关键词： 糖尿病   糖尿病并发症   糖尿病足  

摘要： [病例]女,81岁。有糖尿病史10余年。因左足红肿疼痛4个月,发黑、破溃、恶臭半个月入院。查体:左足无苍白、发绀及厥冷,皮温无改变,足背及胫后动脉搏动存在;左踝关节外侧、足跟及足底部破溃面分别为2.0cm×2.0cm、2.0cm×2.5cm、5.0cm×4.5cm,组织发黑,较多恶臭脓性分泌物;近疮口病变肌腱形似败絮,深部肌腱失去银色光泽,呈灰白色,弹性、柔韧性减退,水肿增粗。[第一段]

关键词： 股四头肌腱断裂   Ⅰ型糖尿病   双侧   关节被动活动   行走不稳   软组织损伤   膝关节肿胀   膝关节疼痛  

摘要： 患者,男,65岁。因跌伤致左膝部乏力、行走不稳半年,右膝部肿痛无力6d于2005年9月26日入院。患者于2005年3月10日滑倒,臀部先着地,左膝关节突然伸直致伤。当地医院先后按软组织损伤及风湿等治疗。9月20日再次跌伤致右膝部肿痛、乏力,行走不稳,未特殊处理。查体:神志清,Bp130/80mmHg,左髌骨上缘凹陷,凹陷处可触及股骨髁部骨质,左膝关节被动活动正常;右膝关节肿胀明显,髌骨上缘凹陷,浮髌试验阳性,伸膝无力,右膝关节疼痛、活动受限,远端感觉及血运可。双膝关节MRI示:双侧股四头肌腱断裂。3年前在外院确诊为Ⅰ型糖尿病,入院前服用糖尿乐胶囊治疗,平时血糖控制在6－10mmol/L之间。[第一段]

关键词： Aged   Anti-Inflammatory Agents/administration & dosage   Blood Glucose/metabolism   Diabetes Mellitus, Type 1/complications   Diabetes Mellitus, Type 1/metabolism   Diabetes Mellitus, Type 2/complications   Diabetes Mellitus, Type 2/metabolism   Female   Follow-Up Studies   Hemoglobin A, Glycosylated/metabolism   Humans   Injections, Intralesional   Male   Middle Aged   Predictive Value of Tests   Tendon Entrapment/drug therapy   Tendon Entrapment/etiology   Tendon Entrapment/metabolism   Treatment Outcome   Triamcinolone/administration & dosage  

摘要： Steroid injec- tions for FTS were reported to be effective with variable success rates ranging from 38 to 92% in the general population (9 14). Among several steroids, triamcino- lone is widely used (9 11). However, there are only a few organized reports dealing with the results of intrasheath in- jection of steroids for FTS in diabetes (15,16). Each report shows lower success rates in diabetic patients when compared with those in nondiabetic patients. The reason for unsatisfactory results in dia- betic patients is assumed to be associated with disturbances of collagen metabolism in exor tendon sheaths, which may be due to the accumulation of advanced gly- cation end products, increased cross- linking of collagen and resistance to collagenase, increased oxidative stress, or increased hydration of collagen mediated by the polyol pathway (6,8,15,16). This study documented for the rst time the factors affecting the outcome of steroid injections for FTS in diabetic con- ditions. The success rate at the 1-year fol- low-up period appears to be much lower when compared with other reports. This may be because we considered any sign of recurrence within 1 year as treatment fail- ure. According to logistic regression anal- ysis with 15 independent variables, only A1C values were positively correlated with poor clinical results. High values of A1C represent poor glycemic conditions for the previous 1 2 months, and more abnormal glucose metabolism, including enhanced formation of advanced glyca- tion end products, oxidative stress, or ac- tivation of the polyol pathway, is expected to occur. A surprising nding was that the estimated duration of diabetes was in- versely correlated with the clinical results, though the nonadjusted OR was not sta- tistically signicant. We cannot draw con- clusions from this subject. We demonstrated that A1C values de- termine the outcome of intrasheath injec- tion of triamcinolone for FTS in diabetic conditions. Diabetic patients with poor glycemi

关键词： 体外震波   治疗仪   末端病   肌腱   软组织损伤   运动损伤   网球肘   跟腱炎   EMS   肩周炎  

摘要： 体外震波治疗(ESWT)源于20年前,开始仅用于碎石.1990年初德国医生将其用于治疗网球肘、跟腱炎等末端病和其它软组织损伤,取得了较为满意的结果,并逐渐得到广泛应用,是目前欧美治疗运动损伤的主要手段之一.作者自2004年1月以来,使用新一代的EMS治疗仪对部分网球肘、肩周炎等病人进行了治疗,取得了近期较好的效果。[第一段]

关键词： 肌腱断裂   ller   眼眶病   兔眼   上睑退缩   矫正手术   暴露性角膜炎   手术失败率   矫正过度   病例研究  

摘要： PURPOSE: To evaluate the efficacy of transconjunctivalMü ller muscle recession and graded levator disinsertion for eyelid retraction in patients with thyroid-related orbitopathy (TRO). DESIGN: Retrospective consecutive case series. METHODS: Medical record review of 78 TRO patients (107 eyelids) who underwent surgery for upper eyelid retraction in a 5- year period was performed. Main outcome measures were anatomic and functional success, minimal reflex distance (MRD), lagophthalmos, eyelid asymmetry, and patient discomfort. RESULTS: One hundred seven eyelid retraction surgeries were performed on 78 TRO patients (63 women, mean age 49 years); mean follow-up time was 16.7 months. Upper eyelid position, lagophthalmos, exposure keratopathy, and patients’ discomfort markedly improved after surgery (P < .001). Marginal reflex distance (MRD1) decreased an average of 2.6 mm from 6 mm pre-operatively to 3.4 mm post-operatively (P < .001); lagophthalmos decreased an average of 0.6 mm from 1.3 mm pre-operatively to 0.4 mm post-operatively (P=.006) Failure rate was 8.4% , most improved with a second surgery. Overcorrection was noticed in three cases (2.8% ). Eyelid asymmetry improved from a mean of 1.0 mm pre-operatively to 0.4 mm post-operatively (P=.001); more than 80% of patients showed eyelid asymmetry of 1 mm or less. CONCLUSION: Transconjunctival M¨ uller muscle and levator recession is safe and effective in correction of mild, moderate, or severe eyelid retraction in TRO patients. The failure rate is less than 10% and may be addressed by a second surgery.

关键词： 肌腱病   病理改变   凋亡  

摘要： 肌腱病是由过度使用所引起的肌腱及腱周疼痛、肿胀和功能障碍的综合征。三十年来,它的发病率明显增加。尽管人们对肌腱病进行了广泛研究,但目前仍然不能完全阐明肌腱病的发病机制、病理改变和治疗方案。本文阐述了肌腱病的病理分类、形态学、光镜及电镜下的特点,以及光镜下凋亡细胞的形态学特点。并着重介绍了最近关于从各种刺激到凋亡再发展为肌腱退变这一热点问题的研究。

关键词： 肌腱病   前列腺素E2   动物模型   凋亡  

摘要： 本文建立肌腱病动物模型,探讨其与凋亡的关系。结果显示局部注射前列腺素(PGE2)可成功建立肌腱病动物模型;退变肌腱中存在着过量凋亡。

关键词： 发病机制研究   分子生物学   肌腱   腱病   前列腺素E2   发病过程  

摘要： 肌腱腱病的准确发病机制尚无定论。肌腱基质的重塑以及前列腺素E2在肌腱腱病发病过程中所起的作用是目前研究的热点之一。该文对此作一综述。

关键词： Grave病   提上睑肌   上睑   腱膜   眼轮匝肌   眼外肌   眶部   睑裂   睑板   睑部  

摘要： Background: The chronic stage in Grave’s orbitopathy is characterised by fibr otic changes within the orbital soft tissues, especially the extraocular muscles . Retraction of the eyelids is a common clinical feature of this phenomenon. To solve this problem several techniques for lengthening the upper eyelid have been described with variable rates of success. In this report we describe our modifi ed Harvey’s technique for the correction of upper eyelid retraction which inclu des a complete recession of the Müller’s muscle/levator complex from the tarsa l plate without the interposition of a spacer. Finally only the skin and the sup erficial orbicularis muscle are sutured. We also report about our results with t his procedure. Methods: 8 patients (1 male, 7 female) with lid retraction in Gra ve’s ophthalmopathy were recorded who had undergone the modified lengthening te chnique by an external approach between 2001 and 2004. Four patients underwent a bilateral procedure and 1 patient showed a significant undercorrection, necessi tating reoperation. So a total of 13 procedures were included in this follow-up study. Beside the common ophthalmological examination, special interest was put in the difference of the two eyelid apertures in primary position pre-and post operatively. Results: Within a follow-up period of at least 3 months we recorde d an averaged lengthening of the upper eyelid of 3.1 mm. The difference of the t wo eyelid apertures in primary position improved from 2.2 mm preoperatively to 1 .0 mm postoperatively. Only 1 patient needed reoperation because of a significan t undercorrection. There were no late overcorrections observed. Conclusions: The modified Harvey’s technique to lengthen the upper eyelid is a safe and effecti ve method to reduce upper eyelid retraction in Grave’s disease. An eventually r equired orbital decompression orextraocular muscle surgery has to be done before the lid surgery.

关键词： 肌腱病   动物模型   跟腱   前列腺素   病理学   细胞凋亡  

摘要： 本文通过在兔的跟腱局部注射前列腺素E2建立起肌腱病的动物模型，并从病理学角度探讨肌腱病与细胞凋亡的关系。方法：用48只大白兔分为处理组和对照组，分别于处理后第1、3、5周取材。进行HE染色，并应用TUNNEL法检测凋亡。结果是注射不同剂量前列腺素E2的跟腱均发生了肌腱病;大剂量组的跟腱退化性改变要比小剂量组更明显;大剂量组的凋亡发生率要比小剂量注射组高;增生的血管内皮细胞中凋亡也出现了异常的增高。结论为通过在兔的跟腱局部注射前列腺素E2可成功建立动物模型;揭示了退变的肌腱中存在着过量的凋亡的表征。