肩部调衡法治疗肩峰撞击综合征

目的:探讨肩部调衡法治疗肩峰撞击综合征的临床应用。方法:自2019年7月至2020年8月我们对36例肩峰撞击综合征患者,通过松解颈、胸、肩、上臂部相应肌肉及筋膜,调整肌肉张力,抗阻强化相关肌肉,纠正肱骨头向下移位,减缓肩峰下间隙内压力和减轻肩部周围软组织张力,达到筋骨平衡,治疗肩峰撞击导致的疼痛。结果:采用目前广泛应用...     

上臂主动和被动抬高过程中盂-肱关系的动态观察

目的　运用开放MRI和三维数据后处理技术分析主动和被动上臂抬高过程中肱骨头相对于肩胛盂的变换过程。方法　选择 16名健康志愿者 ,用开放MRI分别在肌肉放松 (外展 30°～ 15 0°)和肩部肌肉参与活动 (6 0°～ 12 0°)两种情况下、不同的外展位置上进行检查 ,在断层和三维重建后 ,关节盂的中心点、肱骨头的中心点被确定下来 ,再计算两者之间的相对位置变化。结果　在被动抬高过程中 ,自外展 30°到外展 15 0° ,肱骨头从下方 +1 5 8mm转移到下方 +0 36mm位置 ,自后方 +1 5 5 转移到 - 0 0 7mm。肌肉的参与导致盂 -肱关节变换关系的显著改变 ,肱骨头更加偏向下方和靠近中心 ,特别在 90°和 12 0°外展时表现得最为明显 (P <0 0 1)。前后方向在肌肉的参与下 ,6 0°和 90°外展时 ,肱骨头更趋向中心。结论　神经 -肌肉的控制作用对于保证关节稳定性具有重要作用 ,该组数据也可用于研究神经 -肌肉功能障碍对于肩关节的影响及二者之间的生物力学相关性。     

肩峰下撞击综合征38例临床症状体征分析

目的 探讨判断肩峰下撞击综合征的严重程度,即肩袖是否撕裂的可靠的检查方法。方法 对 1999年 2月～ 10月间, 38例诊断为肩峰下撞击综合征的患者的临床资料进行总结。结果 对肩峰下撞击综合征的检查中,阳性率较高的有 :疼痛弧 33例 (阳性率 86.8％ ),大结节压痛 36例 (94.7％ ),前撞击征 33例 (86.8％ ),侧撞击征 36例 (94.7％ ), 60°～ 90°外展抗阻试验阳性 37例 (97.4％ ),牵拉试验阳性 35例 (92.1％）,冈上肌试验阳性 32例 (84.2％ ),封闭试验阳性 37例 (97.4％ )。 30°外展抗阻试验及夜间疼痛在肩袖撕裂与未撕裂患者间阳性率差异有显著性意义（ P 0.05)。结论 侧撞击征、 60°～ 90°外展抗阻试验、牵拉试验与封闭试验、大结节压痛、前撞击征、冈上肌试验及疼痛弧等对肩峰下撞击综合征的诊断有很高的阳性率。 30°外展抗阻试验及夜间疼痛在肩袖撕裂与未撕裂患者间阳性率差异有显著性意义 ,而力弱在肩袖撕裂与未撕裂患者间差异无显著性意义。     

肩峰肱骨头相对位置与肩峰下撞击综合征关系的研究

[目的]探讨肩峰肱骨头相对位置对肩峰下间隙的影响,为肩峰下撞击综合征的诊断、预防和治疗提供理论依据.[方法]对本科2006年10月～2007年3月就诊的肩峰下撞击综合征患者3l肩(平均年龄54.3岁,男13肩,女18肩)的Graghey位片,计算肩峰指数即肩峰最外侧缘至肩关节盂平面的距离与肱骨近端最外侧缘至肩关节盂平面的距离的比值,通过肩峰指数对肩峰肱骨头相对位置进行定量评估,与正常人群40肩(平均年龄52.8岁;男18肩,女22肩)进行比较、分析.[结果]病例组平均肩峰指数及标准差为(0.72±0.05),正常组平均肩峰指数及标准差为(0.61±0.04),2组之间有明显差异(P＜0.0001).[结论]肩峰指数可准确的反映肩峰与肱骨头在冠状位上的位置关系,肩峰下撞击综合征与较大的肩峰指数有关.在较大的肩峰指数所反映的肩峰肱骨头位置关系中,外展时三角肌对肱骨头向上的分力大,肩峰下间隙内压力高,易引发肩峰下撞击综合征.     

改良前肩峰成形术治疗肩部撞击症23例的临床报告

目的分析、总结、改良前肩峰成形术治疗肩部撞击症的临床疗效。方法本组23例肩部撞击症患者为研究组,全部采用改良前肩峰成形术。另23例为对照组,采用传统手术方法。结果两组治疗结果经统计学处理具有显著意义(P<0.05),研究组23例肩部撞击症患者全部治愈。结论改良前肩峰成形术治疗肩部撞击症,使肩峰下间隙充分减压,以消除撞击因素,维持肩关节原有的解剖结构,保留第二肩关节的完整性,手术创伤小,早期功能锻练,肩关节功能恢复满意,明显优于对照组。     

肩部撞击症70例诊治体会

肩部撞击症７０例诊治体会李永才肩部撞击症又称肩峰下疼痛弧综合症。是肩关节外展活动时，肩峰下间隙内结构与像肩韧带穹之间反复摩擦撞击而产生的一种慢性肩部疼痛综合症［１］，是中年以上者的常见病。门诊中大多以肩峰下滑囊炎、冈上肌腱炎及肱二头肌长头腱鞘炎为主要...     

外伤性肩峰下肩关节后脱位一例

患者,男,39岁。骑自行车时为躲避汽车而坠地,右肩部剧痛,不敢活动,急诊于某医院,常规摄右肩前后位Ｘ线片,诊断为右肩部软组织损伤,未予处置。以后患者因疼痛加重,就诊于我院。查体:右肩角状前突畸形,上臂内旋20°,内收10°,前屈10°位,外展外旋受限,Ｄｕｇａｓ征阴性,活动时右肩峰后下方触及肱骨头。仔细阅读右肩前后位Ｘ线片(图1、2),明确诊断后手法复位,固定三周,功能锻炼。随访七个月,右肩无疼痛及功能障碍。图1　正常肩关节前后位Ｘ线片　　　图2　肩峰下肩关节后脱位前后位Ｘ线片讨论　Ｄｅｐａｌｍａ认为肩关节后脱位漏诊率高达60%[1]…     

上臂抬高过程中的盂-肱在体运动模式分析

目的利用核磁共振成像和三维图像后处理技术,在上臂被动抬高过程中对肩带的盂-肱结构进行基本运动分析.方法选用20个志愿者,利用开放核磁共振系统对上臂5个不同外展位置(30°、60°、90°、120°、150°)进行扫描.经过分层扫描采集数据后,实施三维重建,确定肱骨和关节盂平面的轴,并计算它们相对于参考平面之间的运动.结果获得了上臂被动抬高过程中盂-肱结构相对参考平面运动的特殊三维运动数据.结论利用核磁共振成像和三维图像后处理技术可以揭示在上臂被动抬高过程中盂-肱关节相对参考系运动的特殊三维运动模式;所用技术和获得的数据可用于进一步研究患者异常的肩关节运动病理性改变.     

改良前肩峰成形术治疗肩部撞击症20例

肩部撞击症常见中年以上患者,是以肩部慢性病理损害和肩部慢性疼痛及肩关节功能障碍为主的常见疾病,常严重影响病人的生活和工作,本组20例肩部撞击症病人,全部选用改良前肩峰成形术,现将治疗情况总结报告如下。     

肩峰下撞击征的治疗进展

肩峰下结构与典型滑膜关节的结构非常相似,其中喙突、喙肩韧带、肩峰构成的穹隆状结构类似臼窝;肱骨大结节类似关节突;位于肩峰和喙肩韧带、冈上肌之间的肩峰下滑囊类似关节滑囊;冈上肌肌腱在肩峰与肱骨大结节间穿过,肱二头肌长头腱在其深面穿越肱骨头上方。因此,肩峰下结构又被称为“第二肩关节”。肩峰前外侧形态异常、骨赘形成,肱骨大结节骨赘形成,肩锁关节增生以及其它可能导致肩峰－肱骨头间距减小的原因均可造成肩峰下结构的挤压与撞击,即由于与肩峰底面的前 1/3、喙肩韧带和肩锁关节下面的反复异常碰撞,滑囊、肩袖及肱二头…     

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.