髂胫束综合征的临床诊治研究进展

髂胫束综合征作为运动员好发疾病之一已受到日益关注,其诊断主要通过临床症状、查体及MRI确诊,但尚无统一的诊断标准。而髂胫束综合征的发病机制多被认为与压力及摩擦因素有关。治疗上,国内外都公认以手法、肌肉锻炼、药物及理疗等保守方法为主均能达到预期疗效;对于保守失败、顽固性ITBS患者,可采用关节镜、髂胫束松解等手术方式,保守以局部药物注射联合肌肉锻炼可起到很好的疼痛管理,临床上多为采用。此外关节镜作为目前较为先进的手术方式,适用于各类患者群,无绝对禁忌证,对患者早期活动有很大帮助。目前其发病机制尚有较大争论,且临床上对其各种治法的具体适应证也无明显界限,需进一步规范。     

髂胫束挛缩症

髂胫束挛缩症常伴有下肢和躯干畸形,严重影响患者功能。我院从1978～1986年收治髂胫束挛缩症42例,其中儿麻后遗症39例。慢性化脓性髂骨骨髓炎3例。 作者根据髂胫束挛缩程度分轻、中、重三种,根据三种程度采用不同治疗方法。轻和中度挛缩用软组织松解和骨骼牵引治疗,重度挛缩再辅以股骨粗隆间截骨术。     

小切口髂胫束松解术治疗外侧型弹响髋

目的探讨小切口髂胫束松解微创外科治疗外侧型弹响髋的可行性。方法回顾性分析本院2008-11—2012-07采用小切口髂胫束松解术治疗12例外侧型弹响髋,对临床病例进行对比研究,评估手术及切口愈合时间、症状改善程度等指标。结果 12例患双侧病变,手术前11例不能并膝下蹲,另1例重症患者分膝也不能下蹲。手术后当天所有患者弹响消失,完全下蹲。手术后平均住院时间2.5 d,无切口血肿、神经损伤等并发症。结论小切口髂胫束松解术软组织微创外科治疗外侧型弹响髋,是一种安全、有效、美观、经济的术式。     

暂时性体外胫后动脉旁路治疗髂股动脉损伤

目的：报道暂时性体外胫后动脉旁路治疗髂股动脉损伤的手术方法及临床疗效。方法1993年2月—2013年2月,设计并采用暂时性体外胫后动脉旁路术,治疗钝性髂股动脉闭合伤,伴Ⅲ～Ⅳ级失血性休克患者104例。双下肢胫后动脉行端端吻合,术后（30＆#177;10） d再行髂股动脉重建,7 d后分离血管旁路。结果本组患者伤肢均成活,体外旁路术均获得成功。术后平均随访（48＆#177;2.7）个月,所有患者双下肢肌力均为5级,静态两点辨别觉测试得分双足基本等同。结论采用胫后动脉暂时性体外旁路术治疗髂股动脉损伤合并严重失血性休克,能快速恢复下肢远端血供,手术风险较低,手术时间短,失血量少,为后期修复髂股动脉创造有利条件。     

864例代股四头肌手术的远期疗效与并发症

本文报告作者从1959～1985年对864例小儿麻痹后遗症股四头肌瘫痪病例,采用6种手术方法重建股四头肌肌力的远期疗效,并讨论了各种手术并发症的发生原因、预防方法和代股四头肌术中利用髂胫束的优点及手术注意事项。     

关节镜下髂胫束松解术治疗外侧型弹响髋

弹响髋常分为三种类型：外侧型，内侧型和关节内型。外侧型弹响髋最多见，其常规手术方法包括：髂胫束椭圆形切除术，“十”字形切开术，“Z”形髂胫束延长术，而以后者最为普及和有效，但其具有创伤较大，康复慢的缺点。关节镜下髂胫束松解术治疗外侧侧型弹响髋具有创伤小，康复快的优点。我院自2001年9月-2002年8月，共收治外侧型弹响髋患者11例21髋，均采用关节镜下髌胫束松解术治疗，疗效满意。     

改良腹直肌—髂胫束代股四头肌20例疗效分析

我院自1983年6月以来采用改进的腹直肌—髂胫束转移术治疗儿麻后遗股四头肌瘫20例,经随访疗效满意,报告如下。手术方法硬膜外麻醉。先在股外侧分段纵行切开皮肤、皮下组织2～3处。游离出髂胫束并在远端止点处切断,保留近端起点。将髂胫束     

介入联合手术治疗Cockett综合征合并股青肿

目的探讨采用手术联合介入方法治疗Cockett综合征合并股青肿的疗效。方法对2005—2010年采取介入联合手术处理的5例Cockett综合征合并股青肿患者的临床资料进行回顾性分析。结果 5例患者均有典型股青肿表现,其足背动脉、胫后动脉搏动均消失,术前多普勒均提示左下肢深静脉无血流,术中DSA均提示左髂静脉受压狭窄,证实为Cockett综合征。5例患者均行下腔静脉滤器植入,股静脉切开取栓,左髂静脉球囊扩张,其中1例行支架植入,术后均给予抗凝、溶栓治疗。术后患者均恢复满意,足背动脉搏动恢复,下肢肿胀缓解,随访3个月至5年未见血栓复发及其他并发症。结论采用介入联合手术治疗Cockett综合征合并股青肿疗效确切,效果好。     

髂静脉压迫综合征的研究进展

髂静脉压迫综合征是导致下肢静脉高压的重要因素,常表现为下肢静脉曲张、下肢深静脉血栓形成。随着医学诊断技术及认识的提高,越来越多的髂静脉压迫患者被识别。目前关于髂静脉压迫综合征合并有下肢静脉曲张或下肢深静脉血栓形成的治疗,存在一定分歧。笔者对髂静脉压迫综合征的新认识、诊断方法及治疗进展进行综述。     

小针刀松解联合康复训练治疗髂胫束挛缩症

目的观察小针刀松解联合康复训练治疗髂胫束挛缩症的临床疗效。方法回顾性分析自2015-01—2019-12诊治的72例髂胫束挛缩症,37例采用小针刀松解联合康复训练治疗(观察组),35例单纯康复训练治疗(对照组)。治疗后对所有患者进行随访,随访6个月后进行疗效评定,观察指标包括疼痛VAS评分、髋关节活动度(屈曲活动度、内收活动度)、臀肌挛缩症功能量化评分。结果 72例均获得至少6个月随访,治疗期间未出现晕针、断针、血肿、感染、神经损伤、皮肤感觉异常改变、髋外侧肌群无力等并发症。观察组治疗后6个月疼痛VAS评分低于对照组,治疗后6个月臀肌挛缩症功能量化评分高于对照组,治疗后6个月髋关节屈曲活动度、髋关节内收活动度高于对照组,差异有统计学意义(P0.05)。结论小针刀松解联合康复训练治疗髂胫束挛缩症可有效改善下肢功能、缓解疼痛、提高患者生活质量,是一种易操作、微创、经济、有效的治疗方法。     

The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty

STUDY DESIGN: Case report. BACKGROUND: Long-term deficits in quadriceps femoris muscle strength and impaired muscle activation are common among individuals with total knee arthroplasty (TKA). Failure to address strength-related impairments results in poor surgical and functional outcomes, which may accelerate the progression of osteoarthritis in other lower extremity joints. The purpose of the current case report was to implement a neuromuscular electrical stimulation (NMES) treatment protocol in conjunction with an intense weight-training program, with the aim of reversing persistent quadriceps muscle impairments after TKA. CASE DESCRIPTION: The patient was a 62-year-old male cyclist 12 months following simultaneous, bilateral TKA with impairments in left quadriceps strength and volitional muscle activation. His left quadriceps strength was 26% weaker than his right and central activation ratio (CAR) of his left quadriceps was 13% lower than his right quadriceps CAR. NMES to the left quadriceps was implemented for 6 weeks, in addition to an intense volitional weight-training program with emphasis on unilateral lower extremity exercises. OUTCOMES: The patient demonstrated a 25% improvement in left quadriceps femoris maximal volitional force output following 16 treatments of combined NMES and volitional strength training over a 6-week period. The patient's volitional muscle activation improved from a CAR of 0.83 before treatment to 0.97 after treatment. At discharge from physical therapy and at his 18-month postoperative follow-up, the patient's left quadriceps strength was only 4% lower than his right quadriceps strength. At the 24-month follow-up, the patient's left quadriceps strength was 6% stronger than his right quadriceps strength. DISCUSSION: The patient was able to achieve symmetrical quadriceps strength and complete muscle activation following 6 weeks of NMES and volitional strength training. An intense strengthening program may have the potential to reverse persistent strength-related impairments following TKA.     

骨质疏松性骨折与非骨质疏松性骨折患者肌肉病理状态及组蛋白甲基化的差异

目的 评估骨质疏松性骨折（osteoporotic fracture,OPF）患者与非OPF患者肌肉病理状态及组蛋白甲基化情况的差异。方法 从上海中医药大学附属龙华医院骨伤科随机收取6例符合纳入标准的OPF和非OPF患者,手术内固定时取骨折部位肌肉,进行HE染色、MASSON染色、免疫组化染色及RT-qPCR检测,评估OPF患者和非OPF患者的肌肉病理状态差异和组蛋白甲基化情况。结果 HE染色显示OPF患者肌肉与非OPF患者肌肉相比,肌肉松弛现象比较明显,而非OPF患者肌肉较紧实。MASSON染色显示OPF患者肌肉与非OPF患者肌肉相比,肌肉胶原纤维分布更多。骨折断端肌肉RT-qPCR显示OPF患者较非OPF患者SUV39H1基因相对表达量增高。骨折断端肌肉免疫组化显示OPF患者较非OPF患者肌肉H3K9Ac乙酰化程度低,肌肉H3K9me3甲基化程度高。结论 骨质疏松性骨折患者肌肉更加松弛,胶原纤维含量增高,而这可能是由于肌肉组蛋白甲基化程度升高,乙酰化降低造成的。     

急性大面积肺栓塞合并下肢深静脉血栓介入治疗的临床疗效评价

目的评价介入治疗急性大面积肺栓塞合并下肢深静脉血栓的临床疗效。方法选取本院收治的急性大面积肺栓塞合并下肢深静脉血栓患者30例。依就诊先后顺序随机分为两组。14例在下腔静脉滤器植入后采取导管祛栓联合管溶栓的患者为祛栓组,16例在下腔静脉滤器植入后采取全身静脉溶栓的患者为对照组,观察临床症状、体征、血流动力学改变、血管开通以及并发症情况。结果所有患者临床症状均明显缓解。术后1天祛栓组氧饱和度、动脉血氧分压和休克指数与对照组比较改善明显(P0.01)。术后7天祛栓组健、患肢周径差,静脉通畅度评分和Miller评分与对照组比较显著降低(P0.01)。祛栓组的显效率明显高于对照组(P0.05),无严重手术并发症发生。结论介入治疗急性大面积肺栓塞合并下肢深静脉血栓是一种安全有效的方法。     

Treatment of Early and Delayed Esophageal Perforation

Esophageal perforations are life threatening emergencies associated with high morbidity and mortality. We report on 22 consecutive patients (age 20–86; 13 female and 9 male) with an oesophageal perforation treated at the university hospital Duesseldorf. The patients' charts were reviewed and follow-up was completed for all patients until demission, healed reconstruction or death. Patients' history, clinical presentation, time interval to surgical presentation, and treatment modality were recorded and correlated with patients' outcome. Six esophageal perforations were due to a Boerhaave-syndrome, eleven caused by endoscopic perforation, two after osteosynthesis of the cervical spine and three foreign body induced. In 7 patients a primary local suture was performed, in 4 cases a supplemental muscle flap was interposed, and 7 patients underwent an oesophageal resection. Four patients were treated without surgery (three esophageal stent implantations, one conservative treatment). Eleven patients (50 %) were presented within 24 h of perforation, and 11 patients (50 %) afterwards. Time delay correlates with survival. In 17 (80.9 %) cases a surgical sufficient reconstruction could be achieved. One (4.7 %) patient is waiting for reconstruction after esophagectomy. Four (18.2 %) patients died. A small subset of patients can be treated conservatively by stenting of the Esophagus, if the patient presents early. In the majority of patients a primary repair (muscle flap etc.) can be performed with good prognosis. If the patient presents delayed with extensive necrosis or mediastinitis, oesophagectomy and secondary repair is the only treatment option with high mortality.     

脊柱转移瘤分离手术联合立体定向放疗的研究进展

随着癌症治疗水平的不断提升,脊柱转移瘤患者的生存期得到显著延长。当前脊柱转移瘤的治疗呈现多模式趋势,临床采用的手术方式包括椎体肿瘤切除椎管减压重建内固定术、分离手术、微创手术和经皮消融技术等,放疗技术包括传统外照射治疗、立体定向放疗和近距离放疗等。椎体肿瘤切除椎管减压重建内固定术的手术风险较大,术中和术后并发症的发生率较高,术后恢复期的延长可能造成后续放疗和其他内科治疗的延误,对患者的生存期和治疗信心都造成严重影响。而传统外照射治疗的精准度不高,脊髓耐受性的限制使得放疗剂量常难以达到控制放疗不敏感肿瘤的目的。随着放疗和手术技术的发展,精准性更高的立体定向放疗和手术创伤更小的分离手术脱颖而出,成为目前临床医生关注的焦点。本文就分离手术联合立体定向放疗的Hybrid治疗的研究进展作一综述。     

偏瘫侧股骨颈骨折关节置换手术的研究进展

随着我国进入老龄化社会,脑血管意外遗留偏瘫的患者也逐渐增多,而这类患者发病后第1年内髋部骨折的风险比普通人高4倍且多发生在偏瘫侧。对于老年性股骨颈骨折,人工关节置换术几乎是首选治疗方案,手术技术成熟且有很好的疗效。目前认为,脑血管意外后遗留偏瘫的患者在发生偏瘫侧股骨颈骨折后,偏瘫侧肌力如能达到Ⅲ级,则可首选髋关节置换手术治疗。但是手术中偏瘫患者的情况较常人不同,其偏瘫侧肢体可能存在肌肉萎缩、肌力失衡、骨质疏松等问题,为手术方案的制定带来了困难。本文主要针对手术入路的选择问题、使用全髋关节置换还是半髋、使用骨水泥型假体还是非骨水泥型假体以及如何降低术后脱位的发生率这几方面进行讨论,其中针对术后脱位的问题又从假体选择、软组织技术、下肢长度及偏心距的恢复以及髋臼杯外展角几方面出发进行了分析,目的是为骨科医生在临床决策中提供更多的参考证据。     

脊柱转移性肿瘤外科治疗相关问题探讨

以外科为主导的多学科综合治疗模式已成为脊柱转移性肿瘤治疗的综合策略和整体观念,但脊柱转移性肿瘤的手术治疗不同于脊柱原发恶性肿瘤,手术只是多学科综合治疗模式当中的一个环节。因此,脊柱转移性肿瘤的外科治疗策略应首先立足于患者的生存评估,综合评估转移瘤的脊柱稳定性破坏、脊髓神经功能障碍、肿瘤生物学特点,制定适度的外科手术干预级别。应重视脊柱转移性肿瘤的微创治疗,结合放疗新技术、新辅助化疗、靶向治疗等内科治疗的进展,制定个体化、阶梯化的综合治疗模式,以缓解患者疼痛、重建脊柱稳定、避免瘫痪。在改善患者生存、增加局部肿瘤控制率和可能提高生存时间的同时,尽可能避免过度手术。     

Effects of low level laser therapy (808 nm) on physical strength training in humans

Recent studies have investigated whether low level laser therapy (LLLT) can optimize human muscle performance in physical exercise. This study tested the effect of LLLT on muscle performance in physical strength training in humans compared with strength training only. The study involved 36 men (20.8±2.2 years old), clinically healthy, with a beginner and/or moderate physical activity training pattern. The subjects were randomly distributed into three groups: TLG (training with LLLT), TG (training only) and CG (control). The training for TG and TLG subjects involved the leg-press exercise with a load equal to 80% of one repetition maximum (1RM) in the leg-press test over 12 consecutive weeks. The LLLT was applied to the quadriceps muscle of both lower limbs of the TLG subjects immediately after the end of each training session. Using an infrared laser device (808 nm) with six diodes of 60 mW each a total energy of 50.4 J of LLLT was administered over 140 s. Muscle strength was assessed using the 1RM leg-press test and the isokinetic dynamometer test. The muscle volume of the thigh of the dominant limb was assessed by thigh perimetry. The TLG subjects showed an increase of 55% in the 1RM leg-press test, which was significantly higher than the increases in the TG subjects (26%, P = 0.033) and in the CG subjects (0.27%, P < 0.001). The TLG was the only group to show an increase in muscle performance in the isokinetic dynamometry test compared with baseline. The increases in thigh perimeter in the TLG subjects and TG subjects were not significantly different (4.52% and 2.75%, respectively; P = 0.775). Strength training associated with LLLT can increase muscle performance compared with strength training only.     

Surgical Management of Idiopathic Ulcerative Calcinosis Cutis in the Lower Extremity: A Case Report

The purpose of this case study is to describe the surgical treatment of idiopathic ulcerative cutaneous calcinosis or calcinosis cutis of the lower extremity. A 77-year-old Latin American female who reported no significant past medical history presented to our hospital's emergency department from her home complaining of worsening right lower extremity erythema, edema, increased temperature, and pain. It was noted that the patient presented with multiple cutaneous calcified nodules to bilateral lower extremities, which she stated has been present for approximately 40 years. At the time of evaluation, 1 of the nodules on the lateral aspect of the right lower extremity ulcerated and became infected with unknown etiology, which lead to cellulitis of this limb. Radiographic imaging studies of the bilateral lower extremities showed extensive sheetlike soft tissue calcification overlying the middle to distal lower extremities. Serology reports showed the patient was positive for rheumatoid factor, antinuclear antibodies, SS-A/Ro antibody, and SS-B/La antibody. Because of the evidence of frank purulence and cellulitic changes to the infected nodule, the patient was taken to surgery the following day for sharp debridement and biopsy of the site. Postoperatively, there were minimal signs of improved healing to the wound base, although there was evidence of decreased erythema and edema to the extremity after the initial debridement and biopsy. Four days after the initial surgical invention, the patient was taken for a second operative procedure, which included a wide excisional biopsy with application of acellular dermal matrix and negative-pressure therapy. It was during this secondary debridement that further calcified deposits were encountered and specimens were submitted to pathology. Pathologic examination diagnosed the submitted specimen as cutaneous calcinosis. At this time, the patient is currently undergoing local wound care of the soft tissue deficient to her right lower extremity with the assistance of negative-pressure wound therapy with biweekly clinical follow-up.