肱骨近端记忆接骨器的设计与临床应用

目的 探索肱骨头解剖颈至外科颈及肱骨近端干段骨折、骨不连的内固定新技术。方法 根据生物记忆材料镍钛合金性能与肱骨近端解剖生理特征，研制肱骨近端记忆接骨器（proximal humerus memory connector，PHMC），并临床治疗肱骨近端粉碎性骨折、畸形愈合、骨不连共22例。患者平均年龄41．7岁，平均随访18．5个月。结果 骨折骨性愈合时间平均3．6个月；骨不连骨性愈合时间平均4．5个月。骨愈合形式均呈骨板样骨替代，未见无序骨痂出现。PHMC术后弃用外固定，创伤反应期（7～12d）后，进行主动渐进性功能锻炼。肩关节功能按Michael Reese评分，平均88．5分。结论 PHMC能有效治疗肱骨解剖颈始至肱骨近端的各类型骨折与骨不连，亦为减少该部的假体关节置换探索出了新路。     

经皮TriGen髓内钉与股骨近端髓内钉治疗老年股骨转子间骨折的疗效比较

目的 比较经皮TriGen髓内钉（美国Smith Nephew公司）与股骨近端髓内钉（PFN）（瑞士AO／SYNTHES公司）治疗股骨转子间骨折的临床疗效，探讨治疗老年股骨转子间骨折更为合理的方法。方法 分析本院2001年10月-2005年1月收治的股骨转子间骨折患者56例，年龄〉60岁。随机分为两组：A组21例，采用经皮TriGen髓内钉固定；B组35例，采用PFN固定。对两组手术切口长度、手术时间、术中出血量、术中输血、术后引流量、骨折愈合时间、术后至出院时间、髋关节功能优良率进行分析比较。结果 两组间手术切口长度、手术时间、术中出血量、输血量、术后引流量、手术至出院时间比较，差异均有统计学意义（P〈0．05）。术后部分负重时间、骨折愈合时间、髋关节功能评价等差异均无统计学意义。结论 与PFN固定相比，经皮TriGen髓内钉具有手术时间短、出血量少、手术组织损伤小等优点，降低了手术风险，用于治疗老年股骨转子间骨折具有一定优势。     

The use of a single non-timed urine collection in the calculation of fractional lithium clearance

Summary The fractional clearance of lithium (CL_Li/CL_cr) calculated in 15 normal healthy adults from a single morning urine aliquot collection, together with a single venous blood sample (FQ) was compared with the average CL_LI/CL_CR obtained from three timed consecutive urine collections with mid-point blood sampling (FABC). Lithium had been ingested 15–18 h prior to the collection of these samples. Mean CL_Li/CL_CR was similar (FQ, 0.186, FABC, 0.177), with a highly significant correlation in each individual of CL_LI/CL_SR measured by either method (r = 0.97,P 0.0001). Proximal tubular reabsorption of sodium using lithium clearance may be calculated from a single urine and blood sample.     

Base anatomique d'un nouveau concept de stabilité du carpe

Résumé Le concept de stabilité du carpe repose sur l'anatomie et la biomécanique. Celles-ci nous permettent de constater que le lunatum est le centre de deux axes fonctionnels: l'un longitudinal, mécanique, l'autre transverse, dynamique. Le lunatum est fermement stabilisé au radius et au complexe ligamentaire cubital par le V proximal: il devient ainsi un élément porteur; il est de plus fermement uni aux os voisins, le scaphoideum et le triquetrum, avec lesquels il forme une unité fonctionnelle intercalaire différenciée. Le guidage de cette unité est assuré par le V distal et le ligament radio-triquetrum dorsal.

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Summary Based on anatomical and biomechanical evidence, we conclude that the stability of the carpus relies on the lunate bone which is the centre of the longitudinal as well as the transverse functional axis. The lunate is firmly stabilised proximally to the radius and the radio-ulnar ligament complex by the proximal V-ligament, and so becomes a weight bearing structure. It is anchored by strong ligaments to the scaphoid on one side and the triquetrum on the other, thus forming a 3-bone intercalary system, which is in turn guided by the palmar distal V-ligament and the dorsal radio-triquetral ligament.

     

Ascending cluster pinning of the humerus inserted through the deltoid tuberosity

Summary Goal of Surgery Stable internal fixation of extraarticular proximal humeral fractures. Indications Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision. Epiphysiolysis. Fracture-dislocation of the humeral head. Contraindications Pathological fractures. Four part fractures. Segmental fractures of the humerus. Positioning and Anaesthesia Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board. General or regional anaesthesia. Surgical Technique Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly at the metaphyseal level. Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which is controlled by image intensification. Postoperative Management Temporary immobilization in a sling. Passive and active assisted movements after a few days. Active movements after 2 weeks. Removal of wires after 3 months. Possible Complications Fracture of the humerus at the site of the cortical window. Injury to the radial nerve. Results 32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6, mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis nor infection. Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months. Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France.     

中指近节背侧岛状皮瓣

介绍中指近节背侧岛状皮瓣的应用解剖,该皮瓣的营养动脉为第2掌背动脉,位置表浅,解剖容易,安全可靠。自1990年11月以来,应用该皮瓣修复手部软组织缺损共6例,均获成功。     

Dimensional changes of proximal tubules and cortical capillaries in chronic obstructive renal disease

Summary The study was carried out to determine the proximal tubular length, surface area and length of peritubular capillaries and the nephron numbers in kidneys with chronic nephropathy and varying increase in the cortical interstitial volume. Kidneys of pigs with varying chronic obstructive nephropathy were used for the experiments. Two subgroups of ureterobstructed kidneys were defined arbitrarily according to the volume of cortical interstitium. One subgroup (I) comprised kidneys with a volume fraction of cortical interstitium less than 30% (mean 17.2%; mean of controls 9.7%). The other subgroup (II) consisted of kidneys with severe chronic nephropathy and with a volume fraction of interstitium more than 30% (mean 44.5%). Proximal tubular length and length and surface area of peritubular capillaries were assessed by conventional morphometric techniques on 1 m thick sections of plastic embedded material. Nephron numbers were determined by a stereological method for counting glomeruli.The results demonstrated that proximal tubular length and capillary dimensions were significantly reduced in subgroup II, whereas no significant changes were observed in subgroup I. The mean number of glomeruli was not significantly different from control values in any of the subgroups.The results are in line with observations from previous quantitative analyses of proximal tubular cross-sections indicating that proximal tubular dimensions become reduced mainly at advanced stages of chronic nephropathy. The results also indicate that shortening of individual tubules rather than loss of entire nephrons is responsible for the observed reduction in total length of proximal tubules. Finally, the present observations suggest that reduced dimensions of the cortical capillary network may have pathogenetic significance for ongoing proximal tubular atrophy in chronic renal desease.     

Micropuncture studies on the influence of antidiuretic hormone on tubular fluid reabsorption in rats with hereditary hypothalamic diabetes insipidus

Summary Micropuncture studies were carried out on rats with hereditary hypothalamic diabetes insipidus, in order to measure net sodium and water reabsorption in proximal convolutions and short loops of Henle during water diuresis and ADH-induced antidiuresis. Intravenous infusion of 0.15 mU ADH per minute reduced urine flow from 74.5 l per kidney per minute to 10.8 l, and increased urine osmolality from 117 to 605 mOsm/kg. These changes could be reversed by stopping ADH.ADH did not alter the fractional reabsorption of fluid or the reabsorptive capacity for sodium in the proximal tubules. Nor did it change glomerular filtration rates of single superficial nephrons or of the entire kidney.Fractional reabsorption of the glomerular filtrate up to the early distal convolution was significantly higher (82.0%) in water diuresis than in antidiuresis (74.4%). Since this reabsorption remained unchanged in the proximal convolutions, the decreased reabsorption during antidiuresis must have occurred in the short loops. Fractional reabsorption of sodium up to the early distal tubule was essentially identical during water diuresis and antidiuresis, indicating that ADH does not enhance urinary concentration by increasing the reabsorption of sodium from short loops.On leave of absence from the Department of Physiology, Dartmouth Medical School, Hannover, N. H., from January to June, 1967. Recipient of USPHS Research Career Program Award 5-K3-GM-21, 786.     

人工肱骨头置换与肱骨近端锁定钢板治疗老年复杂肱骨近端骨折的近期临床疗效分析

[摘要] 目的 对比分析人工肱骨头置换术和肱骨近端锁定钢板治疗老年复杂肱骨近端骨折的近期疗效。方法 回顾性分析本院骨科2012年1月~2014年6月采用人工肱骨头置换术和肱骨近端锁定钢板治疗的老年（年龄>65岁）NeerⅢ、Ⅳ部分肱骨近端骨折患者54例，人工肱骨头置换治疗（置换组）30例，肱骨近端锁定钢板内固定治疗（内固定组）24例。比较分析两组手术时间、术中出血量、随访Neer评分及Constant-Murley评分来评定两组临床疗效。结果 两组随访时间相仿，平均随访时间为19.5个月（12~36个月）。内固定组手术时间（101±13）分钟，术中出血量（237.9±32.4）mL，Neer评分（82.5±3.2），Constant-Murley评分（71.7±5.0）；置换组手术时间（98±11）分钟，术中出血量（246.0±39.8）mL，Neer评分（82.9±4.5），Constant-Murley评分（73.5±5.0）。两组手术时间、术中出血量、随访Neer及Constant-Murley评分比较差异均无统计学意义（P＞0.05）。内固定组有1例出现肩关节半脱位，肱骨头置换组有2例出现肩关节半脱位，通过三角巾悬吊后关节脱位均得到纠正。有1例四部分骨折患者，行内固定术后出现内固定松动、肱骨头坏死，改行人工肱骨头置换术。结论 人工肱骨头置换术和肱骨近端锁定钢板治疗老年肱骨近端复杂骨折的近期临床疗效相似，对不可修复的肱骨近端骨折宜行肱骨头置换术。     

The early phase of experimental acute renal failure

Summary Experiments were designed to determine whether leakage of substances across the tubular epithelium, which are impermeant in the normal kidney, falsifies the measurement of glomerular filtration rate in acute renal failure. Permeability to those substances most commonly used for filtration rate determination, polyfructosan, inulin and ferrocyanide, was estimated by measuring their recoveries following perfusion through various nephron segments in haeme pigment, ischaemic and nephrotoxic models of actue renal failure. Late proximal recovery of¹⁴C ferrocyanide was only marginally decreased compared to controls, by a maximum of 6%. Distal recovery of polyfructosan,¹⁴C and³H inulin were depressed somewhat more, by a maximum of 11%. Urinary recovery of¹⁴C inulin was reduced by only 15% in kidneys showing severely restricted renal function. It is concluded that tubular leakage is not a feature of significance in the early phase of moderate acute renal failure, that ferrocyanide and inulin are reliable markers for the determination of nephron filtration rate and water reabsorption, and that the reduction in whole kidney inulin or polyfructosan clearance reflects primarily a reduction in glomerular filtration rate.