全髋关节置换术均衡双下肢长度的探讨

目的探讨全髋关节置换术均衡双下肢长度的临床意义和手术设计。方法回顾分析2000-2004年获得随访的单侧全髋关节置换手术病例48例,采用骨水泥型假体12髋,混合型假体36髋,术前双下肢等长30例(含股骨颈骨折患者),10例患肢长度短缩1.0-2.0cm,6例短缩2.0-4.0cm,2例短缩4.0-6.0cm。通过术前肢体长度测量及X片测量制定手术方案,选择假体、预估颈长和截骨平面;术中正确磨削髋臼,寻找最佳旋转中心,结合透视及特殊试验修正截骨平面,调节假体颈长,达到均衡双下肢长度的目的。结果全部病例采用Harris评分,优30例,良12例,中4例,差2例。术前等长30例巾术后出现5例手术侧延长1.0-2.0cm,1例延长2.5cm。术前不等长的18例中,术后恢复等长10例,6例手术侧延长1.0-2.0cm,2例术前重度短缩的先天性髋关节发育不良病人术后仍然短缩2.0-3.0cm。术后肢体等长35例Harris评分平均92.3分,术后肢体不等长13例Harris评分平均88.6分。结论全髋关节置换术的手术设计。手术技巧以及假体设计等诸多因素影响下肢长度,术后肢体不等长降低了患者的满意度。应重视术前测量及术中综合评价方法的运用,重视软组织平衡技术和肢长调节,掌握全髋置换术中均衡下肢长度的手术技术,进一步改善手术效果。     

初次全髋关节置换术前胶片模板测量与评估

目的：通过胶片模板测量进行全髋关节置换术前计划、术后重复测量评估探讨胶片模板测量在全髋关节置换术前计划中的准确性和重要性。方法：2012年3月至2012年8月,收集我科同一位高年资医师行全髋关节置换病例72例（84髋）作研究对象。术前通过胶片模板测量,决定股骨颈截骨位置,计划髋臼、股骨柄、股骨头假体型号以及植入位置,调整双下肢长度;术后通过重复测量对术前计划进行评估和验证。结果：所有病例股骨颈截骨位置与术前计划相差均在5mm范围内,其中相差小于3mm者占84．5％。术前肢体平均短缩10mm（0～35mm）,术后肢体平均短缩3mm（0-11mm）,差异有统计学意义;术后双下肢长度相差在5mm以内者占90．5％。术前模板测量出的假体型号与实际应用的假体比较,髋臼假体完全符合率65．4％、相差1个型号以内的符合率为94．0％;股骨假体完全符合率为83．3％、相差1个型号以内的符合率为96．4％;股骨头假体完全符合率为63．1％、相差1个型号以内的符合率为98．8％。结论：全髋关节置换术前胶片模板测量对于术中假体型号选择具有较好的预测作用,对于假体位置安放以及双下肢长度调整均具有重要意义。     

髋臼发育不良并骨性关节炎的全髋关节置换术

目的探讨原位髋臼、股骨不截骨的全髋关节置换术治疗髋臼发育不良伴骨性关节炎的可行性。方法对18例22髋因髋臼发育不良伴骨性关节炎患者行全髋关节置换。其中男6例7髋，女12例15髋；年龄28～72岁，平均53岁。按Crowe分型，I型2例2髋，Ⅱ型10例13髋，Ⅲ型5例6髋，Ⅳ型1例1髋。术前均存在严重的髋关节疼痛和功能障碍，11例下肢短缩3～6cm。术前Harris评分30～65分，平均40分。采用软组织彻底松解、原位髋臼、股骨不截骨的方法行全髋关节置换。结果随访时间12～60个月，平均24个月。术后下肢延长2～6cm，基本恢复双下肢平衡。未出现关节脱位、股骨干骨折、股神经及坐骨神经损伤等并发症，无假体松动的临床和X线征象。术后Harris评分60～95分，与术前相比有显著差异（P〈0．01）。结论全髋置换术是治疗髋臼发育不良伴骨性关节炎的良好方法，术中彻底松解可以下肢延长4～6cm而无神经麻痹。     

全髋置换术治疗成人髋臼发育不良伴股骨头坏死

目的：探讨全髋置换术治疗成人髋臼发育不良伴股骨头缺血坏死的手术方法。方法：15例成人髋臼发育不良伴股骨头坏死病例，采用自体骨植骨造盖、重建髋臼等方法以达和谐臼容关系、平衡负重力线，恢复股骨头前倾角和颈干角纠正股骨头颈畸形。结果：15例均获随访，随访时间9个月至3年4个月，平均2．6年。术后髋关节功能Harris评分平均81．6分。术后下肢短缩0～2．5cm，平均0．8cm。术后X线显示臼容关系良好，植骨块融合。术后2例两侧肢体不等长仍大于2cm，行走时轻微跛行。结论：成人髋臼发育不良伴股骨头坏死全髋置换术，可以采用自体股骨头松质骨植骨造盖、重建髋臼等方法以达到和谐臼容关系、恢复负重力线，改善病人步态等目的，是一种行之有效的治疗方法。     

股骨转子下截骨的全髋关节置换治疗高脱位髋臼发育不良

背景：高位脱位的髋臼发育不良患者的骨性和软组织畸形严重,常规的全髋关节置换风险高,并发症多,而结合股骨转子下截骨的全髋关节置换可以简化置换方法。 目的：回顾性分析人工全髋关节置换结合股骨转子下截骨治疗高位脱位髋臼发育不良患者17例的疗效及安全性。 方法：对2006年1月到2011年6月在北京积水潭医院行人工全髋关节置换结合股骨转子下截骨治疗髋臼发育不良的患者17例的临床资料进行回顾性分析,均获得至少2年以上随访,共21髋关节,对置换并发症、髋关节功能改善以及髋关节部位影像学改变进行评估。 结果与结论：患者平均随访(48.0±20.5)个月。患者置换后Harris评分高于置换前(P < 0.05)。患者主要症状为双下肢不等长,下蹲后站起困难、下肢力量不足及下肢软组织紧张。1髋发生大转子骨折以钢爪固定;4髋在置换中股骨距裂纹骨折以钢丝捆绑。1例患者置换后出现股神经损伤表现,获得部分恢复。所有患者无感染、脱位和假体松动出现。结果说明,结合股骨转子下截骨短缩的人工全髋关节置换是治疗髋关节脱位的有效方法,安全可靠,但仍需要一定的置换技术控制其并发症的发生,其长期结果有待进一步随访。     

自体股骨头植骨生物型人工全髋关节置换治疗髋关节发育不良的疗效

背景：Crowe Ⅱ、Ⅲ、Ⅳ型髋关节发育不良患者真臼发育差,且受股骨头蚀损影响,外侧壁常有缺损,因此大部分患者均需采用自体植骨、假臼重建。 目的：观察生物型人工全髋关节置换治疗髋关节发育不良时采用自体股骨头植骨的临床效果。 方法：选择2007-03/2009-11四川省骨科医院髋部创伤科收治的髋关节发育不良继发骨性关节炎患者15例15髋,单侧患者双下肢不等长为(2.7±0.8) cm,置换前Harris评分为(41.6±12.8)分。术中15髋采用标准全髋关节置换,同时采用自体股骨头植骨重建髋臼旋转中心。置换后随访摄骨盆正位和患髋侧位X射线平片评价髋臼和股骨假体位置、植骨块愈合情况以及双下肢长度。 结果与结论：置换后切口均Ⅰ期愈合。患者均获随访,随访时间一两年,平均1年。置换后12个月X射线平片示植骨块均已愈合。末次随访时单侧患者双下肢不等长(0.8±0.3) cm,Harris评分为(89.3±6.5)分,与置换前相比,差异均有显著性意义(P < 0.05)。X射线平片示髋臼和股骨假体无移位,未见植骨块有明显移位和吸收塌陷征象。提示髋关节发育不良继发骨性关节炎行全髋关节置换时采用自体股骨头植骨有利于恢复髋臼旋转中心,提供良好髋臼固定。     

第二髋关节与髋臼发育不良

目的探索第二髋关节与髋臼发育不良的关系。方法观察髋臼周围旋转和周旋转联合转子间外翻截骨治疗髋臼发育不良15例15髋,术前、后X线片影像变化。A组髋臼发育不良15例15髋,测量马蹄角,计算平均值 计算术前、后角度差平均值。B组正常10例10髋马蹄角做对照。结果髋部截骨术使马蹄角与头赘相关节-启动第二髋关节。马蹄角均值：A组术前30.80±3.93°,术后19.27±1.58°,术前、后角度差11.53±3.74°。B组20.00±1.77°。A组术后与B组比较,统计学无差异。A组术前与A组术后和B组比较,差异显著。结论圆形股骨头、马蹄角〉23°,行髋臼周围前外侧12°旋转截骨术 椭圆形股骨头、马蹄角﹤23°,行转子间外翻30°截骨术 椭圆形股骨头、马蹄角〉23°,行联合截骨术。     

数字化模板测量对全髋关节置换后下肢不等长的影响

背景：置换前模板测量是全髋关节置换非常重要的置换前计划步骤。准确的模板测量可以帮助骨科医生选择最合适的假体型号,指导置换中下肢长度的控制,使患者获得满意的下肢长度和偏心距,从而减少置换后并发症的发生。 目的：观察置换前进行数字化模板测量对全髋关节置换后下肢不等长的影响。 方法：回顾性分析2004年10月至2012年5月在东南大学附属中大医院骨科行人工全髋关节置换的334例患者,根据是否进行数字化模板测量分为对照组(n=124)和测量组(n=210),分别在置换前未进行数字化模板测量和进行由NEUSOFT PACS/RIS3.0影像系统对骨盆正位进行的数字化模板测量,比较2组患者置换后下肢不等长的发生情况。 结果与结论：测量组全髋关节置换患者下肢不等长绝对值小于对照组(Z=-3.638,P < 0.01),表明测量组比对照组下肢不等长程度更小,更加趋向于下肢等长。以下肢不等长绝对值>10 mm作为下肢不等长的诊断标准,测量组全髋关节置换患者比对照组下肢不等长发生率明显降低(χ²=7.17,P=0.007 < 0.05)。说明数字化模板测量能够减少全髋关节置换后下肢不等长的发生。     

全髋关节置换治疗CroweⅣ型成人髋关节发育性不良

背景：人工全髋关节置换为治疗髋关节发育性不良晚期患者的最佳选择,然而髋关节发育性不良的患者特别是CroweⅣ型因其髋关节解剖结构的显著异常,增加了手术难度且手术方法颇有争议。 目的：探讨人工全髋关节置换治疗CroweⅣ型成人髋关节发育性不良的疗效及髋臼重建与股骨侧处理的方法。 方法：纳入12例(14髋)CroweⅣ型成人髋关节发育不良患者进行人工全髋关节置换,Harris评分术前平均(35.0±6.8)分,髋臼侧采用小臼杯结合髋臼加深技术安置臼杯假体,股骨侧行转子下短缩截骨放置股骨假体,采用Harris评分评价置换后髋关节功能。 结果与结论：所有患者随访1-7年,平均4.6年,2例2髋发生置换过程中股骨大转子不全骨折,予钢丝固定。1例置换后出现坐骨神经刺激症状,1个月后恢复正常,无感染、假体松动及有明显临床表现的深静脉血栓形成等并发症。股骨侧截骨处均骨性愈合。置换后末次随访Harris评分平均为(84.0±7.0)分,置换后肢体延长4-6 cm,平均5 cm,短缩的肢体得到满意纠正。说明采用小臼杯、髋臼内陷技术、股骨短缩截骨对CroweⅣ型成人髋关节发育性不良患者行全髋关节置换能重建关节功能,恢复下肢长度,长期疗效有待于进一步观察。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

股骨偏心距重建对人工全髋关节置换术后功能的影响

目的　分析重建股骨偏心距对人工全髋关节置换术后关节功能的影响。 方法　作者选择2005年01月至2008年01月间行初次单侧人工全髋关节置换术患者68例,随访时间9~24个月,平均19.2个月。手术均采用髋关节前外侧入路,使用Zweymüller双锥形螺旋臼及SL-PLUS矩形直柄（颈干角135°,股骨头假体的直径均为28 mm）。对比术前术后双髋关节正位X线片,测量股骨偏心距、髋外展肌力臂及双下肢长度,记录手术前后髋关节活动度及Harris评分,应用SPSS13.0统计软件分析股骨偏心距与其他指标的相关性。 结果　①股骨偏心距与髋外展肌力臂具有正相关性（r=0.534,P<0.001）。②髋关节术后活动度、Harris评分与股骨偏心距均存在明显回归相关关系（r=0.403,0.344,P<0.001）。③股骨偏心距重建与否对下肢长度的影响存在显著性差异（x2=4.23,P<0.05）。 结论　在人工全髋关节置换术中,重建股骨偏心距可增加髋外展肌力,改善髋关节的活动功能及稳定性。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.