经舟状骨骨折背侧型月骨周围脱位漏诊1例分析

笔者近期收治1例经舟状骨骨折背侧型月骨周围脱位漏诊患者,分析如下. 1 病历摘要 男,27岁.因干活时不慎从约3 m高处坠落,左手掌着地,伤后即感左腕部及左胸部疼痛.入院查体:左腕部肿胀,腕周广泛压痛,腕关节不能背伸,掌腕横纹处有压痛,并可触到脱出的月骨.胸廓挤压实验(+).X线片示:左侧肋骨多发性骨折,左侧桡骨茎突骨折合并月骨脱位.胸部CT示:双肺下叶膨胀不全,左侧胸腔积液.     

月骨摘除联合掌长肌腱填塞治疗陈旧月骨脱位

目的:总结采用月骨摘除联合掌长肌腱填塞治疗陈旧性月骨脱位15例疗效.方法:本组陈旧性月骨脱位患者15例,经掌侧入路,摘除坏死月骨,掌长肌腱球填塞进行治疗.对疼痛、握力、神经损伤症状等进行观察,测量术前、术后腕关节伸屈活动度,复查术后X线测量腕高比值.结果:随访12～36个月,平均24个月.术后12例疼痛完全缓解,3例因疼痛再次手术.腕背伸、掌屈度数较术前明显改善,腕高比值无明显降低.结论:应用月骨摘除联合掌长肌腱球填塞治疗陈旧性月骨脱位,能够有效地缓解疼痛、改善握力和腕关节活动.     

溃疡性结肠炎合并坏疽性脓皮病误诊骨结核1例

患者,女,40岁,主因左腕背侧皮肤红肿2个月于2011年6月21日入院。2011年4月15日患者无诱因出现左腕背侧皮肤红肿,直径约0.5cm,面积逐渐扩大伴疼痛,外院查抗核抗体阴性,X线片示左腕钩状骨骨质破坏,我院门诊考虑左腕关节骨结核收入骨病科。查体:体质量指数23.6,轻度贫血貌,心肺听诊未见异常。腹平软,无压痛,肠鸣音活跃。左腕背侧皮肤红肿,直径约2.0cm,皮温高,压痛明显,活动受限,     

带血管蒂桡骨远端骨瓣移植治疗腕舟骨骨不连

腕舟状骨骨折 ,尤其是腰部骨折后常出现近端缺血性坏死 ,发生骨不连 ,导致腕关节疼痛、功能障碍。１９９２年９月以来 ,本科采用带桡动脉腕背支或茎突返支的桡骨远端骨瓣植入术加桡骨茎突切除治疗腕舟骨骨不连１８例 ,效果满意 ,现报告如下。１资料与方法１．１一般资料本组男１５例 ,女３例。年龄１８～４５岁。右侧１４例 ,左例４例。舟状骨腰部骨折１７例 ,近１ /３处骨折１例。骨折后不愈合时间８～２４个月 ,平均１年３个月。主诉腕部酸痛、手握力明显减退 ,腕关节桡侧及背侧活动受限。Ｘ线片示 :舟状骨腰部陈旧性骨折 ,均伴有骨折端吸…     

隐性腕背腱鞘囊肿的超声诊断

目的 探讨隐性腕背腱鞘囊肿的超声特性,评价超声检查隐性腕背腱鞘囊肿的应用价值.方法 对16例慢性腕背疼痛患者行超声检查,其中11例患者采用手术治疗,将超声图像与手术结果进行分析,术后随访1～8个月.结果 隐性腕背腱鞘囊肿的超声特性为:①腕背舟骨、月骨骨皮质连续未见明破坏;②腕背舟月间隙附近可见一卵圆形的无回声区,边界尚清晰.囊壁尚光滑,伴侧方声影及后方回声增强,③彩色多普勒血流显像示病灶内部及周边均未见明显血流信号.结论 超声检查对于隐性腕背腱鞘囊肿的定性和定位有重要意义,可作为慢性腕关节背侧疼痛患者x线检查后首选检查方法.     

手舟月骨间韧带和月三角骨间韧带的解剖学特点

背景:国内外已对舟月骨间韧带和月三角骨间韧带做过一些解剖学、组织学及生物力学特性的研究,尚缺乏对韧带的长、宽、厚的形态学测量.目的:探讨手舟骨、月骨与三角骨间的舟月骨间韧带和月三角骨间韧带的解剖学特性及作用.设计、时间及地点:重复测量设计实验,于2008-02/12在湖南省永州职业技术学院医学院解剖教研室完成.材料:38侧成人尸体手标本,其中34侧为甲醛固定标本,另4侧为新鲜标本.方法:去除腕掌背侧的皮肤,皮下组织,切断腕横韧带,在掌侧正对桡腕关节的腕关节囊上作弧形切口,从桡骨茎突处至桡尺远侧关节处切开桡腕关节,在5倍解剖放大镜下,解剖并观察舟月骨间韧带和月三角骨间韧带的起止走行及与关节囊韧带的联系,测量两韧带在不同附着部位的长度.最后将两韧带逐一切断,观察它们在舟骨、月骨和三角骨相对关节面上的附着宽度.并在韧带的中段测量其宽度和厚度.在切断两韧带时,先近侧部,再掌背侧部,了解切断后对舟月骨关节和月三角关节的稳定性影响.主要观察指标:舟月骨间韧带和月三角骨间韧带在背侧部、掌侧部和近侧部的长度、宽度和厚度.结果:舟月骨间韧带位于舟、月骨相对关节面之间,连接关节面的掌侧缘、近侧缘和背侧缘.月三角骨间韧带连接于月骨和三角骨相邻的掌侧、背侧和近侧边缘.两韧带分为背侧、掌侧和近侧3个部分,其掌背侧部以致密纤维结构为主,但近侧部显示有纤维软骨样成分.舟月骨间韧带和月三角骨间韧带在掌侧部的长度、宽度和厚度都较相近;在背侧部舟月骨间韧带的长度较长、宽度较宽,厚度明显厚于月三角骨间韧带;在近侧部两韧带长度和厚度相差较大.两韧带在掌侧部、近侧部和背侧部的宽度基本接近.月骨间韧带和月三角骨间韧带的近侧部切断后,舟月关节和月三角关节稳定性未受到明显影响,再切断掌背侧部,舟月骨间关节和月三角关节稳定性受影响.结论:舟月骨间韧带和月三角骨间韧带结构特殊,对舟骨、月骨与三角骨及骨间关节起稳定性作用.     

经舟骨月骨周围腕脱位的损伤机理与X线类型（附35例分析）

目的：通过分析经盘骨月骨周围腕脱位的Ｘ线类,探讨损伤机理与其内在的相关性。材料与方法：回顾性复习有关文献和腕关节损伤资料，总结经舟骨、月骨周围腕脱位的规律，按类分型。结果：经舟骨、月骨周围腕背侧脱位１６例，不典型的经舟骨、月骨周围腕背侧脱位１１例，经舟骨、月骨周腕背侧脱位伴桡骨茎突骨折7例，经舟骨、月骨周围腕掌侧脱位1例；其中各型的损伤机理与腕关节的自身解剖，韧带的生理强度和生物学密切相关。结论：经舟骨、月骨周围腕脱位的X线征象复杂，只有掌握损伤机理、诊断要点、准确分型，方能为临床治疗提供科学依据。     

巴尔通骨折1例

1病例报告男，44岁。主因跌倒摔伤后左腕疼痛、畸形2d．患者伤后于当地医院拍片诊断为smith骨折，并给予手法复位，掌侧石膏托外固定，固定后复查X线片见骨折位置欠佳，腕关节随同骨折的桡骨远端向掌侧移位，当时认为手法复位力量小，未复位，给予去除石膏，再次复位拍片见位置仍无改善。     

腕月骨无菌坏死2例报告

腕月骨无菌坏死少见，近期我们发现2例报告如下；例1，男，24岁。右腕部疼痛，无力，半年余。休息后好转，用力时加重，局部略肿胀和压痛，症状逐渐加重，于1993年2月2日来院检查。查体：右腕关节活动障碍，握力减低，局部压痛略肿胀。X线拍片：正侧位见右腕关节月骨，骨质密度增高，外形正常。有裂隙出现，（图1一2），但关节间隙正常。X线诊断：腕月骨无菌坏死。例2，女，3O岁。右腕部疼痛，无力，稍休息后即愈，而后复发，症状逐渐加重，腕关节活动障碍，局部压痛，肿胀2年。于1993年2月22日来院诊治。查体：同例人）线拍片：正侧位：…     

带血管桡骨瓣转移填塞治疗月骨缺血坏死效果及安全性分析

目的探讨带血管桡骨瓣转移填塞治疗月骨缺血坏死的临床效果及安全性。方法收集2015年8月至2016年6月行带血管桡骨瓣转移填塞治疗的32例月骨缺血坏死患者的临床资料进行回顾性分析。采用X线片检测健侧、患侧腕关节高度及桡舟角,用量角器测量腕关节活动度,用Jamar测力计测量握力,用疼痛视觉模拟评分(VAS)评估腕关节疼痛,用Evans评分系统评估腕关节功能。结果术后随访8~22个月,平均10.3个月。32例患者术后均获得切口Ⅰ期愈合,均无严重并发症发生。末次随访时与术前比较,患侧腕高度指数、桡舟角均明显改善(t=-4.05,P=0.01;t=5.17,P=0.00);掌屈、背伸均明显改善(t=7.25,P=0.00;t=8.13,P=0.00);握力明显提高(t=10.47,P=0.00);腕关节VAS明显降低(t=5.70,P=0.00);腕关节功能Evans评分优良率为87.5%;无腕骨塌陷和骨性关节炎病例。结论带血管桡骨瓣转移填塞治疗月骨缺血坏死,可明显改善患侧腕关节疼痛与握力,减小腕关节功能受限程度,近期疗效与安全性较高。     

活性煅烧骨复合骨水泥修复骨缺损:修复后的血管化及结构变化

目的观察活性煅烧骨(TBC)复合骨水泥(BC)修复骨缺损后的血管化及结构变化。方法将活性TBC和BC复合后植入兔尺骨缺损部位,不同时间行印度墨汁动脉血管灌注及材料断面扫描电镜观察,观察血管生成情况及结构变化。结果墨汁灌注2周时见TBC周围血管形成密集,并向材料中长入,4、8和12周时新生血管逐渐增多,并深入材料中央。电镜观察4周时TBC周围及内部孔隙被胶原纤维束充填,部分胶原矿化。8～12周新生骨组织附于TBC颗粒及BC表面,原孔隙接近消失,TBC颗粒少量降解。结论活性TBC复合BC具有骨诱导作用,新生血管及新生骨组织生成良好,是理想的骨缺损修复材料。     

活性煅烧骨颗粒与骨水泥修复微波灭活后骨缺损

目的探讨活性煅烧骨颗粒和骨水泥复合修复微波灭活后骨缺损的效果.方法用复合材料修复兔右侧股骨中段微波灭活后的骨缺损,左侧单纯植入骨水泥做对照.分别于术后不同时间行X-射线照相、99mTc-MDP骨扫描、组织学观察.结果4周开始形成骨痂,12周骨痂最丰富,24周复合材料与宿主骨边缘模糊,边缘部分的煅烧骨颗粒被新生骨替代,并与宿主骨融合.结论活性煅烧骨颗粒和骨水泥复合易塑形,能修复骨肿瘤微波灭活后的骨缺损.     

理想的骨缺损修复材料研究- - 首次将提取牛煅烧骨形态发生蛋白骨水泥复合材料的成骨诱导活性报告

目的探讨煅烧骨粒、骨形态发生蛋白(bBMP)及骨水泥复合材料的成骨诱导活性.方法小鼠股部肌袋内植入复合材料,不同时间取材HE染色观察复合材料的异位诱导成骨活性.结果7d时材料外即形成间充质组织包膜,并沿材料不规则裂隙向内部长入;14d间充质组织细胞向软骨细胞分化;21d软骨样组织生成量增多,煅烧骨颗粒部分被新生软骨样组织包裹,间有新骨生成;28d较多量的新骨生成,并可见类似哈佛氏系统样组织,有吸收现象.结论复合材料具有诱导成骨活性,其中的煅烧骨颗粒能降解.     

骨髓抽吸-活检双标本一步法取材在骨髓转移癌诊断中的应用

本研究旨在探讨骨髓抽吸-活检双标本一步法取材在骨髓转移癌诊断中的价值。对我院46例骨髓转移癌患者采用骨髓抽吸-活检双标本一步法取材,同步分析骨髓穿刺涂片及骨髓活检组织切片结果。结果表明,骨髓抽吸-活检双标本一步法取材成功率95.7%。46例患者中45例(97.8%)骨髓活检组织切片中可观察到多少不等的成团、成簇的转移癌细胞,且可见形态异常改变。骨髓涂片中可观察到癌细胞团者占54.3%。转移癌患者骨髓活检中有不同程度的骨髓纤维组织增生,以轻中度增生为主。除食管癌中骨髓活检诊断阳性率为83.3%外,其余转移癌骨髓活检诊断阳性率为100%。骨髓涂片在卵巢肿瘤、胸椎肿瘤、肺癌、胃癌、乙状结肠癌、食管癌及不明原发灶转移癌中诊断阳性率分别为33.3%、50%、72.2%、60%、50%、33.3%和25%。骨髓活检诊断阳性率高于骨髓涂片。结论:骨髓抽吸-活检双标本一步法取材成功率高;骨髓活检在骨髓转移癌诊断方面优于骨髓涂片,将两者结合同步分析能提高诊断准确率。     

Long-term pamidronate treatment of polyostotic fibrous dysplasia of bone: A case series in young adults

Background: Limited information is available about long-term pamidronate treatment in adults with fibrous dysplasia (FD) of bone.Objective: The aim of this case series was to report the clinical outcomes and the biochemical and densitometric findings in a group of young adult patients with polyostotic FD treated for ≥3 years with IV pamidronate.Methods: Pamidronate was administered every 6 months (60 mg/d for 3 days) for 2 years. Thereafter, treatment was individualized. Pamidronate was administered at shorter or longer intervals based on response. Bone pain, radiography, serum bone alkaline phosphatase (BALP) activity, and urinary C-terminal cross-linking telopep-tide of type I collagen (CTX-I) concentration were assessed for a mean of 7 years. Bone mineral density (BMD) of FD areas (FDas) and contralateral areas (CLas) were measured at baseline and at 12 and 24 months. Data were collected prospectively.Results: Seven patients (5 women, 2 men; mean [SD] age, 31.0 [7.2] years [range, 22-43 years]) were included in the study. Patients received IV pamidronate for a mean of 6.9 years (median, 7.1 years [range, 3.7-10.9 years]). Pamidronate was associated with a reduction in bone pain and a significant reduction in BALP in all patients at the end of follow-up (P < 0.02). The mean reduction from baseline in CTX-I concentration (measured in 3 patients) was 56%; this difference was not significant. Mean BMD values of FDas were significantly increased at 12 months (by 5.9%; P < 0.05) compared with baseline; but was not significantly increased at 24 months (7.3%), probably reflecting a higher dispersion of values due to individual responses to treatment. No significant changes were observed in CLa BMDs. Mean BMD of FDa had a numerically lower decrease of 15.3% compared with CLa at baseline; these decreases with pamidronate were 10.8% at 12 months (P = NS) and 9.3% at 24 months (P < 0.05). Refilling of osteolytic lesions was not observed.Conclusions: These patients with FD of bone treated with IV pamidronate long term had improvement in bone pain and BMD. The effectiveness of individualized pamidronate administration in the long-term treatment of FD in adult patients should be investigated in blinded controlled trials.     

The breast tumor microenvironment: role in cancer development,progression and response to therapy

Introduction: Numerous clinical and pre-clinical studies have provided ample evidence supporting that the tumor microenvironment plays a significant role during breast cancer development, progression and in determining the therapeutic response.

Areas covered: This review focuses on the evolving concept of the microenvironment as the critical participant in each step of the multi-stage process of malignant progression. Currently, only a small number of molecules form part of routine molecular diagnostics in breast caner, but microenvironment-derived biomarkers are potential additions to existing predictive and prognostic marker panels. The authors discuss the dependency of the breast tumor cells on different components of the microenvironment for their survival, dissemination, dormancy and establishment in secondary sites to form overt metastasis, as well as the potential as a therapeutic target to improve breast cancer outcome.

Expert commentary: Despite the importance in the development of breast cancer, the contribution of the microenvironment is not considered in routine diagnostic testing or informing therapeutic decisions. However, introduction of immunotherapy will increasingly require patient selection based on the stromal composition of the primary breast tumor. Better understanding of the role of specific microenvironment-derived molecules is likely to inform personalized therapy, leading to improved patient outcome.     

骨形态发生蛋白复合材料修复兔皮质骨缺损

目的通过磷酸钙骨水泥(CPC)复合同种异体脱钙骨基质颗粒(DBM)及骨形态发生蛋白(bBMP)修复皮质骨缺损,探讨其对骨缺损的修复情况。方法在兔前肢桡骨制作长1cm的骨缺损,填充CPC与复合bBMP异体同种的DBM的复合物,应用大体标本观察、X线摄片、组织学观测、印度墨汁灌注等方法观察其对骨缺损的修复情况,对侧以单纯的CPC做对照。结果第2周开始复合材料组有血管长入,第4周X线片上显示可见、骨痂形成,12周后,复合材料与两端的骨质愈合良好,局部板层骨致密,哈夫氏系统排列整齐。结论磷酸钙骨水泥复合bBMP及同种异体脱钙骨颗粒修复、皮质骨缺损有较好的效果。     

Guiding Patient Decision-Making Regarding Bone Marrow Donation

Primary care providers (PCPs) must have accurate information regarding bone marrow donation to effectively educate patients. Since unrelated bone marrow donors are important sources for individuals requiring bone marrow transplant, providers must understand the donation process in order to facilitate it. How bone marrow donations are used, how to join the registry, the process of donation, and the risks and benefits of donation are described. With the increasing need for bone marrow donation, PCPs who are well-educated on this subject can guide their patients in making the potentially life-saving decision to donate.     

Anatomical sector analysis of load-bearing tibial bone structure during 90-day bed rest and 1-year recovery

The aim of this study was to investigate whether the bone response to long bed rest-related immobility and during subsequent recovery differed at anatomically different sectors of tibial epiphysis and diaphysis. For this study, peripheral quantitative tomographic (pQCT) scans obtained from a previous 90-day 'Long Term Bed Rest' intervention were preprocessed with a new method based on statistical approach and re-analysed sector-wise. The pQCT was performed on 25 young healthy males twice before the bed rest, after the bed rest and after 1-year follow-up. All men underwent a strict bed rest intervention, and in addition, seven of them received pamidronate treatment and nine did flywheel exercises as countermeasures against disuse-related bone loss. Clearly, 3-9% sector-specific losses in trabecular density were observed at the tibial epiphysis on average. Similarly, cortical density decreased in a sector-specific way being the largest at the anterior sector of tibial diaphysis. During recovery, the bed rest-induced bone losses were practically restored and no consistent sector-specific modulation was observed in any subgroup. It is concluded that the sector-specific analysis of bone cross-sections has potential to reveal skeletal responses to various interventions that cannot be inferred from the average analysis of the whole bone cross-section. This approach is considered also useful for evaluating the bone responses from the biomechanical point of view.