改良食指背侧岛状皮瓣及其感觉训练的临床研究

目的关于食指背侧岛状皮瓣改良术式临床修复拇指软组织缺损或瘢痕挛缩及皮瓣异位感觉康复训练的临床研究。方法2006年2月至2007年12月,对12例拇指软组织缺损患者利用改良的食指背侧岛状皮瓣方法修复拇指创面。术后鼓励患者做患指康复训练,拆线后指导患者加强拇指康复训练,特别加强改善皮瓣异位感觉的康复训练。结果所有皮瓣均成活。本组病例随访4-6月,患者拇指皮瓣外形好,拇指掌指关节及指间关节活动在正常范围,皮瓣血运良好,皮瓣感觉正常,皮瓣异位感觉康复训练后的感觉恢复需要约4个月,而未经过康复训练的皮瓣异位感觉恢复要晚2个月左右。结论临床上修复拇指软组织缺损,无论食指背桡侧动脉为三型中的哪一种分型,通过改良食指背侧岛状皮瓣切取修复,均能保证皮瓣一期成活,经康复训练,使拇指皮瓣异位感觉提前2个月恢复。     

尺神经手背支卡压所致腕尺侧痛的解剖和临床研究

目的 对尺神经手背支卡压引起腕尺侧痛的机理进行研究并探讨尺神经手背支卡压症的诊断和治疗。方法 对40侧福尔马林固定的成人尸体前臂部和腕部进行大体解剖和显微解剖。在临床上诊治了13例尺神经手背支卡压的病例并进行分析。结果 尺神经手背支在尺骨茎突以近5.6-6.8cm处尺侧腕屈肌（腱）深面内侧缘穿出,紧贴尺骨行走,在尺骨小头内侧分成2－3大支,其中的横支紧贴骨膜,横跨尺骨小头或绕经尺骨小头远端斜行向桡侧,腕关节活动和尺骨小头的位置改变极易对其造成损伤。临床发现患该症的患者尺骨小头远端或尺侧缘有一显著而局限的压痛点,其周围有局部的皮肤感觉改变。13个病例中,7例局部封闭,6例手术,其中9例随访4个月－1年,未见复发。结论 腕关节反复屈伸时尺神经手背支尤其是横支被牵拉和压迫是造成尺神经手背支卡压的解剖学基础。临床上对腕尺侧痛并有皮肤感觉改变的病例,应考虑尺神经手背支卡压的可能性。     

Anomalies of atrioventricular valves in origin of the aorta and pulmonary artery from the right heart ventricle

Anomalies of the atrioventricular valves may influence essentially the choice of the method and volume of surgical intervention in origin of the aorta and pulmonary artery (PA) from the right ventricle (RV). The results of morphological study of 55 heart specimens with origin of the aorta and PA from the RV are analysed; structural anomalies of the atrioventricular valves were revealed in 19 of them (34.5%). The anomalies were surgically significant only in 16.4% of cases. Isolated anomalies of biventricular attachment, simultaneous biventricular attachment and displacement of one of the atrioventricular valves, and anomalous chordae and supernumerary fibrous structures connected to the atrioventricular valves, etc. were the most commonly encountered anomalies of the atrioventricular valves in origin of the aorta and PA from the RV. The frequency and complexity of anomalies of the atrioventricular valves in origin of the aorta and PA from the RV were determined by the morphology of the cardiac complex, the type of the anomaly, and the side involved in the pathology of the atrioventricular valves. The complexity of the atrioventricular valve disorders in such cases could influence noticeably the volume of the surgical intervention. Anomalies of the atrioventricular valves in origin of the aorta and PA from the RV were encountered most frequently in malposition of the heart or discordant atrioventricular connection. The frequency of anomalies of the tricuspid valve was much higher than that of mitral valve anomalies, but the last named were surgically significant in most cases as a rule.     

Microsurgical anatomy of the choroidal fissure

The microsurgical anatomy of the choroidal fissure was examined in 25 cadaveric heads. The choroidal fissure, the site of attachment of the choroid plexus in the lateral ventricle, is located between the fornix and thalamus in the medial part of the lateral ventricle. The choroidal fissure is divided into three parts: (a) a body portion situated in the body of the lateral ventricle between the body of the fornix and the thalamus, (b) an atrial part located in the atrium of the lateral ventricle between the crus of the fornix and the pulvinar, and (c) a temporal part situated in the temporal horn between the fimbria of the fornix and the lower surface of the thalamus. The three parts of the fissure are the thinnest sites in the wall of the lateral ventricle bordering the basal cisterns and the roof of the third ventricle. Opening through the body portion of the choroidal fissure from the lateral ventricle exposes the velum interpositum and third ventricle. Opening through the temporal portion of the choroidal fissure from the temporal horn exposes the structures in the ambient and crural cisterns. Opening through the atrial portion of the fissure from the atrium exposes the quadrigeminal cistern, the pineal region, and the posterior portion of the ambient cistern. The neural, arterial, and venous relationships of each part of the fissure are reviewed. The operative approaches directed through each part of the fissure are also reviewed.     

Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation

The pedicles of lumbar vertebrae were measured both directly and radiographically to determine the differences between the sexes and the accuracy of radiographic measurement. The lumbar pedicles of cadavera of forty-nine patients--twenty-four men and twenty-five women--who died between the ages of sixty and ninety-eight years were measured directly and on radiographs. The pedicles of lumbar vertebrae from fifty-one patients--twenty-three men and twenty-eight women--between the ages of twenty and fifty years who had low-back problems were measured on radiographs and computerized tomographic scans. Comparison revealed that the average transverse and sagittal diameters of the pedicles and the distance from the posterior aspect of the laminar cortex to the anterior aspect of the cortex of the vertebral body along the central axis of the pedicles were 5 to 20 per cent greater in men, but the transverse and sagittal angles of the pedicle did not differ significantly between the sexes. Measurements on radiographs and computerized tomographic scans of the transverse angles of the pedicles and of the distances from the posterior aspect of the laminar cortex to the anterior aspect of the cortex of the vertebral body from the second to the fifth lumbar vertebra were greater than direct measurements, even without magnification. Direct measurements of the diameters of the transverse and sagittal diameters of the pedicle of the fifth lumbar vertebra, however, were greater than the radiographic measurements.     

Epidemiologic and etiologic features of urinary infections in children at the pediatrics service of the CHU-Campus de Lome (Togo)]

From 1st January 1989 to 31th December 1997, 175 infants (108 females and 67 males) were hospitalised and treated at the pediatric service of CHU-Campus for urinary tract infection; this study follows the observation of the increasing of urinary tract infection in several centers of health in Togo; the aim of this study was to have a list the contributing factors, to understand the mechanism of such infection in order to reduce its frequency and the high percent of the mortality; the diagnosis of urinary tract infection was given by the result of the cytobacteriological exam of the urine which shows the pathological germ; others forms of the investigation, as abdominal echography were used also to look for the etiology of the urinary tract infection; but, the deficit of the of the medical imagery or the old material of the laboratories limited the searching of urinary tract infection etiology; cured infants were declared on the basis of absence of pathological germ in the result of the cytobacteriological exam control of the urine; the prevalence of the urinary tract infection was 8.29% with an incidence of 7.84% at the pediatric service of CHU-Campus; clinics symptoms were atypic and polymorphic; but the fever was the first clinical sign in the newly born and the urological signs were clear only from two to thirty months; 141 children (80.57%) were cured and 34 presented the complications with 3.43% of mortality; preventive measures on the urinary tract infection in infancy were proposed for the children parents and the practical physicians; these measures included information, education and communication (IEC) on the urinary tract infection, the symptomatology and the cytobacteriological exam of the urine.     

Choice of a rational method and optimization of terminal colostomy

The author analyses the results of various methods of terminal colostomy, among which are the "column" technique, with stitching of the edges of the peritoneum to the skin and leaving the excess of the brought out intestine in 258 patients, the formation of a flat stoma by the ordinary method in 179 patients, and with retroperitoneal passing of the intestine in 752 patients in radical surgical treatment of rectal carcinoma and other diseases of the large intestine. The operations were conducted in the period from 1973 to 1987. The frequency of early paracolostomy complications (suppuration, retraction, etc.) in these groups of patients was, respectively, 31%, 22.9%, and 17.6%; that of late-term complications, 70.6%, 50.3%, and 20.3%. The article shows the results of study of the causes of these complications, which formed the basis for improving the methods and techniques of the operation the principal differences of which consisted in: (1) colostomy, except for the final formation of the opening at the level of the skin, was conducted before mobilization of the rectum; (2) retroperitoneal passing of the intestine was accomplished through the upper angle of a lyre-shaped incision of the pelvic peritoneum to the left of the sigmoid colon; (3) the use of a "closed" method of flat stoma formation by cutting the intestinal wall at the level of the skin down to the mucosa and attaching it to the skin by the musculoserous coat with interrupted catgut sutures, and only after that is the excessive mucosa cut off and the intestinal lumen opened.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ligamento-periostosis of the attachment of the patellar ligament

The analysis of 1140 observations of ligamento-periostosis of the apex of the patella (the proximal attachment of its proper ligament) revealed that it was rather frequently present (3.1%) in the latent form during the prophylactic examinations of sportsmen, which constituted an important part (7.6%) in the structure of the diseases of the locomotor system. It was confirmed that the disease depended on the intensity of the loads and on the age of the patients. Early (at the preclinical stage) treatment allows to reduce the transition of the latent course of the disease into its clinical forms down to 6%. The administration of a complex treatment with novocaine electrophoresis and vitamin R12, drug blocks of the pathologic foci at the site of the attachment of the ligament and differential correction of the static and dynamic loads provide for steady healing without recurrences and relapses of the disease in 89% of the patients.     

股骨颈动力交叉钉系统内固定植入物安放位置的力学差异分析与临床应用

目的:利用三维重建方法建立股骨颈动力交叉钉系统内固定有限元模型,比较植入物不同置入位置对内固定效果差异的影响。方法:分别建立植入物处于股骨中上三分之一处,股骨中心以及股骨中下三分之一处,股骨中心沿矢状面前三分之一处,股骨中心沿矢状面后三分之一处,5种股骨颈动力交叉钉系统内固定有限元模型,比较在这5种位置下,股骨颈动力交...     

股骨头骨内静脉造影的临床意义

目的：应用股骨头骨内静脉造影术（ＩＶＦＨ）判断股骨头血运情况，为术式选择及判断预后、康复提供依据。方法：收集３４例股骨颈骨折病例行造影，将造影剂直接注入股骨头中，显示其中的血管，造影剂潴留时间和从静脉引流方向，推断股骨头血运情况。结果：３４例中，新鲜骨折２３例，有７例注入阻力少，在数秒至十余秒即显出股骨头全部血运，５分钟内显出引流静脉，属股骨头血运正常。其中有５例用闭合复位螺纹钉内固定，２例有牢固嵌插，保守治疗，均于５个月内愈合。５年随访无坏死发生。新鲜骨折２３例中，１６例有循环障碍，５例用人工关节置换术，１１例切开复位，螺纹钉内固定及带旋髂深血管蒂的髂骨植骨术，术后６～９个月愈合，随访９年，有３例发生骨坏死。结论：ＩＶＦＨ能显示股骨头的血液供应情况，对临床选择疗法及术后康复有指导意义。     

A new model to facilitate palpation of the level of the transverse processes of the thoracic spine

STUDY DESIGN: Nonexperimental, normative research design. OBJECTIVES: To test a proposed model to locate the level of the transverse processes (TPs) of the thoracic spine through surface palpation. BACKGROUND: Palpation of the TPs of the thoracic spine is challenging because of their depth relative to the more superficial structures of the spine. Many clinicians use the more superficial spinous processes (SPs) of the thoracic spine to orient themselves for palpation of the TPs. In 1979, Mitchell described a "rule of threes," which attempted to predict the location of the level of the thoracic TPs relative to their corresponding SPs. We previously conducted a pilot study to investigate the validity of the rule of threes and concluded that it is not an accurate predictor of the level of the location of the TPs of the thoracic spine. Based on that previous work, we hypothesized that a more accurate model for predicting the level of the TPs would be that they are generally at the level of the SP of the adjacent cranial thoracic vertebra throughout the thoracic spine. METHODS AND MEASURES: We dissected 15 cadavers and measured the vertical distance between the transverse (horizontal) plane of the TPs of 1 vertebra and the SP of the adjacent cranial thoracic vertebra for all levels of the thoracic spine. RESULTS: Mean vertical distances ranged from 2.0 to 4.0 mm. The means for all thoracic vertebral levels except for T11 and T12 were significantly less than the normal 6-mm threshold of 2-point discrimination of the fingertips (P<.01). CONCLUSION: The results of this study indicate that the TPs of each thoracic vertebra are generally at the level of the SP of the vertebra 1 level above, throughout the thoracic spine. It may be more difficult to predict the location of the TPs of the 2 most caudal levels (T11 and T12), given their greater variability of position.     

应用体表测量法预测骨质疏松症及并发椎体骨折的研究

目的通过测量体表骨性标志的距离,为骨质疏松症患者的早期筛查、诊断及判断是否并发椎体骨折提供依据。方法对52例老年骨质疏松患者和45例正常青年进行了对比研究,每名受试者均测量胸骨下端到耻骨联合上端的距离和两侧肋弓下缘到髂嵴上缘的距离,部分尚进行胸腰椎摄片、骨密度检测,将结果进行统计学分析。结果老年骨质疏松患者和正常人的胸骨下端到耻骨联合上端的距离和两侧肋弓下缘到髂嵴上缘的距离有明显差异(P<0.05)。结论老年人的身高缩短与骨质疏松性椎体骨折及相应的脊柱畸形有关,可通过测量体表骨性标志之间的距离,为骨质疏松症及椎体脆性骨折的早期筛查及诊断提供依据。     

Therapeutic procedures in the middle lobe syndrome

From study of the case records of 113 patients with isolated affection of the middle lobe or lingular segments of the left lung the authors believe that nonspecific inflammatory diseases of the lungs are the most frequent cause of the development of the syndrome. Tomography and bronchography of the involved lung play the principal role in the diagnosis of the middle-lung syndrome. The etiological factor is verified by the findings of tracheobronchoscopy. The authors consider surgery to be the main method of treatment of the middle-lobe syndrome or syndrome of the lingular segments.     

Effect of plate position relative to bending direction on the rigidity of a plate osteosynthesis. A theoretical analysis

Mechanical unloading of the plated bone segment is observed after plate osteosynthesis because the implant takes over a part of the physiological loading. Strain reduction in the bony tissue depends on the rigidity of the plate (cross-sectional area, geometrical form, and modulus of elasticity). The aim of the present study was to calculate theoretically the effect of plate position relative to bending direction on the overall bending stiffness of the composite system plate-bone. To calculate the rigidity, a cylindrical bone model with mechanical characteristics similar to a sheep tibia and a rectangular plate cross-section corresponding to a DC-plate with either a modulus of elasticity of steel or titanium was used. Calculations under different bending directions were performed according to the laws of the linear bending theory and the composite beam theory. The bending stiffness of a plate osteosynthesis reaches a minimum and a maximum respectively, in cases in which the bending moment acts in the direction of the main axis of the area moment of inertia of the plate. The minimum is present with the plate bent vertically, the maximum with the plate bent horizontally, e.g. on the tension side of the composite system--on the assumption that the bone structure opposite the plate is capable of withstanding compressive loading. For steel and titanium plates, factors of 2 and 2.25 respectively were calculated between the minimum and the maximum bending stiffnesses of the osteosynthesis. The bending rigidity of the plate alone has only a minimal effect on the total stiffness of the osteosynthesis. With a plate bent vertically, the difference between steel and titanium plates was 18%, with the plate bent horizontally (situated on the tension side), it was only 7%. The bending stiffness of a plate osteosynthesis depends on the cross-section, the geometrical form, and the modulus of elasticity of the plate, as well as on the plate position relative to the bending direction of the composite system. The modulus of elasticity of the plate is relatively unimportant, while with a given plate the individual plate position relative to the bending direction is of crucial importance. Thus, changing the modulus of elasticity of the plate cannot solve the problem of implant induced unloading of the bone cortex because the bending stiffness of the composite system depends much more on the plate position relative to the bending direction.     

Pathogenesis and early conservative combined treatment in the initial stages of osteochondropathy of the femur head in children

The investigations carried out by the author have revealed that the basis of osteochondropathy of the femoral head in children are neurodystrophic changes caused by disadaptation of vegetotrophic provision of the hip joint area and of the lower extremities on the ground of dysembryogenesis. The predisposing factor for the development of the pathological process may be anatomical and functional immaturity of the vascular net of the joint connected with age. It is advisable to carry on the treatment at the initial stages of Perthes' disease taking into consideration the pathogenetic mechanisms. Improvement in the blood supply of the hip joints is achieved by drug action on the vegetative ganglia of the lumbosacral section of the spine, by an increase in the level of microcirculation in the joint tissues and by local influence on the vascular net of the area by means of physical factors. Early pathogenetic conservative complex treatment of Perthes' disease allows to obtain positive results in most cases (87.4%). In cases of unsuccessful conservative treatment at the initial stages of the disease surgical treatment is advisable for prevention of possible complications, such as deformation of the femoral head and disturbances in the spatial location of the femoral neck. The operation of choice in this case may be plasty of the femoral neck by an osseous autograft on the feeding muscular pedicle.     

Pathogenetic aspects of decompression interventions in complicated injuries of the spine

The paper is based on the analysis of the results of clinical, pathophysiological and roentgenological examinations and on the data of surgical verification of the causes of neurologic deficiency in 163 patients. Proceeding from the condition that the principal operations in cases of complicated fractures of the spine are decompression and stabilization interventions, the authors have elaborated a system of such interventions and stated the main principles of choice of the methods of decompression. In particular they have proposed the following extents of decompression interventions: decompression of the contents of the vertebral canal, decompression of the contents of the dural sac and intratrunk decompression of the spinal cord. The methods of decompression interventions may be correction, correction and stabilization, resection and resection and stabilization. The proposed scheme allows to eliminate the existing terminological discord and provides for objective evaluation of the efficiency of the intervention.     

The surgical treatment of degenerative-dystrophic diseases of the hip joint

An analysis of long-term results of surgical treatment of 609 patients with degenerative-dystrophic diseases of the hip-joint was made. Choice of the optimum methods of surgical treatment of such patients must be based on the prognosis of effectiveness of the operative intervention taking into account general regularities associated with the degree of the arthrosis alterations, dyscongruence of the articulation surfaces and duration of the disease, the degree of disturbances of the femur head blood supply, the disturbed supporting ability and severity of the trauma. When choosing the method of surgical treatment of young patients with coxarthrosis the operative interventions aimed at saving the hip joint should be considered.     

Reconstructive surgery of the esophagus in patients with combined chemical burns of the esophagus and stomach

The article generalizes the experience in the treatment of 317 patients with burns of the esophagus and stomach, 140 of them underwent restorative operations on the esophagus. The indications for the choice of the restorative operations are determined by the character of the burn and the condition of the patient's organism before the accident. Retrosternal plastics of the esophagus with the colon is the operation of choice in this group of patients. The elaboration of rational therapeutic tactics, improvement of preoperative management, and the introduction of effective methods of treatment into practice with the use of microsurgical and laser techniques improved considerably the results of restorative operations on the esophagus in patients with combined burn pathology.     

Radiographic Assessment of Fibular Length Variance: The Case for “Fibula Minus”

Given the high prevalence of ankle fractures and morbidity of malalignment after fixation, an appropriate anatomic relationship between the distal fibula and adjacent tibia and talus is important. The tip of the lateral malleolus of the fibula has often been described to be at the level of the lateral talar process. However, no studies to date have examined the relationship of the distal fibular tip to the lateral process of the talus. We assessed 66 weightbearing mortise radiographs for variability of the distal fibular tip in relation to the lateral process of the talus. The subjects were all skeletally mature, with a mean age of 45.3 ± 14.6 years. We used a paired t test with a null hypothesis that the true mean difference in the distance from the distal fibula to the lateral process was equal to 0. The mean distance of the distal tip of the fibula was 0.257?± 0.127 cm proximal to the tip of the lateral process of the talus. The 95% confidence interval was 0.226 to 0.288. Of the 66 subjects, 65 had the distal tip of the fibula proximal to the lateral process of the talus, corresponding to a negative fibular variance. In the remaining subject, the distal tip of the fibula was at the same level of the tip as the lateral process of the talus. The distal tip of the fibula is most commonly not at the level of the talus lateral process, as often described in published reports. Instead, it has a variance analogous to the relationship between the lengths of the ulna compared with the radius. The distal tip of the fibula in our study was more often proximal to the tip of the lateral process of the talus and can be described as a negative fibular variance, or “fibula minus.”