Forces and moments on the human leg in the frontal plane during static bipedal stance.

An experimental apparatus was assembled that permitted measurement of the vertical and lateral ground reaction forces as the hip is abducted, resulting in foot separations ranging from 0.25 to 71 cm, with the knee in 0 degree flexion. Twelve healthy volunteers (8 men and 4 women) were tested. The hip joint was located by means of center of rotation measurements on each subject's legs, and the location of the knee joint was determined using anatomical measurements. It was observed that the mediolateral force was nonzero and directed toward the body midline, even when the subject's feet were placed together. With the feet placed at shoulder width, the population mean mediolateral force was 3% of body weight. It was determined that simplifying assumptions based upon either "zero lateral force," or "zero hip moment," produced errors, when compared with our measured values, over various ranges of foot separation, with the zero hip moment assumption providing accuracy over a broader range. The inclination of the tibial plateau, with respect to the long axis of the tibia, that would produce minimal mediolateral shear at the knee is presented. Research and clinical applications of our results and techniques are discussed.     

Gliomatosis peritonei: the value of a "second look" operation.

The case history of a 10-year-old black girl with gliomatosis peritonei, Grade 0, is presented. The primary tumour was resected and a "second look" operation carried out 3 months later. The glial implants demonstrated distinct circumferential and intra glial fibrosis (resolution). Because the peritoneal implants had undergone resolution, further therapy became unnecessary. We believe gliomatosis peritonei fully justifies a second laparotomy in order to be able to accurately grade the implants. The grade of the peritoneal implants influences the prognosis and therefore determines the type of therapy to be instituted.     

颞骨岩部胆脂瘤

目的：探讨岩部胆脂瘤的临床特征及手术方法。方法：经迷路前上径路手术治疗1例，经迷路-耳蜗径路手术治疗8例。结果：术后8例随访2-9年，局部无胆脂瘤复发，其中2例面神经全程减压，术后未能恢复；1例术后2个月出现面肌运动，7个月后恢复正常，1例术后仅2个月，有待随访。结论：根据病变部位及侵犯范围选择适当的手术途径；术腔内填塞脂肪，封闭外耳道可防止脑脊液外漏。     

矢状窦旁脑膜瘤的手术治疗(附39例报告)

目的 提高矢状窦旁脑膜瘤的手术疗效。方法 对39例经手术治疗的矢状窦旁脑膜瘤的临床资料进行回顾性分析，探讨该病的诊断、手术方法、受累矢状窦的处理及对无法全切除之残瘤的补充治疗。结果 本组39例无1例死亡。随访34例，其中3例分别于手术后1年、1．5年、2年复发，均为无法全切除而术后又未行补充治疗者；其余31例随访9个月～11年，未发现复发。结论 矢状窦旁脑膜瘤应尽可能行肿瘤全切除手术，术后辅以放疗可提高疗效。     

国产自体-2000型血液回收机临床应用探讨

目的探讨由北京精医疗设备有限公司研制的自体-2000型血液回收机的临床应用效果。方法自2002年6月～2003年12月,我院应用北京精医疗设备有限公司自体-2000型血液回收机进行术中回收血液100例,其中男41例、女59例,年龄12～63岁,体重19～68公斤,手术包括外伤如肝破裂、大血管损伤、破裂脊柱外伤、脑外伤、器官移植手术。术中监测心电图、血压、血氧饱和度、尿量。结果全组病例中,总手术时间62～180分钟,平均102分钟,全部患者抢救成功,无死亡,无出现血尿现象。结论自体-2000型血液回收机安装使用安全、可靠、操作方便、血液回收效果好,经过滤、分离、清洗、净后再输回病人可以节约大量用血,又能避免异体输血传染疾病,是一种值得在临床广泛推广的国产血液回收机。     

经去颧弓扩大颞下入路切除海绵窦,岩尖,上斜坡肿瘤

本文介绍采用改进的去颧弓扩大颞下入路手术治疗８例位于或累及海绵窦、岩骨尖部、上斜坡、天幕游离前外缘肿瘤患者。该方法的要点是断去颧弓，扇形形成颞肌瓣，翻向颧弓断段以下，咬除蝶骨嵴外侧部分，形成低位颞额骨窗，仅轻度上抬颞叶，则可充分暴露病变范围。由于手术空间扩大，更利于肿瘤切除。本组８例均达到全部或大部分切除，患者术后均得以康复，原有体征不同程度改善。     

输卵管妊娠保留输卵管手术后综合疗法的宫内妊娠探讨

对输卵管妊娠52例有生育要求者，其中28例行切开输卵管壶腹部取胚胎术，10例行输卵管峡部破裂口修补术，7例行输卵管伞部成形术，5例行输卵管峡部端端吻合术，2例行输卵管子宫角部植入术。术后给MTX与中药等综合治疗2～5个月，对其中45例行输卵管通畅检查，双侧输卵管通畅4O例，通畅率为88.9％；有41例宫内妊娠，妊娠率为78.9％，另有1例再次异位妊娠。提示：对有生育要求的输卵管妊娠尽量根据输卵管的不同情况采用相应的手术方法，并应用有效的术后综合措施，对保留患者的生育功能和提高妊娠率有重要意义。     

Do the hamstrings and adductors contribute to excessive internal rotation of the hip in persons with cerebral palsy?

Children with cerebral palsy frequently walk with excessive internal rotation of the hip. Spastic medial hamstrings or adductors are presumed to contribute to the excessive internal rotation in some patients; however, the capacity of these muscles to produce internal rotation during walking in individuals with cerebral palsy has not been adequately investigated. The purpose of this study was to determine the hip rotation moment arms of the medial hamstrings and adductors in persons who walk with a crouched, internally-rotated gait. Highly accurate computer models of three subjects with cerebral palsy were created from magnetic resonance images. These subject-specific models were used in conjunction with joint kinematics obtained from gait analysis to calculate the rotational moment arms of the muscles at body positions corresponding to each subject’s internally-rotated gait. Analysis of the models revealed that the medial hamstrings, adductor brevis, and gracilis had negligible or external rotation moment arms throughout the gait cycle in all three subjects. The adductor longus had an internal rotation moment arm in two of the subjects, but the moment arm was small (<4 mm) in each case. These findings indicate that neither the medial hamstrings nor the adductor brevis, adductor longus, or gracilis are likely to be important contributors to excessive internal rotation of the hip. This suggests that these muscles should not be lengthened to treat excessive internal rotation of the hip and that other factors are more likely to cause internally-rotated gait in these patients.     

马根维显动态增强核磁共振评价肾积水疗效

目的了解马根维显(Gd-DTPA)动态增强核磁共振(MRI)评估肾积水术后疗效的应用价值。方法单侧肾积水患者11例,年龄7～42岁,平均19.5岁,均为男性;左侧肾积水9例,右侧2例;病因经静脉尿路造影(intravenousurography,IVU)和B超确诊,10例为先天性肾盂输尿管连接部狭窄(pelvicureterjunctionobstruction,PUJO),1例为输尿管中段慢性炎症所致不完全性梗阻;10例PUJO实施狭窄部成形术,另1例施行输尿管狭窄段切除并输尿管端端吻合术。应用Gd-DTPA作为对比剂,分别在术前1个月和术后3个月实施动态增强MRI检查,选取肾实质、肾盂和集合系统的类圆形区域作为兴趣区(regionofinteresting,ROI),计算不同时间点不同兴趣区的信号强度(signalintensity,SI)和相对信号强度(relativeSI,RSI),绘制T-SI曲线,对术前术后肾脏的形态和功能状态进行评估和比较。结果积水肾脏术前肾实质与术后综合评价无显著性差异(P>0.05),肾盂和集合系统排泄对比剂明显减慢,各ROI和SI以及持续时间与术后肾脏相比均有明显的差异(P<0.05)。结论动态增强MRI作为一种简单、安全无创的技术、联合评估肾形态和功能,对于评价肾积水手术疗效具有重要的临床价值。     

腹腔镜腹部手术520例临床分析

目的探讨腹腔镜在腹部手术中的应用及并发症的预防。方法回顾性分析2001年3月～2005年3月腹腔镜下胆囊切除、阑尾切除、溃疡病穿孔修补、肠粘连松解、肝囊肿开窗、直肠癌前切术等520例临床资料。结果腹腔镜手术应用12种类，520例中有5例因胆囊三角解剖不清且胆囊萎缩而中转开腹手术，2例因术中出血而中转开腹。手术并发症3例（0．58％），其中胆管损伤2例。出血1例。结论腹腔镜手术的适应证随技术进步和设备改善将逐步拓宽；严格腹腔镜手术程序，严重并发症发生率可降低。