交叉韧带重建手术中可吸收挤压螺钉的应用

目的探讨交叉韧带重建术中可吸收挤压螺钉的使用方法和疗效。方法总结53例交叉韧带重建病例使用可吸收挤压螺钉的情况，在术中、术后并发症、术后康复、膝关节功能状况等方面进行回顾性分析。结果三例出现韧带切割现象。两例股骨侧螺钉拧入后导引针无法拔出。一例挤压螺钉断裂。术后Lysholm评分平均92.4±4．1。结论交叉韧带重建术中使用可吸收挤压螺钉固定的方法固定牢固，术后恢复快，利于早期康复。     

Plain radiographic findings in anterior cruciate ligament injury and repair

Although magnetic resonance imaging is the most accurate imaging method of evaluating the anterior cruciate ligament, several plain radiographic signs suggestive of anterior cruciate ligament injury have been described. Plain radiographs also play an important role in evaluating anterior cruciate ligament reconstruction.     

Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise

This study deals primarily with the stability of the base of the spine. The sacroiliac joints are vulnerable to shear loading on account of their predominantly flat surfaces. This raises the question of what mechanisms are brought into action to prevent dislocation of the sacroiliac joints when they are loaded by the weight of the upper part of the body and by trunk muscle forces. First a model is introduced to compare load transfer in joints with spherical and with flat joint surfaces. Next we consider a biomechanical model for the equilibrium of the sacrum under load, describing a self-bracing effect that protects the sacroiliac joints against shear according to ‘the sacroiliac joint compression theory’, which has been demonstrated in vitro. The model shows joint stability by the application of bending moments and the configuration of the pelvic arch. The model includes a large number of muscles (e.g. the gluteus maximus and piriformis muscles), ligaments (e.g. the sacrotuberous, sacrospinal, and dorsal and interosseous sacroiliac ligaments) as well as the coarse texture and the ridges and grooves of the joint surfaces.     

骨桥栓桩与界面螺钉固定前交叉韧带重建移植物胫骨端的临床价值对比

对比骨桥栓桩与界面螺钉在膝关节前交叉韧带断裂重建术中的临床价值。方法 回顾性分析2019年7月—2020年12月我院700例在关节镜下行前交叉韧带重建手术的患者,股骨隧道均以横穿钉固定。按移植物胫骨端固定方式分为骨桥栓桩组（380例）及界面螺钉组（320例）。对比两组手术时间、切口长度、住院时间及费用;比较两组术后3个月、12个月胫骨隧道大小、膝关节功能Lyshlom评分及术后12个月关节松弛度。结果 两组患者手术时间、胫骨端切口长度、住院时间比较差异均无统计学意义（P＞0.05）,但骨桥栓桩组手术费用显著低于界面螺钉组（P＜0.05）。术后3个月、12个月两组患者胫骨隧道大小、膝关节功能Lyshlom评分及关节松弛度比较差异均无统计学意义（P＞0.05）,但随着时间的延长,两组患者隧道均有不同程度的扩大（P＜0.05）。结论 对于行关节镜下前交叉韧带重建术的患者,采用骨桥栓桩胫骨端固定方式可取得与界面螺钉固定相当的临床效果,但骨桥栓桩固定更具医疗经济优势,是一种可广泛推广的胫骨端固定方法     

Ligament tissue engineering: an evolutionary materials science approach

The anterior cruciate ligament (ACL) is important for knee stabilization. Unfortunately, it is also the most commonly injured intra-articular ligament. Due to poor vascularization, the ACL has inferior healing capability and is usually replaced after significant damage has occurred. Currently available replacements have a host of limitations, this has prompted the search for tissue-engineered solutions for ACL repair. Presently investigated scaffolds range from twisted fiber architectures composed of silk fibers to complex three-dimensional braided structures composed of poly (l-lactic acid) fibers. The purpose of these tissue-engineered constructs is to apply approaches such as the use of porous scaffolds, use of cells, and the application of growth factors to promote ligament tissue regeneration while providing mechanical properties similar to natural ligament.     

子宫阔韧带内静脉的解剖学研究及其临床意义

子宫底和体上部的静脉汇集于子宫角处浅出,应称子宫上静脉。该静脉续为卵巢静脉。子宫上静脉1条者占30%,2条者占56.7%,3条者占13.3%。子宫上静脉与输卵管峡部中点相对处的口径是3.7±0.2mm,卵巢丛与子宫上静脉汇合后的口径为5.0±0.4mm。输卵管峡部中点与子宫上静脉的间距为6.3±0.6mm。在输卵管系膜中见有输卵管静脉汇入子宫上静脉。本文研究结果认为盆腔静脉淤血症的发生,与结扎手术中损伤子宫上静脉和输卵管静脉有关。     

下胫腓联合分离内固定术式的生物力学研究

目的　探讨下胫腓联合分离采用新型内固定术式———下胫腓钩板固定器 (Hook -platefixation ,HPF)的生物力学特性 ,与螺钉、钢板和带钩固定器三种内固定方式比较 ,为临床提供科学依据。方法　采用新鲜成人尸体足标本 6具 ,运用生物力学实验应力分析方法和压敏片技术 ,测量不同内固定术式的远端胫腓骨强度、应变、负重面积、接触应力和足弓承载能力及踝关节稳定性的变化。结果　新型下胫腓钩板固定器内固定术式无论在胫腓骨强度和刚度、负重面积、接触压力、足弓的变形、移位强度和刚度、承载能力以及踝关节的稳定性方面均优于其它三种内固定术式 ,具有显著性差异 (P <0 .0 1)。结论　实验结果表明 ,采用下胫腓钩板固定器 (HPF) ,既有利于提高生物力学性能 ,又有利于改善踝关节的稳定性 ,与传统手术方式相比可减少一次手术 ,避免了断钉等并发症 ,且能有效地提高足部承载能力 ,是下胫腓联合分离内固定的一种优良术式     

Quantitative ultrastructure of synapses on functionally identified primary afferent neurons in the cat trigeminal mesencephalic nucleus

Though a number of studies have reported the presence of synapses on neurons in the trigeminal mesencephalic nucleus (Vmes), there have been no quantitative studies of either the density of innervation, or the ultrastructure, of the synapses on single, physiologically identified neurons in this nucleus. In this study we recorded from single neurons in the Vmes, identified them as being either muscle spindle afferents (MS) or periodontal ligament mechanoreceptor afferents (PL), and then labeled the neurons by intra-axonal injection of horseradish peroxidase (HRP). The material was first processed to reveal the HRP activity, following which ultrathin sections through the labeled somata were cut and examined under the electron microscope. Complete serial reconstructions were made through the soma of one MS neuron and one PL neuron, and the contacts on the neurons reconstructed. Boutons were found on the soma, spines, appendages and the axon hillock and the initial segment of the axon. The numbers of boutons terminating on the two neurons were 198 (PL) and 424 (MS), giving a packing density of 4.4 and 10.7 boutons respectively (i.e., number of boutons/100 micron 2 of the postsynaptic membrane). Boutons could be separated into two types on the basis of their vesicles: those containing clear, round vesicles (i.e., S-type) and those containing a mixture of round, oval and flattened vesicles (P-type). Ninety-five (PL neuron) and 99% (MS neuron) of terminals on the two neurons were P-type. All the S-type boutons and 80% of the P-type boutons formed asymmetric synaptic contacts while 10% of the P-type boutons made symmetric contacts. Quantitative measurements of the P-type boutons on the labeled neurons, in which the data of MS and PL neurons were pooled, revealed that bouton volume was highly correlated with bouton surface area, active zone number, total active zone area, vesicle number, and mitochondrial volume. However, comparing the quantitative measurements of the P-type boutons with those of previously reported vibrissa afferent terminals and their associated axon terminals revealed that all the parameters were smaller for the P-type boutons (on Vmes neurons) than those of the vibrissa afferent terminals but similar to those of axon terminals presynaptic to the vibrissa afferents. Taken together, our results emphasize the wide scope for synaptic interactions in the Vmes and suggest that it may be more fruitful to view the Vmes as an integrating center.     

掌指关节的三维解剖及形态分析

目的：观测掌指关节关节面的几何形态,为人工关节的设计和应用提供解剖学依据。方法：10只成人手标本,解剖掌指关节,测量侧副韧带起点距掌骨头关节面的直线距离,三维数据检测仪获得关节面三维坐标数据,应用SPSS软件进行统计分析和成像。结果：掌骨头有双髁结构,桡侧髁略大,第1掌骨头形态特殊;各掌骨头高度的比较无显著差异;其掌侧关节面大于背侧,第2、3掌骨头关节面面积明显较大。近节指骨底在形态、高度和面积方面各序列相似;各序列侧副韧带起点桡侧较尺侧距离掌骨头关节面远。结论：手指人工关节的设计应符合解剖形态,并根据各序列形态的差异进行个体化设计,尤其拇指更应区别对待;手指人工关节的设计和应用中应注意软组织保护,关节的切除范围应注意保留侧副韧带的起止点。     

Does a torn anterior cruciate ligament lead to change in the central nervous drive of the knee extensors?

Summary Integrated surface electromyograms of the three superficial parts of the quadriceps and isokinetic knee extensor maximum torque and power production were recorded simultaneously and at different angular velocities in both legs in 11 male subjects with unilateral tear of the anterior cruciate ligament. The cross-sectional area (CSA) of the thigh and its muscular components were measured by computerized tomography. The principal findings were a small but significant decrease in quadriceps CSA on the affected side; a decreased active, but not passive, range of movement; decreased mechanical output, whether or not corrected for differences in CSA; and decreased electrornyographic activity — particularly in rectus femoris. These findings suggest that the reason for the decreased maximum and total knee extensor performance seen in these patients is a change in knee joint receptor afferent inflow.