人工关节松动病因的研究

目的：探讨人工关节松动的病因。方法：选择７例松动人工髋关节，翻修手术时取松动关节周围的界膜组织；同时选择１０例骨折内固定患者，拆除内固定物时取内固定物周围瘢痕组织。标本做组织学检查和肿瘤坏死因子（ＴＮＦ）测定。选择１０只成年兔，将２０只模拟假体分别置入双侧股骨远端。分别于术后第６、８、１０、１２、１４周向右侧膝关节腔注射聚乙烯微粒悬液，作为实验侧；左侧膝关节腔注射生理盐水，作为对照侧。第１６周取股骨远端标本，做组织学检查。结果：松动人工髋关节周围的界膜组织主要含大量的组织细胞和聚乙烯微粒，而骨折内固定物周围的瘢痕组织主要为纤维成分，无聚乙烯微粒。松动关节周围界膜组织中的ＴＮＦ浓度明显高于骨折内固定物周围的瘢痕组织（Ｐ＜０．０１）。动物实验发现，实验侧模拟假体周围有一层充满组织细胞的纤维结缔组织界膜，并有明显骨吸收和骨溶解现象，而对照侧无明显纤维结缔组织界膜，也无骨破坏现象。结论：人工关节磨损后，产生大量的磨损微粒，微粒刺激组织细胞分泌ＴＮＦ等溶骨性因子，这些溶骨性因子直接或间接地激活破骨细胞，从而引起假体周围骨吸收、骨溶解，最终导致假体松动。假体松动后又可加重磨损，产生更多的微粒，形成恶性循环     

膝关节后交叉韧带断裂治疗临床分析

目的 对35例膝关节后交叉韧带断裂治疗进行临床分析,重点探讨了有关交叉韧带断裂的治疗问题。方法 经明确诊断后,分析采用胫骨附着处撕脱骨折复位固定手术治疗26例、早期髌韧带中1／3移植重建3例、单纯长腿石膏固定6例。结果 本组病例全部进行随访,随访时间13个月－5年,胫骨附着处撕脱骨折复位固定及髋韧带中1／3移植重建29例为优良、单纯长腿石膏固定6例为差。结论 后交叉韧带断裂后应该及时给予手术修复;膝后外侧手术入路,操作简单,暴露充分;少于3个月的陈旧性病例仍适应手术治疗。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Evaluation of systems of grading of neurological deficit in tuberculosis of spine

STUDY DESIGN: Prospective comparative study. OBJECTIVE: To compare the efficacy of the ASIA scoring system and Tuli's classification for assessment of neurological status in a typical case of Pott's paraplegia/tetraplegia and suggest a suitable classification. SETTING: Department of Orthopaedics of University College of Medical Sciences and GTB Hospital, Delhi, India. METHODS: A total of 33 cases of tuberculosis of the spine with paraplegia were evaluated serially for the severity of the neurological deficit by grading systems as suggested by Tuli and ASIA score, during the course of treatment. A total of 111 readings of neurological status were recorded and analysed. RESULTS: Tuli's grading was found to be sensitive for detection of early stage (grade I) of neurological deficit. The rest of the grades (grade II, III, IV) of Tuli's classification have a wide range of sensory-motor deficit and hence are insensitive to early detection of any deterioration/improvement in the neurological status. The ASIA score failed to grade all types of neurological deficit associated with the Pott's spine. The sensory-motor score obtained by the ASIA scale depends on the level of involvement of the spinal cord. The higher the level of the cord damage, the poorer is the score. CONCLUSION: Neither Tuli's grading nor the ASIA scale alone can effectively grade all stages of neurological deficit in tuberculosis of the spine. The neurological deficit in tuberculosis of the spine should be described in stages and each stage should have sensory and motor scoring. A new staging system of Pott's tetraplegia/paraplegia is suggested.     

Surgical correction of rupture of aneurysm of the sinus of Valsalva

Operations were performed on 48 patients with aneurysms of the thoracic aorta, one of them had a rupture of aneurysm of the noncoronary sinus followed by the formation of a fistula between the aorta and the right atrium. The fistula was ligated by an access through the right atrium with good nearest and long-term results.     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

Evaluation of outcome of treatment of congenital clubfoot

The study was undertaken to determine whether existing systems of outcome evaluation of clubfoot are comparable; to determine the relationship between the shape of the foot, its function, and radiological tarsal relationships; and to identify which objective variables used in the assessment of clubfeet are reproducible.Fifty treated idiopathic clubfeet were assessed by the scoring systems of Laaveg and Ponseti, McKay, Magone, and Ghanem and Seringe. Although there was a good correlation between the scores, there was very poor agreement between the grading of feet by these different systems.The feet were also evaluated using a new scoring system that has 3 domains of evaluation, viz, morphological, functional, and radiological. Comparison of the scores in each of these domains showed that there was a correlation between morphology, function, and radiological measurements of tarsal alignment. Several of the criteria used in this new scoring system were reproducible.     

Substantiation of the selection of a method of surgical treatment of varicose veins of the legs

An examination and operative treatment of 207 patients have shown that findings of plethysmometry and plethysmography reflecting the state of the direct and retrograde blood flow in the veins of lower extremities help to the correct selection of the method of surgery without phlebography. Long-term results of the operation confirm this conclusion.     

食管穿孔83例分析

８３例不同原因引起的食管穿孔，保守治疗５７例；手术２６例，行单纯食管修补术２０例、开胸行纵隔和／或胸腔引流２例、切除贲门肿物行胃食管吻合１例、颈部食管外置２例（其中１例并行二期结肠代食管手术）、１例开胸取异物形成食管瘘后，行二期修补瘘术。全组死亡８例，其中死于纵隔胸腔感染和主动脉破裂出血各４例。总治愈率８５％。并指出异物假牙造成食管穿孔的重要性，对严重的腐蚀性食管灼伤应早期行食管镜检，并针对食管穿孔部位、种类、间隔期、纵隔与胸腔的感染程度及病人具体情况采取相应的治疗措施。     

Criteria of assessment of restriction of vital activity of patients after total endoprosthesis of the hip joint

Total endoprosthesis of the hip joint is an effective method of rehabilitation of patients with a severe pathology of the hip joint. But the lack of exact criteria of assessment of restriction of vital activity of patients after total endoprosthesis results in leveling the effects of medical rehabilitation due to the existing stereotype solution of the MSE bureau and so the majority of patients (90%) after operation get invalidization of the I and II groups for a long time without sufficient causes. Results of complex clinico-rentgenological, biomechanical, electrophysiological examinations and expert assessment of 450 patients after implantation of various domestic and foreign endoprostheses allowed the elaboration of differentiated criteria for the examination of restricted viral activity depending on the nosological form of the disease, degree of the disturbance of the statico-dynamic function, prognosis, complications, character and conditions of work.     

Choice of the method of treatment of unilateral fractures of the femur and bones of the shin

The authors present their experience in the treatment of 74 patients with unilateral fractures of the femur and the bones of the crus. The peculiarities of these injuries which unfavourably affect the results of the treatment are discussed. Four versions of treatment are distinguished, with surgical treatment of fractures of the femur and the bones of the crus being the preferable one. The best results, concerning both the duration of the period of in-patient treatment and the final outcome, were obtained in cases of combined intraosseous osteosynthesis of the femur and perosseous osteosynthesis of the fragments of the tibia with Ilizarov's apparatus.     

Sonographic evaluation of hypertrophy of septum of Bertin

Sonography was utilized to evaluate 12 patients with hypertrophy of the septum of Bertin. To confirm the diagnosis, angiography was used in 7 patients and radionuclide imaging in 2. Three sonographic characteristics were found: (1) an isoechogenic, ellipsoid mass with an echogenic linear rim of renal sinus fat; (2) contiguity of the mass with a normal-placed septum of Bertin; and (3) the occurrence of the mass effect always at the level of the emergence of the renal vein. The sonographic findings could be divided into two definite types. Type I showed moderate hypertrophy with a mass effect ranging from 1.1 by 2.3 cm to 2.0 by 3.2 cm in diameter, usually presenting with a smooth contour and discrete mass effect on the intravenous pyelogram (IVP). Type II showed severe hypertrophy with a mass effect ranging from 3.2 by 4.0 cm to 3.5 by 4.5 cm in diameter, usually presenting with a lobulated contour and irregular stretching of the calyceal system on IVP. The differential diagnosis is discussed. In conclusion, we found that sonography associated with excretory urography is an accurate method for the diagnosis of hypertrophy of the septum of Bertin.     

Results of operative treatment of fractures of the posterior wall of the acetabulum

BACKGROUND: The purpose of this study was to determine the clinical outcome in patients in whom a displaced fracture of the posterior wall of the acetabulum had been treated by open reduction and internal fixation. METHODS: One hundred patients who had had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum were studied. Ninety-four patients were assessed at a mean of five years (range, two to fourteen years) after the injury. Six patients with a poor result were followed for less than two years. The functional outcome was evaluated with use of the clinical grading system adopted by Letournel and Judet with incorporation of modifications by Matta. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional outcome. RESULTS: The reduction of the fracture, as determined with plain radiography, was graded as anatomic in ninety-seven patients and as imperfect in three. The clinical outcome at the time of final follow-up was graded as excellent in fifty-five patients, very good in twenty-five, good in nine, fair in one, and poor in ten. The radiographic result was excellent in eighty-one patients, good in five, fair in four, and poor in ten. There was a strong association between the clinical outcome and the final radiographic grade. Variables identified as risk factors for an unsatisfactory clinical result included a delay of greater than twelve hours before reduction of an associated hip dislocation, an age of fifty-five years or older at the time of injury, intra-articular comminution, and osteonecrosis. CONCLUSIONS: The uncomplicated radiographic appearance and relatively simple operative approach for fractures of the posterior acetabular wall belie the risk of poor results. Prompt reduction of an associated hip dislocation is imperative. Fractures in elderly patients and those with extensive comminution are more likely to have a poor clinical result. However, a high likelihood of a long-term good-to-excellent result can be expected following anatomic reduction and internal fixation of these fractures.     

腹膜透析患者癌症相关抗原125水平与腹膜转运功能关系的研究

目的:检测腹膜透析患者腹透液中癌症相关抗原125(CA125)水平及腹膜转运功能,并探讨二者之间关系及其临床意义.方法:电化学发光法测定过夜腹透液中CA125浓度,行腹膜平衡试验检测腹膜转运功能.结果:腹透短期组、腹透中期组、腹透长期组三者的腹透液中CA125水平及4 h D/PCr相比较皆有统计学差异(P<0.05或P<0.01);腹透腹膜炎中、低发组观察前后两指标皆无统计学差异,也无明显的相关性,而腹透腹膜炎高发组观察前后两指标有统计学差异;观察各组两指标皆呈非显著性负相关.结论:腹膜透析患者癌症相关抗原125水平与腹膜转运功能关系不大.     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

Predictors of outcome of non-displaced fractures of the base of the fifth metatarsal

The purpose of this study was to identify those factors that influence the outcome after conservative treatment of undisplaced fractures of the fifth metatarsal. This was done with univariate analyses and, for the first time, with regression analyses of day-to-day clinical practice. Thirty-eight patients were treated with plaster and periods of no weight bearing (NWB). Their mean age was 48 years. They were evaluated using the Olerud ankle score, with analogue scales for pain and comfort, and with questions about cosmesis and wearing of shoes. Six patients sustained a Jones fracture and 32 a tuberosity avulsion fracture. The mean period of NWB was 17 days and of casting was 38 days. Three Jones fractures and all the avulsion fractures were healed at the end of treatment. After a mean of 490 days, the global ankle score was 82/100. Ten patients reported problems with shoes and nine reported cosmetic problems. The linear analogue scale for pain was 2.11/10 and for comfort 8.42/10. Gender, age, and fracture type did not affect outcome. The most significant predictor of poor functional outcome was longer NWB, which was strongly associated with worse global outcome, discomfort, and reported stiffness. NWB should be kept to a minimum for acute avulsions of the tuberosity of the fifth metatarsal.     

肌少症的定量测量现状及研究进展

肌少症是一种以骨骼肌质量减少及其功能减退为主要临床表现的复杂的老年综合征。在全球其发病率逐年增高,目前已成为威胁老年人健康,影响老年人生活质量的重要危险因素。其诊断标准主要由欧洲老年人肌少症工作组、亚洲肌少症工作组、国际肌少症会议工作组提出的,通过骨骼肌质量、肌肉力量和身体活动能力进行诊断。肌少症前期仅有肌肉质量减少,肌少症期包括肌肉质量减少伴随肌肉力量下降或身体活动能力降低,重度肌少症期肌肉质量以及身体活动能力均会降低。早期对骨骼肌进行定量测量成为诊断肌少症的重要手段之一。骨骼肌定量测量方法主要有计算机X线体层摄影、磁共振成像、双能X线吸收法、生物电阻抗测量、超声等方法。计算机体X线层摄影在骨骼肌质量的研究中主要应用是作为金标准来校准其他方法;磁共振成像在肌肉定量测量中发挥着越来越重要的作用;双能X线吸收测定法和生物电阻抗方法是目前公认筛查肌少症的手段,并且有诊断的阈值,然而精确性欠佳;超声有经济、易携带、高效等优点,但其对体成分的检测价值有限。本文探讨了骨骼肌定量测量研究的现状及其进展。     

手部深度烧伤的临床治疗分析

目的 总结手部深度烧伤的临床治疗经验. 方法 46例54只深度烧伤手,其中深Ⅱ度烧伤30例33只手,Ⅲ度烧伤16例21只手.根据伤情不同,早期选择不同手术方式修复创面,术后早期进行功能锻炼. 结果 54只手的修复方式:中厚皮片移植33只手,异体脱细胞真皮与自体薄皮片复合移植12只手,腹部带蒂皮瓣1只手,前臂骨问背动脉逆行皮瓣3只手,股前外侧皮瓣5只手.治疗后,51只手移植皮片、皮瓣均成活,仅3只手移植皮片后有局灶性坏死,创面得到有效覆盖.按关节活动范围( range of motion,ROM)评定,本组优31只手(57.4％),良17只手(31.5％),中4只手(7.4％),差2只手(3.7％). 结论 手部深度烧伤后,选择合适术式,早期手术修复创面及功能锻炼,可取得很好的疗效.     

531例肺腺癌切除术的治疗效果分析

目的 总结肺腺癌的外科治疗结果,探讨肺腺癌的临床特点及影响预后的因素。方法 采用ＳＴＡＴＡ统计软件建立病例资料数据库并进行统计分析。生存率用寿命表法计算,两组赣一存率差异的显著性检验用Ｌｏｇｒａｎｋ检验。结果 无症状体检发现病变者占１４．８８％;周围型病变占８６．１８％;淋巴结转移率为４７．８０％。