髋关节骨折－后脱位合并坐骨神经损伤的创伤机制及漏诊分析

目的：探讨髋关节骨折-后脱位合并坐骨神经损伤的创伤机制及漏诊原因。方法：统计分析1986年1月－1997年6月髋关节骨折-后脱位并坐骨神经损伤36例临床资料。结果：此类损伤发病率占同期收治髋关节后脱位的69.3％,明显高于以往的报道，且首诊漏诊率高达58.2％，其中15例病人疗效不满意。结论：特定环境下屈髋、屈膝位时，经股骨轴向的暴力打击是髋关节-后脱位合并坐骨神经损伤的主要创伤机制，细致的临床检查，特别是CT扫描是早期确诊、提高疗效的关键。     

髋关节骨折--后脱位合并坐骨神经损伤的创伤机制及漏诊分析

目的探讨髋关节骨折-后脱位合并坐骨神经损伤的创伤机制及漏诊原因.方法统计分析1986年1月～1997年6月髋关节骨折-后脱位并坐骨神经损伤36例临床资料.结果此类损伤发病率占同期收治髋关节后脱位的69.3%,明显高于以往的报道,且首诊漏诊率高达58.2%,其中15例病人疗效不满意.结论特定环境下屈髋、屈膝位时,经股骨轴向的暴力打击是髋关节骨折-后脱位合并坐骨神经损伤的主要创伤机制,细致的临床检查,特别是CT扫描是早期确诊、提高疗效的关键.     

髋关节骨折脱位合并坐骨神经损伤的临床特点及疗效分析

目的：回顾性分析髋关节骨折脱位合并坐骨神经损伤的特点及治疗效果。方法：对48例髋关节骨折脱位合并坐骨神经损伤者的手术及保守治疗后进行随访，平均随访2年6个月。结果：48例中，39例行手术治疗,其中32例伤后3周内进行，7例伤后3周－3个月内进行。9例行非手术治疗。根据MCRR标准，伤后3周内手术的32例中，优18例，良8例，差5例，劣1例。伤后3周－3个月内手术的7例中，优1例，良3例，差1例，劣2例。9例非手术治疗者，优6例，良3例。结论：髋关节骨折脱位合并坐骨神经损伤的患者应及早积极手术治疗，尽快恢复髋关节解剖结构，尽快解除坐骨神经的压迫，对髋关节创伤性关节炎的发生发展及坐骨神经功能的恢复有密切关系。     

髋部骨折脱位合并坐骨神经损伤治疗分析

目的：回顾分析髋部骨折脱位合并坐骨神经损伤的诊断治疗特点。方法：对47例髋部骨折脱位合并坐骨神经损伤的病例进行回顾性分析，随访1～3年。男35例，女12例，年龄18～62岁。髋部骨折脱位分类：单纯髋关节后脱位8例，单纯髋臼骨折4例，髋臼骨折合并髋关节后脱位29例，股骨头、股骨颈骨折合并髋臼骨折各3例。坐骨神经损伤类型：单纯腓总神经损伤34例，腓总神经、胫神经联合损伤13例，非手术治疗15例。手术治疗32例。结果：解剖复位21例，满意复位14例，不满意复位4例。坐骨神经恢复情况：优10例，良18例，差10例，劣9例。结论：对于单纯髋关节后脱位或髋臼骨折移位小于0．5cm者，应用非手术治疗。而对于骨折移位大于0．5cm者，应采取手术治疗，尽早解剖复位并探查坐骨神经，以减低创伤性髋关节炎的发生，并促进坐骨神经功能的恢复。     

髋臼骨折、后脱位合并坐骨神经损伤的临床分析

髋臼骨折、髋关节后脱位，是由于受高能量暴力打击所致，伤情较为严重且复杂。目前交通事故不断增多，髋臼骨折、髋关节后脱位合并坐骨神经损伤增多。Baumgaertner报告髋部骨折脱位合并坐骨神经损伤占髋部骨折脱位患者的3％～18％。且影响预后的相关因素较为复杂，其临床诊断、治疗不恰当，将严重影响肢体功能。本院自1998年7月至2007年3月共收治髋臼骨折、髋关节后脱位合并坐骨神经损伤28例，通过临床诊治，结合有关文献，对此类损伤进行总结分析、探讨。     

髋臼骨折、后脱位合并坐骨神经损伤的临床分析

髋臼骨折、髋关节后脱位，是由于受高能量暴力打击所致．伤情较为严重且复杂。目前交通事故不断增多，髋臼骨折、髋关节后脱位合并坐骨神经损伤增多。Baumgaertner报告髋部骨折脱位合并坐骨神经损伤占髋部骨折脱位患者的3％～18％。影响预后的相关因素较为复杂，其临床诊断、治疗不恰当，将严重影响肢体功能。本院自1998年7月至2007年3月，     

髋臼后壁骨折伴髋关节后脱位与坐骨神经损伤的临床分析

目的 探讨髋臼后壁骨折伴髋关节后脱位合并坐骨神经损伤的创伤机制、类型和预后关系.方法 笔者收治髋臼后壁骨折伴髋关节后脱位合并坐骨神经损伤21例,在骨折内固定时,均行坐骨神经探查术,按MCRR标准评定神经功能恢复情况.结果 21例在术后24个月内,神经均有不同程度的功能恢复,优11例,良9例,可1例,优良率为95.2%.本组无一例出现医源性损伤.结论 髋臼后壁骨折伴髋关节后脱位常合并坐骨神经损伤者,在骨折内固定时应探查神经,结合损伤性质和程度,采取相应疗措施,有利于正确判断预后和恢复神经功能.     

髋关节后脱位合并股骨头骨折术后近期疗效

目的总结髋关节后脱位合并股骨头骨折手术后近期疗效。方法2001年3月-2003年5月收治8例髋关节后脱位合并股骨头骨折,年龄23-46岁。按Pipkin分型,其中型4例,型3例,型1例;合并多发肋骨骨折2例,颅脑损伤、腰椎压缩骨折、患侧坐骨神经损伤各1例。分别采用不同的手术入路给予治疗。结果术后经9-24个月随访,7例骨折愈合;1例4个月骨折块坏死吸收。按赵炬才等髋关节功能评价标准优6例,良2例。结论对髋关节后脱位合并股骨头骨折,应早期复位髋关节脱位,骨折块行有效的内固定,术后结合早期功能锻炼,可减少股骨头缺血坏死和创伤性关节炎的发生。     

创伤性双髋关节一前一后脱位一例

外伤性双髋关节一前一后脱位合并股骨头骨折及坐骨神经损伤较为少见.笔者于2006年6月,收治1例双髋关节脱位合并骨盆、股骨头、胫腓骨骨折及坐骨神经损伤的病人.报告如下.     

髋关节后脱位伴后壁骨折的治疗

目的：探讨提高髋关节后脱位伴后壁骨折疗效的方法。方法：回顾总结15例髋关节后脱位伴后壁骨折的治疗过程。12例切开复位内固定,3例侧方牵引。结果：手术病例中优10例,良2例,无一例坐骨神经损伤、感染等．3例非手术病例结果优。结论：对于髋关节后脱位伴后壁骨折的治疗应在急诊手法复位的基础上根据骨折类型、骨折块情况结合全身情况综合考虑治疗方法。II型以上应采用简单、有效的“生物学”内固定;术前应及时完善辅助检查,避免过多搬动相反复检查。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

---

Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.