创伤性睾丸脱位5例报告

目的 探讨创伤性睾丸脱位的诊断和治疗。方法 对所收治的5例患的诊治情况进行分析研究，并结合复习有关献。结果 1例手法复位成功，4例行手术复位．1例发生睾丸萎缩后切除患睾。结论 创伤性睾丸脱位临床少见，漏误诊率较高。对骨盆部、会阴部、阴囊部外伤患应警惕本病；详细检查阴囊及睾丸．确诊后尽早行手法或手术复位固定．定期随访。     

贺斯预防骨水泥所致低血压的临床探讨

目的:观察6%贺斯预防骨水泥所致低血压的效果。方法:30例人工股骨头置换病人随机分为两组:Ⅰ组为6%贺斯组(n=15);Ⅱ组为平衡盐组(n=15)。在填充骨水泥前分别输入6%贺斯及平衡盐500ml,分别测定入室(基础)、填充骨水泥前1min收缩压、填充骨水泥后5min最低收缩压,并观察心率变化。结果:Ⅰ组用骨水泥后最低收缩压明显高于Ⅱ组(P<0.01)。I组低血压发生率仅为13.3%,而Ⅱ组为60%。结论:在填充骨水泥前输注胶体能有效预防骨水泥所致的低血压。     

特异性COX-2抑制剂保护骨关节炎软骨的临床观察

目的探讨特异性COX-2抑制剂对骨关节炎的关节软骨保护作用的临床研究。方法门诊选取膝关节骨关节炎患者80例,随机分为特异性COX-2抑制剂组和维骨力对照组,各40例,单盲给药。应用平均Womac关节炎指数评分和平均OA严重程度指数评定两组用药前后临床症状改善情况及使用血清软骨代谢标志物蛋白聚糖与型胶原和关节MRI进行检测关节软骨结构与功能的改变情况,并作统计学分析。结果经12个月治疗观察,特异性COX-2抑制剂组的平均Womac关节炎指数评分和平均OA严重程度指数在前3个月改善明显优于维骨力对照组(P<0.01),但在治疗12个月后,两组差异不显著(P>0.05);治疗12个月后特异性COX-2抑制剂组的软骨代谢指标蛋白聚糖和型胶原及关节MRI均显示组内变化显著(P<0.01),而与维骨力组对比结果无显著性差异(P>0.05)。结论特异性COX-2抑制剂对骨关节炎的软骨有保护和促进修复作用,兼有抗炎与保护软骨双重疗效,它是一类既能改善关节炎症状又能改善关节软骨结构的药物,值得临床广泛应用。同时本研究为其在临床应用和进一步研究此类药物提供了更好的理论基础和依据。     

颈椎脱位的闭合复位

1985年5月～1996年3月,我们经治34例单纯颈椎脱位患者,30例行Crutchfield颅骨牵引闭合复位,20例成功,占66.6％。在成功组中,牵引重量最大为18kg,无一例出现神经损害加重。不全瘫均有不同程度恢复。尸体头颅标本测定,Crutchfield颅骨牵引承受的最大抗拨出力为60.3kg,在治疗颈椎脱位时,颅骨牵引是安全有效的闭合复位方法。     

Long-term results of open reduction for residual subluxation in congenital dislocation of the hip: A new open reduction method involving 360° circumferential capsulotomy

We report satisfactory results with a new operative treatment, conducted via an extensive anterolateral approach, involving 360 degree circumferential capsulotomy, for residual subluxation in congenital dislocation of the hip (CDH). Long-term radiographic results of this procedure (group A) were compared retrospectively with the results of partial capsulotomy (group B), which preserved the posteroinferior joint capsule. The mean center edge angle in group A (22.5°) was greater than that in group B (16.0°). Satisfactory results were achieved in 11 of 15 hips (73%) (Severin class I or II) in group A, and in 5 of 12 hips (42%) in group B. These results suggest that whole circumferential capsulotomy can remove obstacles to complete reduction, and that acetabular development can be expected in hips reduced by the procedure, without the performance of innominate osteotomy. We believe that our technique is a useful alternative for the treatment of residual subluxation in CDH.     

手术治疗外展外旋力所致踝关节骨折

手术治疗外展外旋力引起的踝关节骨折３５例，平均随访２年半，满意率为８８．６％。效果不佳者与软组织损伤严重和关节软骨受损有关。恢复腓骨的长度对防止距骨移位与倾斜十分重要。用钢板固定外踝时要使其下端适应腓骨下段的外翻角。下胫腓联合不论是完全还是不全分离，都应用螺钉固定，以增加踝关节稳定性，早期练习活动。三角韧带断裂时，只要腓骨解剖复位与坚强固定，三角韧带可不予修复。对小于胫骨远端关节面２５％的后踝骨折可不予处理。     

Posterior dislocation of the sternoclavicular joint: report of two cases,with emphasis on radiologic management and early diagnosis

Posterior dislocations of the sternoclavicular joint are uncommon, but are potentially quite serious. Radiologic diagnosis and management are frequently difficult. The specialized projections available are not widely known, and the role of plain films is poorly understood. The incidence, pathomechanics, and clinical manifestations of such dislocations are presented and the radiologic diagnosis is discussed.     

Synovial fluid levels of fluconazole in a patient with Candida parapsilosis prosthetic joint infection who had an excellent clinical response

A 73-year-old woman presenting with persistent swelling of the right knee 30 months after total joint arthroplasty was found to have a Candida parapsilosis infection. Treatment with fluconazole resulted in full recovery.     

The Mitek mini anchor in the treatment of the gamekeeper's thumb

The fixation of a distally ruptured ulnar collateral ligament of the MP 1 (Metacarpophalangeal) joint without a portion of ligament which can be sutured or a small bony fragment can be accomplished with a variety of methods, most of which require drillholes through borth cortices and a counter incision as well as the removal of the material at a second stage [1, 11, 13, 15]. The Mitek bone mini anchor (Ethicon-Mitek®) proved to be a reliable and quick alternative [10, 12, 16, 18, 19]. It was successfully used in eleven patients with excellent stability of the reconstructed joint.     

屈膝过程中的胫股运动特性分析

本文采用三维位移测量方法，测试１０例离体人膝标本的胫股关节三维运动特性。发现屈膝过程中，胫股运动也具有典型的三维运动特点。其中在屈膝初期的３０°内，胫骨内旋最明显并伴有胫骨内翻现象，平均内旋８°，内翻６－７ｍｍ，膝关节完全伸直时胫股扣锁使膝关节稳定，屈曲时胫股“解锁”使膝关节松弛，具重要的临床意义，同时提示，在解释传统的胫股扣锁现象时不应遗漏伴随发生的胫骨内／外翻现象。