桡骨远端骨折治疗后腕部尺骨撞击综合征

目的探讨桡骨远端骨折后尺骨撞击综合征与遗留腕部功能受限的关系。方法对桡骨远端骨折后遗留腕尺侧疼痛、握力下降的患者进行仔细检查,结合Tamaino和Cerezal的诊断标准,确诊尺骨撞击综合征52例,并探讨腕关节功能评分(Sarmiento改良方法)与尺骨变异程度的关系。结果尺骨阳性变异38例(73.1%),其中变异超过10mm者31例(59.6%);优、良组的平均尺骨变异为(1.5±0.5)和(4.5±1.8)mm,可、差组的平均尺骨变异为(9.6±3.7)和(16.2±4.8)mm,腕部症状与尺骨变异程度关系密切(P<0.01)。MRI检查发现腕骨及三角纤维软骨复合体(TFCC)不同程度信号改变,腕骨坏死位于月骨尺侧部分的近端和三角骨腰部及底部。结论桡骨远端骨折后治疗不当可导致尺骨撞击综合征,遗留腕尺侧疼痛、握力下降,其病理过程是腕骨及TFCC损伤,而非单纯的软组织损伤。     

孟氏并科雷氏骨折一例

患儿 ,男 ,9岁 ,左前臂跌落伤 9小时入院。腕部呈银叉样畸形。查体 :右肘部及前臂与腕部肿胀明显。肘部呈半屈曲畸形 ,腕肘部及前臂可触及骨擦音。桡骨小头窝消失。Ｘ线片示 ,上尺桡关节分离 ,桡骨小头向外前方移位 ,尺骨上段粉碎性骨折。桡骨远端向背外侧明显移位。尺骨远段向桡背移位骨折。入院诊断 :①孟氏 (Ｍｏｎｔｅｇｇｉａ)骨折 ;②科雷氏 (Ｃｏｌｌｅｓ)骨折 ;③尺骨远段骨折。入院后立即行手术治疗。术中用克氏针分别固定尺骨近远端骨折、桡骨远端骨骺。复位桡骨小头后修补环状韧带 ,再用一根克氏针从肱骨小头将桡骨小头固定。术…     

尺骨鹰嘴影像学参数测量及临床意义

目的通过测量尺骨鹰嘴的影像学数据,为尺骨鹰嘴骨折张力带手术克氏针置入方向、角度及宽度提供理论参考。方法回顾性收集2020年9月至2020年12月我院60例成人正常肘关节正侧位X线片,其中男30例,女30例;男性平均年龄(37.63±13.75)岁,女性平均年龄(39.70±14.60)岁。分别测量并记录肘关节正位尺骨近端内翻角、鹰嘴最狭窄处宽度,肘关节侧位鹰嘴尖端过鹰嘴窝切线与尺骨轴线的夹角。结果尺骨近端内翻角男性平均为(10.71±2.77)°,女性平均(9.97±2.89)°,两组比较差异无统计学意义(P=0.70);男性鹰嘴最狭窄处宽度(1.90±0.96)mm,女性(1.61±0.12)mm,两组比较差异有统计学意义(P=0.00);鹰嘴尖端过鹰嘴窝切线与尺骨轴线的夹角男性平均(25.42±2.31)°,女性平均(23.12±2.64)°,两组比较差异无统计学意义(P=0.10)。结论通过测量的尺骨鹰嘴影像学参数,为鹰嘴骨折张力带手术时克氏针进针方向、角度及宽度提供参考,提高手术准确度。     

腕部X线正位片形态学测量及临床应用

Objective To obtain normal values of parameters of the wrist joint by measuring posteroanterior X-rays of normal wrist joints and provide basis of using these parameters for judgment of pathological conditions of the wrist. Methods Standard postereanterior X-rays of 40 normal wrists were taken.The "Pacs System" software was used to measure 9 parameters in these radiographs, including 7 new parameters:the ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width ( PDRW), sigmoid notch width (SNW) and sigmoid notch length (SNL). The respective indices were defined by the ratio of these parameters to the length of the third metacarpus. Results The values and indices of USL, UHL, UHD, MDRW and PDRW are (3.01±1.65) mm,(0.05±0.03), (9.11±1.54) mm, (0.15±0.02), (18.56±1.96) mm, (0.30±0.03),(29.60±2.70) mm, (0.48±0.04), (27.60±2.00) mm and (0.45±0.03), respectively. Four types (Ⅰ toⅣ) of sigmoid notch were identified, with types Ⅰ, Ⅱ and Ⅳ present dominantly. The SNW of types Ⅰ, Ⅱ, and Ⅳ are (3.32±1.61) mm, (3.53±1.15) mm and (1.55±1.01) mm, respectively. The SNL of types Ⅰ, Ⅱ,and Ⅳ are ( 10.15±1.61 ) mm, ( 10.96 ± 2.33) mm and ( 10.32 ± 1.57) mm, respectively. Correspondingly,the SNW indexes were (0.05±0.02), (0.06±0.02), and (0.03±0.02); the SNL indexes were (0.16±0.02), (0.18±0.03) and(0.17±0.02). Conclusion The study presents a number of new indices which may be useful in quantifying the changes of wrists in radiograph. The measured normal values provide a basis for evaluation of changes in wrist disorders.     

腕部X线正位片形态学测量及临床应用

Objective To obtain normal values of parameters of the wrist joint by measuring posteroanterior X-rays of normal wrist joints and provide basis of using these parameters for judgment of pathological conditions of the wrist. Methods Standard postereanterior X-rays of 40 normal wrists were taken.The "Pacs System" software was used to measure 9 parameters in these radiographs, including 7 new parameters:the ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width ( PDRW), sigmoid notch width (SNW) and sigmoid notch length (SNL). The respective indices were defined by the ratio of these parameters to the length of the third metacarpus. Results The values and indices of USL, UHL, UHD, MDRW and PDRW are (3.01±1.65) mm,(0.05±0.03), (9.11±1.54) mm, (0.15±0.02), (18.56±1.96) mm, (0.30±0.03),(29.60±2.70) mm, (0.48±0.04), (27.60±2.00) mm and (0.45±0.03), respectively. Four types (Ⅰ toⅣ) of sigmoid notch were identified, with types Ⅰ, Ⅱ and Ⅳ present dominantly. The SNW of types Ⅰ, Ⅱ, and Ⅳ are (3.32±1.61) mm, (3.53±1.15) mm and (1.55±1.01) mm, respectively. The SNL of types Ⅰ, Ⅱ,and Ⅳ are ( 10.15±1.61 ) mm, ( 10.96 ± 2.33) mm and ( 10.32 ± 1.57) mm, respectively. Correspondingly,the SNW indexes were (0.05±0.02), (0.06±0.02), and (0.03±0.02); the SNL indexes were (0.16±0.02), (0.18±0.03) and(0.17±0.02). Conclusion The study presents a number of new indices which may be useful in quantifying the changes of wrists in radiograph. The measured normal values provide a basis for evaluation of changes in wrist disorders.     

桡骨小头三维解剖研究及其对假体设计的影响

目的 通过数字化三维重建正常中国人桡骨小头大体形态,测量解剖参数,为选择、设计假体提供解剖学依据. 方法对45例正常中国人进行单侧肘关节CT扫描,利用Mimics 10.0软件进行数字化三维重建来测量桡骨小头的解剖形态,并与国外相关资料进行比较. 结果桡骨小头的形状和大小有明显的个体差异,各形态参数接近正态分布,桡骨小头冠状面最大直径平均(22.34±2.46)mm,髓内冠状面直径平均(9.04±1.50)mm,桡骨小头矢状面最大直径平均(22.63±2.50)mm,髓内矢状面直径平均(9.34±1.51)mm,颈于角平均166.80°±2.20°,头颈长平均(18.71±2.44)mm.身高与桡骨小头直径成正相关(P<0.05). 结论测量所得桡骨小头解剖资料与欧美人种的桡骨小头解剖存在差异,应对进口假体适当改进,以提高疗效.三维数字化重建对解剖学测量和定制假体的意义重大.     

马德隆畸形一例

患者 女,29岁.自诉17年前于活动时发现双腕畸形,劳累后疼痛,患者及家属未予以重视.近半年来双腕关节活动后出现肿痛,休息后略缓解,为求进一步诊治遂来我院.否认外伤史及家族遗传史.临床检查:双腕部向背侧弯曲,尺骨茎突向背部隆起,隆起部压痛,双腕关节活动略受限,余关节活动正常(图1).X线正位片示:双侧桡骨短粗,并向外侧轻度弯曲,远端关节面向掌侧、尺侧明显倾斜,与尺骨远端关节面形成"V"形切迹,桡尺间隙增宽,桡骨近端骨皮质可见膨胀性改变,尺骨相对较长并向远端、背侧突出,腕骨以月骨为中心嵌入桡尺"V"形切迹内.     

新型接骨板内固定桡骨远端骨折的临床解剖学研究

目的为新型桡骨远端接骨板内固定治疗桡骨远端骨折的临床应用提供解剖学理论。方法取成人桡骨标本60根(左、右侧各30根),以桡骨茎突尖为测量起点,向上每间隔1 cm为测量点,测桡骨远端宽度、厚度,外侧缘、前内缘、后内缘横断面骨皮质厚度。测量桡骨体外侧缘与桡骨茎突的角度,桡骨体外侧缘与桡骨外前唇的角度,桡骨体内侧缘与桡骨内前唇的角度。以桡骨远端前后骨唇缘、尺骨切迹的前后骨唇缘的连线为测量点,测量桡骨远端关节面舟骨凹、月骨凹、桡骨尺骨切迹凹的体表投影关系。常规防腐固定上肢标本30侧,解剖观测旋前方肌上、下界的附着部位,旋前方肌的下界与桡骨前骨唇缘的间隙。结果桡骨体呈三棱柱形,下端粗大,宽大平坦,有旋前方肌附着。左侧与右侧桡骨远端宽度差异无统计学意义(P0.05)。左侧与右侧桡骨远端内、外侧厚度差异无统计学意义(P0.05)。左侧与右侧桡骨远端外侧缘、前内缘、后内缘横断面骨皮质厚度差异无统计学意义(P0.05)。桡骨远端左侧与右侧舟骨凹、月骨凹、桡骨尺骨切迹凹差异无统计学意义(P0.05)。旋前方肌的上界外侧附着于桡骨远端前骨唇缘上5.2~8.4(6.43±0.64)cm,上界内侧附着于桡骨远端前骨唇缘上5.3~8.5(6.54±0.70)cm。旋前方肌的下界外侧距桡骨远端前骨唇缘上0.6~1.5(1.02±0.90)cm,内侧距桡骨远端前骨唇缘上0.6~1.5(0.90±0.20)cm。桡腕掌侧韧带附着于桡骨前唇缘上0.6~1.4(1.01±0.16)cm。结论根据桡骨远端解剖学特点设计的新型桡骨远端接骨板能有效固定桡骨远端各类粉碎性骨折。     

桡骨远端骨折对下尺桡关节稳定性的影响

目的:分析桡骨远端骨折后腕部功能与下尺桡关节稳定性之间的关系,探讨桡骨远端骨折影响下尺桡关节稳定性的原因。方法:85例桡骨远端骨折患者,男27例,女58例;年龄17~74岁,平均42.3岁。采用手法复位石膏外固定治疗,伤后6~9个月(平均6.7个月)摄腕关节正侧位X线CR片,检查下尺桡关节稳定性,采用Sarmiento改良的Gartland-Werley评分系统(GW评分)对腕部进行功能评估。结果:85例获得6~9个月随访,平均6.7个月。19例有下尺桡关节不稳定。下尺桡关节不稳与放射学检查下尺桡关节情况之间无明显的联系。下尺桡关节不稳的患者GW评分平均为12.37±5.899,稳定的患者GW评分平均为6.85±4.222,差异有统计学意义。尺骨茎突是否骨折其GW评分差异无统计学意义。是否有尺骨茎突骨折其下尺桡关节不稳发生率比较差异无统计学意义。结论:明显成角或短缩畸形的桡骨远端骨折损伤三角纤维软骨复合体可能是造成下尺桡关节不稳、影响腕部功能的主要原因。伴随桡骨远端骨折的尺骨茎突骨折对下尺桡关节稳定性无明显影响。     

桡骨远端骨折对下尺桡关节稳定性的影响

目的:分析桡骨远端骨折后腕部功能与下尺桡关节稳定性之间的关系,探讨桡骨远端骨折影响下尺桡关节稳定性的原因.方法:85例桡骨远端骨折患者,男27例,女58例;年龄17～74岁,平均42.3岁.采用手法复位石膏外固定治疗,伤后6～9个月(平均6.7个月)摄腕关节正侧位X线CR片,检查下尺桡关节稳定性,采用Sarmiento改艮的Gartland-Werley评分系统(GW评分)时腕部进行功能评估.结果:85例获得6～9个月随访,平均6.7个月.19例有下尺桡关节不稳定.下尺桡关节不稳与放射学检查下尺桡关节情况之间无明显的联系.下尺桡关节不稳的患者GW评分平均为12.37±5.899,稳定的患者GW评分平均为6.85±4.222,差异有统计学意义.尺骨茎突是否骨折其GW评分差异无统计学意义.是否有尺骨茎突骨折其下尺桡关节不稳发生率比较差异无统计学意义.结论:明显成角或短缩畸形的桡骨远端骨折损伤三角纤维软骨复合体可能是造成下尺桡关节不稳、影响腕部功能的主要原因.伴随桡骨远端骨折的尺骨茎突骨折对下尺桡关节稳定性无明显影响.     

The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study

We examined 248 wrist X-rays of patients over 50 years of age to find out if ulnar variance, orientation of the sigmoid notch and ulnar head inclination play a role in the development of non-traumatic osteoarthritis of the distal radioulnar joint. Minor degenerative changes, viz. focal joint space narrowing and/or lipping, or small osteophytes at the inferior edge of the ulnar head, were present in 13% of the X-rays of these wrists. They were significantly more frequent in wrists with a more inclined ulnar head and significantly less present in wrists with an oblique, distally orientated sigmoid notch. There was no significant association with ulnar variance or age. This study suggests that articular morphology may play a role in the development of degenerative changes of the distal radioulnar joint.     

腕尺桡偏运动时腕韧带长度变化的活体研究

目的 研究腕关节在尺桡偏运动过程中,腕关节韧带长度的变化.方法 对6名志愿者腕关节进行CT扫描,获得腕关节在桡偏20°至尺偏40°内每隔20°的运动范围内各腕骨及尺桡骨远段三维重建图像.男3名,女3名,仅研究单侧右侧腕关节.年龄20～32岁,平均24岁.在腕关节尺桡偏运动过程中,在重建各腕骨及尺桡骨结构图像上以软件测量掌、背侧腕韧带的长度.结果 腕关节尺偏时桡舟头韧带、长桡月韧带、背侧腕间韧带止于舟骨、大多角骨和小多角骨部分的长度较中立位显著伸长,分别伸长(2.4±0.3)mm、(2.3±0.8)mm、(1.2±0.6)mm、(1.2±1.2)mm与(2.6±1.0)mm,差异均有统计学意义(P＜0.05);腕关节桡偏时尺头韧带与背侧桡腕韧带长度显著伸长(P＜0.05),分别为(0.8±0.6)mm和(1.0±0.5)mm.结论 在腕关节尺桡偏运动时,桡舟头韧带、长桡月韧带、背侧腕间韧带于桡偏位缩短,尺头韧带、背侧桡腕韧带长度于尺偏位缩短.这些位置可能使不同腕韧带张力降低,有利于损伤韧带的修复.     

Extensor tendon rupture associated with osteoarthritis of the distal radioulnar joint

Non-rheumatoid osteoarthritis of the distal radioulnar joint can cause extensor tendon rupture. We analysed the radiographic morphology of the distal radioulnar joint to identify the risk factors for this complication. Forty-one wrist X-rays of 37 patients with extensor tendon rupture caused by distal radioulnar joint osteoarthritis were evaluated retrospectively for the severity of osteoarthritis by the Kellgren/Lawrence scoring system. Measurements were obtained from posteroanterior views. All but one wrist had severe osteoarthritic changes exceeding grade 3. The radiographic features that were different from those of the contralateral wrists included deepening and widening of the sigmoid notch, radial shift of the ulnar head and dorsal inclination of the sigmoid notch. There was no significant association between tendon rupture and the morphology of the ulnar head or ulnar variance. The scallop sign, dorsal inclination of the sigmoid notch and radial shift of the ulnar head are radiological risk factors for extensor tendon ruptures.     

Relationship between joint laxity and radio-ulno-carpal joint morphology

The relationships between wrist laxity, ulnar variance, sigmoid notch inclination, and lunotriquetral motion were analysed in 60 normal volunteers. A strong correlation between ulnar length and sigmoid notch inclination was found for the entire group. Joint laxity was found to correlate with ulnar variance and lunotriquetral mobility in women, but not in men. The greater the laxity, the shorter the ulna and the greater the lunotriquetral motion during radial to ulnar deviation. These results support the concept that laxity increases the vulnerability of the wrist to injury.     

Motion analysis in two dimensions of radial-ulnar deviation of type I versus type II lunates

The motions of 2 different types of lunate (type I, no medial hamate facet; type II, medial hamate facet) were evaluated and compared during radial-ulnar deviation of the wrist using radiography and magnetic resonance imaging. Ten right wrists (5 type I and 5 type II lunates) were studied using posteroanterior and lateral x-rays. Six of the 10 normal volunteers (3 type I and 3 type II lunates) were studied using magnetic resonance imaging in 6 positions of radial-ulnar deviation. In the radiographic study the ulnar shift ratio of the lunate (USR), the shortest distance between the proximal ulnar tip of the lunate and the distal ulnar edge of the sigmoid notch of the radius (R-L), the closest distance between the distal ulnar tip of the lunate and the proximal pole of the hamate (L-H), the radius of curvature of the proximal head of the capitate (Cr) on posteroanterior view, and the radiolunate angle on lateral view were measured in each wrist in each of the 6 positions. There were statistically significant differences between type I and II lunates with regard to average maximum ulnar deviation of USR and R-L, total change of USR, R-L distance and L-H distance, average L-H distance and Cr distance in all positions, and average radiolunate angle in neutral and 15 degrees ulnar deviation. In the magnetic resonance imaging study the wrists with a type I lunate did not have contact between the lunate and hamate in any position; the wrists with a type II lunate did have contact between the hamate and the lunate, but only in ulnar deviation. The results of this study demonstrate that the kinematics of a type I lunate are different from those of a type II lunate during radial-ulnar deviation of the wrist.     

Ulnar shortening for the treatment of early post-traumatic osteoarthritis at the distal radioulnar joint

This prospective study describes the outcome of ulnar shortening performed on 32 wrists with early osteoarthritis of the distal radiounlar joint (DRUJ) in an attempt to change the contact area between the ulnar head and the radial sigmoid notch. By changing the contact area, we attempted to relieve pain, while maintaining the function of the DRUJ. The mean age of the patients was 34 years, and the mean follow-up was three years and two months. The wrists were graded by the patients' self-assessment of satisfaction and by a clinical wrist rating that assessed pain, functional status, range of motion, and grip strength. In terms of self-assessment, 16/32 patients were very satisfied, with complete pain relief. Of the 32 patients, 26 said that they would have surgery again if circumstances were similar. The postoperative wrist ratings were 7/32 excellent, 11/32 good, 9/32 fair, 5/32 poor. The most frequent postoperative complaint was plate irritation.     

Distal ulnar recession for disorders of the distal radioulnar joint

Thirty-six wrists of 35 patients were treated with distal ulnar recession for pain and limitation of motion associated with chondromalacia of the ulnar head, triangular fibrocartilage complex tears, ulnocarpal impingement, and instability of the distal radioulnar joint. Contributing factors were positive ulnar variance in 31 wrists, fracture of the distal radius in five, sprains in 14, premature closure of the distal radial epiphysis in five, and lax ligamentous habitus in five. The ages of the patients averaged 33 years. Clinical findings were local tenderness, crepitus, and instability evident by a positive "piano key" effect. Roentgenographic findings were positive ulnar variance (29 of 36), zero ulnar variance (four), negative ulnar variance (three), positive arthrogram (11 of 19), and "forme fruste" Madelung's deformity (two). The surgical procedure is a modification of the Milch cuff resection with the use of a dynamic compression plate. Recession ranged from 2 to 13 mm (average of 4 mm). Findings at surgery included chondromalacia of the ulnar head (19), tears of the triangular fibrocartilage complex (11), and excessive mobility of the ulnar head (10). At an average follow-up of 24.5 months, results were excellent in 7 wrists, good in 21, fair in four, and poor in four. Poor results in two wrists were upgraded to good after osteosynthesis of a nonunion in one and recessional osteotomy of the radial sigmoid notch in the other. Ulnar recession offers a less destructive alternative to disorders of the distal radioulnar joint than the Darrach resection.     

腕关节镜对三角纤维软骨复合体损伤的诊断和治疗价值分析

目的 对腕关节三角纤维软骨复合体(TFCC)损伤行关节镜检查,并分析其疗效.方法 对2006年1月至2009年12月诊断为TFCC损伤并行腕关节镜治疗的15例患者进行回顾性分析,其中男6例、女9例,平均年龄42岁,平均随访时间26.5个月.根据Palmer分型,Ⅰ型损伤5例(ⅠA型3例,ⅠB型1例,ⅠD型1例),Ⅱ型损伤10例(ⅡA型6例,ⅡC型4例).所有患者保守治疗3个月以上无效后行关节镜治疗.测量指标:腕关节疼痛、握力、关节活动度、腕关节评分(改良Mayo评分)、DASH问卷.结果 术后15例患者腕关节疼痛均有缓解,握力改善;腕关节屈伸(129±26)°,桡尺偏(40±8)°,旋转(174±11)°.按照改良Mayo评分:优3例,良8例,可4例;优良率为73%.术后DASH评分为4～28分,平均(15±7)分.结论 关节镜对于TFCC损伤的诊断明显优于MRI检查,而且关节镜能在检查的同时进行治疗,应作为腕尺痛的常规诊断手段.关节镜治疗各型TFCC损伤均能缓解疼痛,但Ⅰ型效果好于Ⅱ型.伴有尺骨正变异的TFCC损伤应同时行尺骨缩短术以提高术后效果.

Abstract：

Objective The objective of this study was to determine the efficiency of arthroscopic diagnosis and repair of triangular fibrocartilage complex (TFCC) tears. Methods Fifteen cases of TFCC tears diagnosed and treated with arthroscopic repair in our hospital between January 2006 and December 2009 were retrospectively reviewed. There were six males and nine females. The average age was 42 years. The average follow-up was 26.5 months. TFCC tears were classified by Palmer classification as follows:ⅠA (3 cases),ⅠB (1 case),ⅠD (1 case),ⅡA (6 cases),and ⅡC (4 cases). Arthroscopic repair was performed after at least 3 months of conservative treatment failed. Wrist pain,grip strength,range of motion (ROM),wrist score (modified Mayo wrist score),disabilities of the arm,shoulder,and hand questionnaire (DASH) score were evaluated. Results Postoperatively alleviation of pain and improved grip strength was noted in all 15 patients. ROM averaged (129±26)° for the extension/flexion arc,(40±8)° for the radial/ulnar deviation arc,and (174±11)° for the pronation/supination arc of motion. The good-to-excellent rate of modified Mayo wrist score was 73% (excellent in 3 of patients,good in 8,fair in 4,and poor in 0). The average DASH score was 15±7 (range,4 to 28). Conclusion Standard arthroscopic procedure is more efficient in the diagnosis of TFCC injury than MRI. The advantage of simultaneous repair makes arthroscopic examination a normal procedure for patients with ulnar wrist pain. The outcome of type Ⅰ is better than type Ⅱ,although pain relief is obtained in each form of TFCC injuries after arthroscopic repair. In cases associated with marked positive ulnar variance,the simultaneous use of primary ulna-shortening osteotomy leads to promising results.     

Computed Tomography-Based Morphologic Analysis of Osteoarthritis of the Distal Radioulnar Joint Associated with Extensor Tendon Ruptures

BackgroudAlthough the scallop sign is considered the most important risk factor for extensor tendon ruptures (ETRs) in patients with osteoarthritis of the distal radioulnar joint (DRUJ), previous reports provide a limited understanding of the changes at DRUJ, as risk factors were examined in plain radiographs of the wrist. The aim of this study was to assess the changes of DRUJ using axial images of computed tomography (CT) in patients with DRUJ osteoarthritis and associated ETRs and to evaluate the relationship between the changes of DRUJ and ETRs.MethodsTwelve patients with ETRs due to osteoarthritis of the DRUJ were enrolled. The changes of DRUJ were examined on axial images of CT and the following 8 parameters were measured: width of radius, anteroposterior (AP) length of radius, width of sigmoid notch (SN), AP length of SN, AP length of ulnar head, subluxation length of ulnar head, dorsal inclination of SN, and distance from Lister''s tubercle to SN. Radiological parameters of the DRUJ were measured in 60 control wrists without trauma or osteoarthritis, and the patient and control groups were statistically compared.ResultsStatistically significant differences were observed between the patient and control groups in all the radiological parameters except for the AP length of SN and AP length of ulnar head. The width of radius, AP length of radius, width of SN, subluxation length of ulnar head, and dorsal inclination of SN were greater and the distance from Lister''s tubercle to SN was smaller in the patient group than in the control group. The width of SN, dorsal inclination of SN, and distance from Lister''s tubercle to SN were statistically significant risk factors among the 8 parameters.ConclusionsETRs due to osteoarthritis of the DRUJ was related to the changes of DRUJ, especially the changes around SN of the distal radius. In addition to the existing risk factors, a decreased distance from Lister''s tubercle to SN and increased dorsal inclination of SN were identified as new risk factors. Axial images of CT were effective to evaluate degenerative changes at the DRUJ.     

全阴囊Ⅲ度烧伤不同方式重建阴囊对生精功能的晚期影响的实验研究

目的:探讨全阴囊Ⅲ度烧伤不同方式重建阴囊对睾丸生精细胞凋亡及bcl-2蛋白表达的影响。方法:以2月龄贵州小型猪为实验动物,雄性40只,雌性24只。雄性随机分正常对照组(Ⅰ),自然愈合组(Ⅱ),植皮组(Ⅲ),皮瓣组(Ⅳ),每组10只。建模10月末雄性对照组及实验组每组6只与同期饲养的雌猪一一配对饲养,配对3周后雌猪继续喂养4个月观察生育情况,雄猪1年末取各组双侧睾丸标本,原位末端标记法(TUNEL)检测睾丸生精细胞凋亡指数(AI),免疫组化(SABC法)检测bcl-2蛋白表达。对数据行单因素方差分析。结果:细胞凋亡结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ的AI值(x±s)%分别为:7.07±3.50、40.34±4.85、15.14±1.36、39.29±5.73,Ⅰ与Ⅱ、Ⅲ、Ⅳ相比差异均有显著性(P<0.05),Ⅱ与Ⅳ相比差异无显著性(P>0.05),Ⅲ与Ⅱ、Ⅳ相比差异均有显著性(P<0.05)。bcl-2蛋白表达结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ的bcl-2蛋白表达(x±s)%分别为:75.07±3.74、54.93±4.03、66.85±3.06、53.33±5.22,Ⅰ与Ⅱ、Ⅲ、Ⅳ相比差异均有显著性(P<0.05),Ⅱ与Ⅳ相比差异无显著性(P>0.05),Ⅲ与Ⅱ、Ⅳ相比差异均有显著性(P<0.05)。配对喂养结果:Ⅱ、Ⅳ组配种没有成功,Ⅰ组全部配对成功,生育幼猪(10.0±1.18)头,Ⅲ组4头配种成功,生育(9.92±1.31)头,Ⅰ组与Ⅱ、Ⅲ、Ⅳ组相比差异均有显著性(P<0.05),Ⅲ组与Ⅱ、Ⅳ组相比差异均有显著性(P<0.05),Ⅱ与Ⅳ组相比差异无显著性(P>0.05)。结论:全阴囊Ⅲ度烧伤不同方式重建阴囊1年后对生精功能均有抑制作用,导致生精细胞凋亡增加,bcl-2蛋白表达降低,其中植皮重建阴囊对睾丸生精功能影响最小,建议阴囊Ⅲ度烧伤创面采用植皮修复。