前臂桡神经浅支卡压的解剖与临床表现

为了解桡神经浅支在前臂卡压的解剖学基础与临床表现 ,掌握该征的诊断与治疗原则 ,解剖了 2 0具 40例成人上肢标本 ,观测桡神经浅支穿出处的局部特点及其距桡骨茎突的距离 ;对 15例桡神经浅支卡压的患者进行临床分析、治疗并随访。结果显示 :桡神经浅支穿出部位为腱性组织所包绕 ,该处筋膜与肱桡肌肌腱挤在一起 ,易受压 ;15例患者经保守治疗 ( 12例 )、手术治疗 ( 3例 ) ,症状消失无复发。认为桡神经浅支在前臂中下段易发生卡压有其解剖学基础 ,在临床工作中遇到腕背痛的患者应考虑到该征的存在 ,从而采取积极有效的治疗     

A histological observation on the flexor tendon healing within intact sheath

Summary In this study we allowed the sutured chicken flexor tendons to glide back into the uninjured sheaths in order to keep the healing process of flexor tendon from being affected by the healing of surrounding wounded tissues. By observing 12 chickens, 72 digits, with light microscope and transmission electron microscope, it was found that the visceral and parietal synovium of the sheath were the regions with earliest and most active cell proliferation and the major source of repairing cells during the healing process of the flexor tendon. Tendon cells had the ability of intrinsic healing, but delayed as compared to synovium cells. Adhesion between intact parietal synovium and healing tendon and its surrounding tissue could not be avoided.     

Extraarticular pigmented villonodular synovitis of the distal forearm: a case report

Extraarticular pigmented villonodular synovitis (PVNS) is very rare in the distal forearm. There has only been one previous case report of this disease in the extensor tendons of a child. We report a case of PVNS of the distal forearm that presented as two nodules over the radial aspect and a separate nodule on the ulnar aspect beneath the flexor carpi ulnaris tendon. Surgical exploration revealed an extensive extraarticular PVNS over the first and second dorsal compartment extensor tendons. On the anterior aspect it extended in the deep plane between the flexor tendons and the pronator quadratus and encased the radial artery completely. Complete excision of the tumour with the radial artery was done.     

茎突综合征114例误诊原因分析

目的：探讨茎突综合征误诊误治原因,以提高其诊治水平。方法回顾分析114例茎突综合征的病程、误诊疾病及手术治疗效果。结果114例患者首诊均被诊断为其他疾病。诊断为慢性咽炎、慢性扁桃体炎、舌咽神经痛77例,占总数比例为67．5％,该组病例病程相对较短,为1～6个月,中位病程为2．5个月,茎突部分截短手术有效率高,为87．0％。诊断为焦虑症、更年期综合征、神经官能症14例,该组病例病程相对较长,中位病程分别为7、2、8年,手术治疗有效率较低,为50．0％。结论茎突综合征临床症状具有多样性、与其他疾病交叉的特点,了解掌握此病特点有助于确诊,严格掌握手术指征有助于提高手术治疗效果。     

透明质酸钠在防治鞘管区屈肌腱粘连中的临床应用

应用透明质酸钠（ＳＨＰ）作为防止肌腱粘连的辅助药物，Ⅰ期修复鞘管区屈肌腱损伤２８例４６指，配合早期功能练习，经８个月以上随访，按ＴＡ法评定疗效，优良率８８．４％，与对照组比有明显差异（Ｐ〈０．０１）。就ＳＨＰ的作用机理进行了探讨，认为高分子ＳＨＰ具有促进肌腱愈合、防止或减轻术后粘连、改善肌腱滑动的作用，并强调无损伤操作和早期功能练习的预防肌腱粘连的重要性。     

Multiple variations of the tendons of the anatomical snuffbox

INTRODUCTION

Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain''s syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain''s tenosynovitis.

METHODS

Routine dissection of ten upper limbs was performed to determine the variations in the tendons of the anatomical snuffbox of the wrist.

RESULTS

In all the dissected upper limbs, the APL tendon of the first extensor compartment was found to have several (3–14) tendon slips. The insertion of the APL tendon slips in all upper limbs were at the base of the first metacarpal bone, trapezium and fascia of the opponens pollicis muscle; however, in seven specimens, they were also found to be attached to the fleshy belly of the abductor pollicis brevis muscle. In two specimens, double tendons of the extensor pollicis longus located in the third extensor compartment were inserted into the capsule of the proximal interphalangeal joints before being joined to the extensor expansion. In two other specimens, the first extensor compartment had two osseofibrous tunnels divided by a septum that separated the APL tendon from the extensor pollicis brevis tendon.

CONCLUSION

Multiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery.     

Multiple tendons of abductor pollicis longus muscle: A cadaveric study with clinical implications

Abductor pollicis longus (APL) muscle is known to exhibit numerous variations. Variations in the number of tendons of APL muscle may be asymptomatic and are often incidental findings. The present case report, detected in a 42 year male cadaver, describes the APL muscle having three tendons. The presence of accessory tendons may be important in De Quervain's stenosing tendovaginitis. Anatomical knowledge of such variations may be clinically important for surgeons performing reconstructive hand surgeries in the dorsolateral region of the hand. In a wider perspective, variations in the number of tendons of APL may also be important for anthropological correlation and academic studies. Key Words: Abductor pollicis longus, muscle, variations, tendon, cadaver.     

Eagle‘s综合征的诊断和治疗

目的;研究Eagle's综合征的诊断和治疗。方法;对临床确诊为Eagle's综合征的84例行茎突截短术治疗。结果：痊愈56例,有效15例,无效13例。结论：经茎突过长和方向异常是咽喉,头面颈部疼痛的常见原因,扁桃体窝触到茎突或诱发疼痛症状和X线检查示茎突过长可明确诊断,茎突截短术治疗有效。     

高频超声在闭合性肌肉肌腱损伤诊疗中的应用探讨

目的:探讨高频超声对闭合性肌肉、肌腱损伤诊疗中的应用价值。方法:对26例外伤性和运动性所致闭合性四肢肌肉、肌腱损伤进行高频超声追踪检查,并对手术治疗的10例肌腱损伤患者超声影像特征进行分析及复查。结果:高频超声可显示肌肉肌腱损伤及愈合过程中超声图像特征性相应的变化,其中10例患者术中探查情况均与超声诊断符合。结论:高频超声能够提供闭合性肌肉肌腱损伤特异性的图像资料,可以作为临床了解闭合性肌腱损伤和愈合情况首选的辅助检查手段之一。     

28例腱鞘结核高频超声诊断分析

目的探讨腱鞘结核的超声表现特点,为正确及时诊断该病提供依据。方法选择病理检查确诊的28例腱鞘结核为研究对象,结合临床病史,回顾性分析其超声表现特征。结果3例为囊性病变,无血流信号,肌腱无受侵;25例低弱回声或不均质回声团块,肌腱包绕其中,有粘连、受侵,其中20例病灶内见少许血流信号,5例病灶内见丰富血流信号。超声准确诊断18例,漏诊10例,符合率64．3％。结论腱鞘结核的超声表现复杂多变,缺乏特征性,极易漏诊,应结合临床病史,对包绕、侵蚀肌腱的病变提高警惕。     

可吸收缝线吻合肌腱的疗效观察

目的 探讨可吸收缝线吻合肌腱的临床疗效。方法 2008年9月-2013年2月,131例肌腱离断患者随机分为两组：A组76例163条肌腱采用可吸收缝线吻合,B组55例114条肌腱采用非吸收缝线吻合,观察其临床疗效。结果全部患者均获得随访8-13个月,平均10个月,伤口均甲级愈合,均未发生肌腱缝线断裂。术后患指功能：A组优124例,良23例,可16例,差0例,优良率90.18%%;B组优75例,良18例,可15例,差6例,优良率81.58%%;两组优良率相比差异具有统计学意义（P〈0.05）。结论 用可吸收缝线吻合肌腱可取得较好疗效。     

高频超声对肩关节病变的诊断及其疗效评估

目的 探讨高频超声对肩关节病变的诊断及在疗效评估中的应用价值.方法 应用高频超声对43例肩关节疼痛患者43个肩关节扫查,观察肱二头肌长头腱、冈上肌肌腱、冈下肌肌腱、肩胛下肌肌腱、盂肱关节、肩锁关节、滑囊的情况,并对最大积液深度、肌腱厚度进行治疗前后对比.结果 43例患者其中肱二头肌长头腱病变39例占90.7%,冈上肌肌腱19例占44.2%,冈下肌肌腱14例32.6%,滑囊10例占23.3%,盂肱关节9例占20.9%,肩胛下肌肌腱9例占20.9%,肩锁关节7例占16.3%.治疗前后超声检查在积液最大深度与肌腱厚度上比较,差异有统计学意义(P＜0.05).结论 高频超声可以观察肌腱、关节,同时可以进行疗效评估.     

Spontaneous rupture of the quadriceps tendon and patellar ligament during treatment for chronic renal failure.

The quadriceps tendon and patellar ligament rupture rarely, even when under great stress or trauma, but can rupture spontaneously in patients with chronic diseases such as gout, rheumatoid arthritis and renal disease. Several factors probably combine to weaken the tendon, including an impoverished local vascular supply, repeated microtrauma and secondary hypoparathyroidism with osteodystrophy. In the three cases reported here, one of which was bilateral, the patients were being treated for chronic renal disease; surgical repair of the tendons led to sound healing and a return to normal function of the joints.     

Kessler联合田岛肌腱缝合法及其临床应用

目的探讨一种在kessler缝合法基础上改良的肌腱缝合方法(Kessler联合田岛肌腱缝合法)的可行性及优点。方法将126例肌腱断裂病例随机分A、B两组,A组79例159条屈肌腱采用Kessler联合田岛肌腱缝合法,B组47例65条屈肌腱采用Kessler缝合法,比较两组的优良率,并行抗拉强度测试。结果 A组:优113条(71.12%),良29条(17.93%),可17条(10.95%),差0条(0%),优良率89.31%;B组:优29条(45.32%),良17条(26.71%),可14条(22.17%),差5条(8.73%),优良率70.77%。两组优良率差异有统计学意义(P<0.05)。抗拉强度测试结果显示,Kessler联合田岛肌腱缝合法比Kessler缝合法的抗拉能力强。结论 Kessler联合田岛肌腱缝合法具有比kessler缝合法抗拉能力强的优点,适合术后早期功能锻炼,是一种较好的防止术后肌腱粘连的肌腱缝合方法。     

可吸收医用膜在手肌腱损伤一期修复中的应用

目的:观察可吸收医用膜在手肌腱损伤一期修复中的疗效。方法:126例(285条)肌腱损伤患者为治疗组,均一期采用改良Kessler法缝接肌腱,并用可吸收医用膜包裹,术后早期循序渐进康复锻炼。对照组120例(282条肌腱损伤)予一期改良Kessler法缝接肌腱,术后早期康复锻炼。结果:随访3~24个月,按TAM法评定疗效:治疗组优59例,良52例,可10例,差5例,优良率为88.10%;对照组优45例,良50例,可12例,差13例,优良率为79.17%;两组比较差异有统计学意义(P<0.05)。结论:修复肌腱损伤应仔细清创,无创操作、良好肌腱吻合技术加可吸收医用膜的应用及早期功能锻炼是肌腱功能恢复的关键。     

茎突综合征的诊断和手术治疗

目的:探讨茎突综合征的诊断方法及症状性茎突过长的手术治疗。方法:总结62例病程两个月以上的茎突过长病人的资料,男32例,女30例;年龄36~64岁;病程2个月~6年。结果:经咽部扁桃体触诊及影像学检查后,诊断明确。62例中接受手术治疗的14例,保守治疗48例,手术治疗后症状消失者9例,症状减轻5例,手术治疗有效率100%。结论:茎突综合征的诊断主要依靠临床症状、触诊及影像学检查,对于有症状的茎突过长应以手术治疗为主。     

胶原酶预防肌腱腱鞘内粘连的实验研究

目的 研究胶原酶预防肌腱鞘内粘连的作用。方法 采用鸡屈趾肌腱损伤的修复模型。实验趾和对照趾腱鞘内分别注入胶原酶和生理盐水。术后对实验趾和对照趾进行生物力学测定;解剖和组织学观察粘连性状、肌腱愈合情况。结果 各组实验趾和对照趾的肌腱滑动距离和关节活动度差异有显著性（Ｐ〈０．０５）,实验趾优于对照趾。术后早期两者肌腱吻合口最大抗张力强度无差异。解剖和组织学观察实验趾肌腱粘连程度轻于对照趾。结论 胶原酶     

Biomechanical and Macroscopic Evaluations of the Effects of 5-Fluorouracil on Partially Divided Flexor Tendon Injuries in Rabbits

Background:

The main goals of flexor tendon surgery are to restore digital motion by providing tendon healing and to preserve tendon gliding. Our purpose was to investigate the effects of 5-fluorouracil (5-FU) on tendon adhesions in partially divided profundus flexor tendons (flexor digitorum profundus [FDPs]) following surgical repair and in partially divided FDPs without surgical repair, and to compare the results of the repair versus the nonrepair of zone two injuries via macroscopic and biomechanical evaluations of tendon adhesions.

Methods:

We used 32 adult male European rabbits (Oryctolagus cunniculus) weighing from 2.5 to 3.5 kg. The study was performed on the deep flexor tendons of the second and third digits of the right hind paws of the rabbits; thus, a total of 64 tendons were examined in this study.

Results:

Based on the results achieved in our experimental study, the load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared with subgroup 2a in which tendons were surgically repaired and treated with 5-FU.

Conclusions:

The load (N) significantly increased in subgroup 1a in which the tendons were surgically repaired and were not treated with 5-FU compared to subgroup 2a in which the tendons were surgically repaired and treated with 5-FU. Therefore, these results revealed a decrease in adhesion formation in the subgroup that was treated with 5-FU due to increased resistance to tendon adhesions during their excursion through the tendon sheath, which in this case required greater traction force.     

可吸收线治疗肌腱损伤

目的 探讨用可吸收线治疗肌腱损伤的方法和疗效。方法 用可吸收线对10例患者,共26根肌腱行改良Kessler单线法核心缝合及周边缝合。术后石膏固定3周,早期适当功能锻炼。结果 随访2月～12月,按TAM系统评价,优6例,良3例,中1例,优良率90%。结论 可吸收线可以用于肌腱缝合,并且能取得较好疗效。