A quantitative analysis of valgus torque on the ACL: a human cadaveric study.

The loads needed to elicit a positive pivot shift test in a knee with an anterior cruciate ligament (ACL) rupture have not been quantified. The coupled anterior tibial translation (ATT), coupled internal tibial rotation (ITR), and the in situ force in the ACL in response to a valgus torque, an inherent component of the pivot shift test, were measured in 10 human cadaveric knee specimens. Using a robotic/universal force-moment sensor testing system, valgus torques ranging from 0.0 to 10.0 Nm were applied in nine increments on the intact and ACL-deficient knee in flexion ranging from 0 degrees to 90 degrees. At 15 degrees of knee flexion, the coupled ATT and ITR were significantly increased in the ACL-deficient knee when compared to the intact knee. Coupled ATT increased a maximum of 291% (6.7 mm, p<0.05), while coupled ITR increased a maximum of 85% (5.1 degrees, p<0.05). At 30 degrees, the increases in coupled ATT and ITR were significant at valgus loads of 3.3 Nm and greater with a maximum increase in coupled ATT of 137% (6.3 mm, p<0.05) and a maximum increase in coupled ITR of 38% (3.6 degrees, p<0.05). At 45 degrees, coupled ATT increased significantly (maximum of 69%, 4.4 mm, p<0.05), but only at torques > or =6.7 Nm. The in situ force in the ACL was less than 20 N for all flexion angles when a torque between 3.3 and 5.0 Nm was applied. Low valgus torque elicited tibial subluxation in the ACL-deficient knee with low in situ ACL forces, similar to a positive pivot shift test. Thus, application of a valgus torque may be suitable to evaluate ACL-deficient and ACL-reconstructed knees, since subluxation can be achieved with minimal harm to the ACL graft. This work is important in understanding one load component needed for the pivot shift examination; further studies quantifying other load components are essential for better comprehension of the in vivo pivot shift examination.     

Morphological inspection of 80 consecutive Gyro pumps after cardiopulmonary bypass

 We have been using the Gyro centrifugal pump C1E3 for cardiopulmonary bypass in anticipation of high efficiency, low hemolysis, and antithrombogenicity of this pump. However, the clinical evaluation of this pump remains to be clarified, because it has been a short time since the pump appeared in clinical situations. The aim of the present study is to inspect and analyze the Gyro pumps morphologically after clinical use. We examined 80 consecutive pumps after cardiopulmonary bypass for 186 ± 67 min with a mean flow rate of 2.52 ± 0.22 l/min/m² at a mean rotational speed of 2485 ± 81.1 rpm. Although no abnormal findings were present in 79 pumps, one pump was found to contain effusion at the connection between the impeller body and the shaft. The extudate was supposed to be blood, based upon the results of X-ray spectrometer analysis. The cause was determined to be the upward deviation of the shaft off the impeller body. Scanning electron microscopy showed scratches on a part of the bottom housing and a smooth surface of both the male and female pivots of the pump. Surface profile measurement revealed that the deformity of the female pivots was 0.14 mm (top) and 0.05 mm (bottom). These observations suggest that the floating force and vibration by the rotating impeller acted on the joint zone between the alumina ceramic shaft and the polycarbonate impeller body, resulting in dissection of the adhesive agent from the polycarbonate. Although this abnormality may be rare, the structural design still may need to be improved. Received: November 9, 2001 / Accepted: February 4, 2002     

Can rotatory knee laxity be predicted in isolated anterior cruciate ligament surgery?

Purpose

Despite the overall success of the surgical anterior cruciate ligament (ACL) reconstruction, some patients still present with instability symptoms even after the surgery, mainly due to the presence of associated lesions. At present, the pivot shift test has been reported to be the benchmark to assess rotatory knee laxity. The purpose of this study was to quantitatively evaluate rotatory knee laxity at time-zero in order to determine whether detected post-reconstruction laxity was predictable by its value measured before the reconstruction, which was hypothized to be influenced by the presence of associated lesions.

Methods

Rotatory knee laxity was retrospectively analysed in 42 patients, including two different ACL reconstructions. The maximal anterior displacement and the absolute value of the posterior acceleration reached during the reduction of the tibial lateral compartment were intra-operatively acquired by using a navigation system and identified as discriminating parameters. For each parameter, statistical linear regression analysis (line slope and intercept) was performed between pre- and post-reconstruction values.

Results

No statistically significant influence of the initial posterior acceleration on the post-reconstruction outcome was found (line slope, p > 0.05), although a statistically significant line intercept was indeed identified (p < 0.001). A statistically significant influence on the surgery outcome was instead found for the initial value of the anterior tibial displacement (line slope = 0.39, p = 0.004), meaning that, on average, about 40 % of the post-reconstruction lateral compartment displacement could be explained by the corresponding pre-reconstruction value. Both of these findings highlighted the importance of intra-operative quantification of rotatory knee laxity to identify correct indications for the surgery.

Conclusions

This study provided important implications for the future possibility of defining a quantifying tool able to assess rotatory knee laxity during ACL reconstruction. This could allow detection of additional injuries to secondary restraints by easily performing rotatory knee laxity tests, which in turn could reduce post-surgical recurrence of knee instability.     

灵龟八法针法治疗抑郁性神经症的临床研究

目的:观察灵龟八法针法对于抑郁性神经症的疗效。方法:60例病人,随机分为灵龟八法组31例,普通针刺组29例,灵龟八法组为在普通针刺基础上加用灵龟八法,每周治疗3次,共治疗3个月。结果:治疗1、2、3个月后两组汉密尔顿抑郁量表(HAMD)计分均较治疗前明显降低,P<0.01,灵龟八法组均分别明显低于普通针刺组,P<0.01;分别于1、2、3个月后做疗效比较,灵龟八法组均优于普通针刺组,P<0.05;治疗3个月后中医证候评定量表计分和抑郁自评量表(SDS)计分比较:灵龟八法组计分均明显低于普通针刺组,均P<0.01。结论:灵龟八法针法对于抑郁性神经症是一种有效的治疗手段,值得临床推广。     

吴考槃教授精研经典解惑学术真谛

[目的]探讨吴考槃教授研究《素问》《灵枢》《难经》等名著的学术思想。[方法]通过对吴老研究素、灵等名著而发表的相关论文与出版著作的系统收集,采用文献研究的方法进行挖掘整理研究。[结果]吴老对经典名著的研究不仅运用校勘、训诂、注解、今译的方法,并通过归类、分析、阐发等挖掘与加工,将经文中的理论精髓和蕴涵的学术思想给予揭示剖析。[结论]对中医经典的研究不仅要有基本的中医基础理论功底,更重要的具有博而精的文献底蕴。     

略论《素问》林亿新校正对《灵枢》经文的利用

<素问>林亿新校正利用<灵枢>经文校对<素问>经文和王冰的注文,并与<甲乙经>联系起来简释,并指出<灵枢>与<针经>是异名同书.     

肝脾共主枢纽论

探讨肝脾在人体生理,病理中的作用和意义。方法结合历代医家临床运用心得和现代医学研究结果,从肝脾同 焦,为气血生化之源,气机升出入之枢纽,病变之纲领等角度加以论证。结果：肝脾同属中焦,为气血生化之源,气机升降出入之枢纽。结论肝脾共主人体枢纽。     

《灵枢》半夏汤浅谈

探讨《灵枢》半夏汤药物组成及煎服法。认为半夏为生半夏,秫米为黏高粱;煎服法较繁且有颇多讲究;主要用于治疗邪客于内、阳不入阴之不寐。     

《灵枢经·九针十二原第一》学术思想探源

《九针十二原》是《灵枢经》卷一之首篇,文章对针灸的理、法、方、穴作了纲领性的阐述,特别是着重辨证论治的针术。九针十二原第一主要论九种不同形态针具的名称和功用,以及人体十二原穴的治疗意义。故取篇中“九针”和“十二原”之文,以“九针十二原”命篇。本文从九针的选用,用针的基本原则,十二原穴的作用及针刺治病的效应等方面总结概括其学术思想,这些为后世针灸的发展奠定了基础。     

《黄帝内经》的成书年代

《黄帝内经》非一时一人所编写,在它定稿之前,已有许多医书存在,这些古代医书在《内经》之前未经系统整理,《内经》便是这些医书的集成和缩影。它的成书年代为春秋战国时代至西汉末年,大约经历了七八个世纪。