电针对大鼠跟腱病影响的实验研究

目的：探讨电针治疗方法对跟腱病组织修复的影响,为电针治疗跟腱病提供科学依据。方法：从36只2月龄雄性SD大鼠中选出6只,设为空白对照组（A组,n=6）,对其余大鼠行跟腱病造模后随机分为阳性对照组（B组,n=18）、电针患侧组（C组,n=12）,B组随机分为‰组、B,组和B,组,各6只,C组随机分为C1组和C2组,各6只。造模3周后,C组取患侧的阳陵泉、足三里、承山以及太溪,给予电针治疗,每日1次,每次15min,10天为1疗程,共2个疗程,2疗程间隔2天,A组和B组大鼠不予任何干预,均自由饮食。造模3周后分别处死民组和A组大鼠,第一疗程和第二疗程后分别处死B1、C1、组和B2、C2、组大鼠,标本用H．E染色观察组织学结构改变,作跟腱内成纤维细胞计数后用Microsoft Excel统计软件进行统计分析。用免疫组织化学染色法检测TGF-β1表达情况,并与组织学观察及统计结果作比较,以评价跟腱病组织学恢复情况。结果：①细胞计数：第一疗程后C．组成纤维细胞数量显著高于B1组,差异具显著;第二疗程后C2组成纤维细胞数量显著低于B2组,差异具显著。②TGF-β1：A组未见TGF-β1表达,各期阳性对照组有弱阳性表达,而C组有TGF-β1阳性表达。结论：电针能改善跟腱病组织胶原纤维结构排列,有效地促进跟腱病的修复,其机制可能是电针刺激了TGF-β1的合成,进而促进了成纤维细胞数量增殖与胶原合成。     

Exact moment of tendon of pectoralis major muscle rupture captured on video

A powerlifting athlete ruptured his left tendon of the pectoralis major muscle while attempting to lift 160 kg in a Brazilian bench press championship. The injury seemed to occur in the concentric phase of exercise; however, the more common mechanism of rupture is during the eccentric phase. The tendon was reinserted to the humerus 3 weeks later with screws and washers. The athlete returned to competitive activities after 5 months. One year later he lifted 170 kg and won the national championship.     

MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome

Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed.     

Diagnosis and treatment of peroneal tendon disorders

Peroneal tendon disorders are a common cause of lateral hindfoot pain and dysfunction that are often overlooked and misdiagnosed. Disorders can be divided into instability, inflammation and tears but often occur concurrently or as a result of each other. A detailed history and examination is required with an early level of suspicion as there are several differential diagnoses with similar presentations. Investigations such as ultrasound and MRI are useful to confirm diagnosis. Understanding of the pathophysiology and evidence-based management of peroneal disorders is mostly backed by opinion-based medical literature. The majority of acute disorders can be managed non-operatively with rest and physiotherapy but in many cases arthroscopic or open surgery is needed. If not managed appropriately the problem can become chronic and very challenging to treat. Early recognition of the characteristic clinical findings and the appropriate use of investigations and treatments is therefore essential to prevent this. This review article focuses on current understanding of common peroneal tendon pathologies, their diagnosis and treatment.     

早期功能锻炼对髌骨骨折术后患者的影响

目的：探讨不同时期功能锻炼方法对髌骨骨折患者术后膝关节功能的影响。方法：选取2009年1月～2010年12月本院进行髌骨骨折术后的患者58例,随机分为两组,综合组29例术后早期采取被动锻炼及自主活动,对照组29例术后早期进行常规功能锻炼,两组患者术后3个月进行疗效评估。结果：综合组优良率为96.6%,对照组为62.1%,综合组优良率膝关节功能恢复显著高于对照组,P〈0.05。结论：早期功能锻炼能减少和预防并发症的发生,促进膝关节功能的恢复,但其中尤以综合锻炼组能够有效防止术后关节粘连,促进关节功能恢复,此综合锻炼具有临床推广应用的价值。     

Radiographic and Tomographic Analysis in Patients with Stickler Syndrome Type I

Objective: To further investigate the underlying pathology of axial and appendicular skeletal abnormalities such as painful spine stiffness, gait abnormalities, early onset osteoarthritis and patellar instability in patients with Stickler syndrome type I. Radiographic and tomographic analyses were organized.Methods: From a series of Stickler syndrome patients followed from early life to late childhood. Ten patients (6 boys and four girls of different ethnic origins were consistent with the diagnosis of Stickler syndrome type I ). Phenotypic characterization was the baseline tool applied for all patients and genotypic correlation was performed on four familiesResults: A constellation of axial abnormalities namely; anterolateral ossification of the anterior longitudinal spinal ligament with subsequent fusion of two cervical vertebrae, early onset Forestier disease (progressive spinal hyperostosis with subsequent vertebral fusion on top of bridging osteophytes and “Bamboo-like spine” resembling ankylosing spondylitis) and severe premature spine degeneration were evident. Appendicular abnormalities in connection with generalized epiphyseal dysplasia were the underlying aetiology in patients with Intoeing gait and femoral anteversion, early onset severe osteoarthritis of the weight bearing joint. Remarkable trochleo-patellar dysplasia secondary to severe osteoarthritis causing effectively the development of patellar instability was additional pathology. Mutation of COL2A1 has been confirmed as the causative gene for Stickler syndrome type IConclusion: We concluded that conventional radiographs and the molecular determination of a COL2A1 in patients with (Stickler syndrome type I) are insufficient tools to explain the reasons behind the tremendous magnitude of axial and appendicular skeletal abnormalities. We were able to modify the criteria of the clinical phenotype as designated by Rose et al in accordance with the novel axial and appendicular criteria as emerged from within our current study.     

Traumatic patellar tendinopathy

Purpose. In patellar tendinopathy, there is anterior knee pain with tenderness of the attachment of the patellar tendon over the lower pole of the patella. The condition is commonly associated with athletic overuse, but we have encountered it in some patients following direct blunt trauma to the anterior aspect of the knee. We describe the history and management of patients with traumatic patellar tendinopathy.

Method. Between April 2000 and August 2006, we managed eight otherwise healthy well trained athletes who developed signs and symptoms compatible with classical patellar tendinopathy after a direct trauma to the anterior aspect of the patellar tendon during sport activity.

Results. The clinical diagnosis of patellar tendinopathy was confirmed clinically and at imaging by MRI and ultrasound scans. Patients responded to conservative or surgical management, in the same way as patellar tendinopathy secondary to overuse.

Conclusion. A single direct traumatic event can lead to chronic tendon problems. Hence, in addition to overuse injury, patellar tendinopathy can follow a direct trauma and exhibit the same clinical features. Further research is required to better understand the pathophysiology of the clinical condition.     

羊肠线缝合内固定治疗髌骨骨折

目的：探讨羊肠线缝合内固定治疗髌骨骨折的疗效。方法：针对各种髌骨骨折的横断、粉碎骨折分别采用“U”形，交叉“U”形及“U”形或交叉“U”形加环形缝合内固定。结果：术后随访6个月至18年，骨折全部愈合，优良率达98.3%。结论：羊肠线缝合内固定治疗髌骨骨折，固定可靠，适应证广泛，无需二次手术取除内固定物，功能恢复好，并发症少，是治疗髌骨骨折的较理想的手术方法。     

膝关节制动对髌韧带力学特性影响的实验研究

目的：探讨膝关节制动对髌韧带力学特性的影响。方法：将兔膝关节伸直位制动６周，然后对制动前后髌韧带的本构方程、极限强度、弹性模量、极限载荷等力学特性进行研究。结果：正常组与制动组间髌韧带的应力－应变关系理论曲线有明显不同，其材料常数亦有显著差异；制动组髌韧带的极限强度和弹性模量较正常组均有明显下降，其极限载荷却下降并不明显。结论：膝关节制动使得髌韧带所受应力下降，为适应这种改变，组织将进行重塑，从而导致其力学特性的改变