双侧示指伸肌变异1例

1 结果左侧示指伸肌起自前臂骨间膜后面下缘,桡骨下端后部,以扁圆形肌腱止于示指中节指骨底尺侧份,该肌肌腹长5.8 cm,宽1.1 cm,厚0.2 cm;肌腱长6.2 cm,直径0.2 cm.该肌由骨间后动脉分支供血;骨间后神经发肌支下行于拇长伸肌深面,穿过第一骨纤维管分布于该肌(图1).右前臂后部指伸肌深面和拇长伸肌内侧无任何肌肉连于桡、尺骨至示指,亦未发现该处遭破坏迹象,故认为右侧示指伸肌缺如(图2).     

前臂骨间背侧动脉逆行岛状皮瓣修复手部软组织缺损

我们从 1985年 5月～ 1999年 3月 ,应用前臂骨间背侧动脉逆行岛状皮瓣修复各种原因引起的手部背侧、虎口、腕部软组织缺损 2 1例。皮瓣全部成活 ,效果满意。报道如下。1　应用解剖骨间背侧动脉在前臂上段发自骨间总动脉 ,有 2条同名静脉伴行。在旋后肌下缘穿过前臂骨间膜上缘至前臂背侧。与骨间脊侧神经伴行 ,神经位于动脉桡侧。沿尺侧伸腕肌和伸小指肌之间向远端行走 ,沿途发出许多肌支和数支皮支营养前臂背侧皮肤。皮支以上段较多 ,约 3～ 9条且长而粗 ,下段少而细 ,皮支直穿过肌间隔和深筋膜 ,在皮下组织内交织成网 ,分布可达动脉主干两…     

国人桡管的观察和测量

桡管位于前臂桡侧,是由肱桡关节、桡骨上段及前臂部分肌肉所围成的一个潜在性管道。其上端开口于肱桡关节的近侧缘,下端终于旋后肌浅层下缘,管内有桡神经深支穿过。1972年,Roles根据桡神经深支受压迫产生麻痹而出现伸腕、伸指无力等临床表现,提出了“桡管”的名称,并将此种临床表现称为桡管综合症。1979年Lister将压迫桡神经深支的因素归纳为:桡骨头纤维带、桡返动脉分支、桡侧腕短伸肌腱弓和Frohse弓四种解剖学结构。近年来,国内已先后有桡管综合症的报道。然而,有关     

前臂伸肌腱“V”形切断剥离延长术治疗肱骨外上髁炎47例体会

肱骨外上髁炎俗称网球肘，是肱骨外上髁处前臂伸肌总腱起点处的慢性损伤性炎症。是由于在各种活动中，过度运用桡侧腕长伸肌、桡侧腕短伸肌、指总伸肌、小指固有伸肌、肱桡肌、旋后肌、尺侧腕伸肌，引起附着于肱骨外上髁处的肌腱筋膜劳损与慢性损害。临床以肘关节外侧疼痛为主症，严重时影响前臂功能活动。笔者体会近几年来该病在农村有增多趋势，报告如下：     

示指伸肌起点变异一例

正常的示指伸肌起始于桡骨和尺骨及骨间膜的背面,位于拇长伸肌腱的尺侧,止于示指的指背腱膜。笔者见到一例成年男尸,双侧示指伸肌与正常的起始点不同,位于拇长伸肌腱的尺侧,腕背侧韧带的深面。起始于桡尺远侧关节囊的背面,此肌由内上斜向外下越过腕骨的背面,止于     

左上肢掌长肌缺如伴有尺动脉变异一例报告

1、掌长肌及其肌腱缺如,掌腱膜近侧端附着在腕横韧带的浅面。2、尺侧浅动脉由腋动脉第三段分出,位置表浅,形成高位尺浅动脉。 3、骨间总动脉由肱动脉分出,肌支丰富,与正常的尺动脉在前臂的分支分布基本相同。4、在手背桡动脉除发一穿支,穿第一掌骨间隙与尺侧浅动脉的掌深支构成掌深弓外,还发一异常分支,继续下行,到达拇收肌下缘,在此处发出拇指尺侧动脉和食指桡侧动脉,然后绕过拇收肌下缘达手掌,与尺侧浅动脉的掌浅支吻合成掌浅弓。     

人的桡侧腕深屈肌及掌深肌

作者为观察前臂深层屈肌的变异,对日本人225具尸体450侧上肢进行了观察。结果有九例异常肌,独立于指深屈肌、拇长屈肌及旋前方肌。可分为四种类型:第一型。肌肉起自桡骨前面,旋前圆肌附着点远侧,拇长屈肌及旋前方肌外侧。行于桡侧腕屈肌及指浅屈肌深层,止于第三掌骨或外侧腕骨。骨间前神经的某些终支分布     

三岁左右儿童桡侧腕伸肌的应用解剖

用72例3岁左右的儿童尸体标本对桡侧腕伸肌及其血管和神经进行了观测。观测了桡侧腕长伸肌和桡侧腕短伸肌肌腹和肌腱的长度、宽度和厚度。桡侧腕长伸肌的动脉主要发自桡侧副动脉和桡侧返动脉。前者分支的起始径和长度分别为0.85±0.05mm,20.33±1.13mn。桡侧腕短伸肌的动脉主要起于桡侧返动脉和桡动脉。它们分支的起始径和长度分別为0.82±0.02mm、0.78±0.02mm和8.15±0.33mm、9、60±0.44mm。桡侧腕长伸肌的神经多发自桡神经干,桡侧腕短伸肌的神经多起自桡神经深支,它们分支的外径和长度分别为0.84±0.03mm、0.76±0.02mm和13.04±0.52mm、15.02±1.76mm。还就其临床应用进行了讨论。     

50例前臂背侧高位损伤致伸指、伸拇功能障碍重建的临床体会

目的分析前臂背侧高位肌肉损伤一期手术修复后伸指、伸拇功能障碍原因,提高对前臂背侧高位肌肉损伤恢复机理的认识,保证手部伸指、伸拇正常功能.方法回顾性分析2010-2012年我科收治50例前臂背侧近端开放性外伤患者(术中探查排除桡神经深支损伤),46例肌肉损伤患者同时出现伸指、伸拇功能障碍,占92%,2例肌肉损伤患者出现伸指功能障碍,占4%,2例肌肉损伤患者出现伸拇功能障碍,占4%;而后都行功能重建恢复伸指、伸拇功能,术后上肢石膏托外固定,1月左右行功能锻炼.结果50例患者功能重建伤口均愈合良好,随访各指背伸功能良好,伸腕功能无影响或影响不是很大.结论前臂背侧高位开放性外伤致肌肉损伤,一期术后肌肉伸缩功能障碍导致伸指、伸拇功能障碍时,其中拇指功能最为重要,占整个手部功能的50%[1]左右,二期手术行功能重建尤为重要.可用收缩功能较好的桡侧腕长伸肌移位修复拇长伸肌腱的伸拇功能,桡侧腕屈肌移位修复指伸肌腱的伸指功能,将收到良好的效果.     

正中神经肌支转位治疗尺神经高位损伤的解剖学研究

目的 探讨正中神经肌支转位治疗尺神经高位损伤的可行性.方法 经甲醛固定的成人尸体10具共20侧上肢标本,利用游标卡尺测量正中神经各肌支的长度、神经入肌点处的直径、分支点到肱骨内侧髁以及正中神经主干在肘窝处距肱骨内侧髁的距离.结果 正中神经前臂的主要肌支有旋前圆肌支、桡侧腕屈肌支、掌长肌支、指浅屈肌支、指深屈肌桡侧半支、拇长屈肌支和旋前方肌支,其长度分别（46.3±12.5）、（44.5±9.7）、（43.5±4.1）、（53.5±7.2）、（62.4±19.8）、（64.4±7.8）、（109.4±14.9） mm;神经入肌点处的直径分别是（1.7±0.2）、（1.5±0.5）、（0.9±0.3）、（1.2±0.3）、（1.5±0.1）、（1.2±0.3）、（1.0±0.4）mm;正中神经主干距内侧髁距离为（35.4±3.3） mm;旋前圆肌支标本可直接与肱骨内侧髁上方尺神经主干无张力缝合.结论 正中神经肌支转位治疗尺神经高位损伤在解剖学上是可行的,旋前圆肌支和桡侧腕屈肌支是最佳供体神经.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…