甲状软骨侧切术治疗声门旁间隙病变

目的：探讨经一侧甲状软骨板入路行声门旁间隙手术的可行性和优越性。方法：3例位于声门旁间隙的喉黏液囊肿患者，采用一侧甲状软骨“U”形部分切除术入路切除囊肿；1例喉外伤声门旁间隙异物采用一侧甲状软骨板垂直切开取出异物。结果：3例喉黏液囊肿患者随访1年均无复发，声音恢复正常状态；1例喉外伤异物患儿术后双侧声带运动正常，声门闭合良好。结论：经一侧甲状软骨板切开或部分切除入路，可清晰显露声门旁间隙，在直视下彻底切除囊肿或取出异物，手术创伤小，不破坏喉的框架结构，不损伤喉黏膜，术后无并发症，是处理声门旁间隙良性病变的理想手术方式。     

Foot pressure and radiographic outcome measures of lateral column lengthening for pes planovalgus deformity

The purpose of this study was to establish and characterize the relationship between foot pressure analysis and radiographic measurements in children that underwent a lateral column lengthening procedure for pes planovalgus (PPV). Eight children (13 feet) with PPV that had failed non-operative treatment underwent a lateral column lengthening procedure. Pre-operative and post-operative standing AP and lateral radiographs and foot pressure data were obtained. The relationships between the radiographic and foot pressure measurements were investigated. The findings from this study demonstrated strong relationships between these parameters. The relationships seen in this study indicate that the addition of foot pressure analysis provides objective documentation of the improvement in foot pressure distribution following a lateral column lengthening. Also, there is a direct, positive relationship between the key radiographic and foot pressure measurements.     

A di-synaptic projection from the lateral cerebellar nucleus to the laterodorsal part of the striatum via the central lateral nucleus of the thalamus in the rat

We have examined a cerebello–thalamo–striatal pathway from the lateral cerebellar nucleus (LCN) to the laterodorsal part of the striatum (LDS) through the central lateral nucleus (CL) using light and electron microscopy through the employment of a combination of anterograde and retrograde tracing techniques. Biotinylated dextran amine (BDA) was injected into the unilateral LCN, and used as an anterograde tracer. Cholera toxin B subunit (CTb), used for light microscopy, and wheat germ agglutinin–horseradish peroxidase (WGA-HRP), used for electron microscopy, were injected into the contralateral LDS as retrograde tracers. Light microscopic analysis showed a good overlap of the distribution of BDA-labeled axon terminals and CTb-labeled neurons in the middle third of the CL in both dorsoventral and rostrocaudal axes on the LDS injection side. Electron microscopy confirmed the presence of direct synaptic contacts between BDA-labeled terminals and WGA-HRP-labeled dendrites in the CL.     

Expression of immunoregulatory cytokines in neurons of the lateral hypothalamic area and amygdaloid nuclear complex of rats immunized against human IgG

Present results showed that interleukin-1 (IL-1), IL-6 and transforming growth factor-beta (TGF-beta) were constitutively expressed in the supraoptic and paraventricular nuclei of the rat hypothalamus. Immunoreactive cells were also detected, but to a lesser extent, in other parts of hypothalamus as well as in the cerebral cortex. In rats immunized with IgG, there was moderate increase in immunoreactivities of the cytokines. A notable feature, however, was the induction of the cytokine expression in the lateral hypothalamic area and the amygdaloid nuclear complex, suggesting that the neurons in these two areas are involved in possible immune regulation.     

集合不足型外斜视外直肌斜向后徙

目的　评价集合不足型外斜视外直肌斜向后徙的效果。方法　研究组 2 2例 ,对照组 8例 ,看近斜视角大于看远斜视角至少 15PD ,研究组 2 2例行外直肌斜向后徙术 ,对照组 8例行标准的外直肌后徙术。结果　研究组 18/2 2术后看近外斜度≤ 10PD ,2 2 /2 2术后看远外斜度≤ 10PD ,看近看远外斜角平均差值由术前 2 5± 8 11PD减少到术后 5 2 3± 4 0 3PD。对照组仅 3 /8术后看近外斜度≤10PD ,6/8术后看远外斜度≤ 10PD。结论　集合不足型外斜视外直肌斜向后徙术效果优于标准的外直肌后徙术。     

川芎嗪对大鼠局灶性脑缺血后侧脑室室下区细胞增殖的作用

目的 观察川芎嗪对大鼠局灶性脑缺血后侧脑室室下区（SVZ）细胞增殖的作用。方法 SD雄性大鼠随机分为假手术组、缺血模型组和川芎嗪组。线栓法制作大鼠大脑中动脉阻塞模型，川芎嗪组术后2h腹腔注射川芎嗪（80mg／kg，1次／d），各组术后4h腹腔注射5-溴脱氧尿核苷（BrdU，50mg／kg，1次／d）。术后7、14、21d取材，采用免疫组织化学染色观察SVZ BrdU阳性细胞数和Doublecortin（DCX）的表达。结果 缺血模型组术后7d时SVZBrdU阳性细胞较假手术组明显增加（P〈0．01），并持续至14d，21d减少；川芎嗪组14dSVZ BrdU阳性细胞达峰值，21d有所减少，与缺血模型组比较，7、14dBrdU阳性细胞均明显增加（P〈0．01）。缺血模型组7d时SVZ有DCX阳性表达，14d达最多，21d表达减少，与假手术组相应时间点比较均明显增加（P〈0．01）；川芎嗪组随缺血时间延长SVZDCX表达明显增强，21d仍处于高水平，与缺血模型组比较，14、21dDCX表达明显增强（P〈0．01）。结论 川芎嗪对成年大鼠局灶性脑缺血诱导的SVZ神经干细胞／祖细胞增殖可能有促进作用。     

旋股外侧动脉升支肌骨瓣治疗髋部病损

髋部病变造成的股骨颈骨缺损及股骨头缺血性坏死病例的治疗方法较多。80年代以来,随着显微外科及修复外科的发展,利用带血管蒂的肌骨瓣、骨膜瓣修复髋部病损的新方法开始用于临床[1~3]。作者近6年来采用旋股外侧动脉升支阔筋膜张肌髂骨与骨膜瓣转位治疗髋部病损31例,获得满意效     

Surgical management of medial and lateral elbow instability secondary to acute atypical complex elbow dislocation: Case report and literature review

Introduction and importanceElbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. “Terrible triad” injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to “terrible triad” injury of the elbow with no radial head injury.Case presentationThe patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion.Clinical discussionMulti-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the “terrible triad” injury. Surgical options vary according to the surgeon’s experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively.ConclusionThe injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management.     

Arthrodesis for chronic lateral subtalar joint dislocation caused by posterior tibial tendon dysfunction: A case report

IntroductionAdult acquired flatfoot deformity (AAFD) caused by posterior tibial tendon dysfunction (PTTD) can lead to the development of peritalar subluxation (PTS) and much more rarely to lateral subtalar dislocation.Presentation of caseA 75-year-old woman was referred to our hospital with an approximately 15-year history of pain in her right foot without obvious trauma. The lateral shifting foot deformity had worsened in the previous 5 years. On presentation, she had tenderness over the talonavicular joint, and the skin overlying the talar head on the medial foot was taut. Imaging revealed lateral displacement of the calcaneus with simultaneous dislocation of the talonavicular and talocalcaneal joints. We diagnosed lateral subtalar dislocation including the talonavicular and talocalcaneal joints caused by PTTD, which we treated by reduction and fusion of the subtalar joint complex. The foot and ankle were immobilized with a cast for 6 weeks.DiscussionAt the 1-year follow-up visit, the patient reported no pain during daily activities, although flatfoot persisted.ConclusionWe report a rare case of chronic lateral subtalar dislocation caused by PTTD that was treated by fusion of the talonavicular and talocalcaneal joints.