髋关节撞击综合征导致髋臼软骨损伤的修复

髋关节撞击综合征导致的全层髋臼软骨损伤会影响髋关节镜手术疗效,因此应在处理原发髋关节病理改变的基础上,根据损伤的深度和面积,采取相应的治疗措施。非全层软骨缺损采用软骨成形术;全层缺损面积小于400 mm² ,可行微骨折术;超过400 mm² 的全层缺损,应在微骨折后加用自体基质诱导软骨生成技术、自体软骨细胞或干细胞移植以促进软骨再生。自体基质诱导软骨生成技术主要包括胶原支架和壳聚糖支架,通过稳定血凝块及骨髓干细胞,促进纤维软骨再生, 其中,远期影像学及临床疗效优于微骨折术。自体软骨细胞及干细胞移植有望在缺损区域形成透明软骨,理论上可避免远期再生纤维软骨退化,但在髋关节软骨缺损中的应用尚处于早期阶段,还需进一步临床研究证实其有效性。     

A comparative radiographic investigation of femoroacetabular impingement in young patients with and without hip pain

OBJECTIVE:

To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain.

METHODS:

A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45°, and Ducroquet.

RESULTS:

A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45° view (p = 0.008). The difference in the α angle in the anteroposterior, Dunn, Dunn 45°, and Ducroquet views for all of the cases studied was p<0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively).

CONCLUSIONS:

We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45°, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.     

Cam型髋关节撞击综合征关节软骨接触力学的有限元分析

目的 通过有限元方法探讨不同严重程度的Cam型髋关节撞击综合征(femoroacetabular impingement,FAI)关节软骨接触力学的变化。方法 建立正常髋关节及不同α角的 Cam型FAI髋关节三维有限元模型,计算行走、坐下、起立等日常活动下的关节软骨接触压力和应力。结果 完整步态周期加载过程中,不同α角的Cam型FAI软骨接触压力分布与正常髋关节接近,无高接触压力和Von Mises应力集中区域;坐下、起立加载过程中,Cam型FAI软骨接触压力均大于正常髋关节,且随α角的增加而增大,其接触区域主要位于髋臼缘前上方,局部出现过高压力和Von Mises应力集中。结论 Cam型FAI软骨接触力学变化的关键影响因素是运动方式,关节软骨过高的接触压力和Von Mises应力,可能是其引起软骨退变并最终导致骨性关节炎的力学原因。     

关节镜下治疗股髋撞击综合征合并I度盂唇损伤的临床疗效观察

目的探讨和总结关节镜下治疗股髋撞击综合征(FAI)合并Ⅰ度盂唇损伤的临床疗效。方法按照纳入和排除标准,将2011年2月至2016年4月在我院治疗的32例股髋撞击综合征合并Ⅰ度盂唇损伤的患者纳入本研究,其中男18例,女14例,左髋12例,右髋20例,平均年龄37.5岁(25~58岁),均行关节镜清理和盂唇修整术,术中对增生的骨赘进行磨削、清理,损伤的盂唇进行修整,术后进行髋关节功能康复锻炼。末次随访记录Harris髋关节功能评分及VAS视觉模拟疼痛评分,比较术前术后HHS评分(Harris)及VAS评分(visual analogue score),评价临床疗效。结果术后所有患者均获随访,随访时间平均18个月(12~24个月),Harris髋关节评分由术前的(67.03±2.56)分,提高到术后12个月的(93.75±3.75)分(0.05),具有显著的统计学差异。髋关节视觉模拟疼痛评分从术前的(6.59±0.91)分,下降到术后12个月的(1.78±0.55)分(0.05),具有显著的统计学差异。结论应用关节镜技术治疗股髋撞击综合征合并Ⅰ度盂唇损伤能够有效缓解髋关节疼痛症状,改善髋关节功能,延缓髋关节骨性关节炎的发展,术后短期临床疗效确切。     

髋关节镜治疗股骨髋臼撞击综合征中短期疗效观察

目的　探讨髋关节镜下行头臼成形术治疗股骨髋臼撞击综合征临床疗效。 方法 回顾分析2012年1月至2016年12月收治的30例（30髋）股骨髋臼撞击综合征患者,其中男19例,女11例,左髋21例,右髋9例,年龄22~50岁,平均年龄34.91岁。根据分型分别于关节镜下行股骨头成型术、髋臼成型术以及髋臼成型联合股骨头成型术,患者术后均采用Harris评分评估临床疗效并随访研究。 结果 所有患者均获随访,平均随访时间43.2月（34~51月）,术前Harris髋关节评分为（65.7±6.3）分,术后3、6、12个月及末次随访分别为（74.5±6.0）、（79.2±6.1）、（82.5±6.1）、和（83.1±8.2）分,与术前比较差异有显著性（P＜0.05）,术后1年内Harris评分持续改善差异有显著性（P＜0.05）。 结论 髋关节镜治疗股骨髋臼撞击综合征可有效消除或减轻髋部疼痛、改善关节活动功能,可成为治疗股骨髋臼撞击综合征的良好选择。     

Diagnosis and management of Histoplasmosis

Histoplasmosis occurs throughout the world but is more common within the endemic areas of North America, particularly in fertile river valleys. Disease manifestations range from asymptomatic infection in the normal host with low-inoculum exposure to rapidly fatal, disseminated infection in the severely immunocompromised host, emphasizing the importance of cellular immunity in defense againstHistoplasma capsulatum. Diagnosis depends on a high index of suspicion, knowledge of the clinical and epidemiologic features of the infection, and a thorough understanding of the uses and limitations of fungal cultural and serological laboratory procedures. Recently, a method has been developed for rapid diagnosis based on detection of a polysaccharide antigen in body fluids of patients with histoplasmosis. Amphotericin B remains the preferred treatment for more severe forms of histoplasmosis, particularly in the immunocompromised host, but oral treatment with ketoconazole or newer imidozoles appears to be effective in less severe infections in non-immunocompromised individuals.     

Diagnosis and management of antibiotic-resistant bacteria

Antibiotic-resistant infections acquired in hospitals are of great concern, and have become a serious public issue. Antibiotic-resistant infections can be associated with a variety of bacteria, such as methicillin resistant Staphylococcus aureus(MRSA) and multidrug-resistant Pseudomonas aeruginosa (MDRP). Since clinical laboratories are responsible for detecting information regarding antibiotic-resistant bacteria, they are required to perform analysis and dissemination of the information. Currently, rapid methods for detecting antibiotic-resistant bacteria using molecular techniques are being developed in response to the problem of the conventional methods for bacteriological testing, which require a few days to obtain results. This article presents the diagnosis and management of antibiotic-resistant bacteria, which comprise a serious health care issue.     

Diagnosis and management of laryngotracheal trauma

Laryngotracheal trauma is life-threatening. We identified 23 patients between 1992 and 1998 with laryngeal (12), tracheal (8), and combined injuries (3). Nineteen patients had penetrating trauma (gunshot wound, 12; stab wound, 7), and four patients had blunt injury. Flexible laryngoscopy identified the injury in 8 of 12 patients (75%), and computer tomography scan was positive in 9 of 9 patients (100%). Twelve of the 19 patients with penetrating wounds were managed by primary repair, 4 had endotracheal intubation without surgical repair, and 3 were observed. No patient with a blunt tracheal injury required repair. Two had endotracheal intubation, and two were observed. A high index of suspicion is essential to identifying laryngotracheal injury. Computer tomography scan is a sensitive diagnostic test for laryngotracheal injury, and may be indicated despite normal flexible laryngoscopy. The decision to repair injuries or observe injuries is primarily based on respiratory distress and associated injuries.     

Diagnosis and management for antiphospholipid syndrome

It has been reported that antiphospholipid antibodies have the diversity against epitopes and the clinical significance, while the concept of antiphospholipid syndrome has been established. Dr. Harris and Dr. Hughes proposed the diagnostic criteria for antiphospholipid syndrome, and their criteria were widely used. Thrombosis, recurrent fetal loss (intrauterine fetal death), thrombocytopenia, IgG anticardiolipin antibodies and lupus anticoagulants were adopted in their criteria. However, recent studies have revealed the evaluation of the standardization of the methods to detect antiphospholipid antibodies and the clinical significance of both anti-cardiolipin-beta 2-GPI complex antibodies and other isotypes of antiphospholipid antibodies. Thus, the preliminary classification criteria for antiphospholipid syndrome have been discussed. It has been reported that anticoagulation therapy is effective in the management of antiphospholipid syndrome by the recent retrospective studies. It is necessary to confirm these points by the prospective study in the near future.     

Diagnosis and management of heterokaryotypic monochorionic twins

The diagnosis, management, and outcome of six consecutive heterokaryotypic monochorionic twins were evaluated. All suspected cases, based on discordant ultrasound findings, underwent amniocentesis of both sacs. Two cases also had chorionic villous sampling (CVS). Dual amniocentesis was superior to CVS in diagnosing heterokaryotypic monochorionic twins. In four cases, the X-chromosome was involved and autosomal aneuploidy was noted in the others. In five cases, the anomalous twin was selectively reduced by cord coagulation. All pregnancies ended with a phenotypically normal liveborn and all children are developing normally at 1-7 years of age.     

Diagnosis and clinical management of post-stroke depression

Major or minor depression occurs in almost half of relatively unselected acute stroke patients and continues for more than six months. The most important determinant of its type and severity is lesion location. Left frontal lesions produce major depressive disorder in more than half of the patients, and the closer the anterior border of the lesion is to the frontal pole, the more severe the depression. In contrast, patients with right frontal lesions show an inappropriately cheerful but apathetic state. Time elapsed since stroke also is an important variable for prevalence of depression, and the high-risk period for post-stroke depression lasts for two years. Some mood disorders in stroke patients may result from injury to the norepinephrine-containing neurons as they arborize throughout the cerebral cortex, and this may explain the association with anterior hemisphere injury.     

Diagnosis and management of persistent psychogenic vomiting

Twenty-four patients who had been diagnosed by a gastroenterologist as psychogenic vomiters were evaluated. Eighteen underwent a comprehensive psychological evaluation consisting of an interview, administration of the MMPI and the Beck Depression Inventory, and follow-up contacts. The majority of the patients did not have serious psychiatric disturbances and were not incapacitated by their illness. The vomiting seemed to be chronic and nondebilitating, with exacerbations in times of stress. The authors conclude that most psychogenic vomiters can be treated effectively by an empathetic primary care physician.