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The rate of excellent and good functional recovery of hip was 94.0%. Postoperative internal-fixation-related complications occurred in 31 cases, including hip varus in 14 cases who had posterior intertrochanteric fragments, delayed union of fracture in 12 cases who had fractured calcar and lesser trochanter and massive dissection of soft tissues, and cutting-out of lag screws in five cases, three of whom had to receive prosthetic replacement.

术后髋关节功能恢复良好率达94.0%。215例患者中31例出现内固定相关术后并发症,其中髋内翻14例,主要发生于股骨转子内后方存在明显骨折碎裂的患者;骨折延迟愈合12例,为骨折累及股骨距及小转子,术中做软组织广泛剥离、骨折复位固定的患者;内固定物股骨头颈内切割并螺钉穿入髋关节腔5例,其中3例再行人工关节置换,关节功能Harris评分为82分。

These include fluid within the tendon sheath, fluid withinthe medial or lateral bursae, sinus tarsi syndrome, periostitisat the insertion of the flexor retinaculum on the tibia, hindfootvalgus, subtalar and talonavicular malalignment, and accessorynavicular bone.

这些包括腱鞘内、内外侧滑膜内水分滞留,跗骨窦综合症、屈肌支持带的胫骨侧附着处骨膜炎、后足外翻、距下关节和距舟关节排列不整及副舟骨。

Results: Arthroscopic examination showed that there were synovitis, debris and fibrillation in the joints of ADD with reduction; synovitis, synovial hyperplasia, debris, fibrillation, chondromalacia,fibrocartilage rupture and adhision in the joints of ADD without reduction.

76例84侧临床诊断为颞下颌关节盘前移位以及关节盘穿孔的病例进行颞下颌关节内窥镜检查。结果:可复性关节盘前移位的病例出现滑膜炎,关节腔内有絮状物,关节结节表面有纤维形成。

Results: Arthroscopic examination showed that there were synovitis, debris and fibrillation in the joints of ADD with reduction; synovitis, synovial hyperplasia, debris, fibrillation, chondromalacia,fibrocartilage rupture and adhision in the joints of ADD without reduction.

结果:可复性关节盘前移位的病例出现滑膜炎,关节腔内有絮状物,关节结节表面有纤维形成。不可复性关节结节表面纤维形成,关节软骨软化,软骨剥脱,同时伴有纤维粘连。

Dissect the fascia from the dorsum down to the bursa oer the medial aspect of the metatarsal head. Then make a cured incision through the bursa and capsule of the joint Fig. 1-24,; begin the incision oer the dorsomedial aspect of the joint, continue it proximally dorsal to the metatarsal head and then plantarward and distalward around the joint, and end it distally on the medioplantar aspect of the metatarsophalangeal joint.

然后弧形切开滑囊及跖趾关节囊图1-24,,切口起自关节背内侧,自跖骨头背侧向近端延长,然后转向跖侧,再转向远瑞,环绕关节而行,最后在远端终止于跖趾关节的跖内侧面,此切口形成一椭圆形网球拍状组织瓣,连接于近节趾骨的基底部

The results were expressed in mean±1SD. Pearson X~2 test and One-way ANOVA test were used. The data analyzed using the SPSS (version 11.5). Results: The sensitivity, specificity, positive and negative value of US for the LPEH model on the children cadaver were 88%, 84%, 79%, 91%, respectively. With regard to the thickness of femora head cartilage, the thickness of the anterior layer or posterior layer, there were no significant differences among three groups. However, the anterior layer was thicker than the posterior layer in three groups. The fluid in hip joint was detected in all of 21 symptomatic hips, which was clear commonly (90%) in early procedure. The amount of fluid in anterior recess showed a positive correlation with age (p .05). No fluid was detected in the asymptomatic and normal hips (2mm). The mean maximum width of inferomedial recess was significantly larger than that of anterior recess (12.50±4.04mm vs.4.35±0.8mm, p 0.05) in the symptomatic hip joints. The echogenic entrapped labral plicaes were demonstrated in the inferomedial recess in all of 21 children with LPEH, whose length and width ranged from 5.3mm-25.0mm (mean,15.6±5.6mm) and from 4.0mm-17.0mm (mean,8.9±7.8mm).

结果1,尸体LPEH髋关节模型的超声诊断敏感性、特异性分别为88%、84%,阳性预测值、阴性预测值分别为79%、91%。2,21例患儿的LPEH患髋(21侧)、健髋(21侧),以及21例正常儿童健髋(42侧)的超声检查显示:髋关节周围软组织及股骨头无形态结构差别;股骨头软骨厚度无统计学差异(3.5±0.5mm vs.3.6±0.4mm vs.3.6±0.5mm,p>0.05);关节囊前层及后层厚度无统计学差异(前层厚度2.79±0.74 mm vs.2.56±0.40mm vs.2.56±0.72mm;后层厚度2.70±0.82mm vs.2.48±0.54mm vs.2.44±0.58mm,p>0.05),但LPEH患髋关节囊前、后层均较后二组有增厚趋势。3,LPEH患髋均存在关节腔内积液,且早期较为清晰;积液以髋关节内下间隙明显,内下间隙较前间隙明显增宽(12.50±4.04mm vs.4.35±0.8mm,p<0.05),其内见嵌顿滑膜唇皱襞呈稍强回声的占位性团块,长约15.6±5.6mm,宽约8.9±7.8mm,90.5%(19/21)嵌顿皱襞内未见血流信号。4,所有LPEH患髋治疗后超声复诊均显示正常。

Make a curved incision 5 cm long on the medial aspect of the joint (Fig. 1-24, A). Begin it just proximal to the interphalangeal joint, curve it over the dorsum of the metatarsophalangeal joint medial to the extensor hallucis longus tendon, and end it on the medial aspect of the first metatarsal 2.5 cm proximal to the joint.

于关节内侧做一5cm弧形切口(图1-24,A),切口起自趾间关节近端,弧形延伸至拇趾跖趾关节的背侧,拇长伸肌腱内侧,终止于跖趾关节近侧2.5 cm处的第一跖骨内侧面。

Direction and length of trajectory are the key of posterior atlano-occipital transarticular fixation, if combined with C1-C2 transarticular fixation, it will be an ideal fixation method for occipitocervical fusion.

寰枕关节后路经关节螺钉植入存在一定的方向性和钉道长度,结合后路C1-C2经关节螺钉内固定后可视为能满足当前临床需要的一种相对理想的枕颈融合内固定术式。

Results(1) Group of electroacupuncture in Shu and dense wave can significantlyreduce the degree of ankle swelling(P<0.05, P<0.01), which shows thatelectroacupuncture has obvious anti-inflammatory and repercussive roles;(2) Theresults of HE staining showed that group of electroacupuncture in Shuand dense wave can significantly reduce inflammatory cell infiltration,inhibit synovial cell proliferation, and decrease proliferation of granulationtissue in rats joints;(3) group of electroacupuncture in dense-wave can increase the pain thresholdof experimental rats (P<0.05, P<0.01), reduce the content of peripheral painmediums, such as K~+, DA and 5-HT(P<0.05, P<0.01), which shows thatelectroacupuncture has significant analgesic effect;(4) In the local lesion of joints, electroacupuncture can significantly reducethe content of IL-1β, IL-8, TNF-a, increase IL-4 content, decrease theexpression of COX-2mRNA, and significantly promote the expression ofHSP-70 protein in synovial tissues of acute gouty arthritis rats (P<0.05,P<0.01),thus restrain the occurrence of synovial tissue inflammation.

结果:(1)电针疏密波组能显著减轻踝关节肿胀度(P<0.05,P<0.01),表明电针有明显的抗炎消肿作用;(2)HE染色显示:电针疏密波组可使大鼠关节炎症细胞浸润明显减轻,滑膜细胞增生明显被抑制,肉芽组织增生明显减少;(3)电针密波组能提高实验性大鼠痛阈(P<0.05,P<0.01),降低外周疼痛介质K~+、DA、5-HT的含量(P<0.05,P<0.01),表明电针有明显的镇痛作用;(4)在病变关节局部,电针能显著降低急性痛风性关节炎大鼠滑膜组织IL-1β、IL-8、TNF-α含量(P<0.05,P<0.01),升高IL-4的含量(P<0.05,P<0.01),并降低关节滑膜内COX-2mRNA的表达(P<0.05,P<0.01),可促使急性痛风性关节炎大鼠滑膜内HSP-70蛋白表达显著增加(P<0.05,P<0.01),从而抑止滑膜组织炎症发生。

Results 1、 Generally, we can see the original blue and white, shiny, no cracks in the articular surface of the cartilage after the stress increases gradually yellow, surface roughness, cracks appear; when the pressure decreases, the yellowing, rough, the color of the fracture restore gradually and become shiny.2、the shiny smooth surface can be seen under a light microscope, formation, cell distribution, tidy, clear the level of cartilage at the articular surface stress increases, the surface roughness changes, defects, disordered cells, uneven dyeing ; when the articular surface of the pressure gradually decreased, the cartilage gradually repair and the surface of cells at the surface appear only disorder.3、immunohistochemical observation can be seen throughout the observation period, cartilage cells are type Ⅱ collagen expression and expression after 3 weeks gradually weakening, when the seventh week begin to strong gradually.4、 electron microscopy shows that when stress increases the articular surface, the cartilage cells became flat, the cytoplasm in the endoplasmic reticulum, Golgi apparatus decreased with collagen disorders; and when stress decreases the articular surface, cartilage cells gradually returned normal, cytoplasm in the endoplasmic reticulum, Golgi body gradually restore quantity; collagen fibers with a gradual rules.

结果:①大体观察可见到原本蓝白色、有光泽、无裂纹的软骨在关节面压力增大后,逐渐呈灰黄色,表面粗糙,出现裂隙;当压力逐渐减小后,变黄、粗糙、有裂隙的软骨颜色逐渐恢复,变得有光泽②光镜下可见表面光滑、平整,细胞分布均匀、整齐,层次清楚的软骨在关节面压力增大后,表面变粗糙、缺损,细胞排列紊乱、染色不均;当关节面压力逐渐减小后,软骨表面逐渐修复,细胞仅在表层排列紊乱③免疫组织化学观察可见整个观察期内软骨细胞胞浆内均有Ⅱ型胶原表达,术后3周内表达逐渐变弱,从第7周时开始逐渐变强。④电镜下可见当关节面压力增大后,软骨细胞逐渐变扁,胞质中内质网膜、高尔基体减少,胶原排列紊乱;当关节面压力减小,软骨细胞形态逐渐恢复正常,胞质中内质网膜、高尔基体数量逐渐恢复;胶原纤维排列逐渐有规则。

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