Athletes and military recruits are often afflicted by stress fractures. Rigorous training programs consisting of increased repetitive mechanical loading may contribute to the high incidence of tibia stress fracture in...Athletes and military recruits are often afflicted by stress fractures. Rigorous training programs consisting of increased repetitive mechanical loading may contribute to the high incidence of tibia stress fracture in the athletic and army populations. The purpose of this study was to assess the effect of incremented height on tibia bone strains and strain rates during landing. Seven healthy college males performed drop-landing tasks from 26 cm, 39 cm, and 52 cm, respectively. Tibia bone strains and strain rates were obtained through subject-specific multi-body dynamic computer simulations and finite element analyses. One-way repeated measures ANOVAs were conducted. Both 39 cm and 52 cm conditions resulted in larger tibia bone strains and strain rates than the 26 cm condition. The 52 cm condition also resulted in greater bone strains and strain rates than the 39 cm condition. A dose-response relationship exists between incremented landing height and bone strains and strain rates. Activities consisting of high impact landings are associated with increased risk of developing tibia stress fracture. When designing training programs involved high impact activities, athletes and military recruits should consider the effect of impact loading on tibia bone health and giving enough time for bones to adapt to new trainings.展开更多
Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability a...Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.展开更多
Objective: to investigate the clinical effect of Ilizarov lateral tibial lateral displacement in the treatment of diabetic foot foot (DF). Methods: from August 2017 to December 2019, 60 patients with DF of Wagner grad...Objective: to investigate the clinical effect of Ilizarov lateral tibial lateral displacement in the treatment of diabetic foot foot (DF). Methods: from August 2017 to December 2019, 60 patients with DF of Wagner grade 3 ~ 4 were selected from the Department of Endocrinology, Department of orthopedics and rehabilitation of Loudi central hospital. The patients were randomly divided into the control group with routine treatment and Ilizarov tibial transverse bone transfer on the basis of routine treatment, with 30 patients in each group. The pain (VAS) score, ankle brachial index, affected foot skin temperature, ulcer healing rate, 10 # g nylon filament measurement and limb salvage rate were compared between the two groups before and after treatment, and the incidence of postoperative complications in the study group was analyzed. Results: after treatment, the VAS score, skin temperature of affected limbs, 10 g nylon thread test, ankle brachial index, ulcer healing rate and limb salvage rate in the study group were significantly better than those in the control group (P < 0.05);Three patients in the study group had red and swollen skin around the nail path during treatment, which improved after antibiotic treatment. Conclusion: transverse tibial bone transfer can improve the clinical symptoms, lower limb blood supply and peripheral nerve function, accelerate ulcer healing and improve limb salvage rate in patients with DF, which is safe and effective.展开更多
Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)是NF1基因突变导致的常染色体遗传病,典型临床症状包括牛奶咖啡斑、神经纤维瘤、NF1相关骨骼损害等。目前NF1相关骨科疾病如脊柱侧凸、先天性胫骨假关节、骨质疏松等逐渐被重视,其多学...Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)是NF1基因突变导致的常染色体遗传病,典型临床症状包括牛奶咖啡斑、神经纤维瘤、NF1相关骨骼损害等。目前NF1相关骨科疾病如脊柱侧凸、先天性胫骨假关节、骨质疏松等逐渐被重视,其多学科诊疗和疾病管理成为研究的重点。本文阐述NF1及相关骨科疾病的诊疗进展,以提高临床对其多学科全程管理的认识,改善患者生存质量。展开更多
The histological changes after tibial lengthening with metaphyseal osteotomywere observed in 30 goats.It was found that(1)a slow lengthening rate of 1 mm/d couldenable the tissues to adapt the mechanical traction and ...The histological changes after tibial lengthening with metaphyseal osteotomywere observed in 30 goats.It was found that(1)a slow lengthening rate of 1 mm/d couldenable the tissues to adapt the mechanical traction and consequently increase thelengthening limitation;(2)the newly-formed bone in the lengthened area might be due to acombined osteogenesis of endochondral,intramembranous,and fibrous tissue ossification;and(3)the osteogenetic process could be distinguished into 3 stages as hemorrhage andorganization of the hematocele,callus formation,and remodelling of the newly-formedbones.展开更多
In this paper, the Von Mises stresses and stiffnesses measured by experiments on a human cadaveric tibia and composite ones compared to those predicted by a FE model based on the same bone. Modeling of exact geometric...In this paper, the Von Mises stresses and stiffnesses measured by experiments on a human cadaveric tibia and composite ones compared to those predicted by a FE model based on the same bone. Modeling of exact geometrical tibia including cortical and spongy bone using human bone CT scan images and mechanical validating of obtained model, is the aim of this study .The model produced by the current study supplies a tool for simulating mechanical test conditions on human tibia.展开更多
Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial a...Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.展开更多
Background: The aim of this study was to evaluate the accuracy of initial bone cutting of the distal femur and the proximal tibia in TKA using an image-free navigation system. Methods: From February 2006 to March 2013...Background: The aim of this study was to evaluate the accuracy of initial bone cutting of the distal femur and the proximal tibia in TKA using an image-free navigation system. Methods: From February 2006 to March 2013, we evaluated 60 knees in 50 patients using an image-free navigation system (Navigation: Stryker Navigation Cart System;Software: Stryker Knee Navigation;Ver2.0: Stryker Orthopaedics US NJ Mahwah). First, we measured the angle shown by the navigation system before cutting, at the time we set the jig. Second, we measured the angles shown by navigation after the bone was cut using the jig. Then, we compared these two angles for each patient to determine the bone cutting error. Results: In the distal femur, 37 of 60 knees were cut in an extended position in the sagittal plane, and 26 of 60 knees were cut in a varus in the coronal plane. In the proximal tibia, 29 of 60 knees were cut with decreased posterior slope in the sagittal plane, and 26 of 60 knees were cut in a valgus. Conclusions: In this study, the distal femur tended to be cut in an extended and a varus position and the proximal tibia did with decreased posterior slope and in a valgus position after initial bone cutting. It is necessary to note the initial cutting error in TKA. Since cutting errors affect postoperative outcome, we should cut bones several times. And as the reasons of the cause of the error, we propose new reason that cutting bone is not parallel with accuracy to AP axis.展开更多
目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)行胫骨近端延长的愈合指数及并发症情况。方法回顾性分析2012年2月至2019年12月湖南省儿童医院骨科使用伊氏外固定装置行胫骨近端延长手术的57例CPT患儿临床...目的评估儿童先天性胫骨假关节(congenital pseudarthrosis of the tibia,CPT)行胫骨近端延长的愈合指数及并发症情况。方法回顾性分析2012年2月至2019年12月湖南省儿童医院骨科使用伊氏外固定装置行胫骨近端延长手术的57例CPT患儿临床资料,平均随访时间72.9个月。根据愈合指数的平均值分组,愈合指数小于57.1 d/cm为A组(n=32),大于57.1 d/cm为B组(n=25)。于胫骨近端延长治疗结束后1个月行X线检查,采用Li分类法评估骨痂质量,并随访患儿胫骨延长术后并发症情况。结果57例CPT患儿平均愈合指数为57.1 d/cm。A组手术时平均年龄为80个月,平均随访时间为75.5个月,平均延长长度为5.9 cm,延长结束后1个月骨痂形态质量良好者占81%(26/32),愈合指数为39.1 d/cm。B组手术时平均年龄为100.9个月,平均随访时间为69.6个月,平均延长长度为4.9 cm,延长结束后1个月骨痂形态良好者占56%(14/25),愈合指数为80.1 d/cm。57例中,3例于胫骨延长过程中腓骨提前愈合,5例出现针道感染,3例踝关节僵硬,1例出现踝关节跖屈20°畸形,4例出现延长段成角畸形,8例膝关节活动受限。结论CPT患儿胫骨延长过程中平均愈合指数为57.1 d/cm,存在腓骨提前愈合、延长段成角畸形等并发症,延长过程中需密切关注骨痂形态。展开更多
文摘Athletes and military recruits are often afflicted by stress fractures. Rigorous training programs consisting of increased repetitive mechanical loading may contribute to the high incidence of tibia stress fracture in the athletic and army populations. The purpose of this study was to assess the effect of incremented height on tibia bone strains and strain rates during landing. Seven healthy college males performed drop-landing tasks from 26 cm, 39 cm, and 52 cm, respectively. Tibia bone strains and strain rates were obtained through subject-specific multi-body dynamic computer simulations and finite element analyses. One-way repeated measures ANOVAs were conducted. Both 39 cm and 52 cm conditions resulted in larger tibia bone strains and strain rates than the 26 cm condition. The 52 cm condition also resulted in greater bone strains and strain rates than the 39 cm condition. A dose-response relationship exists between incremented landing height and bone strains and strain rates. Activities consisting of high impact landings are associated with increased risk of developing tibia stress fracture. When designing training programs involved high impact activities, athletes and military recruits should consider the effect of impact loading on tibia bone health and giving enough time for bones to adapt to new trainings.
文摘Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.
文摘Objective: to investigate the clinical effect of Ilizarov lateral tibial lateral displacement in the treatment of diabetic foot foot (DF). Methods: from August 2017 to December 2019, 60 patients with DF of Wagner grade 3 ~ 4 were selected from the Department of Endocrinology, Department of orthopedics and rehabilitation of Loudi central hospital. The patients were randomly divided into the control group with routine treatment and Ilizarov tibial transverse bone transfer on the basis of routine treatment, with 30 patients in each group. The pain (VAS) score, ankle brachial index, affected foot skin temperature, ulcer healing rate, 10 # g nylon filament measurement and limb salvage rate were compared between the two groups before and after treatment, and the incidence of postoperative complications in the study group was analyzed. Results: after treatment, the VAS score, skin temperature of affected limbs, 10 g nylon thread test, ankle brachial index, ulcer healing rate and limb salvage rate in the study group were significantly better than those in the control group (P < 0.05);Three patients in the study group had red and swollen skin around the nail path during treatment, which improved after antibiotic treatment. Conclusion: transverse tibial bone transfer can improve the clinical symptoms, lower limb blood supply and peripheral nerve function, accelerate ulcer healing and improve limb salvage rate in patients with DF, which is safe and effective.
文摘Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)是NF1基因突变导致的常染色体遗传病,典型临床症状包括牛奶咖啡斑、神经纤维瘤、NF1相关骨骼损害等。目前NF1相关骨科疾病如脊柱侧凸、先天性胫骨假关节、骨质疏松等逐渐被重视,其多学科诊疗和疾病管理成为研究的重点。本文阐述NF1及相关骨科疾病的诊疗进展,以提高临床对其多学科全程管理的认识,改善患者生存质量。
文摘The histological changes after tibial lengthening with metaphyseal osteotomywere observed in 30 goats.It was found that(1)a slow lengthening rate of 1 mm/d couldenable the tissues to adapt the mechanical traction and consequently increase thelengthening limitation;(2)the newly-formed bone in the lengthened area might be due to acombined osteogenesis of endochondral,intramembranous,and fibrous tissue ossification;and(3)the osteogenetic process could be distinguished into 3 stages as hemorrhage andorganization of the hematocele,callus formation,and remodelling of the newly-formedbones.
文摘In this paper, the Von Mises stresses and stiffnesses measured by experiments on a human cadaveric tibia and composite ones compared to those predicted by a FE model based on the same bone. Modeling of exact geometrical tibia including cortical and spongy bone using human bone CT scan images and mechanical validating of obtained model, is the aim of this study .The model produced by the current study supplies a tool for simulating mechanical test conditions on human tibia.
文摘Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.
文摘Background: The aim of this study was to evaluate the accuracy of initial bone cutting of the distal femur and the proximal tibia in TKA using an image-free navigation system. Methods: From February 2006 to March 2013, we evaluated 60 knees in 50 patients using an image-free navigation system (Navigation: Stryker Navigation Cart System;Software: Stryker Knee Navigation;Ver2.0: Stryker Orthopaedics US NJ Mahwah). First, we measured the angle shown by the navigation system before cutting, at the time we set the jig. Second, we measured the angles shown by navigation after the bone was cut using the jig. Then, we compared these two angles for each patient to determine the bone cutting error. Results: In the distal femur, 37 of 60 knees were cut in an extended position in the sagittal plane, and 26 of 60 knees were cut in a varus in the coronal plane. In the proximal tibia, 29 of 60 knees were cut with decreased posterior slope in the sagittal plane, and 26 of 60 knees were cut in a valgus. Conclusions: In this study, the distal femur tended to be cut in an extended and a varus position and the proximal tibia did with decreased posterior slope and in a valgus position after initial bone cutting. It is necessary to note the initial cutting error in TKA. Since cutting errors affect postoperative outcome, we should cut bones several times. And as the reasons of the cause of the error, we propose new reason that cutting bone is not parallel with accuracy to AP axis.
