B型超声对诊断半月板损伤的临床价值

自１９８７年以来，我院采用Ｂ超对半月板进行实验研究并对２６４例病人进行检测，结果表明Ｂ超不仅能显示半月板图象还能区分正常与异常半月板。Ｂ超诊断的临床符合率为８６．３６％，手术符合率为９５％。本检查具有无创性，不接触ｘ射线，操作简便等优点。     

微创内固定系统在高能量胫骨平台骨折中的应用

目的:探讨微创内固定系统治疗高能量胫骨平台骨折的方法和临床疗效。方法:本组27例,男19例,女8例;年龄21~59岁,平均36岁;其中左侧12例,右侧15例。按Schatzker分型:Ⅴ型9例,Ⅵ型18例。其中合并前交叉韧带撕脱骨折3例,后交叉韧带断裂2例,半月板损伤3例。用改良内外侧联合切口,行微创内固定系统结合有限接触加压钢板(LC-DCP)内固定,其中3例半月板损伤,2例给予修补,另1例部分切除;3例前交叉韧带撕脱骨折给予钢丝固定;2例后交叉韧带断裂行Ⅱ期手术。术后2周、1、3、6个月、1年随访,行摄片及关节活动度检查,测定胫骨平台内翻角(TPA)及后倾角(PA);术后1年行膝关节HSS评分。结果:术后与术后1年TPA及PA平均值的差异无显著性统计学意义(TPA:t=1·012,P=0·356;PA:t=0·667,P=0·521)。术后1年膝关节HSS评分平均为86·9分(56~98分),根据此评分标准:优15例,良7例,中4例,差1例。结论:微创钢板治疗高能量胫骨平台骨折是理想、有效的方法,它具有手术创伤小、并发症少,骨折愈合率高,长期稳定性良好,膝关节功能恢复满意等优点。     

Load to failure of common meniscal repair techniques: Effects of suture technique and suture material

Success of meniscal repair with early or immediate motion depends on the ability of the suture fixation to withstand the loads applied. Vertical and horizontal mattress suture techniques were tested using 2-0 Ethibond, and 0-PDS and 1-PDS sutures (Ethicon, Somerville, NJ). Mulberry knot technique was tested with 0-PDS and 1-PDS sutures. Twenty menisci (60 sutures) were tested for each suture material. Sutures were placed 3 to 4 mm from the peripheral edge of the meniscus with double barreled cannulas for vertical and horizontal mattress techniques or a spinal needle for the mulberry knot technique, reproducing clinical techniques of meniscal repair. Mechanical testing of suture fixation was performed to failure at a rate of 10 mm/min on a MTS material testing system (MTS Systems Corp. Minneapolis, MN). Suture pullouts were reported as the load displacement to failure from the inner fragment only, because clinical failure would ensue should a suture pull through the inner fragment of a tear. Vertical mattress technique with 1-PDS suture had significantly greater load to failure than any other combination (P < .05). Analysis of variance showed that the vertical mattress technique had statistically superior pullout strength (P < .0001) compared with the horizontal mattress and mulberry knot techniques, which were statistically similar. There were significant differences (P < .0001) between suture types, with 1-PDS proving best compared with 0-PDS, which was stronger than 2-0 Ethibond. Selection of suture material had the greatest impact on vertical mattress load to failure and was not important to the strength of the other techniques.     

膝关节半月板损伤的MRI诊断

目的 :探讨 MRI对膝关节半月板损伤的诊断价值。方法 :对手术、关节镜或临床证实的 33例 36个膝关节半月板损伤的 MRI表现进行回顾性分析。结果 :MRI能较好地显示膝关节半月板撕裂和损伤的改变 ,还能对半月板损伤和退变进行分级 ,同时还能显示急、慢性半月板损伤的并发骨、软骨、韧带等病变。结论 :MRI检查能清楚地显示膝关节半月板病变特点和严重程度 ,为临床医生选择合适的治疗方案提供了依据。     

The long-term results of meniscus transplantation for articular cartilage defects in the knee joint

The purpose of this study was to examine the long-term clinical results of meniscus transplantation for articular cartilage defects in the knee joint. The type of study was case series. From October 1990 to June 1995, eight cases underwent allogenic or autogenic meniscus transplantations for articular cartilage defects, and seven cases were available for follow-up evaluations. The age at surgery ranged from 14 to 42 years of age (average 22.5). In one case, transplantation of tissue-engineered cartilage was performed due to pain 5 years after surgery. The other six cases were followed up for 8–13 years (average 10.1). The size of the cartilage defect ranged from 1.0 to 6.3 cm² (average 2.8 cm²). Patients were evaluated with the Lysholm score and MR images. We also performed arthroscopic examinations in three cases at the final evaluation. This study leads to the conclusion that meniscus transplantation for articular cartilage damage is not comparable to autologous chondrocyte transplantation. Two cases showed a good clinical outcome but the tissue remained as fibrocartilage tissue in the long-term.     

膝关节半月板撕裂的磁共振诊断：附61例关节镜对照分析

目的：比较分析半月板撕裂的ＭＲＩ表现和关节镜所见，明确半月板撕裂ＭＲＩ成像的作用和价值。材料和方法：对一组６１例（６８膝）ＭＲＩ资料的影像学特征与关节镜所见作对照分析，ＭＲＩ半月板内异常高信号影的判断采用Ｌｏｔｙｓｃｈ提出的分级标准。结果：ＭＲＩ对半月板损伤的诊断敏感性为９５％，特异性为８８％，关节镜符合率为９２％。ＭＲ的Ⅲ级信号与关节镜所见半月板撕裂具有高度相关性，其中Ⅲ级信号仅见于一层和见于一层以上者分别与半月板撕裂的对应关系有显著差别。病变信号发生部位及其与半月板特定表面的关系对诊断结果无影响。结论：ＭＲＩ对膝关节半月板撕裂的诊断极有价值，半月板内Ⅲ级信号是诊断半月板撕裂的可靠征象，而当Ⅲ级信号影仅见于一层时，诊断须慎重。     

Asymmetric and Axisymmetric Constant Curvature Liquid-Gas Interfaces in Pulmonary Airways

Airway closure and gas trapping can occur during lung deflation and inflation when fluid menisci form across the lumina of respiratory passageways. Previous analyses of the behavior of liquid in airways have assumed that the airway is completely wetted or that the contact angle of the liquid-gas interface with the airway wall is 0, and thus that the airway fluid forms an axisymmetric surface. However, some investigators have suggested that liquid in the airways is discontinuous and that contact angles can be as high as 67. In this study we consider the characteristics of constant curvature surfaces that could form a stable liquid-gas interface in a cylindrical airway. Our analysis suggests that, for small liquid volumes, asymmetric droplets are more likely to form than axisymmetric toroids. In addition, if the fluid contact angle is greater than 13, asymmetric droplets can sustain larger liquid volumes than axisymmetric toroids before collapsing to form menisci. These results suggest that (1) fluid formations other than axisymmetric toroids could occur in the airways; and (2) the analysis of the behavior of fluids and the development of liquid menisci within the lungs should include the potential role of asymmetric droplets.