气管插管后环杓关节半脱位的诊断和治疗

目的　提高对气管插管后环杓关节半脱位 (AS)诊断和治疗的认识。方法　分析了 10例AS的症状、体征及电视频闪喉镜表现 ;所有患者均在表麻下行环杓关节拔动复位术 ,同时服用类固醇激素和阿斯匹林 2周。随访 2～ 6年。结果　患者症状为气管插管拔管后出现声嘶 ,检查可见声带固定 ,声带突高低不一 ,患侧声带振动存在。伤后 40天内就诊治疗 9例 ,拔动复位后杓部对称 ,声门闭合良好 ,嗓音恢复正常 ;1例伤后 4个月就诊者 ,多次拔动失败后 ,行甲状软骨板成形术Ⅰ型 ,嗓音得以改善。结论　病史及电视频闪喉镜检查可早期诊断AS。关节复位术是首选治疗方法。类固醇激素及阿斯匹林在治疗中有重要的辅助作用     

环枢椎不稳

环枢椎不稳包括的由于先天性异常、陈旧性外伤及周围软组织炎症等所引起之环枢椎脱位、半脱位。症状轻重悬殊很大，重者可致四肢瘫、晕厥、窒息等，轻者只有颈痛及活动障碍等。治疗原则为复位、解除脊髓之压迫及重建稳定性。     

A method for classification of the posterior atlanto-axial subluxation

Summary Atlanto-axial subluxation and dislocation in rheumatoid arthritis is a multidirectional abnormality. The most common subluxations take place anteriorly, vertically or laterally. Posterior atlanto-axial subluxations are rare. The distance between a line tangential to the anterior aspect of the axis (C2) and the most posterior aspect of the anterior arch of the atlas (C1) could be used to measure the displacement in posterior atlanto-axial subluxation. Routine measurement of this distance could give us a better idea of the frequency of this type of affection in rheumatoid arthritis of the cervical spine. Serial measurements might be used to estimate the progression of the disease.     

When does subluxation of the first carpometacarpal joint cause swan-neck deformity of the thumb in rheumatoid arthritis: A 20-year follow-up study

The aim of our study was to assess the incidence of subluxation of the first carpometacarpal joint (CMC I) and to evaluate which degree of subluxation produces swan-neck deformity of the thumb in rheumatoid arthritis (RA) occurring over 20 years. The hands of 83 rheumatoid factor (RF)-positive RA patients with recent (6 months) arthritis were evaluated radiographically at onset and at 1, 3, 8 and 15 years; 68 patients were evaluated at 20 years from entry. Subluxation was assessed in millimetres and compared with the MCP-I angle measurement to evaluate the thumb deformity. A statistical end-point analysis was performed between two different grades of subluxation. Subluxation of 2–3 mm was non-specific and only one third of these thumbs showed swan-neck deformity. At the end-point, subluxation of 4 mm was present in 17% of the thumbs, 81% of which had the swan-neck deformity; only five thumbs did not show this deformity, but presented deformed and unstable MCP I and interphalangeal joints. The frequency of swan-neck deformity was highly significantly (p<0.0001) increased in the thumbs with severe CMC I subluxation (4 mm) compared with lesser subluxation (<4 mm). When subluxation of the CMC I exceeds 4 mm, the swanneck deformity of the thumb is a common consequence. This deformity is often progressive, and the hand function of such patients should be followed up carefully, both clinically and radiographically.     

Locking knee caused by subluxation of the posterior horn of the lateral meniscus

The authors report a case of repetitive locking knee caused by a subluxation of the posterior horn of a normal lateral meniscus. The posterior horn was sutured to the posterior knee capsule and the athlete resumed complete sports activity 4 months after the surgery.     

关于脊柱“半脱位”内涵及名称之思考

＂半脱位＂是脊柱推拿治疗脊柱伤病的核心病理概念,＂半脱位＂概念既应该包含关节解剖位置的变化,同时更应该强调在解剖位置变化基础上造成的关节功能活动障碍;当前手法医学＂半脱位＂与现代医学＂半脱位＂名称虽然一致,但是二者的内涵存在明显差异,容易造成混淆,也不能很好体现手法医学的特点,可以考虑将当前手法医学＂半脱位＂的名称改为＂亚脱位＂。     

屈髋屈膝旋转复位法治疗小儿髋关节半脱位

目的探讨屈髋屈膝旋转复位法治疗小儿髋关节半脱位的疗效。方法选择2006—2013年在该院门诊治疗的小儿髋关节半脱位病例32例,采用屈髋屈膝旋转复位手法分型治疗。结果经治1次症状消失、功能恢复正常者25例,2次治愈5例,3次治愈2例,疗效满意。结论屈髋屈膝旋转复位手法治疗小儿髋关节半脱位,方法简单,效果显著。     

晶状体脱位继发急性闭角型青光眼误诊分析

目的:分析晶状体脱位继发急性闭角型青光眼的临床特点及误诊原因。方法:对晶状体脱位继发急性闭角型青光眼患者36例(41只眼),采用房角镜和(或)超声生物显微镜(UBM)检查,根据其临床特点,选择适当的手术治疗。结果:41只眼中31只眼(75.61%)误诊为原发性急性闭角型青光眼。单眼晶状体脱位继发急性闭角型青光眼的前房深度较对侧眼明显变浅,差异有统计学意义(P<0.05)。术后1个月,患者视力不同程度提高;眼压正常。结论:晶状体脱位继发急性闭角型青光眼容易误诊为原发性急性闭角型青光眼,误诊原因主要为病史询问不清、眼部检查不仔细。治疗晶状体脱位继发急性闭角型青光眼,需要解除晶状体因素,才能提高手术成功率。