应用椎弓根钉技术治疗寰枢椎不稳

目的探讨和评估应用椎弓根钉固定融合技术治疗寰枢椎不稳的,临床疗效和应用价值。方法对本院2006年1月至2008年12月间15例采用寰枢椎椎弓根螺钉内固定治疗寰枢椎不稳患者的手术方法、复位效果、植骨融合情况进行分析。结果全部患者均获随访,随访时间4—38个月,平均20个月,术后日本骨科学会（JOA）评分2-18分,平均13．8分。其中有1例在置入椎弓根螺钉时一侧后弓破碎,直接将螺钉固定在寰椎侧块上,其余螺钉位置良好。寰枢关节复位满意。未发生神经血管并发症,无内同定松动或断钉现象,全部病例均达到骨性融合。结论只要熟练掌握上颈椎解剖关系和椎弓根螺钉固定技术,采用后路椎弓根钉技术治疗寰枢椎不稳效果肯定可行。     

脊柱椎间融合术治疗椎间盘突出症合并腰椎不稳

目的评价椎间脊柱融合术治疗椎间盘突出症合并腰椎不稳的手术疗效。方法对2004年5月至2007年2月,12例腰椎间盘突出症合并腰椎不稳患者行后路椎板开窗、椎间盘摘除、椎弓根螺钉系统固定、单枚Cage植骨的脊柱融合术治疗。术后随访1～3年（平均1．5年）,术前和随访时行视觉模拟疼痛评分法（VAS）和疼痛功能指数评分法（Oswestry）评分并进行比较。结果VAS评分术前7．50±2．78,随访时2．04±1．12,比较有显著下降（t=8．23,P〈0．01）。Oswestry评分术前66．8±11．3,随访时下降为26．0±9．8（t=12．54,P〈0．01）。症状改善明显,优9例,良2例,可1例;综合评价标准优良率93．7％。随访时椎间融合11例,未见影像学融合1例,植入物无移位,未发现断钉现象。结论对合并有退变性腰椎不稳的椎间盘突出症采用后路椎间单枚Cage置入加椎弓根螺钉固定的脊柱融合术可以获得良好疗效。     

Shoulder instability

Shoulder instability can result from acute injury or repetitive overhead activity. Once the injury is identified, the initial course of treatment is aggressive rehabilitation. Structural injuries can occur but may not be clinically significant. Should a thorough scapular stabilization and rotator cuff strengthening program fail, consultation with an orthopedic surgeon to consider further imaging or possible intervention is appropriate. As the physician's study of approaches to the first-time dislocator continues, they will be better informed of reasonable options to offer the athlete.     

Evaluation of plaque instability

CT angiography is commonly used for exclusion of coronary artery disease and demonstration of the extent of coronary vascular involvement. It has been recently proposed that definition of vessel wall characteristics at the site of luminal stenosis may serve as a useful prognostic tool. Presence of positively remodeled plaques with low attenuation portends a greater risk for development of acute coronary events. Although not recommended currently as a population-based strategy, CT angiographic examination may help identify very high-risk asymptomatic subjects.     

Diagnostic imaging of wrist instability

Wrist instability is an important clinical problem. The diagnosis of instability is not easy, because it includes very subtle structures and changes between them, which are difficult to evaluate. A detailed and careful evaluation of the changes in connection with specific anatomical and pathological knowledge leads to the appropriate interpretation of the results of diagnostic examination. The aim of the present study is to look closely at all available methods of imaging diagnosis and diagnostic arthroscopy, with particular emphasis on the technical aspects of the examination.     

Novel determinants of plaque instability

Summary.  Arachidonic acid metabolism plays an important role in acute ischemic syndromes affecting the coronary or cerebrovascular territory, as reflected by biochemical measurements of eicosanoid biosynthesis and the results of inhibitor trials in these settings. Two cyclooxygenase (COX)-isozymes have been characterized, COX-1 and COX-2, that differ in terms of regulatory mechanisms of expression, tissue distribution, substrate specificity, preferential coupling to upstream and downstream enzymes and susceptibility to inhibition by the extremely heterogeneous class of COX-inhibitors. While the role of platelet COX-1 in acute coronary syndromes and ischemic stroke is firmly established through approximately 20 years of thromboxane metabolite measurements and aspirin trials, the role of COX-2 expression and inhibition in atherothrombosis is substantially uncertain, because the enzyme was first characterized in 1991 and selective COX-2 inhibitors became commercially available only in 1998. In this review, we discuss the pattern of expression of COX-2 in the cellular players of atherothrombosis, its role as a determinant of plaque 'vulnerability,' and the clinical consequences of COX-2 inhibition. Recent studies from our group suggest that variable expression of upstream and downstream enzymes in the prostanoid biosynthetic cascade may represent important determinants of the functional consequences of COX-2 expression and inhibition in different clinical settings.     

Dynamic instability of lithiated phosphorene

Li-ion batteries are widely used energy storage units. Although phosphorene delivers a high Li capacity, the transition capacity between the intercalation reaction and the conversion reaction is still not clear. We investigate the structural and electronic properties of Li intercalated phosphorene and graphene/phosphorene/graphene sandwiches by first-principles calculations. The competition to obtain charge from Li between C and P reduces charge depletion on the interlayer P–P bonds, improving stability. Importantly, the sandwiches show higher transition capacities than freestanding phosphorene, confirmed by ab initio molecular dynamics simulations. The trilayer structures show better structural reversibility than the monolayers.

Introduction of C improves transition capacity between intercalation and conversion reactions for multilayer phosphorene.     

Glenohumeral instability and dislocation

Glenohumeral joint instability and dislocations are common diagnoses seen by physicians. There are many different pathologic etiologies for these conditions. A thorough understanding of the history,physical examination, pathoanatomy, and classification systems is required to make an accurate diagnosis. With the appropriate diagnosis, the clinician can choose the correct treatment and improve the patient's outcome.     

JJXA钉棒脊柱内固定置入及椎间颗粒骨植骨治疗动力性腰椎不稳症46例

选择2003—03／2007—03南阳市第九人民医院和南阳市第二人民医院收治的动力性腰椎不稳患者46例，行后正中入路下的椎管减压手术，钛制JJXA椎弓根螺钉置入，并行椎间隙撑开，双侧切除椎间盘保留侧方以及前方的纤维环，刮除终板的软骨层，行椎间颗粒骨植骨，椎弓根螺钉系统加压固定。46例随访时间≥15个月，优良率91.3％。JJXA固定牢靠，无断钉断棒和螺钉松动现象，无复位丢失，无炎症及排异现象发生，植骨融合率为97．8％。提示JJXA钉棒内固定及椎间颗粒骨植骨治疗腰椎不稳，能够达到即刻腰椎稳定性重建以及长期骨性融合的治疗目的。     

Diagnosis of knee instability using sonography

Objective. A sonographic method has been developed to diagnose knee joint instabilities and to gain exactly quantifiable and reproducible measurements.

Design. Based on biomechanical considerations, a new positioning device to analyse knee instabilities sonographically has been developed and tested in in vivo studies.

Background. Common instrumental testing techniques are difficult to reproduce and show a lack of reliability.

Method. Using sonography the cortical line of the femur and tibia are observed. At the same time a translation of these two partners at the knee joint is provoked in a defined position using the special holding device and under a defined amount of stress. Using this method 142 healthy people, placed in different age groups, were tested to establish standard values for the physiological knee joint translation. A prearthroscopic stability analysis was performed on 101 patients.

Results. This study proves that the special device developed, together with the technique used, provides reliable and exact measurements for knee instability in different translation directions. In healthy subjects the lateral compartment always showed a larger translation than the medial compartment. A gradual increase in translation was determined in the age groups over 30 years. A significant difference of 0.0001 was shown between knee stability and instabilities. Moreover, a further differentiation between partial and total ACL ruptures and chronic instabilities was determined. This provides an important advantage not offered by usual instrumental testing techniques.

Conclusions. The ability to diagnose even a very low extent of instability and to differentiate between different kinds of instabilities enables exact controls to be carried out for both conservative and operative treatment.     

Arthroscopic treatment of traumatic shoulder instability

Background. Traumatic shoulder instability is a common sequel following first shoulder dislocation, especially in young population (< 30 y.a). Shoulder arthroscopy is getting more and more popular among orthopaedic community. Efficacy of arthroscopic treatment of shoulder instability approaches that of conventional operative techniques.
Aim. The purpose of the study was the analysis of arthroscopic treatment of traumatic shoulder instability.
Material and methods. Study was based on 22 patients, 24 shoulders were operated. Capsulolabral complex has been stabilized arthroscopically in all patients.
Functional was assessed by means of ASES, UCLA and SST scores. Function was improved significantly. There has been no recurrence of instability in follow-up period.
Conclusions. We have proved good efficacy of arthroscopic techniques in treatment of the instability.
Joint stability was restored with decreased invasiveness of operation (better cosmesis, easier rehabilitation).     

Posterolateral rotatory instability of the elbow

Posterolateral rotatory instability of the elbow is often caused by a complex injury to the lateral ulnar collateral ligament complex. This often leads to chronic mechanical symptoms of instability and pain. Surgical repair or reconstruction of the ligament is often required to stabilize the radiocapitellar joint. Multiple techniques have been described in the literature for repair or reconstruction of the lateral ligamentous complex with overall good clinical outcomes.