ABSTRACT
Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of perioperative risk of deep venous thrombosis in patients with acute multiple knee joint injuries was constructed, and the prediction performance was compared.Methods:A total of 120 patients with acute multiple injuries around the knee treated in the Department of Orthopaedic Trauma, Guangzhou Panyu District Central Hospital from January 2017 to June 2020 were retrospectively selected. According to the proportion of 7∶3, the patients were randomly divided into training set ( n=84) and test set ( n=36). The prediction models of Logistic regression and XGBoost algorithm were constructed by training set data, to screen the predictors of perioperative deep venous thrombosis in patients with acute multiple injury around knee joint, and the prediction effect of the model was evaluated by test set data. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the independent t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)], the independent sample Mann-Whitney U test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Results:The results of Logistic regression model showed that age, hypertension, coronary heart disease, time from injury to operation, D-dimer at 1 day after operation and multiple injuries were predictive factors for perioperative deep venous thrombosis in patients with acute multiple injuries around the knee joint. The top five important feature scores of XGBoost algorithm model were combined multiple injuries (35 points), time from injury to operation (28 points), age (24 points), coronary heart disease (21 points) and D-dimer 1 day after operation (16 points). In the training set, the area under the curve of the Logistic regression model was 0.805 (95% CI: 0.637-0.912), and χ2=1.436, P=0.329 for Hosmer and Lemeshow test. The area under the curve of the XGBoost algorithm model was 0.847(95% CI: 0.651-0.920), and χ2=1.103, P=0.976 for Hosmer and Lemeshow test. Conclusion:Logistic regression model and XGBoost algorithm model are similar in predicting perioperative deep venous thrombosis in patients with acute multiple injuries around the knee, and multiple injuries, time from injury to operation, age, coronary heart disease and D-dimer 1 day after operation can be used as predictive factors.
ABSTRACT
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.
Subject(s)
Animals , Humans , Rats , Edema , Electric Impedance , Knee , Knee Injuries , Knee JointABSTRACT
Objective To compare the diagnostic accuracy of 3D-DESS sequences with 30°and 90°flip angles for the knee articular cartilage injury (≥Grade 2).Methods Images of 13 patients (2 men,1 1 women,age range 18-68 years)of the knee articular carti-lage injury were obtained with 3D-DESS flip angles of 30°and 90°at 1.5T MR.Two radiologists classified the presence or absence of cartilage damage of ≥Grade 2 as positive (P)or
ABSTRACT
Objective To explore the role of MRI(T1ρ)in the early osteoarthritis,curative efficacy monitoring and speculated that the mechanism of curative effect.Methods (1)(early OA model)A total of 28 New Zealand white rabbits were randomly divided into A,B,C three groups.group A(treatment)and B(control)were both for 1 1 rabbits,and 6 rabbits were considered as blank control group(group C).0.5 mL 1.6% papain was injected into the right knee joint cavity both group A and B according to three times (1,4,7 days).The equivalent dilution was injected into the left knee joint cavity simultaneously.3 weeks after the first injection,and T2 WI,3D-FS-SPGR,and T1ρ mapping in sagittal plain were scanned for three groups.Randomly selected two models pathology test in the group A and B,confirm early OA model is established.(2)(treat models)Then give epimedium lavage to group A two month.The equivalent sterile saline lavage to group B.A certain time (T0 = 0,T1 = 1 mon,T2 = 2 mon)after treated do MR scanned for group A and B.Analysis of the image.T1ρvalues and the cartilage thickness in bilateral femoral condyle cartilage were measured by post-processing software.The all femurs were pathological examined.T1ρvalues and the cartilage thickness were statistic analysis. Results (1)Articular cavity injection of papain can successfully establish early osteoarthritis rabbit model which pathology has been confirmed.T1ρvalues of the experimental (group A,B)were significant higher than of the control side(P0.05).(2)T1ρvalues of the Epimedium treat model (right side)were significant lower than of the pre-treatment that of the preintervention (P 0.05).Conclusion (1)T1ρvalues of the early and advanced stage of OA had increased in various degree,and the values related cartilage matrix composition.(2 )Single herb Epimedium has effective to treat early stages osteoarthritis in knee joint.Spec-ulated that the possible mechanism for treatment common channel in the development of OA,which inhibition protease formation and promote proteoglycan secretion.
ABSTRACT
Objective To investigate the effects of exercise on knee cartilage tissue structure using quantitative MR T2 mapping. Methods Sagittal T2 maps of the knee joints of 26 healthy volunteers were obtained by using 3.0T MR before,immediately after, and 1 5 min after running.The original images were classified into three terms of knee cartilage T2 map after postreconstruction.The T2 values of regions of interest (ROC)(T2 pre ,T2 post ,T2 delay )in the superficial,middle and deep cartilage of femoral and tibial joint were measured.Statistical differences of cartilage T2 values of three terms after running were analyzed.Results For the tibial joint cartilage,the T2 pre ,T2 post ,T2 delay were (49.71 ± 1.95)ms,(44.30 ± 2.56)ms,(49.41 ± 1.62)ms in the superficial layer,respectively.The three terms T2 were (42.43 ± 2.23)ms,(39.01 ± 2.37)ms,(41.90±2.28)ms in the middle layer,respectively.The differences were statistically significant(F=55.673,16.759 respectively.P<0.001).While the three terms T2 were (19.39±2.13)ms,(19.20±2.22)ms, (19.49±2.05)ms in the deep layers cartilage,respectively.The differences were not statistically significant(F =0.122,P =0.886).And the differences between T2 pre and T2 post ,T2 post and T2 delay were statistically significant (all P <0.001)in superficial and middle alyers,but there were no significant difference between the T2 pre and T2 delay (P =0.610,0.403,respectively).For the femoral joint cartilage,the T2 pre ,T2 post ,T2 delay were (50.22 ± 1.47)ms,(45.60 ± 2.82)ms,(49.84 ± 1.84)ms in superficial layers,respectively.The three terms T2 were (42.67±2.23)ms,(39.36 ± 1.98)ms,(42.40 ± 2.57)ms in the middle layer,respectively.The differences were statistically significant (F=37.976,16.987 respectively,P<0.001).While the three terms T2 were (20.30±2.73)ms,(20.60±2.44)ms,(20.51± 2.24)ms in the deep layer,the differences were not statistically significant (F =0.098,P =0.907).And the differences between T2 pre and T2 post ,T2 post and T2 delay were statistically significant (all P <0.001)in superficial and middle layers,but there were no significant difference between the T2 pre and T2 delay (P=0.520,0.679,respectively). Spatial distribution of T2 values of articular cartilage from deep to superficial layers showed a ascending trend.T2 maps showed the spatial distribution trend of T2 value change.Conclusion T2 mapping can monitor quantitatively the changes of articular cartilage molecular structure after running.The change of articular cartilage T2 value after exercise is uneven and the change of articular cartilage structure after exercise is reversible.
ABSTRACT
Background: Degenerative changes in the knee occur with increasing frequency after the third decade of life. In early osteoarthritis with no mal-alignment of the knee, arthroscopic surgery is an attractive alternative for many elderly patients as it reduces the degree of surgical insult and postoperative rehabilitation with hope of restoration of painless mobility. To study the role of arthroscopic debridement in alleviation of pain in cases of osteoarthritis knee and to evaluate the effectiveness of arthroscopy in diagnosis of osteoarthritis knee and its co-relation with radiological diagnosis. Methods: The present study is cross-sectional study of consecutive cohort of 53 patients. Body mass index was calculated based on height and weight of the patients and from their assessment of X - Rays patients were graded from 0 to 4 based on Kellegren–Lawrence radiological grading method. Selected patient were then assessed by pain domain of the knee society scoring system, which is joint specific score ranging from 0 to 50. These patients were then subjected to arthroscopic examination and debridement. Results: Overall 17 (32.08%) out of total 53 cases studied showed improvement after one year. Majority of patients improved were grade 2 (57.89%) but none of the grade 4 patients showed improvement at 1 year. Conclusions: Arthroscopic debridement does not influence the ongoing pathological process; it is only useful for symptomatic relief in cases of low grade osteoarthritis where it provides pain relief. Conversely, in patient with sever osteoarthritis there is very limited role of arthroscopy.
ABSTRACT
[Objective]To explore the methods and effect of using Ilizarov'techniques for correcting severe flexion contracture of the knee joint.[Method]According to Ilizarov's tension-stress principle and its applying technique,the knee joint distraction apparatus was designed and fixed individually.The joint hinges of the apparatus on the two sides were consistent with the rotational center of the knee joint.Joint distraction of 5 to 10 mm was initially performed and followed by gradual correction of the knee joint flexion contracture at an average rate of 1 mm per day at the level of the knee joint by turning the nuts on the distraction rods at 3～4 rounds per day,with the distraction rate modified according to the patient's tolerance.Regular x-ray exams should be carried out to prevent knee joint dislocation and compression of the articular cartilage.The final requirement of correcting the soft tissue flexion deformity of the knee joint was to overcorrect the joint deformity into 5～10 degrees of hyperextension.As for the joint flexion with anterior bowing deformity of the distal femur,the degree of correcting the knee joint flexion contracture should deduce the degree of the bony deformity.The frame was left on for an additional 2 to 4 weeks.When the frame was removed,the knee joint was immediately casted in full extension for 3 to 4 weeks followed by the range of motion exercise on CPM to regain the knee motion and a long-leg brace was provided simultaneously to maintain the correction for 3 months.Secondary osteotomy was performed on anterior bowing deformity of the distal fermur in 8 patients.[Result]More than 30 degrees of severe flexion contracture of knee joint (mean?sd 58.50?21.28?) in 49 patients (52 knees ) were corrected to an average of 4.12?4.61 degrees after treatment.40 joints of 38 cases were followed for an average of 6.8 months,in which 28 joints maintain the postoperative effect.,while 12 joints had partial relapse of 9.30??8.24?.[Conclusion]Ilizarov's technique for correcting severe flexion contracture of the knee joint,can have satisfactory effect with little complications.It is mini-invasive,reliable and safe.
ABSTRACT
[Objective]To study the safety,clinical effect and therapeutic characteristics of distraction apparatus for correcting flexion contracture deformities of the knee joint by evaluating the clinical outcomes and investigating the results of biomechanic test.[Method]Forty-nine patients (included 52 knees) were treated by the standardized distraction apparatus and the comprehensive assessment standard was adopted to evaluate the clinical outcomes.Five patients were examined by three-dimensional CT of the knee joints pre-operatively and post-operatively to observe the changes in the knee structure.To observe the effect of distraction on the popliteal artery and the limb nerves,the popliteal artery diameter and blood flow speed were examined in 15 patients and the regio cruris electromyogram and nerve conduction velocity were examined in 6 patients before and after treatment.Three different means of distraction and measurement were underwent in 3 patients so as to observe the changes in the flexion curve and force of posterior soft tissues of the knee.[Result]All patients (52 knees) regained congruous structure and better function,the final excellent and good result rate was 65%.Three-dimensional CT examination of 5 patients showed that the postoperative knee joint structures were superior to the preoperative ones and there weren't damage of articular surface.The statistic results indicated that the popliteal arteries weren't obviously disturbed by distraction,whereas the limb nerves were probably disturbed temporarily.Three methods of distraction and measurement in 3 patients showed different outcomes,indicating that the effect of distraction on soft tissues was influenced by the distraction method,the ages of patients and the extents of deformities of the limb.[Conclusion]The distraction speed of therapeutic method is safe,reasonable and effective in correcting flexion contracture of the knee joint;The distraction force on posterior soft tissues of the knee is influenced by various elements,thus,the distraction speed should be individualized.Low-load and steady stretch are advantageous to soft tissue regeneration and safer.
ABSTRACT
AIM: To investigate the efficacy and safety of liduofen in the treatment of patients with osteoarthritis of the knee joint. METHODS: A randomized, double-blind, parallel-controlled, multi-centre study was adapted to compare the efficacy and safety between liduofen and Olfen-75 in 136 patients. Patients were randomly assigned into two groups: liduofen group which was received 75 mg (diclofenac) Liduofen injection (n=69) once a day for seven days and Olfen group which was received 75 mg (diclofenac) Olfen-75 injection (n=67) once a day for seven days. RESULTS: After the treatment, similar improvements for rest pain, pain on exercise, swelling of joint, pressing pain of joint, knee joint bend extend function measured using a 10 cm visual analogue scale was performed in two groups. In Olfen-75 group, the rate of efficacy was 62.69% in the 3rd day, 95.76% in the 5th day and 97.88% in the 7th day. While in liduofen group, the rate of efficacy was 57.97% in the 3rd day, 93.87% in the 5th day and 96.94% in the 7th day. In liduofen and Olfen-75 groups, the progressive rates were 56.72% and 55.07%, respectively. The total improvement rates were 89.85% and 92.54% respectively (P＞0.05), and the rates of side effects were 0% and 1.49%, respectively (P＞0.05). CONCLUSION: Liduofen is an effective and safty drug inthe treatment of patients with osteoarthritis of the knee joint. There is no significant difference on efficacy and safety between the two groups using liduofen and Olfen-75.
ABSTRACT
Objective To discuss the less invasive stabilization system(LISS)in treatment of fractures around the knee joint.Methods Between February 2002 and December 2005,103 cases of periarticular fractures of knee joint were treated with LISS in our department.There were 58 cases of comminuted distal femoral fracture and 45 cases of comminuted proximal tibia fracture.Follow-ups were conducted once per week during the first four weeks and once per month in the following months to observe whether such complications as loosening of internal fixators and nail breakage would occur.Results All the cases were followed up for a mean time of 16.5 months(range, 6 to 27 months).Loosening and breakage of internal fixation was found in only one case,while others obtained bony union.In fractures of types A and C,the knee range of motion varied from 95?to 145?(average,130?)and 85?to 140?(average,110?)in flexion respectively.HSS score:excellent in 84 cases(81.6%),good in 15 cases (14.6%),fair in three cases(2.9%),and poor in one case(0.9%).Conclusions The LISS can be the best choice for the treatment of periarticular fractures around the knee joint,but we should take care to implant the plate and screws in a proper position and direction and avoid early weight-bearing.In application of the 13-hole plate, large incision should be made to approach the distal tibia for fear of damaging the superficial peroneal nerve.
ABSTRACT
[Objective] We analyzed the clinical findings in 5 patients with osteonecrosis in the medial condyle of the tibia. We also evaluated the usefulness of a tibial percussion test that we developed for examination of differences between the healthy and affected sides in percussion caused by knocking on the tibial rough surface.<BR>[Methods] The subjects were 5 females, who consulted our hospital with a chief complaint of gonalgia and in whom conditions such as osteonecrosis in the medial condyle of the tibia were confirmed by MRI in 4 limbs. In addition to X-p, MRI findings, medical findings by interview, and findings by physical examination were evaluated as clinical findings. Furthermore, the tibial percussion test was performed.<BR>[Results] The causes of pain in the knee joint were unclear in all patients. Pain was severe in 3 patients and marked in 2 patients. Physical examination showed marked tenderness in the medial articular gap and tenderness in the medial condyle of the tibia. In all patients, a difference in the percussion findings between the healthy and affected sides was confirmed by the tibial percussion test.<BR>[Conclusions] These findings indicated that the tibia percussion test in addition to confirmation of characteristic clinical conditions, such as the initial condition of the disease and the severity of tenderness, is useful for the evaluation of conditions of this disease.
ABSTRACT
The tender points treatment has been widely used for both treatment and diagnosis, but there have been very few studies that have examined its diagnostic usefulness. Thus, the purpose of this study was to clarify the diagnostic importance of tender points. The subject was a patient who had osteoarthritis of the knee of Meiji University of Oriental Medicine Hospital. The relationship between pressure pain thresholds (PPTs) and symptoms in osteoarthritis of the knee (painful knee motion) were evaluated with the Japanese Orthopaedic Association scale (JOA scale), a knee scale and the subject's knee pain diary (starting pain, flexion pain, walking pain and total pain Wong-Baker faces pain rating scale). After 40 acupuncture treatments, improvement was noted in the symptoms and PPTs. The changes in PPTs were related to the symptoms of the knee (flexion and walking pain). This suggests that changes in PPTs (around the knee) are a useful indicator for evaluating knee pain.
ABSTRACT
0.05 ). CONCLUSION: Liduofen is an effective and safty drug inthe treatment of patients with osteoarthritis of the knee joint. There is no significant difference on efficacy and safety between the two groups using liduofen and Olfen 75.