舌质超微结构与微循环

用活体微循环检查与舌尖取材作超微结构切片法,对14例白血病和10例健康人作了研究。结果表明:1.白血病的舌质微循环与超微结构有多样变异。2.微循环状态与超微结构间有密切的关系。3.舌质超微结构多种变化与微循环是中医舌诊的病理生理基础之一。     

银屑病中医分型及微循环的观察

对38例不同证型银屑病患者的微循环进行了观测比较.结果显示:血热型、血瘀型、血燥型患者的微循环变化各异,但与对照组比较均有显著差异.而血燥型患者微循环变化类似血瘀型患者但较血瘀型轻.微循环的变化在各分型间具特征性,可作为本病中医分型的重要参考指标.     

正常孕妇甲襞微循环的变化

为探讨妊娠期间机体病理生理变化与微循环的关系,做好孕期保健工作,我们观察了不同孕周正常孕妇甲襞微循环的变化.     

脉络宁对糖尿病周围血管神经病变及甲襞微循环的影响

目的探讨脉络宁对糖尿病(DM)周围血管神经病变及甲襞微循环的影响和作用.方法74例DM病人随机分为两组,治疗组39例,对照组35例,分别观察两组间治疗前后的临床症状、体征变化及甲装微循环的改变.结果1、治疗前后疗效两组间对比有显著性差异,P<0.05;2、脉络宁治疗组甲襞微循环改变,治疗前后差异显著,P<0.01,对照组治疗前后无明显变化,P>0.05;3、两组间治疗前后甲襞微循环加权积分值差异显著,P<0.05.结论脉络宁对DM周围神经病变及微循环有明显改善作用,与对照组相比,具有见效快、疗效好、安全、可靠之优点.     

微血栓对心脏的影响及肝素的治疗作用——Ⅰ、大鼠循环血中微血栓与心电图变化的关系

用高分子右旋糖酐(MW.10万)静脉注射的方法复制大鼠循环血中出现微血栓的微循环障碍模型,用微循环电视显微镜观察微血栓的形态与结构,分析微血栓与心电图变化的关系。结果发现微血栓与ST段的变化间呈正相关，对其意义作了简单讨论。     

老年前期和老年期高血压病患者甲襞微循环的变化和意义

目的:探讨中老年高血压病患者甲襞微循环变化的特征及临床意义。方法:检测109例老年前期和老年期轻中度高血压病患者的甲襞微循环,并与58例健康中老年人作对照;比较老年前期和老年期高血压病患者甲襞微循环变化。结果:老年前期和老年期高血压病患者存在甲襞微循环障碍,甲襞微循环形态积分、流态积分、管周状态积分和总积分值均增高,与对照组比较有显著性差异。而老年期组甲襞微循环的管周状态、流态及总积分比老年前期组高。结论:中老年高血压病患者存在不同程度的微循环障碍,在治疗过程中辨证运用活血化瘀法以改善微循环有积极意义。     

冠状动脉狭窄患者舌尖和唇微循环定量研究

本研究用激光多普勒显微血流计定量研究冠状动脉狭窄患者舌尖和唇微循环。依平行对照设计分为5个实验组:正常对照组,Ⅰ支组、Ⅱ支组和Ⅲ支狭窄组,心肌梗塞组。结果显示:舌尖和唇的血流速度、血管管径、红细胞聚集和出血等异常变化与冠状动脉狭窄支数多少呈相关关系。冠状动脉狭窄支数愈多.微循环异常变化愈显著。提示监测体表微循环变化对冠状动脉狭窄患者是有价值的。     

老年前、老年期弦细脉甲襞微循环观察(附66例分析)

对66例老年前、老年期弦细脉患者行甲襞微循环观察,以探讨脉学原理与微循环间的相互关系。结果发现:弦细脉患者的甲襞微循环异常发生率与平脉者(53例)有显著差异,且脉象的不同,微循环亦呈伴行性变化。提示:微循环可侧面反映脉象的微观变化,对鉴别脉象有一定意义,与中医宏观认识具有一致性。     

实验性高胆固醇血症家兔血液流变性改变在微循环障碍中的作用

本文利用实验性高胆固醇血症家兔模型,研究了微循环灌流和血液流变性改变间关系。结果表明,微循环流量、流态、流速,微血管形态有明显改变,而这些变化与血清中胆固醇浓度,血浆粘度,全血粘度,红细胞聚集性及红细胞变形有着明显相关性。血液流变性变化构成此模型微循环障碍的基础。     

老年前期和老年期轻中度高血压病甲襞微循环观察

我们自2001年1月至2003年6月检测了109例老年前期和老年期轻中度高血压病患者的甲襞微循环,并与58例健康中老年人作对照,以探讨老年前期和老年期轻中度高血压病甲襞微循环变化的特征.     

Relationship between anterior cruciate ligament and anterolateral meniscal root bony attachment: High-resolution 3-T MRI analysis

BackgroundThe tibial bony attachments of the anterior cruciate ligament (ACL) and the anterolateral meniscal root (ALMR) are very close, and drilling the tibial tunnel in ACL reconstruction may damage the ALMR attachment. This study investigated the relationship between the tibial attachment of the ACL and ALMR using high-resolution 3-T magnetic resonance imaging (MRI).MethodsTwenty healthy subjects (35.8 ± 13.0 years) had 20 knees scanned using high resolution 3-T MRI. The tibial bony attachments of ACL, ALMR, and the tibia were segmented and three-dimensional models were created. The shape, area, and location of each attachment were evaluated using this model.ResultsThe ACL tibial attachment was elliptical in nine knees (45%), C-shaped in nine knees (45%) and triangle in two knees (10%). The mean values of the ACL vs ALMR tibial attachments were as follows: area, 106.2 ± 21.3 vs 56.2 ± 21.3 mm²; length, 16.8 ± 2.0 vs 11.0 ± 1.8 mm; and width, 6.9 ± 1.3 vs 6.6 ± 1.0 mm. The location of the ACL vs ALMR attachment centres was 46.5 ± 1.7% vs 56.5 ± 1.9% in the medial-lateral direction and 36.3 ± 3.6% vs 36.7 ± 3.5% in the anterior–posterior direction. The distance between the ACL and ALMR centres was 8.1 ± 1.3 mm.ConclusionsACL and ALMR tibial attachments were individually distinguished using high resolution 3-T MRI. The short distance between both centres of the attachments may suggest that ALMR can be damaged when the tibial tunnel is drilled in ACL reconstruction.     

Functional Activity of the Anterior and Posterior Cruciate Ligaments Under In Vivo Gait and Static Physiological Loads

The loading of the anterior and posterior cruciate ligaments (ACL and PCL) during normal gait has not been quantified. Also, it is not clear whether ligaments under “static” physiological loads commonly used in cadaveric studies behave similarly to normal gait experienced in vivo. We measured the in vivo kinematics of the stifle joint of sheep (N = 4) during “normal gait,” then reproduced these gait paths using a robotic system. The loads borne by the cruciate ligaments were determined using the principle of superposition and plotted against each other. This indicated some functional interaction between the ACL and PCL under in vivo physiological loads. To examine this relationship under static loading conditions, cadaveric knees (N = 6) were tested in the anterior–posterior (AP) direction, along the axes of the ACL and the PCL, as well as under combined AP and tibial rotations. The same process was repeated after either the ACL (N = 3) or the PCL (N = 3) was transected. Our results show a mutually exclusive relationship in ACL and PCL load bearing under both “in vivo gait” and “static” loading conditions. High ACL loads were associated with low PCL loads and vice versa. This is a novel study quantifying the actions of the cruciate ligaments during gait and comparing them to commonly used static loading conditions in cadaveric studies.     

自噬在兔部分损伤前交叉韧带和内侧副韧带中的差异

目的：确定兔前交叉韧带和内侧副韧带部分损伤后自噬的存在,并比较损伤后不同时间两者之间自噬的表 达差异,探讨其愈合能力差异与自噬的关系。方法： 3 月龄健康雄性新西兰大白兔18 只,随机选取3 只作为对照 组,其余兔建立前交叉韧带和内侧副韧带部分损伤模型, 随机分为5 组,各组分别在造模后3 d、1 周、2 周、4 周、 6 周取材。H-E 染色观察损伤部位形态学变化,透射电镜观察损伤部位超微结构变化,免疫印迹检测自噬相关蛋 白Beclin 1、LC3Ⅱ/Ⅰ、p62 表达水平,RT-PCR 检测自噬相关基因Beclin 1、ATG-5 mRNA表达水平。结果：在 部分损伤后3 d、1 周、2 周、4 周、6 周5 个时间点,前交叉韧带和内侧副韧带均未表现出明显的愈合趋势,观察 到自噬小体的存在。与对照组相比,自噬相关蛋白Beclin 1、LC3Ⅱ/Ⅰ、p62 在前交叉韧带中的高表达更为显著, 在内侧副韧带中的表达更早恢复至正常水平,并继续降低;自噬相关基因ATG-5、Beclin 1 在前交叉韧带中始终 处于高表达状态,峰值出现在1 周,内侧副韧带高表达峰值出现在2 周,此后逐渐恢复至正常水平。结论： 兔前 交叉韧带、内侧副韧带部分损伤后自噬相关因子的表达随时间推移,总体呈现先升高后降低的变化趋势,损伤后 不同时间点前交叉韧带、内侧副韧带中自噬的表达存在明显差异,推测前交叉韧带损伤后自噬的过度激活可能导 致其内源性修复障碍。     

The anterior cruciate ligament–lateral meniscus complex: A histological study

The anterior root of the lateral meniscus (LM) dives underneath the tibial attachment of the anterior cruciate ligament (ACL). Although the distinct role of meniscal attachments has been investigated, the relationship between the LM anterior insertion (LMAI) and ACL tibial insertion (ACLTI) remains unclear. This study histologically analyzed the LMAI and ACLTI. Samples were divided into four regions in an anterior-to-posterior direction. Histological measurements of these insertion sites were performed using safranin O-stained coronal sections. Distribution and signal densities of type I and II collagen were quantified. The ACLTI and LMAI formed the ACL–LM complex via fiber connections. The anterior part of the ACLTI had a widespread attachment composed of dense fibers. Attachment fibers of the LMAI became dense and wide gradually at the middle-to-posterior region. The ACL–LM transition zone (ALTZ) was observed between the LMAI and the lateral border of the ACLTI at the middle part of the ACL tibial footprint. Type II collagen density of the LMAI was higher than that of the ACLTI and ALTZ. Our results can help create an accurate tibial bone tunnel within the dense ACL attachment during ACL reconstruction surgery.     

The relationship between a Segond fracture and meniscus injury in patients with anterior cruciate ligament tears

BackgroundSegond fracture may be identified when an anterior cruciate ligament (ACL) tear is diagnosed, and it has historically been considered a sign of significant knee trauma indicating intra-articular injury. There are few studies on the correlation between a Segond fracture and meniscus injury. The purpose of this study was to evaluate the relationship between a Segond fracture and meniscus injury in patients with ACL tears.MethodsA retrospective review of all patients undergoing acute ACL reconstruction (less than 1 month from the time of injury) between 2013 and 2020 was performed. The absence or presence of a Segond fracture was confirmed using preoperative radiographs. Demographic data (age, sex and body mass index), injury variables (time from injury and mechanism of injury) and arthroscopic features (meniscal or chondral injury) were analysed to investigate the relationship between a Segond fracture and meniscus injury.ResultsA total of 427 patients were included in the study. The incidence of Segond fractures was 12.4%. Among the patients with a Segond fracture, 15 patients were injured playing soccer (28.3%), 11 patients were injured playing basketball (20.8%), eight patients sustained the injury during racquet sports (15.1%), five patients (9.4%) were injured during less popular sports (such as skiing, ice-skating and boxing), and 14 patients (26.4%) were injured by contact mode of injury. A Segond fracture was a significant risk factor for lateral meniscus tears in patients with ACL tears (adjusted odds ratio, 1.938; 95% confidence interval, 1.078–3.481; P = 0.027).ConclusionThe incidence of Segond fractures in patients with acute ACL tears was higher than that reported in previous studies. A Segond fracture could increase the risk of a lateral meniscus tear in patients with an ACL tear.     

Pre-operative quadriceps strength predicts IKDC2000 scores 6 months after anterior cruciate ligament reconstruction

Level of evidenceLevel II.BackgroundQuadriceps strength deficits are ubiquitous after anterior cruciate ligament (ACL) injury. Deficits prior to surgery can influence knee function post-operatively. Inhibition contributes to quadriceps strength deficits after an ACL injury. Body mass index, meniscal injury, and sex influence functional outcomes after ACL reconstruction. The purpose of this study is to examine the relationship of pre-operative quadriceps strength and post-operative knee function and to investigate how other pre-operative factors may influence this relationship.MethodsAfter an ACL injury, subjects received pre-operative rehabilitation and performed quadriceps strength testing. Subjects underwent reconstruction and post-operative rehabilitation. Six months after ACL reconstruction, subjects completed the International Knee Documentation Committee 2000 subjective form (IKDC2000). Linear regression models were developed using IKDC2000 scores at 6 months after ACL reconstruction as the dependent variable.ResultsFifty-five subjects had complete pre-operative data and IKDC2000 scores at 6 months after ACL reconstruction. Pre-operative involved quadriceps strength was a significant predictor for IKDC2000 scores 6 months after ACL reconstruction. Sex, meniscal injury, pre-operative BMI, and pre-operative involved quadriceps activation ratio were not significant predictors in the regression model.ConclusionsPre-operative quadriceps strength can predict IKDC2000 scores 6 months after ACL reconstruction. Deficits in pre-operative quadriceps strength influence self-reported function 6 months after surgery. Factors that are known to influence quadriceps strength and self-reported outcomes do not influence the relationship between pre-operative quadriceps strength and post-operative IKDC2000 scores.     

前交叉韧带解剖重建股骨隧道与外侧副韧带解剖重建股骨隧道的关系

目的探讨前交叉韧带(ACL)单束解剖重建股骨隧道与外侧副韧带(LCL)重建股骨隧道的关系,以期为临床中ACL解剖重建提供解剖学数据,便于临床实际操作中避免2个股骨隧道相互干扰,为ACL和LCL一期解剖重建提供依据。方法采用30例成人尸体膝部标本,保留膝关节上下至少20cm,排除关节明显退变、畸形及关节损伤。男性16例,女性14例,年龄在23~66岁,平均年龄38.7岁。屈膝120°经前内辅助入路(AMP)钻取股骨隧道。在股骨外髁外侧面寻找后外侧角(PLC)结构,钝性分离LCL,并钻取LCL隧道。标本进行CT扫描,在CT片上观察隧道碰撞数,并计算两个隧道的最短距离。结果在LCL股骨隧道深度为25mm时,其与ACL股骨隧道最短距离为(3.9±2.4)mm;在LCL股骨隧道深度为30mm时,其与ACL股骨隧道最短距离为(2.7±1.9)mm。在ACL股骨隧道深度为25mm时,其与LCL股骨隧道的最短距离为(4.4±2.6)mm;在ACL股骨隧道深度为30mm时,其与LCL股骨隧道的最短距离为(3.2±2.1)mm。在30例标本中,共发现6例隧道碰撞,碰撞的几率高达20%。结论我们发现两者隧道发生碰撞的几率高,临床一期解剖重建时,术前应做个体化准备,规划好LCL重建所需股骨隧道的长度和隧道直径,从而规避与ACL股骨隧道的碰撞。     

A novel technique,dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: A preliminary biomechanical study

BackgroundAnterior cruciate ligament (ACL) rupture is a common lesion. Current treatment emphasizes arthroscopic ACL reconstruction via a graft, although this approach is associated with potential drawbacks. A new method of dynamic intraligamentary stabilization (DIS) was subjected to biomechanical analysis to determine whether it provides the necessary knee stability for optimal ACL healing.MethodsSix human knees from cadavers were harvested. The patellar tendon, joint capsule and all muscular attachments to the tibia and femur were removed, leaving the collateral and the cruciate ligaments intact. The knees were stabilized and the ACL kinematics analyzed. Anterior–posterior (AP) stability measurements evaluated the knees in the following conditions: (i) intact ACL, (ii) ACL rupture, (iii) ACL rupture with primary stabilization, (iv) primary stabilization after 50 motion cycles, (v) ACL rupture with DIS, and (vi) DIS after 50 motion cycles.ResultsAfter primary suture stabilization, average AP laxity was 3.2 mm, which increased to an average of 11.26 mm after 50 movement cycles. With primary ACL stabilization using DIS, however, average laxity values were consistently lower than those of the intact ligament, increasing from an initial AP laxity of 3.00 mm to just 3.2 mm after 50 movement cycles.ConclusionsDynamic intraligamentary stabilization established and maintained close contact between the two ends of the ruptured ACL, thus ensuring optimal conditions for potential healing after primary reconstruction. The present ex vivo findings show that the DIS technique is able to restore AP stability of the knee.     

The interrelationship between anterior cruciate ligament tibial footprint and anterolateral meniscal root insertions: Quantitative,morphological and positional analyses using three-dimensional computed tomography images

BackgroundThe purpose of this study was to evaluate quantitative, morphological and positional differences between the anterior cruciate ligament (ACL) tibial footprint and anterolateral meniscal root (ALMR) insertion and investigate an intraoperative landmark to estimate their boundaries.MethodsThirty-three fixed human cadaveric knees were evaluated. After resecting the components, the anterior fiber (AF) and posterior fiber (PF) of ALMR, the tibial center of ACL bundles (anteromedial (AM) and posterolateral (PL) bundles) and ACL were marked. Insertion morphology was classified into three categories, and the distance and relative positional relationship between AF/PF insertions and the center of each attachment were measured on three-dimensional computed tomography images.ResultsThere was no significant difference between the AF of AM and ACL (P = 0.16), but both were significantly shorter than the AF of PL (both P < 0.001). There was no significant difference between the PF of ACL and PL (P = 0.99), which were significantly shorter than PF of AM (both P < 0.001). Morphology of the ACL tibial insertion was classified as follows: triangular, 15 knees (45.5%); oval, 18 knees (54.5%); none, C-shape. Quantitative and positional analyses showed that the AF insertion was significantly closer to AM and ACL centers in the oval type than in the triangular type. Excluding two cases, the AF/PF insertion was located laterally to the ML center of the medial and lateral intercondylar tubercles.ConclusionProximity of ACL tibial footprint and ALMR varies by their footprint morphology. The medial and lateral intercondylar tubercles were useful landmarks for ALMR injury prevention.