The Influence of a Local Injection of Cortisol on the Mechanical Properties of Tendons and Ligaments and the Indirect Effect on Skin

The effects of local Cortisol treatment on the mechanical properties of muscle tendon and ligament in rats were studied. in addition to the local effects, possible systemic effects as reflected in the properties of the skin, remote from the site of the injection, were investigated. Two groups of rats were given Cortisol injections, 20 mg/kg, every third day for 24 days. in one of the groups the injections were given bilaterally around the peroneal tendons and in the other they were given into both knee joint cavities. Specimens from the peroneal tendons, the posterior cruciate ligament with bone attachments, and strips of skin from the dorsum, were tested in a materials testing machine. the local treatment resulted in increased “tensile strength” of the peroneus brevis tendon and increased maximum load and stiffness of the peroneus longus tendon with no change in the collagen content in any of the samples. the posterior cruciate ligament always broke at one of the two sites of attachment to the bone and the maximum load value at these points was decreased after local Cortisol treatment. the systemic effects of this local Cortisol treatment on the skin were decreased thickness and fat content, increased collagen concentration and higher “tensile strength” and failure energy. From this study it is concluded that local Cortisol injections for 24 days increase the strength and stiffness of muscle tendons, but decrease the strength of the bone attachments of ligaments. This treatment also results in a systemic effect which shows itself as increased strength of the skin remote from the site of the injections.     

Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome

The most common etiology of carpal tunnel syndrome (CTS) is idiopathic. However, secondary causes of CTS should be considered when symptoms are unilateral, or electrodiagnostic studies are discrepant with the clinical presentation. Imaging of the carpal tunnel should be performed when secondary causes of CTS are suspected. An ultrasound evaluation of the carpal tunnel can assess for pathologic changes of the median nerve, detect secondary causes of CTS, and aid in surgical planning.     

保留残端自体绳肌腱重建前交叉韧带

目的：探讨保留残端自体绳肌腱重建前交叉韧带（ACL）的临床疗效。方法15例患者经关节镜检查证实为ACL损伤,其中完全断裂12例,部分束支断裂3例。对ACL完全断裂的残端稍作清理后予以保留,部分束支断裂的残留束支予以保留,同时对断裂束支的残端予以保留,采用自体四股绳肌腱单束重建前交叉韧带,股骨端采用Endobutton固定,胫骨端采用界面螺钉固定。结果患者均获得随访,时间9～12个月。患者膝关节稳定性均增强。Lysholm 膝关节功能评分：术前56～76（63±8.11）分,术后86～100（94±6.31）分。Lachman试验阴性12例,弱阳性3例。末次随访时膝关节活动度达120°～160°（140°±3.15°）,15例患者均恢复伤前运动水平。结论 ACL重建术中残端的保留有助于重建韧带的再血管化、腱骨愈合及本体感觉的建立,术后膝关节功能恢复满意。     

带掌长肌腱的静脉皮瓣修复伸肌腱Ⅰ区复合组织缺损

目的:介绍应用带掌长肌腱的静脉皮瓣修复伸肌腱Ⅰ区复合组织缺损的治疗方法。方法:对11例11指中末节指背皮肤及伸肌腱缺损采用同侧前臂静脉皮瓣带掌长肌腱修复,并予以伸肌腱止点重建。结果:11例皮瓣成活,伤口Ⅰ期愈合。皮瓣供区直接缝合,术后随访4～26月,平均8月,手指外形及功能恢复良好。结论:应用静脉皮瓣带掌长肌腱修复伸肌腱Ⅰ区指背皮肤软组织及伸肌腱缺损,同时行伸肌腱止点重建,是Ⅰ期修复指背皮肤软组织及伸肌腱同时缺损的理想方法。     

基于“筋为骨用”探讨“舒筋”手法治疗膝骨关节炎的力学机制

分别从"筋为骨用"的中医理论溯源、对模型构建的指导、生物力学基础等入手,分析韧带、肌肉、软骨等筋性组织的力学变化在膝骨关节炎中的重要性,并从手法的作用目的、作用靶点及整合素途径分析手法治疗膝骨关节炎最终在于达到恢复膝部筋骨力学平衡,减缓软骨退变。     

保留或非保留 ACL 残迹对自体腘肌腱重建 ACL 术后胫骨骨道影响的对比研究

目的：探讨保留或非保留 ACL 胫骨残迹对 ACL 重建术后胫骨骨道的影响以及与临床疗效的关系。方法65例孤立性 ACL 损伤病例行关节镜下自体半腱肌、股薄肌肌腱重建 ACL,其中 A 组27例,保留 ACL 胫骨残迹,B 组38例,采用非保留残迹进行 ACL 重建。术后进行 MRI 检查,测量胫骨矢状位骨道最宽处直径,以术后1周对应部位骨道直径为衡量基准,对骨道扩大率进行统计学分析。采用 Lysholm 评分评估各组临床疗效。结果 A组25例,B 组35例得以随访,其中 A 组平均随访12.4个月,B 组平均随访12.1个月。两组病例术后胫骨骨道均有不同程度增宽,以 B 组骨道扩大程度相对较高。结果表明胫骨骨道随时间延长逐步扩大,在术后6周即有明显的扩大,自术后3个月,骨隧道变化程度相对较小,并趋于稳定;两组资料胫骨骨隧道扩大程度在各个时间段上均无统计学意义。所有病例稳定性良好,术后 Lysholm 评分在随访过程中逐步提高,两组病例在各个时间段对比无统计学意义（P ＆gt;0.05）。结论是否保留 ACL 残迹对骨道扩大、术后疗效无相关性,但保留 ACL 残迹可以促进腱-骨愈合,降低骨道扩大的发生程度。     

中药外用治疗膝关节骨性关节炎

中医认为,膝关节骨性关节炎的发病与肝肾亏虚、筋骨失养,风寒湿邪侵袭,痰瘀凝滞有关,属本虚标实之证。中药外用药多具有强筋健骨、活血通络、祛风除湿之功。研究证明,外用中药可改善局部血液循环,降低骨内压,提高自由基清除剂（SOD）活性,保护关节软骨。主要方法有中药外洗、中药熏蒸、中药热敷、中药熨烫、中药贴敷、中药离子导入等。     

保留残端纤维重建前交叉韧带对腱骨 界面愈合影响的早期临床研究

目的探讨关节镜下保留残端纤维重建前交叉韧带对腱骨界面愈合的影响。方法对48例急性前交叉韧带断裂的患者行关节镜下重建。均采用保留韧带残端纤维的前交叉韧带单束重建,股骨端应用Endo-button钢板固定,胫骨端应用可吸收挤压螺钉固定。术后随访,观察临床治疗效果,通过前抽屉试验、Lachman试验、轴移试验及Lysholm膝关节评分评价术后疗效。结果术后所有的患者均获得随访,随访时间为12~32个月,平均随访19个月。所有患者前抽屉试验阴性,46例患者Lachman试验阴性,2例Lachman试验度阳性,轴移试验检查所有患者均为阴性。Lysholm膝关节功能评分从术前54.6分改善至92.8分。术后平均10周活动度恢复至100°。复查X线片显示骨隧道愈合满意。结论采用保留残端纤维的ACL单束重建是一种恢复膝关节稳定性的可靠方法,保留残端纤维有利于腱骨愈合,有利于维持膝关节的稳定性。