肘部尺神经半脱位的解剖学和流行病学研究

目的：研究肘部尺神经半脱位的发生原因及其临床意义。方法：对１００侧成人尸体肘部的尺神经位置进行解剖观察；在人群中随机调查了８５４位正常人肘部尺神经的位置。结果：肘管深度为７．１±０．１４ｍｍ（χ±ｓχ）。解剖观察发现，６侧肢体的尺神经在屈肘时发生半脱位，肘管深度平均为４．８ｍｍ。８５４位正常人肘部尺神经半脱位发生率为８．９％（７６／８５４）。结论：绝大多数的肘部尺神经半脱位是先天性的。肘部尺神经半脱位不一定是肘部尺神经卡压的发病原因。     

Radiographical definition of the proximal tibiofibular joint – A cross-sectional study of 2984 knees and literature review

BackgroundProximal tibiofibular joint (PTFJ) injuries are not uncommon but relatively understudied. This study evaluates the effectiveness of 2 radiographic methods in assessing the integrity of the PTFJ.Study designThis is a cross-sectional study of 2984 consecutive patients with knee X-rays done in a single institution over a 4-month period. A total of 5968 knee X-rays were assessed using 2 methods–[1] The direction in which the fibula points to in relation to the lateral femoral epicondyle on anteroposterior view and Blumensaat line on lateral view. [2] The degree of tibiofibular overlap as percentage of widest portion of the fibula head. Sensitivity and specificity of these methods in diagnosing a disrupted PTFJ are calculated. Variables including quality of X-rays, weight-bearing status of AP views and degree of knee flexion on lateral views are also recorded. Univariate analysis was carried out to investigate the association between variables using chi-square test for nominal data and student t-test for continuous data.ResultsThe fibular points towards the lateral femoral epicondyle on AP view in 94.4% of the patients and points towards the posterior half of the Blumensaat line on lateral view in 98.1% of the patients. Using this method, weight-bearing X-rays are significantly associated with the direction the fibula is pointing (p < 0.01) on the AP view and the degree of knee flexion is associated with the direction the fibula is pointing (p < 0.01) on the lateral view.The AP tibiofibular overlap ranges from >0% to <75% in 94.1% of the patients and the lateral tibiofibular overlap ranges from >0% to <75% in 84.5% of the patients.This method is associated with whether true orthogonal X-rays of the knees are taken (p = 0.048).ConclusionThe direction in which the fibula is pointing and the percentage of tibiofibular overlap are highly specific radiographic methods useful in defining the PTFJ. The first method requires a weight-bearing view on AP assessment and >20 degrees of flexion on lateral assessment. True orthogonal AP and lateral views are required for the second method to be used.     

穴位埋线治疗卒中后肩关节半脱位疗效及对血清TNF-α、IL-6的影响

目的观察穴位埋线治疗卒中后肩关节半脱位临床疗效及对血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)因子水平的影响,探讨抑制炎症反应的相关机制。方法将92例卒中后肩关节半脱位患者按1:1:1随机分3组,共剔除2例,最终每组30例。埋康组采用康复训练加穴位埋线;针康组采用康复训练加针刺治疗;康复组采用单纯康复治疗。分别于治疗前后采用Fugl-Meyer(FMA)上肢运动能力、视觉模拟评分(VAS)及血清TNF-α、IL-6炎性因子水平进行评价。结果治疗后3组患者Fugl-Meyer及VAS评分比较差异有统计学意义(P<0.05);血清TNF-α、IL-6炎性因子水平降低(P<0.05);3组中埋康组疗效最优;且3组治疗前后组内比较差异均有统计学意义(P<0.05)。结论穴位埋线能改善卒中肩关节半脱位患者上肢肩痛及运动功能,降低机体炎症性应激反应。     

23G玻璃体切除联合重水辅助下超声乳化摘除术治疗晶状体后脱位的临床观察

【目的】探讨23G玻璃体切除重水辅助下脱位晶状体超声乳化摘除治疗晶状体后脱位的疗效。【方法】11例11眼晶状体脱位患者,行23G玻璃体切除后重水浮起脱位晶状体至虹膜平面,常规透明角膜切口行标准超声乳化摘除脱位晶状体。液体‐重水置换吸除重水。连续环形撕囊完整者,植入人工晶状体于睫状沟位或将人工晶状体缝线固定于巩膜,线结埋于巩膜瓣下。观察术后最佳矫正视力、手术并发症。【结果】术后所有患者视力均提高,其中大于0．5者5眼,0．3～0．5者3眼,0．1～0．3者3眼。无术后高眼压,眼内出血,视网膜脱离等并发症。【结论】23G玻璃体切除联合重水下超声乳化摘除人工晶状体植入术治疗晶状体后脱位是一种安全有效的手术方法。     

复位导向器在强直性脊柱炎胸腰椎后凸畸形截骨矫形术中的应用

目的 :探讨经椎弓根椎体截骨(pedicle subtraction osteotomy,PSO)治疗强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形术中采用复位导向器预防截骨椎脱位的有效性。方法 :回顾性分析2014年4~12月在我院行单节段PSO矫形内固定术中应用复位导向器的27例AS胸腰椎后凸畸形患者。所有患者手术前后均摄站立位全脊柱正侧位X线片并在矢状面上测量胸椎后凸角(thoracic kyphosis,TK)、全脊柱最大后凸Cobb角(global kyphosis,GK)、腰椎前凸角(lumbar lordosis,LL)和矢状面平衡距离(sagittal vertical axis,SVA)。随访观察神经并发症及截骨椎脱位情况,以截骨水平的头侧与尾侧脊椎间,截骨椎在矢状面上移位(sagittal translation,ST)大于5mm定义为截骨椎脱位。结果:所有患者均顺利完成手术。平均随访5.2±2.4个月(3~12个月),术前TK为43.2°±10.6°,GK为72.6°±15.1°,LL为2.3°±13.5°,SVA为12.8±4.2cm;术后分别为42.9°±11.8°、38.2°±12.4°、-38.6°±13.0°和3.2±5.8cm;末次随访时分别为42.7°±10.5°、38.8°±15.2°、-38.4°±11.6°和3.3±6.4cm。除TK外,其余参数手术前后相比均有统计学意义(P0.01);末次随访时,TK、GK、LL及SVA的矫正丢失无统计学差异(P0.05)。无患者出现术中截骨椎脱位,除1例短暂性右下肢麻木外,无其他神经并发症发生。结论:采用PSO治疗强直性脊柱炎胸腰椎后凸畸形患者,术中应用复位导向器械能有效预防截骨椎脱位的发生。     

Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity

BackgroundThe objective of this study was to evaluate the correlation between Weightbearing CT (WBCT) markers of pronounced peritalar subluxation (PTS) and MRI findings of soft tissue insufficiency in patients with flexible Progressive Collapsing Foot Deformity (PCFD). We hypothesized that significant correlation would be found.MethodsRetrospective comparative study with 54 flexible PCFD patients. WBCT and MRI variables deformity severity were evaluated, including markers of pronounced PTS, as well as soft tissue degeneration. A multiple regression analysis and partition prediction models were used to evaluate the relationship between bone alignment and soft tissue injury. P-values of less than .05 were considered significant.ResultsDegeneration of the posterior tibial tendon was significantly associated with sinus tarsi impingement (p = .04). Spring ligament degeneration correlated to subtalar joint subluxation (p = .04). Talocalcaneal interosseous ligament involvement was the only one to significantly correlate to the presence of subfibular impingement (p = .02).ConclusionOur results demonstrated that WBCT markers of pronounced deformity and PTS were significantly correlated to MRI involvement of the PTT and other important restraints such as the spring and talocalcaneal interosseus ligaments.LEVEL OF EVIDENCE: Level III, Retrospective comparative study.     

Sagittally split fracture of trapezium associated with subluxated carpo-metacarpal joint of thumb

Trapezial fractures are uncommon, and require careful clinical and radiological assessment and treatment. Poor or inadequate treatment of displaced fractures of trapezium can lead to long-term morbidity. We report two displaced fractures of the trapezium. The clinical and radiological features are discussed. Both fractures were treated operatively and a good functional outcome was achieved.     

A multivariate analysis of risk factors for anterior atlantoaxial subluxation and an evaluation of the effect of glucocorticoid treatment on the upper rheumatoid cervical spine

Summary A cross-sectional, retrospective computerized analysis of risk factors for anterior atlantoaxial subluxation (AAS) was performed. Logistic regression performed on the clinical variables involved in 145 cases of rheumatoid arthritis (RA) disclosed a high joint score index and a low blood haemoglobin level as significant independent risk factors. This means that the development of anterior AAS is connected with widespread RA. Linear multiple regression analysis showed an association between the extent of anterior AAS in millimetres and the spread of erosions of the dens of axis and negative correlation with the severity of vertical atlantoaxial dislocation (VD). This suggests that whereas the presence of anterior AAS is connected with the severity of the systemic disease, its actual extent is associated with signs of local involvement, other than severe VD. The duration or cumulative dosage of glucocorticoids were not associated with the development or extent of anterior AAS, nor with the severity of vertical dislocation. This suggests that low dose glucocorticoid treatment is not involved with the development of rheumatoid changes in the upper cervical spine. It should be borne in mind, of course, that although no correlation was found, a causal relation cannot be excluded.     

儿童Marfan综合征晶状体半脱位手术的探讨

报告16例18眼儿童马方综合征晶状体半脱位的手术治疗。术前视力0．08以下者10眼占55．56％，0．1者8眼占44．44％。采取晶状体摘出和四点固定法植入人工晶状体。随访1－6年，矫正视力0．5至0．7者12眼占66．7％，最佳达0．8以上6眼占33．3％。未发现视网膜脱离等并发症。术前应做详细检查，严密手术设计，确保手术成功。