关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱一期重建膝关节前后交叉韧带

目的 探讨关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱同时重建膝关节前后交叉韧带的近期临床效果.方法 对2004年6月～2005年3月收治的10例膝关节前后交叉韧带同时断裂的患者,切取双侧腘绳肌腱,2条半腱肌腱和2条股薄肌腱分别对折成四束,折端固定同直径EndoPearl.关节镜下利用两组移植物同时分别重建膝前后交叉韧带.股骨端应用可吸收界面螺钉顶压固定EndoPearl与移植肌腱,胫骨端应用Intrafix固定四束肌腱.结果 10例均获得随访,平均7.5个月(6～15个月),切口Ⅰ期愈合,无感染.其中新鲜损伤4例,陈旧性损伤6例,合并后外侧复合体损伤3例,均予同期修复,合并内侧副韧损伤6例,未予特殊处理,5例曾急诊修复腘动静脉.术后3个月膝关节活动范围均超过120°,无伸膝受限,后抽屉试验Ⅰ度阳性2例,其余为阴性;Lyshlom评分(92.6±3.2)分.结论 关节镜下应用EndoPearl与Intrafix固定双侧腘绳肌肌腱同时重建膝关节前后交叉韧带方法确切,可有效恢复膝关节功能.     

Motor unit territory in relation to tendons in the human masseter muscle

In the human masseter, motor-unit (MU) territories are reportedly focal and it is possible that they are confined to the muscle's internal aponeuroses. However, previous electromyographic (EMG) investigations of MU sizes have not correlated them with the muscle's internal architecture. In this study, 162 single-MU territories were assessed by scanning EMG recordings throughout the masseter muscles of 4 subjects. The needle-electrode scans were stereotactically located with magnetic resonance imaging and an optical system capable of tracking the needle movement in three dimensions. Mediolateral territorial dimensions were then displayed graphically within muscle reconstructions. The mean territorial width was 3.7 ± 2.3 mm and varied between 0.4 and 13.1 mm. The widths were comparable in size to those of previous reports, and were related to the subject's muscle size. Most MU territories were confined, and lay between tendons, although 10% of the units clearly extended across at least one tendon. The dispersion of most territories within discrete tendon-bounded compartments in the masseter provides an anatomical basis for selective activation of the muscle. However, it is also possible that this arrangement provides a flexible means for ensuring tendon stiffness and mechanical adaptation of the multipennate masseter during growth and development, whether or not the muscle is activated selectively. © 1994 John Wiley & Sons, Inc.     

中轴远距离包埋缝合法治疗屈肌腱断裂

目的 :为了克服肌腱术后早期活动所需的张力 ,更有效地减少肌腱粘连 ,寻找一种有效的屈肌腱缝合法。方法 :用中轴远距离包埋法缝合 15例 2 4条肌腱 ,术后 72h早期伸屈活动。结果 :全部病例得到随访 ,随访时间为 6～ 12mo ,平均为 10mo ,按TAM评定方法评定疗效 :优 :16条 ;良 :5条 ;差 :3条。优良率为 87 5 % ,无一例断裂。结论 :中轴远距离包埋缝合法操作简单 ,抗拉强度足够临床需要 ,术后可早期进行主动屈指活动     

拉筋牵曲法结合四黄悬液外敷治疗桡骨远端骨折临床观察

目的:观察拉筋牵曲法结合四黄悬液外敷治疗桡骨远端骨折的临床疗效。方法:选取2012年7月一2015年6月本院治疗的桡骨远端骨折患者22例,随机分为四黄悬液外敷组10例和单纯石膏托组12例。两组患者均给予伤科跌打胶囊口服治疗,四黄悬液外敷组给予拉筋牵曲法结合四黄悬液外敷治疗,单纯石膏托固定组给予闭合手法正骨石膏托固定治疗。结果:四黄悬液外敷组骨折二期愈合时间优于单纯石膏托组(P0.05);单纯石膏托组优良率75.0%,四黄悬液外敷组优良率100.0%,四黄悬液外敷组优于单纯石膏托组(P0.05)。结论:拉筋牵曲法结合四黄悬液外敷治疗桡骨远端骨折疗效显著,缩短骨折愈合时间,能促进腕关节功能恢复。     

A Quantitative and Comparative Analysis of the Muscle Architecture of the Forelimb Myology of Diurnal Birds of Prey (Order Accipitriformes and Falconiformes)

Flight is a key feature in the evolution of birds. Wing anatomy reflects many aspects of avian biology such as flight ability. However, our knowledge of the flight musculature has many gaps still, particularly for the distal wing. Therefore, the aim of this work was to investigate the form–function relationship of the forelimb myology of birds to understand the role of individual muscles during flight. Dissections of six species of birds of prey were performed to collect numerical data of muscle architecture, which is the primary determinant of muscle function and force-generation capacity. Birds of prey are a highly diverse group that presents different flight styles throughout the taxa, making them a good model for our purposes. Wing muscle mass (MM) isometrically scaled with body mass^1.035, muscle length to MM^0.343, and fascicle length (FL) scaled allometrically to MM^0.285. The shoulder musculature scaled differently than the other regions where the FL increases more slowly than would be expected in geometrically similar animals, which affects flight mechanics. A proximal-to-distal reduction of MM occurs, which helps to minimize the wing moment of inertia during flight while allowing precise control of the distal wing. Interestingly, the distribution of MM appeared to be species-specific, suggesting a functional signal. This study provides numerical information of muscle architecture of the avian wing that helps us to understand muscle function and its implication in flight, and can be used in future studies of flight mechanics. Anat Rec, 302:1808–1823, 2019. © 2019 American Association for Anatomy     

Bone tunnel enlargement following hamstring anterior cruciate ligament reconstruction: a comprehensive review

Nowadays, bone tunnel enlargement (BTE) after anterior cruciate ligament reconstruction is a well-known phenomenon. It has been identified, investigated and described by many authors during the last thirty years. Nevertheless, the etiology of bone tunnel enlargement still remains unclear. It is known that the causes are multifactorial and may include the surgical technique, the method of fixation, materials used, type of graft as well as biological factors. Due to the recent popularization of the use of hamstring grafts in anterior cruciate ligament reconstruction, the bone tunnel enlargement phenomenon is becoming increasingly common. In this review article, the authors focus on compiling current knowledge about the etiology, diagnosis, and the possibility of reducing the occurrence of this phenomenon by using the latest methods of supporting reconstruction surgery.