尺侧腕屈肌移位重建屈肘功能16例疗效分析

我院于1998年1月～2002年9月行尺侧腕屈肌移位重建屈肘功能16例，现将疗效分析如下。１资料与方法１．１一般资料本组16例，男15例，女1例；年龄18～38岁，平均28.8岁。其中臂丛神经上、中干损伤13例，上干损伤3例。手术距受伤时间10个月～32个月，平均15个月，术前尺侧腕屈肌肌力均5级。2例术前曾行臂丛神经探查松解术，1例术后行肩外展功能重建术。１．２手术方法臂丛神经阻滞或全麻下，取仰卧位，前臂内侧直切口，掌横纹处切断尺侧腕屈肌腱，逆行游离远端2/3肌腱及肌腹；肘前横切口，经皮下隧道与前臂切口相通，将尺侧腕屈肌游离端抽出至…     

骨间前神经旋前方肌支移位修复鱼际肌支,尺神经深支的？…

为了进一步主宰骨间前神经移位术式的可行性，选用１０例新鲜前臂标本，对骨间前神经旋前方肌支、鱼际肌支及尺神经深支进行显微解剖，发现正中神经旋有方肌支前径为（１．５±０．４）ｍｍ，分别测量各肌支的有骨神经纤维数为（８６６±１４４）条；正中神经鱼际返支直径为（１．７±０．３）ｍｍ，有糊神经纤维数为（１１２０±９７）；尺神经深支直径为（２．１±０．４）ｍｍ，有髓神经纤维数为（１３６８±１２０）条。用神经移     

尺神经肌下前置术治疗尺神经延迟麻痹

尺神经肌下前置术治疗尺神经延迟麻痹谈志秋，邵维城，秦世杰，王毛顺尺神经肌下前置术是在尺神经前置术的同时，加作肱骨内上踝屈腕肌群起点松解，以此治疗尺神经延迟麻痹，可使尺神经嵌压得以松解；屈腕肌群亦得以松解。用本法治疗，具有比尺神经皮下前置术有更好的疗效...     

程序化操作在尺神经皮下前置术中的应用

目的 探讨程序化手术操作在尺神经皮下前置术中的应用效果.方法 我院自2017年1月至2019年12月采用尺神经松解皮下前置术治疗肘管综合征病人34例.所有病人均采用程序化操作处理前臂内侧皮神经、Struthers弓、内侧肌间隔、Osborne韧带、尺侧腕屈肌两头、指浅屈肌筋膜、尺神经伴行血管、尺侧屈腕肌肌支及关节支、屈...     

尺侧腕伸肌转位重建拇指外展、对掌功能

我科对20例因正中神经损伤导致拇指丧失对掌、外展功能的病例，行尺侧腕伸肌腱加掌长肌腱转位重建拇指外展、对掌功能，取得良好效果。１资料与方法１．１一般资料本组20例，其中4例因正中神经毁损无缝合条件行急症手术；8例正中神经缝合后形成神经瘤，瘢痕粘连，鱼际肌萎缩，拇指对掌、外展功能丧失；6例断腕再植后拇指功能恢复较差；2例正中神经的腕横支和鱼际肌挫灭伤，外展肌腱毁损，急症重建。１．２手术方法臂丛麻醉后，患肢外展，掌背侧取“S”切口，分离出尺侧腕伸肌，从止点处切断，分离至尺骨茎突处，做皮下隧道，转向掌侧，斜向…     

前臂肌腱部分移位修复桡尺远侧关节脱位的应用解剖

目的为前臂肌腱部分移位修复桡尺远侧关节脱位提供解剖学依据。方法30侧成人上肢标本,将尺侧腕屈肌腱、尺侧腕伸肌腱、桡侧腕长伸肌腱、肱桡肌腱作形态学测量,将尺侧腕屈肌腱、尺侧腕伸肌腱进行力学测试。结果尺侧腕屈肌腱长(16.7±2.7)cm;尺侧腕伸肌腱长(14.9±2.5)mm;桡侧腕长伸肌腱长(19.0±2.0)cm;肱桡肌腱长(11.7±2.4)cm。力学测试:尺侧腕屈、伸肌腱其全肌腱破坏载荷分别为(2.4±0.9)Mpa、(3.1±0.9)Mpa,半肌腱破坏载荷分别为(2.2±0.9)Mpa、(2.5±0.8)Mpa,t检验无显著性差异。结论前臂肌腱部分转位有足够的长度和强度修复桡尺远侧关节脱位。     

尺神经肌下前置术治疗肘管综合征

目的 探讨尺神经松解加肌下前置术治疗肘管综合征的有效性。方法 观测２０例成人尸体上肢标本及３２例患者尺神经移置前后的解剖变化,临床应用３２例。结果 尺侧上副动脉可与尺神经一前置;皮下前置伸肘位时尺神经易受牵拉,肌下前置伸、屈肘时均不受牵拉;新肘管可充分容纳尺神经。３２例中获完整随访２６例。随访期１～３年,１６例（６１．５％）恢复正常。结论 尺神经松解加肌下前置术为治疗肘管综合征较佳术式。     

尺、桡侧腕屈肌内神经分布和血供特点的研究

目的研究人尺侧腕屈肌和桡侧腕屈肌内神经分布、血供模式及肌肉结构。探讨将其分成两个或两个以上具有独立神经和血管支配肌肉束的可能性,指导临床切取部分肌肉移植重建运动功能的应用。方法以解剖学、血管造影、肌内神经染色等方法,研究神经和血管在两肌内的分布特点;电刺激神经支,检测相应肌束可否具有独立收缩功能及正常血供;测量肌肉的生理横截面积和肌纤维长度,并与相关肌肉比较。结果支配和供应两肌肉的主要神经和血管均在肌腹的近、中1/3结合部入肌,神经在肌内分成2支,分别在肌中央腱两侧沿长轴走向远端,直至肌肉的末端,且与血管紧密伴行;电生理证实,沿中央腱将肌肉分成的两部分在功能上具有独立性;该两肌的尺侧部和桡侧部生理横截面积和肌纤维长度与支配手的有关肌肉相近。结论尺侧腕屈肌和桡侧腕屈肌都可分成两个具有独立的神经支配及血管供应、功能上相对独立的肌束,可用于转位移植重建运动功能,而且对供区的功能影响也较小。     

腕部尺神经深支卡压综合征

目的了解腕部尺神经卡压的受压因素及其临床特点。方法对１０具２０侧成人上肢标本进行解剖,仔细观察腕部尺神经深支解剖特点;并对临床５例腕部尺神经深支卡压患者行手术治疗。结果尺神经深支均穿过小指短屈肌的腱性纤维弓,平均长５．２ｍｍ,此处尺神经深支有伴行动脉横跨;手术切开该纤维弓并作神经松解,经２～４年随访,疗效满意。结论尺神经深支卡压主要是小指短屈肌的腱性弓状缘,术中应彻底切开该缘。     

尺侧腕屈肌移位重建屈肘功能

１９８１年５月～１９９２年１１月，连续应用尺侧腕屈肌移位重建屈时功能２１例。经平均３．８年随访，肘关节屈伸活动度最小为７０°，最大为１２０°。肌力最小达Ⅲ级，最大达Ⅴ级。全部病人能满足日常生活工作需要。讨论了在屈时功能重建的同时，需从上肢整体功能考虑肩关节的稳定性及前臂旋转功能。分析了影响疗效的因素，包括肱三头肌肌力不足致伸肘障碍；尺侧腕屈肌肌力小于Ⅳ级者，重建的屈肘活动度较小；肩关节不稳定影响屈肘肌的力量；以及康复治疗的重要性等。提出了相应的提高疗效的措施。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.