膝,髋类风湿关节炎与颈椎的相关病变

了解类风湿关节炎患者在接受全膝,全髋关节置换术时颈椎受累情况。方法通过对４６例接受全膝,全髋置换术的类风湿关节炎患者的颈椎Ｘ线片的测量,了解寰枢椎的前后半脱位,垂直半和下位颈椎半脱位的发生情况,以及手术时有无颈部症状的主诉,神经学检查是否异常等进行回顾性调查。     

Rheumatoid Arthritis of the Hip

The hip joint may be affected in 15% to 28% of all patients with rheumatoid arthritis. Radiographic evidence of involvement includes periarticular osteopenia, cystic changes, and a variable amount of progressive protrusio acetabuli. Histomorphometric study has shown increased bone turnover in acetabular biopsy specimens from rheumatoid patients undergoing total hip arthroplasty. Due to the relative fragility of bone in these patients, there is an increased risk of fracture of the proximal femur due to minor trauma, and a high rate of loss of fixation has been reported. Total hip arthroplasty has been successful in the treatment of severe rheumatoid arthritis of the hip in patients of all ages. Special attention should be paid to the cervical spine and the patient's medical treatment regimen during the preoperative evaluation. Cemented total hip arthroplasty has been associated with a higher prevalence of late infection and acetabular component loosening in rheumatoid patients than in osteoarthritic patients. Loosening of cemented components is accelerated in patients with juvenile rheumatoid arthritis. Several short-term studies have documented successful early results with noncemented components in patients with rheumatoid arthritis; however, longer-term studies are necessary to determine whether the improvements in function and survival are greater than with cemented components.     

Extension Injuries of the Cervical Spine

Extension injuries of the cervical spine can result in a wide spectrum of clinical presentations. The very young as well as the elderly population may be uniquely predisposed to this group of injuries. Radiographic signs are often subtle, and therefore, a high index of suspicion followed by careful clinical examination and appropriate radiological evaluation are mandatory to minimize the danger of missing the diagnosis. Accurately identifying specific radiological injury patterns can ensure that appropriate treatment measures are promptly instituted, thereby potentially promoting the chances of recovery.     

Orion钢板固定后对植骨块及小关节突应力影响的实验研究

目的:研究单纯植骨及植骨+Orion钢板内固定后对植骨块及相邻椎节小关节突应力的影响。方法:采用8具男性新鲜颈椎标本,分别行单纯植骨及植骨+Orion钢板内固定后测量植骨块及相邻椎节小关节突应力的变化。结果:单纯植骨时融合节段上小关节突的应力无明显增加,而植骨+Orion钢板内固定后则显著增加。单纯植骨及植骨+Orion钢板内固定后融合节段下小关节突的应力无明显增加。植骨+Orion钢板内固定后植骨块的应力较单纯植骨时变小。结论:植骨+Orion钢板内固定后融合节段上小关节突的应力明显增加,容易造成融合上节段的退变,并且存在一定的应力遮挡,故在治疗单纯颈椎退行性病变的患者时,使用Orion钢板内固定应持谨慎态度。     

Orion钢板固定后对植骨块及小关节突应力影响的实验研究

目的：研究单纯植骨及植骨 Orion钢板内固定后对植骨块及相邻椎节小关节突应力的影响。方法：采用8具男性新鲜颈椎标本，分别行单纯植骨及植骨 Orion钢板内固定后测量植骨块及相邻椎节小关节突应力的变化。结果：单纯植骨时融合节段上小关节突的应力无明显增加，而植骨 Orion钢板内固定后则显著增加。单纯植骨及植骨 Orion钢板内固定后融合节段下小关节突的应力无明显增加。植骨 Orion钢板内固定后植骨块的应力较单纯植骨时变小。结论：植骨 Orion钢板内固定后融合节段上小关节突的应力明显增加，容易造成融合上节段的退变，并且存在一定的应力遮挡，故在治疗单纯颈椎退行性病变的患者时，使用Orion钢板内固定应持谨慎态度。