跖腱膜炎与功能性腓肠肌挛缩关系的临床观察

目的 研究跖腱膜炎与腓肠肌挛缩的关系.方法 对2010年9月～2010年1 1月足踝外科门诊收治的20人跖腱膜炎患者和31人正常足进行对比研究.结果 29足跖腱膜炎中16例(55.2％)合并腓肠肌挛缩.62正常足中 11例(17.7％)合并腓肠肌挛缩.结论 跖腱膜炎与腓肠肌挛缩关系密切,跖腱膜炎的患者多伴有腓肠肌挛缩.     

关节镜下治疗半月板损伤疗效观察

目的探讨关节镜下微创技术在半月板损伤治疗中的应用价值。方法对获得随访(平均随访3年)的关节镜下治疗的半月板损伤患者30例,根据临床表现及X线征象评定疗效,分析其近、远期效果。结果30例中,优22例,良5例,可2例,差1例,优良率90%。结论关节镜下治疗半月板损伤具有损伤小、疗效好、符合生物力学要求等优点,值得推广应用。     

关节镜下射频松解与开放手术治疗臀肌挛缩症疗效比较的Meta分析

背景：有大量文献报道证实关节镜下射频松解治疗臀肌挛缩症在某些方面较开放手术好,但关于两种术式优劣比较,尚缺乏循证医学方面证据。 目的：采用Meta分析的方法对关节镜下射频松解与开放手术治疗臀肌挛缩症的疗效进行对比。 方法：检索EMbase、Medline、PubMed、OVID、Cochrane Library、Springerlink、万方数据库、中国知识资源总库、维普数据库,检索时间为1970年1月至2014年5月。收集关节镜下射频松解与开放手术治疗臀肌挛缩症疗效的相关文献,按纳入与排除标准筛选文献并对纳入文献进行质量评价,采用RevMan 5.2软件进行Meta分析。 结果与结论：共纳入14篇文献,病例数合计为830例,在其中关节镜下射频松解组394例,开放手术组436例。结果显示在主要观察指标中,关节镜下手术组术后疼痛发生率(RR=0.33,95%CI：0.27-0.42,P < 0.001)及术后并发症发生率(OR=0.40,95%CI：0.23-0.70,P=0.001)比开放手术组低,而术后疗效比较两组间差异无显著性意义(OR=1.09,95%CI：0.52-2.26,P=0.82);在次要观察指标分析中,关节镜组在术后住院天数、术后下床活动时间、切口长度方面优于开放手术组(P < 0.05),在其他2项指标两组之间差异无显著性意义(P > 0.05)。结果证实,关节镜下组织松解治疗臀肌挛缩症与传统开放手术相比在疗效、复发率、手术时间等方面并无差异,而在切口长度美观、术后疼痛、术后下床活动时间、术后住院时间、术后并发症等方面占有明显优势。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

关节镜下松解术治疗冻结肩疗效观察

目的观察关节镜下粘连松解术治疗冻结肩的临床疗效。方法 2014年1月至2015年12月,对23例冻结肩患者,原发性18例、继发性5例,进行关节镜下粘连松解。术前、术后根据VAS疼痛评分及Constant肩关节功能评分评价治疗效果。结果 23例患者全部随访,平均随访16个月(12~30个月)。在术后1、3、12月时疼痛评分(2.5±0.95),(1.3±0.54),(1.0±0.42)分,较术前(6.5±2.31)分明显降低,肩关节功能评分(78.6±4.61),(80.6±3.99),(85.5±4.45)分,均高于术前(30.6±3.63)分,差异具有统计学意义(0.05)。结论采用关节镜下粘连松解治疗原发性及继发性冻结肩,创伤小,恢复快,疗效可靠。     

关节镜微创治疗膝关节骨性关节炎的疗效观察

目的探讨关节镜下微创治疗膝关节骨性关节炎（OA）的疗效。方法对129例膝关节OA患者行关节镜检及有限化微创清理术,采用HSS膝关节评定系统及Denis疼痛测定法进行术后疗效评定。结果术后随访6～36个月,129例中104例患者临床症状明显缓解,关节功能改善,优良率达80.62%。结论关节镜有限微创清理术能有效缓解OA症状,改善关节功能,提高生活质量。     

全后足关节镜下肌腹部分切除治疗 长屈肌腱撞击综合征的效果观察

目的:探讨全后足关节镜下肌腹部分切除术治疗 长屈肌腱撞击综合征的手术方法和临床效果。 方法:回顾性分析徐州市中心医院2016年1月—2018年10月接受全后足关节镜下的 长屈肌腱部分肌腹切除联合部分腱鞘清理治疗的27例(27足) 长屈肌腱撞击综合征患者的临床资料,其中男17...     

关节镜下囊肿切除半月板修复术治疗半月板囊肿疗效观察

目的探讨关节镜下囊肿切除半月板修复术治疗半月板囊肿的疗效。方法 2010年1月~2014年1月,26例半月板囊肿患者,囊肿位于外侧半月板体部10例,前角6例,内侧半月板体部7例,前角3例。其中半月板水平状撕裂16例,纵形撕裂6例,盘状半月板并水平撕裂4例。所有患者均在关节镜下切除囊肿,囊肿切除后缝合修复半月板。结果所有病例随访16~43个月,平均22.3个月。所有病例疼痛,交锁,包块等症状均明显改善。膝关节功能评分采用Lysholm评分,术前为(77.64±3.75)分,术后3月时(92.65±3.45)分,术后6月时为(93.25±4.17)分,术后15月时为(94.77±3.93)分,术前与术后3月,6月及15月时相比,差异有统计学意义(0.05)。术后3月与6月及15月时相比,差异无统计学意义(0.05)。术后3月,6月及15月随访时应用GLASOW评分评价疗效,均为优23例,良3例。结论关节镜下半月板修复术治疗半月板囊肿创伤小,功能恢复快,效果良好。     

关节镜下Triple TRUE-button治疗肩锁关节脱位的疗效观察

目的 探讨关节镜下采用Triple TRUE-button治疗肩锁关节脱位的临床疗效。方法 分析2018年12月至2019年12月南京中医药大学武进附属医院采用关节镜下使用Triple TRUE-button技术行喙锁韧带重建治疗肩锁关节脱位的患者15例。其中男9例,女6例;年龄21 ～ 58岁,平均38.2岁;左肩5例,右肩10例;Rockwood分型：Ⅲ型8例,Ⅴ型7例。记录患者术前和术后6个月的美国加州大学（UCLA）肩关节评分系统和Constant-Murley（CMS）评分。记录患者术前,术后2 d、6个月的患侧肩关节正位X片,测量喙锁间距（CCD）;记录手术时间和并发症情况。结果 15例患者均获得随访,随访时间6 ～ 19个月,平均13.3个月。所有患者切口均甲级愈合,无锁骨和喙突骨折等并发症。1例因术后外伤肩锁关节再脱位,行切开复位翻修。手术时间平均为（62.34±13.76） min。UCLA评分和CMS评分从分别从术前的（14.47±2.59）分和（74.40±3.92）分改善至术后的（26.87±1.37）分和（93.07±2.22）分,差异有统计学意义（P＜0.05）。术前喙锁间距为（21.34±1.32）mm,术后6个月为（8.93±1.03）mm,差异有统计学意义（P＜0.05）。结论 关节镜下Triple TRUE-button技术治疗肩锁关节脱位可以取得满意的近期临床疗效,但其远期疗效仍需观察。     

关节镜下同种异体肌腱重建膝关节前后交叉韧带的临床观察

目的比较关节镜下同种异体肌腱移植和自体肌腱移植重建膝关节前后交叉韧带的临床效果。方法将130例膝关节前后交叉韧带断裂的患者按手术方式的不同分为2组,观察组采用同种异体肌腱移植,对照组采用自体肌腱移植,观察患者临床疗效。结果观察组手术时间明显少于对照组(P0.05);观察组IKDC评定与对照组比较差异无统计学意义(P0.05);2组患者术后Lysholm及Tengner评分均明显高于术前,2组差异有统计学意义(P0.05),观察组及对照组术后Lysholm及Tegner评分比较无明显差异(P0.05)。结论同种异体与自体肌腱重建ACL及PCL的疗效相近,是重建ACL及PCL良好的移植物。     

关节镜下治疗各型膝关节脱位的中期疗效评价

目的 探讨关节镜下治疗各型膝关节脱位的可行性及中期临床疗效。方法 回顾性分析2007年2月—2012年8月收治的35例膝关节脱位患者的临床资料。按照Schenck分型：KD-Ⅱ型4例,KD-ⅢL型6例,KD-ⅢM型18例,KD-Ⅳ型2例,KD-Ⅴ型5例。根据Lysholm功能评分、Tegner评分、膝关节活动度及膝关节稳定性对手术前后患膝功能进行评估,并采用配对t检验统计分析。结果 所有患者均获随访,平均随访24.8个月（6～48个月）。末次随访时,Lysholm膝关节功能评分由术前（36.7±5.7）（0～70）分提高至（86.5±11.2）（49～100）分,Tegner膝关节运动水平评分由术前（0.8±0.6）（0～2）分提高至（5.4±1.2）（3～6）分,膝关节关节活动度由术前73.2°±15.1°（15°～125°）提高至120.1°±7.3°（90°～135°）,差异均有统计学意义（P值均〈0.05）。结论 关节镜下治疗各型膝关节脱位是治疗膝关节脱位的安全、有效方法,具体治疗策略应根据脱位分型以及膝关节损伤情况来制定。     

关节镜下臀肌挛缩松解术

目的探讨关节镜监视下等离子刀松解臀肌挛缩的疗效。方法回顾我院2015年5月至2017年5月在关节镜监视下进行臀肌挛缩松解的病人,对其中随访资料完整者19例进行总结分析。手术采取侧卧位,两侧依次手术。在股骨大粗隆最隆起处后缘、其后上方约5 cm处分别做切口,切口长约0.8 cm。用关节镜钝性穿刺头沿深筋膜浅层向大粗隆前方穿刺,分离皮下组织,形成关节镜工作腔隙,插入关节镜及器械,在关节镜监视下用低温等离子刀松解。第一步从大粗隆后方斜向前方切断髂筋束,第二步切断臀大肌止点的上半部,然后屈伸髋关节检查松解效果,若仍不满意,进行第三步松解,沿臀大肌纤维向近端剥离,找到肌肉纤维内的疤痕挛缩带,松解切断,直至阳性体征消失。结果切口均Ⅰ期愈合,无血管神经损伤等严重并发症。术后随访3~12个月,参照刘国辉提出的臀肌挛缩术后功能综合评价标准,优15例,良4例,中0例,差0例。术后三个月对患者进行满意度调查,非常满意2例,满意15例,一般2例,不满意0例。结论关节镜下松解臀肌挛缩创伤小,恢复快,效果满意,是治疗臀肌挛缩的有效微创手术方式。     

全内侧深入路造腔内镜技术在难治性跖筋膜炎治疗中的应用

目的:探讨全内侧深入路造腔内镜技术治疗难治性跖筋膜炎的可行性及其临床疗效。方法:回顾性研究。纳入徐州市中心医院2018年5月—2020年5月采用全内侧深入路造腔内镜技术治疗的28例30足难治性跖筋膜炎患者的临床资料。其中,男13例13足,女15例17足;年龄22～57（40±11）岁。症状持续时间8～24（17.0±4...     

Relations between identified tendon organs and motor units in the medial gastrocnemius muscle of the cat

Summary In one medial gastrocnemius muscle of each of several cats, the response was recorded of a single tendon organ to the contraction of a single motor unit which strongly excited the receptor. The motor unit was depleted of its glycogen and the depleted muscle fibres identified in PAS-stained transverse sections. The site of maximum tendon organ sensitivity was marked and the tendon organ identified in the same sections. Five pairs of tendon organs and motor units were studied completely. Each tendon organ was found to have one or two (mean 1.6) depleted muscle fibres attached to it, included in the bundle of fibres attached to the end (mean no. 14.4) and side (mean no. 5.6) of the tendon organ. A correlation was found between tendon organ discharge rate and the tension calculated from cross-sectional area measurements of the depleted muscle fibres attached to the tendon organ, with variation between individual pairs of tendon organs and motor units. One estimate of the average sensitivity of the sample was 28 imp/s/mN. A nearly linear discharge rate vs. tension relation was found for single tendon organ and motor unit pairs when tension was graded during a series of fatiguing contractions. Under these conditions the sensitivity, measured as the slope of the relation between discharge rate and motor unit tension recorded at the common tendon, varied between 0.11 and 0.30 imp/s/mN for 6 pairs.     

PAD patterns of physiologically identified afferent fibres from the medial gastrocnemius muscle

Summary Intracellular recordings were made in the barbiturate-anesthetized cat from single afferent fibres left in continuity with the medial gastrocnemius muscle to document the transmembrane potential changes produced in functionally identified fibres by stimulation of sensory nerves and of the contralateral red nucleus (RN). Fifty five fibres from muscle spindles had conduction velocities above 70 m/s and were considered as from group Ia. Stimulation of group I afferent fibres of the posterior biceps and semitendinosus nerve (PBSt) produced primary afferent depolarization (PAD) in 30 (54%) Ia fibres. Stimulation of the sural (SU) nerve produced no transmembrane potential changes in 39 (71%) group Ia fibres and dorsal root reflex-like activity (DRRs) in 16 (29%) fibres. In 17 out of 28 group Ia fibres (60.7%) SU conditioning inhibited the PAD generated by stimulation of the PBSt nerve. Facilitation of the PBSt-induced PAD by SU conditioning was not seen. Repetitive stimulation of the RN had mixed effects: it produced PAD in 1 out of 8 fibres and inhibited the PAD induced by PBSt stimulation in 2 other fibres. Nine fibres connected to muscle spindles had conduction velocities below 70 m/s and were considered to be group II afferents. No PAD was produced in these fibres by SU stimulation but DRRs were generated in 5 of them. In 23 out of 31 fibres identified as from tendon organs group I PBSt volleys produced PAD. However, stimulation of the SU nerve produced PAD only in 3 out of 34 fibres, no transmembrane potential changes in 30 fibres and DRRs in 1 fibre. The effects of SU conditioning on the PAD produced by PBSt stimulation were tested in 19 Ib fibres and were inhibitory in 12 of them. In 9 of these fibres SU alone produced no transmembrane potential changes. Repetitive stimulation of the RN produced PAD in 3 out of 9 Ib fibres. SU conditioning inhibited the RN-induced PAD. The present findings support the existence of an alternative inhibitory pathway from cutaneous to Ib fibres, in addition to the well known excitatory pathway producing PAD. Possible functional implications of inhibitory actions of cutaneous fibres with the pathways mediating the PAD of group Ia and Ib fibres are discussed.     

Anatomical relationship between the medial head of the gastrocnemius and the occurrence of a dystrophic bony lacuna

Summary A bony lesion with identical radiological features was seen in the medial part of the distal femoral metaphysis in five patients who practised cross-country motorcycling. These findings suggested that the cause of the lesions was of muscular origin. The nature and physiopathogenesis of the lesions were studied by roentgenography, computerized tomography and analysis of anatomical specimens. The results of these procedures were compared to observations made peroperatively.The lesion was identified as a specific, dystrophic bony lacuna resulting from the action of the medial head of the gastrocnemius (caput mediale m. gastrocnemii). In certain conditions this powerful biarticular muscle induces multiple microtrauma via traction on the structures of its tendinous insertion, especially the underlying bone, thus leading to bony avulsion. It is shown in this study that the bone-tendon-muscle complex forms a veritable biomechanical unit.

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Relation anatomique entre le jumeau interne et la survenue d'une géode osseuse dystrophique

Résumé La découverte d'une lésion osseuse de même localisation métaphysaire fémorale distale interne et de même aspect radiographique chez cinq patients pratiquant le moto-cross, orientant vers une origine musculaire, un bilan radiographique et tomodensitométrique, une vérification sur pièces anatomiques et une confrontation aux constatations per-opératoires, a permis aux auteurs d'en préciser la nature et la physiopathogénie.Il s'agit d'une géode osseuse dystrophique, spécifique, due à l'action du muscle jumeau interne (caput mediale m. gastrocnemii), muscle biarticulaire puissant travaillant dans certaines conditions favorisantes et exeçant des poly-micro-traumatismes par traction sur l'ensemble de l'insertion tendineuse, et en particulier dans l'os sous-jacent, provoquant ainsi des arrachements osseux. Il est démontré que le complexe os-tendon-muscle forme une véritable unité biomécanique.

     

Physiological characteristics of two extreme muscle compartments in gastrocnemius medialis of the anaesthetized rat

Rat medial gastrocnemius (GM) muscle is a compartmentalized muscle. The functional properties and fibre type composition of the most proximal and most distal compartment were studied in in situ preparations. The proximal compartment contained predominantly fast twitch oxidative fibres. The distal compartment was mainly composed of fast twitch glycolytic fibres. With the use of two small electrodes placed around the primary nerve branches, both compartments could be separately stimulated within the same muscle. The length-force relationship was less broad and maximal twitch and tetanic forces were obtained at lower muscle lengths for the proximal compartment. The differences (mm) were 0.9 ± 0.2 and 1.2 ± 0.2 for maximal twitch and tetanic force (120 Hz) production, respectively (P < 0.001). The shortening velocity for maximal power production was lower (P < 0.001) for the proximal compartment (proximal: 57.1 ± 2.7 mm s^-1, distal: 73.1 ± 3.0 mm s^-1). During a standard fatigue test the fatiguability was significantly lower for the proximal compared with the distal fibres. Our findings suggest that the proximal compartment is likely to be activated in vivo during activities requiring relatively low power outputs for longer time periods. In contrast the distal compartment is probably recruited only during high power demanding short lasting activities. The presented model makes it possible to study fatigue related changes in power production of the ‘red’ and ‘white’ areas of the GM separately in a way that is probably meaningful with respect to in vivo function.     

3D打印患手模型指导个性化选择皮瓣治疗虎口挛缩的效果研究

目的　探讨利用3D打印患手模型指导个性化选择皮瓣治疗虎口挛缩的临床效果。 方法　自2018年3月至2019年10月,对10例虎口中~重度挛缩者,术前3D打印患手模型,依据模型设计虎口开大后创面的形状及面积,个性化选择合适的皮瓣修复创面,术中比对验证,术后随访观察治疗效果。 结果　术中发现创面形状及面积与术前模拟设计基本一致,皮瓣选择与术前模拟一致,10例皮瓣均成活,供区及受区创面Ⅰ期愈合,随访6 ~ 12个月,皮瓣外形满意,感觉部分恢复,拇指恢复外展及对掌功能,虎口角度增加50~60 °（平均53.4 °）,虎口宽度增加18 ~ 35 mm（平均31.3 mm）,虎口修复评定：优7例,良2例,中1例。 结论　术前3D打印患手模型可指导个性化的皮瓣,使虎口挛缩开大的创面达到精准修复,减少手术时间,术后虎口外形及功能恢复良好。     

内镜经黏膜下隧道肿瘤切除术治疗食管胃接合处固有肌层来源的黏膜下肿瘤

目的 探讨内镜经黏膜下隧道肿瘤切除术(STER)在食管胃接合处(EGJ)固有肌层来源的黏膜下肿瘤(SMTs)治疗中的有效性及安全性。方法 回顾性分析2013年10月—2015年10月滨海县人民医院消化内科46例EGJ固有肌层来源的SMTs患者的临床资料,其中男25例、女21例,年龄34~69(46.3±12.7)岁;肿瘤直径1.2~3.0 cm,中位直径2.1 cm。46例患者均行STER治疗,手术切除标本均经病理学检查明确诊断;术后观察患者手术并发症发生情况,并随访疗效。结果 肿瘤完整切除率为100%。46例中,平滑肌瘤26例、胃肠间质瘤20例,切缘均阴性;手术时间42~125 min,中位时间85 min。术后7例发生少量皮下气肿伴气胸,未予特殊处理,保守治疗后痊愈;未发生迟发性出血、继发性感染及消化道瘘等并发症。46例均获随访,中位随访时间为8个月(1~24个月),无局部复发或转移者,无一例患者死亡。结论 采用STER治疗EGJ固有肌层来源的SMTs,短期疗效好、并发症少,术式安全有效。