三七总皂苷促进腱骨愈合的实验研究

目的：研究三七总皂苷对腱骨愈合的影响。方法：取20只成年新西兰大白兔,随机分为PNS组及空白对照组,每组10只。两组动物均切断双侧膝关节前交叉韧带,以趾长伸肌腱重建前交叉韧带,制作腱骨愈合模型。PNS组骨隧道内注射三七总皂苷注射液,干预腱骨愈合。空白对照组不予干预措施。术后4周及8周每组各处死5只新西兰大白兔,获取腱骨愈合标本。通过肉眼、组织学切片观察两组腱骨愈合的变化及差异。结果：顺利完成所有手术,20只大白兔无死亡及关节感染。大体观察,两组动物4周时腱骨界面为纤维连接,8周时腱骨间隙已不容易辨认。组织学观察,PNS组腱骨界面细胞成熟度更高,sharphy纤维生长更加密集,间质钙化程度更高,新骨形成量更多。8周时界面组织形态分类,两组分布差异有统计学意义。结论：三七总皂苷能够促进腱骨界面细胞成熟,促进腱骨界面胶原生长,促进新骨形成,加快腱骨愈合速度,提高腱骨愈合质量。但本研究尚未对各项指标进行定量测量,三七总皂苷促进腱骨愈合的详细机制尚未完全明确。     

Current status of brachial plexus reconstruction: restoration of hand function

Although restoration of hand function in brachial plexus patients remains a formidable challenge, the past decade has brought significant improvement in our ability to restore hand function even in the most severe cases. Today, the following options are available to restore hand function: (1) direct nerve repair; (2) nerve grafting; (3) nerve transfers from intraplexal or extraplexal sources; (4) tendon transfers (and tenodesis); (5) free functioning muscle transfer; (6) arthrodesis; and (7) a combination of these techniques. Opportunity for future improvement exists, and the next decade will no doubt bring further innovation.     

Giant cell tumour of tendon sheath of the digits. A systematic review

Background  

We reviewed the literature to evaluate the demographic, clinical and histological profile of giant cell tumour of tendon sheath of the digits (GCTTSD). The overall recurrence rate and the factors affecting tumour recurrence were also assessed.     

Causes of renal forniceal rupture

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Renal forniceal rupture is a common finding in patients with ureteral obstruction. It is thought to be due to increased renal pelvis pressure from backup of urine, causing one or more renal fornices to leak urine. This phenomenon has not been systematically studied. Herein we retrospectively review the causes and associated clinical findings in over 100 cases of renal forniceal rupture.

OBJECTIVE

? To perform a retrospective review aiming to identify causes of renal forniceal rupture.

PATIENTS AND METHODS

? A retrospective review was performed of the longitudinal medical record and CT records for patients identified as having renal ‘forniceal rupture’ or ‘calyceal rupture’ using a radiological database.

RESULTS

? In total, 108 patients were identified with the CT diagnosis of renal ‘forniceal’ or ‘calyceal’ rupture. ? Forniceal rupture was caused by ureteric stones in 80 cases (74.1%), malignant extrinsic ureteric compression in nine cases (8.3%), benign extrinsic ureteric compression in two cases (1.9%), pelvic‐ureteric junction obstruction in two cases (1.9%), vesico‐ureteric junction (VUJ) obstruction in one case (0.9%), bladder outlet obstruction in one case (0.9%) and iatrogenic causes in four cases (3.7%). ? No definitive cause was found in nine cases (8.3%). For patients in whom a ureteric stone was the cause of forniceal rupture, the level of obstruction was proximal ureter in 24.3% of cases, distal ureter in 17.6% of cases and VUJ in 58.1% of cases. ? Mean (sd ) stone size was 4.09 (2.0) mm. Mean (sd ) stone size was 5.34 (1.87) mm for proximal stones, 4.08 (1.69) mm for distal stones and 3.53 (1.96) mm for VUJ stones (P= 0.005). ? Urinary tract infection was present in five out of 97 patients (5.2%) in whom data were available for analysis.

CONCLUSION

? The most common aetiology of renal forniceal rupture is obstruction caused by distal ureteric stones followed by malignant extrinsic ureteric compression.     

Early Surgical Repair of Acute Complete Rupture of the Proximal Hamstring Tendons

Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed.     

Neglected patellar tendon rupture: a case of reconstruction without quadriceps lengthening

Neglected rupture of the patellar tendon is a rare, can be easily missed in a group of patients. We present a 24 year old, male patient who sustained right femoral diaphyseal and tibial plateau fractures and a patellar tendon rupture following a motor vehicle accident. The fractures were treated by open reduction internal fixation but the patellar tendon rupture was missed and the diagnosis was delayed by 7 months. Patella was migrated proximally. It was moved distally to the original location and neglected patellar tendon rupture treated successfully with modified Ecker technique. Neither preoperative traction nor additional intraoperative procedures were performed to relocate the patella to its anatomic position in the extended knee and good functional result was achieved with intensive rehabilitation.     

成人外伤性脾破裂非手术治疗55例分析

目的对非手术治疗外伤性脾破裂进行临床分析,为外伤性脾破裂临床治疗方法的选择提供初步证据。方法回顾1992年至2006年我院收治的包括选择性脾动脉栓塞和保守治疗的非手术治疗脾破裂患者55例,对治疗成功率、死亡率和并发症发生率进行分析比较,并评价其卫生经济学效益。结果治疗总成功率87．27％（48／55）,元患者死亡。损伤严重程度分组,51例脾Ⅰ、Ⅱ级损伤,总有效率90．19％（46／51）,再次栓塞或开腹手术5例。4例脾外伤Ⅲ级患者,2例非手术治疗成功,再次栓塞或开腹手术2例。治疗分组分析,传统保守治疗组保脾成功率为81．3％（26／32）,选择性脾动脉栓塞组成功率为100％（23／23）（P=0．035）。选择性脾动脉栓塞组2例并发左侧胸腔积液,1例并发左下肺感染;保守治疗组1例并发脾周脓肿。选择性脾动脉栓塞组平均住院日较保守治疗组[（7．9±4．2．1）d比（11．9±4．4．6）d]明显缩短（P=0．045）,但住院花费增加[（4216±668．4）元比（2616±437．8）元]（P〈0．05）。结论脾损伤Ⅰ、Ⅱ级患者适宜保脾治疗,选择性脾动脉栓塞术比传统非手术保守治疗疗效更为可靠,在医疗设备和经济条件允许的情况下建议考虑栓塞治疗。     

锁式肌腱缝合的生物力学研究

目的本实验通过比较Strickland、Augmented Becker、Savage及Tang法四种锁式缝合的生物力学特性,以期指导临床肌腱修复.方法将40根新鲜成年猪后蹄Ⅱ区屈肌腱随机分成4组,分别用Strickland、Augmented Becker、Savage及Tang法进行修复.用材料力学测定仪测定2-mm间隙形成负荷、最大负荷、弹性模量及断裂功耗,同时记录中心缝合的操作时间.结果Tang法的2-mm间隙形成负荷、最大负荷、断裂功耗与Savage法相近,弹性模量为各组中最高,中心缝合的操作时间明显短于Augmented Becker及Savage法.结论Tang法能提供较大的抗张强度、有效抵御间隙形成、操作简便,有利于肌腱早期活动.