髋关节强直双髋关节同时置换的探讨

[目的]探讨强直性脊柱炎晚期引起的髋关节骨性强直双侧髋关节同时置换术的方法和疗效.[方法]对19例(38髋)强直性脊柱炎合并髋关节强直患者在全麻口插、鼻插下或气管切开插管麻醉下施行双侧同时全生物型全髋关节置换术,手术采用后外侧切口入路,两次截骨后髋臼成形的方法,根据髋关节术前畸形状态调整髋臼及股骨柄角度,安装大一号生物臼、股骨柄假体紧密压配.指导患者早期肌肉及关节功能锻炼.术后均进行了最短1年,最长8年,平均5.5年的随访,对临床疗效及手术相关问题进行探讨.[结果]术后2例出现脱位,经及时手法复位后未再脱位,2髋在扩髓击入假体股骨柄时出现股骨距裂纹骨折,未做特殊处理.6髋发生轻度异位骨化,根据Brooker分期,Ⅰ级3髋,Ⅱ级3髋,病人除感不适外,对功能无明显影响.术后患者均能生活自理.放射学评定骨皮质较术前有明显增粗,骨小梁结构稀疏改善明显.所有患者髋关节主动屈伸活动由术前的0°增加到随访时的平均81°(650～115°),活动度平均达到160.(110°～230°).[结论]强直性脊柱炎髋关节强直双髋关节同时置换可重建患者髋关节,恢复关节功能,提高生存和生活质量.双侧髋关节同时置换有利于双下肢关节功能的协调发展,也可避免两次择期手术间隔时间里因使用不当导致的人工关节损坏,同时能节约患者医药费用又可减轻患者痛苦,利于其他矫形手术开展和负重功能恢复.     

Periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces

Abstract – The purpose of the study was to evaluate periodontal healing after replantation of intentionally rotated teeth with healthy and denuded root surfaces. Ten teeth with hopeless prognoses because of extensive alveolar bone loss and deep pockets extending to the apexes only on one or two surfaces, but with a healthy periodontal apparatus on the other surfaces, were selected. A mucogingival flap was elevated and the teeth were extracted carefully so as not to damage the healthy remnant of the periodontal membrane remaining on the root surfaces. Thorough extra‐oral debridement was performed on the contaminated root surface and the remnant was carefully conserved. Retrofilling was also done to eliminate an endodontic cause of attachment loss. The teeth were horizontally rotated and then replanted so that the healthy root would face the connective tissue at the initially periodontally involved sites, and the root planed surfaces, which had been periodontally involved, would face the surfaces of the alveolar sockets at initially healthy sites. The teeth were splinted with adjacent teeth. Clinical parameters and radiographic examination were performed pre‐operatively, and at 3 or 6 months, 1, 2, and 3 years postoperatively. One tooth was extracted 1.5 years postoperatively due to reduced support and the treatment strategy of the patient. The other nine teeth were well maintained without any discomfort for the whole maintenance period of 3 years. In all teeth, areas that previously had no pocketing but were now against denuded root surfaces maintained the previous pocket depth readings. In areas where a deep pocket was present but now had a root surface with healthy periodontium, a distinct decrease of mean pocket depth was observed at the first reexamination 3 months postoperatively. The mean radiographic alveolar bone level increased from 0.3% to 45.3% in 2 years and was thereafter maintained for the entire observation period. Loss of periodontal space and possible root resorption were observed in only one case without other ankylotic symptoms. These results suggest that the healing without ankylosis of an extensive denuded root surface may occur by mechanisms other than the maintenance of a viable periodontal ligament on the root surface.     

关节镜下松解膝关节粘连僵硬的探讨

目的　探讨关节镜下治疗膝关节僵硬的可行性及效果。方法　关节镜下行膝关节伸膝装置松解术治疗膝关节僵硬 2 0例 ,术中切断关节内粘连 ,松解髌骨支持带 ,在股中间肌同股骨干之间作切割分离 ,然后用刨削器将股中间肌刨除。术后早期CPM及主动股四头肌锻炼。结果　随访 3个月～3年 ,膝关节活动度均较术前明显改善 ,屈膝活动均超过 90° ;膝关节活动度达 12 0°者 13例 ,占 6 5 % ;股四头肌肌力均恢复到 5级 ;无严重并发症发生。结论　关节镜下作粘连松解创伤小 ,可早期功能锻炼 ,发生再粘连机会少 ,术后效果好 ,术中发现关节内其它病变可同时治疗     

Congenital infiltrating lipomatosis of the face with exophytic temporomandibular joint ankylosis: a case report and review of the literature

Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lipomatous lesion with diffuse fatty infiltration of tissues and hyperplasia of underlying bone. We report clinical and CT findings in an unusual case of CIL-F presenting with progressive hemifacial asymmetry, manifesting as severely restricted mouth opening owing to exophytic temporomandibular joint ankylosis. The role of imaging in diagnosis is presented with a review of the literature. Differential diagnosis of CIL-F and its exclusion as a cause of hemifacial hyperplasia are also discussed.     

The aetiology behind torticollis and variable spine defects in patients with M��llerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome: 3D CT scan analysis

The aim of the article is fourfold; firstly, to detect the aetiology of torticollis in patients with Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome; secondly, spine pathology in Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome varies considerably from one patient to another and there are remarkable differences in severity and localization; thirdly, mismanagement of congenital spine pathology is a frequent cause of morbid/fatal outcome; and fourthly, the application of prophylactic surgical treatment to balance the growth of the spine at an early stage is mandatory. Reformatted CT scans helped in exploring the craniocervical and the entire spine in these patients. The reason behind torticollis ranged between aplasia of the posterior arch of the atlas, assimilation of the atlas and extensive fusion of the lower cervical vertebrae (bilateral failure of segmentation) in four patients; in one patient, in addition to the hypoplastic posterior arch of the atlas, we observed ossification of the anterior and the posterior longitudinal spinal ligaments giving rise to a block vertebrae-like suggestive of early senile ankylosing vertebral hyperostosis (Forestier disease). Scoliosis at different spine levels was attributable to variable spine defects. Pelvic ultrasound showed the classical renal agenesis in four patients; whereas in one patient, the MRI showed pelvic cake kidney (renal fused ectopia) associated with ovarian, uterine and vaginal abnormalities. This is the first exploratory study on the craniocervical and the entire spine in a group of patients with MURCS association.     

非生物材料用于颞下颌关节强直的半关节置换术

总结了26例真性颞下颌关节强直,用以钛合金及碳/碳复合非生物材料制成的半关节行颞下颌关节半置换术,取得了较好效果。手术的成功不仅在于选择最佳术式还在于关节材料的选择。手术要点为:切除骨性融合区后的间隙应达2.5～3.0cm,否则易复发。要求依据张闭口及咬合关系维持置换侧下颌支的高度,并达到关节的点面接触,以防止术后错咬合且有利于咀嚼功能的恢复。同期行颏部水平截骨颏成形术,以取得美容效果。     

撬拨加推拿治疗20例膝关节纤维性强直

用撬拨加推拿治疗20例膝关节纤维性强直。成功的关键为:①术前充分操练股四头肌和髌骨,使其松软和能够推动;②麻醉完善,术中要求膝关节屈曲达110°以上;③术后早期锻炼;④病人合作。主要优点是操作简便,组织损伤少,效果可靠。但应注意无菌操作,进针时要避开主要的神经血管,注意髌骨前血液循环,避免发生医源性骨折或股四头肌扩张部断裂。     

应用钛合金人工关节凹半置换术治疗颞下颌关节强直的初步报告

作者采用钛合金人工关节凹治疗颞颌关节强直。该方法解决了其它方法所产生的因去骨过多而致下颌偏位、开合、以及填隔物固定不佳而致脱位等缺点,具有手术简单,对机体创伤小,有良好的固定装置,又可免除切取自体移植料而给病人造成痛苦的优点。通过对一例双侧颞颌关节骨性强直病人行钛合金人工关节凹置换治疗,经1.5年的观察随访,开口度为2.5cm,达到理想效果。     

应用非生物关节半置换术治疗真性颞下颌关节强直疗效评价

外科手术是治疗真性颞下颌关节强直有效方法，治疗目的在于重建关节功能和防止术后复发。本文报告２６例真性颞下颌关节强直，全部应用非生物关节、单侧置换１６例，双侧置换１０例，术后随访１～３年，结果表明，非生物关节半置换术重建关节功能良好，复发率低。本文讨论了半关节置换术式选择，该手术方法简单，安全、且术后二周就可早期进行关节功能练习，并从口腔进食     

Effect of delayed calcium hydroxide treatment on periodontal healing in contaminated replanted teeth

Abstract – The effect of delayed intracanal calcium hydroxide treatment on experimentally induced extensive inflammatory root resorption in monkeys was studied. A significant shift from inflammatory resorption to ankylosis was noted following calcium hydroxide treatment. Furthermore, calcium hydroxide treatment appeared to change the pattern of ankylosis over time, although the total ankylotic area remained the same. Ankylosis preceded by root resorption (replacement resorption) increased, while ankylosis not associated with root resorption decreased. It was concluded that intracanal calcium hydroxide treatment of teeth with compromised PDM may cause unnecessary replacement resorption if left in the root canal for a long time or changed repeatedly.