用带血管的腓骨近段重建桡腕关节的临床研究

用绘图法对１５具尸体１５对腓骨小头的胫腓关节面及桡骨腕关节面进行了解剖学的对比研究，观察关节面形态，测量其长径、横径、关节面倾斜角度、曲率半径，发现腓骨小头的胫腓关节面和桡腕关节面解剖相似。在此基础上，临床应用带血管腓骨近段移植重建桡腕关节４例收到良好的疗效，根据Ｇｒｅｅｎ评分标准，腕关节评分为７０～８５分。     

膝关节 Q 角变化规律的实验研究

本研究利用精密三维位移测读仪，研究分析了Ｑ角的变化趋势，以及对髌股关节运动的影响。研究结果表明，Ｑ角是一空间夹角，随屈膝角的增大而增大。力线在平面上的投影所呈的平面夹角Ｑｐ也就是通常所指的Ｑ角，在屈膝１５°左右达最大，而在９０°左右达最小。整个屈膝过程中，ＱＰ在５°－１５°之间变化，变化幅度达１０°左右。     

Dislocation of the second through fifth carpometacarpal joints

We report a case of dislocation of the second through fifth carpometacarpal joints and review the mechanism of injury and radiographic findings in such injuries.     

Normal morphology of sacroiliac joints in children: magnetic resonance studies related to age and sex

Objective. To determine in a prospective study the normal MRI morphology of the sacroiliac joints (SIJs) in relation to age and sex during adolescence. Design and patients. A total of 98 children (63 boys, mean age 12.7±2.8 years; 35 girls, mean age 13.7±2.3 years), ranging in age from 8 to 17 years, with juvenile chronic arthritis (JCA) but without signs of sacroiliitis fulfilled the study prerequisites (no back pain and no pathologic changes of the SIJs on physical examination before MRI in a 1.5-year follow-up). An additional eight HLA-B27-negative boys and eight HLA-B27-negative girls without arthritis served as controls. The MRI protocol comprised a T1-weighted SE sequence, an opposed-phase T2*-weighted GE sequence, and a dynamic contrast-enhanced study in single-section technique. Results. Noncontrast MRI permitted differentiation of “open” from ossified segmental and lateral apophyses of the sacral wings, with a significant difference in age (P <0.05) between children with open and ossified apophyses. Ossification of the apophyses of the sacral wings was seen significantly earlier (P <0.05) in girls than in boys. Girls also had a significantly higher incidence of transitional lumbosacral vertebrae, pelvic asymmetries, and accessory joints. In the contrast-enhanced opposed-phase MRI study, normal cartilage of the SIJs showed no contrast enhancement whereas the joint capsule showed a moderate enhancement. Conclusion. There are significant age- and sex-related differences in the normal MRI morphology of juvenile SIJs. Our findings might serve as a standard of comparison for the evaluation of pathologic changes – in particular for the early identification of juvenile sacroiliitis.     

羊间接性颞下颌关节损伤后髁突软骨中基质金属蛋白酶-3表达及其意义

目的 探讨基质金属蛋白酶-3(matrix metalloproteinase-3，MMP-3)在羊颞下颌关节((temporomandibular joint，TMJ))间接创伤后骨关节病发生中的作用。方法 用自制撞击装置造成山羊双侧颞下颌关节间接性创伤，分别于伤后1周、1，3，6个月取TMJ髁突软骨，并以正常TMJ作为对照，用免疫荧光组织化学方法观察MMP-3的表达。结果 TMJ髁突软骨中MMP-3伤后1个月表达开始增强，后期进一步增强；荧光着色于软骨破坏区及增生的滑膜样组织、软骨肥大带及骨髓内较强，正常对照组基本呈阴性反应。结论 MMP-3参与了TMJ创伤所致TMJ骨关节病过程，并起了重要作用。     

板股韧带的MRI研究及临床意义

目的　明确板股韧带正常MRI表现 ,建立由它所致假撕裂与外侧半月板后角真撕裂的鉴别方法。资料与方法　采用 6 0侧正常膝进行矢状和冠状位MR扫描 ,观察板股韧带的MRI表现。结果　板股韧带显示率为88.3% (5 3侧 ) ,其中板股前韧带为 2 6 .7% (16侧 )、板股后韧带为 86 .7% (5 2侧 )和两条韧带同时存在为 2 3.3% (14侧 )。板股韧带在矢状像上表现为位于后交叉韧带前或后方的类圆形或短棒状低信号结构 ,而在冠状像上表现为自外侧半月板后角至股骨内侧髁外侧面的条带样低信号结构。在矢状像上 ,5 2 .8% (2 8/5 3)板股韧带与外侧半月板后角之间显示出一线样高信号 ,被称为假撕裂 ,易与外侧半月板后角撕裂混淆。但假撕裂仅有两种走行方向即后下斜行 (2 1/2 8)或垂直方向 (7/2 8)。结论　根据假撕裂位置、方向以及冠状像和连续矢状面的观察 ,可正确区分外侧半月板后角真假撕裂     

Rotational acetabular osteotomy for acetabular dysplasia of the hip with a giant acetabular bone cyst: a case report

In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum.     

踝关节骨折脱位的治疗

踝关节骨折脱位为临床常见损伤之一，若处理不当，易并发创伤性关节炎。现将我科1996年3月～2001年10月住院治疗的53例患者的治疗方法及疗效进行总结。