肱骨外上髁炎病因探讨：附20例手术报告及文献复习

采用伸肌总腱起始部及穿经此处的微血管神经束切除术治疗２０例肱骨外上髁炎。术中肉眼可见有微血管神经束穿出者９例，活动性出血者５例。经８—１５个月随访，１６例优，２例良。肱骨外上课炎是一种特殊类型的“微血管神经束卡压综合征”，应与桡管综合征及骨间后神经受压综合征相鉴别。     

应用显微外科技术治疗顽固性网球肘的体会

应用显微外科技术治疗顽固性网球肘的体会王栓科，张风岗，刘春选，田永虎肱骨外上髁炎又称网球肘。其病理变化为指总伸腱的慢性炎症，仅有少数病例保守治疗无效。杜心如等通过解剖发现，穿经指总伸腱起始部的微血管神经束卡压是该病的病因。并发现，该血管神经束有完整的...     

网球肘病因的解剖学研究

正网球肘也称为肱骨外上髁炎,是肱骨外上髁部的慢性炎症,在人群中的患病率为1%~3%,在手部工作为主的人中可达7%~([1])。主要临床表现为外上髁部疼痛,在患者做伸腕动作时加剧~([2])。目前,学界对网球肘的病因有很多争论,其中受到广泛认同的包括伸肌总腱起始部的损伤、环状韧带创伤性炎症变性、血管神经束的卡压等~([2,3])。因为病因不     

肱骨外上髁炎的手术治疗

目的：探讨肱骨外上髁炎手术疗效。方法：对215例经保守治疗无效的肱骨外上髁炎，在局麻下行肱骨外上的伸肌总腱切断剥离术，切口深度以不损伤关节囊为宜。结果：本组病例全部随访，时间2～10年，结果除16例自觉肘外不适或微痛外，余全无任何特殊不适，正常工作及生活。结论：肱骨外上髁炎行肱骨外上处伸肌总腱切断剥离术，是有效的疗法。     

小切口微血管神经束切断治疗顽固性肱骨外上髁炎

目的评价小切口微血管神经束切断治疗顽固性肱骨外上髁炎的效果。方法对21例顽固性肱骨外上髁炎,以外上髁痛点为中心做2~3cm切口,皮下伸肌筋膜表面找到直径0.2~0.5mm的微血管神经束,切除1~2cm。结果术后随访6~30个月。治愈19例,术后疼痛完全消失,手握力恢复正常;显效2例,术后疼痛及压痛基本消失,手握力基本正常。均未发生并发症。结论小切口微血管神经束切断是治疗顽固性肱骨外上髁炎的有效方法。     

肱骨外上髁炎的高频彩色多普勒超声诊断

目的通过高频彩色多普勒超声对肱骨外上髁炎患者肘关节外上髁的超声表现,评价其对肱骨外上髁炎的诊断价值。方法 25例临床诊断为肱骨外上髁炎患者的25个患侧肘关节和17例对照组的25个正常肘关节行高频彩色多普勒超声检查,观察肱骨外上髁伸肌总腱的厚度、内部回声、有无钙化、撕裂以及内部血流情况,肱骨外上髁骨质骨面是否光整、有无毛糙,病变组超声结果与对照组以及MRI结果行对比分析。结果高频彩色多普勒超声能清晰的显示肱骨外上髁、伸肌总腱的结构及回声。对照组伸肌总腱平均厚度约(0.39±0.02)cm,LE组伸肌总腱平均厚度约(0.59±0.11)cm,较对照组明显增厚,差异有统计学意义(t=9.39,P0.01)。LE组与MRI结果具有较高的一致性。肱骨外上髁骨皮质回声毛糙、不光整,病变伸肌总腱回声减低,内部可有钙化或撕裂(无回声区或缺损区),彩色血流信号较对照组增多。结论高频彩色多普勒超声对肱骨外上髁炎诊断中,能准确的显示伸肌总腱的病变,评价病变位置、范围、严重程度及是否在急性充血期,可作为诊断肱骨外上髁炎的有效、实用、无创、廉价的一种检查方法,也可做为定期随访临床治疗效果和预后的重要参考手段。     

顽固性肱骨外上髁炎显微手术治疗与伸肌总腱起点松解术比较

江苏大学第四附属医院骨科陆晓文、羊国民及第二军医大学长海医院骨科张少成、马玉海、桑井贵来稿，我们自2001年10月至2003年1月，对37例38臂顽固性肱骨外上髁炎进行显微松解、切断微神经支手术，在局部麻醉下，取肱桡关节处斜切口，长约2．0-2．5cm，显露前臂伸肌总腱表面，在手术显微镜下将从肌筋膜穿出直径为0．5mm的微血管及直径为0．2mm的小神经束，用显微剪刀切断穿出的一段，     

封闭配合小针刀治疗网球肘129例疗效观察

网球肘，医学上称肱骨外上髁炎，是骨科常见病、多发病，是肱骨外上髁部伸肌总腱处的慢性损伤性肌膜炎，临床上多以非手术治疗为主。自1998年1月～2002年12月门诊采用局部封闭配合小针刀治疗反复发作的网球肘患者129例，疗效满意、治愈率高，现总结报告如下。     

多点灼烧与伸肌总腱起点剥离治疗顽固性肱骨外上髁炎

目的：比较微创多点灼烧法和伸肌总腱起点剥离法治疗顽固性肱骨外上髁炎的疗效。方法：回顾性分析采用微创多点灼烧法和伸肌总腱起点剥离法治疗的顽固性肱骨外上髁炎患者116例（129臂）患者的疗效。结果：随访时间6个月~3年,平均18个月,两组疗效差异无统计学意义（P＞0.05）;在手术简易程度、术中副损伤、手术时间、治疗费用等方面两组差异有统计学意义（P＜0.05）。结论：微创多点灼烧法具有手术操作简单、术后功能恢复快、费用低等特点。     

超声引导下经皮针刺伸肌总腱治疗肱骨外上髁炎

目的观察超声引导下经皮针刺伸肌总腱治疗肱骨外上髁炎的效果。方法对68例肱骨外上髁炎患者行超声引导下经皮针刺伸肌总腱,治疗后随访,观察并发症,对比治疗前、治疗后1个月及6个月视觉模拟评分(VAS)和网球肘评分。结果针刺治疗后3天,64例(64/68,94.12%)疼痛症状加重,1～2周后均逐渐好转。平均随访(9.74±1.95)个月,68例均未因握力减弱而影响劳动及生活;治疗及随访期间无神经损伤、感染及出血等并发症。治疗前、治疗后1个月及6个月VAS及网球肘评分差异均有统计学意义(P均0.001);治疗后1、6个月VAS均较治疗前降低(P均0.001),且治疗后6个月低于治疗后1个月(P0.001)。治疗后1、6个月网球肘评分均较治疗前升高(P均0.001),但治疗后1个月与6个月差异无统计学意义(P0.05)。结论超声引导下经皮伸肌总腱针刺治疗肱骨外上髁炎的效果及安全性均较好。     

关节融合术治疗拇指第一腕掌关节炎的疗效

目的 探讨关节融合术治疗拇指第一腕掌关节炎的临床疗效.方法 选择自2011年5月至2017年4月,通过关节融合治疗第一腕掌关节炎患者31例,男8例,女23例,年龄在42～55岁,平均48岁.术前依据影像学Eaton?Little分期:Ⅱ期5例,Ⅲ期26例.所有患者均行克氏针固定.术后定期复查X线片观察第一腕掌关节融合情...     

脊柱节段血管阻断对椎间盘退变发生发展的影响

目的：探讨结扎脊柱节段血管对椎间盘退变发生发展的影响。方法：16只成年犬随机平均分为两组．每只犬均结扎左侧T6～T9的节段血管。分别于造模后3个月和8个月急性失血法各处死一组动物，处死后立即取整段胸椎。T6，7至T8／9为实验区(结扎节段血管区)，取结扎血管以上的T4／5椎间盘为病理检查中的对照区，T6／7为病理检查实验区；T7／8和F8/9椎间盘为生化分析的实验区，结扎血管以下的T11/12、T12／13椎间盘为生化分析的对照区。对对照区和实验区内椎间盘的形态和成分进行比较。结果：与对照组相比．实验组的椎间盘在3个月时胶原成分已有显著增加，而糖胺多糖成分显著降低；8个月组与3个月组无显著性区别。结论：在脊柱节段血管阻断后，椎间盘的周围血供减少，影响椎间盘的营养供应，可诱发或加速椎间盘的退变。     

Congenital Dislocation of the Head of the Radius

Twenty patients with chronic ankle instability were examined radiographically for anterior talar displacement and talar tilting. The examinations were carried out with the ankles untaped and taped, and the taped ankles were examined again after 20 min running. The measurable instability was significantly improved after taping, but after exercise this was seen only for talar tilting. Generally, the best stabilizing effect of taping was obtained in the ankles with the greatest degree of instability. After exercise, all but one of the adhesive taping bandages were loose and were mostly acting as canvas boots, affording the ankle only limited protection.     

The role of anesthesiologists in the intensification of the activities of the surgical department

The authors have widened the volume of clinical, biochemical and functional examinations of patients and introduced the examination by the anesthesiologist and other specialists under ambulatory conditions. The patients having concomitant diseases were given the necessary treatment at the prehospital stage. Most of the patients were operated upon in the day of their admission. The patients who needed preoperative preparation were operated in the nearest days (after performing intensive therapy). These measures allowed to shorten the average stay of the patients at the hospital from 16.1 to 10.3 days, and annually 600 patients were admitted additionally to the hospital at the department with 75 beds without an increase of the number of places.     

Remote results of the treatment of fractures of the distal portion of the bones of the forearm]

Under observation were 309 patients with fractures of the distal portion of the antebrachial bones, in whom 311 fractures were observed (in 2 cases fractures occurred twice for a 9-year period). All these patients were subdivided into two groups: the Ist group comprised 139 patients treated at the in-and outpatient center of general surgery, and in the second group (172) patients were treated at the traumatological in-outpatient center. The results of treatment in both groups are analysed, and some appropriate conclusions are made.     

髂骨皮瓣移植加外固定器固定修复胫骨缺损伴小腿软组织缺损

目的 探讨髂骨皮瓣移植加外固定器固定修复胫骨缺损伴小腿软组织缺损的方法和临床效果。方法1998年5月～2001年5月,应用Bastiani外固定器固定腔骨骨折及缺损端,同时行旋骼深血管为蒂的骼骨皮瓣移植,治疗腔骨缺损伴小腿软组织缺损共22例。男15例,女7例;年龄16～58岁,平均37岁。随访5～36个月,平均25.5个月。结果22例髂骨皮瓣均完全成活,胚骨及软组织缺损Ⅰ期修复,骨外固定器固定牢固,骨折愈合快,植骨与骨折端于术后2～4个月达临床愈合,术后3～6个月达骨性愈合。患肢功能恢复良好,无一例发生骨不连、骨坏死、关节僵直等并发症。结论 吻合旋骼深血管的髂骨皮瓣移植,可Ⅰ期修复胫骨缺损伴小腿软组织缺损。结合骨外固定器固定,可为植骨愈合创造便利条件,且固定牢靠,受区创伤小,可早期进行功能锻炼,避免应力遮挡,促进骨折愈合,是目前治疗胚骨缺损伴小腿软组织缺损的有效方法。     

Evaluation of the use of the Flexiblade

The Flexiblade is a laryngoscope which has a 'flexible' blade. The 'front' half of the blade can be moved in an anterior direction during laryngoscopy, enhancing the view of the glottis. The degree of movement can be controlled with the lever. We studied 200 ASA 1 and 2 adult patients requiring tracheal intubation and the patients acted as their own controls. The view of the larynx was improved in 93% of the cases when the vocal cords were not completely visible at laryngoscopy with the lever in the neutral position. Ninety-seven per cent of patients with a Cormack and Lehane grading of 2 at normal laryngoscopy were transformed to grade 1 when the lever of the Flexiblade was depressed and 84% of cases with a grading of 3 were transformed to grade 2 or 1. In four patients, there was deterioration in the view of the cords: three patients with grade 1 were transformed to grade 2 and one with grade 2 to grade 3. There was no improvement in one case with grade 2 and three with grade 3.     

Measurement of the time course of bending of the back in the sagittal plane

Summary A simple, inexpensive method has been developed for measuring the position of the back, projected onto the sagittal plane, during flexion. Light-emitting diodes (LEDs) were attached to the skin overlying the T6, L1, L3 and L5 vertebrae. They started to flash, at a controlled frequency, at the beginning of movement from an upright to a flexed position. The positions of the markers together with the initial (upright) and final (flexed) positions of the back were recorded on a single photograph. A plumb line provided a vertical reference. Times were determinded from the flashing frequency. Vertical and horizontal components of the position were measured from the photograph; their resultant represented total displacement at a given instant in time. The results were scaled so that the displacements were expressed as a fraction of their maximum value, and time was expressed as a fraction of the total movement time. The reproducibility of the technique was tested by making repeated measurements from a single healthy volunteer. At any instant, the horizontal, vertical and resultant displacements of the T6 marker could be determined to within 7% of theirmaximum values; the resultant displacement of the L5 marker could be determined to within 10%. The results from the other markers were less reliable.     

膝关节后外侧角股骨止点的X线测量与分析

目的 探讨国人膝关节后外侧角(PLC)中外侧副韧带(LCL)、腘肌腱(PT)股骨止点的位置,以期为临床膝关节PLC重建术中骨隧道的定位及术后骨隧道的评估提供放射学数据.方法选取30具成人尸体膝关节标本,男14具,女16具;死亡年龄为45～71岁,平均55岁.解剖分离出LCL、PT股骨止点,用钢针标记二者止点中心及股骨外上髁后摄股骨侧位X线片.住侧位X线片上建立以Blumensaat线为基准的矩形,用比率的方式测世LCL、PT止点中心在矩形中的位置;另外,测量LCL和PT止点中心与股骨外上髁的距离.结果侧位X线片上LCL止点中心为(14.80±5.76)%和(38.06±4.60)%;PT止点中心为(39.85±6.86)%和(49.27±8.01)%.LCL 止点中心位于股骨外上髁近端(1.16±2.81)mm,后方(3.09±1.45)mm;PT止点中心位于股骨外上髁远端(8.69±2.83)mm,后方(4.07±1.76)mm.结论 LCL和PT的股骨止点中心比较稳定,在侧位X线片上可以被定量描述.

Abstract：

Objective To obtain radiological data of the femoral insertions of the lateral collateral ligament (LCL) and the popliteus tendon (PT) for reconstruction of the posterolateral corner (PLC) .Methods Thirty Chinese cadaveric knees were investigated in our study. They were 14 males and 16 females, with an average death age of 55 (rang, 45 to 71 years). The lateral epicondylar and femoral insertions of LCL and PT were dissected, identified and marked with steel wires before a lateral femoral X-ray was taken.Then the centers of the insertions were recorded as a ratio pattern on a modified reticule which was established on lateral femoral X-rays with the Blumensaat' line as the base reference. The distances from the centers of the insertions to the lateral epicondyle were also measured. Results On the lateral femoral X-ray films, the insertion centers of the LCL and PT were located on the reticule at 14. 80% ±5. 76% , 38. 06% ±4. 60% and 39. 85% ±6. 86% , 49. 27% ±8. 01% , respectively. The LCL insertions were located at a mean distance of 1. 16 ± 2. 81 mm proximally and 3. 09 ± 1. 45 mm posteriorly to the lateral epicondyle, and the PT insertions were located at a mean distance of 8. 69 ± 2. 83 mm distally and 4. 07 ± 1. 76 mm posteriorly to the lateral epicondyle. Conclusion LCL and PT have a consistent pattern of insertion on the femur, which can be quantitatively measured on a lateral femoral X-ray film.     

弹性义龈的不同修复设计对牙周菌群的影响研究

目的:通过对两种不同设计的弹性义龈修复前后牙周菌群变化的观测探讨弹性义龈对严重牙龈退缩患者修复治疗的效果。方法:30例严重牙龈退缩患者经系统性牙周治疗后按弹性义龈修复方式随机分为A、B两组,分别提取修复治疗前后各观察时段的龈沟液做细菌学检查。结果:A型设计组弹性义龈修复后不同时期的细菌学检查结果变化均大于B型设计组,差异有统计学意义。结论:B型设计的弹性义龈由于与邻牙接解面积小,对牙周生态系的影响相对较小,对患者牙周健康的保持更为有利,是一种较为理想的治疗严重牙龈退缩的修复方法。