跟骨、距骨的计算机三维重建及其解剖学测量

目的:建立跟骨、距骨数字化计算机三维模型,测量相关解剖数据,为踝部的手术设计提供解剖学参数.方法:正常成人志愿者40例,男性20例,女性20例,进行CT扫描,扫描层厚5 mm,以1.25mm层厚、0.6 mm层间隔进行重建,重建后的图像用Mimics软件进行处理,进行三维测量.测量指标包括距骨与跟骨的相关解部学参数.结果:重建的跟骨、距骨数字化虚拟可视模型能够从多角度、多平而进行观察及测量,距骨上关节而前中后宽度,弧形关节面半径,跟骨长度,跟骨前部、沟部及后部的高度和宽度,载距突的长、宽、高的测量值男性大于女性,同性别间左右两侧比较无明显差异,Gissane's角的测量值同性别间、左右两侧及男女间同侧比较无明显差异.结论:本研究获取的踝部解剖学数据可能对跟距骨手术器械的设计、手术方案的制定有一定参考意义.     

跟骨前部与载距突关系的解剖学研究及其临床意义

目的　研究跟骨前部与载距突的解剖关系, 探讨自跟骨前部外侧壁向载距突置钉的可行性和方法。 方法　观察跟骨前部与载距突的解剖形态。用解剖测量法、数字化X线摄影法和多层螺旋计算机断层扫描法,测量36只跟骨标本的前部和载距突数据,确定自跟骨前部外侧壁向载距突进钉点和方向。在标本上模拟置钉,评价置钉的安全性。 结果　跟骨前部与载距突具有密切的解剖关系。跟骨前部长(22.27±2.96)mm,宽(23.60±1.99)mm,高（25.25±3.03)mm。载距突长(24.24±2.27)mm,宽(15.44±1.41)mm,高　(10.96±1.25)mm,前倾角（39.13±5.28）°,外倾角（27.78±4.36）°。自跟骨前部外侧壁取两点向载距突置钉,前点进钉方向为上斜角（21.37±3.35）°,后斜角（22.39±3.13）°,有效固定长度（43.16±2.12）mm;后点进钉方向为上斜角（33.60±4.15）°,后斜角（10.09±1.03）°,有效固定长度（44.69±2.32）mm。模拟置钉,无螺钉穿透跟骨前部上面的骨皮质。 结论 载距突是跟骨骨折螺钉置入的理想位置,自跟骨前部外侧壁可以向载距突安全地置钉,跟骨前部与载距突的相互关系决定螺钉进钉方向和长度。这些数据为跟骨骨折内固定手术提供了可靠的解剖学依据。     

跟骨载距突的解剖特点及其临床意义

目的 :探讨跟骨载距突的解剖特点及其临床意义。方法 :对 10 8侧成人跟骨干燥标本和 2 6侧成人足部标本进行解剖学观察。结合观察测量结果 ,分析 45例跟骨骨折患者的X线片和CT片中的载距突移位情况。结果 :载距突的长、宽、高分别为 (2 3 .6± 3 .0 )mm ,(15 .3± 2 .2 )mm和 (9.5± 1.2 )mm。在 45例跟骨骨折患者中 ,无一发生载距突移位。在跟骨载距突的周围 ,有牢固的肌腱、韧带和关节囊附着 ,故当跟骨骨折时 ,这些结构可限制载距突移位。结论 :载距突周围的解剖特点决定了载距突在跟骨骨折中不会发生移位 ,故临床上可利用稳定的载距突骨块作为跟骨骨折行内固定术时的固定点。     

载距突轴向X线投照的影像解剖学研究

目的 探讨载距突轴向X线投照技术,为判断跟骨骨折内固定置钉质量提供依据。方法 选取45侧成人足踝标本(标本组)行足踝X线摄片、多层螺旋CT(MSCT)扫描及3D重建,然后行解剖观测;收集2014年7月—2017年6月南京鼓楼医院集团宿迁市人民医院成人足踝侧位X线影像资料225例(X线组)进行回顾性分析,其中男132例、女93例,年龄18～72(42.6±11.7)岁。借助形态解剖和MSCT 3D图像观察标本载距突形态,分析载距突与内踝、距骨、舟骨解剖关系,研究内踝、距骨、舟骨对载距突轴向X线投照影响。以足底平面为参照面,测量标本的载距突长、宽、高和前倾角;在临床X线图像上测量载距突前倾角,比较各组前倾角差异,分析载距突与轴向投照角之间关系,确定载距突轴向投照角。按照简单随机抽样法随机抽取标本组5例标本行实验置钉,2017年1—6月对我院10例跟骨骨折患者手术置钉,用载距突轴向X线投照法分析置钉效果。结果 标本解剖和MSCT图像观察表明,载距突位于跟骨内侧,高出跟骨前部的上面并向内侧延展,呈后上-前下倾斜,与内踝、距骨、舟骨之间具有密切的解剖关系。但在轴线方向,仅有距骨后突与载距突重叠,影响载距突轴向X线投照效果。标本组载距突平均长(24.36±2.25)mm、宽(14.91±1.58)mm和高(11.03±1.24)mm。标本组载距突前倾角分别为解剖测量30.38°±1.21°、MSCT测量30.47°±1.54°和X线测量30.17°±1.44°,X线组男性与女性载距突前倾角分别为30.09°±1.82°和30.52°±1.62°;组间比较差异均无统计学意义(F=1.768, P>0.05),表明不同研究方法获得结果一致,确定载距突前倾角约为30°,此角度即为载距突轴向X线投照角。应用轴向X线投照法判断实验和临床载距突置钉情况,成像效果较为满意。结论 载距突轴位X线成像能显示载距突长轴方向的前后位影像,及中距关节面,可用于跟骨骨折内固定术中透视和术后摄片分析螺钉置入效果,为载距突相关临床影像学检查提供了新视角。     

跟骨的解剖分部及其临床意义

目的研究跟骨解剖学分部的特点和临床意义.方法[HTSS〗将跟骨按其解剖学特点分为前部、体部、结节部、载距突部和丘部5个部,并在54对108侧跟骨干燥标本上对各区进行骨性测量.结果跟骨各区在骨的质量、大小、形态和结构方面各有其解剖特征和功能.跟骨前部长、高和宽分别为(19.8±2.2)、(24.5±3.2)、(22.4±3.2)mm;跟骨水平长(68.6±6.4)mm;跟骨载距突长、宽、高分别为(23.6±3.0)、(23.6±3.0)、(9.5±1.2)mm;跟骨丘部宽、高和底长分别为(27.5±2.6)、(16.4±1.2)和(40.9±5.1)mm.结论[HTSS〗跟骨解剖分部与跟骨骨折线的形成有关,并有利于对跟骨骨折和病损进行恰当的解剖学描述.     

跟骨各分部损伤程度的观测分析

目的 :观测跟骨各分部的损伤程度,更好地理解跟骨各部位骨折损伤机制及术后并发症。方法 :收集589例跟骨,按解剖学特点分为前部、体部、结节部、载距突部、丘部,划分无损、轻度、中度、重度4个损坏等级,结合观测法采用χ~2检验。结果 :无损的可能性排序为载距突部体部丘部结节部前部;轻度坏损可能性为丘部前部载距突部;中度坏损可能性为前部结节部体部丘部;重度坏损可能性为结节部丘部体部。结论 :跟骨分部与坏损程度发生率有相关性,前部坏损可能性最大,载距突部坏损可能性最小。     

载距突解剖形态学分型及特征分析

目的 基于CT三维重建的载距突,探讨其解剖形态学分型及特征,为螺钉植入治疗跟骨骨折提供解剖学支持。 方法 2019年3月~2020年3月,经纳入标准排除后,最终共收集336例来自西南医科大学附属中医医院的成年人跟骨CT三维重建图像,依据载距突冠状位轴线与跟骨轴线的夹角（β）进行分型,研究参数：β、载距突内侧中点与后距关节面内侧中点的距离（AB）,载距突内侧中点与后距关节面外侧中点的距离（AC）,载距突内侧中点冠状位轴线与跟骨最外侧交点的距离（AD）,载距突内侧中点与跟骨结节内侧突中点的距离（AE）,载距突内侧中点与跟骨结节中点的距离（AF）,载距突内侧中点与跟骨结节外侧突中点的距离（AG）,根据分型和男女、左右分别对测量结果进行统计学分析。 结果 根据 β,我们将载距突分为3型：Ⅰ型（β<70°,68例,20.24%）、Ⅱ型（70°≤β<80°,153例,45.54%）、Ⅲ型（80°≤β<90°,115例,34.23%）。其中Ⅲ型与其他型别在 β、AB、AF上具有差异（P<0.05）,Ⅲ型和Ⅰ型在AE上具有差异（P<0.05）。此外,男性和女性的载距突在AB、AC、AD、AE、AF、AG上均具有差异（P<0.05）,左右两侧的载距突在 β、AB上具有差异（P<0.05）。 结论 载距突可以分为3型,以Ⅱ型为主,内固定治疗跟骨骨折时,螺钉植入角度可以尽量在70°~ 80°,其解剖形态学分型对螺钉植入有一定的临床指导意义。     

有关跟骨骨折复位与内固定的应用解剖

目的 :为跟骨骨折的内固定设计提供解剖学基础。方法 :对 5 4对 10 8侧成人跟骨干燥标本的一些与其骨折内固定有关的骨性标志进行测量。结果 :跟骨的长度为 68.6± 6.4mm ;跟骨前部、跟骨沟部及跟骨后部的宽度分别为 2 2 .3± 3 .2mm ,2 4.4± 2 .9mm和 3 0 .3± 3 .2mm。载距突的长、宽、高分别为2 3 .6± 3 .0mm ,15 .3± 2 .2mm和 9.5± 1.2mm ,载距突与跟骨水平面存在 2 7.7°± 6.8°的上翻角。Gissane′s角为 116.7°± 8.0°。结论 :本文结果对跟骨骨折的复位和固定具有指导意义。     

距跟骨间韧带断层解剖及磁共振成像的对照研究及临床意义

目的 为临床MRI诊断距跟骨间韧带的损伤提供断层解剖学依据. 方法 选取12例成年男尸右足踝标本,于自然松弛位(即跖曲20°)经低温冷冻后制成断层标本,其中冠状位4例、矢状位4例、横断位4例,并与该区的MRI图像对比. 结果 在矢状面过距骨颈外侧缘内侧(19.2±2.8)mm范围,在冠状面过距骨体中部(17.9±5.2)mm范围内可见距跟骨间韧带.在过距骨体中部的矢状位断面距跟骨间韧带显示最清晰,平均长17.2mm,矢状径平均宽11.9mm.过距骨体中部的冠状位断面距跟骨间韧带显示最清晰,平均长13.1mm,横径平均宽14.1mm.水平面对于显示距跟骨间韧带效果不佳. 结论在MRI上能清楚显示距跟骨间韧带,为诊断距跟骨间韧带损伤提供了依据.     

跟骨的形态结构特点及其临床意义

目的：为跟骨骨折的治疗提供形态学的依据和标准。方法：观察成人正常跟骨的形态特征和骨小梁分布情况，测量跟贩的长、宽、高和Ｂｏｈｌｅｒ’ｓ角、Ｂｉｓｓａｎｅ‘ｓ角等。结果：（１）骨形态结构较复杂，骨皮汪，骨松质多，跟骨前部跟骨沟下方骨小梁稀疏，后梁侧骨小梁密集。（２）正常跟骨各指标左右俩则无明显差异，而不同性别暗除Ｇｉｓｓａｎｅ’ｓ角外，其他各项指标均有显著差异；有高／长的比值〉１／２。结论：（１）跟     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.