石蜡疗法治疗肩周炎的疗效观察与护理

肩周炎是肩周肌肉、肌腱等软组织的慢性炎症，加上反复的细微损伤和肩部活动的减少引起。其特点是起病缓慢，肩部疼痛进行性加重，伴功能活动受限。2004年1月至2004年6月，我科用石蜡疗法配合功能锻炼治疗肩周炎，疗效显著，现报告如下。     

软组织牵伸配合物理因子改善第3磨牙拔除后的张口受限及下颌功能

背景:第3磨牙拔除过程可能引起周围软组织不同程度的损伤。由于超声波和超短波均属于热疗的范围,可以使组织温度升高,有助于提高软组织牵伸的治疗效果。目的:比较软组织牵伸配合超声波、超短波改善第3磨牙拔除后张口受限及疼痛的效果。方法:选取确诊为第3磨牙拔除术后致颌面部疼痛和张口受限的患者16例,采用随机数字表法分为牵伸组与对照组,每组各8例。牵伸组患者接受超声波和超短波治疗后联合软组织牵伸;对照组仅进行超短波和超声波治疗。治疗1次/d,5次/周,连续治疗2周。结果与结论:经治疗后两组患者最大主动张口度均增大,疼痛明显减轻,颞下颌关节的功能显著提高;牵伸组张口度的改善显著优于对照组,颞下颌关节功能的提高显著优于对照组。结果说明超声和超短波治疗均能改善拔牙术后患者张口受限及疼痛症状,提高下颌功能状态;配合软组织牵伸治疗效果更好。     

Q角测量评估膝关节软组织平衡和骨性手术治疗习惯性髌骨脱位的疗效

背景：手术治疗习惯性髌骨脱位可通过平衡髌骨内外侧软组织,改善Q角,达到纠正髌骨脱位。 目的：探讨Q 角测量评估膝关节软组织平衡和骨性手术治疗习惯性髌骨脱位的疗效。 方法：治疗前常规测量18例习惯性髌骨脱位患者Q角,按Q角分为两组：<16°组,行膝关节外侧关节囊松解、内侧关节囊紧缩;>16°组,行膝关节外侧关节囊松解、内侧关节囊紧缩+髌韧带止点内移或膝关节外侧关节囊松解、内侧关节囊紧缩+髌韧带止点内移和股内外侧肌止点位移。 结果与结论：两组术后Q角明显低于术前,术后膝关节评分明显高于术前(P < 0.001),两组间比较差异无显著性意义(P > 0.05)。Q 角测量评估显示平衡膝关节软组织和骨性手术治疗习惯性髌骨脱位具有疗效明确,并发症少,功能恢复好的优点。     

肩锁关节脱位研究：如何达到解剖复位和持续性稳定及关节微动

文题释义： 肩锁关节脱位：肩锁关节是由锁骨远端和肩峰外侧缘向内2.0-3.0 cm部分组成的微动关节,是肩胛骨活动的支点。由于肩锁关节位于皮下,易被看出局部高起,双侧对比较明显,可有局部疼痛、肿胀及压痛;伤肢外展或上举均较困难,前屈和后伸运动亦受限,局部疼痛加剧,检查时肩锁关节处可摸到一个凹陷,可摸到肩锁关节松动。 肩锁关节脱位分型：最常用的是Rockwood分型系统,其将肩锁关节脱位分为6型,其中Ⅰ、Ⅱ型多采用保守治疗,Ⅳ-Ⅵ型多采用手术治疗,Ⅲ型的治疗尚存争议。 背景：肩锁关节脱位的治疗方式繁多,尚无统一标准,其治疗效果受损伤机制、脱位类型、治疗方式的选择及术后锻炼等多方面影响。 目的：归纳总结目前肩锁关节脱位的研究进展。 方法：由第一作者用计算机检索PubMed数据库(2010至2019年),万方数据库(2010至2019年),以“Acromioclavicular;Dislocation;Diagnosis;Therapy; Anatomical reconstruction ;Endobutton;Internal Fixators”为英文检索词,“肩锁关节;脱位;诊断;治疗;解剖重建;Endobutton;骨科植入物”为中文检索词,排除重复性研究,共检索到2 187篇文献,最后保留55篇文献进行归纳总结 结果与结论：目前对于Rockwood Ⅰ、Ⅱ型肩锁关节脱位多采取保守治疗,Ⅳ-Ⅵ型多采取手术治疗,Ⅲ型的治疗尚存争议,为了最大限度地发挥功能,建议年轻和对功能要求高的患者采取积极手术治疗。目前,非手术治疗以吊带固定为主,手术治疗越来越趋向于微创解剖重建喙锁韧带,如关节镜辅助下Endobutton技术,虽能获得良好的短期疗效,但尚需大样本长期随访研究证实其在临床应用中的价值。肩锁关节脱位的治疗仍需进一步的研究,期望寻找一种既能解剖复位,获得持续性稳定,又能保证肩锁关节微动的治疗方法。 ORCID: 0000-0002-6856-190X(房燚) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

肩关节后脱位2例漏诊原因分析

例1,患者女,30岁。2012年5月25日因车祸摔伤致左肩部疼痛伴活动受限1周入我院就诊,拟诊左肩部软组织损伤收住急诊科。患者入院后请骨科会诊,行左肩X线平片检查未见异常。诊断为左肩部软组织损伤。给予消肿、镇痛治疗。治疗1周后,疼痛减轻,但左肩关节不能外旋、外展及后伸,活动轻度受限。再次请骨科会诊,行左肩关节CT及3D重建检查示：左肩关节后脱位（肩峰下型）。查体：右肩部稍肿胀,皮肤青紫伴淤血。关节囊无空虚, Dugas征（-）。左肩关节活动度：屈100°,伸25°,外旋0°,外展80°,内旋40°。患者转入骨科,于伤后2周在臂丛、静脉复合麻醉下闭合复位取得成功。术后石膏外固定4周后,行康复训练。患者出院后随访6个月,肩关节活动时无疼痛,复查X线片未见创伤性关节炎改变。按美国加州大学肩关节评分系统评分30分。见图1。     

急性闭合性软组织运动损伤的临床治疗研究进展

急性闭合性软组织运动损伤在体育运动中很常见,可能会引起关节、韧带、软组织撕裂等损伤。损伤发生后处理不恰当,会引起患者运动功能障碍,降低患者生活质量。现对闭合性软组织运动损伤的治疗方法进行综述,以期对闭合性软组织运动损伤的治疗有一个全面的认识,为临床闭合性软组织损伤的治疗提供一定的参考。     

《局解手术学杂志》简介

肩周炎又称肩关节周围炎，主要临床特征为肩臂疼痛和活动受限，肩周炎周围肌肉、肌腱、韧带和滑囊等软组织的慢性无菌性炎症，是临床上常见病多发病。肩周炎属于一种自限性疾病，病程6个月～3年，病痛难熬。现介绍一种既经济又方便的家庭新型运动疗法辅助治疗肩周炎。     

运动防治膝骨关节炎的关键因素及注意事项

文题释义： 运动疗法：是指利用器械、徒手或患者自身力量,通过某些运动方式(主动或被动运动等),使患者获得全身或局部运动功能、感觉功能恢复的训练方法。运动疗法主要采用“运动”这一机械性的物理因子对患者进行治疗,着重进行躯干、四肢的运动、感觉、平衡等功能的训练,包括：关节功能训练、肌力训练、有氧训练、平衡训练、易化训练、移乘训练、步行训练。 骨关节炎：为一种退行性病变,系由于增龄、肥胖、劳损、创伤、关节先天性异常、关节畸形等诸多因素引起的关节软骨退化损伤、关节边缘和软骨下骨反应性增生,又称骨关节病、退行性关节炎、老年性关节炎、肥大性关节炎等。临床表现为缓慢发展的关节疼痛、压痛、僵硬、关节肿胀、活动受限和关节畸形等。 背景：目前膝骨关节炎的治疗以缓解症状为主,真正根治较难。运动疗法是为了达到一些特定的治疗目标而专门设计和规范的体育活动计划,旨在恢复正常的肌肉骨骼功能和减少疾病或身体损伤引起的疼痛。有关运动疗法防治膝骨关节炎存在不同观点。 目的：探讨影响运动疗法防治膝骨关节炎疗效中的关键因素及注意事项,为运动疗法防治膝骨关节炎提供一定参考依据。 方法：应用计算机检索至2019年1月PubMed数据库、中国期刊全文数据库相关文章,英文检索词为：“exercise therapy,knee osteoarthritis,prevention and treatment”;中文检索词为：“运动疗法,膝骨关节炎,防治”。根据纳入排除标准,对检索到的关于运动疗法对膝骨关节炎作用的相关文献进行分析。 结果与结论：①运动疗法应尽早介入,早期需注意各部损伤时膝关节的角度问题,需逐渐增加活动度及强度,可以从非负重训练开始到后期训练可以负重;②运动疗法的强度应以中小强度为主,避免过度训练,特别是对于软骨磨损的患者。 ORCID: 0000-0002-1708-5181(宋校能) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

新型运动疗法辅助家庭治疗肩周炎

肩周炎又称肩关节周围炎,主要临床特征为肩臂疼痛和活动受限,肩周炎周围肌肉、肌腱、韧带和滑囊等软组织的慢性无菌性炎症,是临床上常见病多发病。肩周炎属于一种自限性疾病,病程6个月~3年,病痛难熬。现介绍一种既经济又方便的家庭新型运动疗法辅助治疗肩周炎。1临床资料本组16     

生物力学在软组织修复中的应用

<正>软组织损伤是指由于肌肉、肌腱、筋膜和韧带等承受超负荷活动引起不同程度的纤维断裂或由于积累性损伤或由于软组织无菌性炎症所导致的一系列临床症状,主要表现为疼痛、肿胀和局部活动障碍。随着机械化程度和生活水平的迅速提高,因交通事故和运动等原因造成的软组织损伤发生率明显增多。同时由于致     

三黄破瘀散外敷治疗创伤性软组织肿痛的疗效观察

目的观察三黄破瘀散外敷治疗创伤性软组织肿痛的临床疗效。方法临床选择286例创伤性软组织肿痛患者,根据初诊日单双数分为两组,治疗组150例,对照组136例,两组患者局部冷敷后,治疗组采用三黄破瘀散外敷,对照组采用周林频谱仪治疗,观察两组疼痛和肿胀的改善情况。结果治疗组用药后12h、24h、36h、48h疼痛及肿胀改善程度与对照组比较,差异均有统计学意义（P〈0．05）。结论三黄破瘀散外敷对创伤性软组织肿痛有较好的消肿、止痛作用。     

Fine-needle aspiration cytology of soft tissue lesions: diagnostic challenges

Clinical and radiographic data provide important information in the evaluation of soft tissue lesions/neoplasms. Morphologic tissue and cytologic examination is considered to be a necessary part of the diagnostic work-up. The standard procedure for obtaining tumor tissue for morphologic evaluation has been incisional (open) or core needle biopsy. An increasing use of minimally invasive diagnostic procedures has resulted in better acceptance of fine-needle aspiration cytology (FNAC) in the diagnosis of soft tissue lesions. This article discusses challenges in FNAC of soft tissue lesions based on the experience at a multidisciplinary referral sarcoma center. Obtaining sufficient specimens from deeply seated small and necrotic/cystic lesions is technically a potential pitfall and misdiagnosis of cells from reactive zones surrounding the tumor as well as the correct evaluation of spindle cell lesions, rare soft tissue neoplasms, and "new entities" lacking reproducible cytological criteria are other important challenges in FNAC of soft tissues. The successful cytological evaluation of soft tissue lesions requires the application of strict, reproducible morphological criteria in the context of the clinical findings as well as ancillary techniques. The minimal criteria for diagnostic intervention in various clinical settings and the relative advantages and disadvantages of FNAC must be understood. FNAC of soft tissue lesions is facilitated when limited to specialized orthopedic-oncologic centers with a well-integrated multidisciplinary team and experience in the evaluation and therapy of soft tissue lesions.     

不同软组织移植治疗儿童复发性髌骨脱位的比较

背景：成人复发性髌骨脱位由于不必考虑损伤骨骺的问题,多数采用骨移植,但在儿童复发性髌骨脱位采用骨移植并不适宜,多数学者采用软组织移植治疗。 目的：回顾性评估22例骨骺未闭儿童复发性髌骨脱位患者采用软组织移植治疗的临床效果。 方法：回顾性分析2006年5月至2009年4月上海长征医院关节外科采用软组织移植治疗儿童复发性髌骨脱位患者22例共29膝,分别在移植后3周,6周,3个月,1年和此后每年对患者进行随访,评估髌骨稳定性、主观症状以及患膝康复情况。 结果与结论：22例患者中1例复发,1例发生髌骨内侧脱位,其余患者均取得较好疗效。软组织移植前后膝关节功能主观评分分别为46.99±5.91与94.40±9.70 (P < 0.01),Lysholm膝关节功能综合评分在移植前后分别为44.37±4.49与90.10±11.00 (P < 0.01),移植后髌骨-滑车适配角由移植前(16.27±6.74)°改善为移植后(5.33±8.78)°(P < 0.01),髌股外侧角由移植前(-1.92±7.64)°改善为移植后(11.95±3.99)°(P < 0.01)。软组织移植治疗骨骺未闭儿童复发性髌骨脱位,简单易行、可操作性强、疗效确切,有利于缓解症状,改善膝关节功能。     

Practical morphological approach to the diagnosis and differential diagnosis of soft tissue sarcomas

Sarcomas have long been a source of diagnostic difficulty. This has been attributed to their rarity and to the tremendous overlap in their histological patterns. The problem is compounded by the fact that a number of other tumours may show sarcoma-like features. Despite the significant contribution of immunohistochemistry and lately of molecular genetics, in the field of soft tissue tumours, there still exist areas where reliable tumour markers or cytogenetic changes are lacking making conventional morphology the main avenue for diagnosis. In this review, a simple practical morphological approach to the diagnosis of the various soft tissue sarcomas is presented.     

The unsuspected soft tissue chondrosarcoma

Five cases of undifferentiated soft tissue sarcomas have been studied with particular reference to the identification of their mucosubstances. The use of alcian blue in solutions of magnesium chloride is described. It is suggested that undifferentiated soft tissue chondrosarcomas may be missed owing to inadequate investigation.     

Aeromonas sobria infection with severe soft tissue damage and segmental necrotizing gastroenteritis in a patient with alcoholic liver cirrhosis

A 49-year-old man, who had a 3-year history of liver dysfunction but had not been treated, was admitted to the hospital with a sudden onset of fever and generalized muscle pain. He subsequently developed generalized purpura with scattered hemorrhagic bullae of the skin and massive bloody stools. Aeromonas sobria was proven by culture of both blood and bullous fluid. In spite of the extensive treatment with antibiotics and other medications in the intensive care unit (ICU), the patient went into septic shock and died 2 days after admission. Pathological examination on autopsy revealed segmental necrotizing gastroenteritis with bacterial colonies and alcoholic liver cirrhosis, in addition to extensive severe soft tissue damage involving cellulitis and rhabdomyolysis and epidermolysis. Although the prognosis for Vibrio vulnificus infection with severe soft tissue damage in patients with liver cirrhosis, malignancy, diabetes mellitus or other pre-existing diseases is poor, the unfavorable progression of Aeromonas species, especially A. sobria infection is rare. This is thought to be the first report of an autopsied case.     

Immunohistochemistry in diagnosis of soft tissue tumours

Immunohistochemistry in soft tissue tumours, and especially sarcomas, is used to identify differentiation in the neoplastic cells. In some cases, specific antigens are expressed; however, an initial panel of antibodies is often required in order to establish the broad lineage, with a subsequent, more focused, panel to allow classification. Immunohistochemical evaluation must be employed with the clinical picture, the morphology, and, when necessary, other ancillary techniques such as molecular genetics and cytogenetics. Whereas some diagnoses are evident on morphology, many soft tissue neoplasms are seen microscopically as spindle cell, epithelioid cell, small round cell or pleomorphic tumours that need to be further characterized. This article reviews selected applications of immunohistochemistry in the diagnosis of each of the principal morphological groups, concentrating on areas of most use in daily practice.     

Myoepithelioma of soft tissue

A myoepithelioma occurred in the subcutaneous tissue of the right shoulder of a 28-year-old man. The well-demarcated nodular tumor (3. 0 x 2.8 cm) was located in the subcutaneous tissue with no adhesion to the deltoid muscle. The tumor was composed of a fascicular proliferation of spindle cells with variable amounts of stroma and showed areas of sheets of epithelioid cells. In most areas, the tumor cells had uniform nuclei, but pleomorphic epithelioid cells were focally present. Mitotic activity was three per 10 high-power fields. No ductular structure was found throughout the tumor. Immunohistochemical and ultrastructural studies confirmed the myoepithelial origin of the tumor cells. The occurrence of myoepithelioma in the subcutaneous tissue has been rarely reported. Even though the tumor showed no aggressive behavior on the 2-year follow-up, it is still too early to comment definitely on the behav- ior of myoepithelioma of the subcutaneous tissue. This case provides further information about soft tissue myoepithelioma.     

Fine-needle aspiration cytology of giant cell tumor of soft tissue (soft tissue giant cell tumor of low malignant potential)

Giant cell tumor of soft tissue is an uncommon neoplasm. To our knowledge, its cytopathology obtained using the fine-needle aspiration biopsy technique has not been previously described. We report an example of the fine-needle aspiration cytology of giant cell tumor of soft tissue in a 40-year-old woman, and correlate it with the corresponding tissue specimen.