地佐辛复合丙泊酚在股骨头坏死关节囊针刀松解术中的应用

目的:观察地佐辛复合丙泊酚用于股骨头坏死关节囊针刀松解术的镇痛镇静效果及不良反应。方法:120例择期行股骨头坏死关节囊针刀松解术的患者用数字表法随机分为2组:观察组给予地佐辛联合丙泊酚进行静脉麻醉(D组);对照组给予芬太尼联合丙泊酚进行静脉麻醉(F组)。记录2组术中生命体征、镇痛效果、丙泊酚用量、麻醉恢复时间、呼吸抑制及恶心、呕吐的发生情况。 结果:2组镇痛效果优良率均为100%,循环均较稳定,D组呼吸抑制和恶心呕吐发生率均明显低于F组,差异有统计学意义(P<0.05)。D组麻醉恢复时间明显短于F组,差异有统计学意义(P<0.05)。结论:地佐辛复合丙泊酚用于股骨头坏死关节囊针刀松解术具有血流动力学较平稳、镇痛效果确切、苏醒迅速、麻醉期间呼吸抑制和恶心呕吐发生率低等优点,值得临床推广应用。     

体外冲击波对兔膝骨关节炎软骨白细胞介素-1β及肿瘤坏死因子-α表达的影响

目的观察体外冲击波(ESW)对兔膝骨性关节炎软骨白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)水平的影响。方法将30 只新西兰大白兔随机分为对照组、模型组和治疗组,每组各10 只。模型组和治疗组采用改良伸直位固定6 周,制备兔膝骨关节炎模型。治疗组造模后立即给予ESW治疗1 次,能流密度0.1 mJ/mm2,冲击次数1000 次。各组分别于治疗后4 周处死,观察大体标本形态学变化,采用免疫组织化学法检测各组关节软骨中IL-1β和TNF-α的水平。结果治疗组IL-1β 和TNF-α的表达较模型组明显下调(P<0.01)。结论ESW能下调兔膝骨关节炎软骨细胞IL-1β、TNF-α的表达。     

Pericardial effusions with tamponade and visceral constriction in patients with rheumatoid arthritis on tumour necrosis factor (TNF)‐inhibitor therapy

Tumour necrosis factor‐inhibitor (TNF‐inhibitor) therapy is increasingly used for the treatment of rheumatoid arthritis. While it is effective for the articular manifestations of rheumatoid arthritis we have reason to believe that it is less effective for extra‐articular disease. We present two cases of life‐threatening cardiac tamponade in two patients with well‐controlled rheumatoid arthritis on adalimumab. An extensive literature search was carried out and three other patients were found. We believe that these cases highlight the need for rheumatologists to be vigilant for extra‐articular manifestations of rheumatoid arthritis even in the presence of quiescent joint disease while on TNF‐inhibitors.     

自体软骨细胞立体培养修复兔关节软骨缺损的实验研究

目的探讨自体软骨细胞立体培养构建的组织工程软骨修复关节软骨的效果。方法24只4～6月龄新西兰大白兔进行标记,首先在股骨下端建立动物软骨3.5mm缺损模型,获取软骨细胞进行体外培养、扩增,3代后获取足够细胞数量,制成1×108/ml细胞悬液,植入细胞载体Ⅰ型胶原海绵培养,两周后移植到自体3.5mm的软骨缺损面上,分别1、2、3个月处死观察。结果软骨细胞与细胞载体Ⅰ型胶原海绵有良好组织相溶性,两者培养形成自体组织工程软骨能完成关节软骨缺损修复。第1个月修复组织初步具备纤维软骨特征,第2个月初步具备透明软骨特征,第3个月修复组织具备透明软骨的生物学特性。结论细胞载体Ⅰ型胶原海绵与软骨细胞体外培养形成的组织工程软骨,能完成关节软骨的修复,修复组织为透明软骨。     

Validity of the Fingertip-To-Floor Test and Straight Leg Raising Test in Patients With Acute and Subacute Low Back Pain: A Comparison by Sex and Radicular Pain

Ekedahl KH, Jönsson B, Frobell RB. Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.

Objective

To use self-reported disability (Roland-Morris Disability Questionnaire [RMDQ]) to assess the criterion validity of straight leg raising (SLR) test and flexion range of motion (ROM) (fingertip-to-floor test) before and after stratification by sex and presence/absence of radicular pain.

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Subjects with acute/subacute low back pain with (n=40) and without (n=35) radicular pain.

Interventions

Not applicable.

Main Outcome Measures

We examined the relationship between RMDQ (reference variable) and SLR test and fingertip-to-floor test. The sample was stratified by presence/absence of radicular pain (categorized by the dichotomous slump test).

Results

In the entire sample, fair correlations were found between both physical impairment tests (ie, SLR test and flexion ROM) and self-reported disability (.27<r>.44). After stratification by sex, the correlation between RMDQ and flexion ROM and between RMDQ and nonside-specific SLR test increased in women but decreased in men. In those with radicular pain, good correlations were found between RMDQ and flexion ROM (r=.68 for men and r=.70 for women), and moderate correlation was found between the RMDQ and SLR tests of the affected side in women (r=.60), but only fair correlation was found between the RMDQ and SLR tests of the affected side in men (r=.28).

Conclusions

After stratification by sex and presence/absence of radicular pain, the present study supports a good validity of the fingertip-to-floor test for both men and women with radicular pain. The SLR test, however, was of less value as an indicator of self-reported disability after stratification, especially for men.     

Reversed laminar appearance of articular cartilage by T1‐weighting in 3D fat‐suppressed spoiled gradient recalled echo (SPGR) imaging

Purpose:

To investigate the reversed intensity pattern in the laminar appearance of articular cartilage by 3D fat‐suppressed spoiled gradient recalled echo (FS‐SPGR) imaging in magnetic resonance imaging (MRI).

Materials and Methods:

The 3D SPGR experiments were carried out on canine articular cartilage with an echo time (TE) of 2.12 msec, a repetition time (TR) of 60 msec, and various flip angles (5° to 80°). In addition, T1, T2, and T2* in cartilage were imaged and used to explain the laminar appearance in SPGR imaging.

Results:

The profiles of T2 and T2* in cartilage were similar in shape. However, the T2 values from the multigradient‐echo imaging sequence were about 1/3 of those from single spin‐echo sequences at a pixel resolution of 26 μm. While the laminar appearance of cartilage in spin‐echo imaging is caused mostly by T2‐weighting, the laminar appearance of cartilage in fast imaging (ie, short TR) at the magic angle can have a reversed intensity pattern, which is caused mostly by T1‐weighting.

Conclusion:

The laminar appearance of articular cartilage can have opposite intensity patterns in the deep part of the tissue, depending on whether the image is T1‐weighted or T2‐weighted. The underlying molecular structure and experimental protocols should both be considered when one examines cartilage images in MRI. J. Magn. Reson. Imaging 2010;32:733–737. © 2010 Wiley‐Liss, Inc.     

膝关节镜下韧带修补术康复指导

目的探讨关节镜下膝关节前交叉韧带、后交叉韧带、内侧副韧带、外侧副韧带、后外侧结构联合损伤的康复护理效果。方法采用膝关节镜下重建交叉韧带、修复或重建侧副韧带和后外侧结构治疗急性膝联合韧带损伤患者10例。术后早期行肌力练习、完全负重、本体感觉练习、被动练习,出院后随访并功能评分。结果 10例均获得随访,随访时间6～24个月,平均14个月。结论膝关节联合韧带损伤行关节镜手术治疗配合正确的康复护理可取得良好效果。     

肱骨远端关节内骨折手术治疗效果分析

目的分析肱骨远端关节内骨折的手术方法和常见并发症,评价手术治疗效果。方法2003年6月至2008年4月,收治肱骨远端关节内骨折患者43例,男30例,女13例;年龄18～76岁,平均39．3岁。其中AO／OTA分类B型18例,C型25例。分别采用经尺骨鹰嘴截骨入路、肱三头肌旁入路、劈开肱三头肌入路和肱三头肌远端舌形切断入路行肱骨远端关节内骨折切开复位及钢板内固定术,术后患者均未行外固定。术后1．5、3、6、12、24、36个月复查肘关节活动度和功能。结果术后开始主动及被动功能锻炼的时间为2～8d,平均3．6d。43例患者中36例获得随访,随访时间11～69个月,平均28个月。按照Mayo肘关节功能评分标准：优18例,良15例,可3例;优良率为91．2％。关节活动度74°～125°,平均95°。术后2例发生切口浅层感染,1例一过性尺神经损伤,1例复位不良。2例骨折延迟愈合,1例尺骨鹰嘴截骨处延迟愈合。结论肱骨远端关节内骨折的手术治疗效果良好。不同的肘关节后方手术入路方式中,经尺骨鹰嘴截骨入路的疗效评分优于经肱三头肌旁入路、劈开肱三头肌入路和肱三头肌远端舌形切断入路。     

兔膝关节内骨折后关节面塑形能力的实验研究

目的观察兔膝关节内骨折后不同形式关节面不平整的塑形能力。方法在兔胫骨平台造成关节内骨折,骨折移位0.5、1.0、2.0 mm,形成关节面凹陷或台阶样结构。术后3个月取胫骨平台标本进行组织切片、HE染色,观察不同形式关节面不平整的塑形能力。结果兔胫骨平台凹陷性或台阶性不平整关节面移位0.5 mm时,通过凹侧软骨增生肥厚等塑形,可恢复关节面的平整。关节面移位1.0 mm及2.0 mm时,通过凹侧软骨增生肥厚及来自髓腔的增生修复组织,凹陷性不平整仍可恢复关节面的平整,但台阶性不平整难以通过关节面的重新塑形恢复关节面的平整。结论关节内骨折后形成关节面不平整,凹陷性骨折的再塑形能力可能优于台阶性骨折。     

关节镜和MRI诊断膝关节软骨损伤的对照研究

目的通过对比关节镜手术结果和MRI图像,评价关节镜和MRI在膝关节软骨损伤中的诊断价值,提高膝关节软骨损伤诊断的准确性。方法2006年4月至2007年4月,对60名膝关节疼痛,拟膝关节镜检查的病人进行术前MRI成像,与关节镜手术结果对照对比。结果以关节镜诊断为标准,MRI分级结果与关节镜诊断结果具有一致性。结论MRI能够准确评价膝关节软骨损伤病变的程度,指导临床上采用合理的治疗手段。