手指指间关节侧副韧带断裂20例分析

我院自 1994年 2月～ 1999年 10月对 2 0例手指近、远侧节指间关节韧带断裂行早期韧带重建术 ,随访 0 .9～ 1.5年 ,效果满意。1　临床资料本组共 2 0例 ,男 17例 ,女 3例。年龄 17～ 5 4岁 ,平均 3 5 .5岁。致伤原因 :刀切伤 2例 ,挤压伤 11例 ,扭转伤 7例 ,其中6例伴骨块撕脱。临床表现 :伤指指间关节疼痛、梭形肿胀、伸屈受限 ,手指偏向一侧 ,侧方应力试验阳性。Ｘ线片示伤指指间关节间隙宽窄不等 ,并伴有不同程度的关节脱位。2　手术方法作伤侧正中切口 ,显露侧副韧带及近远节指骨 ,于指骨侧副韧带起止点各钻一横行骨髓道 ,用圆针带取好…     

应用微型骨锚亚急诊修复指关节侧副韧带撕脱伤

目的 探讨微型骨锚在亚急诊指关节侧副韧带近点撕脱伤修复中的疗效.方法 对2例拇指掌指关节和7例手指近侧指间关节侧副韧带断裂伤的患者早期应用Mitek微型骨锚植入侧副韧带指骨附着处,再用锚尾部的Ethibond缝合线与撕脱的侧副韧带缝合.结果 9例术后随访10～12个月,平均11.1个月.按Saetta评定标准评定疗效,优6例,良3例.结论 微型骨锚用于修复指关节侧副韧带止点撕脱,操作简便,疗效可靠.     

急性膝交叉韧带损伤的早期治疗

1989年～1994年，我们共收治急性膝交叉韧带损伤病例20例，现将治疗体会讨论如下。临床资料本组20例，男17例，女3例；年龄14岁～58岁；左侧12例，右侧8例；20例均为韧带完全损伤、断裂，其中前交叉韧带（ACL）损伤15例，后交叉韧带（PCL）损伤5例；ACL损伤中韧带股骨髁附着部断裂3例，带骨片撕脱损伤1例，韧带腔骨附着部断裂1例，带骨片撕脱伤7例，韧带中部断裂3例。其中合并内侧副韧带损伤5例，内侧半月板损伤2例，内侧副韧带加内侧半月板损伤2例；PCL损伤中韧带胜骨附着部断裂1例，该处带骨块撕脱损伤2例，韧带中部断裂2例，其中合…     

近侧指间关节侧副韧带断裂保守与手术治疗的疗效比较

手指近侧指间关节侧副韧带损伤 ,如早期得不到及时治疗 ,可导致指间关节变形 ,关节韧带侧偏和功能障碍等。 1992至 2 0 0 0年 ,我科对 42例手指近侧指间关节侧副韧带断裂者 ,进行了保守与手术两种方法治疗 ,治疗后随访 1～ 9年 ,结果证实 ,手术治疗的疗效优于保守疗法。一、资料与方法　　 1.一般资料 :本组共 42例 45指 ,男 3 2例 3 4指 ,女 10例 11指。年龄 10～ 82岁 ,平均 3 4.5岁。致伤原因 :侧方挤压伤 2 8例 ,扭转伤 14例。指别 :示指 18指 ,中指 8指 ,环指 14指 ,小指5指。症状与体征 :伤指局部疼痛 ,梭形肿胀 ,伤指近节伸屈受限。…     

前交叉韧带损伤的重建术

前交叉韧带 (ＡｎｔｅｒｉｏｒＣｒｕｃｉａｔｅＬｉｇａｍｅｎｔ简称ＡＣＬ)损伤在膝关节损伤中比较多见 ,约占 15 %～ 2 0 % ,通常为复合伤。ＡＣＬ损伤特别是断裂后的治疗比较棘手 ,除单纯的止点处撕裂或伴有骨块撕脱者手术比较简单外 ,其余的断裂均需早期或后期行韧带重建 ,一般认为伴有合并损伤尤其是内侧关节囊、伸膝筋膜横形撕裂以及内侧副韧带断裂时需早期重建 ,单纯ＡＣＬ损伤则应后期重建[1] 。恢复或加强关节囊或侧副韧带的手术称外重建 ,因其疗效不确切而临床很少单独使用 ,常作为内重建的补充 ;内重建是模拟恢复关节内的正常解…     

应用微型骨锚重建手指侧副韧带-附7例报告

目的探讨微型骨锚在修复手指侧副韧带撕脱伤中的临床疗效。方法2004年3月-2006年1月，对7例手指侧副韧带损伤的患者，先用一枚直径为0．8mm克氏针斜行将患指近侧指间关节固定于平伸位，然后采用1．3mm Mitekmero微型带双针40 Ethibond骨锚植入近节指骨头或中节指骨基底侧方侧副韧带的腱附着处，用锚尾部的缝合线缝合撕脱的侧副韧带重建起止点。结果术后7例获得3至11个月随访，平均4．8个月。按TAM功能评定方法评定：优6例，良1例。x线片示骨锚未见松动、脱落。结论微型骨锚用于修复与重建手指侧副韧带．其操作容易掌握，简便、快捷，疗效可靠。     

阔筋膜重建膝交叉韧带

膝交叉韧带损伤是膝关节较严重损伤之一。近年来交通事故致此类损伤明显增加，并因常伴有膝关节侧副韧带损伤及股骨课或胫骨平台骨折，如不仔细检查易造成漏诊。早期不及时治疗，将严重危害膝关节功能，影响生活与劳动，故应引起重视。我院1986～1995年收治21例该类患者，采用阔筋重建韧带治疗，效果满意．现报告如下。临床资料本组ZI例．男19例，女2例；年龄15～54岁；左膝15例，右膝60例；损伤类型：前交叉韧带（ACL）损伤16例，其中股骨悍附着点断裂3例．附着点骨块撕脱1例，胫骨髁间突附着点断裂10例，附着点骨块撕脱2例；后交叉韧带…     

伸肌腱止点断裂伴撕脱性骨折的克氏针内固定治疗

目的：介绍伴有末节指骨基底撕脱性骨折的指伸肌腱止点断裂重建技术。方法收治20例伴有远节指骨基底背侧撕脱性骨折的指伸肌腱止点损伤患者,最大骨折块波及大于1/3关节面。骨折块大于1/3关节面时,1枚克氏针直接复位固定骨折块,再固定指间关节于过度背伸位。骨折块小于1/3关节面时,1枚克氏针内固定远指间关节于过度背伸位,用另一枚克氏针在指背以30±176;～45±176;向远端挤压骨折块,将骨折块复位。术后6周拔出克氏针,行功能练习。结果术后随访6～12个月,术后均无疼痛、无畸形、无感染;X线正侧位片示撕脱骨折块均获得解剖复位并愈合。采用Dargan功能评定：优15例,良5例。结论双克氏针内固定是治疗合并骨折的指伸肌腱止点损伤的有效方法,疗效确切。     

陈旧性胫骨髁间棘撕脱骨折的手术治疗

胫骨髁间棘撕脱骨折随着交通事故增多而趋于常见。导致撕脱骨折的暴力较强 ,多伴有不同程度侧副韧带损伤。保守治疗使骨折块异位畸形愈合 ,造成前交叉韧带止点抬高 ,前交叉韧带处于松驰状态 ,引起膝关节的不稳定及伸膝受限 ,反复关节积液 ,肿痛[1,2 ] 。我院自 94年始收治 15例患者 ,采用钢丝可吸收螺钉内固定术 ,效果满意。1　临床资料1 1　一般资料　本组 15例患者 ,男性 9例 ,女性 6例。年龄 2 4～ 45岁 ,伤后 1～ 6个月来院治疗。交通事故 12例 ,运动损伤 3例。均曾以非手术治疗 4～ 6周。抽屉试验阳性者 9例。合并侧副韧带损伤 ,侧方挤…     

“双固定螺钉系统”治疗指间关节侧副韧带断裂的疗效评价

目的探讨"双固定螺钉系统"治疗指间关节侧副韧带断裂的疗效。方法选取2015年2月到2016年8月期间在本院接受"双固定螺钉系统"治疗的指间关节侧副韧带断裂患者,对其中得到回访9例患者的伤指外形、疼痛、手指总活动度进行分析评价。结果 9例患者伤指活动均无疼痛,指间关节梭形肿胀消失或遗留轻微梭形肿胀,侧方应力实验阴性,应用"TAM评定标准"评定,优5例,良3例,可1例,无差的病例,优良率为88.9%。结论 "双固定螺钉系统"治疗指间关节侧副韧带断裂的疗效满意,值得推广应用。     

Importance of echocardiography in prognosis of surgical outcomes in cholecystitis in elderly patients

The authors propose to use more often echocardiography (EchoCG) in examination of elderly (over 60 years) of age patients with cholecystitis that permits to increase surgical activity to 92.4%. Left ventricular ejection fraction is the most informative. When this fraction is lower than 45% surgery must be recommended on vital indications only. EchoCG was used in 155 patients with cholecystitis, 131 of them were operated. 2 (1.52%) patients died due to acute cardio-vascular insufficiency and pulmonary artery thromboembolism.     

杭州健康女性定量骨超声测定原发性骨质疏松

目的 评价杭州健康女性骨超声速度(SOS)值随增龄减少和骨质疏松患病率，建立杭州地区女性骨超声速度值参考数据库。方法 定量超声法测定1208例杭州地区健康女性桡骨远端(RAD)，第3指骨近节(PLX)，第V跖骨(MTR)和胫骨中段(TIB)的超声速度值。结果 RAD、PLX、MTR和TIBSOS峰值(Peak of SOS)均出现在40-45岁，TJB的SOS峰值出现在35—40岁，此后随年龄增长而下降。绝经后妇女在绝经后早期和晚期各有1个SOS快速减少期，前见于桡骨近端，平均年减少率为2．4％，后见于胫骨中段，平均年减少率为1．8％。各部位骨SOS累积减少率随年龄增长而增加，到85岁4部位累积减少为13％-18％。60岁以后骨质疏松性症(OP)检出率为45％-70％，OP检出率以桡骨远端最高，60-70岁平均为67％，第3指骨近端次之约50％，胫骨中段最低为36％；75岁以后分别为70％，65％和45％。结论 全身各部位骨超声速度值到达峰值的年龄不同，峰值也各有差异。绝经后妇女骨超声速度值随年龄增加减少较快，应予激素和补钙治疗，桡骨远端为本地区SOS检测和OP检出的敏感部位。     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

目的 评价脊髓胶质细胞在小鼠骨癌痛形成中的作用.方法 健康雄性C3H/He小鼠40只,周龄8～10周,体重18～22 g,随机分为4组(n=10):假手术组(S组)、骨癌痛组(B组)、PBS组(P组)和米诺环素组(M组).S组跟骨骨髓腔内注射PBS 10 μl;余3组跟骨骨髓腔内注射含2×105个骨纤维肉瘤细胞的PBS 10 μl制备骨癌痛模型,于造模前即刻开始PBS组鞘内注射PBS 5μl,M组鞘内注射米诺环素(用PBS溶解为0.2 mmol/L)5μl,1次/d,连续11 d.于造模前1 d、造模后即刻、3、5、7、9、11 d时测定机械痛阈;于造模后3、7、9、11 d机械痛阈测定结束后测定冷痛阈.痛阈测定结束后处死小鼠,取脊髓组织,测定神经胶质纤维酸性蛋白(GFAP)和CD11b的表达水平.结果 与S组比较,B组和P组造模后3-11 d时、M组造模后3、5 d时机械痛阈升高,B组、P组和M组造模后7～11 d时冷痛阈升高,脊髓CD11b和GFAP表达上调(P<0.05).与B组比较,M组造模后3-11 d时机械痛阈降低,造模后7-11 d时冷痛阈降低,脊髓CD11b和GFAP表达下调(P<0.05).结论 脊髓胶质细胞(星形胶质细胞和小胶质细胞)的激活参与了小鼠骨癌痛的形成.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

中脑导水管周围灰质小胶质细胞活化在大鼠神经病理性痛中的作用

目的 评价中脑导水管周围灰质小胶质细胞活化在大鼠神经病理性痛中的作用.方法 雄性SD大鼠176只,体重200 ～ 250 g,9周龄,采用随机数字法,将其分为4组:假手术组(S组,n=40)、神经病理性痛组(NP组,n=40)、生理盐水组(NS组,n=48)和米诺环素组(M组,n=48).NP组、NS组和M组采用慢性坐骨神经缩窄性损伤法制备大鼠神经病理性痛模型;S组仅暴露坐骨神经,而不结扎.术后第7天时,NS组和M组分别于中脑导水管周围灰质的腹外侧区注射生理盐水或米诺环素0.5μl.取8只大鼠,分别于术前1 d(T0)、术后第3天(T1)、第7天给药前30 min(T2)、第7天给药后30 min(T3)、第14天(T4)和第21天(T5)时测定机械痛阈.于T1-5时各处死8只大鼠,取脑组织,行小胶质细胞计数.结果 与S组比较,NP组、NS组和M组T1-5时机械痛阈降低,小胶质细胞计数升高(P＜0.05);NP组和NS组各时点机械痛阈和小胶质细胞计数差异无统计学意义(P＞0.05);与NP组和NS组比较,M组T3时机械痛阈升高,小胶质细胞计数降低(P＜0.05).结论 中脑导水管周围灰质小胶质细胞的活化参与了大鼠神经病理性痛中的形成与维持.     

沈阳男性髋部骨折多于女性原因探讨

为找出沈阳地区髋部骨折发生男性多于女性的原因，探索该病在不发达国家或地区的流行特点，我们再次通过查阅病例记录，对沈阳市１９９４年５０岁以上人口的部分髋部骨折病发生的原因进行了较详细的调查分析。共调查分析２６６髋部骨折病例，其中男１６３例，女１０３例。损伤原因记为单纯摔倒（滑倒或绊倒）、骑自行车摔倒、自行车撞倒、机动车事故和高位跌下（滚楼梯或从较高位置掉下）。结果表明：男女在髋部骨折伤因构成上有差别（Ｐ＝０．００４）。女性髋部骨折的大多数（７０％）是由单纯摔倒引起，而在男性则不足一半（４９％），即男性髋部骨折的一半以上不是由于单纯摔倒而是由各种意外事故造成的（Ｐ＝０．０００８）。在各种意外事故中，男性骑自行车摔倒引起骨折的频率（２８％）明显高于女性（１０％）。除了骑自行车摔倒外，男性由自行车撞倒和高位跌下引起骨折的频率稍高于女性，但无太大差别。机动车事故造成骨折的频率男女基本一致。此结果在一定的程度上说明，１９９４年沈阳５０岁以上的男性髋部骨折发病率高是由于男性发生的各种意外事故多，尤其是骑自行车引起的事故造成的。