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The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.
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10.3969/j.issn.2095-4344.2013.24.001
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BACKGROUND: Autoallergic ligments is used widely in arthroscopic cruciate ligaments reconstruction. However, the therapeutic effect of the surgery is affected severely by the complication at drawing place of the autoallergic ligaments. OBJECTIVE: To explore the application and therapeutic effect of homologous ligaments in arthroscopic reconstruction of cruciate ligments. METHODS: A total of 60 patients who received homologous ligaments at the Second Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University from December 2006 to December 2006 were selected, including 42 males and 18 females, aged 20-42 years. Totally 46 cases had anterior cruciate ligament injury, and 14 cases had posterior cruciate ligament injury. All patients received arthroscopic cruciate ligaments construction under arthroscopy. Physical and clinical examination and Lysholm score had been performed prior to and at 6-12 months after construction. RESULTS AND CONCLUSION: A total of 57 cases (60 cases) were followed up 6-21 months. The incision healed well, without serve immunological rejection. Four cases had hematocele-of the articular cavity, which were regressed after puncturing of the articular cavity and packing with compression. All preoperative symptoms got better apparently. The Lysholm score was obvious elevated than that prior to operation (P < 0.05). The results demonstrated that reconstruction of cruciate ligaments with homologous ligments can recovery the stability and knee function, avoid the complications of autografts. It also has advantages in terms of easy operation, small injury and less complication.
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BACKGROUND: Knee joint trauma results in knee instability and movement track changes, which lead to the degradation of articular cartilages. The main component of articular cartilages, such as chondrocytes, collagen and proteoglycan, are also change during this process.OBJECTIVE: To compare the content changes of collagen, proteoglycan and the apoptosis of chondrocytes on two model groups of knee joint instability, additionally, to investigate the occurrence mechanism of early articular cartilages changes in rabbits with knee joint instability.METHODS: A total of 50 white rabbits were randomly divided into anterior cruciate ligament transection group, medial collateral ligament transection + meniscectomy group and normal control group. The specimens were harvested at weeks 1, 2, 3, 4, and 5 after operation. The osteocartilaginous section of the medial femur condyles were observed by gross observation, histological examination, and Markin scores. The contents of proteoglycan and collagen fiber were also measured.RESULTS AND CONCLUSION: Chondrocytes apoptosis were found with certain degrees at different stages of knee joint instability models. The Mankin score of the anterior cruciate ligament transection group was greater than the medial collateral ligament transection + meniscectomy group at each time point except the 1<'st>week (P ＜ 0.05), which was notably greater in the 5~(th) week. At weeks 3 and 4 after operation, the chondrocytes degenerated with proteoglycan lost in the anterior cruciate ligament transection group, and the chondrocytes degeneration was predominant at 5th week. The changes were more seriously in the medial collateral ligament transection + meniscectomy group. Meantime, the collagen fiber content of two experimental groups were less than the normal control group at Weeks 3, 4, 5 after operation (P < 0.05). The results demonstrated that at early knee joint instability, the articular cartilages degenerated extent is related to the number of chondrocytes, the collagen network disrupts and lost of proteoglycan. During chondrocytes degeneration, cartilage repair simultaneously occurred.
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Objective To investigate the application of multi-slice spiral computed tomography(MSCT) in the diagnosis of solid pseudopapollary tumor of the pancreas (SPTP). Methods Clinical data and CT films of 12 patients with SPTP were retrospectively analyzed from January 2003 to December 2008. Results SPTP presented a typical cystic lesion with well-limited silhouette and no intensification in the cyst on enhanced CT scan. However, a slight to moderate enhancement in the solid components and a markedly enhanced envelope could be seen. Three dimensional images of MSCT can reveal clearly an anatomic relationship of the lesions with surrounding organs and blood vessels. Of 12 cases, there was one case showed that the envelope was incomplete, 3 with duodenal invasion, 2 with superior mesenteric vein involvement, and 1 with closed adhesion with spleen. All 12 patients underwent surgery and had only one tumor, tumor diameter ranged from 4 cm to 18 cm. The location of tumor in pancreas, the relation with surrounding tissue and the pathological presentation were helpful to make peroperative diagnosis. Three dimensional imaging technology of MSCT can offer important referrence for the preroperative evaluation and increase the diagnosis accuracy.
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Objective To observe imaging characteristics and changes of vivo two-dimension multi-voxel proton magnetic resonance spectroscopy (~1H-MRS) in the rabbit models of VX2 hepatic carcinoma after high intensity focused ultrasound (HIFU) treatment. Methods VX2 hepatic carcinoma models were established in 20 New Zealand rabbits. Routine MR and 2-dimentional ~1H-MRS scanning were performed before and after HIFU treatment. The central regions of interest (ROI) of the VX2 tumor, tumor border and paratumor normal liver tissues were selected. The Cho/Cr and Lip/Cr of the same ROI before and after HIFU treatment were compared. Results Total 28 satisfied spectrogram diagram of ~1H-MRS were brought into statistical analysis. Of all the spectra, 6 metabolite peaks were detected as lipids (Lip), glutamine and glutamate complex (Glx), choline (Cho), lactate (Lac) and creatine (Cr). Cho and Lac peak in tumor center and tumor border regions after HIFU treatment were higher than those before HIFU treatment. Lip peak was lower than before, and major metabolites of paratumor normal liver tissues did not changed significantly. Statistical differences of Cho/Cr and Lipid/Cr of tumor center and border region were found between before and after HIFU treatment (P＜0.05). Conclusion Two-dimension multi-voxel ~1H-MRS can reflect major changes in the level of metabolites of different ROI for hepatic VX2 carcinoma after HIFU treatment.
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Objective To investigate multi-slice spiral computer tomography(MSCT)images of gastrointestinal lymphoma.Methods MSCT data of 23 cases with primary gastrointestinal lymphoma verified by pathology were retrospectively analyzed. Results Non-Hodgkin'S lymphoma was confirmed in all of the 23 cases.For all of the cases a B-cell origin was in 22 cases and a T-cell origin in 1 case localized in transverse colon.CT images of gastric lymphoma included three kinds:diffuse thickening(n=13,81.2%),segmental thickening(n=2,12.5%),and mass(n=1,6.3%).Median thickness of gastric wall was 3.3cm (0.6～6.8 cm).CT scan of intestinal lymphoma showed irregular thickening of intestinal wall,and mass was visualized in I case of ileum lymphoma and I case of ileocecal lymphoma.Median thickness of intestinal wall was 2.8cm(0～7.0 cm).Of all the cases lesions appeared a common density by conventional CT scan,and low or moderate intensification by contrast-enhanced CT. Conclusions With its character-istic information MSCT remains the method of choice for the diagnosis of gastrointestinal lymphoma.
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Objective To analyze the clinical features and image manifestations of hepatic inflammatory myofibro-blastie tumor( HIMT), and to investigate the optimal management of this disease. Methods From January 2000 to January 2007, clinical data with HIMT verified by pathology were retrospectively analyzed. Results Eight patients 5 men, 3 women were included in the analysis. The mean age was 41.3 years. All eases did not have a history of previous hepatitis and liver cirrhosis, and 6 with no typical clinical symptoms. Hepatic functions, serum levels of AFP, CEA, CA199 in these patients were all within the normal ranges. Preoperative imaging by ultrasonography and computed tomography(CT) were not indicative of HIMT. Morphologic features by CT scan were summarized: at nonenhanced CT, the masses appeared as low density lesions. At contrast enhanced CT, the masses exhibited mod-erate intensification in the solitary areas, and the intensification peak appeared during the period of artery. During the period of portal vein and delayed scan, the masses showed low to moderate intensification in the solitary areas, in which the degree of intensification was a little lower than that in peripheral liver parenchyma. Gross specimens showed single solid masses, 3～12 cm, without classic envelope. All the patients underwent surgery whereas no incidence of perioperative death. Diagnosis of HIMT was confirmed by pathology of surgical specimens. Condusion Although typical presentation and the diagnostic workup are still lacking for HIMT, CT is helpful in diagnosing HIMT as well as combined with clinical findings. Surgical management would be likely the optimal treatment of this disease.
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AIM:Discoid meniscus is named because its width and height are abnormally increased like a disc.In this study,we observed the injury classification and special features of discoid meniscus and natural meniscus,and compare the postoperative outcome of arthroscopy comparatively.METHODS:①360 cases of meniscus injury in knee joint were selected from the First Affiliated Hospital of Anhui Medical University from June 2001 to September 2006.They were divided into natural meniscus injury group(n =300),and discoid lateral meniscus injury(n =60).People with complete clinical data before operation and following data,confirmed by arthroscopy were selected.The written informed consent was obtained from them.②Meniscus injury in 360 cases was examined by arthroscopy,and plasty,or partial excision or incomplete resection or full resection was performed according to the injury types and surgical circumstance.③All subjects were followed for 6 months to 2 years.The knee function was evaluated by the criteria of Ikeuchi.RESULTS:300 cases of natural meniscus injury and 60 of discoid lateral meniscus injury were all included in the result analysis.①Five tear types of natural meniscus were as follows:43.7% longitudinal,30% radial,12.3% horizontal,7.5% transverse,and 6.5% complex.Four tear types of discoid meniscus were as follows:68.3% horizontal,6.7% radial,3.3% longitudinal,and 21.7% complex tear.②The surgical pattern was determined by the injury types,and all patients were followed up.In 300 cases of natural meniscus,there were 62 knees with excellent function,190 with good,34 with fair and 14 with poor.The excellent and good rate was 85%.In 60 cases of discoid meniscus,there were 19 knees with excellent function,34 with good,5 with fair and 2 with poor.The excellent and good rate was 90% approximately.CONCLUSION:Discoid meniscus is different in anatomical feature and histological structure from natural meniscus;therefore the arthroscopic surgery for discoid meniscus is also different.