包皮系带撕裂伤的急诊手术整形治疗

自1995年2月至2000年6月对17例包皮系带急性撕裂伤施行急诊手术整形治疗,疗效肯定.见于尚无报道,现报道如下:

自发性气胸伴胸膜粘连带撕裂伤1例

患者男性，28岁，因右侧胸痛1天，加重伴呼吸困难半天，于2002年6月22日入院。患者平素体健，既往无特殊病史。

Nonlinear ultrasonic characterizing online fatigue damage and in situ microscopic observation

A robust experimental procedure was developed, by which the evolution of fatigue damage in AZ31 magnesium alloy was tracked online with the ultrasonic nonlinearity parameter β. β values of three sets of samples under different stress levels were measured. Microstructures of specimens at different fatigue stages were observed in situ by optical microscopy. The experimental results show that there is a significant increase in β linked to the accumulation of persistent slip bands （PSBs） and micro-cracks at the early stages of fatigue life and reaches the maximum, about 55% of fatigue life. Ultrasonic attenuation coefficient increases with the expanding of micro-cracks and leads to β decrease slightly after 55% of fatigue life. The variation of β with fatigue cycles is in good agreement with the growth of PSBs and micro-cracks. In addition, it has no significant effect on the experimental results for the changes of low- and high-cycle fatigue and the fatigue mode with tension-tension and tension-compression.

医用胶粘合包皮系带撕裂伤与传统缝合法的疗效比较

目的探讨包皮系带撕裂伤采用医用胶粘合与传统缝合效果的比较。方法收集2011年1月至2016年1月北京市和平里医院泌尿外科收治的包皮系带撕裂伤患者30例,采用随机数字表法随机分成观察组(15例)与对照组(15例),2组均经常规创口消毒后,观察组采用医用胶粘合创口,对照组采用传统缝合法处理创口。记录医师处理创口所需时间、医疗费用、愈合时间,随访并统计创口愈合评分与患者满意度。结果与对照组相比,观察组明显减少了外科医师处理创口所需时间[(4.46±1.01)min vs.(10.71±1.42)min,P<0.05];并获得了更好的创口愈合评分与患者满意度(93.33%vs.46.67%,P<0.05);可减轻患者经济负担,但差异无统计学意义[(223.01±15.43)元vs.(238.58±30.91)元,P>0.05];在伤口愈合时间方面2组差异无统计学意义[(6.70±0.95)d vs.(7.47±1.01)d,P>0.05]。结论包皮撕裂伤患者采用医用胶粘合伤口能减少患者痛苦和心理负担,提高患者满意度,降低医师工作强度。

Viscoelastic behavior with damage evolution of a new smart geosynthetic in service temperature range

A new type of intelligent geosynthetic product,sensor-enabled geobelt(SEGB),is developed to improve the health monitoring of geotechnical structures.It can be used as a strain monitoring sensor owing to its unique property.As a conductive polymer,its electrical resistance regularly changes with its strain.Simultaneously,the SEGB is a geosynthetic product.This implies that it can be used as a reinforcement to strengthen a geotechnical structure.Therefore,to investigate its long-term mechanical properties within the temperature range of its service,a stress relaxation test is performed within the range of−20℃ to 40℃.The results show that the stress relaxation of the SEGB stabilizes at a certain stress level instead of decreasing to zero.Additionally,the process of its stress relaxation is accompanied by damage.Based on this phenomenon,a ternary physical constitutive model reflecting the constitutive relationship of the SEGB is established.Furthermore,a stress relaxation model involving damage evolution,temperature,and initial strain is established.It can be used to describe the stress relaxation process of SEGB at different service temperatures.

Granular Effect of Fly Ash Repairs Damage of Recycled Coarse Aggregate

Repairing effect of fly ash （FA） on damage of recycled coarse aggregate was evaluated by characteristics of pores and cracks in the vicinity of interracial transition zone （ITZ）. The interracial structure between the virgin aggregate and the attached old mortar was investigated and compared with ITZ of recycled aggregate concrete in the presence of FA or ultra-fine FA（UFA） by means of scanning electron microscope （SEM）. Diameter and plumpness frequency distribution of pores as well as width of the old ITZ, length of contacting points and cracks density were analyzed. The SEM results reveal that the diameter of pores is decreases significantly but pores plumpness increases. A decreased ITZ width and cracks density as well as an increased bonding zone length can also been observed, which indicates that FA or UFA repairs damage of recycled coarse aggregate due to its granular effect.

Biomechanical characteristics of an anterior cruciate ligament injury in javelin throwing

Purpose： The purpose of this study was to understand the mechanism of an anterior cruciate ligament （ACL） injury in javelin throwing and javelin throwing techniques relevant to this ACL injury. Methods： The patient in this study was an elite female javelin thrower who completed the first three trials and sustained a non-contact ACL injury on her left knee in the fourth trial of javelin throwing during a recent track and field meet. Three-dimensional kinematic data were collected in the injury and non-injury trials. The kinematic data of 52 male and 54 female elite javelin throwers were obtained from a javelin throwing biomechanical database. Results： The patient had greater forward center of mass velocity and less vertical center of mass velocity after the first 25% of the delivery phase in the injury trial compared to non-injury trials. The patient had less left knee flexion angle and angular velocity but similar left knee valgus and internal rotation angles during the first 21% of the delivery phase in the injury trial compared to non-injury trials. The video images showed an obvious tibia anterior translation at the 30% of the delivery phase in the injury trial. The left knee flexion angle and angular velocity at the time of the left foot landing and the maximal left knee flexion angle during the delivery phase were not significantly correlated to the official distance for 52 male and 54 female elite javelin throwers. Conclusion： The ACL injury in this study occurred during the first 30% of the delivery phase, most likely during the first 25% of the delivery phase. A stiff landing of the left leg with a small knee flexion angle was the primary contributor to this injury. Javelin throwers may have a soft left leg landing with a flexed knee, which may help them prevent ACL injuries without compromising performance.

Anterior cruciate ligament injuries in soccer:Loading mechanisms,risk factors,and prevention programs

Anterior cruciate ligament （ACL） injuries are common in soccer. Understanding ACL loading mechanisms and risk factors for ACL injury is critical for designing effective prevention programs. The purpose of this review is to summarize the relevant literature on ACL loading mechanisms, ACL injury risk factors, and current ACL injury prevention programs for soccer players. Literature has shown that tibial anterior translation due to shear force at the proximal end of tibia is the primary ACL loading mechanism. No evidence has been found showing that knee valgus moment is the primary ACL loading mechanism. ACL loading mechanisms are largely ignored in previous studies on risk factors for ACL injury. Identified risk factors have little connections to ACL loading mechanisms. The results of studies on ACL injury prevention programs for soccer players are inconsistent. Current ACL injury prevention programs for soccer players are clinically ineffective due to low compliance. Future studies are urgently needed to identify risk factors for ACL injury in soccer that are connected to ACL loading mechanisms and have cause-and-effect relationships with injury rate, and to develop new prevention programs to improve compliance.

青春的秘密带着伤

高三那年的一个清晨，文静乖巧的我有了自己的秘密。当阳光带着薄雾，透过白色的纱帘弥漫进来时，我突然发现自己有了柳枝一样细软开来的腰身，身体就像窗台上春寒料峭中想要开放的蔷薇花。

忘掉绰号带给我的伤

班上有几个喜欢搞恶作剧的男生，整天以给同学起绰号为乐。有一天，这件“邪恶”的事情降临到了我的头上。 午休的时候，我正在专心做数学练习题。 “大婶，你姑妈来看你了!”

P25 Scoring Method for the Assessment of R/C Buildings

An effective rapid assessment technique, called ＂P25 Scoring Method＂, has been developed and tested on 26 different case studies recently, in order to predict the collapse vulnerability of the R/C buildings. After a short description of the approach, the study presents the sensitivity study of the method to the selected structural parameters by considering incremental deviation of the final scores from the base model. Further, the methodology was applied to an additional 100 damaged buildings in order to check the reliability of the method and some necessary modifications have been applied to the algorithm after considering this larger database. The evaluation of the results has been interpreted as a beneficial guidance for local authorities. The risk bands are defined according to the final scores and the effect of changing the band-width has also been studied through a safe but an economical procedure. A satisfactory correlation of the method with real damage states is obtained and a ready-to-use methodology has been introduced for future studies.

铝带热连轧头部变厚度轧制工艺和应用

带卷头部压伤是影响铝合金热轧带卷成品率的主要质量缺陷之一。为了有效控制该缺陷的产生,首先分析其产生的原因和机理,确定了采用穿带时依次改变各机架辊缝对带卷头部进行变厚度轧制的解决方案,建立了变厚度轧制的工艺数学模型,可实时计算各机架辊缝的调整量和调整速度,以达到增大带卷头部与内圈卷面间接触面积、减少带卷头部压伤缺陷的目的。在生产现场采用该方法后,头部压伤的不良比例由之前的5%降至1%左右,同时可以提高卷取机的最大允许卷取厚度。

Concurrent arthroscopic bicruciate ligament reconstruction using Achilles tendon-bone allografts： experience with 15 cases

Objective： To evaluate the clinical outcome of arthroscopically assisted combined anterior and posterior cruciate ligament （ACL/PCL） reconstructions using Achilles tendon-bone allografts. Methods： Associated meniscus injuries were treated according to established methods prior to ligament reconstructions during arthroscopic surgery. Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees. At postoperative follow-up, all knees were graded using the modified IKDC and the Lysholm scoring systems just as done preoperatively. Results were analyzed compared with the contralateral healthy knees. Results： Eleven men and 4 women with a minimum of 3-year follow-up （mean 38 months） were included in the study. Preoperatively, the group ratings by the modified IKDC standards were all severely abnormal. Twelvebicruciate reconstructions were performed in subacute or chronic stage （〉3-8 weeks）, 3 for acute ligamentous deficiencies （≤ 3 weeks）. The noticeable early complication was transitory local fever combined with joint effusion in one case. At postoperative follow-up, 9 knees were normal, 5 nearly normal and 1 abnormal. On Lysholm score the difference was statistically significant （ttest, P〈0.001） before and after operation. Conclusions： Achilles tendon-bone allograft offers an alternative for simultaneous arthroscopic ACL/PCL reconstructions. However, further investigation is needed to eradicate its potential immunogenicity for better use.

Operative treatment for separation of distal tibiofibular syndesmosis

Objective： To study the influence of separation of distal tibiofibular syndesmosis on ankle joint and to compare various operative methods so as to find suitable stabilization for separated distal tibiofibular syndesmosis. Methods： From July 1997 to July 2002, we treated 87 patients （64 males and 23 females, aged 18-54 years） with separation of distal tibiofibular syndesmosis, among whom, 79 were combined with fracture of malleolus. Manipulative reduction, internal fixation with cancellous screws and external fixation with plaster support were performed on 37 patients, fixation with plate and screws for fibular fracture and fixation with cancellous screws for distal tibiofibular syndesmosis on 34 patients, and repair of the distal tibiofibular ligaments with tendon of peroneus Iongus, reduction of the separated distal tibiofibuiar syndesmosis, and fixation with cancellous screws on 16 patients. The ankle joint had been dorsiflexed for 30° when the distal tibiofibular syndesmosis was fixed with cancellous screws. And the cancellous screws were taken out at 8-10 weeks after operation. Results： These patients were followed up for at least two years. The curative effects were assessed according to the complaints of the patients and the contour, function and radiogram of the ankle joint： excellent in 55 patients （63 % ）, good in 18 patients （ 21% ）, and fair in 14 patients （16%）. Separation of distal tibiofibular syndesmosis recurred in 2 patients, who underwent a reoperation for repairing the distal tibiofibular ligaments with tendon of peroneus Iongus and recovered. One cancellous screw was broken off. No necrosis developed in the anterior skin of the ankle mortise. Conclusions ： Separation of distal tibiofibular syndesmosis can be treated with various reasonable operations. Repair with tendon of the peroneus Iongus can get excellent outcomes for complete separation of the distal tibiofibular syndesmosis.

Histological comparison of fate of ligamentous insertion after reconstruction of anterior cruciate ligament: autograft vs allograft

Objective ：To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament （ ACL ） with autograft or allograft tendon. Methods： Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylineosin （HE） stain under light microscope. Results： The insertion structure of normal ACL typically consisted of four layers, i. e. , dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenons fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group. Conclusions： At the 6th month postoperatively, although the ligament-eartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.

A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

Objective： To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the cfinical results. Methods： From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray flms were undertaken to detect the bony healing of avulsed fragment. Results： The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1 ± 15.2 （ ranging from 10 to 56 ） preoperatively to 97.5 ± 3.7 （ranging from 91 to 100） postoperatively on average in 12-54 months follow up （mean 23 months）. The statistically significant difference was shown in Student＇s t test （t = 18. 483, P =3. 100×10^-11, P 〈 0. 01）. Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively. Conclusion： This technique has many advantages, such as simplicity, wide indications from type Ⅱ to type Ⅳ fractures, minimal invasion, short operating time and predictable satisfactory results.

Biologic characteristics of fibroblast cells cultured from the knee ligaments

To culture fibroblast cells from th e knee ligaments and to study the biological characteristics of these cells. Methods: Cells of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) from New Zealand white rabbit were cultured in vitro. Cellular growth and expression of the collagen were analyzed. Moreover, a n in vitro wound closure model was established and the healing of the ACL and th e MCL cells was compared. Results: Maximal growth for all these cells were obtained with Dulbeccos modified Eagles medium supplemented with 10% fetal bovine serum, b ut RPMI 1640 and Hams F12 media were not suitable to maintain these cells. Mor p hology of both ACL and MCL cells from New Zealand white rabbit was alike in vitr o, but the MCL cells grew faster than the ACL cells. Both cell types produced si milar amount of collagen in culture, but the ratio of collage type Ⅰ to type Ⅲ produced by ACL cells was higher than that produced by MCL cells. Wound closure assay showed that at 36 hours after injury, cell free zones created in the ACL cultures were occupied partially by the ACL cells; in contrast, the wounded zon e in the MCL cultures was almost completely covered by the cells.Conclusions: Although the ACL cells and the MCL cells from New Zealand white rabbit show similar appearance in morphology in culture, the cellu lar growth and the biochemical synthesis of collagen as well as the healing in v itro were significantly different. These differences in intrinsic properties of the two types of cells in vitro might contribute to the differential healing pot entials of these ligaments in vivo.