试论“外伤瘀血成痹”

痹证,是祖国医学一大类疾病,也是骨科临床上常见疾病之一。早在黄帝内经就提出了痹证的成因,病理及临床症状。《黄帝内经·痹论》“风寒湿三气杂至,合而为痹也。其风气胜者为行痹,寒气胜者为痛痹,湿气胜者为著痹也。”①自内经后,历代医家在临床实践中,对痹证不断提出新的见解,使痹证理论不断完善。但在临床上可以看到一部分肢节痹证,并不是外感风寒湿而引起的,其发病与外伤有密切的关系。本文试就“外伤瘀血成痹”这一问题,根据古代医学文献及临床所见,作一探讨。     

“骨、筋、肌肉”三位一体对膝骨关节炎的防治作用

膝骨关节炎(Knee Osteoarthritis,KOA),是以膝关节软骨的变性、破坏关节周围骨质增生为特征的慢性关节病,临床表现为膝关节局部疼痛、晨僵、肿胀、活动受限、严重者可出现关节的畸形,并最终可导致残疾的风险,据其证候特点属于中医学"膝痹病"、"骨痹"、"痹证"等范畴,该病核心病机为本痿标痹,以肝肾亏虚、筋骨失养为本,以腠理空虚易感风寒湿邪、瘀血阻滞筋络为标,主要病位在软骨,但其疾病的发生、发展应涵盖骨、筋、肌肉三者之间的相互作用。故笔者分别就对KOA"骨、筋、肌肉"三者关系认识、不同发病因素对"骨、筋、肌肉"的影响,以及在KOA临床治疗中的对"骨、筋、肌肉"的调节三方面说明"骨、筋、肌肉"与KOA的发生、发展、治疗、转归等密切关系,为"骨、筋、肌肉"三位一体理论在指导认识KOA的发生、发展、治疗、转归的理论价值和实际应用价值。     

膏方治疗风湿病优势探讨

近年来,膏方因能"补益扶正"逐渐成为治疗慢性疾病的热点。追溯古代文献,总结现代各医家使用膏方治疗风湿病的经验,探讨膏方治疗强直性脊柱炎、类风湿关节炎、干燥综合征等常见风湿病的优势。     

基于“骨正筋柔”理论的保膝治疗

膝骨关节炎（knee osteoarthritis,KOA）是以关节软骨的破坏,变性以及骨质增生为主要特征的慢性关节病。在中医病症中,此病归为“痹证”和“骨痹”等范畴,其早期的病位在筋,筋即软骨,继而由筋及骨,形成筋骨并病。在 KOA 的晚期可见“筋失其柔,骨失其正”之态。面对众多治疗方法,膝关节单髁置换术（unicompartmental knee arthroplasty,UKA）和胫骨高位截骨（high tibial osteotomy,HTO）是“筋柔骨正”理论指导下的代表保膝措施。     

肩痹的源流及相关历史文献复习

肩痹为肢体痹之一,是按肢体部位分类的风湿病三级痹病。历史上对于肩痹相关论述有着丰富的文献记载。通过对肩痹有关历代文献的整理和研究,包括肩痹的病名、肩痹的病因病机、历代医家对肩痹的论述,及肩痹的治疗等,以便能更清晰地认识肩痹,更好地应用于临床。     

膏肓损伤初探

膏肓损伤又称膏肓腧穴伤〔１〕、伤膏肓〔２〕,原属太阳筋病、背痛范畴。清代医家赵廷海首先在《救伤秘旨》一书中,作单一损伤疾患列出。我们通过文献复习和临床观察发现：祖国医学所说膏肓损伤与现代医学中肩胛肋骨综合征〔３〕,有许多相似之处。现就二者的病变部位、...     

王海东教授针药结合治疗类风湿关节炎膝关节病变经验

王海东教授认为,类风湿关节炎膝关节病变发病以正气亏虚为本,风、寒、湿、热等外邪侵袭为标,病位主要在脾,与肝、肾关系密切,形成了“正虚则生积致痹”的学术思想。治疗时注重内外合治、针药并用,针刀治疗时强调解剖结构和经筋理论并重,提出辨筋论治的针刀舒筋解结术,重视形、气、神一体观,整体治疗。用药时提出了“益气法”治痹理论,选方以“益气蠲痹汤”为基础,临证时随症加减、灵活处方。     

肺痹的源流及相关历史文献复习

肺痹为五脏痹之一,是按五脏组织分类的风湿病三级痹病。《黄帝内经》之后,众多中医文献中对肺痹系统论治较少,以致现在相当一部分学者对肺痹认识不清。通过对历代文献有关肺痹的论述进行整理和研究,包括肺痹的病名、肺痹的病因病机、历代医家对肺痹的论述及肺痹的治疗等,以便能更清晰地认识肺痹,更好地应用于临床。     

肝痹的源流及相关历史文献复习

肝痹为五脏痹之一,是按五脏组织分类的风湿病三级痹病。《黄帝内经》之后,众多中医文献中对肝痹系统论治较少,以致现在相当一部分学者对肝痹认识不清。通过对历代文献有关肝痹的论述进行整理和研究,包括肝痹的病名、肝痹的病因病机、历代医家对肝痹的论述及肝痹的治疗等,以便能更清晰地认识肝痹,更好地应用于临床。     

脾痹的源流及相关历史文献复习

脾痹为五脏痹之一,是按五脏组织分类的风湿病三级痹病。《黄帝内经》之后,众多中医文献中对脾痹系统论述较少,以致现在相当一部分学者对脾痹认识不清。通过对历代文献有关脾痹的论述进行整理和研究,包括脾痹的病名、脾痹的病因病机、历代医家对脾痹的论述及脾痹的治疗等,以便能更清晰地认识脾痹,更好地应用于临床。     

Adenovirus-mediated gene transfer into tendon and tendon sheath

In this study, we successfully transferred the Escherichia coli β-galactosidase gene, LacZ, into the chicken tendon and tendon sheath by a recombinant adenovirus. The recombinant adenovirus Adv-βgal that carried the E. coli LacZ gene was constructed by homologous recombination in 293 cells (human transformed embryonic kidney) between the expressing vector and the ClaI large fragment of adenovirus 5 genome. Each chicken received a 10 μl injection, containing 10⁵ plaque-forming units of recombinant virus Adv-βgal, into the tendon sheath of the long toe. Samples of tendon and tendon sheath were harvested at 3, 30, and 75 days after the injection. The LacZ gene transfer was detected for its coding product β-galactosidase by staining with X-gal solution. The results showed that all tendon and tendon sheath samples from the three harvest times stained positive (blue). The tendon sheath samples were more extensively stained; staining of the tendon was limited to the epitenon layer. These data suggest that a functional exogenous gene can potentially be transferred into the tendon and tendon sheath by similar techniques; such techniques may be used to improve healing and reduce adhesion formation.     

手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植的比较学研究

目的比较手指鞘管区异体滑膜肌腱与自体非滑膜肌腱移植结果并对异体滑膜肌腱在鞘管区的移植进行评估.方法对在手指屈肌腱鞘区内应用异体滑膜肌腱与自体非滑滑膜肌腱移植的病例,术后进行3个月以上的随访.评定标准为关节活动范围（TAM法）、力量,及二期肌腱松解率.结果异体滑膜肌腱移植280例,优良率达57.0%,较差或差为11.0%.松解率为32.0%,松解后总优良率达93.0%.自体非滑膜肌腱移植98例,优良率达43.0%,较差或差为9.0%.松解率为49.0%,松解后总优良率达94.2%.两者的最终结果无明显差异.结论肌腱表面结构影响肌腱的营养途径及肌腱愈合质量,滑膜肌腱表面结构则有益于肌腱营养与较快建立起血循环及组织液的渗透,是减少肌腱术后粘连再次松解的主要因素.     

Active tendon implants in flexor tendon reconstruction

Forty-five active flexor tendon implants were evaluated after placement in scarred tendon beds of digits II through V. The implant is constructed of silicone rubber with a Dacron core, terminating in a loop proximally and a metal plate distally. Modification of the implant during the period of study has improved its reliability and longevity. The improvement in total active motion (TAM) averaged 72 degrees during implant functioning (stage I) in a group of digits that before operation were classified as 78% Boyes grade 5 (salvage). Complication rate during stage I was 11% (5 out of 45). Of the 27 digits evaluated after implant replacement by tendon autograft (stage II), there was an overall improvement in 62 degrees total active motion with 70% of digits being Boyes grade 5. Many of the complications were believed to be avoidable with experience. This study demonstrates the feasibility of an active tendon implant and the possibility of a permanent prosthesis.     

Experimental tendon grafting within intact tendon sheath

A chicken toe experimental model was used to study the fate of flexor tendon grafts, introduced into intact tendon sheaths. After perfusion of the limb by India Ink, the vascular pattern of the graft and the synovial sheath could be identified. The grafts showed no or few adhesions to the sheath. With time, there was a conversion from a diffuse superficial vascular pattern towards a concentration of vessels on the dorsal aspect of the graft. In a control group, where the sheath had been resected, adhesions were more apparent, and could be observed still after 16 weeks. These results are in complete agreement with previous experimental findings and further confirm the importance of an intact tube system in the digit.