Objective To investigate the relationship between the vertical distance from semitendinosus insertion to tibial plateau (S-T) and the physical characteristics of patients, in order to provide reference for incision design to expose the semitendinosus insertion. Methods The patients with ligament injury who underwent primary anterior cruciate ligament reconstruction between January 2022 and December 2022 were selected as the research subjects. The patients’ baseline data were collected, including age, gender, height, and body mass. During reconstruction operation, the S-T was measured. Considering the S-T as the dependent variable and baseline data as the independent variable, multiple linear regression analysis was used to establish a regression equation to determine the possible influencing factors of semitendinosus insertion location. Results According to the selection standard, a total of 214 patients were enrolled, including 156 males and 58 females, aged (27±9) years (14-49 years), with a height of (174.7±6.8) cm (range, 160-196 cm) and a body mass of (73.43±12.35) kg (range, 53-105 kg). The S-T was (56.36±3.61) mm (range, 47-67 mm). The multiple linear regression analysis results showed that the height was positively correlated with S-T (β=0.407, SE=0.055, t=7.543, P<0.001); the regression equation was S-T=?14.701+0.407×height, R2=0.690. ConclusionThere was a linear relationship between the height and semitendinosus insertion. The location of semitendinosus insertion estimated by the formula (S-T=?14.701+0.407×height) is reasonable, which provides a theoretical basis for rapid, accurate, and safe location of semitendinosus insertion and design of surgical incision in clinic.
ObjectiveTo investigate the knowledge and need of caregivers who perform self-nursing for children with peripherally inserted central catheter (PICC), in order to provide evidence for health education for children in-patients and children discharged from hospital with central venous catheter. MethodsSelf-designed questionnaire was used to investigate 364 caregivers who performed nursing for 162 PICC pediatric in-patients bwtween December 2013 and July 2015. The investigation was carried out on the general information, nursing knowledge, and the acquisition approach of caregivers' existing nursing knowledge. ResultsThe majority of indwelling PICC pediatric caregivers were elderly people, and the common care model was alternate caring carried out by core family members. The children were cared by the elderly in 59 families (36.42%). Twenty-one families had the parents of the children as the major caregivers (12.96%), and alternate caring by parents and the elderly happened in 82 families (50.62%). The total score of the investigation was ranged from 5 to 29 with an average of 11.37±5.68. Nineteen children were discharged with catheter, whose caregivers got a score from 6 to 11, averaging 8.41±4.33. ConclusionThe ratio of self-nursing knowledge in caregivers for pediatric PICC patients is generally low, especially in those caregivers for patients discharged with central venous catheter. Nursing administrators should pay attention to training of the nurses, trying to improve the knowledge of nurses on PICC health education. Different forms of health education should be carried out for different caregivers. Finally, health education model should also be continuously improved to raise the quality of PICC pediatric nursing.
Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results (Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results (P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient’s knee joint function recovers well.
ObjectiveTo compare the early effectiveness of arthroscopic suture bridge technique and conventional double tunnel suture technique in the treatment of avulsion fracture of posterior cruciate ligament (PCL) insertion.MethodsBetween June 2013 and December 2018, 62 patients with tibial avulsion fracture of PCL insertion that met the criteria were selected and randomly divided into trial group (using arthroscopic suture bridge technique) and control group (using conventional double tunnel suture technique), 31 cases in each group. There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, Meyers & McKeever classification, Kellgren-Lawrence classification, and preoperative knee range of motion, difference of posterior relaxation of bilateral knee joints, International Knee Documentation Committee (IKDC) score, and Lysholm score between the two groups (P>0.05). The operation time and IKDC score, Lysholm score, knee range of motion, the difference of posterior relaxation of bilateral knee joints (measured by KT-2000 under knee flexion of 90° and 30 lbs) were recorded and compared between the two groups before operation and at 3 and 12 months after operation.ResultsBoth groups successfully completed the operation, and the operation time of the trial group and the control group were (61.81±6.83) minutes and (80.42±4.22) minutes respectively, showing significant difference between the two groups (t=12.911, P=0.000). All the incisions healed by first intention, and there was no wound infection and other early postoperative related complications. All patients were followed up 13-18 months (mean, 14.6 months). The fractures in both groups healed at 3 months after operation. No knee pain, limited movement, or other complications occurred. At 3 and 12 months after operation, the IKDC score, Lysholm score, knee range of motion, and the difference of posterior relaxation of bilateral knee joints in both groups were significantly improved when compared with preoperative ones, and further improved at 12 months after operation when compared with at 3 months after operation (P<0.05). At each time point after operation, the above indexes and the grade of the difference of posterior relaxation of bilateral knee joints in the trial group were significantly better than those in the control group (P<0.05).ConclusionArthroscopic suture bridge technique in the treatment avulsion fracture of PCL insertion is simple and reliable, which can significantly improve the function and stability of the knee joint and obtain satisfactory early effectiveness.
ObjectiveTo observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament (ACL) in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. MethodsFifteen adult cadaveric knees (8 left knees and 7 right knees) were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years (mean, 32.4 years). All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion (direct and indirect insertions) were anatomically measured. ResultsIn all specimens, the ACL was flat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc-shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was (11.2±2.4) mm; the thickness was (3.0±0.3) mm; and the cross-sectional area was (28.8±7.8) mm2. And the left-right diameter of the whole insertion was (9.5±1.8) mm; anteroposterior diameter was (11.9±0.6) mm; and the cross-sectional area was (117.8±12.5) mm2. The width of the anterior horn of lateral meniscus was (12.3±2.0) mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. ConclusionAnatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.
A certain degree of varus alignment is physiological in the native knee, and alignment strategies such as kinematic and functional alignment permit residual postoperative varus. However, identical total varus angles may result from varying combinations of femoral and tibial varus, whose biomechanical implications for implant loading and ligament stress remain unclear. This study aims to investigate the biomechanical effects of different femoral–tibial varus configurations in total knee arthroplasty (TKA). Using combined geometric modeling and finite element analysis, TKA models with different varus combinations were constructed to evaluate changes in limb moment arms, polyethylene insert stress, and ligament forces during static knee flexion (0°–90°). Results demonstrated that a higher proportion of femoral varus, under equivalent total varus and flexion angles, led to reduced maximum polyethylene stress and decreased tension in the medial collateral ligament (MCL) and anterolateral ligament complex (ALL). Knee flexion angle had a more significant impact on polyethylene stress than varus: stress increased by approximately 2.48 times at 90° flexion compared to 0°, whereas 12° varus increased stress by only approximately 14%. The ALL experienced the greatest tensile load during flexion, indicating a key stabilizing role. In conclusion, optimizing the combination of femoral and tibial varus may help redistribute loads and improve implant longevity. This study reveals, from a biomechanical perspective, how different varus configurations affect stress distribution in the prosthesis and surrounding soft tissues, suggesting that intraoperative osteotomy strategies should comprehensively consider the combined alignment of the femur and tibia.
Objective To analyze the effectiveness of minimally invasive safe approach of the knee joint in the treatment of avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL). Methods The clinical data of 26 patients with avulsion fractures of tibial insertion of PCL treated with open reduction and internal fixation via minimally invasive safe approach of the knee joint between February 2019 and March 2022 were analyzed retrospectively. There were 18 males and 8 females with an average age of 45.5 years (range, 33-58 years). The causes of injury were traffic accident in 14 cases, falling from height in 7 cases, and sports injury in 5 cases. There were 15 cases of left knee and 11 cases of right knee. The preoperative Lysholm score of knee joint was 34.4±7.3 and the flexion range of motion of knee joint was (69±12)°. According to Meyers classification, there were 8 cases of type Ⅱ and 18 cases of type Ⅲ. The time from injury to operation ranged from 1 to 5 days, with an average of 2 days. ResultsThe operation time was 40-70 minutes, with an average of 55 minutes; the intraoperative blood loss was 10-30 mL, with an average of 15 mL. Delayed incision healing occurred in 1 case after operation, and the incision healed after conservative treatment, and the incisions of the other patients all healed by first intention. Postoperative X-ray films showed satisfactory fracture reduction. All 26 patients were followed up 3-30 months, with an average of 22 months. No complication such as neurovascular injury, infection, and knee extension disorder occurred after operation. X-ray films at 3 months after operation showed that all fractures healed without displacement of the fracture ends; the posterior drawer test was negative. At last follow-up, the flexion range of motion of knee joint was (120±9)°, the Lysholm score was 90.7±3.8, which were significantly improved when compared with those before operation (t=16.376, P<0.001; t=47.665, P<0.001). Conclusion The minimally invasive safe approach of the knee joint for the treatment of PCL tibial insertion avulsion fractures is easy to operate, with minimal surgical trauma, safe and reliable approach, and satisfactory recovery of knee joint function after operation.
Objective To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Methods Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 ± 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. Results All patients got primary wound heal ing without any compl ication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain rel ief at 6 months after surgery and hadgood appearance of the feet. The AOFAS ankle-midfoot score was 90.4 ± 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus incl ination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P lt; 0.01). Conclusion The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.
ObjectiveTo investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). Methods A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. ResultsAll operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores (t=?22.899, P<0.001; t=?29.870, P<0.001; t=?19.979, P<0.001). ConclusionMulti-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.