钢丝固定法治疗肩锁关节骨折脱位合并喙锁韧带撕裂

目的：介绍肩锁关节骨折脱位并喙锁韧带撕裂骨折复位、关节重建的新方法。方法：沿锁骨外1／3的前下缘切开，暴露锁骨及喙突，在锁骨外1／3钻孔，用1．0mm直径的双钢丝，自锁骨钻孔及喙突下穿过，固定重建喙锁韧带。结果：用该方法治疗50例，均能达到肩锁关节骨折脱位复位和喙锁韧带撕裂分离后重新闭合间隙的目的。结论：该手术方法的设计，符合生物力学的要求，操作简单，复位作用良好，能早期恢复上肢的运动功能，值得推广应用。     

经皮内固定治疗陈旧性肩锁关节全脱位生物力学分析

肩锁关节是上肢与躯干的唯一骨性关节,肱骨承载的应力大部分要通过肩胛骨与锁骨传到躯干骨。所以,肩锁关节不仅是个很重要的力的传递关节,而且也是上肢活动力的一个支撑点。如果肩锁关节脱位得不到良好的复位,将限制锁骨和肩胛骨的运动,直接影响到上肢的功能。因此,保证肩锁关节的良好复位与固定就显得尤为重要。经皮内固定治疗陈旧性肩锁关节全脱位的治疗方法,是依据肩锁关节的生物力学原理,吸取了闭合疗法和手术疗法的双重优点,具有损伤小,痛苦少,固定牢靠及可进行早期功能锻炼的特点,达到了韧带修复与功能恢复并进的目的．对…     

影响下颈椎骨折脱位在麻醉下手法复位失败的多因素分析

目的探讨影响下颈椎骨折脱位在麻醉下闭合复位失败的相关影响因素。方法通过回顾我科于2006年1月~2011年1月治疗下颈椎骨折脱位病例85例。分别记录患者的年龄、性别、颅骨牵引重量、颅骨牵引时间、骨折脱位节段、交锁、并发多颈椎骨折、关节突关节骨折、前纵韧带及椎间盘损伤、后方韧带复合体损伤等相关因素,观察患者麻醉下复位的情况,分析引起复位失败原因。结果影响复位失败的相关因素和顺序为关节突关节交锁;前纵韧带及椎间盘损伤;多发颈椎骨折。结论下颈椎骨折脱位伴双侧交锁是麻醉下手法复位的适应症;单侧交锁或多发颈椎骨折受伤是相对禁忌症,选择适当的病例,可以减少医源性损伤,简化手术。     

改良式张力带法胸锁关节固定术的解剖学基础

目的:探讨胸锁关节的形态特点,用改良式张力带法设计胸锁关节复位后内固定术式,为临床应用提供解剖学依据。方法:在30例男性成尸标本上进行解剖观测,测量了胸锁关节胸骨及锁骨关节面的前后径、左右径,并模拟手术设计,确定穿针点,测量了钢针与经穿针点的矢状轴之间的夹角。结果:胸锁关节胸骨关节面前后径、左右径分别为16.7±1.3mm,23.3±2.4mm,锁骨关节面前后径、左右径分别为22.3±2.1mm,23.7±2.6mm;两根钢针与经穿针点的矢状轴之间的夹角分别为69.7±9.8°,75.7±8.2°。结论:胸锁关节的形态特点决定以前脱位多见,且复位后不易保持稳定;张力带钢丝法是保持胸锁关节稳定的一种简单有效的手术方法。     

拇指掌指关节绞锁18例临床分析及发病机制的探讨

目的 探讨拇指掌指关节绞锁的发病机制,对现有治疗方法做出改良。方法 回顾性分析北京积水潭医院2007年3月-2014年10月收治的18例拇指掌指关节绞锁患者的临床资料,其中男17例、女1例,年龄19~41岁,右侧15例、左侧3例。手术治疗4例,根据手术中发现的解剖特征,推断发病机制;保守治疗14例,其中改良复位手法治疗3例,传统复位手法治疗11例。观察患者治疗后拇指掌指关节的主、被动活动度、疼痛、稳定性以及和关节绞锁是否复发等。结果 (1)4例手术治疗患者术中观察到桡侧籽骨近侧缘撞击掌骨头关节面导致出现软骨缺损,籽骨嵌于软骨缺损内致使拇指掌指关节绞锁。在近节指骨基底处部分松解拇短展肌和拇短屈肌腱止点,可以很容易地解除关节绞锁。术后随访3~6个月,所有患者拇指掌指关节未见不稳定和疼痛,未见绞锁复发。患者术前拇指掌指关节主动活动度平均为-31.8°~-19.3°,被动活动度平均为-32.5°~30°;术后关节主、被动活动度一致,平均为-3.8°~52.5°;患者对手术疗效的主观评价均满意。(2)14例保守治疗患者均复位成功,其中改良复位手法3例,传统复位手法11例。复位前拇指掌指关节活动度平均为-28.6°~-15.2°,被动活动度为-30.4°~26.5°;复位后关节主、被动活动度一致,平均活动度为-15.8°~47.5°。随访6~8周,末次随访双侧拇指掌指关节活动度一致,未见关节不稳定和疼痛,未见绞锁复发。结论 拇指掌指关节绞锁的发病机制为拇指过伸时桡侧籽骨向远端和桡侧移位,其近侧缘在掌骨头关节面上刻划出一沟槽状软骨缺损,在拇短展肌和拇短屈肌腱的张力作用下,籽骨嵌于软骨缺损中而导致关节发生绞锁。根据这一损伤机制,改良复位手法可被用于治疗拇指掌指关节绞锁。     

股骨骨折的有限切开复位交锁扩髓髓内钉固定术治疗分析

目的 探讨有限切口复位交锁髓内钉治疗股骨干骨折的临床治疗效果.方法 对有限切口复位交锁髓内钉内固定治疗54 例股骨干骨折的疗效进行回顾性分析.结果 随访12～18 个月,平均14 个月,全部骨性愈合,肢体、关节功能恢复优良率92.6%(50/54).结论 有限切口复位交锁髓内钉在治疗股骨干骨折中具有固定坚强、骨折愈合率高、能早期活动、并发症少等优点.     

TossyⅢ型肩锁关节脱位的手术治疗

目的：探讨TossyⅢ型肩锁关节脱位的手术方法及临床疗效。方法：对38例TossyⅢ型肩锁关节脱位采用双克氏针＋张力带钢丝、喙锁间螺钉、AO锁骨钩钢板三种不同内固定方法进行手术治疗。结果：所有患者经过6个月-2a（平均11个月）随访，三种方法优良率均在85％左右，并且无统计学差异。结论：三种内固定方法均是手术治疗TossyⅢ型肩锁关节脱位的有效方法；肩锁关节的稳定复位、有效修复肩锁关节间的韧带及术后及时有效的功能锻炼是获得理想临床效果的关键。     

联合腱与喙肩韧带双束重建喙锁韧带修复RockwoodⅢ型肩锁关节脱位:解剖学及临床试验验证

背景:RockwoodⅢ型肩锁关节脱位的修复方法繁多,其中大部分通过各种内固定物(如锁骨钩钢板钢板、螺钉、克氏针等)来达到肩锁关节的初次稳定性和复位。但术中内固定物对肩锁关节不同程度的占位及损伤,以及术后取出内固定后复位丢失均较为常见。目的:应用联合腱与喙肩韧带双束重建喙锁韧带修复RockwoodⅢ型肩锁关节脱位,并通过尸体解剖提供理论基础,临床病例随访分析其修复效果。方法:1尸体解剖形态学研究:于2012年9至11月在新疆医科大学解剖教研室行成人肩部尸体解剖共46例,观察肩锁关节解剖形态并测量相关骨性标志和韧带的形态学参数。2临床病例分析:对2012至2014年采用联合腱外侧半肌腱与喙肩韧带内侧半肌腱双束共同重建喙锁韧带修复RockwoodⅢ型肩锁关节脱位的11例患者进行随访。最终随访时应用放射学评估术后肩锁关节恢复情况,并采用美国肩肘外科协会评分、Constant-Murley肩关节功能评定法、美国加州大学洛杉矶分校评分系统及肩关节简明测试问卷评价患者肩关节功能,目测类比评分法评价疼痛情况。结果与结论:1尸体解剖形态学研究结果:试验获得了肩锁关节及其周围组织、肌皮神经较为详细的形态学参数,为该部位手术提供了解剖学资料。2临床病例分析结果:11例RockwoodⅢ型患者行联合腱外侧半肌腱与喙肩韧带内侧半肌腱双束共同重建喙锁韧带治疗肩锁关节脱位,随访2-24个月,平均美国肩肘外科协会评分为92.3分,平均Constant-Murley肩关节功能评分为90.4分,平均美国加州大学洛杉矶分校评分31.6分,平均目测类比评分1.4分,平均肩关节简明测试问卷肯定答案为8个,总体优良率为91%(10/11)。1例患者修复结果较差。课题通过解剖重建肩锁关节的静态稳定性结构(如喙锁韧带)和动态稳定性结构(如关节囊、斜方肌和三角肌)实现了肩锁关节的解剖复位。总而言之,联合腱与喙肩韧带双束重建喙锁韧带修复RockwoodⅢ型肩锁关节脱位是一种有效的修复方法。     

三重固定纽扣钢板肩锁关节复位的生物力学

背景：研究表明喙锁韧带在维持肩锁关节的稳定性中起重要作用,因而重建喙锁韧带至关重要。 目的：对比观察三重固定纽扣钢板重建肩锁关节复位的生物力学性能。  方法：采集新鲜肩关节标本15具,造成肩锁关节脱位,分别行三重固定纽扣钢板重建和双Endobutton钢板重建,进行生物力学应力分析,对照比较两者重建肩锁关节的性能和效果。  结果与结论：三重固定纽扣钢板技术在应力-应变关系中,强度比正常喙锁韧带和双Endobutton钢板分别高25%和15%,弹性模量分别高17%和14%,轴向刚度分别高24%和14%,差异均有显著性意义(P < 0.05)。 结果提示,三重固定纽扣钢板重建肩锁关节的生物力学性能,在强度、刚度均远超过初始的喙锁韧带的生物力学性能,而三重固定纽扣钢板重建肩锁关节复位的性能和效果比双Endobutton钢板重建更具有力学上的优势。     

肩关节脱位及锁骨远端骨折临床外科治疗分析

锁骨骨折和肩锁关节脱位的主要原因是交通事故，其次是坠落伤。肩部为人体的最外侧部位，车祸后最先着地的部位以肩关节居多，因此发生锁骨骨折比例高，占全身骨折的10％左右，同时，发生肩锁关节脱位的比例也高。为提高肩关节脱位及锁骨远端骨折的疗效，本文对其治疗方法进行了临床外科分析，现报告如下。     

腹主动脉杈处的形态观察及力学分析

对87例尸体腹主动脉权的形态进行标定,拍照,通过MYPAD-A_3 K_(510)数字化仪及IBM PC/XT计算机进行参数统计、分析。结果为:①左、右髂总动脉口径无性别、年龄差异;③腹主——髂总动脉分权角左侧大于右侧;③左、右支分支角与相应侧腹主——髂总动脉密切圆半径呈负相关。本文从流体力学角度阐明血管形态与流体间关系,并探讨腹主动脉瘤形成的力学机理。     

山东半岛地区大学生手,足长非对称性的研究

对山东半岛地区１０００名汉族大学生的手、足长度进行了活体测量，对优势利别进行了问卷调查，并将左右两侧形态和利别进行比较，发现大学生手足长均以不对称多见。在形态上大学生以左侧较长者居多，优势利别以右侧为著，手足的长度与利别无关。     

我国三种常见蛙类的预定水晶体分化对眼泡的依赖性及其眼泡诱导水晶体的能力

本文采用切除和移植实验,研究了黑斑蛙、泽蛙和狭口蛙预定水晶体的分化,对眼泡的依赖性及其眼泡诱导水晶体的能力。实验结果表明,脱离眼泡以后,3种蛙的预定水晶体均不能进一步分化,属于“依赖分化型”。至于眼泡诱导水晶体的能力大小,在3种蛙中有明显差别:黑斑蛙的眼泡不仅能诱导头部普通表皮,而且也可诱导腹部表皮形成水晶体;泽蛙眼泡对腹部表皮的诱导能力则较弱;而狭口蛙的眼泡仅能诱导头部普通表皮形成水晶体。本文讨论了造成这种差别的原因,认为除了眼泡的诱导能力之外,外胚层本身的反应能力及其时相的差异,也是应予考虑的因素。还讨论了温度可能影响眼杯分化以及水晶体的大小影响眼杯的大小等问题。此外,还报道了1例预定水晶体接触前脑顶壁,发生次生眼杯的事实。     

EVALUATION OF THE STAINING CONDITIONS OF IMMUNOFLUORESCENCE IN PRIMARY GLOMERULONEPHRITIS

A study of the evaluation of various staining conditions of immunofluo-rescence in renal biopsy specimens is described. Renal biopsy specimens were obtained from 52 patients with various types of primary glomerulone-phritis, and stained with fluorescein-conjugated anti-human IgG, IgA, or IgM antisera under various staining conditions. The results indicated that IgM was more prominently stained at 4°C overnight than at 37°C or room temperature by the immunofluorescent staining. Both IgG and IgA did not show any dmerences in the pattern of staining under different conditions. It is suggested that the different staining conditions of immunofluorescence in patients with glomerulonephritis is useful for the evaluation of the classes of immunoglobulins deposited in the glomeruli.     

TIME STUDY OF MACROSCOPIC IDENTIFICATION OF EXPERIMENTAL CEREBRAL INFARCTION IN RAT

Cerebral infarctions were induced in rats by injection of Sephadex G-200 into the internal carotid artery. Unfixed slices of brain were stained with nitro blue tetrazolium (nitro-BT). Tissue dehydrogenase in normal regions reacts with this chemical and changes from a pale yellow color to dark blue consequent to formation of formazan. However, the color changes do not develop in infarcted tissue as there is depletion of tissue dehydrogenase in these regions. Ischemic lesions are identifiable by this method in over half the brain 2 to 4 hours after the embolization, but are seen in all brains 6 hours or more following the embolization. The procedure is simple, requires 30 minutes, and is useful for identification of small or acute cerebral infarction.     

踝、距下关节外侧韧带的计算机三维重建

目的：对踝、距下关节外侧韧带进行计算机三维重建。方法：用生物塑化技术制作1．2mm厚的薄层断面标本,在SGI工作站上,对踝、距下关节骨骼及外侧区韧带进行了三维重建。结果：重建结构均能单独显示、任意搭配显示或总体显示,可在三维空间位置上绕任意轴旋转任意角度,并且,所有结构在任意角度,并且,所有结构在任意方向上的径线和角度均可适时测量。结论：由于采用了先进的断面标本制作技术和contours marching cubes算法,较之以往的三维重建研究,图像显示效果更好,较清晰地反映了各结构的解剖关系。     

CLINICAL APPLICATION OF THE CONCEPT OF INTERNAL COHABITATION

ABSTRACT Across the spectrum of diagnostic categories, patients allude in various ways to states of mind and emotion in which their autonomy is taken over to the detriment of their own goals and ambitions. These'take-overs' happen within the therapeutic space or outside in the daily life of the patient, but a characteristic common to all is that they are experienced as outside the patient's control. Indeed it is for the very reason that patients feel their lives to be out of their control that they seek help in the first place. This paper reviews the concepts available to understand such processes and shows the clinical application of the concept of Internal Cohabitation.     

ULTRASTRUCTURAL STUDY OF EXPERIMENTAL THROMBOSIS IN PULMONARY MUSCULAR ARTERIES OF RABBITS

In order to clarify the ultrastructural change of initial phase of thrombosis, an autologous clot Injection or one shot of thrombin was performed via an auricular vein of each rabbit.
In the groups of clot injection, platelets located between an inserted thrombus and endothelial cells show viscous metamorphosis. Degeneration and disappearance of the endothelial cells are followed by invasion of platelets and dense liquid materials into the subendothelial space and the media of the muscular arteries in both experimental groups. There is no detectable morphological difference between thrombosis in rivo induced by an injection of thrombin and thromboembolism induced by an injection of autologous whole blood clots coagulated in vitro.
Phagocytosis in the course of thrombosis is mainly derived from the activity of subendothelial cells and partly from that of endothelial cells. Ultrastructural features of the subendothelial edema are based on the detachment of endothelial cells from the elastic lamina or on the edematous swelling of subendothelial cell cytoplasm. The initial stage of the organization of thrombus, showing smooth muscle cells arranged in the vertical position towards the thrombus, is noted three days after a clot or thrombin administration. Myofilamentous structures with dotted density are detected in the endothelial cells of muscular artery, not only of experimental groups but also of control ones.     

ANALYSIS OF ANTI-TRANSPLANTATION IMMUNITY OF TUMOR

In allogeneic immunity against tumors induced by methylcholanthrene in the W/KA strain rat, serum antibody agglutinated red blood cells of the W/KA strain rat. The allogeneic antiserum was cytotoxic to the lymphocyte, but not to the tumor cells induced by methylcholanthrene.
In vitro and in vivo studies of allogeneic immunization of tumor suggested that immune macrophages or histiocytes play a major role in the rejection of transplanted tumor. Direct adhesion of immune macrophages with target cells is necessary for destruction of allografted tumor.
In antitransplantation immunity of the syngeneic and autochthonous rat, there was no cytotoxic serum antibody demonstrable in so far as routine techniques were employed. However, this may not exclude the existence of specific serum antibody or non-cytotoxic reaction with target cells of specific serum antibody. On the other hand, immune macrophages were always cytotoxic to target tumor cells, thus showing tumor specifity.
Experiment in which diffusion chambers were inserted into syngeneic immune rats suggested the possible participation of a humoral factor which was released from the immune rats immediately after contact with target cells and transform normal macrophages to immunologically active macrophages. The ascites macrophages have the greatest effective cytotoxic action among the three types of cells. In allogeneic tumor immunity, one immune macrophage can damage one target tumor cell showing single hit interaction. ACTA PATH. JAP. 18: 207–225, 1968.