髋关节滑膜软骨瘤病误诊1例

患者女,33岁,农民.因右膝关节疼痛8年、右髋部腹股沟区疼痛6年、加重半年于2001年12月入院.起病以来无发热、消瘦,无嗜酒史及糖皮质激素服用史,无外伤史.在外院曾诊断为右股骨头缺血性坏死并于1999年诊断为右髋关节结核后口服抗痨药物半年,因症状无好转自行停药.入院前行走100米后即感右髋疼痛.……     

帕米磷酸钠和降钙素对人工关节磨损微粒引起单核细胞分泌溶骨性因子的影响

目的　探讨帕米磷酸钠和降钙素防治人工关节松动的可能性。方法　采集人体外周血 ,分离单核细胞 ,分组培养。实验分 4组 ,第 1组 :仅单核细胞 ,为对照组 ;第 2组 :单核细胞及微粒 ,为微粒组 ;第 3组 :单核细胞、微粒及帕米磷酸钠 (阿可达 ) ,为阿可达组 ;第 4组 :单核细胞、微粒及降钙素 (密钙息 ) ,为密钙息组。培养 48h后 ,检测细胞上清液中肿瘤坏死因子 (TNF) α、白细胞介素 (IL) 1和IL 6的含量。结果　微粒组的细胞上清液中溶骨性因子含量明显高于对照组 (P <0 .0 1) ;而阿可达组和密钙息组的溶骨性因子含量明显低于微粒组 (P <0 .0 1)。结论　阿可达和密钙息能有效地抑制微粒刺激单核巨噬细胞分泌溶骨性因子 ,从而间接抑制破骨细胞的活性。     

人工全髋置换术中拉钩对下肢深静脉血栓影响的研究

目的：通过对髂外动静脉及股动静脉与髋臼解剖学与临床的研究，探讨在全髋臼置换术中拉钩在髋放置位置对下肢深静脉血栓的影响。方法：通过解剖学研究56具成年骨盆标本中髂外动静脉及股动静脉来源及走行、与髋臼的关系进行测量分析；并通过临床观察22例（股骨颈骨折12例、股骨头缺血性坏死6例、类风湿性关节炎4例）在人工全髋置换术（THR）中拉钩放置安全区，经下肢静脉超声多普勒检查观察下肢深静脉血栓发病率。结果：在左侧3-5点间、右侧7-9点、左侧9点、右侧3点使用拉钩用力要适度，牵拉时间过长，会造成臀下血管、股动脉的牵拉过度或时间过长，易引起下肢深静脉血栓；通过临床22例THR拉钩放置安全区的观察，无一例下肢深静脉血栓，仅有2例轻度深静脉血流缓慢、但无明显的症状体征，经过口服活血通络中药后消失。结论：通过解剖学与临床观察研究，确定在THR中拉钩放置位置、深度是避免下肢深静脉血栓的重要因素。     

改良Richard钉在髋部骨折中的应用

髋部骨折是常见骨折之一，且逐年增多。多发生于老年人，并发症多，死亡率高。应用Ｒｉｃｈａｒｄ钉治疗是目前最佳方法之一。我们将Ｒｉｃｈａｒｄ钉进行了改进，一是增加了松质骨螺钉粗螺纹长度；二是根据不同类型的粗隆下骨折，增加了套筒钢板的长度。经５２例粗隆间骨折和２１例粗隆下骨折患者的临床应用，无死亡，无髋内翻及机械装置并发症的发生。术后病人无需外固定，可早期床上及下地活动。经随访８～３８个月，平均随访时间１５．６个月，骨折全部愈合。我们认为改良Ｒｉｃｈａｒｄ钉是治疗髋部粗隆间和粗隆下骨折更为理想的内固定装置。     

高效液相法测定金樱子中三萜酸类成分的含量

定量测定不同产地金樱子中2α,3α,19α,23-四羟基乌苏-12-烯-28-羧酸的含量.采用高效液相法,色谱柱:Kromasil-C18(4.6 mm×250 mm,5 μm)柱,大连依利特公司;检测波长203 nm,柱温:35 ℃;流动相:乙腈-水(35:65),流速1 mL/min.结果表示所测成分与其他组分具有良好的分离度,线性范围为0.4～10 μg, 加样回收率为102.5%,RSD=2.66%.说明不同产地的三萜类有机酸的含量差别很大.本方法操作简单,结果准确,可用于含2α,3α,19α,23-四羟基乌苏-12-烯-28-羧酸的药物的含量测定.     

肩关节脱位手法整复的流派及发展动态

肩关节脱位指的是肩肱（或称盂肱）关节脱位，临床上十分常见，肩关节脱位通常采取手法整复，疗效确切，手法整复研究也较多，笔者参阅有关文献资料，结合自己的临床体会，对国内肩关节脱位的手法整复流派和发展动态做一整理，与同仁共飨。     

Tibial-talar dislocation without fracture: treatment principles and outcome

The incidence of tibial-talar dislocations without fracture is unknown and has been sparsely reported in the literature. The diagnosis of the injury is straightforward with the appropriate examination and roentgenograms. Good to excellent results can be achieved with open or closed dislocations treated by closed reduction and immobilization for 4–6 weeks. Although open dislocations require irrigation, debridement, and possibly delayed closure, controversy exists with regard to acute ligament repair. Because good to excellent results are possible without acute ligament repair, and delayed repair on reconstruction can be accomplished with good outcomes, we recommend treating these injuries without ligament repair.     

Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

 Objective. The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses. Design. Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Results. Digital subtraction arthrography was best (P<0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P=0.24) and scintigraphy (P=0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P=0.001), while the plain radiograph was of significant (P=0.04) additional value and scintigraphy was of no additional value (P=0.13) on multivariate analysis. Conclusion. Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.     

髋关节结核临床治疗的观察（附120例报告）

自１９５８年～１９９６年我院治疗髋关节结核１２０例，随访７４例，平均随访期１４６年，其优良率８１１％。从治疗结果看，为保持关节功能对髋关节结核以早期彻底清除病灶为主，对少数儿童、年老体弱及有手术禁忌症者可采取非手术治疗。对陈旧性结核经病灶清除而留有髋关节畸形者，可作关节成形术，髋关节功能恢复虽不满意，但结核未复发