腓骨长短肌腱鞘造影术在跟骨骨折中的应用及临床意义

目的通过影像学上客观的腓骨长短肌腱受压现象，探讨陈旧性跟骨骨折跟骨增宽引起跟骨外侧疼痛的原因。方法对2006年5-11月15例波及跟距关节面的跟骨骨折患者及15例陈旧性跟骨骨折遗留跟骨外侧疼痛的患者进行腓骨长短肌腱鞘造影术。左侧18例，右侧12例，均为单侧骨折。双侧腓骨长短肌腱鞘同时造影，然后用数字化放射影像技术进行踝关节正位、跟骨侧位和跟骨轴位x线片，再行螺旋CT二维测量和三维成像观察，并与对侧正常跟骨比较。结果30例患者均有不同程度的跟骨增宽和腓骨长短肌腱鞘受压现象。当跟骨增宽小于3mm时，造影剂可以通过；当跟骨增宽大于3mm时，造影剂通过受阻，腓骨长短肌腱鞘即出现受压现象。对于陈旧性跟骨骨折患者，跟骨增宽超过3mm以上即出现跟骨外侧疼痛。结论陈旧性跟骨骨折患者跟骨增宽对腓骨长短肌腱的压迫是引起跟骨外侧疼痛的原因。     

Using the FT-IR linear dichroism method for molecular order determination of tendon collagen bundles and nylon 6

Polarized Fourier transform-infrared (FT-IR) was used to compare the orientation of vibrational chemical groups of bovine tendon collagen bundles (CBs) to that of nylon 6, a simpler polyamide model, in terms of linear dichroism (LD). Subtraction of spectral profiles identified the most significant differences regarding the amide regions. At 1630 cm⁻¹, the CBs displayed higher peak areas and absorbance when positioned perpendicularly (A_⊥) to the plane of polarized light, in comparison with nylon 6. In contrast, at the 1526 cm⁻¹ amide II spectral region the inverse occurred. In the amide III region (1232 cm⁻¹), the LD was positive and higher for CBs. Dichroic ratios (DR = A_||/A_⊥) calculated from the average of ten measured spectra for CBs and nylon 6 revealed that the values for CBs were <1.0 in the 3298–1655 cm⁻¹ wavenumber range and >1.0 in the 1536–1234 cm⁻¹ wavenumber range. From 1535 to 1120 cm⁻¹, nylon 6 displayed DR values higher than those of CBs. The LD band integrated areas were higher in CBs than in nylon 6. The LD differences between CBs and nylon 6 are probably due to a more complex chemical composition and supramolecular oriented architecture in CBs in comparison to nylon 6.     

Optical Microscopy and Electron Microscopy for the Morphological Evaluation of Tendons: A Mini Review

The morphological characteristics of tendons have been thoroughly evaluated via microscopy. Optical microscopy and electron microscopy are the most commonly used techniques for tendon tissue observation. According to the principles of both microscopy types, preparation and evaluation methods vary. Simple optical microscopy is commonly used in the observation of cells and extracellular matrix, and many stains, including hematoxylin–eosin, Van Gieson, Prussian blue, Alcian blue, and toluidine blue, are used for evaluating cells, collagen fiber arrangement, and noncollagenous proteins. Histological scoring systems have been used in many studies for semi‐quantification. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) are the most commonly used electron microscopy types, and special consideration is needed for the fixation and embedding protocols. Glutaraldehyde followed by osmium is most commonly used in the chemical fixation of tendon tissue, followed by epoxy resin embedment. Longitudinal sections captured in SEM images show the arrangement of collagen fibrils and the cells and lipid drops among them, while cross sections captured in TEM images show the diameter and distribution of collagen fibrils. SEM and TEM are used together for comprehensive evaluations. This mini review is focused on the preparation methodology and related evaluation indexes for the morphological evaluation of tendons.     

Acute lateral ankle sprain alters muscle and tendon properties: Case series

BackgroundAcute lateral ankle sprain (LAS) is the most prevalent acute sports trauma. Ankle muscle atrophy and tendon volume decrease have not been analyzed concomitantly with functional impairment and pain following LAS. The objective of the present study was to investigate muscle cross-section area (CSA), tendon CSA and volume, ankle function, and pain in individuals who suffered an acute LAS.MethodsA series of cases, cross-sectional study with 20 participants who suffered moderate (grade II) and severe (grade III) acute LAS was undertaken. CSA for muscles (Tibialis Posterior, Fibularis, and Soleus) and tendons (Tibialis Anterior, Tibialis posterior, Fibularis, and Achilles), and volume were measured by magnetic resonance imaging (MRI) less than 48 h (baseline) and 6-weeks after the acute LAS. Ankle function (Cumberland Ankle Instability Tool [CAIT] and Foot and Ankle Outcome Score [FAOS]), ankle mechanical instability (Anterior Drawer Test [ADT]), and pain were also assessed.ResultsAll tendons and muscles showed a significant reduction in CSA and volume between baseline and 6-weeks (P < .001). A significant decrease in ankle function was observed 6 weeks after the LAS, along with a reduction in pain and mechanical instability (P = .001). Regarding sprain magnitude, the only difference observed was greater atrophy in muscle CSA in participants with grade III ankle sprain.ConclusionPatients with acute LAS showed atrophy of ankle muscles and decreased tendon volume and CSA, followed by function impairments at 6-week follow-up.Level of evidenceIV, Case series study.     

Evaluation of the Effusion within Biceps Long Head Tendon Sheath Using Ultrasonography

Background

Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath.

Methods

A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score.

Results

The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 ± 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease.

Conclusions

The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.     

超声定量评估肱骨结节间沟形态的准确性及可重复性

目的 探讨超声定量评估肱骨结节间沟解剖结构的准确性及可重复性。方法 回顾性分析42例行肩部超声检查患者的临床及影像学资料,19例于超声检查后1个月内再次接受CT检查,23例再次接受超声复诊。测量结节间沟的宽度、深度、开放角及内侧角。比较超声与CT、超声首诊与复诊所测数值的差异,计算组内相关系数（ICC）及变异系数（CV）,并评估2次超声检查的可重复性。结果 超声与CT测量结节间沟各参数差异均无统计学意义（P均>0.05）;2种方法测量结节间沟宽度、深度、内侧角的一致性中等（ICC=0.79、0.68、0.73）,测量开放角的一致性良好（ICC=0.94）,CV为5.78%~9.64%。超声首诊与复诊所测各参数差异均无统计学意义（P均>0.05）;测量结节间沟宽度、深度的一致性中等（ICC=0.65、0.74）,测量开放角、内侧角的一致性良好（ICC=0.98、0.94）,CV为3.61%~11.47%。Bland-Altman图显示95.65%（22/23）的数据点位于一致性界限内。结论 超声测量结节间沟解剖参数的准确性及可重复性较好,可用于定量评估结节间沟形态。     

肌腱移植加生物膜包裹修复Ⅱ区屈肌腱陈旧性断裂

目的 报告应用肌腱移植加生物膜包裹修复Ⅱ区屈肌腱陈旧性断裂的临床效果.方法 对27例36指屈肌腱陈旧性断裂患者,采用肌腱移植加医用可吸收生物膜包裹的方法进行修复,术后进行系统的康复锻炼,观察临床效果.结果 27例36指伤口均Ⅰ期愈合,术后随访4～36个月(平均13个月),按Strickland和Glogovac评价标准进行评价:优10指,良17指,一般和差共9指;优良率为75%.术后无一例发生肌腱再次断裂.9指效果一般和差者再次行肌腱松解术后3个月随访,优2指、良4指、一般和差共3指,总的优良率为92%.结论 肌腱移植加可吸收生物膜包裹修复Ⅱ区屈肌腱陈旧性断裂,可获得较满意的效果.肌腱牢固的缝合、可吸收生物膜的应用及术后早期系统的康复锻炼是获得良好效果的关键因素.     

筋痹与《黄帝内经》

筋痹首见于《黄帝内经》,是以病变部位命名疾病,乃痹证之一。系"风寒湿三气杂至,合而为痹也","以春遇此者为筋痹","大凡风寒暑湿之邪入于肝,则名筋痹"。临床表现为"痹…在于筋则屈不伸","病在筋,筋挛节痛,不可以行,名曰筋痹","手屈而不伸者,其病在筋,伸而不屈者,其病在骨。"治疗宜"在筋守筋",强调"筋病治当守筋,不可误求于骨","病在筋,调之筋"。治疗以"刺筋上为故,刺分肉间,不可中骨也。病起,筋炅。病已,止","恢刺者,直刺傍之,举之前后,恢筋急,以治筋痹也"。转归如《素问·痹论》所说:"筋痹不已,复感于邪,内舍于肝"。     

从经筋论治难治性面瘫

临床上单纯性面瘫的治疗效果较好,而患病1～2个月以上的难治性面瘫治疗效果却很不理想,下面将针对难治性面瘫谈谈我的心得体会,希望能给临床上治疗难治性面瘫提供一点思路。