The modified outside-in suture: vertical repair of the anterior horn of the meniscus after decompression of a large meniscal cyst

This article describes a modified suture technique designed for the vertical repair of the anterior horn of the meniscus after arthroscopic decompression of a large meniscal cyst. This procedure comprises of three steps: first, the meniscus was pierced vertically using a suture hook and a No. 0 PDS suture. Second, both ends of the No. 0 PDS on the femoral and tibial surfaces of the meniscus were pulled to the outside of the joint capsule using a spinal needle preloaded with suture material. Finally, a skin incision was made adjacent to the suture materials, and both ends were tied. We recommend this technique not only for the vertical repair of the anterior horn of the meniscus after decompression of large meniscal cyst, but also to repair a longitudinal tear of the meniscus.     

Migration of a Kirschner wire from the greater trochanter to the popliteal fossa: a case report

Migration of Kirschner (K) wires from the upper extremity joints has often been reported, but it is less common from the lower extremities. In this report, we describe an 85-year-old man treated, during a hip replacement procedure, with a K-wire because of a trochanteric fracture; after one year, the K-wire was found in the popliteal fossa. This report illustrates the first case of K-wire migration in the popliteal area of the knee and suggests avoiding the use of free K-wires without any tension banding.     

后十字韧带重建后移植物组织学与胶原表型的变化

目的探讨采用半腱肌腱重建后十字韧带（posterior cruciate ligament,PCL）后移植物的组织学与胶原表型的变化.方法取20只成年新西兰大白兔,实验组18只切除右膝PCL后即刻用双股自体半腱肌腱重建,实验组于术后3、6、52周各处死动物2只,12、26周各处死动物6只,切取半腱肌腱移植物;对照组2只直接切取半腱肌腱和PCL.标本采用HE、甲苯胺蓝以及Ⅰ、Ⅲ型胶原免疫组化染色观察移植物的组织学与胶原表型变化,并与正常半腱肌腱和PCL进行比较.结果常规组织化学染色显示正常半腱肌腱和PCL在细胞构成上有明显的差别,PCL内可见软骨样细胞;重建后的移植物经过坏死、细胞重新长入、胶原形成和重塑阶段,52周时形成的结构类似于正常PCL,但在纤维排列上与正常PCL仍有差异.免疫组织化学染色结果显示正常PCL纤维内部仅有Ⅰ型胶原表达,重建韧带Ⅰ型胶原染色随时间延长从少到多,Ⅲ型胶原染色从多到少,52周时移植物内局部仍有表达.结论采用半腱肌腱重建PCL 52周时移植物和正常PCL结构相似,但仍有差异.     

漂浮膝伴交叉韧带损伤9例的治疗

漂浮膝是指同侧股骨干和胫骨干或相邻的干骺端骨折而导致整个膝关节呈连枷状。骨折多属于高能量损伤，常合并全身多处复合伤，治疗较困难。在漂浮膝中合并膝关节交叉韧带损伤使治疗、康复更困难。复习我科漂浮膝合并交叉韧带损伤9例，现报告如下。     

树枝状静脉移植在手部创伤中的应用

目的探讨手掌严重碾挫伤应用血管移植手术方法的选择。方法对12例手掌碾挫伤伴血管损伤的患者，采用树枝状浅表静脉倒转后多级移植修复缺损的手掌动脉，同时对缺损皮肤一期行植皮或皮瓣修复。结果术后12例创面全部Ⅰ期愈合，手指血循环好。术后随访3～22个月，手功能评定： 优5例，良4例，可2例，差1例，优良率为75％。手掌恢复了良好的外形和功能，能完成手指的捏、握、对掌和对指功能。结论对严重的手掌毁损伤，利用树枝状静脉移植修复缺损的血管，能获得较好的手功能和外形。     

Effect of a patellar realignment brace on patellofemoral relationships: Evaluation with kinematic MR imaging

The effect of a newly developed patellar realignment brace was evaluated in 21 patellofemoral joints (19 patients) with patellar subluxation (13 joints with lateral subluxation and eight with medial subluxation) by using active-movement, loaded kinematic magnetic resonance (MR) imaging. Sixteen patellofemoral joints (76%) demonstrated a qualitative correction of or improvement in patellar subluxation (ie, centralization of the patella or a decrease in the displacement of the patella) after application of the brace. Four of the five “failures” occurred in patellofemoral joints that had patella alta and/or dysplastic bone anatomy. These results indicate that the patellar realignment brace was able to counteract patellar subluxation in the majority of patellofemoral joints studied, as shown by active-movement, loaded kinematic MR imaging. This brace appears to be useful for conservative treatment of patients with patellofemoral joint pain secondary to patellar malalignment and maltracking.     

脾脏钝伤的CT诊断

本文回顾性分析了３２例脾脏钝伤ＣＴ平扫的表现；对脾损伤进行ＣＴ分类；指出腹腔积血和脾周血块（“哨兵血块征”）在诊断脾损伤方面的作用。ＣＴ平扫诊断钝性脾脏损伤是一种敏感、可靠的方法，可帮助外科医生制订治疗方案。ＣＴ平扫诊断钝性脾损伤的灵敏度为９４％，诊断正确率为９１％     

健血升白冲剂对小鼠造血功能的影响

目的：研究健血升白冲剂对小鼠血液系统的影响。方法：以骨髓细胞计数，白细胞计数和血象为指标，观察健血升白冲剂对正常小鼠和化学及放射损伤小鼠的影响。结果：健血升白冲剂明显增加正常小鼠白细胞计数（Ｐ＜００１），显著改善环磷酰胺诱导小鼠白细胞和骨髓细胞的减少作用（分别为Ｐ＜００５，Ｐ＜００１），并能显著增加６０Ｃｏ放射损伤小鼠骨髓细胞（Ｐ＜００１）和白细胞（Ｐ＜００１）。结论：健血升白冲剂对化学及放射损伤小鼠血液系统有明显的保护及改善作用。是一个有开发价值的药物。     

谷氨酰胺肠外营养对创伤后多器官衰竭患者的营养作用

目的探讨补充谷氨酰胺(Gln)的肠外营养在严重创伤后多器官衰竭(MOF)患者治疗中的作用。方法采用随机对照方法,将60例MOF患者分为Gln组和对照组,每组30例。Gln组给予Gln1.5ml/kg联合常规治疗[热量104～125kJ/(kg·d),其中脂肪供热40%,氮供给量为0.2～0.25g/(kg·d)的完全胃肠外营养(TPN)支持];对照组仅给予常规治疗,连续7d。对照分析营养指标、免疫指标、并发症及临床结果。结果所有患者营养指标(血清白蛋白、前清蛋白、转铁蛋白)和免疫指标(IgG、IgA、IgM)明显减低,处于负氮平衡。第8天时,Gln组营养指标明显高于治疗前及对照组(P<0.05),负氮平衡得到纠正(P<0.05),而对照组仅血清白蛋白、转铁蛋白较治疗前增高(P<0.05),仍处于负氮平衡(P>0.05)。Gln组免疫指标明显高于治疗前及对照组(P<0.01),而对照组仅IgG高于治疗前(P<0.01)。对照组14例(46.7%)出现了血清胆红素、丙氨酸转氨酶和血糖的升高,而Gln组仅4例(13.3%)增高(P<0.05),至14d时对照组病死率为36.7%,而Gln组仅为10%,两者相比差异有显著性(P<0.05)。结论应用Gln的肠外营养能够明显纠正MOF患者的营养代谢障碍,纠正负氮平衡,增强免疫功能,降低并发症及病死率。