Impairment of bone turnover in elderly women with hip fracture

Summary Hip fracture is one of the most severe consequences of osteoporosis affecting aged women. However, abnormalities of bone turnover responsible for bone loss in this condition have not been clearly defined. To further evaluate the bone metabolic status of women sustaining hip fracture, we have prospectively measured serum osteocalcin as a marker of bone formation and urinary excretion of pyridinoline (Pyr) and deoxypyridinoline (D-pyr) cross-links as markers of bone collagen degradation in 174 independently living women (80 ± 8 years) within a few hours after a hip fracture. Comparison was made with 77 age-matched controls (80 ± 5 years) and 17 premenopausal women (39 ± 3 years). In addition 15 of the patients were followed with daily measurements during the first postoperative week. At the time of admission osteocalcin was 20% lower in the fractured women compared to the elderly controls (7.6 ± 3.8 vs. 9.5 ± 4.5 nglml,P = 0.001). Pyr and D-pyr were 36% and 40% higher, respectively (P = 0.0001), than in elderly controls and 85% and 76% higher than in premenopausal controls (P = 0.0001). Serum osteocalcin did not correlate with the cortisol level measured at the same time (r = 0.03, ns), nor with serum albumin and creatinine. Serum osteocalcin remained unchanged within 18 hours after fracture, whereafter it progressively decreased until the third postoperative day. No correlation was noted between the excretion of pyridinoline cross-links and the time elapsed from fracture.These data suggest that the abnormal levels of osteocalcin and pyridinolines are unrelated to traumatically induced acute changes, but reflect abnormalities of bone turnover existing prior to the fracture. Thus, hip-fracture patients have biochemical evidence of decreased bone formation and increased bone resorption when compared to age-matched controls. We suggest that these abnormalities may play a role in the decrease of the bone mass and the consequently increased bone fragility that characterize the osteoporotic hip fracture in the elderly.     

AO肩锁钢板钩治疗重型肩锁关节脱位

目的评估AO肩锁钢板钩治疗重型肩锁关节脱位的手术疗效.方法回顾性分析两年来27例手术病人的手术治疗和疗效.结果手术方法符合生理结构,手术时间平均30分钟,内固定牢靠.根据Murley和Constant[1]评分,优良率94%.结论 AO肩锁钢板钩治疗重型肩锁关节脱位,手术方法简单,疗效可靠,允许病人术后早期功能锻炼.     

Acoustic transmission in normal human hips: structural testing of joint symmetry

An acoustical technique has been developed for the measurement of structural symmetry of the hip joints. A mild vibratory force was applied to the sacrum and sound signals were picked up at both hips by a pair of microphones installed in two stethoscopes. These stethoscope–microphone assembles were calibrated to achieve a difference in relative sensitivity of less than 0.2 dB. The relative transmission of sound signals was analysed and compared between both hips by a dual-channel signal analyser. Twenty-seven healthy adults, 20 healthy pre-school children and 19 normal neonates were tested. Results from these three groups showed high coherence of the sound signals and that the discrepancy between both hips was smallest in the frequency range of 200–315 Hz. For normal neonates, the sound signals maintained a high coherence (γ²>0.97) and small discrepancy (D<1.25 dB) between both hips. This study has shown that the acoustical technique provides a practical structural testing for bony symmetry of the hips and the results offer a baseline for further investigation into developmental dysplasia of the hip (DDH) in neonates. Clinical screening for DDH is still problematic in developing countries.     

全髋关节置换术均衡双下肢长度的探讨

目的探讨全髋关节置换术均衡双下肢长度的临床意义和手术设计。方法回顾分析2000-2004年获得随访的单侧全髋关节置换手术病例48例,采用骨水泥型假体12髋,混合型假体36髋,术前双下肢等长30例(含股骨颈骨折患者),10例患肢长度短缩1.0-2.0cm,6例短缩2.0-4.0cm,2例短缩4.0-6.0cm。通过术前肢体长度测量及X片测量制定手术方案,选择假体、预估颈长和截骨平面;术中正确磨削髋臼,寻找最佳旋转中心,结合透视及特殊试验修正截骨平面,调节假体颈长,达到均衡双下肢长度的目的。结果全部病例采用Harris评分,优30例,良12例,中4例,差2例。术前等长30例巾术后出现5例手术侧延长1.0-2.0cm,1例延长2.5cm。术前不等长的18例中,术后恢复等长10例,6例手术侧延长1.0-2.0cm,2例术前重度短缩的先天性髋关节发育不良病人术后仍然短缩2.0-3.0cm。术后肢体等长35例Harris评分平均92.3分,术后肢体不等长13例Harris评分平均88.6分。结论全髋关节置换术的手术设计。手术技巧以及假体设计等诸多因素影响下肢长度,术后肢体不等长降低了患者的满意度。应重视术前测量及术中综合评价方法的运用,重视软组织平衡技术和肢长调节,掌握全髋置换术中均衡下肢长度的手术技术,进一步改善手术效果。     

Anatomic basis of the transgluteal approach to the hip-joint by anterior hemimyotomy of the gluteus medius

The authors present a study of the intrinsic anatomy of the gluteus medius m. and of its innervation through the caudal branch of the superior gluteal n. The existence of an intramuscular tendon in the thickness of the gluteus medius was constantly prooved in 40 muscles. The relations of the intrinsic fibrous structure of the muscle and its innervation were studied. The authors deduce from that the topography of a gluteus medius incision, with respect to a safety area towards its innervation, which leads to an exposure of the acetabulum that is satisfying and gives opportunities of a sound repair after the surgery of the hip joint through the transgluteal approach. They propose the anterior hemimyotomy of the gluteus medius m designation.

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Bases anatomiques de l'abord transglutéal de la hanche par hémimyotomie antérieure du muscle moyen fessier

Résumé Les auteurs présentent une étude de l'anatomie intrinsèque du m. moyen fessier (MF) et de son innervation par le rameau caudal du n. glutéal supérieur (NGS). 40 muscles ont été étudiés. L'existence d'une lame tendineuse dans l'épaisseur du MF a été constamment mise en évidence. Les rapports entre les éléments de l'architecture fibreuse intrinsèque du muscle et son innervation ont été étudiés. Les auteurs en déduisent la topographie d'une incision du MF respectant une zone de sécurité vis à vis de son innervation, procurant une exposition acétabulaire satisfaisante et des possibilités de réparation solide après chirurgie de l'articulation coxo-fémorale par voie d'abord transglutéale, et proposent la dénomination hémimyotomie antérieure du MF.

     

肩锁关节及关节盘的相关解剖学特征

背景:目前临床上多数认为,肩部疾病如肩锁关节脱位、肩峰下撞击综合征等与肩锁关节的解剖形态有很大的关系,但国内外文献很少有关于肩锁关节的形态学数据支持,特别对于肩锁关节关节盘的解剖学研究。同时肩锁关节属于微动关节,参与肩关节的联合运动,现临床上有关肩锁关节脱位的手术方式繁多,较流行的手术方式多为刚性固定,并未保留其微动特点以及锁骨和肩胛骨的运动特点,其中关节盘的取舍目前国内外并无大样本多中心对照研究。目的:对肩锁关节及关节盘行相关解剖学研究,用于更好地指导肩部疾病的诊治。方法:对58具肩锁关节尸体标本(同济大学解剖教研室提供)进行形态学及组织结构研究,共获得58个肩峰、58个锁骨和36个关节盘(包括完全型和不完全型)。采用BIGLIANI肩峰形态分型、DEPALMA锁骨形态分型、EMURA肩锁关节盘分型,获得各肩峰与锁骨组合下关节盘出现的频率并行苏木精-伊红染色(上海市普陀区人民医院提供)。结果与结论:①在58个肩锁关节尸体中,肩锁关节盘type1型共15例,所占比例最高,为25.9%;type3a型共4例,所占比例最少,为6.9%。②Ⅰ型肩峰32个,所占比例最高,为55.2%;Ⅲ型肩峰3个,所占比例最低,为5.2%。③Ⅰ型锁骨27个,所占比例最高,为46.6%;Ⅲ型锁骨9个,所占比例最低,为15.5%。④以Ⅰ型及Ⅱ型肩峰与Ⅰ型锁骨组合所占比例较大,分别为24.1%和22.4%,以Ⅲ型肩峰对Ⅰ型锁骨所占比例最小,为0%。⑤而在Ⅰ型肩峰与Ⅰ型锁骨组合下type1型和type2b型关节盘所占比例最大,分别为35.7%和28.6%;Ⅱ型肩峰与Ⅰ型锁骨组合下type2a型和type1型关节盘所占比例最大,分别为38.5%和23.1%。⑥苏木精-伊红染色在组织切片中可以发现,关节盘中的细胞外基质清晰可辨,细胞形态饱满,含有丰富的细胞质,提示为软骨细胞,即形成纤维软骨的主要成分。此外,从关节囊顶端和底端两侧可见部分骨膜纤维层移行至关节盘内侧,考虑共同组成关节盘结构,即关节盘由近骨面的软骨细胞及远离骨面的纤维层共同构成。     

桡侧腕屈与腕长伸肌腱部分转位修复手部关节脱位应用解剖

目的 :为桡侧腕屈与腕长伸肌腱部分转位修复桡尺远侧及第 1腕掌关节脱位提供解剖学基础。方法 :3 0侧成人上肢标本 ,分别对桡侧腕屈肌腱、桡侧腕长伸肌腱进行形态学测量。结果 :桡侧腕长伸肌腱性部长 ( 17.8± 2 .6)cm ,肌腱的上、中、下段宽分别为 ( 13 .7± 3 .1)、( 5 .6± 1.1)和 ( 4 .6± 0 .5 7)mm肌腱的上、中、下段厚分别为 ( 1.5± 0 .5 )、( 2 .0± 0 .3 )和 ( 2 .4± 0 .3 )mm。桡侧腕屈肌腱性部长 ( 14 .3± 1.1)cm ,肌腱的上、中、下段宽分别为 ( 9.11.4)、( 5 .5± 0 .9)和 ( 4 .0± 0 .4) ,肌腱的上、中、下段厚分别为 ( 2 .4± 0 .6)、( 2 .2± 0 .4)和 ( 2 .6± 0 .5 )mm。结论 :采用桡侧腕屈肌腱和桡侧腕长伸肌腱部分转位 ,有足够的长度和强度 ,适用于桡尺远侧关节或第 1腕掌关节脱位的修复 ,临床应用获得良好效果     

Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula

In a cadaveric instability model that leaves all muscles intact initially, we studied anteroinferior glenohumeral dislocation behavior after section of the ligaments on the humeral side of the joint. In this study, the latissimus dorsi seemed to play a role when complete section did not result in a locked anteroinferior dislocation. We therefore initiated a study to test the hypothesis that the latissimus dorsi may, in certain circumstances, depending on variations in its anatomy, influence dislocation behavior. Here, in Part I, we present the results of the anatomic study of latissimus dorsi and its tendons. The anatomy of the latissimus dorsi pertaining to the scapula and humerus was studied in 100 cadaver specimens. The distance between the uppermost part of the tendon of both the latissimus dorsi and the teres major and the edge of the articular cartilage of the humeral head (tendon-cartilage distance, TCD) as well as the width and length of the tendons were measured. Furthermore, the relationship between latissimus dorsi and the inferior angle of the scapula was studied. The tendon of the latissimus dorsi inserted at a variable distance from the cartilage of the humeral head: the TCD ranged from 12.6 to 31.6 mm (mean 21.06 mm+/-5.11 mm). The latissimus dorsi can have muscular fibers arising from the inferior angle of the scapula (type 1 scapular connection, 43%). Alternatively, there may be only a few fibrous strands between the muscle and the scapula or there may be an intervening bursa (type 2 scapular connection, 57%). This variability in the morphology of the latissimus dorsi may be a factor explaining the differences observed in a study of humerus-based sequential cutting of the glenohumeral capsule. This possibility is explored in Part II of the study. The latissimus dorsi may also complete the tendinous protection of the humeral side of the capsule generally provided by the rotator cuff.     

经舟骨月骨周围脱位的诊断和治疗

目的 探讨经舟骨月骨周围脱位的诊断和治疗。方法 回顾性分析17例经舟骨月骨周围脱位病例，背侧型13例，掌侧型4例；新鲜损伤组10例中8例行撬拨复位成功，仅2例因舟骨对位不良接受手术治疗；陈旧性组7例中均接受手术，4例行开放复位内固定，3例行近排腕骨切除术。结果 采用Cooney评价标准，优11例，良3例，可1例，差2例，优良率82．35％。结论 经舟骨月骨周围脱位的早期治疗简单且疗效较好，而一旦误诊，则多数需手术治疗，且残留不同程度的功能障碍。提高对本病损伤机制、腕部体征和影像学特点的认识和了解，减少误诊。是提高本病预后的关键因素之一。     

Male with type II autosomal recessive cutis laxa

A 5-year-old boy, who had pre- and postnatal growth retardation, delayed motor development, cutis laxa, delayed closure of large fontanels, congenital hip dislocation and characteristic facies, is described. Disorders with cutis laxa are now divided into five types. The patient had clinical manifestations very similar to those of cutis laxa with bone dystrophy (type II autosomal recessive cutis laxa). Eighteen patients have been reported, the ratio of males to females being 5 to 14. This is the fifth case of this disorder occurring in a male, which provides further evidence for autosomal recessive inheritance.