改良限制性切口额颞部除皱术

目的　为提高额颞部除皱术的效果 ,延长有效时间 ,从理论与实际观察探讨额颞部老年化改变形成的原因 ,并采用相应的手术术式进行矫正。方法　肿胀麻醉下 ,通过颞部发际缘切口入路 ,在颞深筋膜浅面剥离 ,内达颞肌前缘及眶外缘 ,下达颧弓上缘 ,后达耳屏前线。额部切口入路在帽状腱膜下剥离 ,下达眶上缘外至颞线后至枕外隆突。口腔内上颊龈沟入路在颧骨及颧弓骨膜下剥离。上述各剥离区域相互贯通 ,最后将颞区皮瓣上提 ,并将颞浅筋膜与颞深筋膜缝合固定。结果　本组共 32例 ,术后眉外侧平均上提 8mm ,鼻唇沟变浅 ,获随访的 7例为术后 3～2 4个月 ,除皱效果满意。结论　本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊 ,同时减少上面部降肌的作用 ,相对增强提肌的作用 ,再辅以筋膜及皮肤上提固定达到除皱的目的 ,效果确实、可靠、安全、持久。     

Corpectomy for multi-level cervical spondylosis and ossification of the posterior longitudinal ligament

The choice of a surgical approach for multi-level cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) is still a controversial issue. While most of the surgeons are still performing decompression by laminectomy some are doing multi-level anterior decompression. Few neurosurgeons are performing decompression by corpectomy. We have treated 26 patients by median cervical corpectomy during the last 4 years. These patients were followed up for a mean period of 25 months. Twenty one (80%) patients had a good outcome, 2 patients remained unchanged and 3 expired. Review of the literature and our experience indicates that patients with CSM and OPLL should be operated by median cervical corpectomy (anterior approach).     

MRI在膝关节损伤诊断中的应用价值

目的:通过膝关节损伤MRI影像的分析,确定其诊断价值及意义。材料和方法:本文收集了自1992年以来我院所检查的42例膝关节损伤患者,52个膝关节成像。其中男性34人;女性8人,各年龄组以30～40岁组最多。损伤以前交叉韧带和外侧半月板损伤者多见,分别占总损伤数的20％及30％。损伤又以左膝多见,占总数的61％。结果:MRI能较明确地显示膝关节的半月板、关节软骨、韧带、滑膜及骨质的改变,明显地比CT所能看到的层次多,对软组织的损伤显示清晰。结论:只要正确地应用不同序列及切层方向、厚度等技术,可清晰地显示其信号特征,从而能确定其损伤部位、程度。     

Efficacy of tolterodine in women with detrusor overactivity and anterior vaginal wall prolapse: is it the same?

The aim of this study was to assess the efficacy of tolterodine in women with overactive bladder (OAB) and concomitant anterior vaginal prolapse. In this prospective study, 235 consecutive women with OAB symptoms and urodynamic diagnosis of detrusor overactivity who either had no prolapse or had pure anterior vaginal prolapse were included: 184 women (group 1) had no prolapse and 51 women (group 2) had anterior prolapse greater than and equal to stage IIa. Tolterodine 4 mg slow release once a day was prescribed. After 12 weeks, women were reassessed using a 3-point scale (no change, improvement and cured). A total of 158 (85.9%) women in group 1 and 31 (60.8%) women in group 2 reported improvement or cure ( P = 0.0002). Women with OAB and significant anterior vaginal prolapse should be informed of a reduced efficacy of antimuscarinics in treating their urinary symptoms.     

子宫阔韧带肌瘤的CT诊断

目的　探讨子宫阔韧带肌瘤的CT诊断价值。方法　收集 2 1例子宫阔韧带肌瘤CT资料 ,进行回顾性分析 ,所有病例均经手术病理证实。结果　 2 1例均在盆腔内、子宫外显示肿块 ,CT表现 :实质性肿块 19例 ,边界清楚光整 16例 ,不甚清楚 3例 ,密度均匀 6例 ,平扫时与子宫肌密度相当 ,增强扫描呈明显强化 ,与子宫肌强化基本同步 ,不均匀 13例 ,其强化程度低于子宫肌 (约相差 10～ 2 0HU) ,瘤内变性、坏死或液化区不明显强化或不强化 ;囊实性 2例 ;肿块位置较固定 ,大多在宫旁匍匐生长 ,与子宫位置密切相关 ,其最大径层面与子宫体中心层面基本保持一致 ;形态各异 ,呈条块状、哑铃分叶状及扁圆烧饼状共 15例 ,呈圆形、椭圆形6例。结论　子宫旁呈条块、哑铃分叶状及扁圆烧饼状的实质性或实质性为主的肿块是本病较为可靠的CT征象 ,CT对诊断阔韧带肌瘤有实用价值     

板股韧带的MRI研究及临床意义

目的　明确板股韧带正常MRI表现 ,建立由它所致假撕裂与外侧半月板后角真撕裂的鉴别方法。资料与方法　采用 6 0侧正常膝进行矢状和冠状位MR扫描 ,观察板股韧带的MRI表现。结果　板股韧带显示率为88.3% (5 3侧 ) ,其中板股前韧带为 2 6 .7% (16侧 )、板股后韧带为 86 .7% (5 2侧 )和两条韧带同时存在为 2 3.3% (14侧 )。板股韧带在矢状像上表现为位于后交叉韧带前或后方的类圆形或短棒状低信号结构 ,而在冠状像上表现为自外侧半月板后角至股骨内侧髁外侧面的条带样低信号结构。在矢状像上 ,5 2 .8% (2 8/5 3)板股韧带与外侧半月板后角之间显示出一线样高信号 ,被称为假撕裂 ,易与外侧半月板后角撕裂混淆。但假撕裂仅有两种走行方向即后下斜行 (2 1/2 8)或垂直方向 (7/2 8)。结论　根据假撕裂位置、方向以及冠状像和连续矢状面的观察 ,可正确区分外侧半月板后角真假撕裂     

Double-bundle technique: Endoscopic posterior cruciate ligament reconstruction using tibialis posterior allograft

Recently, attention has been given to the double-bundle technique for treating the posterior cruciate ligament (PCL)-deficient knee. We present an arthroscopic PCL reconstruction using a double-bundle technique with 3-stranded tibialis posterior (TP) allograft that has not been described before. The anterolateral bundle of the PCL is reconstructed using 2-stranded TP allograft and the posteromedial bundle using 1-stranded TP allograft. Three-stranded TP allograft will be an alternative graft choice for PCL reconstruction.     

肌腱结嵌压固定法重建前交叉韧带生物力学实验研究

目的探讨绳肌腱结嵌压固定法重建前交叉韧带(ACL)影响初始固定效果的相关因素及对策。方法采用猪膝关节模拟重建ACL不同术式,即绳肌腱结股骨隧道嵌压固定和胫骨端肌腱编织缝合骨桥打结固定法,与骨-髌腱-骨两端界面螺钉固定法,比较其生物力学初始固定最大拔出载荷、抗拉刚度和位移等生物力学指标。结果最大抗拉载荷肌腱结组与正常ACL组接近,无显著性差异;肌腱结组大于骨-髌腱-骨界面螺钉固定组。抗拉载荷在100N和400N时的位移两组无显著性差异。胫骨端肌腱编织缝合骨桥上打结固定组最大抗拉载荷大于BPTB界面螺钉固定组和肌腱编织缝合后界面螺钉固定组。抗拉刚度正常ACL组>骨-髌腱-骨组>绳肌腱结组。最大位移正常ACL<髌腱骨组<肌腱结组。结论绳肌腱结嵌压固定法抗拉强度和刚度完全可以满足重建后ACL的生理需求;术中克服位移因素,是有效防止ACL重建术后松弛的关键。