腕关节功能指标的动态MRI研究

目的:测量与分析正常志愿者腕关节从极度桡偏到极度尺偏5种运动状态下,腕骨角及舟月骨间距的动态MRI变化。材料和方法:选取20个健康志愿者的腕关节为研究对象。使用Cine技术,腕关节从极度桡偏到极度尺偏每隔10°定格的5种运劝状态下进行MR扫描,分别测量各个位置上腕骨角与舟月骨间距值。结果:在腕关节从极度桡偏到极度尺偏5种运动状态中,腕舟月骨间距测定,最大值为3.15mm,最小值为3.07mm,平均为3.11±0.03mm,随着腕关节运动位置的变化,各组舟月骨间距离变化比较无显著性差异(P>0.05)。腕骨角从桡偏时的116.65°增至尺偏时的137.55°,其变化具有显著性的差异(P<0.05)。结论:腕关节功能指标的动态MRI检测研究,对于腕关节不稳等腕关节疾病的诊断和治疗具有参考价值。     

月骨坏死后带蒂豆状骨移位替代术二例报告

我们应用带蒂豆状骨移位替代坏死月骨2例.经1年左右随防,效果较好,现报告如下.例1,男,35岁.因左腕月骨坏死,疼痛活动受限2年入院.查腕背轻度肿胀,腕中部压痛,活动受限.功能测定:屈伸40～0～20°.尺偏25°,桡偏20°.X线片示:月骨密度增高,变形不规则,腕掌塌陷.于1990年4月12日在臂丛麻醉下行带蒂豆状骨移位替代术.术中见月骨硬化变形,病理检查:月骨坏死.术后3周活动锻炼、3个月后症状消失并恢复工作.随访2年症状无复发.腕屈伸度增加到60～0～30°.X线片复查:腕掌塌陷恢复近正常.移位豆骨密度、位置及充填良好.     

桡骨远端骨折不同程度背屈畸形后腕动力学变化

目的测定桡骨远端骨折背屈成角畸形后腕动力肌腱的滑动距离和力臂变化,为矫正临床上骨折畸形提供依据. 方法采用7只新鲜成人尸体上肢标本,将桡侧腕长伸肌腱、桡侧腕短伸肌腱、尺侧腕伸肌腱、桡侧腕屈肌腱和尺侧腕屈肌腱与旋转电压计相连,测定肌腱活动距离 ,在桡骨远端、桡骨骨折向背侧成角10°、20°、30°、40°时,分别测定在腕屈曲45°至伸展45°、桡偏20°至尺偏25°过程中5根腕主要活动肌腱距离,用方差分析法分析不同程度桡骨成角时力臂变化的统计学差异. 结果桡骨骨折背屈成角显著影响腕动力肌腱的力臂,骨折畸形程度越大,力臂变化越大.背倾成角10°时即可引起力臂显著变化,背倾30°～40°时力臂变化很大.桡侧伸腕肌腱力臂显著增大,屈腕肌腱力臂显著减小. 结论桡骨远端骨折背屈畸形显著影响腕动力学,临床上即使10°的背屈畸形也需要予以矫正,强调对此骨折完全解剖复位.     

定量分析评价180°与360°采集对心肌显像图的影响

笔者应用定量分析方法探讨了 180°与 36 0°采集方式对心肌断层显像的影响 ,现报道如下。一、资料与方法1.临床资料。正常者 15例 ,男 8例 ,女 7例 ,年龄 (45 .3± 5 .6 )岁 ;冠心病患者 12例 ,男 9例 ,女 3例 ,年龄 (5 5 .6±6 .4 )岁。2 .方法。采用Ｔｏｓｈｉｂａ 72 0 0 Ａ ＤＩ双探头ＳＰＥＣＴ仪。受检者于注射99Ｔｃｍ 甲氧基异丁基异腈 (ＭＩＢＩ) 5 5 5～ 74 0ＭＢｑ后 1.5～ 2ｈ行静息心肌断层显像 ,采集矩阵为 12 8× 12 8,2 0～ 30ｓ 帧 ,6° 帧 ,共6 0帧。采集完毕后 ,分别行 36 0°和 180°(左后斜位 4 5°～右前斜位 4 5°…     

盆腔动脉造影正位与斜位对子宫动脉开口显示的比较

目的　探讨子宫动脉开口显示的最佳位置 ,指导医生超选择子宫动脉插管。资料与方法　回顾性分析84例髂动脉血管造影的结果 ,采用正位、同侧斜位和对侧斜位血管造影 ,以及采用不同角度的同侧斜位造影 (将斜位造影分为 16°～ 30°,31°～ 4 5° ,4 6°～ 6 0°三组 ) ,对子宫动脉开口显示结果进行对比 ,选择出显示子宫动脉开口的最佳位置与角度。结果　 (1)正位、同侧斜位和对侧斜位对子宫动脉开口的显示率分别为 6 %、6 5 .4 %和 12 .5 %(χ2 =2 8.12 ,P <0 .0 1)。 (2 )同侧斜位 16°～ 30°、31°～ 4 5°和 4 6°～ 6 0°对子宫动脉开口的显示率分别为 2 5 %、85 .7%和75 %。结论　髂动脉造影显示子宫动脉开口的最佳位置为同侧斜位 ;最佳倾斜角度为 31°～ 4 5°。     

急进高原健康人不同海拔高度血液流变学变化研究

目的 :研究急进高原健康人的血液流变学变化。方法 :采用北京普利生集团公司生产的LBY -N6型旋转式血液流变自动分析仪。测定急进格尔木组 (海拔 2 80 0m ,n =2 8) ,沱沱河组 (海拔 4 70 0m ,n =2 8) ,健康志愿者血液流变学项目。结果 :格尔木组的全血粘度、血浆粘度、全血还原粘度、红细胞压积分别为 (13.6 6± 3.6 1)mPa s、(1.81± 0 .2 2 )mPa s、(2 4 .86± 4 .6 7)mPa s、(5 0 .31±5 .4 9) % ;沱沱河组分别为 (2 0 .5 6± 4 .10 )mPa s、(2 .0 4± 0 .2 9)mPa s、(2 9.5 6± 3.91)mPa s、(6 4.79± 5 .32 ) % ,差别有显著性 (P <0 .0 0 1)。在低切变率及高切变率下全血粘度 ,全血还原粘度均升高明显 ,间接提示红细胞的聚集性增强 ,变形性减弱。结论 :随着海拔的升高 ,血液流变学检测指标有明显的变化 ,具有“浓、粘、聚、凝”的特点     

女性年龄与体外受精胚胎移植结果的关系

目的　探讨女性年龄与体外受精 胚胎移植结果的关系。方法　分析IVF ET 10 6个起始周期、90个移植周期的临床资料 ,按女性年龄≤ 30岁 ,31～ 34岁 ,≥ 35岁分Ⅰ ,Ⅱ ,Ⅲ组 ,比较取消率、Gn用量、卵泡数、回收卵子数、受精数、卵裂数、优质胚胎数、受精率、卵裂率、优质胚胎率及临床妊娠率的差别。结果　 3组的取消率分别为 12 .5 0 % ,2 .78% ,33 .33 % ,三组间相比差异显著 (P <0 .0 5 ) ;Gn用量分别为 (2 8.71± 5 .45 )支、(33 .46± 7.5 1)支、(34.0 5± 5 .78)支 ,3组相比 ,Ⅰ组与Ⅱ ,Ⅲ组差异显著 (P <0 .0 5 ) ,Ⅱ组与Ⅲ组之间差异不显著 (P >0 .0 5 ) ;各组间卵泡数、周期取卵数、受精数、卵裂数、优质胚胎数无显著性差异 (P >0 .0 5 ) ;3组受精率分别为 74.49% ,6 8.0 7% ,6 7.82 % ,各组间相比 ,Ⅰ组与Ⅱ ,Ⅲ组差异显著 (P <0 .0 5 ) ,Ⅱ组与Ⅲ组间差异不显著 (P >0 .0 5 ) ;而卵裂率、优质胚胎率无显著性差异 (P >0 .0 5 ) ;3组的每移植周期妊娠率分别是 45 .71% ,2 5 .71% ,15 .0 0 % ,各组间相比差异显著 (P <0 .0 5 )。结论　女性年龄是影响IVF ET成功的重要因素     

腕高、腕高率和腕高指数的X线测量及其临床意义

腕高、腕高率和腕高指数是腕骨塌陷的定量指标，对于Ｋｉｅｎｂｏｃｋ’ｓ病、腕舟状骨骨折不连接、腕关节类风湿性关节炎、桡骨远端骨折和腕关节不稳等疾病的诊断和治疗均有重要的临床意义。其中腕高指数优于腕高率优于腕高。     

经肝动脉化疗栓塞加血管生长抑制剂对兔肝移植瘤生长及转移的影响

目的　观察经肝动脉化疗栓塞术 (TACE)后血管生长抑制剂TNP 470治疗对兔VX2肝移植瘤生长及转移的抑制作用。材料与方法　将VX2肿瘤接种于日本大白兔的肝脏内 ,植入 2周后将 45只携有肿瘤的实验兔随机分为对照组、单纯TACE治疗组及TACE术后TNP 470治疗组 ,分别给予不同的处理。TACE术后TNP 470治疗组于TACE术后 3天给予TNP 470静脉灌注 ,隔日 1次 ,剂量为 30mg/kg体重 ,共治疗 9次。植入肿瘤后 5周处死动物 ,测量肝移植瘤的大小、坏死面积 ,观察肝内及双肺转移的发生率。结果　 5周末对照组肝移植瘤体积 2 6 .5± 6 .5cm3 ,平均坏死率 35 .5± 9.2 %。单纯TACE治疗后肝移植瘤体积约 19.9± 7.3cm3 ,平均坏死率 5 2 .4± 17.8%。TACE术后TNP 470治疗组移植瘤平均体积 14.7± 4.6cm3 ,平均坏死率 6 9.5± 12 .6 % ,各组之间对比有显著性差异 (P <0 .0 5 )。肝内及双肺转移率分别为 :对照组 :15 /15 (10 0 % )、11/15 (73.3% )。单纯TACE治疗组 :15 /15 (10 0 % )、10 /15(6 6 .7% )。两组之间无显著性差异 (P >0 .0 5 )。TACE术后TNP 470治疗组肝内及双肺转移率分别为 7/15(4 6 .7% )、5 /15 (33.3% ) ,与前两组比较有显著性差异 (P <0 .0 5 )。结论　单纯TACE治疗虽然能抑制肝移植瘤的生长 ,但对其转移无     

静脉应用不同剂量胺碘酮转复心房颤动的安全性和有效性研究

目的　观察静脉应用不同剂量胺碘酮对阵发性房颤复律的临床疗效 ,探讨经静脉途径胺碘酮转复心房颤动的最佳剂量 ,对临床应用胺碘酮有积极的指导作用。方法　选取 2 0 0 2年 1月～ 2 0 0 4年 6月收入我院的阵发性心房颤动患者 6 0例 ,年龄 4 8～ 81岁 ,平均 (6 9± 9)岁。随机分成 3组 ,每组 2 0人。组 1:以 75mg 次 (生理盐水稀释成 2 0毫升 )缓慢静脉注射 10min ,每半小时不转复为窦性心律重复1次 ,达 4次后以 1mg min速度静脉点滴 ,持续 6h后减半维持 2 4h或至恢复窦性心律 ;组 2 :以 15 0mg 次 (稀释成 2 0ml)静脉注射 10min ,余同组 1;组 3:以 2 5 0mg 次 (稀释成 2 0ml)静脉注射 10min ,余同组 1。结果　①组 1、组 2、组 32 4h复律率分别为 10 0 % ,10 0 % ,95 % ,各组间差异均无显著性 (P >0 .0 5 )。②组1、组 2、组 3平均复律时间分别为 2 0～ 10 0 5min ,平均 (4 14 .5 8± 2 4 0 .0 1)min ,30～ 6 0 0min ,平均 (2 34.5±99 .6 )min ,30～ 96 0min ,平均 (2 74 .11± 192 .36 )min ,组 1、组 2、组 3均有显著差异 (P值分别为 0 .0 15、0 .0 4 7) ,组 2与组 3无显著差异 (P =0 .972 )。③转复时所用胺碘酮的剂量分别为 2 2 5～ 12 5 0mg ,平均(6 0 3± 2 4 6 )mg ,15 0～ 10 5 0mg ,平均 (5 2     

Carpal tunnel syndrome in athletes

Carpal tunnel syndrome is the most frequent peripheral compression neuropathy found in sporting activities. The recent introduction of endoscopic methods to release the transverse carpal ligament has generated renewed interest in the clinical, social, and economic issues relating to this pervasive condition. This report reviews the most common open, minimum open, and endoscopic techniques used in the operative treatment of carpal tunnel syndrome.     

Fibrolipoma Causing Carpal Tunnel Syndrome

Teaching point: A space-occupying lesion should be considered in the differential diagnosis of progressive unilateral carpal tunnel syndrome.     

Carpal ligamentous laxity with bilateral perilunate dislocation in Marfan syndrome

A case of persistent bilateral perilunate dislocation unrelated to trauma in a patient with Marfan syndrome is discussed. This finding is believed to be a manifestation of the generalized ligamentous laxity occurring in this disorder. Radiographs of eight additional Marfan syndrome patients failed to demonstrate similar carpal instability. Because some carpal derangements are dynamic events, stress views or wrist fluoroscopy may be necessary to demonstrate unsuspected carpal instability in Marfan patients.     

Carpal instability

This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads (“dyskinetics”) or suffers from abnormal motion of its bones during movement (“dyskinematics”). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being “occult” for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the handsurgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.     

Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome

ObjectiveTo investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR).Materials and MethodsThis prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared.ResultsAll patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months.ConclusionPostoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.     

Carpal Tunnel Syndrome

Many common conditions in sports medicine are eponymous; that is, they are named for the person first describing or popularizing the diagnosis. But other medical conditions are named for the action or activity that is associated with the pathology. This article lists and references these conditions, and suggests that this group of conditions should be called “motionyms”.