膝关节后外侧结构损伤的临床研究进展

<正>膝关节后外侧结构(posterolateral structure,PLS),又被称为后外侧角(posterolateral corner,PLC)或后外侧复合体(posterolateral complex,PLC),其损伤可导致严重的功能障碍,造成膝关节不稳定及关节软骨退变。过去一段时间内的相关研究表明,PLC损伤不仅导致膝关节     

膝关节韧带损伤与胫骨平台骨折Schatzker及AO分型的相关性分析

目的分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。方法选取2018年1月至2019年6月厦门大学附属福州第二医院骨科收治的28例胫骨平台骨折合并膝关节韧带损伤患者作为研究对象,根据Schatzker分型及AO分型系统对胫骨平台骨折进行分型,同时判定前交叉韧带(anterior cruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)、内侧副韧带(medial collateral ligament,MCL)及后外侧角(posterior lateral corner,PLC)的损伤情况,并采用Spearman相关系数分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。结果Schatzker分型与AO分型(仅以关节外、部分关节内和完全关节内3种类型计算)对应分析结果显示,两者具有显著相关性(P=0.000)。Schatzker分型及AO分型与韧带损伤类型Spearman相关分析结果显示,Schatzker分型及AO分型与ACL、MCL及PLC损伤均呈显著相关性(r=-0.465、-0.639、0.756,P=0.013、0.000、0.000;r=-0.588、-0.420、0.532,P=0.001、0.026、0.004),但若AO分型以关节外、部分关节内和完全关节内3种类型计算,则仅与ACL损伤呈显著相关性(r=-0.465,P=0.013)。结论膝关节损伤时膝关节相关韧带之间有一定协同作用,故胫骨平台骨折多合并膝关节韧带损伤,且随着Schatzker分型与AO分型等级的增高,ACL、MCL及PLC损伤的可能性均增大。     

关节镜下半腱肌、半膜肌腱联合重建后交叉韧带的疗效分析

后交叉韧带(PCL)是膝关节韧带结构中最强的稳定结构,断裂后可造成关节直向不稳、旋转不稳和侧方不稳,从而影响膝关节功能,并导致膝周其他韧带松弛、半月板损伤和关节软骨退变等病变[1].近年来,PCL重建的研究已成为矫形骨科医师探讨的热点.自2001年3月至2004年4月,笔者在关节镜下联合半腱肌、半膜肌腱重建PCL 46例.现报告如下.     

分期治疗膝关节多发伤22例

膝关节多发损伤常由于严重外伤引起,且多伴有骨折、韧带或血管、神经损伤等[1],如治疗不当,将导致膝关节功能障碍及相关并发症.正确处理其损伤, 选择和把握手术时机,减少膝关节功能损害至关重要.我院于2010-10至2012-10收治22例膝关节多发伤患者,采取分期治疗,效果满意.     

骨挫伤与膝关节附属结构损伤关系的MRI评价

目的　探讨骨挫伤与膝关节附属结构损伤的关系。方法　回顾性分析了 5 8例膝关节骨挫伤病人的影像学资料 ;记录患者的年龄 ,骨挫伤病灶的部位、病灶数、MRI表现、关节附属结构损伤的部位及类型。结果　膝关节骨挫伤好发于青少年 (3 1.0 % ,18/ 5 8) ;80 % (8/ 10 )的股骨外侧髁及胫骨外侧平台的骨挫伤伴有前交叉韧带撕裂 ;侧副韧带损伤中有 45 % (9/ 2 0 )伴有同侧的骨挫伤 ,5 0 % (10 / 2 0 )对侧有骨挫伤 ;64 .9% (2 4/ 3 7)的骨挫伤发生于半月板撕裂的同侧 ,对侧为 13 .5 % (5 / 3 7) ,内、外侧半月板同时累及2 1.6% (8/ 3 7)。关节软骨损伤均伴有软骨下的骨挫伤。结论　青少年膝关节外伤后关节疼痛 ,行MRI检查可发现相关的关节损伤。膝关节的骨挫伤是前交叉韧带撕裂、半月板撕裂及关节软骨损伤的重要间接征象。     

加强膝关节损伤的研究与治疗

膝关节损伤是临床上一种十分常见的损伤类型 ,绝大多数属运动性损伤。近十年来 ,对这一课题的基础与临床研究方兴未艾 ,值得临床医师进一步关注。膝关节是人体内最大的和最复杂的滑膜关节(synovialjoint) ,由股骨远端、胫骨近端、髌骨以及周围的肌肉、韧带、关节囊、半月板等共同组成。膝关节本身骨性结构的稳定性较差 ,其关节稳定主要依靠软组织结构加以支持。现代解剖学研究证实 ,膝关节支持结构共分为四组 :内侧支持结构、外侧支持结构、前方支持结构和中央支持结构。因为膝关节具有独特的解剖、功能和力学特征 ,所以很容易受到损伤。根…     

自体中1/3股二头肌腱和股薄肌重建膝关节后外侧角韧带复合体损伤

目的 探讨采用自体中1/3股二头肌腱和股薄肌重建膝关节后外侧角韧带复合体(PLC)的技术及近期的疗效. 方法 本组21例,均为联合型的直向外侧+后外侧旋转＞Ⅱ度不稳定,重建范围:胭肌腱、外侧副韧带、胭腓韧带.术中单独提取健侧或患侧股薄肌重建膕肌腱.切取股二头肌肌腱中1/3部,折叠后对折端拉入股骨外髁骨隧道固定,分出的前束重建外侧副韧带(LCL),后束重建胭腓韧带. 结果 术后随访6～24个月,平均16个月.Lyshohn膝关节功能评分,术前为(43±2)分,术后半年为(90±3)分,有明显改进. 结论 PLC损伤可造成患肢功能受损,采用自体中1/3股二头肌腱和股薄肌修复重建韧带手术可获得良好预后.     

膝关节软骨损伤及修复术后的MRI研究进展

膝关节软骨损伤影像学检查的重要性及研究现状 膝关节是人体最大最复杂的关节,其表面覆盖着一层关节软骨。关节软骨是无血管、淋巴管和神经的组织,因此损伤后自身的修复能力有限;并且修复组织的组成、结构和力学特性均明显区别于正常关节软骨。因此关节软骨损伤后常导致关节功能障碍．严重影响关节的正常功能。应用影像学方法正确评价关节软骨损伤的程度是临床治疗的基础。     

膝关节关节软骨损伤的MRI研究

膝关节是人体最复杂的关节,膝关节损伤居所有关节损伤之首。在膝关节病变的影像诊断中,X线摄片仅显示骨性结构的改变,软骨等结构的显示还须依靠其他影像技术,尤其是MRI能确定软骨损伤的性质及范围,已成为重要的检查手段之一。本文就膝关节关节软骨的MRI诊断及研究进展进行概述。1膝关节关节软骨断层影像解剖膝关节内,各关节骨表面被覆关节软骨。MR扫描显示髌股关节表面平整光滑,但关节腔形态不尽相同,分别呈磨合紧密狭窄凸向后的弧形、前后径短的横位“X”形及前小后大相通的“工”字形[1]。郭世萍等[2]用一组男尸标本,依据解剖学骨性标…     

自体半腱和股薄肌腱移植双束重建膝关节后外侧角

目的:观察采用自体半腱和股薄肌腱移植双束重建膝关节后外侧角韧带结构的近期临床效果。方法:对21例膝关节后外侧角韧带结构损伤患者(23个膝关节),采用自体半腱和股薄肌腱移植,双束重建膝关节后外侧角韧带结构。自体半腱肌腱移植物经胫骨骨道和腓骨骨道返折分别重建腘肌腱和腘腓韧带,于腘肌腱股骨外侧髁解剖止点处钻孔固定重建的腘肌腱和腘腓韧带;股薄肌腱移植物经腓骨骨道返折重建腓侧副韧带,于腓侧副韧带股骨外侧解剖止点处钻孔固定重建的腓侧副韧带。对于合并交叉韧带损伤者,同期行关节镜下韧带重建术。术后对患者膝关节内翻稳定性和外旋活动度进行至少1年(12~31个月,平均26.7个月)随访,通过Lysholm膝关节评分法评价膝关节术前、术后功能。结果:术后1年以上的回顾性随访中,膝关节完全伸直位无膝内翻不稳定者;屈膝30°位,无膝内翻不稳定者19例,膝内翻Ⅰ度不稳定伴硬性终止点者2例;俯卧位膝关节屈膝30°,所有患者小腿外旋活动均与对侧相同;Lysholm膝关节评分术前平均54.3分,术后平均89.2分。结论:自体半腱和股薄肌腱移植双束重建膝关节后外侧角韧带结构具有移植腱割取创伤小、移植材料理想、解剖等长重建及固定强度高的特点,近期疗效理想。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.