臀肌筋膜挛缩症的外科手术治疗

臀肌筋膜挛缩症(Gluteal Muscle Contracture,GMC)是指由于各种原因引起的臀肌及其筋膜挛缩,导致髋关节功能受限,表现出特殊的症状、体征的临床综合征。GMC多发生于青少年和儿童患者,目前普遍认为一旦确诊GMC,应尽早手术治疗。随着临床技术的发展,GMC的手术方式也在不断创新、不断发展,其大致分为开放式手术和微创手术两大类,两者虽各具优缺点,但针对不同的患者都取得了不错的治疗效果。本文现对GMC的外科手术治疗的进展作一简要综述。     

儿童臀肌挛缩症臀肌小血管损伤的相关免疫细胞化学研究

应用免疫细胞化学方法(间接免疫荧光法)对32例儿童臀肌挛缩症及10例正常儿童臀肌小血管Ⅷ因子相关抗原进行了定位、定性及定量研究。结果发现,儿童臀肌挛缩症臀肌小血管内皮细胞Ⅷ因子相关抗原荧光强度显著高于正常儿童组(P<0.01),并向管腔及内皮下突出,有的血管腔内充满荧光阳性物质,管径明显变小;而小血管数目显著低于正常儿童组(P<0.01)。结合普通切片结果分析,我们认为,小血管损伤导致组织缺氧可能是臀肌纤维化,儿童臀肌挛缩症的主要发病机理。     

青少年腰椎间盘突出症病因及治疗分析

青少年腰椎间盘突出症在临床少见,发病率约占手术病例的1％～6％,国内报道占椎间盘手术的3．71％。我院自1986-1998年共手术治疗腰椎间盘突出症501例,其中20岁以下青少年病例8例,约占1．5％。现就其发病原因、临床表现及治疗进行分析。     

腰椎间盘突出症传统后路手术治疗进展

腰椎间盘突出症是骨伤科疑难病症之一,也是临床常见病、多发病,有10%～20%的病人需经手术治疗[1]。腰椎间盘突出的传统手术治疗大致可分为后路手术方式和前路手术方式二种,其中后路手术方式是大多数腰椎间盘突出的基本术式。     

新疆肉羊18号染色体上与后臀肌发育相关基因的多态性分析

通过对新疆肉羊18号染色体与后臀肌发育相关基因的多态性分析,试图找到与新疆肉羊后臀肌性状发达相关基因,为肉羊分子标记辅助选择提供理论线索。运用PCR-SSCP、PCR-RFLP方法,对陶赛特和萨福克两个肉羊品种群体及其与本地细毛羊杂交1代和2代群体Callipyge（CLPG）基因的多态性进行分析,结果表明：位于18号染色体内的DLK1和GTL2间的103849 bp处没有发现PCR-RFLP多态性,表明新疆肉羊后臀肌过度发育与CLPG基因无关。随后,实验进一步对18号染色体Meg3.9位点158520处进行PCR-SSCP分析,发现扩增片段存在着多态性;Meg3.9扩增片段多态性位点在肉羊群体中的基因型有AA、AB和AC,以AA型为主。其中AA、AB基因型与新疆肉羊后臀肌肉发达的表型无关（P>0.05）,AC基因型与新疆肉羊后臀肌肉发达的表型相关（P<0.05）。在陶赛特与本地细毛羊杂交1代群体中,AC基因型的屠体重和屠宰率与AA、AB基因型差异显著（P<0.05）,但三种基因型的各月龄体重没有差异(P>0.05)。通过以上分析可以推断,引起新疆肉用绵羊后臀肌过度发育的性状不是CLPG基因内9571-268.3位点突变导致,可能还存在其他基因或与其连锁的多个QTL的共同作用。     

不同手术方式对腰椎间盘突出症治疗的效果比较分析

目的:探讨应用微创技术治疗腰椎间盘突出症的疗效.方法:对我院脊柱骨科自2005年l1月～2010年10月收治的128例腰椎间盘突出症患者应用不同手术方式进行治疗,其中应用APLD( automated percutaneous lumbar discectomy)治疗单纯腰椎间盘突出症48例;应用MED(microendoscopic discectomy)治疗复杂型腰椎间盘突出症42例;应用传统后路椎板开窗技术治疗单纯腰椎间盘突出症38例;比较各组手术时间、术中出血、术后住院时间、疗效及并发症.术后均随访8个月～3年,观察复发情况.结果:三组不同手术方式手术时间及优良率比较差异无统计学意义(P＞0.05),APLD及MED组术中出血量及术后住院时间与传统手术组比较,差异有显著性(P＜0.05);术后随访疼痛全部缓解,无复发.结论:在严格掌握适应症的基础上,采用微创技术和采用传统手术治疗腰椎间盘突出症疗效相当,但微创技术创伤小、术中出血量少,术后住院日短,恢复快,优于传统手术.     

104 例重症急性胰腺炎的手术治疗与非手术治疗对比分析

目的:探讨重症急性胰腺炎的有效治疗方法以及施行外科手术治疗的时机与指征.方法:回顾性分析104例重症胰腺炎患者的临床治疗资料,其中63例患者行非手术治疗,41例患者行手术治疗,观察比较患者治愈率、死亡率、并发症发生率、住院时间以及治疗前后血尿淀粉酶的变化.结果:①非手术组与手术组间治愈率、死亡率和平均住院时间无明显差异(P＞0.05),但手术组并发症发生率显著高于非手术组(P＜0.05).②早期手术组与延期手术组间治愈率比较无明显差异(P＞0.05),但延期手术可有效降低患者死亡率与并发症发生率(P＜0.05).③经过治疗,早期与延期手术组患者血尿淀粉酶水平均明显降低(P＜0.01),且早期手术组下降幅度大于延期手术组(P＜0.05).结论:非手术治疗与手术治疗的综合治疗可有效提高SAP的治疗效果,同时手术治疗中应尽量避免早期手术.     

全程护理在C臂导向下注射胶原酶治疗腰椎间盘突出症的应用

胶原酶溶解术(简称溶解术),具有微创、操作简便、疗效确切、疗程短等优点,已在临床上广泛应用。我院于2002年8月至2005年2月行盘、盘外、盘内外联合注射胶原酶治疗腰椎间盘突出症102例,并进行全程护理,收到满意效果,现报告如下。1临床资料1·1一般资料经CT或MRI确诊,以腰痛、下     

脊柱双通道内镜治疗青少年腰椎间盘突出症的临床研究

摘要 目的：探讨使用单侧双通道脊柱内镜技术（unilateral biportal endoscopy,UBE）在青少年腰椎间盘突出症患者中的优势及安全性。方法：采用回顾性分析的方法,对符合纳入及排除标准的共计96例患者进行分析和比较,根据手术方式的不同,分为UBE组（52例）和单通道孔镜患者组（44例）。评价围手术期,手术前后疼痛、功能变化及影像学资料。结果：两组患者均无严重并发症。两组患者术后VAS评分及ODI评分较术前有显著改善 （P<0.05）,但从远期来看,UBE组优于PELD组。在术中透视次数、复发等指标中,UBE组显著优于PELD组。影像学指标中,UBE组在椎管面积,术后残留等指标中有显著优势（P<0.05）。结论：单侧双通道脊柱内镜技术在青年椎间盘突出症的治疗中是一种理想且安全的治疗方式。     

提高胞外钾引起的蛙骨骼肌咖啡因挛缩增强

用蛙胫前肌小束为材料, 研究了提高胞外钾[K+]O对咖啡因挛缩的作用.[K+]O从2 mmol/L提高到10或25 mmol/L, 由3 mmol/L咖啡因引起的挛缩明显增强.以PKC/PC (PKC和PC分别为在高钾和正常钾条件下的咖啡因挛缩)表示的咖啡因挛缩增强, 依赖[K+]O和高钾作用时间.随着10 mmol/L [K+]O作用时间延长, 直至10 min, 增强逐渐增加.但是, 25 mmol/L [K+]O作用1 min时增强达到最大, 然后下降到对照.PKC/PC变化时程不能用高钾引起的去极化解释, 而与由相似[K+]O引起的胞浆自由钙变化时程相符.提示, 至少在蛙骨骼肌, 高钾引起的咖啡因挛缩增强主要是由胞浆自由钙升高引起的.     

Effect of divalent cations on the potassium contracture of slow muscle fibers ofRana temporaria

Summary K contractures of single slow muscle fibers ofRana temporaria were measured isometrically in the presence of normal, reduced, and increased Ca²⁺ concentrations at 18 to 20°C. At normal Ca²⁺ concentration (1.8mm) contracture tension decreased from its peak value of 35.4±8.2 N/cm² to 59.4±23.9% within one minute, and to 48.3±27% within two minutes (30 fibers). Peak tension was virtually unaffected by changes of the Ca²⁺ concentration, but maintenance of tension was impaired by low (0.2mm), and improved by high (10mm) Ca²⁺ concentrations. When Ca²⁺ was added during the K contracture, there was practically no restoration of lost tension. Effects similar to those of Ca²⁺ were observed upon addition of foreign divalent cations to the medium. Co²⁺, Ni²⁺, and Cd²⁺ were slightly more effective than Ca²⁺ and Mn²⁺; the smallest effects were obtained with Mg²⁺, Sr²⁺, and Ba²⁺. The effects of foreign divalent cations were independent of the presence of Ca²⁺. It is concluded that in slow fibers ofRana temporaria maintenance of contracture tension is not due to an influx of Ca²⁺ ions. Instead, binding of divalent cations to superficial sites seems to be essential.     

Influence of ryanodine receptor agonist and antagonist on development of potassium contracture in phasic (twitch) and tonic fibers of frog skeletal muscle

We compared the influence of external calcium and the inhibitor (dantrolene) and activator (4-chloro-m-cresol) of ryanodine-sensitive Ca channels of the sarcoplasmic reticulum on the characteristics of potassium contracture in phasic and tonic frog skeletal muscle fibers. The duration of contracture in tonic fibers, as contrasted to the phasic ones, is not limited by the presence of Ca²⁺. The tonic contractile response is virtually indifferent to dantrolene and is much less sensitive to chlorocresol than the phasic one (1 mM vs. 0.25 mM). In phasic fibers, the K⁺ contracture on the chlorocresol background is quite similar in amplitude and dynamics to that in control, whereas tonic fibers exhibit response summation without relaxation upon removal of excessive K⁺. One can suggest that in phasic fibers the Ca²⁺ influx can directly create a level sufficient to sustain contraction, while in tonic fibers its effect is mediated by Ca-dependent activation of the beta isoform of the ryanodine-sensitive channel.     

Electromyography of the gluteal muscles in Hylobates,Pongo, and pan: Implications for the evolution of hominid bipedality

The gluteal musculature of primates has been a focus of great research interest among those who study human evolution. Most current theorists agree that gluteus superficialis (= maximus) need not have changed its action in the step from pongid to hominid, but dispute has arisen over a purported change in action and role of the gluteus medius. To clarify the functions of gluteus medius, gluteus superficialis, and tensor fasciae femoris during ape locomotion, we conducted a telemetered electromyographic study of these muscles in two gibbons, one orangutan, and four chimpanzees as they walked bipedally on the ground and on a horizontal tree trunk, walked quadrupedally on the same substrates, and climbed a vertical tree trunk. The results indicate that the gluteus medius of apes is not, as has been previously suggested, primarily an extensor of the thigh; its action is chiefly that of medial rotation. The role of the gluteus medius during bipedality is the same in apes and humans–to provide side-to-side balance of the trunk at the hip. The change in the hominid lateral balance mechanism can be viewed as primarily osteological, allowing preservation of the same muscle function with an extended thigh. As a result, the stride length is increased and there occurs a diminution of the demands placed on other muscles to maintain anteroposterior balance at the hip and knee. Our data also support the view that vertical climbing may be specifically preadaptive to bipedalism. One may picture the earliest hominid as part biped, when on the ground traveling between scattered food trees, and part climber, when moving from the ground to food.     

A comparative analysis of the contracture responses induced by acetylcholine and choline in the twitch and tonic fibers of frog skeletal muscles

A comparative analysis of the contractile responses induced by acetylcholine and replacement of the external Na⁺ ions with choline ions in the isolated twitch and tonic fibers of frog skeletal muscles was performed. The effects of extracellular Ca²⁺ concentration and several pharmacological agents modulating the activity of various systems maintaining Ca²⁺ level in the myoplasm (dantrolene, cresol, d-tubocurarine, and tetrodotoxin) were studied. It has been found that a voltage-dependent Ca²⁺ release from the sarcoplasmic reticulum depot is the main mechanism inducing the acetylcholine contracture in the fibers of both types. However, the twitch and tonic fibers differ in the properties of the α-isoform and(or) the ratio of α- to β-isoforms of ryanodine-sensitive channels. In the fibers of both types, the replacement of over 25% of Na⁺ ions with choline induces long-term contracture responses, which are also mediated by activation of acetylcholine receptors. It is assumed that an additional mechanism—accumulation of choline ions in the myoplasm and their direct action on the ryanodine-sensitive channels—is involved in the development of such contractile responses.     

Chronic muscle stimulation increases lactate transport in rat skeletal muscle

The aim of this study was to examine the effects of chronic low frequency stimulation on the lactate transport across the plasma membrane of the tibialis anterior (TA) muscle of the rat. Stimulating electrodes were implanted on either side of the peroneal nerve in one hindlimb. Chronic stimulation (10 Hz, 50 psec bursts, 24 h/day) commenced 7 days after surgery, and were continued for 7 days. Animals were then left for 24 h, and thereafter muscles were obtained. Cytochrome C-oxidase activity was increased 1.9-fold in the stimulated TA compared to the control TA (p < 0.05). Lactate transport (zero-trans) was measured in giant sarcolemmal vesicles obtained from the chronically stimulated TA and the control TA. At each of the concentrations used in these studies a significant increase in lactate transport was observed: 2.8-fold increase at 1 mM lactate p < 0.05); 2-fold increases at both 30 mM and 50 mM lactate p < 0.05). These studies have shown that lactate transport capacity is markedly increased in response to chronic muscle contraction.     

Penetration of horseradish peroxidase into the terminal cisternae of frog skeletal muscle fibers and blockade of caffeine contracture by Ca++ depletion

Summary Horseradish peroxidase, an extracellular marker, was given intravenously to frogs, and 40 min later the sartorius muscles were removed. The isolated muscles were exposed for an additional hour to Ringer solution containing peroxidase, then fixed with glutaraldehyde. Peroxidase activity was found in the T tubules, in some of the terminal cisternae (TC) of the SR, and occasionally in the longitudinal tubules of the SR. In transverse sections, the structures containing tracer formed a pattern of approximately parallel columns reaching to the cell surface; the statistical distribution of their spacing was nearly the same as that of the interdistances between the current-sensitive spots on the Z-line which triggered localized contraction (Huxley and Taylor, 1958). The caffeine contracture of frog sartorius muscles remained unchanged in isotonic Ringer solutions which were Ca⁺⁺-free or contained Mn⁺⁺ or La⁺⁺⁺; however, contracture was blocked by prior exposure of the muscles to the same solutions made 2 × hypertonic with sucrose (known to produce swelling of T tubules and (TC). Since Mn⁺⁺ and La⁺⁺⁺ are known to depress Ca⁺⁺ influx, these results suggest that washout of Ca⁺⁺ from the TC, and penetration of La⁺⁺⁺ or Mn⁺⁺ into it, occur more rapidly due to the swelling of T tubules and TC associated with hypertonicity. It is concluded that at least some of the terminal cisternae are open to the interstitial fluid via the T tubules. Thus, depolarization of the T tubules could readly depolarize the cisternae and lead to Ca⁺⁺ influx into the myoplasm.Supported by grants from the Public Health Service (HE-11155, HE-05815, and HE-10384) and from the American Heart Assocation. The authors are indebted to Mrs. Jan Redick for expert technical assistance.     

Penetration of horseradish peroxidase into the terminal cisternae of frog skeletal muscle fibers and blockade of caffeine contracture by Ca++ depletion

Summary Horseradish peroxidase, an extracellular marker, was given intravenously to frogs, and 40 min later the sartorius muscles were removed. The isolated muscles were exposed for an additional hour to Ringer solution containing peroxidase, then fixed with glutaraldehyde. Peroxidase activity was found in the T tubules, in some of the terminal cisternae (TC) of the SR, and occasionally in the longitudinal tubules of the SR. In transverse sections, the structures containing tracer formed a pattern of approximately parallel columns reaching to the cell surface; the statistical distribution of their spacing was nearly the same as that of the interdistances between the current-sensitive spots on the Z-line which triggered localized contraction (Huxley and Taylor, 1958). The caffeine contracture of frog sartorius muscles remained unchanged in isotonic Ringer solutions which were Ca⁺⁺-free or contained Mn⁺⁺ or La⁺⁺⁺; however, contracture was blocked by prior exposure of the muscles to the same solutions made 2 × hypertonic with sucrose (known to produce swelling of T tubules and (TC). Since Mn⁺⁺ and La⁺⁺⁺ are known to depress Ca⁺⁺ influx, these results suggest that washout of Ca⁺⁺ from the TC, and penetration of La⁺⁺⁺ or Mn⁺⁺ into it, occur more rapidly due to the swelling of T tubules and TC associated with hypertonicity. It is concluded that at least some of the terminal cisternae are open to the interstitial fluid via the T tubules. Thus, depolarization of the T tubules could readly depolarize the cisternae and lead to Ca⁺⁺ influx into the myoplasm.Supported by grants from the Public Health Service (HE-11155, HE-05815, and HE-10384) and from the American Heart Assocation. The authors are indebted to Mrs. Jan Redick for expert technical assistance.