V-Y肌腱瓣修补术治疗陈旧性跟腱断裂

目的 研究V—Y肌腱瓣修补术治疗陈旧性跟腱断裂的手术方法及结果。方法 对9例平均112d的陈旧性跟腱断裂患，采用小腿三头肌V—Y肌腱瓣修补术治疗修补缺损为3．2～6cm，平均4．6cm。结果 平均随访2年8个月，按Arner-Lindholm疗效评定标准评估，优7例(77．8％)，良2例(22．2％)，优良率为100％。结论 对于陈旧性跟腱断裂，小腿三头肌V—Y肌腱瓣修补术足一种方法简单、疗效满意的手术方法。     

Earthquake generated proximal tibial nerve compression treated by surgery

Purpose

This article reports on nine cases of proximal tibial nerve compression by the soleal tendinous arch caused by unsuitable treatment of acute compartment syndrome (ACS). Also, we report the clinical results of neurolysis and analyse the cause of this special type of neurological compression.

Methods

There were nine extremities in nine patients included in the study. All patients were among the victims of the Wenchuan earthquake in 2008. All patients had a previous lower extremity ACS. Pain level, numbness in the sole, muscle strength of the flexor hallucis longus and Tinel’s sign were evaluated pre- and post-operatively. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal tendinous arch.

Results

At a mean follow-up of 22 months, eight patients (87 %) with weakness of the flexor hallucis longus showed improvement in flexor strength and seven patients (78 %) exhibited improved sensory function in the sole. All patients experienced pain relief. Subjective pain was reduced from an average score of 2.7 to 0.7 based on a visual analogue scale. Physical examination for Tinel’s sign revealed all patients experienced relief of radiating pain, but two patients still retained a positive Tinel’s sign (mild) over the soleal tendinous arch. In summary, four patients were highly satisfied, four were satisfied and one was neither satisfied nor dissatisfied with functional recovery after neurolysis.

Conclusions

Unsuitable treatment of lower extremity ACS can lead to tibial nerve compression beneath the soleal tendinous arch. Neurolysis may improve pain and sensory and motor function.     

尺神经深支的解剖学观测

目的：为临床尺神经深支损伤的诊治提供解剖学资料。方法：选择３０只成人尸体的无损伤、无畸形手,在解剖手术显微镜下观测尺神经深支的行程、分支、分布。结果：尺神经深支腕尺侧管段长（１８．６７±０．７４）ｍｍ,横径（３．１７±０．６６）ｍｍ,厚（１．７０±０．３７）ｍｍ;小鱼际鞘段长（１４．３５±２．４７）ｍｍ,横径（２．４９±０．６９）ｍｍ,厚（１．１７±０．４３）ｍｍ,发出小指展肌支、小指短屈肌支、小指对掌肌支;中间鞘段长（１８．０３±３．６１）ｍｍ,横径（１．８７±０．４６）ｍｍ,厚（０．８７±０．２２）ｍｍ,发出第３、４蚓状肌支和部分骨间肌支及关节支;鱼际鞘内段长（５．０７±２．２３）ｍｍ。结论：尺神经深支在腕尺侧管段特别是穿小指短屈肌腱弓前最易受损;其体表投影是ＡＢ段以及以ＯＢ为半径向虎口方向所画的弧。     

86例腱鞘结核临床特点误诊原因及治疗转归分析

[目的]分析总结腱鞘结核的病例特点、治疗经过，探讨该病的误诊影响因素及治疗转归，从而为临床诊治提供循证依据。[方法]回顾分析1994年1月～2006年6月间文献报道86例腱鞘病例，就其性别、年龄、病灶部位、临床表现、治疗经过及效果等进行统计学分析。[结果]高发年龄为30～49岁，占65％。男女性别比基本为1：1，发病部位右侧（67％）明显高于左侧（30％），以肿胀、压痛、活动障碍为主要表现，误诊率88％，复发率1．2％。[结论]临床症状体征不典型、实验室检查非特异性是导致腱鞘结核误诊的主要原因。局部病灶完整切除并全身化疗和（或）局部应用化疗药是治疗腱鞘结核的最佳治疗方案，复发率低。     

Magnetic resonance imaging may be an asset to diagnose and classify fluoroquinolone-associated Achilles tendinitis

Summary— The aim of this study was to document the accuracy of magnetic resonance imaging (MRI) during fluoroquinolone- associated Achilles tendinitis. Fourteen Achilles tendons were examined by MRI (T1 and T2 or T2*-weighted sequences) in nine patients with typical tendinopathy (13 cases of tendinitis and 1 rupture) during fluoroquinolone therapy. Tendinous involvement was classified according to the prominence of intra- or peritendinous changes. The most typical feature was the presence of intratendinous changes, longitudinal or transversal, detected on T1 or T2-weighted sequences. Peritendinitis was most visible in two cases and nodular involvement in three cases. It was concluded that MRI appears a helpful and accurate method in identifying and classifying such iatrogenic tendinitis. In addition, MRI indicates orthopedic management when detecting risk of rupture.     

枕后腱弓在颈源性头痛中的发病机制

目的通过枕后腱弓松解治疗颈源性头痛的临床观察,探讨其作用机制及临床治疗。方法随机将40位头痛患者分为二组、分别予以局部封闭配合松解枕后腱弓中紧张挛缩的纤维以及口服非甾体类药物治疗,观察其治疗后及3个月后随访的疗效变化。结果治疗一个疗程后,局部封闭配合枕后腱弓松解其有效率达95％,与口服药物治疗组相比（P〈O．01）。3个月后随访见松解组疗效与治疗后变化不明显．而口服药物组其疗效比治疗后明显降低（P〈O．05）。结论（1）枕后腱弓的病理改变是引起颈源性头痛的发病机制之一。（2）局部封闭配合枕后腱弓松解是治疗颈源性头痛的有效方法之一。     

热休克蛋白60抗体与冠心病的关系研究

[目的]探讨热休克蛋白60（HSP60）抗体水平与冠心病（CHD）的关系。[方法]采用病例．对照研究方法,选取未治疗过的CHD患者615例为病例组,以同性别、年龄（土1岁）进行1：1匹配,共选取615例无CHD且无重要脏器疾病者为对照组。采用间接酶联免疫吸附法测定血浆HSP60抗体水平,Logistic回归分析HSP60抗体与CHD的关系。[结果]CHD组的HSP60抗体水平明显高于对照组,差异有统计学意义（P=0．000）。在校正了传统的危险因素后,与下四分位数HSP60抗体组相比,上四分位数HSP60抗体组发生CHD的危险度是其2.48（95％CI：1．78～3．46）倍;多支病变的危险度是其3．60（95％CI：1．32．9．83）倍,差异有统计学意义。[结论]HSP60抗体与CHD的发病风险及其严重程度相关,提示HSP60抗体在CHD的发生发展中可能发挥某些作用。