急性膝关节损伤的低场MRI诊断

在日常诊疗中．由于外伤或运动不当等原因造成的膝关节损伤很常见．常规X线检查．常仅能显示明显关节骨折，而对关节内半月板、韧带及软骨的损伤显示有很大的局限性。MRI能多平面成像，对软组织具有很高的分辨率．能使关节内和关节周围的软骨、韧带、肌肉等满意显示，对平片或CT不能发现的骨挫伤也可清晰显示．是诊断膝关节损伤最理想的检查方法。笔者回顾分析了应用低场MRI明确诊断的85例86个急性膝关节损伤的MRI检查结果．以探讨低场MRI在无明显关节骨折的急性膝关节损伤中的应用价值。     

膝关节创伤的关节镜手术进展

膝关节损伤指涉及膝关节的骨、软骨和关节内结构(交叉韧带、半月板等)的急性或慢性创伤。膝关节是结构复杂的负重关节,创伤机会多,病废率高。传统的诊断和治疗方法都存在一定的局限性,临床疗效并不满意,常导致关节失稳和创伤性关节病变的发生,影响关节功能。应用关节镜技术是诊断和治疗急性和慢性关节创伤的微创治疗方法。随着关节镜手术理论和技术的普及和提高、关节镜设备、器械和方法的改进,更显示了它是治疗关节创伤的一种重要手术方法〔1〕。1　急性膝关节创伤不同暴力的方向和程度,以及肢体所处的位置和动作,产生的急性膝关节创伤后有…     

关节镜下评价MRI在观察股骨远端骨挫伤对关节软骨影响中的作用

[目的]通过关节镜检查探讨MRI在观察股骨远端骨挫伤区域对关节软骨影响中的作用。[方法]采用关节镜下直视对2007年1月～2009年1月共收治经MRI影像检查显示股骨远端骨挫伤29例,其中12例合并内、外侧半月板损伤,14例伴前交叉韧带断裂,3例前交叉韧带合并内侧副韧带损伤,在行手术治疗同时观察关节软骨损伤情况。[结果]关节镜下见到股骨远端关节软骨损伤与MRI所显示基本吻合,其MRI信号改变的范围与软骨损伤面积呈正比,根据关节镜所见到的软骨损伤程度,将其分Ⅰ～Ⅳ度。[结论]关节镜下观察股骨远端关节软骨损伤与MRI影像有一定的相似符合,但1.0cm2的软骨损伤区MRI有时不能真实表现出。对Ⅰ度软骨损伤关节镜下无阳性发现,由于MRI的扫描条件及层厚原因,在某些情况下尚不能反映出关节软骨损伤的严重程度,关节镜是诊断关节软骨损伤的金标准。     

MRI与关节镜对急性膝关节软骨损伤的诊断对比

目的通过MRI与关节镜的对比研究,探讨MRI为关节软骨损伤的临床诊断和治疗提供可靠的影像学依据。方法回顾本院经MRI诊断急性膝关节软骨损伤的病例,对照关节镜检查结果进一步分析。结果根据MRI表现90例膝关节中共720个关节软骨面。其中Ⅰ级损伤23个,Ⅱ级损伤56个,Ⅲ级损伤83个,Ⅳ级损伤134个。除软骨损伤外,部分病例还合并膝关节韧带及半月板损伤,关节腔积血、骨挫伤及骨折等其他征像。结论 MRI是诊断膝关节软骨损伤的重要方法,提高MRI诊断准确率对手术治疗膝关节软骨损伤有指导性意义。     

低磁场MRI在膝关节软骨损伤中的价值

目的分析关节软骨损伤的低磁场MRI、CT和常规X线平片（CR）表现,评价低磁场MRI在关节软骨损伤检查、诊断中的临床应用价值。方法分析5例有膝关节损伤病史,且经膝关节镜手术证实为关节软骨损伤患者的膝关节MRI、CT和CR所见,着重观察关节软骨和软骨游离体,并与关节镜手术结果对照分析。结果 5例关节软骨骨折在MRI上均有表现异常,其中软骨信号异常3例,软骨凹陷2例,软骨连续性中断2例,软骨缺损1例,软骨缺损伴关节内游离软骨体1例。5例均有关节腔、囊积液,2例见轻微骨挫伤。CT仅1例见局部骨皮质毛糙,但均可见不同程度关节囊肿胀;CR除见局部关节周围软组织稍肿胀外,均无异常改变。结论低磁场MRI在关节软骨损伤检查诊断中同样具有很大优势,对急性关节软骨损伤显示准确,可准确评价急性膝关节损伤的范围、程度,决定治疗方案。     

膝关节创伤的微创处理

关节镜技术最早应用于膝关节内创伤微创性诊断与治疗．提高了急性膝关节损伤时关节内软骨损伤的诊断率；可以正确评估半月板损伤的部位、类型和范围，合理选择损伤半月板缝合、部分切除等术式，最大限度保留了半月板；可以进行前、后交叉韧带损伤的修复与重建。关节镜技术结合做创内固定技术可以治疗胫骨平台、髌骨、股骨髁骨折，辅助完成逆行交锁钉治疗股骨远端骨折。经皮微创解剖钢板内固定(如LISS)治疗膝关节邻近股、胫骨干骺端骨折，均提供了临床疗效。     

60例半月板损伤并关节软骨损伤的临床观察

目的在关节镜下观察半月扳损伤的部位、形态及病程与关节软骨破坏程度的相关性。方法将60例(72膝)半月板损伤患者按受伤到接受手术的时间(Keene时间划分标准)分为急性期组、亚急性期组和慢性期组3组。观察半月板损伤的形态、部位及病程与关节软骨破坏程度之间的相关性。结果本组患者均有不同程度的软骨病损。其中软骨病损处于1～2度的大多为急性损伤患者.亚急性损伤患者的软骨病损多为2～3度,而慢性损伤以3度为主,少数患者伴有4度病损。7例伴有交叉韧带损伤患者的关节软骨毁损明显重于同期患者。半月板破损的部位、形态及病程与软骨损伤程度成正相关。结论半月板的破损可导致关节软骨的损伤,两者可相互促进对方的损伤。关节韧带的损伤也会加重关节软骨的磨损。对半月板的损伤要尽量做到早期诊断和治疗,对关节韧带的损伤也不可忽视,以减少关节软骨的磨损,延长关节使用寿命。     

《中国骨伤》杂志2014年重点专题征稿通知

《中国骨伤》杂志2014年的专题策划工作已经开始,以下是2014年拟刊出的重点专题,欢迎广大读者和作者踊跃投稿.1.脊柱手术并发症的预防和处理2.退变性脊柱侧凸的非手术及手术治疗的选择3.保守治疗在脊柱疾患中的疗效及评价4.关节内骨折术后感染的预防和处理5.关节软骨和韧带损伤修复与重建的远期疗效评估6.关节镜在关节创伤、软骨及滑膜病变的诊断与治疗     

《中国骨伤》杂志2014年重点专题征稿通知

《中国骨伤》杂志2014年的专题策划工作已经开始,以下是2014年拟刊出的重点专题,欢迎广大读者和作者踊跃投稿.1.脊柱手术并发症的预防和处理2.退变性脊柱侧凸的非手术及手术治疗的选择3.保守治疗在脊柱疾患中的疗效及评价4.关节内骨折术后感染的预防和处理5.关节软骨和韧带损伤修复与重建的远期疗效评估6.关节镜在关节创伤、软骨及滑膜病变的诊断与治疗     

儿童膝关节镜的临床应用

目的 探讨儿童膝关节损伤和疾病的关节镜诊断和治疗效果。方法 27例儿童行关节镜下诊断和治疗，包括半月板或盘状半月板损伤、髌骨脱位或半脱位、滑膜炎、关节内异物、游离体、前交叉韧带损伤、关节内血管瘤、绒毛结节性滑膜炎、关节僵直和化脓性关节炎。结果 经2个月～2年随访，优良率为26／27。结论 膝关节镜是诊断和治疗儿童膝关节创伤与疾病的一种微创手术方法，具有创伤小、修复快、疗效好的优点；应掌握儿童膝关节镜的应用指征，治疗要个体化设计，预防并发症的产生。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Single center experience in single-incision laparoscopic surgery in children in Turkey

Purpose

Minimally invasive surgery has evolved into single-incision laparoscopic surgery (SILS) in the recent years. Few reports have addressed the practicality of SILS in children. Our current experience with regard to feasibility and effectiveness of SILS in children is presented.

Methods

A retrospective review of the operative database for patients operated on using SILS in our department from March 2009 to July 2010 was performed. Data regarding the type of the procedure, age, sex, operative performance, hospital stay, and complications were collected.

Main Results

Among 43 patients, cholecystectomy was performed in 11; appendectomy, in 10; unroofing for ovarian cysts, in 5; unroofing for splenic cysts, in 4; oophorectomy, in 6 (ovarian torsion, 2; teratoma, 4); ovary-preserving teratoma excision, in 1; splenectomy, in 1; gonadectomy, in 3; and varicocelectomy, in 2. There were no conversions to standard laparoscopic or open techniques. The only postoperative complication was a wound infection that occurred after an appendectomy.

Conclusion

Although currently more expensive, SILS can be performed in children in almost every pediatric surgical procedure that can be accomplished with conventional laparoscopic techniques. The most significant contribution of SILS procedure is cosmesis. Postoperative pain and length of hospital stay were not improved.     

Decrease in Major Amputations in Germany

A decrease in rate of amputation has been reported from many countries. This study aims to study the trends in amputation rates in Germany. On the basis of DRG‐system, detailed lists of all amputations coded as minor amputations (OPS 5–864) and major amputations (OPS 5–865) performed between 2005 and 2010 were provided by the Federal Statistical Office. There was a significant decrease in age‐adjusted major amputation rates per 100 000 population in Germany from 27·0 in 2005 to 22·9 in 2010 (15·2%, P ? 0·001) in males and from 19·7 in 2005 to 14·4 in 2010 (26·9%, P ? 0·001) in females. Overall, minor amputation rates did not show such a decrease but increased in males (from 47·4 in 2005 to 57·8 in 2010, 21·9%, P ? 0·001) and remained almost unchanged in females (23·1 in 2005 and 23·9 in 2010, not significant). Reduction in major amputation rates were even more pronounced in people above 80 years, especially in males from 216 to 150 (30·5%) and in females from 168 to 117 (30·4%). The present data demonstrate an increasing overall burden of foot lesions as indicated by an increase in incidence of minor amputations but an ongoing success in the fight against amputation, resulting in a significant decrease in major amputation rates in Germany, in the 6‐year period from 2005 to 2010.