腹腔镜下高位宫骶韧带悬吊术治疗盆腔器官脱垂疗效分析

目的:探讨腹腔镜下高位宫骶韧带悬吊术治疗盆腔器官脱垂的疗效和安全性。方法:2017年3月—2019年3月选组,研究组56例采用腹腔镜下子宫全切术+高位宫骶韧带悬吊术,对照组60例采用阴式全子宫切除术+阴道前后壁修补术60。分别比较两组患者手术参数、POP指示点以及盆底疾病生活影响问卷-简易版7 (PFIQ-7)等的改变。结果:研究组和对照组手术时间分别为(123.5±46.3) min及(82.5±20.6) min,差异有统计学意义(t=4.712,P0.05);术中出血量分别为1.4)天及(5.6±1.5)天,以上指标两组比较差异均无统计学意义(P值均0.05)。术后PFIQ-7评分研究组为(2.54±1.23)分、对照组为(3.58±2.23)分,差异无统学意义(P0.05); PFDI-20评分研究组为(3.07±2.49)分、对照组为(5.12±3.09)分,差异有统计学意义(t=-3.917,P0.05);PISQ-12评分研究组为(52.15±18.87)分、对照组(32.33±13.58)分,差异有统计学意义(t值分别为-3.145、-3.527、-2.190、-2.362、-4.589、2.267,P0.05)。结论:腹腔镜下高位宫骶韧带悬吊术治疗POP-Q分期II-III度盆腔器官脱垂是一种安全、有效的术式,具有较好的解剖及功能疗效。     

人体寰椎横韧带拉伸性能的实验研究

目的：研究人体寰椎横韧带的拉伸性能。方法：新鲜寰椎标本８例,制备成拉伸试件,进行定速率单向拉伸至横韧带断裂。结果：寰椎横韧带平均最大载荷为３１１．６Ｎ,最大变形量为６．０ｍｍ,刚度为７２．９Ｎ／ｍｍ。结论：寰椎侧块间的分离超过６．０ｍｍ,就可存在横韧带断裂。     

牙龈成纤维细胞与牙周韧带细胞在二种玻璃离子水门汀上附着及增？…

目的 比较人类牙龈成纤维细胞（ＨＧＦ）与牙周韧带细胞（ＰＤＬＣ）在两种玻璃离子水门汀（ＧＩＣ）上的附着及增殖情况。方法 利用体外细胞培养技术及＾３Ｈ－ＴｄＲ掺入法检测ＨＧＦ及ＰＤＬＣ在两种ＧＩＣ上的附着及ＤＮＡ合成。结果 ＨＧＦ与ＰＤＬＣ在培养板上的附着及ＤＮＡ合成差异无显著性（Ｐ〉０．０５）,但ＨＧＦ在ＧＩＣ上的附着及ＤＮＡ合成明显强于ＰＤＬＣ（Ｐ〈０．０５）。结论 Ｋｅｔａｃ Ｆｉｌ和Ｆｕｊｉ     

淋巴瘤累及胃结肠韧带的CT表现

目的 探讨非霍奇金氏淋巴瘤（non-Hodgkin’s lymphoma,NHL）累及胃结肠韧带（gastrocolic ligament,GCL）的CT表现及其解剖学基础。方法 回顾性分析26例经病理确诊的累及GCL的NHL病例,着重观察GCL的CT表现。结果 GCL受累主要表现为GCL内淋巴结增大,增大淋巴结呈散在分布,未见淋巴结融合。增大淋巴结表现为均匀强化者25例,均匀强化合并环状强化者1例。有2例显示GCL增厚、局部呈饼状改变,伴有腹腔积液。结论 熟悉GCL影像解剖学特点有助于累及GCL的NHL的CT诊断。     

Spatial heterogeneity of the effects of calcitonin gene-related peptide (CGRP) on the microvasculature of ligaments in the rabbit knee joint

1. Experiments were performed in anaesthetized rabbits to examine the effects of calcitonin gene-related peptide (CGRP) and the CGRP antagonist CGRP_8–37 on blood flow to the medial collateral ligament of the knee joint.
2. Topical application of CGRP (10⁻¹³ to 10⁻⁹  mol) to the exposed external surface of eight knee joints resulted in dose-dependent dilatation of vessels in both the ligament and the joint capsule. The magnitude of this response varied significantly in different regions of the medial collateral ligament, with the 10⁻⁹  mol dose of CGRP giving the maximum response (101.5±25.3% increase) at the femoral insertion site of the medial collateral ligament and lowest (23.1±8.8%) at the tibial insertion site.
3. Topical application of CGRP_8–37 (0.1, 1 and 10  nmol) produced dose-dependent constriction of vessels in the ligament and the joint capsule in five knees, with a trend towards the greatest effect occurring at the femoral insertion site (45.8±8.1% reduction in blood flow). With the 10  nmol dose, the vasoconstrictor response at the femoral insertion site differed significantly (P<0.05) from the responses obtained at the tibial insertion and joint capsule sites.
4. Topical application of CGRP_8–37 (0.1, 1 and 10  nmol) to four chronically denervated knees produced substantially smaller vasoconstrictor responses at all sites. At the femoral insertion site, where 10  nmol CGRP_8–37 normally produces a 45.8±8.1% reduction in blood flow (n=8), ten days following denervation this response was reduced to 6.5±6.1%, this difference being significant (P=0.01).
5. Adrenaline was applied topically to augment blood vessel tone, in order to establish how effectively co-administration of CGRP would offset this increase in tone. Adrenaline (10⁻¹⁰  mol) produced vasoconstriction at all sites (n=6). In the capsule this vasoconstriction was virtually abolished when CGRP (10⁻⁹  mol) was co-administered with adrenaline but in the ligament vasodilatation occurred at all sites. This vasodilatation was significantly greater at the femoral insertion site compared to the tibial insertion and mid ligament sites (P<0.05 for both) and the capsule (P<0.01).
6. Topical application of substance P (10⁻¹⁰ or 10⁻⁹  mol) failed to elicit dilatation of ligament blood vessels.
7. These results suggest that endogenous CGRP may play an important role in regulating blood flow to different structures in and around the knee joint.

     

MRI of the Stener lesion

Objective. To assess the utility of MR in detecting surgically induced Stener lesions (displaced thumb ulnar collateral ligaments) in cadaveric models. Design. Six cadaver thumbs had ulnar collateral ligament (UCL) tears created surgically. MR examinations (2D STIR and 3D GRASS) were performed identically on all specimens both before displacement (non-Stener) and after displacement (Stener lesion) of the UCL. The MR images were then randomly numbered. Each image was evaluated separately in blinded fashion by four musculoskeletal radiologists for the presence or absence of a Stener lesion. Each radiologist reinterpreted the images after an interval of several days. The interpretation was based on previously published criteria for Stener lesion diagnosis by MR. Results. The sensitivity of GRASS ranged from 0.17 to 0.67 with the most experienced reader scoring the lowest. The specificity of GRASS ranged from 0.33 to 1.0 (most experienced reader 0.67, 0.83). STIR had a sensitivity of 0.00–0.17 and a specificity of 0.53–0.83. The values for inter- and intraobserver agreement were measured. The intraobserver for GRASS was 0.27–0.75 (most experienced reader 0.75). Conclusions. 2D imaging is probably inadequate for the evaluation of Stener lesions. The most likely reason is that the STIR slice thickness of 3 mm limits resolution of small UCLs. The poor sensitivity and specificity of GRASS as well as poor interobserver agreement suggest that MR may not be sufficiently accurate for Stener lesion evaluation.     

Compression or distraction of the anterior cruciate injured knee

100 consecutive patients with a recent anterior cruciate ligament injury were examined with respect to type of sports activity that caused the injury, mechanism of injury and the occurrence of collateral ligament and meniscal lesions. There were 53 medial collateral ligament injuries, 12 medial, 35 lateral and 11 bicompartmental meniscal lesions. 59 patients were injured during contact sports, 30 in downhill skiing and 11 in other recreational activities, traffic accidents or at work. An associated medial collateral, ligament tear was more common in skiing (22/30) than during contact sports (23/59), whereas a bicompartmental meniscal lesion was found more frequently in contact sports (9/59) than in skiing (0/30). Weightbearing was reported by 56/59 of the patients with contact sports injuries and by 8/30 of those with skiing injuries. Non-weightbearing in the injury situation led to the same rate of MCL tears (18/28) as those reporting weightbearing (35/72) but significantly more intact menisci (19/28 vs 23/72). Thus, contact sports injuries were more often sustained during weightbearing, with a resultant joint compression of both femuro-tibial compartments as shown by the higher incidence of bicompartmental meniscal lesions. This might be an important prognostic factor for future joint disease and arthrosis. The classic unhappy triad was a rare finding (8/100) and we suggest that this entity should be replaced by the unhappy compression injury.     

Synovialisation of the torn anterior cruciate ligament of the knee: comparison between magnetic resonance and arthroscopy

The aim of this study was to assess the accuracy of MR in the diagnosis of synovialisation of the anterior cruciate ligament (ACL) compared with arthroscopy. One hundred and forty-nine patients were examined with MR imaging and arthroscopy of the knee. The MR sign used to consider a synovialised ACL consisted of hypointense fibrillar tracts, disrupted and wavily, in its expected course. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), comparison of proportions (McNemar test) and Kappa values for agreement between MR imaging and arthroscopy were calculated. Of the 133 (89.3 %) ligaments without synovialisation at arthroscopy, 130 accorded with the MR results. Of the 16 (10.7 %) synovialised ligaments, 13 accorded with the MR results. Three false-positive and three false-negative MR diagnoses were identified. The agreement between both techniques was excellent (Kappa = 0.79; p = 0.000), without differences (McNemar test; p = 1). Sensitivity was 0.81, specificity 0.98, PPV 0.98 and NPV 0.81. Magnetic resonance imaging is highly reliability for synovialisation diagnosis. The imaging sign used to diagnose synovialised ACL (hypointense comma-like tracts in its expected course) is reliable. As this reparative process can simulate an intact ligament, knowledge of this sign is important in diagnosing synovialisation of ACL tears so as not to confuse it with normal ACL. Received: 17 June 1998; Accepted: 6 August 1998     

The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain

The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.