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。     

HLA-B27相关的前葡萄膜炎眼后节并发症的临床特点

目的探讨HLA—B27阳性的前葡萄膜炎眼后节并发症的临床特点及治疗。方法2002年1月至2005年10月就诊的前葡萄膜炎患者采用流式细胞术进行外周HLA-B27的检测，筛选出71-例82眼HLA-B27阳性前葡萄膜炎患者，分为两组：实验组为眼后节受累的患者24例31眼，对照组为眼后节未受累的患者47例51眼。另有HLA—B27阴性前葡萄膜炎患者74例116眼作参考。所有患者均进行裂隙灯、眼底镜等常规眼科查体，部分行眼底荧光血管造影。分析了HLA—B27相关的前葡萄膜炎眼后节并发症的临床特点。采用x^2检验及t检验进行统计学分析。结果71例82眼HLA—B27阳性前葡萄膜炎中有24例31眼占37．8％出现眼后节并发症者，包括：黄斑囊样水肿12例15眼占48．4％，视乳头水肿7例8眼占25．8％，而玻璃体炎最多见为21例27眼占87．1％，8例10眼占32．3％患者存在两种或两种以上的眼后节表现。74例116眼HLA—B27阴性者有8例12眼占10．3％有眼后节表现。实验组中发生前房成型纤维素渗出31眼中18眼占58．06％和积脓31眼中9眼占29．03％明显高于对照组（前房纤维素渗出51眼中3眼，5．88％，X^2=27．56，P〈0．01；前房积脓51眼中1眼，1．96％，X^2=13．20，P〈0．01）；实验组中伴发相关全身性疾病24例中有16例占66．67％的几率高于对照组（47例中有17例，31．66％，X^2=5．94，P〈0．05）。出现眼后节并发症的患者经全身及局部应用糖皮质激素治疗，31眼中有11眼最佳矫正视力≥1．0。结论HLA-B27阳性前葡萄膜炎易出现眼后节并发症，HLA—B27相关的前葡萄膜炎眼后节受累的患者发生相关全身性疾病和前房纤维素渗出与积脓的几率较高。     

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.     

Successful management of laryngotracheosophageal cleft through an anterior approach

Laryngotracheoesophageal cleft is an uncommon disease that is difficult to diagnose and treat. Repair of the cleft depends on length and localization of the defect as well as the associated anomalies. A successful repair of a type II cleft is reported in this paper. An anterior split of the larynx and trachea was used and provided excellent exposure and safe repair without injury to the neurovascular structures. This is the best approach and should be used to correct all type II defects.     

Transient outward current (I A) in clonal anterior pituitary cells: blockade by aminopyridine analogs

Summary Whole cell voltage-clamp recordings from GH₃ cells, a clonal cell line derived from a rat anterior pituitary tumor, demonstrated a rapidly activating and inactivating (transient) voltage-dependent outward current. This current, referred to as I _A, was elicited by step depolarization from holding potentials negative to –50 mV, showed strong outward rectification at potentials positive to –30 mV, and exhibited steady state inactivation with V _1/2 near –64 mV. The current rose to a peak within < 10–20 ms following depolarization and decayed in two exponential phases, I _Af and IA _AS with time constants of 30–50 and 500–700 ms, respectively. Both I _A components exhibited similar voltage dependencies for activation and inactivation. Aminopyridines (2 mol/l – –5 mmol/l) produced a dose dependent, reversible blockade of I _A (70% inhibition at 0.5 to 2 mmol/l) with the following rank order of potencies: 4-aminopyridine > 3,4-diaminopyridine = 3-aminopyridine > 2-aminopyridine. These drugs reduced the peak conductance of I _A, and produced complex effects on its time-dependent decay. With submaximal degrees of block, there was an increase in the inactivation rate, suggesting that open channels are preferentially blocked by the drugs. It is concluded that GH₃ pituitary cells possess an aminopyridine-sensitive transient outward current comparable to the A-current in neural cells. However, this cell line is unusual in that it expresses both rapidly and slowly decaying A-current components.Abbreviations n-AP n-aminopyridine - 3,4-DAP 3,4-diaminopyridine - TEA tetraethylammonium - EGTA ethylene glycol bis(-aminoethyl ether)N,N-tetraacetic acid - HEPES 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid Send offprint requests to M. A. Rogawski at the above address     

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.     

Spontaneous arterial baroreflex control of the heart rate during head-down tilt in heat-stressed humans

The purpose of this study was to elucidate the effect of raised body temperature per se during acute heat stress on the spontaneous arterial baroreflex control of heart rate (f _c) in humans. To investigate whether unloading of cardiopulmonary baroreceptors during whole-body heating would alter the arterial baroreflex control of f _c, we controlled loading of the cardiopulmonary baroreceptors by head-down tilt (HDT) at angles of 5°, 10°, 15°, and 30° during heat stress produced by hot-water-perfused suits. The sensitivity of the arterial baroreceptor-cardiac reflex was calculated from the spontaneous changes in beat-to-beat arterial pressure and f _c. As an index of cardiopulmonary baroreceptor loading, the left atrial diameter (LAD) was measured by echocardiography. During whole-body heating, the LAD decreased with the rising body core temperature and increased with the HDT. The decreased LAD during heating almost recovered to the normothermic control level by 10° HDT. In the supine position, cardiac baroreflex sensitivity remained unchanged during heating. Arterial pressure, f _c and cardiac baroreflex sensitivity were not changed by HDT ranging from 5° to 30° during heating. These results suggest that cardiac baroreflex sensitivity remain unchanged during graded loading of the cardiopulmonary baroreceptors in heat-stressed humans. Also, we conclude that the sensitivity of the spontaneous arterial baroreflex controlling the f _c is not influenced by raised body temperature per se during acute heat stress. Electronic Publication