冰冻盐水灌注兔膝关节的实验研究

目的　观察兔膝关节内组织经冰冻盐水灌注后有无组织损伤、关节内组织血管收缩、疼痛减轻的作用。探讨其临床应用的可行性。方法　利用冰冻盐水进行兔膝关节灌注并与常温盐水对比 ,分别取灌注后 30、 6 0、 90、 12 0 min内各种组织行病理学检查 ,术后松绑家兔 ,观察家兔的活动情况及对疼痛刺激的反应。结论　 3℃以下的冰冻盐水对关节内组织有损伤 ,而 4℃～ 8℃的冰冻盐水对关节内组织无损伤且有收缩血管、减轻关节疼痛、关节功能恢复快的作用。结果　应用冰冻盐水在家兔膝关节灌注试验。 4℃～ 8℃的冰冻盐水对关节内组织无损伤且有收缩血管的作用 ,切取组织活检 ,术后疼痛较常温盐水反应轻。     

Long-term survival analysis of the posterior cruciate condylar total knee arthroplasty: A 10-year evaluation

Long-term survivorship analysis was applied to 394 cruciate condylar type total knee arthroplasties. Clinical and radiographic parameters were evaluated. Failure was defined in three separate survival curves as revision, radiographic loosening, and a pain rating of 20 or less on the HSS knee score scale. Survival at 10 years, using only revision or recommended revision as the criterion for failure, was 94.7%. With the addition of the other two criteria, survival fell to 81% at 10 years. The posterior cruciate condylar knee survival is comparable to that of the total condylar knee when using comparable definitions of failure.     

膝色素沉着绒毛结节性滑膜炎的手术治疗

对12例膝色素沉着绒毛结节性滑膜炎病例的临床观察表明:关节镜检查有助于本病的诊断;局限型可采取单纯结节切除术,而弥漫型应采取综合治疗措施。作者指出,这是防止复发、保持关节正常活动范围行之有效的方法。     

抗Ⅱ型胶原抗体对正常关节软骨表层组织的影响

正常大鼠关节软骨表层组织在抗Ⅱ型胶原抗体的作用下,其表层胶原纤维网状结构可出现排列紊乱,失去乳头状突起等改变,但关节软骨表层结构的这种早期退行性变化在停止关节内注射抗体一段时间后可恢复正常。     

The response to medical litholytic treatment of gallstones according to their specific gravity

Summary The buoyancy of gallstones was observed by taking anterior-posterior scout X-ray films of two patients standing during endoscopic retrograde cholangiography. In case 1, the large and small gallstones differed in buoyancy, and ursodeoxycholic acid treatment dissolved the floating small stones while failing to dissolve the nonfloating large stone. In case 2, both the large and small stones floated and are being dissolved by ursodeoxycholic acid treatment. Since floating or nonfloating and the plane of flotation depend on the specific gravity of the gallstone, the above findings suggest that a gallstone with a low specific gravity is more readily dissolved than one with a high specific gravity. The present method of estimating the buoyancy of gallstones was therefore considered extremely useful in selecting patients for medical litholytic treatment.     

单侧多功能外固定器治疗“漂浮膝”的并发症

我科1993年5月～1998年12月应用单侧多功能外固定器治疗"漂浮膝"24例,在应用过程中出现一些并发症,现结合这些病例对其并发症发生的原因及预防措施进行讨论.     

温针治疗膝痛48例临床观察

目的：观察针灸临床中采用温针治疗膝关节疼痛中医辨证分型为痛痹一型的治疗效果。方法：取血海、梁丘、阿是穴1～2个为主穴，采用温针灸治疗，取辅穴根据临床症状随证加减，单纯针刺留针，每治疗10次为1个疗程计算。结果：温针治疗48例痛痹型膝关节痛的病例疗效明显，有效率达91．7％。结论：温针是治疗痹讧膝痛的有效治疗方法之一，治疗方法简单安全，应在针灸临床中广泛开展。     

The influence of the lower patellar pole in the pathogenesis of chronic patellar tendinopathy

Resection of the lower patellar pole provides good results in the treatment of jumper’s knee. Therefore we hypothesized that the length of the lower patellar pole is increased in patients with chronic patellar tendinopathy. Cohort study, level of evidence 2. Between 2000 and 2005, 25 patients with chronic patellar tendinopathy underwent conservative and surgical treatment in our clinic. All of them had preoperative MRI were three independent examiners measured the Caton Index, the length and the ratio of the articular and non-articular patellar surface, tendon length and thickness and the thickness and length of the hypodens lesions in the patellar tendon. The measurements were compared with 50 MRI of a control group with no clinical patellofemoral disorders or patellar tendinopathy. Significant changes in tendon thickness (9.42 ± 2.87 vs. 4.88 ± 1.13; P < 0.0001), a longer non-articular surface of the patella (10.62 ± 2.86 vs. 7.098 ± 2.53; P < 0.0001) and significant higher ratio between the articular and the non-articular patellar surface (0.32 vs. 0.24; P < 0.0001) were found in the jumper’s knee group. No significant changes were seen in the length of the articular surface or the Caton Index. The development of chronic patellar tendinopathy in athletes might be associated with a longer lower patellar pole as patients with jumper’s knee showed a longer non-articular patellar surface compared with the control group.     

Les lésions intra-articulaires et leur évolutivité au cours des ruptures récentes et anciennes du ligament croisé antérieur. Rapport préliminaire

The purpose of this study is to determine the natural history of chronic injuries to the ligaments of the knee, by assessing the ligamentous and intra-articular lesions with arthroscopy. Functional instability, laxity and chondromalacia are graded according to special scores.Method: 54 patients with acute and 375 patients with chronic anterior cruciate deficient knees had a complete clinical statement of their symptoms, and an examination under anesthesia. An arthroscopic examination of the knee joint determined the intra-articular lesions. These data were compared with the time span between the initial sprain and the arthroscopy (4 days to more than 20 years, average 4.5 years). 92% are resulting from accidents in sports activities. All had initially an untreated hemarthrosis.Results: functional instability varies with time: in the first year, 40% were functionnally stable. Their number gradually disappeared, and the instability score increased in the following years. After 10 years, most of the patients had a feeling of insecurity, or giving way.Laxity equally increases in the first 2 years. It then settles and diminishes after 10 years, with the onset of osteoarthritis. The Lachman test and the anterior drawer followed the same evolution. The pivot shift test was almost always present: 90% in the first year, 100% there after. A jerk in external rotation was present in 30% in the first year, and its rate went up to 65% between 2 and 10 years.The meniscal lesions aggravate in frequency and their type changes with time. Initially, 55% of both medial and lateral menisci were intact. After 10 years, 35% of lateral menisci remained intact, but less than 10% of medial menisci. Repairable vertical peripheral tears were frequent in the first 2 years, and were then replaced by complex unrepairable tears.The lesions to the anterior cruciate were total for 50% (complete ruptures, disappearance of the ligament) and incomplete (partial tears, insertion on the posterior cruciate, stretched anterior cruciate) for 50%. Laxity was significantly more important in the first group, indicating that the ligament may keep some biomechanical effect on the control of the laxity, even if it is abnormal.Chondromalacia score was close to 0 in the first year and then increased regularly. The medial compartment was first damaged, then the patella, last the lateral compartment. At 10 years, 30% of the patients had an osteoarthritis of the 3 compartments, 10% kept normal cartilages of the joint. Meniscectomies, even partial, aggravated the onset of arthritis, but did not correlate with an increase of the laxity.In conclusion, osteoarthritis is the final term of anterior cruciate ruptures. The 22 years period is a key in their evolution, if the surgical treatment tries to stabilize the lesions before they become unrepairable. Both symptoms of instability, laxity and lesions aggravate. Laxity is related to the initial damage to the supporting structures of the knee, and the progressive stretching of the peripheral restraints which remained intact at first, due to the non-functionnal anterior cruciate. Unfortunately, there is no evidence that surgery prevents the knee from post-traumatic osteoarthritis. The therapeutic indications must still rely upon functional disability.