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。     

左室假腱索与心电图异常的相关性研究进展

左室假腱索是左心室腔内除连接乳头肌和二尖瓣叶的腱索外,附着于其他部位的纤维样结构,又称左室纤维肌束.近年来研究发现,左室假腱索除具有抑制心室重构、减轻功能性二尖瓣反流以及减轻主动脉瓣下狭窄等作用外,还可能与多种心电活动异常有关.现对目前左室假腱索与心电图异常相关性的研究进展进行综述分析,为临床加深对左室假腱索的认识提供参考.     

关刺经筋结聚点治疗老年轻中度膝骨关节炎的临床观察

[目的]观察关刺经筋结聚点与常规针刺治疗老年轻中度膝骨关节炎(knee osteoporosis,KOA)的临床疗效差异。[方法]将98例老年轻中度KOA患者随机分为对照组与观察组,每组49例。对照组患者给予常规针刺治疗,观察组采用经筋结聚点关刺法治疗,治疗1次/d,5次为1个疗程,中间休息2d,连续治疗4个疗程,治疗后4周进行随访。治疗后及治疗后4周随访时比较两组患者疼痛视觉模拟量表(visual analogue scale,VAS)评分以及西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)量表评分,并统计临床疗效。[结果]治疗后及随访时两组患者VAS、WOMAC评分均较治疗前降低(均P0.05),且观察组低于对照组(均P0.05);观察组总有效率为87.8%,高于对照组的75.5%,差异有统计学意义(P0.05)。[结论]关刺经筋结聚点治疗老年轻中度KOA患者疗效优于常规针刺,能够降低KOA患者VAS、WOMAC评分,缓解关节疼痛、僵硬症状,改善关节功能,并且疗效持续时间长。     

The proximal hamstring muscle-tendon-bone unit: A review of the normal anatomy, biomechanics, and pathophysiology

Proximal hamstring injuries occur during eccentric contraction with the hip and the knee on extension; hence they are relatively frequent lesions in specific sports such as water skiing and hurdle jumping. Additionally, the trend toward increasing activity and fitness training in the general population has resulted in similar injuries. Myotendinous strains are more frequent than avulsion injuries. Discrimination between the two types of lesions is relevant for patient management, since the former is treated conservatively and the latter surgically. MRI and Ultrasonography are both well suited techniques for the diagnosis and evaluation of hamstring tendon injuries. Each one has its advantages and disadvantages. The purpose of this article is to provide a comprehensive review of the anatomy and biomechanics of the proximal hamstring muscle-tendon-bone unit and the varied imaging appearances of hamstring injury, which is vital for optimizing patient care. This will enable the musculoskeletal radiologist to contribute accurate and useful information in the treatment of athletes at all levels of participation.     

Extensor tendons of the fingers: Arrangement and variations-ii

One hundred eighty-one dissected hands were examined to study the pattern of extensor tendons on the dorsum of the hand. Extensor digitorum often had multiple tendons for the middle and ring fingers. Its contribution to the little finger was usually by a bifurcating tendon common with that of the ring finger. The index finger always received a single tendon. Intertendinous connections between the various tendons of the extensor digitorum were variable but were most frequent between ring and middle fingers. Extensor indicis had one tendon in most of the specimens and it was always on the ulnar side of the extensor digitorum tendon. This remained true even when there were multiple tendons. Extensor digiti minimi had two tendons in most cases. It was always linked to extensor digitorum either by receiving one or part of its tendon or by an intertendinous connection. Two accessory muscles were seen, one was extensor indicis brevis replacing the proper muscle. The other, the extensor medii brevis, was distributed to the middle finger. © 1995 WiIey-Liss, Inc.     

推拿手法治疗颈椎病临床观察

目的　观察推拿手法治疗颈椎病的作用、疗效及其机理。方法　将 2 34例颈椎病患者分为推拿手法治疗组 189例和西医保守对照组 4 5例 ,对各组治疗前后的临床症状、体征进行观察 ,同时对推拿手法治疗本病的疗效及其与本病的病理分型、病程之间的关系做了比较研究。结果　①推拿手法在改善颈痛、颈痛伴上肢痛、头痛以及头晕等方面有着显著性作用 (P <0 0 0 5 ) ;对因压迫神经血管引起的肌肉萎缩的作用极为有限 ,与治疗前相比 ,没有显著性差异。②推拿手法治疗本病的作用与对照组相比有着显著性差异 ,优于对照组 (P <0 0 5 ;P <0 0 1)。③推拿治疗颈椎病的疗效 ,主要与分型、病程有关。结论　推拿手法治疗颈椎病疗效可靠 ,应根据临床分型配合不同手法治疗以获得最佳疗效。     

关节镜下四股腘绳肌腱单束重建膝关节后交叉韧带

[目的]评估关节镜下四股腘绳肌腱单束重建膝后交叉韧带（PCL）的技术和效果。[方法]自2001年4月～2004年10月，49例病人（49膝）经关节镜检查证实为PCL断裂，其中13膝伴前交叉韧带断裂，14膝伴后外侧角损伤，6膝伴后内侧角损伤，9膝伴外侧半月板破裂，5膝伴内侧半月板损伤，2例伴膳动脉损伤，4例伴腓总神经损伤。均于关节镜下行自体四股膳绳肌腱单束PCL重建术，采用Bionx生物可吸收挤压螺钉或钛挤压螺钉解剖位固定重建韧带。[结果]本组术后早期均未发生严重并发症。术后随访10～52个月，平均22个月，Lysholm膝关节功能评分由术前30～60分（平均47．96分），提高至随访时70～95分（平均89．08分）（P〈0．01）。国际膝关节文件编制委员会（IKDC）综合评定由术前异常（C级）10例、显著异常（D级）39例，改进为随访时正常（A级）20例、接近正常（B级）24例、异常（C级）5例（P=0．0000）。49例患者中，40例恢复伤前运动水平，9例运动水平较伤前减低。[结论]关节镜下自体四股腘绳肌腱单束重建膝PCI．管伤小、手术操作简捷，术后膝关节功能恢复满意。     

Biochemical properties of collagen from ligaments and periarticular tendons of the human knee

The biochemical properties of collagens from the periarticular connective tissues of the human knee (ligaments, semitendinosus and gracilis tendons, and the iliotibial band) were investigated in subjects ranging from 20 to 70 years of age. Although the total collagen content of most tissues was more than 90% of the dry weight, the anterior cruciate ligament and the iliotibial band had relatively low collagen contents. There were no significant changes in the tissue collagen content with aging. However, the anterior cruciate ligament and the patellar tendon of the 20-year-old subject had a higher content of soluble collagen than the other ligaments and tendons. The iliotibial band of the 20-year-old subject contained more collagen that was soluble by a combination of salt, sodium citrate extractions and pepsin digestion. Dihydroxylysinonorleucine was the major reducible cross-link of collagen from all the ligaments. The amount of dihydroxylysinonorleucine in the anterior cruciate ligament of the 20-year-old subject was much higher than that in the other ligaments. In contrast, the tendons and the iliotibial band contained a large amount of histidino-hydroxymerodesmosine and hydroxylysinonorleucine, while the patellar tendon was the only tendon with a significant content of dihydroxylysinonorleucine. Hydroxypyridinium non-reducible cross-links were more abundant in collagens from ligaments than in collagens from the other tissues. The cross-link study and the analysis of collagen solubility showed that patellar tendon collagen more closely resembled the collagen from the anterior cruciate ligament than that from periarticular tendons. It was also shown that the anterior cruciate ligament contains relatively immature collagen compared with the other ligaments. Our findings may contribute to an improved understanding of the functions of the ligaments and tendons around the knee joint. In addition, the data may provide some useful pointers that will help in selection of periarticular tissues as appropriate substitutes for ligament replacement.     

Fallbeispiel: Feuchtigkeit-Hitze,die die Sehnen schädigt – nur scheinbar ein Fall einer Außenstörung

The case report explains the successful treatment of a 39 year old male patient suffering from sensory disorders with a suspicion of encephalomyelitis disseminata. A modified traditional Chinese herbal recipe, with acupuncture in a supporting role, was used. The origin of the traditional Chinese pattern diagnosis (damp heat which damages the tendons) will be discussed, and the diagnosis itself will be used as the basis for the formulation of guiding principles in the choice of recipe.