Distal biceps rupture: Evaluation and management

Injury to the distal biceps occurs in certain high risk groups. Anatomical continuity of the lacertus fibrosus has bearing on the extent of retraction of the torn tendon stump. The objective of clinical and imaging evaluation is to discriminate between tendinosis, partial tear, acute complete tear and chronic complete tear. A complete tear of the distal biceps tendon can be diagnosed clinically with the Hook test. The traditional Hook test and the resisted Hook test are useful clinical tests. Though x-rays are routinely done, MRI remains the investigation of choice. Non-operative treatment has a role in selected patients with partial tear or patients with complete tear who have low functional demands. Operative treatment is the recommended treatment for complete tear of the distal biceps and is associated with good functional outcome and patient satisfaction.     

关节镜下胭绳肌腱部分重建、单束重建和双束重建前交叉韧带的疗效比较

目的 研究使用腘绳肌腱进行关节镜下前交叉韧带（ACL）损伤后部分重建、单束重建和双束重建的疗效差异。方法 本研究共包括56例ACL重建病例，其中部分重建11例，单束重建25例，双束重建20例。所有患者术前及随访时均进行IKDC2000、Tegner和Lysholm评分以及常规KT-2000和后推KT-2000测量，并对结果进行统计学分析。结果 平均随访19．84±5．03个月（13～22个月）。对三组的IKDC、Lysholm和Tegner评分的配对t检验显示，术后的IKDC、Lysholm和Tegner评分比术前均有显著改善。后推法KT-2000测量显示，ACL双束重建可以比单束重建获得更好的膝关节稳定性，ACL部分重建组膝关节的稳定性优于单束重建和双束重建组。但常规KT-2000测量无法辨别三种术式之间膝关节稳定性的差异。结论 ACL双束重建可以比单束重建更好地重建膝关节的稳定性，ACL部分重建的临床效果优于单束重建和双束重建；后推KT-2000测量在ACL双束重建和部分重建的术后稳定性评估上可能具有重要的应用价值。     

An uncommon cause of acute right ventricular failure and high mixed venous oxygen saturation

Ruptured sinus of Valsalva aneurysms are rare. We report a case in which the usual clinical manifestations were not present and the patient was initially treated as an acute pulmonary embolus. Despite three negative echocardiograms an intra-cardiac shunt was suspected because of a persistently elevated mixed venous oxygen saturation. Cardiac catheterisation confirmed the diagnosis. Surgical repair was performed and post operative recovery was uneventful.     

Early nerve regeneration after Achilles tendon rupture — a prerequisite for healing? A study in the rat

Nerve regeneration during healing of Achilles tendon rupture in the rat was studied by immunohistochemistry including semi-quantitative assessment. Neuronal markers for regenerating and mature fibers, ie., growth associated protein 43 (GAP-43) and protein gene product 9.5 (PGP 9.5), respectively, were analyzed at different time points (1-16 weeks) post-rupture. In the paratenon, both the ruptured and intact contralateral tendon (control) consistently exhibited immunoreactivity to the two neuronal markers. However, in the proper tendinous tissue only the ruptured tendon showed immunoreactivity to GAP-43 and PGP 9.5. This expression was seen already at week 1 post-rupture to reach a peak at week 6 followed by a successive drop till week 16. Also the occurrence of sensory and autonomic fibers according to immunoreactivity for calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY), respectively, was analyzed. CGRP-positivity was abundantly seen from weeks 2-6 in both perivascular and sprouting free nerve endings in the proper tendon tissue undergoing healing. NPY appeared later, at weeks 6-8 post-rupture around blood vessels mainly located in the surrounding loose connective tissue. Apart from a role in vasoaction (CGRP, vasodilatory; NPY, vasoconstrictory). both neuropeptides have been implicated in fibroblast and endothelial cell proliferation required for angiogenesis. The present study shows that early healing of ruptured tendons is characterized by an orchestrated, temporal appearance of nerve fibers expressing peptides with different actions. The observed pattern of neuronal regeneration and neuropeptide expression may prove to be important for normal connective tissue healing.     

Conservative management of a major post-intubation tracheal injury and review of current management

Tracheal rupture represents a rare but serious complication of intubation. We discuss a case of a major post-intubation rupture. After investigation with CT scan tracheoscopy and bronchoscopy a low tracheostomy was formed protecting the rupture from pressure changes associated with ventilation. The patient was managed with minimal surgical intervention, low tracheostomy with antibiotic cover and monitoring in the intensive care unit for 24 h before being woken and moved to a ward after 48 h. The patient made a full and uncomplicated recovery and was discharged 2 weeks after the original injury. Most of the literature on the subject is made up of review of case reports that conclude management of such a major tear must be with surgical repair. This however confers significant morbidity and an associated high mortality. We suggest an alternative management protocol.     

Damage mechanics and load failure of fiber-reinforced composite fixed partial dentures

OBJECTIVES: Damage mechanics has been defined as the study of the initiation (initial failure) and accumulation of damage to and including rupture (final failure). This study was designed to evaluate the effect of increasing fiber-reinforced composite (FRC) substructure within a standardized fixed partial denture (FPD) model on the failure performance, in terms of damage mechanics. METHODS: The two FRC restorative systems, Targis/Vectris (TV) (Ivoclar Vivadent) and EverStick (ES) (Stick Tech with Gradia, GC Corp.), were used to restore the molar FPD model (1.5 mm axial and 2.0 mm occlusal reduction). Templates were used to standardize substructure designs with 0, 18, 43, and 66% cross-sectional FRC volume fraction (V(FRC)) of fiber substructure. Specimens (n = 5) were homogenized at 29 points and stored for 1 week at 37 degrees C in distilled water. Specimens were luted with calcium hydroxide, then statically loaded until failure. Initial failure (IF), final failure (FF) and the mode of failure were recorded. RESULTS: The lowest mean load to initial failure was 530 N (TV 18%) and the highest was 1208 N (ES 66%). Linear regression analysis calculated the Pearson's correlation coefficient (r) for the interactions between V(FRC) and IF (ES: r = 0.7879, TV: r = 0.6184), V(FRC) and FF (ES: r = 0.912, TV: r = 0.8152), and between IF and FF (ES: r = 0.892, TV: r = 0.7237). Unreinforced specimens universally fractured instantaneously. SIGNIFICANCE: The highest loads to initial and final failure were yielded by specimens with the highest cross-sectional V(FRC).     

腓骨长肌转位修复陈旧性跟腱断裂

陈旧性跟腱断裂手术修复较困难，术后效果与新鲜断裂相比较差，且重建的跟腱由于瘢痕增生而粗大，踝关节活动受限。作者于2000年8月-2003年11月利用腓骨长肌转位重建跟腱术19例，取得满意效果。     

主动脉窦瘤破裂的外科治疗：附16例报告

低温体外循环下手术治疗主动窦瘤破裂１６例，采用右房切口１例，右室流出道切口１１例，窦瘤破入腔和主动脉根部双切口４例。单纯窦瘤破口修补２例；双头垫片针窦瘤基部与空间隔踬同并列间断褥式缝合修补３例；     

脾动脉栓塞治疗外伤性脾破裂28例临床疗效观察

目的：探讨脾动脉栓塞术对外伤性脾破裂的疗效及并发症的处理。方法：采用Seldinger法行脾动脉栓塞术治疗外伤性脾破裂28例。结果：所有患者出血立即停止，其中4例行2次栓塞。28例均有脾区疼痛，22例发热。脾动脉栓塞5天后血小板、白细胞上升近1倍，7天后恢复至正常范围。28例随访6－36月，查免疫球蛋白、CT等结果满意，未有再出血及发生暴发性感染。结论：脾动脉栓塞不但有良好的止血作用，而且能保留脾脏的免疫功能，可在非手术治疗失败时选用，是外伤性脾破裂的一种有效治疗方法。