晶状体不全脱位单襻缝线折叠人工晶状体悬吊术

目的 探讨外伤性白内障晶状体不全脱位时,采用单襻缝合固定可折叠人工晶状体悬吊术的效果.方法 前瞻性病例对照研究.对40例（40眼）外伤性白内障晶状体不全脱位范围180°～240°者,随机分为两组：试验组20例行单襻缝合固定可折叠人工晶状体悬吊术,对照组20例行常规人工晶体悬吊术,术后1d、7d、1月、3月观察裸眼视力、最佳矫正视力、角膜散光、眼压、并发症等情况,并进行统计学分析.结果 试验组与对照组间术后各时期裸眼视力比较及术后1d最佳矫正视力比较,差异有统计学意义,试验组优于对照组,两组间术后7d、1月、3月最佳矫正视力比较,差异无统计学意义.两组间术后各时期角膜散光及术后1d眼压比较,差异有统计学意义,试验组优于对照组,两组间术后7d、1月、3月眼压比较,差异无统计学意义.试验组角膜水肿、玻璃体出血浑浊并发症的出现少于对照组.结论 单襻缝合固定可折叠人工晶状体悬吊术是一种安全有效的手术方法.     

使用Suture-anchor治疗Ⅲ度肩锁关节脱位

[目的]评估使用Suture-anchor治疗肩锁关节脱位的效果。[方法]肩锁关节脱位17例,其中男11例,女6例,均为Tossi III型。年龄17～53岁,平均29．3岁。随访时间6—24个月,平均13．5个月。采用主观评价和Constant评分评价术后肩关节功能,术后X光片评价治疗结果。[结果]术后X-光片显示复位固定良好;肩关节功能评分为93．4分,主观评分为1．7分。[结论]Suture-anchor治疗肩锁关节脱位,创伤小,复位固定确实,术后功能恢复好。     

Lateral retinacular release of the patella

From October 1977 through January 1984, 2,330 arthroscopic procedures of the knee were performed by one of the authors (G.J.S.). Among these procedures, 35 lateral retinacular releases were performed through minimal, lateral incisions. Twenty-two knees in 22 patients were available for follow-up evaluation, and these cases were reviewed retrospectively. The average age of the patients at the time of surgery was 22.6 years. The average follow-up period was 48 months. The patients were divided into three subgroups on the basis of their preoperative diagnosis. Group I (eight knees) had a history of patellar dislocations; group II (seven knees) had recurrent patellar subluxation, identified by history and physical and radiographic examinations; and group III (seven knees) had patellar pain without a history of dislocations or subluxation and with no symptoms of instability. All of these patients underwent diagnostic arthroscopy and lateral retinacular release, as well as arthroscopic treatment of associated pathology. Postoperatively and at the time of followup, all patients were evaluated for pain, function and patellar instability. In 15 patients with a history of patellar dislocation or subluxation, 67% were found to have had significant improvement in their symptoms, which was borne out by the findings during physical examination. None was worse following treatment. Among the seven patients with no history of patellar dislocation or subluxation, only one of the seven had a satisfactory result. Based upon the findings of this study, it was concluded that arthroscopic lateral retinacular release is a reasonable, initial step in the surgical treatment of patellar dislocation or subluxation, resistant to conservative treatment. Its efficacy in cases of recalcitrant patellar pain without a history of instability is doubtful.     

Die Hakenplattenspondylodese an der Halswirbelsäule

Operationsprinzip DorsaleSpondylodese an der Halswirbels?ule (C2 bis C7, eventuell Th1) über ein bis zwei Bewegungssegmente mit speziellen hakenf?rmigen Platten und einem zwischen den Dornforts?tzen eingeklemmten druckfesten autogenen Knochenspan (Abbildung 1) (Grob u. Magerl 1987 [1], Jeanneret et al. 1991 [2], Magerl et al. 1987 [3]).      

眼前段分析系统对晶状体半脱位患者术后人工晶体位置的观察

目的 运用眼前段分析系统获得Scheimpflug图像，对晶状体半脱位患者手术后人工晶体的位置进行客观定量观察和分析。方法 对14例24眼晶状体半脱位患者，根据术中观察的晶状体半脱位情况，采用不同方式完成手术和人工晶体固定。术后12月通过Scheimpflug图像，测量人工晶体偏中心距离、倾斜度数和前房深度。结果 人工晶体偏中心距离：折叠人工晶体囊袋内植入组（A组）：0．27±0．21）mm，折叠人工晶体双襻固定，光学区置于囊袋内组（B1组）：（0．70±0．33）mm；折叠人工晶体双襻固定，光学区置于囊袋外组（B2组）（0．49±0．20）ram；硬性人工晶体双襻固定组（C组）;（0．54±0．16）。人工晶体倾斜度数：A组：（1．10±0．69）度；B1组：（3．30±2．71）度；B2组：（2．14±1．03）度；C组：（3．39±0．77）度。前房深度：人工晶体囊袋内植入眼为（4．38±0．25）mm，人工晶体睫状沟固定眼为（0．40±0．86）mm。结论 Scheimpfiug图像可客观、定量地运用于分析人工晶体位置，评估各种人工晶体固定方法的临床效果，并有助于指导术后人工晶体并发症的处理。     

Multiple cervical cord compressions in psoriatic arthritis

Summary Coexistent atlantoaxial subluxation (AAS) and subaxial spondylitic changes led to multiple cervical cord compressions in a psoriatic arthritis (PA) patient. Magnetic resonance imaging and myelography were unable to define exactly which cervical lesion was responsible for neurological symptoms. After surgical intervention for the worsening of bulbar symptoms, clinical course of neurological complaints suggested that neurological involvement was due only to anterior/vertical AAS.     

儿童寰枢关节半脱位X线及多层螺旋CT诊断价值及对比分析

目的：比较颈椎X线与多层螺旋CT扫描在儿童寰枢关节半脱位诊断中的差异。方法：回顾性分析194例临床疑诊为儿童寰枢关节半脱位的影像学检查资料,X线常规检查73例,〈7岁组32例,≥7岁组41例;多层螺旋CT检查121例,〈7岁组63例,≥7岁组58例。比较两组的诊断阳性率。结果：73例常规X线检查,诊断24例（阳性率32.88%）,其中〈7岁组8例（阳性率25%）,≥7岁组16例（阳性率39.02%）;121例多层螺旋CT检查,诊断58例（阳性率47.93%）,其中〈7岁组29例（阳性率46.03%）,≥7岁组29例（阳性率50%）。〈7岁学龄前儿童组,X线与CT的阳性率有明显统计学差意,（P〈0.05）;≥7岁学龄儿童组,X线与CT的阳性率χ2检验无统计学差异（P〉0.05）。结论：〈7岁学龄前儿童,多层螺旋CT对环枢椎半脱位具有重要的诊断价值,≥7岁儿童可依据临床要求选择常规X线或CT检查。     

手法复位结合针灸治疗寰枢椎半脱位临床观察

寰枢椎半脱位导致左侧椎动脉受压,引起脑基底动脉供血严重不足,致脑缺血、脑乏氧。针灸可缓解肌肉痉挛紧张而引起再脱位和疏通经络,手法复位在于牵引的方向和力度,颈部旋转角度要到位,复位后应立即行针灸治疗。     

三踝骨折伴踝关节半脱位的治疗

目的：探讨三踝骨折手术入路、顺序及方法，提高临床疗效。方法：①通过对7例新鲜踝关节标本的测量，了解三踝骨折的最佳手术入路；②根据解剖测量及踝关节损伤生物力学机制分析结果，对16例三踝骨折伴踝关节脱位的患者进行治疗。结果：①通过后内侧切口暴露后踝，视野宽及深度较浅，视角大，易于暴露。与后外侧切口相比有明显的优势。②手术顺序为外踝→外踝→内踝，术中强调外踝的解剖复位，经前内侧入路固定后踝，易于操作，固定可靠，取出方便。③本组16例患者中15 例疗效评定为优良，优良率达93．7％。结论：先采用外侧切口复位固定外踝，然后行后内侧“L”形切口复位固定后踝及内踝是三踝骨折较理想的手术入路及顺序，其中外踝解剖复位、固定可靠是恢复踝关节正常榫状结构的关键，可以获得良好的临床效果。