腕关节镜术入路有关的应用解剖

为促进腕关节镜术在我国的开展,采用福尔马林固定的成人手标本5只,骨肿瘤截肢的成人手标本5只,对与关节镜术有关的大体及关节镜下解剖进行了观察。文章详尽描述了9个关节镜常用入路的位置及毗邻关系、关节囊韧带和三角纤维软骨复合体的附着点和形态特征、各入路的可视范围及关节囊内诸结构的镜下解剖特征,同时对各入路的安全性和实用性进行了详细的讨论。     

Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical adaptation in individual joints

To estimate subchondral mineralisation patterns which represent the long-term loading history of individual joints, a method has been developed employing computed tomography (CT) which permits repeated examination of living joints. The method was tested on 5 knee, 3 sacroiliac, 3 ankle and 5 shoulder joints and then investigated with X-ray densitometry. A CT absorptiometric presentation and maps of the area distribution of the subchondral bone density areas were derived using an image analyser. Comparison of the results from both X-ray densitometry and CT-absorptiometry revealed almost identical pictures of distribution of the subchondral bone density. The method may be used to examine subchondral mineralisation as a measure of the mechanical adaptability of joints in the living subject.     

不同孔径钻孔术对兔关节软骨缺损修复的影响

目的：观察钻孔修复关节软骨缺损的过程，比较不同孔直径钻孔术对软骨缺损的修复效果．方法：用中国白兔２４只，在股骨关节面造成６ｍｍ×８ｍｍ全层软骨缺损，分别施行孔径１ｍｍ和１．５ｍｍ的钻孔术，术后４、８周取材，行组织学，光、电镜检查并进行评估．结果：（１）两组的优势修复组织均混有类透明软骨、幼稚软骨和纤维软骨，对照组为纤维组织．（２）修复组织厚度，１ｍｍ孔比１．５ｍｍ孔厚．（３）修复组织覆盖缺损的面积，两组间无显著性差异．结论：软骨下骨钻孔可修复关节软骨全层缺损，小孔比大孔修复效果好，非钻孔的缺损修复效果较差．     

Subchondral and trabecular bone remodeling in canine experimental osteoarthritis

Introduction: We wanted to test the hypothesis that quality changes occur in early-stage arthritic subchondral cancellous bone after acute subchondral damage. So far, not much attention has been paid to changes of the subchondral bone after traumatic subchondral lesions. Materials and methods: With an established animal model, we produced pure subchondral damage without initial affection of the articular cartilage in 12 Beagle dogs under MRI and histological control. We utilized bone histomorphometry to evaluate bone turnover, its structure and the articular cartilage 6 months after the initial damage. Results: On follow-up, bone remodelling was indicated, e.g. by a significant increase in the trabecular bone volume and thickness, osteoblast number and osteoid surface and a decrease in the trabecular number in all 12 samples. Several other parameters showed a tendency, e.g. osteoblast surface and osteoclast number. Cartilage analysis showed degenerative changes in ten of 12 samples that had not shown any evidence of damage during the initial examination. Discussion: Our investigation indicates a significant deterioration in the architecture of the cancellous bone with degenerative changes of the overlying articular cartilage after subchondral lesions, which change the mechanical properties.     

Age-Related Three-Dimensional Microarchitectural Adaptations of Subchondral Bone Tissues in Guinea Pig Primary Osteoarthrosis

We explored potential mechanisms of the microarchitectural adaptations of subchondral bone tissues in a guinea pig primary osteoarthrosis (OA) model. We harvested proximal tibiae of male Dunkin-Hartley (Charles River strain) guinea pigs at 3, 6, 9, 12, and 24 months of age (10 in each group). These proximal tibiae were scanned by micro-computed tomography to quantify the three-dimensional microarchitecture of the subchondral plate, cancellous bone, and cortical bone. Subsequently, the bones were compression-tested to determine their mechanical properties. Furthermore, bone collagen, bone mineral, and bone density were determined. Mankin’s score corresponded to OA grading from absent or minimal cartilage degeneration in 3-month-old to severe degeneration in 24-month-old guinea pigs. In young guinea pigs, the volume fraction and thickness of the subchondral plate markedly increased from 3 to 6 months, whereas the volume fraction of the subchondral cancellous bone displayed an initial decline followed by an increase. With age, the trabeculae increased in thickness, changed from rod-like to plate-like, and became more axially oriented. An increasing ratio of bone collagen to mineral in subchondral bone indicated undermineralized bone tissues. In subchondral cancellous bone, Young’s modulus was maximal at 6 months of age, whereas ultimate stress and failure energy showed a gradual increase with age. The findings show pronounced alterations of the microarchitecture and bone matrix composition of the subchondral bone. These alterations did not appear to follow the same pattern as in normal aging and may have different influences on the resulting mechanical properties.     

腕关节镜下治疗三角纤维软骨复合体损伤

目的 探讨腕关节镜下治疗三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)损伤的方法及疗效.方法 2006年1月-2008年12月,收治TFCC损伤16例.男11例,女5例;年龄25～51岁,平均32.5岁.扭伤12例,跌伤4例.左侧10例,右侧6例.病程3个月～6年2个...     

Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques

Because the radioulnar ligament attaches to the ulnar fovea and base of the ulnar styloid, foveal detachment of the triangular fibrocartilage complex (TFCC) induces severe distal radioulnar joint instability. This article describes both an arthroscopic and open repair technique to reattach the TFCC to the fovea. Both techniques reanchor the detached TFCC to the fovea. Both techniques are reliable and promising techniques in the repair of a foveal detachment of the TFCC.     

Arthroscopic knotless peripheral ulnar-sided TFCC repair

Peripheral ulnar-sided tears of the triangular fibrocartilage complex (TFCC) are common injuries and are amenable to arthroscopic repair. This article describes an all-arthroscopic knotless technique for TFCC repair. This technique has the advantage of being all arthroscopic using 3 portals, has the ability to repair both the superficial and deep layers of the articular disk, repairs the articular disk directly back to bone, and does not require any suture knots that may irritate the surrounding soft tissues. The surgical technique is described in detail.     

人半月板纤维软骨细胞培养及生物学特性研究

为探索分离培养人半月板纤维软骨细胞的简便实用方法，采用胰蛋白酶和胶原酶联合消化的方法，简便快速地获得大量成活率高的人半月板纤维软骨细胞，在F－12培养液中进行原代和传代培养，并对传代培养纤维软骨细胞进行了免疫组化鉴定，光镜及超微结构的观察，结果显示，光镜下，原代培养细胞呈线形，单层排列，电镜可见细胞内有丰富的粗面内质网及线粒体，细胞呈多极性，表面有突起，纤维软骨细胞免疫组化Ⅱ型胶原染色阳性，提示本实验建立的人纤维软骨细胞分离培养方法是一种可行的方法。，