关节镜下半月板修复效果分析

半月板损伤是膝关节常见病损。由于半月板功能的重要性已被广大骨科医师所认识以及技术的进步，特别是关节镜的应用，改变过去一直延用的半月板切除而逐渐采用半月板缝合或成形术，减少或延缓了骨性关节炎的发生。我院自1998年开展了关节镜下半月板修复术的临床研究。现将其中320例的随访结果及有关问题总结报告如下。     

复合组织瓣移植修复下肢创伤后骨髓炎伴骨及软组织缺损

目的 总结不同形式骨皮瓣移植修复下肢创伤后骨髓炎合并骨及软组织缺损的方法和疗效.方法 2001年6月至2006年2月,对38例下肢创伤后骨髓炎合并骨及软组织缺损病例,在创面彻底清创的基础上,根据下肢创面骨缺损的程度、皮肤缺损面积以及复合组织瓣的特点,选择复合骨皮瓣18例、组合骨皮瓣14例、联合(体)骨皮瓣6例移植于受区,一期修复股骨、胫骨、踝关节、跟骨、跖骨等部位骨髓炎并骨及软组织缺损,观察术后皮瓣成活情况、骨折愈合情况及骨髓炎愈合情况.结果 术后随访8～56个月,平均30个月.皮瓣全部成活,伤口Ⅰ期愈合35例,Ⅱ期愈合3例;移植骨全部愈合,愈合时间2～14个月,平均4.6个月;骨髓炎6个月后复发2例,经二次病灶清除后愈合.结论 综合考虑下肢创伤后骨髓炎合并骨及软组织缺损患者整体及患肢情况,对病灶区彻底清创,选择多种形式的复合组织瓣移植,可一期修复下肢骨及软组织缺损,提高机体的抗感染能力,缩短疗程,提高骨髓炎的治愈率.     

新生期小鼠七氟醚暴露对其青春期学习记忆及海马组织髓鞘损伤的影响

目的 探究新生期小鼠七氟醚暴露对其青春期学习记忆的影响及其相关机制.方法 6日龄C57BL/6小鼠随机分为对照组(CON组)、七氟醚组(SEVO组)、对照+氯化锂组(LiCl组)、七氟醚+氯化锂组(SEVO+ LiCl组).SEVO组为3％七氟醚连续暴露3d(第6～8天),每天1次,每次2 h,CON组为60％氧气对照,LiCl组为60％氧气暴露前30 min腹腔注射GSK3β抑制剂氯化锂(100 mg/kg),SEVO+LiCl组为七氟醚暴露前30 min腹腔注射氯化锂(100 mg/kg).新物体识别实验和Y迷宫实验检测小鼠第30～32天学习记忆功能;Western blot检测小鼠海马组织髓鞘碱性蛋白(MBP)、β-catenin蛋白表达及pGSK3β/GSK3β比值变化.结果 行为学实验结果显示,SEVO组小鼠识别指数和新臂探索次数百分比均低于CON组(P＜0.05).氯化锂预处理后,SEVO+ LiCl组小鼠识别指数和新臂探索次数百分比较SEVO组升高(P＜0.05),学习记忆功能改善.Western blot结果显示,SEVO组小鼠海马组织MBP蛋白、β-catenin蛋白表达及pGSK3β/GSK3β比值均低于CON组(P＜0.05),氯化锂预处理后,与SEVO组比较,SEVO+ LiCl组小鼠海马组织MBP蛋白、β-catenin蛋白表达增加,pGSK3β/GSK3β比值升高(P＜0.05).结论 新生期小鼠七氟醚暴露致青春期学习记忆功能受损,可能与抑制GSK3β/β-catenin信号通路中GSK3β(Ser9)磷酸化导致的海马组织髓鞘损伤有关.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

超高龄患者行复杂心脏手术的麻醉与围术期管理

(1)一般情况:患者女性, 年龄87岁, 身高150 cm, 体质量56 kg。主因"间断胸闷、气短1月余, 加重3 d"入院。患者1个月前无明显诱因出现间断性胸闷、气短, 活动后加重。心脏超声提示:左心扩大, 节段性室壁运动异常, 左室心尖部室壁瘤形成, 室间隔穿孔, 心室水平左向右分流, 考虑"心肌梗死后室间隔穿孔"。病情稳定后行冠状动脉造影, 提示:冠状动脉左前降支中段近端95%局限性偏心性狭窄, 中段远端至远段近端60%～80%弥漫性狭窄, 可见重度肌桥(收缩期狭窄最重约99%)。该患者近3 d扶床行走出现胸闷气短, 卧床休息无明显症状。     

坐骨神经损伤所致腓总神经瘫痪2例报告

我科收治2例表现为腓总神经瘫痪的患者。但经进一步诊断为坐骨神经主干受压,损伤所致,报告如下。1　病例报告　　例1,男,20岁,因左侧髋部坠落伤后关节疼痛,不能活动2h,收入院。拍X线片示左髋关节后脱位,髋臼骨折并骨块外上后方移位。于全麻下急行髋关节后脱位复位术,复位?..     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

小切口全髋关节置换术早期并发症临床分析

[目的]探讨侧前方小切口入路全髋关节置换术早期并发症和预防措施。[方法]回顾分析153例全髋关节置换患者，分析早期并发症的原因，提出防治措施。[结果]15例出现并发症，脑血管意外2例，股骨假体周围骨折3例，下肢深静脉血栓形成4例，下肢不等长3例，臀上神经损伤3例。[结论]精细手术操作、积极术前准备和术后处理是减少术后并发症的关键。     

膝关节滑膜瘤误诊1例

患者 ,男 ,19岁 ,发现左膝外侧疼痛性肿物 3个月入院。既往有膝外伤史。查体 :左膝外侧可摸及肿物 ,伸膝时明显 ,约 3cm× 2 cm× 2 cm大小 ,张力大 ,有波动感 ,压痛 ,屈膝时肿物消失。穿刺有少量淡黄色稀薄液体 ,清。诊为半月板囊肿 ,穿刺封闭治疗 ,共四次 ,效果不佳。采用膝外侧斜切口手术切除肿物。肿物呈不规则形 ,分叶 ,包膜完整 ,有细蒂连于外侧半月板前角。肿物切面呈肉样 ,白色中杂有黄褐色。肿物中央有一直径 1.5 cm假囊肿形成 ,内有淡黄色清亮液体。镜下见滑膜样细胞中大量巨细胞 ,病理诊断为膝关节滑膜瘤。讨　　论滑膜瘤好发于…     

可分离式髌骨爪治疗髌骨粉碎性骨折

目的 探讨可分离式髌骨爪手术治疗髌骨粉碎性骨折的临床应用和效果.方法 采用可分离式髌骨爪固定治疗髌骨粉碎性骨折35例,常规切口及膝关节加压包扎3 d后,在CPM的辅助下进行膝关节屈伸活动练习.结果 随访8～24个月,平均14个月,骨折愈合时间8～12周,临床疗效:优28例,良6例,中1例,功能恢复优良率达97%,疗效满意.结论 可分离式髌骨爪是治疗髌骨粉碎性骨折一种良好的固定方法.