桡侧伸腕长肌腱部分移位修复第一腕掌关节脱位的应用解剖

为了为第一腕掌关节脱位修复提供术式设计的解剖学依据。对３０ 侧成人上肢标本,对桡侧伸腕长肌腱进行形态学测量。结果桡侧伸腕长肌腱性部分长（１７ ．８ ±２ ．６）ｃｍ ,肌腱上、中、下段宽分别为（１３ ．７ ±３ ．１）ｍ ｍ ,（５ ．６ ±１ ．１）ｍ ｍ 和（４ ．６ ±０ ．５）ｍ ｍ ,肌腱上、中、下段厚分别为（１ ．５ ±０ ．５）ｍ ｍ ,（２．０ ±０ ．３）ｍ ｍ 和（２ ．４ ±０ ．３）ｍ ｍ 。提示：桡侧伸腕长肌部分肌腱,有足够的长度和强度转位修复第一腕掌关节脱位,术式设计合理,是一种新的手术方法。     

中药湿敷治疗慢性唇炎和唇部扁平苔癣20例临床观察

我院自１９８９年以来,对于我港患慢性唇炎和唇部扁平苔癣的露天工作人员,采用中药湿敷疗法,经临床观察疗效满意,现报告如下。 一、临床资料 ｌ．一般资料： （１）慢性唇炎１４例。分型：干燥脱屑型９例,其中病变累及上下唇者３例,病变限于下唇者６例;糜烂型唇炎５例,其中糜烂面波及整个下唇唇红１例,糜烂面约２ｃｍ×１ｃｍ者３例,糜烂面０．５ｃｍ × ０．５ｃｍ者１例。病程１／２～３年。 （２）唇部扁平苔癣糜烂型６例。分别为下唇糜烂面２．５ｃｍ×１．５ｃｍ者１例,下唇糜烂面ｌ．５ｃｍ×１ｃｍ者２例,下唇糜烂面约０…     

优秀足球、跳水运动员赛后唾液IgA浓度的变化

对象：（１）上海远东女子足球队运动员１８例,年龄２４±２岁;身高１６８．３５±４．０４ｃｍ;体重６３．７６±７６±７．５４ｋｇ,于１９９７年第３轮全国足球联赛最后一场比赛前和赛后５小时分别采取唾液标本。（２）上海跳水队运动员１１例（女７例,男４例）,年龄１２±１岁;身高：女１３７．８７±５．１８ｃｍ,男：１４０．６５±５．０１ｃｍ;体重：女３０．５±３．４８ｋｇ,男：３０．９４±３．５５ｋｇ,于１９９６年２月上旬邀请赛前和赛后１５小时内分别采取唾液样本。两队在赛前的采样,均是在用清水洗漱口腔后半…     

超声诊断脾脓肿的价值

资料：超声检查脾脓肿３例均为女性，年龄分别为２７、２９及３４岁，起病分别为脾动脉栓塞术（简称脾栓术、以下同）后左上腹疼痛伴发热４天、４月及２２天，体温３８．０～３９．５℃。查体：脾肋下８．０ｃｍ至平脐。超声检查：术前肋间／肋下脾脏大小分别为８．０ｃｍ×３．５ｃｍ／未探及，１１．８ｃｍ×５．９ｃｍ／１．５ｃｍ×２．０ｃｍ，及１１．０ｃｍ×５．２ｃｍ／３．０ｃｍ×２．０ｃｍ，脾区回声均匀，起病后次日复查，胁间脾脏大小分别为１１．６ｃｍ×５．５０ｃｍ、１５ｃｍ×８．０ｃｍ及１４．０ｃｍ×６．５ｃｍ，脾…     

颅底软骨粘液样纤维瘤一例

颅底软骨粘液样纤维瘤一例柳学国王一兵马强患者女，２９岁。月经周期紊乱，不规则阴道出血１年余，近２周视力下降。图１ＭＲＩ（Ｓｉｅｍｅｎｓ６３ＳＰ４０００，１．５Ｔ）Ｔ１加权像见鞍左旁４．２ｃｍ×３．０ｃｍ×４．３ｃｍ低信号占位病变，向上及向左推挤左丘...     

神经节苷酯对低氧大鼠脑钙,钙调素及蛋白激酶Ⅱ的影响

观察了神经节苷酯对急性低氧组大鼠（Ａ组：模拟海拔７００ｍ，５ｈ；Ｂ组：给神经节苷酯）和常氧对照组大鼠（Ｃ组：常氧；Ｄ组：给神经节苷酯）脑组织Ｃａ￣（２＋）、钙调素（ＣａＭ）及ＣａＭ依赖性蛋白激酶Ⅱ（ＣａＭＰＫⅡ）活性的影响。用Ｆｕｒａ－２测得Ｃａ￣（２＋）水平分别为７２２．１±８１．２．６４０．６±７４．４、２５８。７±３９．２和２６３．８±４１．３ｎｍｏｌ／Ｌ，Ａ组明显高于常氧对照组（Ｐ＜０．０１）；Ｂ组明显低于Ａ组（Ｐ＜＜０．０５）。用流式细胞仪（ＦＡＣＳ）所测ＣａＭ平均荧光强度分别为４０．２±４．７、４４．３±４．８．４６．１±５．１和４５．９±５．０道；Ａ组明显低于常氧对照组。用同位素（ｒ￣（３２）－ＡＴＰ）液闪计数法所测ＣａＭＰＫⅡ活性分别为１８２．９±７．９、１９２．３±８．２、１９７．９±９．２和１９８．２±９．３ｐｍｏｌｐｉ．ｍｉｎ￣（－１）ｍｇ￣（－１）ｐｒｏｔｅｉｎ，Ａ组明显低于其它三组，急性低氧Ｂ组与常氧对照组比无明显差别。表明，低氧时神经节苷酯可以减少胞内Ｃａ￣（２＋）蓄积和稳定ＣａＭ和ＣａＭＫｉｎａｓｅⅡ的变化．     

枕骨骨膜瓣的应用解剖

为枕骨骨膜瓣的临床应用提供解剖学基础。在６ 具成人尸体标本上观测了枕骨骨膜瓣的血管分布。结果发现枕动脉发出骨膜支（１２０ ±１８） 个分支，分支起始处外径为（０２ ±０１） ｍ ｍ ，枕动脉枕支起始处外径为（１２ ±０２） ｍ ｍ 。椎动脉枕部的外径为（２ ．９±０２） ｍ ｍ ，发出骨膜支（３５ ±０５） 支，其分支起始处外径为（０２±００７） ｍ ｍ 。骨膜血管网与对侧吻合丰富。结果提示可设计带骨膜血管蒂的枕骨骨膜瓣向下翻转植骨修复枕颈部骨缺损。     

瘰疬性皮肤结核误诊1例

１病例报告 患者男,１８岁,右大腿外侧肿物伴胀痛不适１个月入院。１个月前因训练不慎被踢中右大腿,１周后大腿外侧出现一核桃大小肿块,质中等硬,以后逐渐增大呈囊性,伴有胀痛不适,团卫生队诊断为血肿。入院查体：体温 ３６． ８ ℃,血压 １６． ２／９． ２ ｋＰａ,全身浅表淋巴结未触及,心肺听诊未见异常。右大腿外侧可见 １０ ｃｍ×４ｃｍ×２ｃｍ包块,表面光滑,颜色正常,境界不清楚,与深部及浅表组织粘连．压痛（±）。血、尿、便常规及肝功能均正常。Ｂ超检查见右股外侧皮下有一１５．０ｃｍ×５．４ ｃｍ×２．０ ｃｍ…     

正常寰枢间放射学测量及临床意义

通过对１２０ 名正常国人寰枢椎放射学测量，提供临床放射学意义。拍摄颈椎侧位屈曲位，伸展位和中立位Ｘ光片，测量３ 项指标：寰齿间距（ＡＤＩ） ，脊髓有效间隙（ＳＡＣ） 和脊髓有效间隙变化率即不稳定指标（ＩＩ） ，所得结果进行统计学分析。测量结果，正常成人ＡＤＩ中立位、屈曲位、伸展位分别为１ ．３６ ±０ ．６２（ｘ ±Ｓ，下同）ｍ ｍ ，（１．３１ ±０ ．６８）ｍ ｍ 和（１ ．３５ ±０ ．７５）ｍ ｍ 。ＳＡＣ分别是（２０ ．３ ±１ ．１）ｍ ｍ ，（２０ ．１ ±０ ．９）ｍ ｍ ，（２０．４ ±１ ．３）ｍ ｍ 。ＩＩ为（１１ ．８５ ±４ ．５６） ％ 。结果提示ＡＤＩ≥４ ｍ ｍ 时即可诊断寰枢椎不稳，≥３ ｍ ｍ 时应高度怀疑寰枢椎不稳。ＳＡＣ≤１４ ｍ ｍ 可论断Ｃ１ 平面椎管狭窄。ＩＩ≥２２ ％ 即有临床诊断意义。     

大鼠肌皮神经感觉纤维在脊髓胶状质内的投射

应用酸性磷酸酶法，定量研究肌皮神经感觉纤维在胶状质内的投射，结果为投射节段Ｃ４下段至Ｃ６上段，长度（３．０９±０．０６）ｍｍ。横向投射区集中在胶状质内侧半２～３区的范围至１～３区，Ｃ４（０．５６２±０．０１５）ｍｍ２、Ｃ５（０．５９２±０．０１）ｍｍ２、Ｃ６（０．５４３±０．０１８）ｍｍ２三者间无显著性差异（Ｐ＞０．０５）。     

喙肱肌腱转位修复肩锁关节脱位的解剖学基础

用31侧常规防腐成人上肢标本,对喙肱肌腱的形态及喙突的局部结构进行解剖学观测;测量34例锁骨干骨的有关数据;2侧标本行摹拟手术实验。结果：喙肱腱长（87±1．6）cm,喙突尖至锁骨最近距离为（2．4±0．5）cm,喙突尖至锁骨后峰端（43±0．4）cm,喙突粗隆处的锁骨及锁骨肩峰端厚度均为（1．0±0．2）cm。提示,设计橡防肌肤转位修复肩锁关节脱位具有可行性。     

Timing of post-exercise protein intake is important for muscle hypertrophy with resistance training in elderly humans

(1) Age‐associated loss of skeletal muscle mass and strength can partly be counteracted by resistance training, causing a net synthesis of muscular proteins. Protein synthesis is influenced synergistically by post‐exercise amino acid supplementation, but the importance of the timing of protein intake remains unresolved. (2) The study investigated the importance of immediate (P0) or delayed (P2) intake of an oral protein supplement upon muscle hypertrophy and strength over a period of resistance training in elderly males. (3) Thirteen men (age 74 ± 1 years; body mass index (BMI), 25 ± 1 kg m^{? 2} (means ± SEM)) completed a 12‐week resistance training program (three times per week) receiving oral protein in liquid form (10 g protein, 7 g carbohydrate, 3 g fat) immediately after (P0) or 2 h after (P2) each training session. Muscle hypertrophy was evaluated by magnetic resonance imaging (MRI) and from muscle biopsies and muscle strength was determined using dynamic and isokinetic strength measurements. Body composition was determined from dual‐energy X‐ray absorptiometry (DEXA) and food records were obtained over 4 days. The plasma insulin response to protein supplementation was also determined. (4) In response to training, the cross‐sectional area of m. quadriceps femoris (54.6 ± 0.5–58.3 ± 0.5 cm²) and mean fiber area (4047 ± 320–5019 ± 615 μ m²) increased in the P0 group, whereas no significant increase was observed in P2. For P0 both dynamic and isokinetic strength increased, by 46 and 15%, respectively (P < 0.05), whereas P2 only improved in dynamic strength, by 36% (P < 0.05). No differences in glucose or insulin response were observed between protein intake at 0 and 2 h post‐exercise. (5) We conclude that early intake of an oral protein supplement after resistance training is important for the development of hypertrophy in skeletal muscle of elderly men in response to resistance training.     

Phosphocreatine resynthesis during recovery in different muscles of the exercising leg by 31P‐MRS

To investigate the high‐energy phosphate metabolism by ³¹P‐nuclear magnetic resonance spectroscopy during off‐transition of exercise in different muscle groups, such as calf muscles and biceps femoris muscles, seven male long‐distance runners (LDR) and nine untrained males (UT) performed both submaximal constant and incremental exercises. The relative exercise intensity was set at 60% of the maximal work rate (60%Wmax) during both knee flexion and plantar flexion submaximal constant load exercises. The relative areas under the inorganic phosphate (P_i) and phosphocreatine (PCr) peaks were determined. During the 5‐min recovery following the 60%Wmax, the time constant for the PCr off‐kinetics was significantly faster in the plantar flexion (LDR: 17.3 ± 3.6 s, UT: 26.7 ± 6.7 s) than in the knee flexion (LDR: 29.7 ± 4.7 s, UT: 42.7 ± 2.8 s, P < 0.05). In addition, a significantly faster PCr off‐kinetics was observed in LDR than in UT for both exercises. The ratio of P_i to PCr (P_i/PCr) during exercise was significantly lower during the plantar flexion than during the knee flexion (P < 0.01). These findings indicated that the calf muscles had relatively higher potential for oxidative capacity than that of biceps femoris muscles with an association of training status.     

Modified gait patterns due to cam FAI syndrome remain unchanged after surgery

BackgroundIn order to reduce the development of hip osteoarthritis related to cam-type femoroacetabular impingement syndrome (FAIS), corrective surgery has evolved to become a safe and effective treatment. Although corrective surgery produces high level of patient satisfaction, it is still unclear how it affects muscle and hip contact forces during level walking.Research questionThe purpose was to compare the muscle force contributions and hip contact forces in patients before and after surgical correction for cam FAIS with healthy control (CTRL) individuals during level walking.MethodsEleven male patients with symptomatic cam-type morphology, who underwent hip osteochondroplasty, had their level walking recorded pre- and at 2-year postoperatively. The patients were sex-, age-, BMI-matched to 11 CTRL individuals. Sagittal and frontal hip kinematics and kinetics were computed and, subsequently, muscle and hip contact forces were estimated using musculoskeletal modelling and static optimization.ResultsPatient-reported outcomes improved postoperatively. The pre- and postoperative FAIS walked slower and with shorter steps than the CTRL. Postoperative biceps femoris (CTRL: 0.35 ± 0.13 N/BW; pre-op: 0.28 ± 0.11 N/BW; post-op: 0.20 ± 0.07 N/BW) and semimembranosus forces (CTRL: 0.77 ± 0.24 N/BW; pre-op: 0.66 ± 0.24 N/BW; post-op: 0.41 ± 0.14 N/BW) were lower at ipsilateral foot-strike. Postoperative rectus femoris force (CTRL: 1.73 ± 0.35 N/BW; pre-op: 1.44 ± 0.24 N/BW; post-op: 1.18 ± 0.23 N/BW) was lower than the other two groups, and the pre- and postoperative FAIS had lower iliacus (CTRL: 1.17 ± 0.18 N/BW; pre-op: 0.93 ± 0.16 N/BW; post-op: 0.94 ± 0.21 N/BW) and psoas (CTRL: 1.55 ± 0.24 N/BW; pre-op: 1.14 ± 0.38 N/BW; post-op: 1.10 ± 0.46 N/BW) muscle forces at contralateral foot-strike compared with the CTRL. Pre- and postoperative FAIS demonstrated lower peak hip contact loading resultant than the CTRL.SignificanceThe altered gait parameters observed in the preoperative FAIS was not restored after surgery, and was still away from the CTRL. It is possible that the reduced dynamic muscle forces of the biceps femoris, semimembranosus and rectus femoris postoperatively were associated with the protected mechanism that involved the iliopsoas preoperatively. This is an indication that the gait adaptations affected by the FAIS do not restore to normal after surgical correction at the 2-years follow-up.     

Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action

Purpose

To evaluate the effects of particle size and course of action of superselective bland transcatheter arterial embolization (TAE) on the efficacy of radiofrequency ablation (RFA).

Methods

Twenty pigs were divided into five groups: group 1a, 40-μm bland TAE before RFA; group 1b, 40-μm bland TAE after RFA; group 2a, 250-μm bland TAE before RFA; group 2b, 250-μm bland TAE after RFA and group 3, RFA alone. A total of 40 treatments were performed with a combined CT and angiography system. The sizes of the treated zones were measured from contrast-enhanced CTs on days 1 and 28. Animals were humanely killed, and the treated zones were examined pathologically.

Results

There were no complications during procedures and follow-up. The short-axis diameter of the ablation zone in group 1a (mean ± standard deviation, 3.19 ± 0.39 cm) was significantly larger than in group 1b (2.44 ± 0.52 cm; P = 0.021), group 2a (2.51 ± 0.32 cm; P = 0.048), group 2b (2.19 ± 0.44 cm; P = 0.02), and group 3 (1.91 ± 0.55 cm; P < 0.001). The greatest volume of ablation was achieved by performing embolization with 40-μm particles before RFA (group 1a; 20.97 ± 9.65 cm³). At histology, 40-μm microspheres were observed to occlude smaller and more distal arteries than 250-μm microspheres.

Conclusion

Bland TAE is more effective before RFA than postablation embolization. The use of very small 40-μm microspheres enhances the efficacy of RFA more than the use of larger particles.     

The acute effect of lower-limb warm-up on muscle performance

It has been purported that the mechanism for muscular improvement after a gluteal warm-up protocol is likely to occur from neural activation. However, little is known about whether changes in muscular performance are due to changes in muscle activity. Therefore, the aim of this study was to determine whether a lower-limb warm-up that targets the gluteal muscle group would improve countermovement jump and short-distance sprinting through increased muscle activity. Ten semi-professional rugby union players (age 25.4 ± 2.9 yr; height 1.83 ± 6.7 m; body mass 96.8 ± 10.6 kg) with at least three years of resistance training experience volunteered for the study. In a cross-over design, participants performed countermovement jumps and 5 m sprints before and after a gluteal warm-up and a 10 min rest (control). Electromyography was used to measure muscle activity of the gluteus maximus and biceps femoris. Countermovement jump height significantly improved (7.9%, p < 0.05) after the lower-limb warm-up protocol compared with the control (3.2%). There was a significant (p < 0.05) improvement in sprint times over 2.5 m and 5 m regardless of the condition. There was no significant change in the muscle activity in any of the conditions. The results indicate that a lower-limb warm-up can acutely enhance countermovement jump performance compared to a control.     

The arcuate ligament revisited: role of the posterolateral structures in providing static stability in the knee joint

Purpose

To determine the involvement of the posterolateral structures including the lateral collateral ligament, the popliteus muscle–tendon unit, the arcuate ligament (popliteofibular ligament, fabellofibular ligament, popliteomeniscal fascicles, capsular arm of short head of the biceps femoris and anterolateral ligament) and the posterior cruciate ligament in providing restraint to excessive recurvatum, tibial posterior translation and external tibial rotation at 90° of flexion.

Methods

Ten fresh-frozen cadaveric knees were tested with dial test, posterior drawer test and recurvatum test. The values were collected, using a surgical navigation system, on intact knees, following a serial section of the posterolateral corner (lateral collateral ligament, arcuate ligament and popliteus muscle–tendon unit), followed by the additional section of the posterior cruciate ligament.

Results

The mean tibial external rotation, recurvatum and posterior drawer were, respectively, measured at 9° ± 4°, 2° ± 3° and 9 ± 1 mm on intact knees. These values increase to 12° ± 5°, 3° ± 2° and 9 ± 1 mm after cutting the lateral collateral ligament; 17° ± 6° (p < 0.05), 3° ± 2° and 10 ± 1 mm after sectioning the arcuate ligament; 18° ± 7°, 3° ± 2° and 10 ± 1 mm after sectioning the popliteus muscle–tendon unit and 27° ± 6° (p < 0.05), 5° ± 3° (p < 0.05) and 28 ± 2 mm (p < 0.05) after the additional section of the posterior cruciate ligament.

Conclusion

Among the different structures of the posterolateral corner, only the arcuate ligament has a significant role in restricting excessive primary and coupled external rotation. The popliteus muscle–tendon unit is not a primary static stabilizer to tibial external rotation at 90° of knee flexion. The posterior cruciate ligament is the primary restraint to excessive recurvatum and posterior tibial translation. The posterior cruciate ligament and the arcuate ligament have predominant role for the posterolateral stability of the knee. The functional restoration of these ligaments is an important part of the surgical treatment of posterolateral ligamentous injuries.     

Early effects of short-term aerobic training. Physiological responses to graded exercise

AIM: The aim of this study was to find out how early the moderate training effects appear and to check the hypothesis that familiarization with exercise protocol may contribute to an early physiological responses to training in previously sedentary subjects. METHODS: Twelve male, sedentary volunteers (22.0+/-0.7 yrs) were submitted to 3 weeks of a bicycle ergometer training, consisting of 45 min of exercise (at 70% VO(2)max), 3-4 times a week. The subjects performed 4 incremental exercise tests until volitional exhaustion: 2 before training (C1 and C2), and then after 1 (T1) and 3 (T3) weeks of training. During exercise HR, VO(2), electrical activity (EMG) of rectus femoris, biceps femoris, soleus and trapezius muscles were recorded and blood samples were taken for blood lactate (LA) determination. RESULTS: Already after 1 week of training HR decreased (p<0.05) with a further decline after 3 weeks the training (p<0.01). Maximal work load after 3 weeks of training increased to 277+/-10.4 W vs 250+/-9.5 W (p<0.05), VO(2)max achieved higher values than in C1 and C2 tests (p<0.05) and LA and EMG thresholds were elevated (p<0.05). CONCLUSION: A decrease in the resting and submaximal heart rate is the earliest effect of increased physical activity. Familiarization to exercise protocol decreased EMG of biceps femoris and soleus muscles during exercise, but did not influence that of rectus femoris muscle the most engaged during cycling.