YAG激光切除人工晶体前膜

资料 :施行后房型人工晶体植入术后形成较厚纤维膜病例 2 1例 (2 1眼 ) ,其中男性 9例 ,女性 1 2例 ,年龄 6～ 78岁。外伤性白内障 4例 ,老年性白内障 1 7例。纤维膜形成时间为 1周～ 7ａ。方法 :使用国产ＬＪＬ50型调Ｑ ＹＡＧ激光眼科治疗机 ,单脉冲 ,小能量开始 ,根据前膜厚度逐渐增大能量至最佳切割效果 ,在近瞳孔缘处切开前膜。纤维膜未与人工晶体前表面粘连可直接击碎前膜。已粘连的 ,沿瞳孔缘切开后 ,用散焦将膜从人工晶体表面剥离 ,然后击碎。术后用皮质类固醇眼液滴眼。激光单脉冲能量 2 2～ 1 0ｍＪ ,单眼治疗能量 1 6～1 2 37ｍ…     

利用残余囊膜行后房型人工晶体植入29例

1995～ 2 0 0 0年 ,我们在行人工晶体植入术中发现后囊破裂 64例。对其中 2 9例实施了不缝线后房型人工晶体植入 ,术后视力恢复良好 ,无严重并发症。1　临床资料1 1　一般情况　 2 9例 (2 9眼 )中 ,男 2 1例 (2 1眼 ) ,女 8例 (8眼 ) ;年龄 15～ 69岁 ,平均 4 2岁。外伤性白内障致囊膜破裂 18眼 ;其他白内障手术中操作致后囊破裂 11眼。术前合并虹膜部分缺损 8例 ,角膜白斑 4例。破损位于后囊中央破孔 1～ 3ｍｍ 8例 ,4～ 6ｍｍ 5例 ,鼻侧及颞侧破孔 7例 ,上方破孔 5例 ,下方 4例。人工晶体选择 :(1)上海ＴＮＣ人工晶体 ,光学直径 6 0ｍｍ ,…     

80例白内障囊外摘除联合后房型人工晶体植入术并发症的处理

近年来 ,显微手术的应用和后房型人工晶体植入术的发展 ,为老年性白内障患者带来了福音。尽管人工晶体的制作 ,工艺及设计型号不断改进以及手术技巧的不断提高 ,其并发症仍有发生 ,正确而及时地消除和减少术后并发症是手术获得成功地关键因素之一。自 1996～ 1998年 ,三年来对 80例人工晶体植入术后并发症及处理总结如下。1　资料与方法1.1　一般资料　本组 80例均来自我院眼科病房收住的白内障患者。其中男性 4 5眼 ,女性 35眼 ,右眼35只 ,左眼 4 5只。年龄最小 4 8岁 ,最大 86岁。其中老年性白内障 66例 ,并发性白内障 8例 ,外伤性白内障 …     

超声乳化摘除术治疗高度近视白内障24例疗效观察

目的:评价高度近视白内障超声乳化摘除术的疗效.方法:对24例(29只眼)混合性、并发性白内障施行超声乳化吸除,通过4.0 mm切口植入后房型人工晶体.平均年龄63.8岁(38～80岁).结果:术后1周裸眼或矫正视力≥0.4者,占73.7%,术后3月为84.2%.结论:高度近视白内障超声乳化及后房型人工晶体植入术,具有术后视力恢复快且稳定等优点,但高度近视并发玻璃体及视网膜疾病者,视力恢复较差.     

表面麻醉下白内障超声乳化术218例

白内障超声乳化术以切口小 ,眼球损伤轻 ,术后视力恢复快等优点迅速在我国推广。 2 0 0 1～ 2 0 0 2年 ,我院采用表面麻醉下行白内障超声乳化摘除 +人工晶体植入术 2 18例 2 37眼 ,疗效良好。1　临床资料1 1　一般情况　男 132例 ,女 86例 ;年龄 13～ 10 2岁 ,平均 6 4 7岁。老年性白内障 197眼 ,继发性白内障 2 6眼 ,外伤性白内障 10眼 ,先天性白内障 4眼。单眼人工晶体植入 199例 ,双眼人工晶体植入19例。术前视力 :光感～ 0 5。LocⅡ分级均为Ⅰ～Ⅳ级核。1 2　手术方法　术前准备参照白内障常规手术 ,不应用镇静剂或镇痛剂。表面麻醉剂…     

单纯小切口白内障囊外摘除＋人工晶体植入治疗闭角型青光眼16例临床观察

目的：观察单纯的白内障摘除加后房型人工晶体植入术后治疗闭角型青光眼并发白内障的疗效。方法：单纯用小切口白内障囊外摘除加后房型人工晶体植入术后治疗闭角型青光眼并发白内障（16例20眼）术前和术后常规做视力,裂隙灯显微镜,非接触眼压计检查,前房深度检查及前房角镜检查,随访1～12个月。结果：所有患者术中及术后均没有出现严重并发症,术后视力均较术前提高,术前眼压（16～36mmHg,平均眼压27.8mmHg）与术后眼压（19～20mmHg,平均17.6mmHg）相比差异有显著性,术前前房深度（1.31±0.62）mm,与术后平均前房深度（2.56±0.68）mm相比差异有显著性,术后所有病例前房角均重新开放或部分开放增宽。结论：单纯小切口白内障囊外摘除加人工晶体植入可有效地治疗合并白内障闭角型青光眼。     

小儿白内障囊外摘除后房型人工晶体植入术的麻醉处理

我院1985年11月至1992年10月在氯胺酮、羟丁酸钠(γ-OH)复合麻醉下行小儿白内障囊外摘除并后房型人工晶体植入术37例,取得满意效果,现报告如下。 1 临床资料 本组男21例,女16例;年龄10个月～14岁,平均7.42±3.08岁;平均体重20.22±7.89kg。先天性白内障33例,外伤性白内障4例。术前心肺、化验检查正常,无其它畸形。均在显微镜下行白内障囊外摘除,20例同时行后房型人工晶体植入术。手术时间为60～140min,平均105.45±31.81min。     

白内障囊外摘出及后房型人工晶体一期植入术

人工晶体植入术是白内障摘出后,恢复视力的先进技术,在国内外已逐渐开展起来。植入的人工晶体可以长期保留在眼内,有极好的生物相容性,属于现代人工器官移植的成功技术之一。我院于1988年5月～1990年11月,借助手术放大镜植入国产硅凝胶GNY515型双袢后房型人工晶体17例(17眼),美国产聚甲基丙烯酸甲酯(PMMA)后房型人工晶体3例(3)眼),共20例(20眼),现简要报告如下。 一、一般资料‘ 男8例,女12例;17～82岁(平均56.7岁),其中老年性白内障15例,并发性白内障2例,外伤性白内障2例,老年性白内障并发角膜斑翳1例。随访0.5～2.5年,术后恢复视力0.5～1.2的16例,占80％;0.3～0.4的3例,占15％;1例并发角膜斑翳术后视力0.06,占5％,总有效率95％。     

人工晶体悬吊术37例手术体会

phaco术、白内障囊外摘除及人工晶体植入手术是白内障患者的主要治疗手段，但一些外伤性白内障合并后囊破裂、晶状体脱位、白内障术时后囊膜巨大破口合并玻璃体脱出，不能行1期后房型人工晶体植入术病人，可以行人工晶体悬吊术。笔者自2002年9月～2005年5月共施行人工晶体悬吊术37例，效果满意，现报告如下。     

白内障超声乳化术后角膜内皮水肿170例

角膜内皮水肿是白内障术后并发症之一 ,严重时可致角膜雾状混浊 ,影响视力。 1999年开始 ,我们采用超声乳化术治疗白内障 ,术后出现角膜内皮水肿 170例 ,经积极治疗后水肿均消退 ,术后视力提高。1　临床资料1 1　一般情况　 16 0例 (170眼 ) ,男 79例 84眼 ,女81例 86眼 ;年龄 6～ 80岁 ,平均 5 6岁。其中老年性白内障 10 5眼 ,外伤性白内障 6 5眼。白内障核分级 :Ⅰ、Ⅱ级 5 2眼 ;Ⅲ、Ⅳ级 118眼。单眼 15 0例 ,双眼 10例。1 2　手术方法　采用白内障超声乳化抽吸 +人工晶体植入术 ,术前 30min充分散瞳 ,球后麻醉。在角膜缘后界 2～ 3mm处…     

Restoring knee joint kinematics after anterior cruciate ligament injury might inhibit synovial membrane inflammation

Sport Sciences for Health - We developed a novel controlled abnormal joint movement (CAJM) model that controls instability after traditional anterior cruciate ligament transection (ACL-T). We...     

Ultrasound evaluation of gravity induced anterior drawer following anterior cruciate ligament lesion

Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL) lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees was to compare the diagnostic accuracy of prone ultrasonographic Lachman testing with KT-1000 measurements in the same study population. Our technique is based on a prone position of the patient. The thigh lies on the table surface such that the patella has no contact. The lower leg is placed on a roll in the ankle area and flexed to 30 degrees . The transducer (5 MHz) is positioned over the medial aspect of the popliteal fossa to visualize the femoral condyle as well as the tibial head. Under ultrasound control the lower leg is manually lifted as far the thigh stays in contact with the surface defining the start position. The lower leg is then released and drawn by gravity into the anterior drawer position, the final position. The distance between the posterior tangent from the medial femoral condyle to the medial tibial plateau was registered by three independent ultrasound measurements of the injured knee. The uninvolved opposite knee served as an internal control. The same procedure was done using a KT-1000 device (89 and 133 Newton and manual maximum force). The patients were split into two groups: acute injury (A), and (B) 6 months following ACL repair with a patellar tendon graft. All patients then underwent arthroscopy. In group A with acute ACL lesions the anterior drawer resulted in 14.1 mm (+/- 3.5) and was significantly (P < 0.001) different from the contralateral knee (7.7 mm +/- 2.9). The KT 1000 showed a comparable difference with 14.4 mm (+/- 3.9) for the injured knee and 8.3 mm (+/- 3.4) for the uninjured (P < 0.001). Sonometrically, group B patients showed no clear difference between the repaired (9.9 mm +/- 2.7) knee and its control (8.1 mm +/- 2.5). This was found for the KT-1000 results as well. The results derived from the ultrasound evaluation of the anterior drawer correlated well with those from the KT-1000 (r = 0.46). Based on a minimum intra-individual difference of 5 mm in the ultrasound measured anterior drawer, the sensitivity of the test in group A resulted in 0.96, and the specificity in 0.98. The described technique is reproducible, painless and easy to perform in order to evaluate acute ACL tears using any commercially available ultrasound device. The reproducibility is similar to the KT-1000 device. We recommend this technique for use in cases of acute ACL tears as well as in the follow-up of ACL repair.     

Restoration of anterior cruciate ligament-hamstring reflex arc after anterior cruciate ligament reconstruction

It has recently been emphasized that restoration of neuromuscular function contributes to dynamic stability of the anterior cruciate ligament (ACL) reconstructed knee. The existence of an ACL-hamstring reflex arc, one of the protective ligament-muscular pathways, has been revealed in normal human knees. Although reinnervation to the reconstructed ACL has been observed histologically, it remains unclear whether the ACL-hamstring reflex arc is reestablished. This study examined the existence of the ACL-hamstring reflex arc in ACL-reconstructed knees by analyzing the changes in the hamstring EMG elicited by electrical stimulation to the reconstructed ACL. The patellar tendon grafts transplanted as an ACL substitute in three patients were electrically stimulated via a bipolar wire electrode inserted arthroscopically. The surface EMG was monitored from the ipsilateral biceps femoris and semitendinosus. In two of the three patients the significantly increased EMG value of the biceps femoris was detected between 120 and 140 ms after the onset of electrical ACL stimulation. The increased EMG activity detected in the biceps femoris after the stimulation to the patellar tendon graft indicated reestablishment of the ACL-hamstring reflex arc in the ACL-reconstructed knee.     

改良前盆底重建术治疗阴道前壁中重度膨出的疗效研究

目的：评价改良前盆底重建术治疗阴道前壁中重度膨出的临床效果。方法：对38例阴道前壁中重度膨出的患者采用普理灵网片行改良前盆底重建术,对30例合并张力性尿失禁的患者同时行TVT-O尿道中段悬吊术,回顾分析其临床病理资料。结果：38例均顺利完成改良前盆底重建术,患者恢复良好,无器官损伤、感染、血肿等并发症。术后随访6~12个月,治愈率100%,无阴道狭窄和缩短,无网片局部侵蚀暴露,1例患者术后出现张力性尿失禁,其余无排尿及排便功能障碍。结论：改良的前盆底重建术是治疗阴道前壁中重度脱垂的有效术式,保留子宫和阴道功能,同时加强盆底组织,手术安全、微创、疗效显著、复发率低,值得临床推广。     

The anterior tibio-talar ligament: one reason for anterior ankle impingement

The purpose of this study was the evaluation of the ankle’s anterolateral ligament structures. We documented the anatomic situation of the ankle’s anterolateral ligament structures in 33 Thiel-embalmed specimens. The ligaments had been isolated. We performed measurements on both length and orientation and additionally classified the ligaments. We also conducted histologic tissue staining. We were able to document a regular appearance of a so far not well-realized structure between the talus and the tibia, present in 26 (79%) specimens. Average length of this structure was 26 mm (in 20° plantarflexion). The angular orientation in relation to the ant. tibio-fibular lig. was on average 43.7°. This structure could be classified as being either isolated or widespread, with a further four sub-classifications for the orientation. Histologic staining showed parallel orientated dense collagen fibers as well as elastic fibers and hyaline cartilage in different stages of proliferation. In addition, there were neural fibers in the perivascular and the soft tissue. The histologic findings proved that the structure was a ligament. Since the ant. tibio-talar lig. is constantly present in most ankle joints, it could be considered as a regular finding. Its morphology and histology show that this ligament is loaded under tension as well as under compression. This could be one reason for anterior ankle impingement.     

Diagnosis of anterior knee pain

A methodical approach to the evaluation of patients with anterior knee pain is extremely helpful. By exploring salient points from the patient's symptoms and history and adding important data from a comprehensive physical examination, the pieces of the puzzle can be fitted together and an accurate diagnosis can be made. This will allow the formulation of a specific plan of rehabilitation that is designed with a knowledge of patellofemoral biomechanics and that will expedite the recovery process and facilitate a return to full function.     

Comparison of Achilles and tibialis anterior tendon allografts after anterior cruciate ligament reconstruction

Purpose

The purpose of this study was to compare the outcomes after anterior cruciate ligament (ACL) reconstruction using Achilles tendon allografts and tibialis anterior (TA) tendon allografts with respect to objective knee testing measures, second-look arthroscopy and femoral tunnel enlargement.

Methods

A total of 131 patients who underwent ACL reconstruction between 2000 and 2006 were retrospectively reviewed. Achilles tendon allografts were used in 81 patients (group I). These patients were compared with 50 patients in whom TA tendon allografts were used (group II). The two groups were assessed using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores, as well as KT-2000 testing. Second-look arthroscopic findings were evaluated. Cross-sectional area (CSA) perpendicular to the long axis of the femoral tunnel was also calculated digitally using magnetic resonance imaging.

Results

No significant differences were observed between the two groups with respect to IKDC, Lysholm or Tegner activity scores or the results of laxity testing with arthrometry. Synovial coverage of more than 50 % was found in 71.1 % cases in group I and 75 % cases in group II. Mean CSA enlargement of 15 % (group I) and 38 % (group II) was detected (p = 0.017).

Conclusions

The clinical results associated with Achilles and TA tendons were not significantly different. The laxity evaluation and second-look arthroscopy demonstrated no significant differences between group I and group II. However, Achilles tendon-bone plugs for femoral tunnel fixation reduced femoral tunnel enlargement compared to the TA allograft. Achilles tendon allografts for ACL reconstruction could be a reasonable option in selected patients.

Level of evidence

Retrospective case series, Level IV.     

MRI of anterior knee pain

Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa’s disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.