Histological comparison of fate of ligamentous insertion after reconstruction of anterior cruciate ligament: autograft vs allograft

Objective: To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament ( ACL) with autograft or allograft tendon. Methods: Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylin-eosin (HE) stain under light microscope. Results: The insertion structure of normal ACL typically consisted of four layers, i. e. , dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperativcly, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group. Conclusions: At the 6th month postoperatively, although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.     

A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

Objective： To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the cfinical results.
Methods： From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray flms were undertaken to detect the bony healing of avulsed fragment.
Results： The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1 ± 15.2 （ ranging from 10 to 56 ） preoperatively to 97.5 ± 3.7 （ranging from 91 to 100） postoperatively on average in 12-54 months follow up （mean 23 months）. The statistically significant difference was shown in Student＇s t test （t = 18. 483, P =3. 100×10^-11, P 〈 0. 01）. Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively.
Conclusion： This technique has many advantages, such as simplicity, wide indications from type Ⅱ to type Ⅳ fractures, minimal invasion, short operating time and predictable satisfactory results.     

沉默单核细胞趋化蛋白3对人增生性瘢痕成纤维细胞增殖、迁移及凋亡的影响北大核心CSCD

目的:探讨沉默单核细胞趋化蛋白3(MCP-3)对人增生性瘢痕成纤维细胞增殖、迁移及凋亡等功能的影响。方法:取增生性瘢痕组织和正常皮肤组织,qRT-PCR检测正常皮肤组织和增生性瘢痕组织中MCP-3 mRNA表达水平;分离培养增生性瘢痕组织成纤维细胞(HSF)和正常皮肤组织成纤维细胞(NSF),qRT-PCR和Western blot检测两种成纤维细胞中MCP-3 mRNA和蛋白表达水平。采用MCP-3干扰慢病毒(shRNA-MCP-3)和其阴性对照病毒(shRNA-NC)感染HSF,MTT检测各组细胞增殖活性,流式细胞术检测各组细胞凋亡情况,Transwell实验检测细胞的迁移能力,qRT-PCR检测各组细胞中MCP-3、collagenⅠ和collagenⅢmRNA水平,Western blot检测细胞中凋亡相关蛋白MCP-3、Bax、Bcl-2、Cleaved-caspase-3及collagenⅠ和collagenⅢ蛋白表达水平。结果:MCP-3在增生性瘢痕组织及HSF中高表达。与blank组和shRNA-NC组比较,shRNA-MCP-3组细胞中MCP-3 mRNA和蛋白表达水平显著下降(P<0.01),细胞增殖活性、迁移能力及细胞中collagenⅠ、collagenⅢ和Bcl-2表达水平均显著降低(P<0.01),同时细胞凋亡率及凋亡蛋白Bax和Cleaved-caspase-3表达水平显著上升(P<0.01)。结论:干扰MCP-3表达可能通过抑制细胞增殖和诱导细胞凋亡,减少细胞合成胶原,从而发挥抑制瘢痕形成与发展的作用。     

关节镜下射频汽化治疗膝关节骨性关节炎的病例对照研究

目的探讨膝关节骨性关节炎患者行关节镜下清理术中射频汽化的治疗作用。方法 2003年6月～2004年6月在我院行关节镜下清理术应用射频汽化治疗的40例膝骨关节炎为实验组,同期40例关节镜下清理术未应用射频汽化治疗为对照组。手术前、后采用Lysholm评分进行膝关节功能评定。结果实验组术前Lysholm评分为(53.6±6.4)分,术后提高至(83.4±4.7)分(t=21.549,P=0.000)。对照组术前Lysholm评分为(55.5±5.1)分,术后提高至(79.8±6.1)分(t=20.697,P=0.000)。实验组术后Lysholm评分总分(83.4±4.7)分和疼痛项评分(18.6±3.9)分明显高于对照组(79.8±6.1)分和(16.6±3.8)分(t=2.957,P=0.004;t=2.323,P=0.023),但2组术后力量项评分无显著差异[(6.3±1.6)分vs(6.2±1.5)分,t=0.288,P=0.774]。结论关节镜下清理术中应用射频汽化可明显改善膝关节骨性关节炎患者术后关节功能和减轻疼痛。     

fMRI辅助神经导航技术结合术中脑电监测在癫痫外科中的应用

目的探讨功能磁共振成像(fMRI)辅助神经导航技术结合术中脑电监测对脑功能区癫痫患者术中功能区定位的意义及手术效果的评估。方法对18例头皮脑电异常放电部位位于功能区的难治性癫痫患者(12例位于感觉运动区,6例位于语言区)术前进行fMRI扫描后,将导航序列的fMRI影像传输至神经导航仪,术中应用导航系统定位感觉运动区及语言区,应用术中脑电监测,对癫痫起源部位进一步精确定位,术中最大限度的切除致痫灶,对波及功能区的病灶实行皮层电灼术或多处软膜下横切(MST),术后常规应用抗癫痫药。结果全部患者在预定的癫痫灶局部均可记录到癫痫波,术后出现感觉运动区功能障碍者2例,言语障碍者1例,除1例出现永久感觉障碍外,其余患者均在术后1周内症状缓解。按照Engel分级评价为:I级7例,Ⅱ级5例,Ⅲ级4例,Ⅳ级2例;总有效者16例,有效率达88.9%。结论fMRI结合术中皮层脑电监测可实现个体化、实时、精确地定位病灶及毗邻的脑皮质功能区,达到在保护重要脑功能的前提下最大限度的切除致痫灶的目的。     

膝关节骨性关节炎影像技术和声波振动信号辅助诊断的研究进展

膝关节骨性关节炎是一类常见的老年性疾病,目前最新的诊断研究方向主要集中在影像学检查和声波振动信号检查。其中X线片诊断阳性率极高,应用普遍,是最基本、最经济的检查方法;半定量和定量MRI具有较高的诊断特异度及灵敏度,应用前景广阔;超声检查能显示滑膜、软骨、软骨下骨病变,具有较高的诊断效力。随着研究的不断深入,膝关节声波信号及关节摆动信号亦可作为简单无创的早期诊断方式。     

经颞下岩前入路手术治疗高血压性脑干出血

目的研究经颞下岩前入路手术治疗高血压相关性脑干出血的可行性及疗效。方法回顾性分析26例经颞下岩前入路手术治疗的高血压性脑干出血患者的临床资料。结果所有患者经手术均成功清除血肿,其中11例患者的血肿完全清除,15例患者的血肿大部分清除。术后随访3个月,本组患者中,手术后死亡者5例,病死率19.2%;格拉斯哥预后量表(Glasgow outcome scale,GOS)评分5分者1例、4分者7例、3分者8例、2分5例、1分5例,恢复良好(GOS评分≥4分)率30.8%(8/26例)。结论对于具备适应证的高血压性脑干出血患者,应积极尽早行外科手术治疗;采用经颞下岩前入路是一种理想的、安全可行的手术方式。     

关节镜手术治疗髌骨脱位17例疗效分析

目的介绍髌骨脱位的关节镜下微创手术技术及疗效。方法2004年1月至2007年6月应用关节镜技术对17例髌骨脱位患者进行了手术治疗，技术要点为关节镜下髌外侧支持带松解，内侧支持带紧缩缝合，其中2例同时行胫骨结节内移抬高术。患者年龄10～28（1．5&#177;4．9）岁，病程7～50（23．1&#177;13．0）个月，随访时间6～24（18，0&#177;6．2）个月。手术前后采用Lysholm评分对膝关节功能进行评定。结果有2例患者失访，患者无1例复发脱位。手术前Lysholm评分为78～90（86．6&#177;4．4）分，手术后提高至90～98（92．9&#177;3．3）分。经过Student-t检验分析，手术前后Lysholm评分有非常显著性差异（t=5．63，P〈0．01）。结论关节镜技术既显示了微创优势，同时又对不同程度的髌骨脱位皆获得了满意治疗效果。     

大鲵咬伤致拇指不完全离断1例

１　临床资料　患者,男,３０岁,于１９９９０４１８１８：００时不慎被大鲵（娃娃鱼）咬伤右手拇指,伤后１８ｈ送至我院。查体：手指表面及伤口附着有一层胶样粘液,为鱼体分泌的粘液,右拇指近节中段可见一环形皮肤裂伤,无皮缘相连,伤口深达骨面,仅剩指骨及屈肌腱连续性存在,指端无血供．急诊行右拇指不完全离断再植术．术中见两侧拇指固有动脉、神经、作者简介：管新宇,男,３０岁,医师收稿日期：１９９９０４２８;　修回日期：１９９９０５２０伸肌腱完全离断．常规清洗浸泡无法清除皮肤上胶样粘液,后用手术刀…     

雷尼替丁治疗变应性鼻炎15例报告

变应性鼻炎又称过敏性鼻炎 ,是常见病 ,临床以鼻痒、打喷嚏、流涕、流泪、鼻塞为主要症状。目前常用息斯敏、扑尔敏等药物治疗 ,效疗不稳定 ,且有严重副作用 ,本组病例采用雷尼替丁治疗 ,现将结果报告如下。1　材料与方法1.1　一般资料　本组 2 5例病例均系 1999年 3月～ 2 0 0 0年4月期间的门诊就诊患者。其中男性 15例 ,女性 10例 ;年龄18～ 5 0岁 ,平均年龄 31岁。 2 5例均系已被确诊的常年发作型变应性鼻炎患者 ,有典型的鼻痒、打喷嚏、鼻塞、流涕的临床症状 ,就诊时均处发作期 ,体检示鼻粘膜苍白水肿。治疗组15例 ,男性 9例 ,女性 6例…