踝关节侧副韧带损伤的超声表现

目的 分析踝关节侧副韧带损伤的超声图像特征并评价其诊断价值。方法 采用7～13MHz线阵探头探查136例临床怀疑踝关节侧副韧带损伤患者，观察胫舟、胫距前、胫跟、距腓前、跟腓、胫距后、距腓后韧带，共计952条韧带，其中，51例的超声结果与手术比较。结果 46例侧副韧带完全及部分撕裂伤的超声诊断与手术结果符合。侧副韧带挫伤以肿胀为主，部分撕裂伤超声表现为韧带局部连续性中断（跟腓韧带）和不规则低-无回声区内见丝状结构相连，完全撕裂伤超声表现为韧带连续性中断，断端挛缩（跟腓韧带）和不规则低-无回声区贯穿整条韧带，无明显断端挛缩征。结论 高频超声对踝关节侧副韧带损伤的诊断无创、较准确、廉价，具有较高的临床应用价值。     

肘管综合征的解剖和病因学探讨

[目的]探讨肘管综合征的解剖特点和发病原因。[方法]对65例肘管综合征患者的临床资料和术中所见,以及其中25例患者术前肌电图检查的结果进行综合研究分析。[结果]术中见60例患者存在肘管弓状韧带的肥厚增生,卡压磨损尺神经导致炎性病变;术前肌电图检查发现25例患者的尺神经传导速度均减慢,平均传导速度为27.97m/s;运动反应波幅降低,平均电压为1.95mv;潜伏期延长,平均时间为5.41ms;65例肘管综合征患者,继发于肘部创伤25例,慢性劳损15例,慢性骨关节炎14例,占位病变5例,先天异常有6例。[结论]肘部的创伤及慢性劳损可以导致肘管弓状韧带出现肥厚增生,引起尺神经卡压磨损,这是肘管综合征最常见的病因;其他病因还包括慢性骨关节炎,占位病变和先天异常;尺神经可被机械性卡压和磨损,出现慢性缺血缺氧,导致肘管综合征的发生;详细的体格检查和术前的肌电图检查是诊断肘管综合征的主要手段,在诊断时应注意该病与其他部位迟发性尺神经麻痹的鉴别。     

Regeneration of periodontal ligament and cementum by BMP-applied tissue engineering

Previously, we demonstrated that the inductive properties of bone morphogenetic protein (BMP) highly depend on the nature of the carrier material used for implantation. In this paper, we show that administration of BMP incorporated in a fibrous collagen membrane can help to regenerate periodontal ligament and cementum both in cat canines and in monkey molars. The partially purified bovine BMP was combined with one or two layers of a fibrous collagen membrane. Although the single layer approach showed partial regeneration of periodontal defects, it also quite often led to ankylosis. The double layer technique in artificially prepared class III furcation defects in monkey molars gave favorable results. After 12 wk, not only the alveolar process but also the periodontal ligament and cementum had regenerated along the entire treated dentin surface. Collagen fibers were arranged more or less perpendicular to the surface of the new cementum. Ankylosis was not seen. It is concluded that the double-layer approach is superior to the single-layer technique in regenerating cementum.     

An ultrastructural study on anterior cruciate ligament reconstruction using autogenous patellar tendon grafts in dogs

An ultrastructural study was undertaken concerning morphological changes within the autografted patellar tendon (PT) after being transplanted to the anterior cruciate ligament (ACL) in mongrel dogs. After 4 weeks, the arrangements of both large and small collagen fibrils in the PT graft became disordered, and the number of inflammatory cells increased. However, the same PT grafts revealed postsurgical signs of newly-produced collagen fibrils around activated fibroblasts at 12 to 24 weeks. At 52 weeks after the transplantation, small collagen fibrils increased in both number and density, showing a remarkable morphological similarity to the collagen fibrils of normal ACL. These data indicate that the characteristics of the PT graft eventually resemble those of a normal ACL. This paper was presented in part at the Combined Meeting of the Orthopedic Research Societies of the USA, Japan and Canada in Banff, Alberta, Canada, October, 1991.     

关节镜下四股半腱肌腱与股薄肌腱重建前交叉韧带

目的　探讨关节镜下应用四股半腱肌腱与股薄肌腱重建前交叉韧带的方法及疗效。方法　对 2 3例前十字韧带 (ACL )损伤患者行关节镜下四股半腱肌腱与股薄肌腱 ACL重建术 ,均取自同侧 ,将两股肌腱分别对折组成 4股 ,编织后预牵张 ,等长点部位钻胫骨骨道、股骨骨道 ,将肌腱拉入骨道 ,分别在屈膝 90°和伸膝位分别将两肌腱收紧 ,两端可吸收扣栓固定。合并损伤同期处理。结果　术后随访 3月～ 4年 ,平均 2 6月。术后 4周关节活动均达正常范围 ,术后抽屉试验除 4例 I度外 ,余 19例均阴性 ;L ysholm评分 ,术后 72～ 10 0分 ,平均 89分 ,较术前 5 4分明显提高 ;Tegner运动评级术后 4～ 8级 ,平均 6级 ,较术前平均 3级有所提高。结论　关节镜下四股半腱肌腱与股薄肌腱重建前交叉韧带 ,可吸收扣栓固定 ,是治疗 ACL断裂的较好方法。     

关节镜下可吸收交叉钉固定腘绳肌腱重建前十字韧带

目的介绍在关节镜下腘绳肌腱移植重建前十字韧带并利用可吸收交叉钉固定的方法，探讨其临床效果。方法2005年3月至2006年3月，共治疗31例前十字韧带断裂患者。男18例，女13例；年龄19-51岁，平均34岁。致伤原因：交通伤15例，日常生活及运动损伤16例。病程为5d～36个月。合并半月板损伤12例，合并内侧副韧带Ⅰ、Ⅱ度损伤6例，Ⅲ度损伤3例，均为新鲜损伤。合并后十字韧带断裂6例。术后随访12-24个月，平均16．8个月，观察此固定方法的可靠性和疗效。以Lyscholm评分和KT-2000评价手术前后膝关节功能及稳定性。结果26例患者获得随访，所有患者均无伸膝受限，膝关节屈曲活动度均〉120°。屈膝90°时前抽屉试验均阴性；Lachman试验强阳性1例，阳性4例，阴性21例；膝关节功能Lyscholm评分为（94．6±4．2）分。KT-2000检查结果：25例双膝差距为0-4．0mm，平均2．4mm，1例患者关节不稳定，双膝差距5．5mm。结论可吸收交叉钉固定可为关节镜下腘绳肌腱移植重建前十字韧带提供早期的初始稳定性和后期的生物稳定性，是一种可靠的固定方法。