儿童髌骨袖形骨折1例

患者男,12岁。因跳高弹跳时忽听到一撕裂声即感左膝剧烈疼痛、随之屈曲着地、活动受限半天入院。查体:左膝重度肿胀、皮肤瘀斑、压痛、浮髌试验阳性,髌骨下缘可扪及一异常间隙,膝关节伸直受限。X线片示左膝关节间隙增宽,髌骨下极有一小骨片撕脱,分离3cm。诊断为左髌骨下极撕脱骨折。于次日在硬膜外麻醉下行切开复位内固定术。术中见浅筋膜瘀血明显,髌前腱膜自髌骨上缘处广泛撕脱,髌腱扩张部关节囊部分撕裂,髌骨中下部边缘有5块软骨骨块,下极有一小撕脱骨片连同髌腱向下移位约3cm。清除关节腔积血,探查前后交叉韧带、半月板正常。在髌骨下部横形钻孔,将下极骨片及髌腱用粗丝线固定。修补关节囊、髌腱扩张部及髌前腱膜。膝屈30°石膏托固定。6周后去石膏托功能锻炼,随访1年,左膝功能正常。     

两侧髌韧带完全断裂一例报告

患者男,32岁,因跌伤致两侧膝关节肿痛活动受限2月入院。查体:两侧膝关节呈45°屈曲位,主动伸膝功能丧失,两侧髌骨下方均扪及一横形凹陷,膝关节侧方应力试验及抽屉试验均阴性。X线侧位片均见髌骨上移。诊断两侧髌韧带断裂。治疗:术中见两侧髌韧带完全横断于髌骨下缘2cm处,取φ3mm克氏针在髌骨中部及胫骨结节后方分别横行钻孔,用双股28号钢丝穿入环绕,膝关节伸直位拧紧,髌韧带断端都能紧密相靠,并间断缝合。术后膝关节伸直位长腿石膏固定。6周后取出钢丝并去石膏锻炼。术后1年6个月随访,两膝关节屈伸功能正常。     

缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴内侧髌股韧带断裂

目的评价缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴内侧髌股韧带（MPFL）断裂的临床疗效。方法自2006-07—2012-01采用缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴MPFL断裂21例,术后12个月采用膝关节功能Lysholm评分标准评价膝关节功能。结果术后切口均一期愈合,无感染。本组均获得随访13~24个月,平均14.6个月。末次随访时髌股关节对合良好,解剖关系正常。术后12个月膝关节功能Lysholm评分78~100分,平均93.7分;疗效等级评价：优13例,良7例,可1例,优良率95.2%。结论缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴MPFL断裂临床疗效满意,手术操作简单、损伤小。     

缝合髌前腱膜屈膝复位克氏针髌骨爪联合内固定治疗髌骨横断骨折的疗效观察

目的探讨应用缝合髌前腱膜屈膝复位克氏针髌骨爪联合内固定治疗髌骨横断骨折治疗。方法自2013-03—2014-01采用缝合髌前腱膜屈膝复位髌骨关节面,克氏针与髌骨爪联合内固定治疗10例髌骨横断骨折。结果所有患者髌骨关节面均解剖复位。手术时间35~55 min,平均42 min。住院时间8~14 d,平均10.5 d。手术切口均一期愈合,所有患者获得随访5~12个月,平均7.4个月。骨折愈合时间3~7个月,平均4.2个月。于骨折愈合后取出内固定物,根据陆氏疗效评定标准进行分级:优8例,良2例。结论通过缝合髌前腱膜屈膝复位联合克氏针髌骨爪固定治疗髌骨横断骨折无需显露髌骨关节面,手术创伤小,治疗效果确切有效。     

髌骨骨折内固定治疗的评价

髌骨骨折是关节内骨折 ,占全身各部骨折的1.6 5% [1] ,治疗上既要求达到骨折解剖复位 ,又要能抵抗影响骨折固定的应力 ,以利膝关节术后能够早期功能锻炼。因此 ,治疗方法是否合理将直接影响膝关节功能恢复。目前治疗方法有多种 ,尚未取得完全一致意见 ,本文就膝关节的解剖与生物力学特点以及国内外对髌骨骨折内固定治疗现状作一综述。1　解剖及生物力学特点髌骨是全身最大的籽骨。其独立位于髌腱之后 ,并且是伸膝结构中的一个重要功能部分。髌骨位置表浅 ,只有皮肤、薄层皮下组织及髌前滑囊在髌骨之上 ,故髌骨易因直接暴力及跌打而受伤。髌…     

髌骨骨软骨骨折2例报告

例1男性,14岁,以“左膝扭伤肿痛6h求诊。查:左膝肿胀,浮髌试验阳性,触摸髌骨外形完整,无明显压痛点,在髌上囊髌骨内上角处可扪及一游离骨块,膝关节主动屈伸完全受限。左膝关节正侧位X线片示:髌骨结构完整,股骨内髁前上方有一游离骨块。行左膝关节探查术。见左股骨内外髁关节面平整,结构正常。髌骨骨软骨面有1.5cm×2.5cm缺损与游离骨块相吻合,采用钢丝悬吊法固定。术后五个月关节功能恢复正常。 例2女性,18岁,以“左膝扭伤后伸屈活动困难20天”求诊。查:左膝软组织无肿胀,髌骨外形完整,无压痛,浮髌试验阴性,左膝基本固定于屈曲30°。X线正侧位片示:左膝关节骨质结构无异常,关节内有一游离体。加拍髌骨轴位片,确诊为“左髌骨骨软骨骨折”。治疗以手术切开复位钢丝悬吊固定,术后半年膝关节功能基本恢复。     

关节镜下改进紧缩髌内侧支持带治疗复发性髌骨脱位杨卿 鲁锐 尚小斌 任晔 游洪波*

【】 目的 探讨关节镜下改进紧缩髌内侧支持带的方法治疗复发性髌骨脱位的疗效。 方法 2013年7月至2015年7月收治复发性髌骨脱位病人23例,男4例,女19例,年龄为10~25岁,平均为15.8岁。术前根据病人的病史、影像学检查和体检发现屈膝关节时髌骨外侧移位,髌骨外推恐惧试验阳性等体征确诊。手术在关节镜下操作,用等离子刀常规进行松解髌外侧支持带,用ACCU PASS自动连续传递缝合勾将PDS缝线四等分整体跨越髌内侧支持带,采用对称集中打结法拉紧缝线,实现对髌内侧支持带的有效紧缩。术后鼓励病人在膝关节支具保护下早期进行功能锻炼。评价末次随访时病人髌骨位置满意度,膝关节静息位或屈伸活动时髌骨情况。手术前后Lysholm膝关节评分、Tegner膝关节运动水平评分、髌骨外移度比较。 结果 单膝的关节镜操作时间为40~55 min,平均为46.4 min。术中实现髌股关节面复位,屈膝关节活动(0°~90°)时髌骨活动轨迹满意,病人没有发生再脱位。随访时间为18~36个月,平均为24.6个月。末次随访时病人髌骨位置满意,膝关节静息位或屈伸活动时未发生髌骨再脱位。术后18个月与术前的Lysholm膝关节评分、Tegner膝关节运动水平评分、髌骨外移度,差异均有统计学意义(均P<0.05)。 结论 关节镜下采用ACCU PASS自动连续传递缝合勾可以方便对髌内侧支持带紧缩的操作,PDS缝线行对称集中式打结能获得坚强的固定紧缩效果。本方法具有操作便捷、固定强度好、膝关节功能恢复快、近期疗效好的特点。     

克氏针结合髌骨钢板治疗粉碎性髌骨骨折的临床研究

目的探讨克氏针结合髌骨钢板治疗粉碎性髌骨骨折的疗效。方法收集髌骨粉碎性骨折55例,随机分为实验组及对照组。实验组采用克氏针结合髌骨钢板内固定治疗,对照组单纯采用镍钛记忆合金聚髌器内固定治疗。分析比较两种不同内固定方法分别在两组骨折患者术中、术后、术后1个月、术后3个月的治疗效果及对于膝关节功能的影响。结果术中出血量手术时间及住院时间两组间结果无明显差异,但实验组在术后1个月及3个月的膝关节功能评定方面明显优于对照组。结论克氏针结合髌骨钢板治疗粉碎性髌骨骨折的疗效优于单纯镍钛记忆合金聚髌器内固定治疗。     

髌前钢丝环内固定治疗粉碎性髌骨骨折

目的探讨髌前钢丝环内固定方法治疗粉碎性髌骨骨折的疗效。方法采用髌前钢丝环内固定治疗急性粉碎性髌骨骨折36例,根据术后膝关节功能恢复情况进行评价。结果术后12周复查X线片显示:骨折全部愈合,髌骨关节面平整。根据陆裕朴等疗效评定标准:优30例,良4例,可2例,优良率94.4%。结论髌前钢丝环内固定治疗急性粉碎性髌骨骨折效果好,值得推广。     

全膝关节置换术中髌骨假体内置的临床研究

目的探讨髌骨置换时髌骨假体内置对髌股关节运动轨迹的影响。方法2001年9月～2002年3月48例(75膝)行全膝关节置换患者,采用髌骨假体内置的方法置换髌骨,并在术中髌骨置换前后测试髌股关节运动轨迹,术后对患者进行随访。观察髌骨假体安放位置对髌股关节运动轨迹及术后关节功能的影响。结果75膝术中胫骨、股骨截骨完成并安装试模后测试髌股关节运动轨迹,69膝可达到“nothumbtest”,髌骨内置2～5mm后再次测试仍全部达到“nothumbtest”;余6膝未达到“nothumbtest”,经髌骨内置4～8mm后5膝达到,1膝经髌外侧支持带松解最终实现“nothumbtest”。术后经12～18个月随访,膝关节活动度平均为116.5°(95°～125°)。无一例出现髌骨脱位、半脱位、髌骨坏死、髌骨骨折、髌腱撕脱、髌骨不稳以及皮肤坏死等并发症。结论在全膝关节置换术中,髌骨假体内置可有效地改善髌股关节运动轨迹,减少对髌外侧支持带松解的需求,降低髌骨相关的并发症。     

Reframing the individual stress response: Balancing our knowledge of stress to improve responsivity to stressors

Although responses to stressors have both adverse and positive consequences on health, many believe that stress is entirely negative. Research revealed that negative beliefs about stress can hinder well‐being and result in the avoidance of stressors. Stress‐optimizing interventions that target various stress appraisal processes may be a useful tool to reframe how individuals understand and respond to stressors. The current study extends previous findings on stress reframing and sought to examine the extent to which the presentation of information about stress outcomes may influence the individual to respond to subsequent stressors. Seventy‐seven undergraduate students (96% female) were randomized into one of four reframing conditions (balanced stress outcomes, negative stress outcomes, positive stress outcomes, and control) and underwent a psychosocial stressor. Results highlight similarities between balanced and positive framings of stress across measures of heart rate and blood pressure, whereas subjective ratings of stress and electrodermal activity suggest balanced framing may be efficacious in attenuating stress. Findings are discussed in the context of differing stress‐optimizing interventions and consider the complexities of the individual stress response.     

Occupational stress and gender: a cross‐cultural study

The aim of this study was to examine the interaction of gender and culture in managers' experiences of work stress. Data were collected on sources of occupational stress (stressors), coping and consequences of occupational stress (strains) from male and female managers from four countries—South Africa, the United Kingdom, United States of America and Taiwan. Few significant results were found for the interaction between country and gender on any of the measures. When the sample as a whole was examined, however, there were also virtually no differences in sources of work stress, but there were differences in the consequences of work stress for male and female managers. The implications of finding a lack of differences in sources of work stress for males and females combined with finding differences in strains for male and female managers are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Biology of Stress Revisited: Intracellular Mechanisms and the Conceptualization of Stress

Application of allostatic theory to stress during the 1990s refocused attention on internal responses to a perceived hazard, and the last 20 years has seen considerable developments in the biological contexts of stress. Evidence from neuroscience now suggests that secretion of the hormone cortisol is not only stimulated by the outcomes of cognitive transaction but it also feeds back and contributes positively to the cognitive adaptation that is a feature of stress resilience. More recently, the operative intracellular mechanisms are beginning to be understood and provide an insight into the regulation and maintenance of intracellular homeostasis that underpins adaptive change and vulnerability. The maintenance or appropriate modulation of intracellular homeostasis usually provides a buffering of potential adverse interactions. However, the capacity to do so is diminished during chronic stress leading to intracellular and subsequently systemic, homeostatic failure and hence maladaptation. This area of research seems far removed from cognitive theory, but placing intracellular homeostasis at the core of cognitive and biological responses supports the concept of stress as a genuinely psycho‐biological phenomenon. Copyright © 2013 John Wiley & Sons, Ltd.     

Understanding stress and quality of life for clergy and clergy spouses

To better understand the stress and quality of life of clergy and clergy spouses, a survey research design was utilized involving a random sample of clergy. Of the 436 respondents involved in this study there were 259 clergy who were employed full‐time and 177 clergy spouses. Various scales related to Family Stress Theory and the ABC‐X model were used in this investigation. Whereas clergy spouses had greater psychological and physiological stress than clergy, clergy had a greater sense of coherence and spiritual resources. Clergy spouses, however had a greater level of coping. Findings indicated that for both clergy and clergy spouses spiritual resources had the greatest total effect on their quality of life. Copyright © 2004 John Wiley & Sons, Ltd.     

Traumatic stress as an area for research

Traumatic stress as a research area draws attention from several disciplines, each contributing its own unique tradition to the field. Three research backgrounds are described, including strengths and weaknesses. Research issues currently focus on the psychophysiological basis for stress reactions, the role of personality in stress response patterns, and the trauma stimulus as an independent variable. An overview of this issue's contributions is provided.     

STRESS IN FARMING

The experience of job-related stress was studied in 318 UK farmers. Of the job-related stress domains investigated, comparatively high amounts of stress were reported as a result of governmental regulation and its resulting bureaucracy, and relatively low amounts of stress resulted from feelings of isolation. Six major domains of stress emerged for farmers: farming bureaucracy, finance, isolation, uncontrollable natural forces, personal hazards and time pressure. The scores on different farming-related stress scales were compared across the sexes, ages and types of farm. In general, women reported more stress than men. Mixed-type and dairy farmers reported the highest levels of stress from time pressure, and cereals farmers the lowest. Livestock farmers had more financial stress than dairy and cereals farmers. Age lessened the stress reported from all aspects of farming except bureaucracy. The psychometric instrument developed in the present study—the Edinburgh Farming Stress Inventory—should be validated in other farming settings and in more representative samples of farmers. © 1997 by John Wiley & Sons, Ltd.     

Implosive therapy for the treatment of combat-related PTSD

Implosive therapy for the treatment of post-traumatic stress disorder is based on the principle of exposing the patient to trauma-related cues until there is a reduction in the anxiety associated with the cues. It is a relatively specialized procedure regarding which few clinicians receive extensive supervised training, despite the numerous case studies that demonstrate its effectiveness. The present paper addresses a number of procedural issues and offers guidelines for conducting implosive therapy with traumatized combat veterans. Elements of controversy regarding the application of implosive therapy are discussed.     

Effectiveness of an intensive stress intervention workshop for senior managers

This study investigates the efficacy of an intensive, integrated approach to stress reduction and coping enhancement directed towards an educated, upper level management population. Ninety‐five US governmental senior managers participated in a 35‐h stress management retreat held over a 3.5‐day period. The retreat combined didactic and experiential activities that were designed to increase participants' knowledge of stress liabilities and coping skills. Participants were encouraged to make positive lifestyle changes and to create specific action plans for the year following the workshop. Evaluations of participant satisfaction were completed at the close of the workshop. Eighty‐three participants completed baseline and follow‐up Stress and Coping Inventory (SCI) assessments in order to identify durable changes in these measures. Across 10 months, participants showed significant improvements in their overall Global Balance scores, psychological symptoms, depression symptoms, and all major coping scales, including Health Habits, Social Support, Responses to Stress and Life Satisfactions. Therefore, an intensive, multifaceted approach to stress intervention is a viable option for encouraging sustained behavioural change. Copyright © 2003 John Wiley & Sons, Ltd.     

Post-traumatic stress disorder

Developments in the study of psychological trauma are briefly charted, prior to the inclusion of the stressor-generic diagnostic category of ‘post-traumatic stress disorder’ (PTSD) in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Against the context of the assumptions underlying the DSM-III classification system, evidence relating to the general validity of the PTSD diagnostic criteria is examined. Progress in the development of assessment techniques and psychotherapeutic procedures is reviewed. and proposals for refinement and revision of the diagnostic category are considered.     

Acute stressors and chronic stress at Three Mile Island

The relationship between acute and chronic stress was examined by studying the effects of an acute stressor on ongoing stress response. A group of people living near Three Mile Island were compared with a group of control subjects living 80 miles away on measures of stress 2 months before and 1 month after restart of the undamaged nuclear reactor at Three Mile Island. Consistent with earlier findings, people living near Three Mile Island, as a group, exhibited more evidence of stress before the restart than did controls, including greater symptom reporting, poorer task performances, and higher blood pressure and urinary catecholamine levels. The restart did not heighten stress responding in the Three Mile Island group; after the restart, symptom reporting decreased slightly but blood pressure, catecholamine levels, and task performance were comparable to prerestart levels. The implications of these findings are discussed.