关键词： 拇长屈肌腱   转移治疗   跟腱病   老年   自体移植   合成材料   异体移植   足内侧缘  

摘要： 有很多技术可以用来重建慢性断裂的跟腱，大多数使用附近的肌腱，也可使用自体移植，异体移植或合成材料。Hansent首先提出用拇长屈肌腱来修复跟腱，通过跟腱后侧切口来获得拇长屈肌腱。以后Wapnert介绍了一种切取拇长屈肌腱方法，即在中足内侧缘从舟骨隆突到第一跖骨头另做一独立切口．从而获得更长的可供转移的拇长屈肌腱。

关键词： foot ulcer   forefoot ulcer   tenotomy   tendon lengthening   toe ulcer  

摘要： Background: Foot ulcers are common causes of hospital admissions for infection and amputation in patients with neuropathy. This retrospective study evaluates the results of treating plantar neuropathic toe ulcers with percutaneous flexor tenotomy. Methods: From 1996 to 2003, 28 toe ulcers in 18 patients were treated with tenotomy of the toe flexors. Results: Fourteen of 18 patients had diabetic neuropathy. No patients were lost to followup. Average followup for the 28 ulcers was 36 (range 20 to 65) months. All ulcers healed. None of the 11 lesser toe ulcers recurred. Three of 17 first toe ulcers recurred but two that had repeat tenotomy healed and did not recur. There were no toe amputations, infections, or other complications of tenotomy. One patient had unrelated transtibial amputation. Conclusions: No long-term results of treating toe ulcers with toe flexor tenotomy by other authors have been found. Toe flexor tenotomies appear to be effective and safe treatment for neuropathic toe ulcers.

关键词： 陈兰花冲剂   糖尿病足   真菌   细胞间黏附分子-1   大鼠  

摘要： 目的研究陈兰花冲剂对糖尿病足坏疽大鼠肌腱组织中细胞间黏附分子-1(ICAM-1)的影响。方法采用腹腔注射STZ复制糖尿病大鼠模型,并以足部注射真菌菌液方法建立糖尿病足动物模型。采用免疫组织化学方法观察比较陈兰花冲剂及糖脉康对大鼠足部肌腱组织ICAM-1表达的影响。结果糖尿病大鼠模型及糖尿病足动物模型均成功复制。造模后,各模型组大鼠体重较对照组明显下降,血糖、糖化血红蛋白显著升高(均为P<0.05),但陈兰花冲剂组与糖脉康组之间差异无显著意义(均为P>0.05);各模型组肌腱组织ICAM-1的表达明显高于对照组,陈兰花组明显低于糖脉康组,差异有显著意义(P<0.01)。结论陈兰花冲剂无明显降低血糖作用,但可明显抑制肌腱组织ICAM-1的表达,抑制机体炎性因子的水平可能是其治疗糖尿病足的重要分子机制之一。

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。