X-Ray Study of the Cat Hindlimb During Treadmill Locomotion

With pulsed X-ray cinematography we have analysed the angular excursions of the distal hindlimb joints (proximal interphalangeal, PIP; metatarsophalangeal, MTP; ankle) in cats walking on a treadmill. These distal joints transmit the body weight and the dynamic forces onto the ground. We have included the knee and hip joints in the analysis to relate the angular excursions of the proximal and distal joints and to verify the data previously obtained with external markers on the kinematics of the proximal joints. At the beginning of the stance phase the PIP joints flexed rapidly, the MTP joints extended slowly and the ankle and knee yielded under body weight. Whereas the PIP joints maintained a rather constant angular position of −75° throughout the stance phase, extension continued in the MTP joints from −230° at touch-down to −270° at the end of the stance phase. Around 50 ms before lift-off the MTP joints flexed rapidly. Early (−30 ms) after lift-off this flexion changed into a slow extension. The PIP joints extended swiftly at the stance-swing transition and moderately at the end of the swing phase. During the middle part of the swing phase they flexed slowly. Small rotatory movements around the long axis of the foot took place in the last 100 ms of the swing phase. The results of this study on the distal joints are discussed in relation to the placing of the paw, to the translation of forward propulsion into a MTP movement and to the lifting of the paw (conventionally described as toe curling). They show a differentiated mechanical interaction between the different distal limb joints during these different phases, which must be known in detail to interpret the corresponding electromyographic data and to understand how the hip is moved forward over the MTP joints which serve as the final pivot during stance.     

Effects of capsaicin in temporomandibular joint arthritis in rats

Temporomandibular joint (TMJ) arthritis was induced in female Lewis rats by unilateral injection of a suspension of heat-killed Mycobacterium butyricum in paraffin oil into the TMJ. Control rats received paraffin oil by the same route. Arthritic and control rats were pretreated either with capsaicin or denervation of the mandibular branch of the trigeminal nerve. Tissues were collected for neuropeptide extraction and analysed by radioimmunoassay and reverse-phase high-performance liquid chromatography. In all groups, the levels of substance P- (SP), calcitonin gene-related peptide- (CGRP) and neuropeptide Y- (NPY) like immunoreactivity (LI) were higher in the trigeminal ganglia than in the TMJs. In control rats, capsaicin significantly lowered the levels of SP-LI in the trigeminal ganglia and TMJ, but not CGRP-LI and NPY-LI. In the arthritic rats, capsaicin pretreatment significantly lowered the SP-LI and CGRP-LI in the trigeminal ganglia and TMJ, but not the NPY-LI. In the trigeminal ganglia the unilateral denervation significantly lowered SP-LI in control rats, and in arthritic rats SP-LI and CGRP-LI. On the denervated side of the arthritic TMJ, NPY-LI, SP-LI and CGRP- LI were significantly lowered as compared to the arthritic control rats and to the contralateral side. In this rat model, pretreatment with capsaicin and surgical denervation decreased the neuropeptide content in the trigeminal ganglia and the TMJ. The results clearly demonstrate a close interaction between increased neuropeptide release from sensory and sympathetic neurones after induction of arthritis in the rat.     

寰枢椎侧块关节运动轨迹数学模型的探讨

应用最小二乘法拟合得到寰枢椎侧块关节运动轨迹方程 ,左半部是 :S(x) =-2 3 .2 42 9-8.663 1x-0 .45 91x2 ;右半部是 :S(x) =-19.683 8+ 7.15 5 4x-0 .3 5 2 6x2 。     

膝关节镜下膝后侧腔室联合手术入路的探讨

[目的]探讨在关节镜下膝关节后侧腔室联合手术入路的重要性和可操作性。[方法]经过前内侧、前外侧和股骨髁切迹以及后内侧、后外侧和后纵隔内切口联合入路分别入镜、入器械，进行膝关节后侧腔室的探查和手术操作。[结果]216例（239膝）应用联合入路探查和治疗，其中5例膝因关节僵硬操作失败；175例膝用于治疗后侧腔室疾病，膝关节后侧腔室手术视野显著改善，探查和手术操作完善，均达到手术目的。1例膝内侧隐神经不全损伤，没有腘后神经、腓总神经、腘后血管、交叉韧带等重要组织损伤。[结论]膝关节后侧腔室病变较多，是检查和治疗的重要部位，并非“技术盲区”。这种联合手术入路，手术风险低，具备可操作性，可以提高手术效率和质量，可作为膝关节镜下常规手术入路。     

旋转铰链型与单纯铰链型膝关节肿瘤假体置换的临床比较研究

目的 研究膝关节肿瘤保肢手术两种假体置换的术后效果及其比较.方法 随访我院1999年6月2006年3月治疗的72例膝关节肿瘤患者，失访9例，余63例中40例采用单纯铰链型假体置换(A组)，23例采用旋转铰链型假体置换（B组）63例随访时间9月~8年平均3年9个月，按MSTS膝关节评分标准、ambulation scores、关节屈伸度及感染、复发、手术时间进行评估。结果：A组：手术时间2.6625±0.3362h，复发5例，转移死亡3例，感染2例； B组：手术时间2.5722±0.2878h，复发3例，转移死亡2例，感染2例 。B组1例术后发生旋转轴聚乙烯轴套断裂关节脱位，再次手术更换轴套后未再出现并发症，两组无假体松动病例。两组手术时间无统计学意义；去除复发及转移死亡病例后,剩50例, A组32例， MSTS评分平均23.0/30分。 B组18例，MSTS评分平均23.7/30分。两组MSTS评分p>0.05，无统计学意义；ambulation scores各分项总分均p<0.05，有统计学意义．两组关节伸直时为0°或接近0°,屈曲度A组119.3750±17.49°，B组125.0000±15.34°，无统计学意义（p>0.05）。结论： 1. 按ambulation scores标准，在步行舒适度和快速步行方面，旋转型铰链假体置换组与单纯铰链型假体置换比较有统计学意义；2.而MSTS标准则未能体现出两组术后功能方面的统计学意义，因此ambulation scores较MSTS评分更灵敏，更适合对膝关节保肢术后功能评价；3.两组在手术时间、术后临床屈伸功能及并发症方面，如复发、感染，未见显著差别，单纯铰链型不会出现脱位，而可旋转铰链型假体有脱位的可能。     

螺旋CT及CAD技术在人工关节定制设计中的应用研究

随着生物医用材料研制和医学的迅速发展，以及生活水平、医疗保健、康复水平的提高，人们对自身组织、器官及骨骼缺损的修复和置换方面的要求日益提高，尤其对人造骨骼和人工关节的需求越来越广泛。由于计算机断层成像技术CT（computed tomography）已经成为显示和研究人体内部结构非常有用的手段，将计算机辅助设计技术CAD（Computer aided design）和计算机辅助工程CAE（Computer aided Engineering）等相关技术应用于人造骨骼和内置假体的设计，不仅可以提高产品的设计质量，同时，结合CT和计算机三维重建方法，     

浮膝损伤的手术治疗

目的 探讨手术治疗浮膝损伤的疗效.方法 将13例浮膝损伤,按Fraser分型方法分为4型.Ⅰ型7例,Ⅱa型3例,Ⅱb型2例,Ⅱc型1例.所有病人均行手术复位固定,术后早期功能锻炼.结果 术后随访1～3年.疗效评定采用Karlstrom和Olerud标准.优8例,良2例,可1例,差2例.结论 对浮膝损伤的手术治疗,视全身及局部情况选择适当的内固定或外固定器,其中交锁髓内钉内固定效果好.     

中药熏洗治疗膝关节骨性关节炎的Meta分析

为运用循证医学方法对中药熏洗治疗膝骨性关节炎（OA）的临床疗效及安全性进行系统评价和Meta分析。全面收集了中药熏洗治疗OA的文献资料。在严格质量评价基础上，对研究结果进行定性分析。合并各篇优、良为阳性结果，中、差为阴性结果。利用RevMan4．1软件对多个研究结果的总体疗效进行固定效应模型的Meta分析，并进行敏感性分析。用漏斗图表示发表性偏倚。结果显示，中药熏洗治疗OA的效应值OR=2．68.95％可信区间为[1．82，3．95]；敏感性分析显示效应值稳定；漏斗图图形不对称；无中药熏洗不良反应的报道。表明中药熏洗治疗OA有一定的疗效，由于漏斗图提示存在发表性偏倚，加上现有临床研究存在的方法学问题，现在的研究结论有一定的局限性，欲得出公认的结论，尚有待进行设计严谨的多中心、随机对照试验。     

前踝骨折诊治分析5例

踝部骨折是最常见的关节内骨折,约占全身骨折的3.9%[1]。自1998年4月至2004年3月收治单纯前踝骨折5例,现报告如下。1临床资料本组5例,均为男性;年龄18～24岁;左侧3例,右侧2例。受伤至住院时间为2h～1d,均为训练时从高处跳下垂直暴力所致。按Lauge-Hansen分类系统踝关节骨折分为