Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture

ObjectiveThe purpose of this study was to evaluate the visibility of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with chronic anterior cruciate ligament (ACL) rupture.Materials and methodsThis retrospective case – control study compared 1.5 - T MRI scans for 50 patients with a chronic ACL rupture with those of a control group of 50 patients with an intact ACL. The ALL was evaluated in three portions: femoral, meniscal, and tibial. The status of each portion was classified as visualized or non-visualized. Two radiologists separately reviewed all the MRI scans to evaluate interobserver reliability.ResultsAt least one portion of the ALL was visualized in 100% of the control group and 72% of the chronic ACL rupture group. All three portions of the ALL were identified in 72% of the control group but only 10% of the chronic ACL rupture group. In both groups, the most commonly visualized portion was the meniscal portion and the least visualized was the tibial portion. In 18% of the chronic ACL rupture group, no portion of the ALL was visualized.ConclusionsThe visibility of the ALL of the knee was significantly lower in patients with a chronic ACL rupture than in those with an intact one.     

Axonal projection of descending pathways responsible for eliciting forelimb stepping into the cat cervical spinal cord

Summary The descending pathways responsible for eliciting forelimb stepping are located in the lateral funiculus (Yamaguchi 1986). In order to determine into which spinal segments the descending pathways project and to know the projections and functions of the other descending system, the ventral funicular pathways, we placed various lesions in the cervical spinal cord of decerebrate cats with the lower thoracic cord transected and studied their effects on forelimb stepping evoked by stimulation of the midbrain locomotor region. (1) The lateral funiculus was transected on one side. The operation removes descending input to all the segments caudal to the lesion. Experiments with serial transections from the caudal to rostral segment revealed that stepping activity of the limb on the lesioned side is reduced when the lesion is placed at the level between the C6 and C7 segment and then between C5 and C6. A slight reduction of activity was also observed after a lesion placed between C7 and C8. (2) Consistently, bilateral transection of the lateral funiculus at the level between C5 and C6 abolished stepping movements of both forelimbs. (3) The cervical cord was split in the parasagittal plane through the dorsal root entry. The operation removes the descending input to the segment in which the lesion is placed. The parasagittal lesions from the C1 to C6 did not abolish stepping activity, although a lesion placed between C5 and C6 could slightly affect stepping. The results, (1)–(3) suggest that the lateral funicular pathways project into the spinal segments mainly at the C6–C7 level with some rostrocaudal extension into C5 and C8. (4) Complete transections of the medial part of the spinal cord cut extensor bursts short and raised stepping frequency. Nevertheless, if the lesion at C1–C5 spared the ventromedial part of the ventral funiculus, it did not result in such high-frequency stepping or in weakened extensor activity. In the case of segments caudal to C6, medial transections which spared the corresponding region could result in such stepping. It is suggested that the pathways descending through the ventromedial part of the ventral funiculus in the rostral segments provide extensor activity during stepping. They may change their course in the more dorsal part of the ventral funiculus below the C6 and presumably project into the grey matter of more caudal segments.     

神经激肽A免疫反应在哮喘豚鼠脊髓中的定量分析

用免疫细胞化学ＡＢＣ法结合显微图像定量分析，研究了神经激肽Ａ（ＮＫＡ）免疫反应物在哮喘豚鼠脊髓中的分布及其变化。结果表明，ＮＫＡ免疫反应纤维及终末分布于豚鼠Ｃ７～Ｔ５段脊髓后角Ⅰ～Ⅲ层和背外侧索核区，ＮＫＡ样阳性免疫反应物的平均密度在前者为４２．２％，后者为３７．２％；它们的平均灰度值分别为１３４．７和９２．９，与对照组（平均密度分别为２７．２％和２４．９％，平均灰度值分别为１９９．９和１２９．２）比较均有显著性差别（Ｐ＜０．０１）。这些研究结果提示脊髓内ＮＫＡ可能参与了哮喘发作的神经病理生理机制，是其发作的重要因素之一。     

Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m² (range, 23.9 to 28.7 kg/m²). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm²). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm²). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.     

60岁以上患者人工股骨头置换分析

目的探讨60岁以上患者人工股骨头置换手术治疗时术前准备,手术入路及疗效.方法回顾性分析87例60岁以上患者人工股骨头置换术手术治疗的临床资料.结果①72例经髋关节前外侧入路手术,其中61例术前采用下肢皮牵引带牵引,11例术前采用骨牵引,术中复位均较容易;术后优良者占93.1%,很好者占4.2%,好者占2.7%,十年内无后脱位和修正者.②15例经髋关节后侧入路手术.其中12例术前采用骨牵引,术中复位较容易;术后优良者占80%,好者占13.3%,尚可占6.7%;术后后脱位者2例,十年内修正者2例;另3例术前采用下肢皮牵引,术中难复位2例,稍难复位1例;五年内无后脱位者,2例进行修正术.结论60岁以上患者人工股骨头置换手术采用髋关节前外侧入路较理想,术前采用下肢皮牵引带牵引即可,不需骨牵引;股骨距(即股骨颈内侧皮质)残留长度和术后早期功能锻炼是决定疗效的关键.     

The anterolateral funiculus in the spinal cord in amyotrophic lateral sclerosis

We carried out a morphometric study on the myelinated fibers in the anterolateral funiculus (ALF) and lateral corticospinal tract (LCS) in the cervical segment of the spinal cord of 13 patients with classic amyotrophic lateral sclerosis (ALS), 6 of whom had been on a respirator: 5 age-matched subjects were used as controls. The results obtained revealed that: (1) the fiber-size distributions of the myelinated fibers in the ALF and LCS of the control subjects had peaks at 2 m; (2) there were marked and significant losses of large myelinated fibers in the ALF and LCS of ALS patients; (3) the patients who required respirator support showed more severe degeneration in the ALF than those who required none; and (4) the degree of myelinated fiber loss in the LCS did not correlate with either the illness duration or the history of respirator use.     

经封闭式负压引流后应用游离股前外侧皮瓣移植修复足部皮肤缺损的临床疗效

目的探讨经封闭式负压引流后应用游离股前外侧皮瓣移植修复足部皮肤缺损的临床疗效。方法选取2017年1月至2019年1月我院收治的76例足部皮肤缺损患者,随机分为两组,对照组进行经封闭式负压引流治疗,研究组在对照组基础上进行游离股前外侧皮瓣移植修复。比较两组治疗总有效率、生活质量评分、感觉功能恢复状况、植皮成功率。结果与对照组比较,研究组治疗总有效率更高(P0.05);与对照组比较,研究组生活质量评分更高(P0.05);与对照组比较,研究组S3、S1区感觉功能恢复率更高(P0.05),但其余区感觉功能恢复没有明显差异;与对照组比较,研究组植皮成功率更高(P0.05)。结论对足部皮肤缺损患者,应用经封闭式负压引流治疗基础上联合游离股前外侧皮瓣移植修复治疗,效果理想,可提高皮瓣移植成功率,改善生活质量,恢复部分感觉功能。因此,该治疗方法值得广泛应用。     

Soft palate reconstruction after radionecrosis: Combined anterolateral thigh adipofascial and nasoseptal flaps

Although radiation-based treatment for nasopharyngeal cancer may achieve excellent long term oncologic results, late effects of therapy may lead to soft tissue radionecrosis and velopharyngeal insufficiency (VPI). Repair of these oro- and nasopharyngeal defects presents a complex reconstructive challenge. We present a case of a long-term survivor treated with chemoradiotherapy for nasopharyngeal cancer who developed progressive dysphagia, velopharyngeal insufficiency, and radionecrosis of the nasopharynx and soft palate, leading to tracheostomy and gastrostomy tube dependence. A staged reconstruction was performed, initially with a tubed nasoseptal flap for a creation of a mucosal-lined nasopharyngeal port. An adipofascial anterolateral thigh free flap was subsequently performed for soft palate reconstruction. Within 2 months, the oropharyngeal reconstruction had remucosalized and she was decannulated, taking an oral diet. Her speech was intelligible and she had good nasal breathing without symptoms of velopharyngeal insufficiency.