335例退行性骨关节病直流感应电康复总结

报告335例退行性骨关节病变,均经 x 线摄影证实,用直流感应电治疗。痊愈62例,占18.51%;显效115例,占34.33%;好转139例,占41.49%;无效19例;占5.67%。总有效率94.33%。有复发者再经治疗仍可收到效果。并对作用机制进行了探讨。     

Arthroscopic synovectomy of rheumatoid shoulder and elbow

Surgical Principles Radical arthroscopic synovectomy of rheumatoid shoulder and elbow. Revised Version from: Operat. Orthop. Traumatol. 4 (1992), 112–129 (German Edition).     

Resolution of skin fibrosis and joint contractures in aggressive diffuse systemic sclerosis using autologous stem cell transplantation

The use of haematopoietic stem cell transplantation (HSCT) has now expanded beyond the domain of haematological diseases. Increasingly, the benefits of intense immunosuppression in the management of severe autoimmune diseases are being recognized. In diffuse systemic sclerosis (SSc), there has been increasing evidence of the efficacy of HSCT in improving morbidity and mortality. We present the first Australian patient to undergo autologous HSCT for SSc and review the current literature in the use of HSCT in SSc. Remarkably, the patient had complete resolution of skin disease (modified Rodnan skin score 27/51–0/51), tenosynovitis, synovitis and myositis.     

肘关节后脱位伴桡骨头和尺骨冠突骨折 (恐怖三联征)5例初步报告

[目的]介绍"肘关节恐怖三联征"的概念(肘关节后脱位同时伴有桡骨头和尺骨冠突骨折),并报告5例患者的临床治疗体会。[方法]自2004年4月～2007年3月,作者共收治肘关节三联征损伤5例。桡骨头骨折按Mason法分类:Ⅱ型4例,Ⅲ型1例;按Schatzker法分类:Ⅰ型1例,Ⅱ型3例,Ⅲ型1例。尺骨冠突骨折按Regan-Morrey法分类:Ⅰ型1例,Ⅱ型4例;按O′Driscoll法分类:5例均为Ⅰ型。4例采取了手术内固定治疗,以3 mm钛空心拉力螺钉或1 mm K针分别固定冠突和桡骨头,并缝合修复肘内外侧副韧带。术后屈肘90°前臂旋转中立位石膏外固定3周,开始屈伸和旋转康复训练。[结果]4例手术治疗的患者经3个月～3年随访,骨折愈合,肘关节稳定,无疼痛。肘关节屈伸幅度平均120°,前臂旋转幅度平均110°。3例随访1年以上,Mayo肘关节功能评分:优2例,良1例。未手术治疗的1例功能评定为差,有肘关节不稳定和疼痛。[结论]肘关节恐怖三联征的骨折片虽然很小,但伴有肘内外侧副韧带撕裂,肘关节严重不稳定。只有在重建了骨关节和软组织结构稳定的基础上,及早(3周内)进行康复锻炼,才能获得较好的功能恢复。     

髁突形态与覆深度关系的研究

目的　探讨髁突形态与不同覆深度的关系。方法　选择正常者、开畸形患者、覆正常的错畸形患者和深覆畸形患者各 5 0人 ,均为 18至 2 6岁成人。应用曲面断层片研究左右两侧的髁突形态 ,分别测量并计算上部髁突高度 /升支高度比 (UCH/RH)和髁突高度 /宽度比 (TCH/CW )。将髁突形态分为四种类型 :直立型 (类A) ,前倾型 (类B) ,后倾型 (类C)和尖型 (类D)。结果　开组的上部髁突高度相对升支高度明显小于其他各组 (P <0 0 0 1)。正常组的髁突形态比较粗壮 ,高度宽度比明显小于其他各组 (P <0 0 0 1)。类A和类B属于正常髁突形态 ,占正常组的 99%。类C和类D属于异常髁突形态 ,且在开组中的比例明显高于正常覆组或深覆组。另外 ,只有开组中显示上部髁突高度两侧不对称 (P <0 0 5 )。结论　开组髁突形态与其他各组相比明显不同。     

FUSION OF THE FIRST METACARPOPHALANGEAL JOINT FOR POST-TRAUMATIC CONDITIONS

Fusion of the metarcarpophalangeal joint of the thumb is an accepted treatment in the management of instability or osteoarthritis following trauma to this joint. A review was made of the literature and 30 of the senior author's (RH) patients who had had this operation, in order to determine what effect the operation had on the pain in their thumb, any symptoms of instability, interference with work and daily activities, and strength in the hand. All of the patients achieved bony union and the average angle of fusion was 7.6 degrees of flexion. All of the patients were either satisfied or very satisfied with the results of the operation, and had an average increase of 6.3 points on a 12 point rating scale. However, 48% of patients had some mild intermittent pain and 43% complained of some difficulty with fine motor tasks. Twelve patients were able to attend for formal evaluation including the Jebson and Crawford Hand Function Tests which revealed some decrease in hand function in all of those tested. It was concluded that this method of arthrodesis of the metacarpophalangeal joint of the thumb gives reliable results, with high patient acceptance, but does not result in an entirely normal thumb or hand function.     

3D kinematic analysis of the acromioclavicular joint during arm abduction using vertically open MRI.

Many researchers have evaluated the motions of the shoulder girdle, especially scapular and humeral motion. However, few reports exist that describe motions of the acromioclavicular joint. The purpose of the present study was to analyze the 3D kinematics of the acromioclavicular joint during arm abduction using 3D MR images obtained by a vertically open MRI. Fourteen shoulders of seven volunteers were examined in seven static positions from 0 degrees to the maximum abduction in a seated position. 3D surface models of the clavicle and scapula were created, and the movements of the acromioclavicular joint from 0 degrees to each position were calculated using the volume-based registration technique. From these calculations, the translations were evaluated and the rotational motions were analyzed using the concept of the screw axis. In the anteroposterior direction, the clavicle translated most posteriorly (-1.9 +/- 1.3 mm) at 90 degrees of abduction and most anteriorly (1.6 +/- 2.7 mm) at maximum abduction. In the superoinferior direction, the clavicle translated slightly superiorly (0.9 +/- 1.9 mm). When analyzing relative motion of the scapula with respect to the clavicle, the scapula generally rotated about a specific screw axis passing through the insertions of both the acromioclavicular and the coracoclavicular ligaments on the coracoid process. The average rotation was 34.9 +/- 8.4 degrees.     

胫骨平台骨折合并软组织损伤的临床分析与治疗

目的:总结分析各种胫骨平台骨折合并不同类型软组织损伤中的相互关系,探索其诊断与治疗策略。方法:自1995年10月至2004年1月共治疗胫骨平台骨折合并软组织损伤143例。所有病例均行开放复位内固定,对不同类型软组织损伤同时采取相应的处理方法。结果:术后随访129例,随访时间6到27个月,平均16个月;骨折均于12周内愈合,所有患者均恢复了患肢的正常力线,患肢稳定。结论:胫骨平台骨折合并软组织损伤的诊断必须早期、全面、详细、明确,坚强的内固定基础上,对不同类型的软组织损伤必须正确处理,术后应注意被动伸膝及CPM功能锻炼,这样才能最大程度挽救膝关节功能,减少晚期并发症。