双极人工股骨头置换术治疗高龄股骨颈骨折

目的 通过对６６例７０岁以上老年人股骨颈骨折临床分析,探讨其手术可行性、术式选择。方法 回顾分析患者的术前并存症、术前准备、术式选择、麻醉方式、术中情况、术后处理及随诊情况。结果 本组无术中死亡病例,平均住院２８天,平均随访２６个月。良好率６３．６％。结论 ７０岁以上老人股骨颈骨折行双极股骨头置换术治疗是可行的。     

Differential roles of neurokinin 1 and neurokinin 2 receptors in the development and maintenance of heat hyperalgesia induced by acute inflammation

1. Following induction of acute inflammation by intraarticular injection of kaolin and carrageenan into the knee joint in rats, there was a significant decrease in the withdrawal latency to radiant heat applied to the paw (i.e. heat hyperalgesia), an increased joint circumference and increased joint temperature.
2. A neurokinin₁ (NK₁) receptor antagonist (CP-99,994, 10 mM) had no effect on the paw withdrawal latency when it was administered spinally through a microdialysis fibre before the induction of inflammation. Pretreatment with a NK₂ receptor antagonist (SR48968, 1 mM) administered spinally through the microdialysis fibre prevented the heat hyperalgesia from developing in the early stages of the inflammation.
3. Post-treatment through the microdialysis fibre with the NK₁ receptor antagonist (0.0110 mM) was effective in reversing the heat hyperalgesia. In contrast, post-treatment spinally with the NK₂ receptor antagonist (0.011 mM) had no effect on the heat hyperalgesia. The inactive stereoisomers of the NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the joint inflammation or the heat hyperalgesia.
4. Pretreatment systemically with the NK₁ receptor antagonist (30 mg kg⁻¹) had no effect on the heat hyperalgesia or pain-related behaviour ratings where 0 is none and 5 is non weight bearing and complete avoidance of limb contact. Pretreatment with a NK₂ receptor antagonist (10 mg kg⁻¹) systemically prevented the heat hyperalgesia and pain-related behaviour ratings from developing in the early stages of the inflammation. The inactive stereoisomers of NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the joint inflammation or the heat hyperalgesia.
5. Post-treatment systemically with either the NK₁ (0.130 mg kg⁻¹) or the NK₂ (0.110 mg kg⁻¹) receptor antagonist resulted in a dose-dependent reversal of the heat hyperalgesia. Pain-related behaviour ratings were reduced by post-treatment only with the NK₁ receptor antagonist. The inactive stereoisomers of the NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the behavioural responses.
6. Direct pretreatment of the knee joint with either the NK₁ (30 mg) or the NK₂ (10 mg) receptor antagonist prevented the heat hyperalgesia from developing without affecting joint swelling. The inactive stereoisomers of the NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the joint inflammation or the heat hyperalgesia.
7. There appears to be a differential role for the spinal tachykinin receptors in the development and maintenance of the heat hyperalgesia associated with acute joint inflammation. The NK₂ receptors appear to be activated early in the development of the heat hyperalgesia and NK₁ receptors are involved in the maintenance of the heat hyperalgesia.
8. Peripherally, both NK₁ and NK₂ receptors are involved in the development of heat hyperalgesia and pain-related behaviour ratings induced by acute inflammation.

     

Osteochondroma and secondary synovial osteochondromatosis

Secondary synovial osteochondromatosis (SOC) is a rare disorder caused by a variety of joint disorders. Two unusual cases of secondary SOC are presented. The first patient is a 43-year-old man with extensive SOC developing within a bursa surrounding an osteochondroma of the pubic bone. The second patient is a 23-year-old man who developed florid and progressive SOC of his hip joint following excision of a femoral neck osteochondroma. SOC recurred despite three excisions over a 15-month period. Imaging was useful in pre-operative diagnosis of bursal SOC in the first patient and in detecting multiple recurrences in the second patient. Both cases illustrate prominent SOC developing secondary to osteochondroma. The different hypotheses regarding bursal and secondary SOC are reviewed. Received: 8 October 1998 Revision requested: 28 October 1998 Revision received: 13 November 1998 Accepted: 16 November 1998     

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.     

Treatment of 78 cases of shoulder periarthritis by warming-needle method

Jiansanzhen, Tianzong (SI 11), Jugu (LI 16), Jianzhen (SI 9), Binao (LI 14) and Quchi (LI 11) were given warming-needle moxibustion to treat shoulder periarthritis in 78 cases, and the result showed total effective rate was 97.4%. Author: LI Jian-wu (1955-), male, junior consultant doctor Translator: WU Xue-fei     

环枢关节紊乱症的临床研究

环枢关节紊乱症，从发病机理到临床表现，乃是颈椎病中较复杂的疑难顽症。用常规诊治方法，疗效不佳。本研究提出新的诊断依据与治疗方法，对３２０例病者随机分为治疗组１６６例（采用改进的诊治方法），对照组１５４例（用常规诊治方法）对照进行疗效观察。结果显示：治疗组治愈率与总有效率及康复率均高于对照组。有非常显著差异，Ｐ＜０．０１。而疗程较对照组短。环枢关节紊乱症的临床研究有利于颈椎病诊治水平的提高，运用于临床，疗效好，效益高，具有推广应用价值。     

双重法固定肩锁关节脱位

为介绍一种新方法修复肩锁关节脱位。肩锁关节脱位整复后采用双重法（交叉克氏针及8字钢丝）固定肩锁关节。结果：16例肩锁关节脱位后无一复发,关节功能无影响。结论：该法操作简单,固定牢靠,可早期行关节功能锻炼,可有效防止脱位复发。     

Assessment of patellar maltracking using combined static and dynamic MRI

Between January 1995 and Jul 1997, 474 patients with anterior knee pain resistant to conservative treatment were referred for MR of the knee. The MR examination consisted of routine sequences with an additional patellofemoral dynamic examination using a technique that has been developed at this institution. The dynamic study examines both knees simultaneously, with the patient supine and the quadriceps loaded. No gating or restraint apparatus is needed. Patellar subluxation or tilt was present in 188(40 %) of cases, bilateral in 104 and unilateral in 84 cases (right 39, left 45). It was classified as mild in 51 %, moderate in 39 % and severe in 10 %. Subluxation was more prevalent in females than males (42 % vs. 37 %) and this was most obvious in the severe group where 68 % were female. In 90 knees selected at random, four measurements of patellofemoral morphology were obtained using reconstructed images from a volume gradient echo sequence. These measurements were correlated with the degree of subluxation or tilt. A tibial tubercle distance greater than 20 mm, a femoral sulcus angle greater than 150 degrees, sulcus depth less than 4 mm were specific for subluxation but no measurement proved to be sufficiently sensitive to preclude a tracking study. MRI can be used to define more precisely the anatomy of the extensor mechanism and its relationship to the femur and tibia, in both a static and dynamic setting. In this way, patients with anterior knee pain can be classified more accurately and the outcomes of treatment more reliably assessed. Received: 17 September 1999; Revised: 31 January 2000; Accepted: 4 February 2000     

多种工作模式的踝关节活动器的研制

各种原因导致患者长期卧床后将引起严重的并发症:踝关节跖屈畸形。新型踝关节活动器以大扭矩、超低速电机为动力,结合定时控制电路,具有多种工作模式,能使踝关节在被动的情况下背伸20～30°,跖屈40～50°,并能根据患者的个体情况设置不同的运用角度与时间,且能根据需要进行缓慢、连续、往返式运动,这对那些踝关节不能或较难进行主动活动的病人防止踝关节跖屈畸形、踝关节僵硬的及下肢肌肉萎缩有良好的作用。     

血府逐瘀汤治疗髋关节置换术后非感染性发热

[目的]探讨髋关节置换术后非感染性发热的防治。[方法]应用血府逐瘀汤加减辨证论治。[结果]43例患者体温恢复正常,其中36例在3天内体温恢复正常。[结论]该方法对髋关节置换术后非感染性发热有较好作用。