetic resonance imaging (MRI) and Computed
topography (CT) analysis of Schatzker type IV tibial plateau fracture revealed
possible mechanisms of injury beyond varus deforming force. Injury. 2022
Feb;53(2):683-690. doi: 10.1016/j.injury.2021.09.041. Epub 2021 Oct 1. PMID:
34663508. 胫骨平台后外侧压缩性性骨折的严重程度与前外侧复合性损伤相关，并对前交叉韧带重建后的功能结果产生影响 译者：吴韦成
李柳炳 目的：在原发性前交叉韧带（ACL）撕裂的情况下，胫骨平台后外侧压缩性骨折（TPIF）对创伤后膝关节稳定性的影响尚不清楚。本文主要目的是确定胫骨平台后外侧骨质丢失增加是否与ACL重建后残端不稳定和功能受损有关。 方法：在一项前瞻性研究中，对术前接受放射诊断和临床评估的急性前交叉韧带损伤患者进行队列研究。计划进行单独的单束自体腘绳肌移植ACL重建患者也包括在内。排除标准为同时进行的前外侧复杂性（ALC）重建（前外侧肌腱固定）、既往手术史或受影响膝盖有较明显症状、部分ACL撕裂、多韧带损伤（需要额外手术干预）和广泛软骨磨损。在MRI上，骨骼（TPIF、胫骨平台和股骨髁形态）和韧带状态（ALC、伴随副韧带和半月板损伤）由放射科医生评估。临床评估包括KT-1000、中枢轴移位和Lachman测试，以及Tegner活动和IKDC评分。 结果：共有58名患者被纳入研究，最低随访时间为12个月。在85%的前交叉韧带损伤中发现了TPIF（n=49）。在58例病例中，有31例（53.4%）患者存在ALC受伤。Pearson分析结果显示，TPIF与伴发的ALC损伤程度呈正相关性（p＜0.001）。多元回归分析显示，高损伤程度TPIF与胫骨外侧凸度增加有明显相关性（p＝0.010）。高损伤程度TPIF分组术后12个月的Tegner评分较差（p＝0.035）。 结论：TPIF损伤程度越高，常提示存在ACL／ALC合并损伤。此外，胫骨平台后外侧骨质损失增加的患者在ACL重建12个月后仍表现出较低的Tegner活动评分。 Extent of posterolateral tibial plateau impaction
fracture correlates with anterolateral complex injury and has an
impact on functional outcome after ACL reconstruction Purpose: The impact of
posterolateral tibial plateau impaction fractures (TPIF) on posttraumatic knee
stability in the setting of primary anterior cruciate ligament (ACL) tear is
unknown. The main objective was to determine whether increased bone loss of the
posterolateral tibial plateau is associated with residual rotational
instability and impaired functional outcome after ACL reconstruction. Methods: A cohort was
identified in a prospective enrolled study of patients suffering acute ACL
injury who underwent preoperative standard radiographic diagnostics and
clinical evaluation. Patients were included when scheduled for isolated
single-bundle hamstring autograft ACL reconstruction. Exclusion criteria were
concurrent anterolateral complex (ALC) reconstruction (anterolateral
tenodesis), previous surgery or symptoms in the affected knee, partial ACL
tear, multi-ligament injury with an indication for additional surgical
intervention, and extensive cartilage wear. On MRI, bony (TPIF, tibial plateau,
and femoral condyle morphology) and ligament status (ALC, concomitant
collateral ligament, and meniscus injuries) were assessed by a musculoskeletal
radiologist. Clinical evaluation consisted of KT-1000, pivot-shift, and Lachman
testing, as well as Tegner activity and IKDC scores. Results: Fifty-eight
patients were included with a minimum follow-up of 12 months. TPIF was
identified in 85% of ACL injuries (n = 49). The ALC was found to be injured in
31 of 58 (53.4%) cases. Pearson analysis showed a positive correlation between
TPIF and the degree of concomitant ALC injury (p < 0.001). Multiple
regression analysis revealed an increased association of high-grade TPIF with
increased lateral tibial convexity (p = 0.010). The high-grade TPIF group
showed worse postoperative Tegner scores 12 months postoperatively (p = 0.035). Conclusion: Higher
degrees of TPIFs are suggestive of a combined ACL/ALC injury. Moreover,
patients with increased posterolateral tibial plateau bone loss showed lower
Tegner activity scores 12 months after ACL reconstruction. 文献出处：Flury A, Hodel S, Andronic O, Kaiser D, Fritz B, Imhoff FB, Fucentese SF. Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2022 Dec 16. doi: 10.1007/s00167-022-07282-y. Epub ahead of print. PMID: 36526932  小腿静脉血栓形成中轴向静脉和肌间静脉血栓预后的比较 译者 ：孟悦峰 徐炜 背景：本研究的目的是探讨下肢深静脉血栓形成(DVT)患者的临床特征和预后，并将其局限于肌间静脉与轴向静脉进行比较。 方法：从Gonda血管中心超声数据库中确定了连续的超声确诊的涉及小腿静脉的急性DVT患者（2016年1月1日至2018年8月1日）。根据血栓部位将患者分为轴向型或肌间型两组。对人口统计学、管理和结果进行了比较。 结果：在研究期间，有647名小腿深静脉血栓患者平均分布在轴向静脉(n=321)和肌间静脉(n=326)。在这些组中，腓肠肌静脉和比目鱼肌静脉最常受累。几乎所有的病例都是因它们引起。相应的肺栓塞(PE)在轴向静脉组(30.8%)较肌间静脉组(20.2%)多见;但近三分之一的患者没有肺部症状。两组中85.5%开始抗凝的中位时间为3个月。静脉血栓栓塞(VTE)的复发在轴向组更常见(15.9% vs. 7.1%， p=0.0015)，其中更频繁的发生VTE蔓延(9.4% vs. 3.1%;p=0.0017)和PE(3.4%比0.6%;P=0.0168)。大出血、临床相关的非大出血和死亡率在组间没有差异。在轴向静脉组中，不进行抗凝导致血栓蔓延更频繁(3.4% vs. 0.9%;P=0.029)。 结果：几个重要的特征可以区分肌间深静脉血栓和轴向深静脉血栓。轴向深静脉血栓更有可能发生相关的PE，更有可能经历静脉血栓复发，特别是在抗凝停止的情况下。 Calf Vein Thrombosis Comparison of Outcomes for Axial and Muscular Venous
Thrombosis Background：The objective of this study was to characterize
clinical features and outcomes among patients with calf deep vein thrombosis
(DVT) limited to the muscular veins compared with axial veins. Methods：Consecutive patients with ultrasound confirmed
acute DVT involving the calf veins (January 1, 2016–August 1, 2018) were identified from the Gonda Vascular Center ultrasound
database. Patients were divided into axial or muscular groups based on thrombus
location. Demographics, management, and outcomes were compared. Results：Over the study period, there were 647 patients
with calf DVT equally distributed between axial (n =321) and muscular (n =326)
locations. Within these groups, peroneal and soleal veins were most commonly
involved. Nearly all cases were provoked (97%). Synchronous pulmonary embolism
(PE) were more common for axial (30.8%) compared to muscular groups
(20.2%;p=0.001); nearly one-third had no pulmonary symptoms. Anticoagulation
for a median of 3 months was initiated for 85.5% of both groups. Venous
thromboembolism (VTE) recurrence was more common in the axial group (15.9% vs.
7.1%, p=0.0015) including more frequent DVT propagation (9.4% vs. 3.1%; p
=0.0017) and PE (3.4% vs. 0.6%; p =0.0168). Major bleeding, clinically relevant
nonmajor bleeding, and mortality rates did not differ between groups.
Withholding anticoagulation led to more frequent thrombus propagation in the
axial group (3.4% vs. 0.9%; p=0.029). Conclusion：Several important features distinguish muscular
from axial DVT. Axial DVT aremore likely to have an associated PE and aremore
likely to experience recurrent VTE, particularly if anticoagulation is
withheld. 文献出处：Kuczmik W, Wysokinski
WE, Hesley GK, Vlazny DT, Houghton DE, Swanson KE, Casanegra AI, Hodge D, White
L, McBane RD 2nd. Calf Vein Thrombosis Comparison of Outcomes for Axial and
Muscular Venous Thrombosis. Thromb Haemost. 2021 Feb;121(2):216-223. doi:
10.1055/s-0040-1715646. Epub 2020 Aug 22. PMID: 32828073. |
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