Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation

Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons Inappropriate management of these injuries may result in chronic pain, stiffness, deformity, or post traumatic arthritis. Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization. The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation. Methods From May 2005 to May 2007, a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation. Of the 26 cases, 11 involved in metacarpophalangeal joint, and 15 interphalangeal joint in proximal interphalangeal. Kirschner wire, mini wire and absorbable suture were used for limited internal fixation. All patients were followed up and patients were accomplished with total active motion （TAM） of fingers. Results All patients were reviewed by an independent observer. The mean follow up was 13 months （range 9 to 24 months）. Subjective, objective and radiographic results were evaluated. X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases, joint incongruity （less than 1 mm） and joint space narrowing in 3 cases respectively. Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases. An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery. Based on TAM the overall good-excellent rate of joint motion function was 80.8%. Conclusion Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.     

Gene expression of fibrinolytic factors urokinase plasminogen activator and plasminogen activator inhibitor-1 in rabbit temporo-mandibular joint cartilage with disc displacement

Background The urokinase plasminogen activator system is believed to play an important role in degradation of the extracellular matrix associated with cartilage and bone destruction; however its precise roles in temporomandibular disorders have not yet been clarified. The aims of this study were to investigate the gene expression of fibrinolytic factors urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1(PAI-1) in the articular cartilage of rabbit temporomandibular joint (TMJ) with disc displacement (DD) and to probe the relationship between fibrinolytic activity and cartilage remodeling.Methods Disc displacement of right joints was performed in 36 of 78 rabbits under investigation. The animals were sacrificed at 4 days and 1, 2, 4, 8 and 12 weeks after surgery, respectively. The right joints of these animals were harvested and processed for the examination of mRNA expression of uPA and PAI-1 in articular cartilage using in situ hybridization techniques.Results The expression of uPA and PAI-1 was co-expressed weakly in the chondrocytes from transitive zone to hypertrophic zone and mineralized zone, while no hybridizing signals were shown in proliferative zone and superficial zone in control rabbits. The most striking was the up-regulation of uPA and PAI-1 mRNA in 4-day rabbits postoperatively at the onset of cartilage degeneration. The strongest hybridizing signals for uPA and PAI-1 were seen in 2-week rabbits postoperatively. After 2 weeks, the expression of uPA and PAI-1 began to decrease and reached nearly normal level at 12 weeks.Conclusions The expression of the uPA/PAI-1 system coincides with the pathological changes in condylar cartilage after DD. The uPA/PAI-1 system may be one of the essential mediators in articular cartilage remodeling.     

Adaptive alterations of elastic fibers in the bilaminar zone of rabbit temporomandibular joint following disc displacement

Objective To study the adaptive alterations of elastic fibers in the bilaminar zone (BZ) of rabbit temporomandibular joint (TMJ) following disc displacement. Methods Twenty-eight Japanese white rabbits were used in this study. The right temporomandibular joints of 20 of 28 rabbits were subjected to the surgical procedure of anterior disc displacement ADD). Four rabbits in the surgical group were sacrificed at 2, 4, 6, 8 and 12 weeks after operation. Their temporomandibular joints were studied histochemically.Results Elastic fibers were reduced in number and ran irregularly in the superior lamina of BZ from ADD rabbits. The jungly elastic fibers (EFs) could still be seen at 2 weeks after operation. At 4 weeks, the number of EFs decreased significantly; EFs lost their jungly arrangement and were shaped like rough dots, of which the arrangement and the lengths were different. Six weeks after operation, many EFs were replaced by distorted, uneven, non-oriented fine EFs, distributed unevenly and some thick or fine EFs that ran irregularly. The number of EFs decreased further and their arrangement was more deranged at 8 weeks. At 10 and 12 weeks, EFs in the superior lamina of BZ were similar to those at 8 weeks. Conclusion Our results show that EFs lost their function as well as their distribution and arrangement after disc displacement.     

Primary Clinical Evaluation of the Joint Replacement for the Treatment of the First Metatarsophalangeal Arthritis

Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant.Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant.There were 2 males and 10 females with a mean age of 61.4 (range,56-75) years old.Of them,9 cases (11 feet) were hallux valgus with osteoarthritis;1 case (2 feet) was rheumatic arthritis;2 cases (2 feet) were traumatic arthritis.The subjective and objective results were evaluated during follow-up.Results All of the patients were followed up regularly with an average of 24.7 months,ranging from 12 to 38 months.Ten patients were completely satisfied with the operation;1 patient showed partial satisfaction,and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation.Osteolysis around the implant occurred in 2 cases without clinical symptoms,and no special treatment was given.Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.     

心理应激后大鼠颞下颌关节内P物质降钙素基因相关肽的表达变化

目的 通过观察心理应激对大鼠颞下颌关节(TMJ)内P物质(SP)和降钙素基因相关肽(CGRP)表达的影响,探讨心理因素与颞颌关节病之间的关系.方法 SD大鼠90只,将动物编号,分为3组,每组30只,分别为心理应激组,足部电击组及空白对照组.采用交流箱心理应激动物模型,分别在1周,3周,5周时,取各组大鼠的颞下颌关节,在同一部位的切片,进行免疫组化(SABC法),图像分析;扫描电镜观察各组大鼠TMJ的变化.结果 心理应激1,3,5周SP(分别为为124.5±16.9,185.6±1.8,193.5±3.5)和CGRP(分别为185.9±5.3,112.5±5.2,174.3±5.3)的表达差异具有显著性(P＜0.05);扫描电镜显示心理应激后髁状突表面出现胶原纤维暴露且排列紊乱及宽窄不一等结构变化.结论 心理应激可使大鼠TMJ内的P物质、CGRP肽能神经纤维的表达发生变化,可能与颞下颌关节病密切相关.

Abstract：

Objective To observe the substance P(SP) and calcitonin gene-related peptide(CGRP) expressions in the temporomandibular joints(TM J) of the rats undergone emotional stress and explore the relationship between emotional stress and temporomandibular joint disorder(TMD). Methods Ninety SD rats were averagely randomly divided into emotional stress ( ES ) group( n = 30 ), electric foot-shocked (FS) group ( n = 30 ) and control (CON) group( n = 30). The emotional stress was induced by communication box. The TMJ tissues in ES and CON groups were removed after 1, 3 and 5 weeks of emotional stress for scanning electron microscope ( SEM ) test and immunohistochemistry test. The SP and CGRP expressions were examined with SABC immunohistochemistry and then analyzed by image analysis system. Results The expressions of SP and CGRP had significant difference after 1 ,3 and 5 weeks emotional stress ( SP: 124.5 ± 16.9,185.6 ± 1.8 and 193.5 ± 3.5, respectively; CGRP: 185.9 ±5.3, 112.5 ±5.2 and 174.3 ±5.3 ,respectively) (P＜0. 05 ). The SEM results showed that there was a series of structural change on the condylar surface after emotional stress. Conclusion The SP and CGRP energy nerve fibers take part in the TMJ pathological process undergone emotional stress.     

Finite element analysis application in presurgical planning:Treatment choise of temporomandibular joint ankylosis

<正>Objective The aim of this study is to evaluate the applicable value of finite element analysis(FEA)for presurgical planning in the treatment of temporomandibular joint(TMJ)ankylosis.Methods CT image data of one patient with unilateral TMJ     

Capitate transposition to replace necrotic lunate bone with a pedicle for Kienbock’s disease: review of 30 cases

Objective To investigate the clinical application of capitate transposition with a pedicle in 30 cases of Kienbock’s disease.Methods The external diameter and curvature of the capitate head and proximal facet of the lunate were observed and measured in 100 specimens. The vascularity of the capitate was also investigated. Capitate transposition with a vascular pedicle was designed to treat 30 patients with advanced Kienbock’s disease who were followed up for 2 to 16 years and then analyzed according to Evans’s scoring system.Results Aseptic necrosis did not occur in the transposed capitate because the pedicle fascia including the dorsal branch of the anterior interosseous artery ensured the vascularity of proximal two thirds of the capitate. The transposed capitate reestablished a relatively pain-free radiocarpal joint. Follow-up results showed that grip strength and motion arc were up to 70% of contralateral side.Conclusions Capitate transposition with a pedicle is a reliable treatment method for advanced Kienbock’s disease, with favorable prognosis for at least five years postoperatively.     

Treatment and Prognosis of Pituitary Adenomas in Children

In order to explore the treatments and prognosis of pituitary adenomas in children, the experience in the treatment of 15 children with pituitary adenomas was summed up. The clinical data of 15 children with pituitary adenomas in Tongji Hospital were retrospectively analyzed from Jan. 1997 to Aug. 2004, including 9 males and 6 females with the age ranging from 9-15 years old （mean 12.8）. The disease duration was 3 months to 5 years （mean 2 years）. Fourteen cases were subjected to the microsurgical operation through oral tanssphenoidal approach and one case to medical treatment. All cases were followed up from 1 to 5 years by imaging studies and endocrine investigation. The results showed that 13 eases obtained total removal of the tumor and one subtotal removal of tumor. No severe complications and operation death occurred. It was concluded that the tanssphenoidal approach was the optimal treatment for children with pituitary adenomas. Regular and long-term follow-up is of great importance.     

心理干预对大鼠颞下颌关节病防治作用的实验研究

目的 通过观察心理干预后心理应激状态下大鼠颞下颌关节的相关变化,探讨心理干预在颞下颌关节疾病防治过程中的作用.方法 应用交流箱心理应激动物模型对大鼠进行心理应激.分别在应激前后应用抗焦虑药物和去除应激源.用ELISA法和RT-PCR检测各组大鼠颞下颌关节髁突软骨细胞内白细胞介素-1(IL-1)和肿瘤坏死因子(TNF-α)的表达变化.结果 PCR结果显示:IL-1βmRNA在应激后第1周表达最强,第3周时减弱,第5周时达到正常水平;TNF-αmRNA在应激后第1周表达最强,第3周后逐渐达到正常水平.Elisa结果显示:抗焦虑药物组IL-1OD值(分别为0.107 ±0.024,0.101±0.005,0.088±0.010)、去除应激源恢复组IL-1OD值(分别为0.090±0.016,0.088±0.005,0.089 ±0.011)和肿瘤坏死因子的OD值(分别为0.095 ±0.006,0.077±0.007,0.069.±0.009;0.079±0.010,0.075±0.009.0.079 ±0.012)与对照组(分别为0.087±0.004,0.090±0.009,0.089±0.010;0.074±0.008.0.069±0.015.0.068±0.011)差异不显著(P>0.05);抗焦虑药物组、去除应激源恢复组IL-1和TNF-α的OD值与心理应激组(分别为0.282±0.045,0.226 ±0.021,0.092±0.002;0.164±0.009,0.123±0.013,0.091±0.006)有显著差异(P<0.05).结论 应用抗焦虑药物和去除应激源能有效降低心理应激对大鼠颞下颌关节的影响.

Abstract：

Objective To investigate the role of psychological intervention in the prevention of the temporomandibular joint disease (TMD) , through the observation of the relative changes in the rat TMJ under psychological stress after psychological intervention. Methods The rat model of communication box was built to exert the psychological stress. The antianxiety agent was applied before stress, and the stressor was removed after stress. The expression of the proinflammatory cytokines IL-1 and TNF-α in the mandibular condylar chondrocytes in rat TMJ was detected by ELISA and RT-PCR. Results The RT-PCR results showed that the expression of IL-1 mR-NA increased into the peak in the 1st week, weakened in the 3rd week, and returned to normal in the 5th week, while the TNF-αmRNA peaked in the 1st week, returned to normal in the 3rd week. The ELISA results showed that there was no significant difference of the OD value of the serum IL-1 and TNF-α(0. 095 ±0. 006,0. 077 ± 0.007,0.069 ±0.009 ;0.079 ±0.010,0.075 ±0. 009,0.079 ± 0.012) in the antianxiety agent group (0. 107 ± 0.024,0. 101 ±0.005,0.088 ±0.010)and the stressor removal group(0. 090 ±0.016,0. 088 ±0.005,0.089 ± 0.011) , compared with the control group(0.087 ±0.004,0.090 ±0.009,0.089 ±0.010;0.074 ±0.008,0.069 ±0.015,0.068 ±0.011) (P>0.05), while significant differences were observed when compared with the psychological stress group(0.282 ±0.045,0.226 ±0.021,0.092 ±0.002;0. 164 ±0.009,0.123 ±0.013,0.091 ± 0.006) (P<0.05 ). Conclusion Application of the antianxiety agent and stressor removal could effectively counter the influence of psychological stress to TMJ, which provides good experience for the clinical prevention of TMD.     

Evaluation of Radiographic Diagnosis on Osteoarthrosis of the Temporomandibular Joint.

Eight-four cadaver specimens of temporomandibular joint were used for the comparison of the results shown in standard lateral tomographs and Shuller's position films with the macroscoopic observations on the bone and cartilage changes. The results and conclusions were as follows: 1. The     

颞肌筋膜瓣转移治疗颞下颌关节强直的临床研究(英)

目的:观察颞肌筋膜瓣转移治疗下颌关节真性强直的临床疗效。方法:采用颞肌筋膜瓣移植治疗颞下颌关节真性强直17例,通过测量术前、术后开口度,摄全景片及关节片测量关节间隙大小,术后随访等综合评价疗效。结果:全部病例均痊愈出院,开口度在30mm以上,咬(牙合)关系恢复良好。12例经6个月～3年随访观察,张口度均在22mm以上,手术效果稳定,令人满意。结论:颞肌筋膜瓣转移是治疗颞下颌关节真性强直的一种比较理想的方法。     

自体喙突移植再造髁突关节成形术伴同期颏成形术的疗效评估

目的：观察自体喙突移植再造髁突关节成形术伴同期颏成形术在颞下颌关节强直伴有小颌畸形矫治中的治疗效果。方法对2003年7月至2012年1月21例应用自体喙突移植再造髁突关节成形术及同期行颏前徙成形术的颞下颌关节强直伴有小颌畸形的患者进行随访。对其颞下颌关节的功能（下颌侧向运动、前伸运动）、张口度、咬合关系、面部外形、影像学表现进行评价。结果经过24个月至8年的观察随访,19例患者的下颌运动、张口度均得到明显的改善,而2例患者出现关节强直复发。且21例患者面形均较术前均有明显的改善,咬合关系较术前均未发生较大的变化。曲面体层线片显示所有患者移植的喙突与下颌升支达到骨性愈合,且改建良好;头影测量片显示,患者面形轮廓及突度与术前比较,差异有统计学意义（P ＜0．05）。结论自体喙突移植再造髁突关节成形术伴同期颏成形术可治疗颞颌关节强直伴有小颌畸形。     

骨性颞下颌关节强直伴小颌畸形及阻塞性睡眠呼吸暂停综合征的牵引成骨治疗

目的:探讨内置式颌骨牵引成骨在治疗骨性颞下颌关节(temporomandibular joint, TMJ)强直伴小颌畸形并发阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)中的应用.方法:应用内置式颌骨牵引成骨,治疗11例(15侧)TMJ强直伴小颌畸形及OSAS患者.患者年龄9～42 岁.4例为双侧颞下颌关节强直伴重度小颌畸形,7例为单侧TMJ强直伴小颌畸形.9例合并重度OSAS,2例伴有轻、中度OSAS.8例患者行双侧下颌骨体延长,3例患者行单侧下颌骨体延长.11例患者15侧TMJ强直均行牵引成骨关节成形术.术后复查10～22 个月,平均复查时间15.3 个月.手术包括两个阶段:第一阶段,小颌畸形的牵引成骨治疗;第二阶段,TMJ强直的牵引成骨关节成形术.术后间歇期4～7 d,牵引速度1 mm*d-1,分4次进行.稳定期为3～4个月.术后即行开口训练.每一患者术前、术后均行X线头影测量及睡眠多导图仪(polysomnography, PSG)检查.结果:11例患者19侧下颌骨经牵引延长后,小颌畸形及OSAS得到有效治疗.15侧关节强直经牵引成骨关节成形术矫治后,开口度均恢复正常.牵引间隙内成骨良好,未见感染及成骨不良等并发症发生,无关节强直复发.结论:牵引成骨技术可有效矫治TMJ强直导致的小颌畸形伴OSAS,并为关节成形提供了新的治疗手段.手术方法简便,风险小,治愈率高,近期效果稳定.远期疗效有待进一步观察.     

单侧颞下颌关节强直伴小颌畸形同期牵引成骨治疗的临床研究

目的:观察应用内置式颌骨牵引器对单侧颞下颌关节(temporomandibular joint,TMJ)强直伴小颌畸形患者进行同期的牵引成骨治疗的临床疗效.方法:应用内置式颌骨牵引器,对7例单侧TMJ强直伴小颌畸形的成人患者进行同期的牵引成骨关节成形及下颌骨体(13侧)的牵引成骨治疗.术前经睡眠多导图仪(polysomnography,PSG)检查,7例患者均患有阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea and hypopnea syndrome,OSAHS),其中3例为重度OSAHS,另4例为轻、中度OSAHS.6例患者行双侧下颌骨体延长,1例患者行单侧下颌骨体延长.7例患者的TMJ强直均行牵引成骨关节成形术.手术包括两个术式:TMJ强直的牵引成骨关节成形术和小颌畸形的牵引成骨治疗.术后间歇期5～7天,牵引速度1 mm/d,分4次进行.稳定期为3～5个月.术后即行开口训练.每一患者术前、术后均行X线头影测量及PSG检查.结果:所有患者术后OSAHS症状均减轻或消失.除1例术前重度者术后诊断为轻度外,其余6例患者术后PSG检查结果显示均已达到治愈标准.7侧关节强直经牵引成骨关节成形术矫治后,开口度均恢复正常.牵引间隙内成骨良好,未见感染及成骨不良等并发症发生.术后随访复查18～51 个月,平均随访复查时间34.3 个月.无小颌畸形及关节强直复发.结论:同期的牵引成骨治疗可有效矫治成人单侧TMJ强直伴小颌畸形及OSAHS.手术方法简便、风险小,能有效缩短治疗疗程,减少手术次数.术后开口训练对牵引间隙内的骨形成无不利影响.     

应用牵引成骨技术治疗颞下颌关节强直

目的：探讨应用牵引成骨技术治疗骨性颞下颌关节强直的方法。方法：应用内置式颌骨牵引器,治疗11例（13侧）颞下颌关节骨性强直患者。9例为单侧,2例为双侧。患者年龄9．51岁,平均年龄20．9岁。手术首先在强直关节区形成15－20mm的骨间隙,然后在残留升支后缘行“L”型截骨,形成一长约2cm,宽约1cm的可移动骨段,然后安置骨牵引器,术后第4－8天开始牵引,牵引速度0．25mm/次。每天4次。直到可移动骨段顶端接近术中制备的假关节窝（保留3－4mm间隙）。术后即行开口训练。稳定期为3－4个月。结果：11例（13侧）患者经牵引成骨关节成形术治疗后,开口度可以达到正常（33－45mm)。牵引间隙内成骨良好。新形成的髁状突经改建变得圆钝,形态接近正常髁状突,无感染及成骨不良等并发症发生。结论：牵引成骨关节成形可有效治愈颞下颌关节强直,与传统治疗方法相比风险小,术后复发率低。     

颞颌关节外伤骨折脱位的诊断与治疗

目的：探讨颞颌关节外伤骨折脱位的诊断与治疗方法。方法：回顾分析手术治疗颞颌关节外伤骨折48例的临床资料并文献复习。结果：头面部外伤史，颞颌关节运动受限，张口困难，关系紊乱，耳颞区压痛及颅内非典型疼痛是本病常见的症状。耳颞部或颅底的X线断层及CT检查能明确诊断。单纯用髁状突切断或髁状颈切除术治疗的患者效果差且并发症和后遗症发生率高。采用以恢复颞颌关节功能为主的关节重建术，临床效果较理想。结论：本病临床行颞下颌关节及颅底X线断层或CT检查有重要的诊断价值。治疗首选颞下颌关节重建术，同时早期诊断与正确选用手术治疗是防止和减少术后颞颌关节功能障碍与后遗症发生的关键。     

刃厚皮片皮囊植入治疗真性颞下颌关节强直36例

目的观察应用刃厚皮片皮囊作为间置物治疗真性颞下颌关节强直的临床效果。方法36例真性颞下颌关节强直患者,经耳前进路,凿除关节区增生和融合的骨质,保持凿开间隙至少1.0 cm,形成的假关节间隙内植入刃厚皮片皮囊。结果36例均痊愈出院。术后28例随访2-7 a,26例恢复良好,张口度平均为3.19±0.43 cm;2例复发,复发率7.14%。结论用刃厚皮片皮囊作为间置物治疗真性颞下颌关节强直是一种简单有效的方法。     

超短波治疗颞下颌关节滑膜炎的临床效果

目的 探讨颞下颌关节滑膜炎超短波治疗的临床效果。方法 回顾性选取2016年11月至2019年11月我院治疗的颞下颌关节滑膜炎患者100例,按照治疗方法分为药物治疗组(n=50)和超短波治疗组(n=50),药物治疗组患者采用双氯芬酸钠缓释片治疗,超短波治疗组患者在药物治疗的基础上同时采用五官超短波电疗机进行治疗。统计分析两组患者的颞下颌关节功能、主观感觉、最大前伸位移、最大张口度及临床疗效。结果 超短波治疗组患者治疗后较治疗前的DI、PI、CMI降低幅度均显著高于药物治疗组,差异有统计学意义(P0.05)。超短波治疗组患者治疗后较治疗前的VAS评分降低幅度,最大前伸位移、最大张口度升高幅度均显著高于药物治疗组,差异有统计学意义(P0.05)。超短波治疗组的治疗总有效率为80.0%(40/50),显著高于药物治疗组的46.0%(23/50),差异有统计学意义(P0.05)。结论 颞下颌关节滑膜炎超短波治疗的临床疗效好,能有效提升患者的颞下颌关节功能、改善患者的主观感觉、提升患者的最大前伸位移及最大张口度,值得在临床推广。     

似颞下颌关节紊乱病张口受限9例临床分析

目的:探讨似颞下颌关节紊乱病的张口受限临床特点。方法:对颞下颌关节外科门诊经治的9例患者诊治情况做回顾性分析。结果:非颞下颌关节紊乱病张口受限,最常见为两大类疾病。一类是发病部位隐蔽的关节周围组织的肿瘤。二类是上颌智齿阻生。结论:由于颌面部深在组织间隙的病变位于关节周围位置隐蔽,有很多症状体征常类似颞下颌关节紊乱病(TMD),尤其是张口受限,这些临床特征可以错误的导向TMD的诊断而误诊。在临床症状持续存在或治疗后加重时应高度重视,及时做X片检查、CT检查,以利于早期诊断正确治疗。     

改良皮囊作间充物治疗颞下颌关节内强直41例

目的：介绍一种手术治疗颞下凳关节内强直（temporomandibular joint ankylosis，TMJA）的改进方法。方法：1987年至1999年间共收治76例TMJA患者，采用改良自体皮囊作为假关节内填充物。结果：41例采用自体皮囊作为间充物以形成假关节，仅有1例复发，复发率为2.44%。选用其他填充物材料治疗35例，8例复发，复发率为22.79%。2组比较差异有显著性（P＜0.05）。结论：采用改良自体皮囊作间充物治疗TMJA效果好，方法简单，复发率低。