前路经枢椎体寰椎侧块螺钉固定术

目的 建立一种新的寰枢椎内固定术式,用来治疗难以实施后路内固定的病例。方法 使用纯钛制成的固定螺钉,做颈前路暴露,经枢椎针两枚螺钉分别拧人左、右寰椎侧块,达到区椎的即刻稳定。结果 １０例手术患者,平均随访１９个月,其中７例螺钉固定位置良好,寰枢椎达到稳定,死亡１例。结论 经枢椎体寰椎愉螺钉固定术是一种比较可犊的寰枢椎内固固定方法,尤其适用于难以施行后路内豁达一术的病例。     

Quantitative determination of the contact pressure distribution in the hip joint during gait

Summary The objective of this investigation was the experimental determination of the contact pressures in the hip joint for characteristic phases of the gait cycle. The joint forces determined in vivo with telemetric endoprosthesis by Bergmann et al. (1993) were converted into a pelvic reference system, based on kinematic gait analysis. In eight cadaveric hip joints (age 18–75 yrs.) the reaction forces were applied corresponding to four phases of the gait cycle (heel strike, mid-stance, heel off, toe off) and the pressure distribution determined with FUJI pressure sensitive film. We found maxima of 10 MPa during mid stance. The areas of highest pressure were located in the ventro-superior aspect of the acetabulum (anterior part of the acetabular roof) and in the dorso-inferior aspect of the lunate surface. The pressure distribution was relatively constant during the four phases and the maxima did not vary proportional to the applied load. The normal pressure distribution in the hip appears to be determined by the physiological incongruity of the articular surfaces and the inhomogeneous bony support of the acetabulum. During operative interventions this normal load transfer should be restored as accurately as possible.      

胫骨结构抬高术治疗髌股软骨病机理的研究

为客观评价胫骨结节抬高术治疗髌股软骨病的机理,采用Ｆｕｉｊ压敏片测压力和染色法测面积相结合,共测试８具新鲜离体膝关节标本,比较胫骨结节抬高术前后的髌股接触部位、面积和应力分布。发现胫骨结节抬高术后,髌骨的习惯性接触区位置向近端移行,这种现象有助于避开对软骨病灶区的挤压和应力集中,对缓解和消除髌股疼痛症状可能有利。因此,提出了“应力集中传导至软骨损伤区导致髌股疼痛”的设想。胫骨结节抬高术后,小屈膝角度（３０°－６０°）有一定的髌股减压作用,但随屈膝角度增加,髌股接触面积减小并出现压力分布不均或局部高压现象。胫骨结节抬高术后,“腱股接触”现象提早（６０°）出现,对髌股关节生物力学行为可能造成影响。     

Disorders of the hallux sesamoid complex: MR features

Numerous painful conditions can affect the first metatarsophalangeal-sesamoid joint complex. Symptoms can be of sudden or insidious onset, and be of acute or chronic duration. Although conventional radiography is recognized as the initial diagnostic procedure for these symptoms, there is often a need to proceed to MR imaging. MR imaging is sensitive and can be utilized in the investigation of the hallux sesamoid complex to differentiate soft tissue from osseous pathology. Synovitis, tendonitis, and bursitis can be distinguished from bony abnormalities such as sesamoid fracture, avascular necrosis, and osteomyelitis. An understanding of MR imaging features and techniques will result in the highest diagnostic yield. Early and accurate diagnosis of sesamoid complex disorders can guide the physician to the appropriate clinical management and prevent potentially harmful longstanding joint dysfunction.     

腰椎小关节真空现象的CT诊断意义

提出腰椎小关节真空现象在ＣＴ诊断意义中的一种新观点。材料与方法：分析９例腰椎小关节真空现象的ＣＴ片及腰椎侧位片的表现。结果；其中７例均有相关椎体的前滑脱。结论；腰椎小关节真空现象不仅仅是关节软骨退行性变的表现，更是腰椎滑脱的征象。     

颞颌关节磁共振成像技术探讨

目的通过选择合理的扫描层面、脉冲序列及参数诊断颞颌关节紊乱综合征。方法对１１例病人行双侧ＭＲＩ检查，斜矢位自旋回波（ＳＥ）Ｔ１ＷＩ，９例用５１２×２５６矩阵，２例单侧用２５６×２５６矩阵，矢状位的快速多相位梯度回波（ｍｕｌｔｉｐｈａｓｅＦＳＰＧＲ），９例用３０°翻转角，２例分别用１０°、３０°及５０°翻转角。结果ＳＥ序列中，用５１２×２５６矩阵能清晰显示颞颌关节半月板的纤维软骨结构，ｍｕｌｔｉｐｈａｓｅＦＳＰＧＲ序列的翻转角选择３０°图像对比度信噪比最佳。结论ＭＲＩ确为诊断颞颌关节紊乱综合征的无创伤性检查方法，对口腔科矫形病人手术前后对照有一定帮助。     

半月板可疑撕裂的MRI与关节镜对照研究

研究半月板可疑撕裂的出现机率及其临床意义。材料和方法：回顾性分析了１２６个膝关节的ＭＲ扫描资料，当二位放射科医生均不能肯定半月板内的高信号是否延伸至半月板表面时，诊断为半月板可颖撕裂，并与关节镜检查结果进行对照。结果：１２６例中有２２例诊断为半月板可疑撕裂，占１７．５％。１２例位于内侧半月板的后角，４例位于外侧半月板的前角，６例位于外侧半月板的后角。２２例中１８例作了关节镜检查，只有２例发现有撕裂     

对抗牵引整复肩关节前脱位的体会

1999年来采用椅背整复法(观察组)治疗的肩关节前脱位38例，与同期采用手牵足蹬法(对照组)治疗的肩关节前脱位40例比较，现报告如下。     

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods

Cmpletedislocationofacromioclavicularjointiscommonindailyorthopaedicpractice,accountingfor 2 % 1 6 %ofvariousjointdislocations.Itisusuallythoughttobeeasilytreatedbymanytreatmentmethods,suchasDewar soperation ,internalfixationwithKirschnertensionbandwires,orinternalfixationwithWolterplates.However,itiswellrecognizedthatnotallthecompletedislocationsofacromioclavicularjointhavegoodoutcomes.Itisnotclearwhichmethodisthebestyet.Inthisstudy,thedataof 96patientswithcompletedislocationofacromioclavi…     

Oxford单髁置换术的术后影像学评价及分析

目的对Oxford单髁置换术治疗膝关节内侧间室骨关节炎（OA）的患者进行术后x线评价,并对假体位置不良原因分析和改进。方法回顾性分析2010年1月～2011年12月的35例膝OA患者行Oxford单髁置换的资料,男7例,女28例,左膝15例,右膝20例,年龄51～73岁,平均年龄63．8岁,体重48～68kg,均为内侧间室置换。手术后常规拍摄膝关节标准正侧位x线片,对患者术后假体位置进行x线片上测量,并按照Oxford单髁的标准值进行数据对比。结果股骨假体内外翻角（A角）和胫骨假体后倾角（F角）的变异百分比小,分别为0和2．857％,而股骨假体屈伸角（B角）和胫骨平台内外翻角（E角）变异百分比较大,分别为31．429％和17．143％。结论Oxford牛津单髁假体位置不良的好发部位是B角和E角,提高B角和E角的准确性将能够明显改善假体位置。