针刀配合膝关节间断主动活动治疗膝关节强直

膝关节强直是膝关节及关节周围创伤、关节炎晚期及手术后的严重并发症,同时伴有髌骨活动度严重减少甚至消失.病理多为髌上囊及两侧沟的广泛粘连,部分患者伴有关节外结构的挛缩.物理治疗几乎无效、开放性手术切开松解及关节镜下松解创伤大,出血多,存在再粘连的可能性,手术并发症多,一次手术失败,没有再次松解的机会.我院自1997年8月-2002年3月,应用针刀闭合松解加关节间断主动活动治疗严重膝关节粘连52例疗效满意.……     

逆行交锁髓内钉治疗股骨髁上骨折及关节僵硬

目的：探讨应用逆行交锁强内钉治疗陈旧性股骨碟上骨折钢板断裂不愈合并膝关节僵硬的临床意义。方法：对5例患采用断裂钢板拆除，手术松解粘连，矫正畸形，股骨碟逆行交锁铝内钉固定，术后早期应用CPM机锻炼。结果：5例随访8—12个月，肢体无畸形，骨折愈合时间6—9个月，平均7．5个月，膝关节功能按Kolmert评定标准，优4例，良1例。结论：应用逆行交锁铝内钉治疗股骨碟上陈旧性骨折钢板断裂骨不愈合并膝关节僵硬，操作简便，固定牢靠，可早期功能锻炼，效果良好。     

Application of Isolite system during treatment of dental caries identified in submerged mandibular second primary molar

We used the Isolite system for treatment of dental caries identified in a submerged mandibular right primary second molar. A 5-year-6-month-old girl was referred to our clinic for close examination of an impacted mandibular right second primary molar. An intraoral examination showed a slight pit extending inside the gingiva and on the occlusal surface of the tooth. X-ray photographic examination revealed that the affected tooth was severely submerged and had a radiolucent area on the occlusal surface, which extended close to the pulp cavity. Most of the periodontal ligament space could not be clearly identified except for the distal side of the distal root. We considered that the area of the tooth was partially ankylosed and consulted with oral surgeons, who decided to postpone extraction, due to the presence of the permanent successor close to the affected tooth. Thus, we treated the dental caries, which appeared to be technically difficult because of the deep location of the tooth. The Isolite system was utilized in this case, as we considered that adjacent soft tissue and saliva could be excluded with its use. Under infiltration anesthesia, gingival tissue covering the occlusal surface was removed with an electric knife, and the carious lesion was removed, which resulted in pulp exposure. Severe inflammation of the pulp was revealed and pulpectomy was performed. There were no signs and symptoms after the treatment. At 1 year after treatment, the occlusal surface remained exposed and no inflammatory findings were observed in adjacent gingival tissue.     

快速免疫色谱测定法在骨关节结核诊断及鉴别诊断中的价值

目的探讨快速免疫色谱法对活动性骨关节结核的诊断价值。方法采用ＩＣＴ快速免疫色谱法检测７５例活动性骨关节结核、６９例以肿瘤为主的骨病患者及７２名正常人血清中的抗体。结果骨关节结核组阳性率为８０％，其中脊柱结核阳性率为９０％，脊柱以外的关节结核阳性率为６１％，合并其它部位结核阳性率为７６％；骨病组３例阳性，正常组２例阳性，假阳性率分别为４％和３％。结论ＩＣＴ快速免疫色谱法是骨关节结核诊断和鉴别诊断的一项有用的辅助手段     

Factors Influencing Treatment Plan and Post Operative Compliance in TMJ Ankylosis Patients: A Retrospective Analysis of Long Term Post Surgical Evaluation

Background and objective

Ankylosis of the temporomandibular joint is a clinical entity significant for a maxillofacial surgeon. Since time immemorial humanity is battling with this condition which is not just disfiguring the normal anatomy of the face but severely hampers the function of mastication. In this study we have tried to evaluate and correlate various factors leading to causation of ankylosis of TM Joint along with clinical manifestation and treatment planning as well as outcomes.

Study design

This is a retrospective study, records of 60 patients were selected out of which 28 patients reported for recall. Based on a predefined format, patients were evaluated and correlation was looked up on various accounts such as age of occurrence and age of reporting to the surgeon, probable etiology, sex distribution, treatment modality and postoperative outcome.

Results

The mean age of onset or occurrence was 4–7 years of age whereas age of reporting to the clinic was 16–17 years. Highest percentage of patients had trauma as an etiology (64 %) and the lowest percentage had congenital deformity (21 %). Three surgical techniques were evaluated and compared for their post surgical mouthopening, gap arthroplasty was done in 61 %, interpositional arthroplasty in 39 % and low ramus osteotomy in 21 %.

Conclusion

This study was aimed at analyzing the clinical form and function of the post surgical patient reviewing the recent radiographs to analyze the surgical site. The data collected was (1) Age of occurrence and age of reporting with the deformity (2) Etiological history (3) Sex and Side predisposition (4) Procedure used for correction of deformity (5) Recall (follow up) data especially recurrence and physiotherapy. We arrived at a conclusion that mean age of occurrence of deformity was approximately 4.7 years and age at which patient reported to clinic was 16.2 years. The main etiological factor was trauma (51 %) and ear infection (21 %). 57 % patients presented with unilateral deformity, with both the sides equally effected. The effectiveness of gap arthroplasty, interpositional arthroplasty and low ramus osteotomy procedures was evaluated. Gap arthroplasty and interpositional arthroplasty were found to be effective procedures. The importance of post operative physiotherapy was emphasised yet again through this study.     

翼外肌在髁突矢状骨折愈合过程中对髁突形态改建的影响

目的：本实验的目的是检查翼外肌在髁突矢状骨折愈合过程中,对髁突形态改建的影响。方法：20只1岁龄成年绵羊,随机分为两组,每组10只动物,所有绵羊都用超声骨刀造成髁突矢状骨折,剪断关节盘前后附着并将其推向内侧,其中组1动物切断翼外肌,组2动物保留翼外肌功能。每组动物分别在术后4周（各2只）、12周（各4只）、24周（各4只）处死。处死后行CT检查,CT三维重建观察髁突形态,并解剖颞颌关节（TMJ）以观察髁突形态。结果：组2即保留翼外肌功能组,较组1髁突有更多新骨形成,髁突形态改变更严重。结论：翼外肌在髁突矢状骨折愈合过程中对髁突形态改建的影响起非常重要的作用。     

Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis

Tuberculosis （TB） occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and inter- nally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by anti- biotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to anti- tubercular drug therapy （ATT）, the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.     

The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process

The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.     

68例骨关节结核的临床特征

目的 探讨骨关节结核的临床特点。方法 对北京协和医院2013年1月至2020年12月住院治疗的68例骨关节结核患者进行回顾性分析。结果 68例骨关节结核患者中,男42例(61.8%)、女26例(38.2%),中位年龄56岁。病原学诊断39例(57.4%)、临床诊断29例(42.6%)。从发病至确诊的病程中位时间为4个月。局部疼痛和功能障碍(86.8%)是最常见的临床表现,其次是发热(47.1%)、消瘦(36.8%)和盗汗(13.2%)。27例(39.7%)合并其他部位活动性结核。单一部位骨关节结核51例(75.0%)、多发骨关节结核17例(25.0%),胸椎和腰椎是最常见受累部位。92.7%的患者结核T细胞检测阳性。患者骨组织活检标本提示上皮样肉芽肿伴/不伴坏死,75.0%的患者组织PCR检测结核分枝杆菌DNA阳性,55.1%的患者组织分枝杆菌培养阳性,20.0%的患者组织抗酸染色阳性。相较单一部位骨关节结核,消瘦患者出现多发骨关节结核的风险是无消瘦患者的5.333倍(P=0.013)。结论 骨关节结核诊断困难,结核T细胞检测是有效的鉴别手段,组织活检是确诊的关键,PCR检测结核分枝杆菌DNA阳性率最高。多发骨关节结核并不罕见,尤其是消瘦患者,建议进行全面的影像评估避免漏诊。