全髋与半髋关节置换术治疗老年股骨颈骨折的疗效研究

目的对比观察全髋与半髋关节置换术治疗老年股骨颈骨折的临床效果。方法回顾性分析2010年7月至2013年7月骨科住院行人工关节置换术的老年股骨颈患者46例的临床资料,其中采取全髋人工关节置换术23例,设为A组;半髋人工关节置换术23例,设为B组。比较并分析两组患者术后的相关手术指标,术后6月、12月的髋关节活动评分(Harris评分)、假体髋臼外展角与前倾角、髋臼完好率、髋臼磨损与增生的发生率等。结果 1A组患者在手术时间、术中出血量、总引流量、拔管时间方面均高于B组,差异具有统计学意义(P0.05);A组患者负重时间、术后并发症发生率均低于B组,差异具有统计学意义(P0.05);2术后6月、12月随访,A组Harris评分、假体髋臼外展角、假体髋臼前倾角情况均优于B组,差异具有统计学意义(P0.05);3A组髋臼完好率显著高于B组(P0.05);A组髋臼磨损、增生的发生率显著低于B组(P0.05),假体松动情况两组对比无统计学差异(P0.05)。结论在老年股骨颈骨折患者身体条件允许的情况下,给予老年股骨颈骨折患者实施全髋关节置换术效果优于半髋关节置换术,可促进髋关节功能的恢复,提高患者术后生活质量,值得推广。     

后外侧入路小切口人工全髋关节置换术的疗效观察

目的评价后外侧入路小切口人工全髋关节置换术的疗效。方法选择行全髋人工关节置换术的患者48例(54髋),采用后外侧入路微创小切口,分别于术后1周,1、2、3、6个月随访1次,以后每年随访1次。结果随访平均8.5年,无翻修病例,术前Harris评分平均(27.3±5.8)分,末次随访平均(90.3±3.8)分,优良率100%,两者比较差异有显著性(P<0.05)。X线正侧位片示假体位置良好,无髋内外翻、脱位,髋臼假体外展角平均为44.6°,前倾角平均为18.2°。结论后外侧入路小切口人工全髋关节置换术的中期随访结果满意,值得临床推广。     

术前肌力训练联合术后BIODEX平衡训练在全髋关节置换术患者中的应用效果

目的 观察术前肌力训练联合术后BIODEX平衡功能训练在改善全髋关节置换术(THA)患者运动功能中的效果。方法 选取2021年1月—2022年12月就诊的110例接受THA治疗患者作为研究对象,采用简单随机化法分为观察组和对照组,每组55例。对照组术后采用常规康复训练,观察组给予肌力训练联合BIODEX平衡功能训练。术后5 d时,比较2组影像学指标[髋臼外展角、前倾角、臼杯位于安全区比率、股骨假体居中率];比较2组治疗前及治疗1个月后关节运动功能(髋关节Harris评分)、平衡能力[Berg平衡量表(BBS)]、日常活动能力[日常生活能力表(ADL)]。结果 术后5 d时,2组髋臼外展角、前倾角、臼杯位于安全区比率、股骨假体居中率比较,差异无统计学意义(P>0.05);治疗1个月后,2组髋关节Harris评分、BBS评分、ADL评分均升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论 术前肌力训练联合术后BIODEX平衡功能训练疗效显著,可有效改善THA治疗患者髋关节运动功能,提高其平衡控制能力。     

不同直径股骨头对人工髋关节置换术患者高交联聚乙烯髋臼内衬的影响比较

目的探讨人工髋关节置换术中采用不同直径股骨头对高交联聚乙烯(HXLPE)髋臼内衬的影响。方法行人工全髋关节置换术患者68例,按股骨头不同直径分为A、B两组,A组36例,普通直径(26 mm、28 mm)球头HXLPE髋臼内衬,B组32例,采用大直径(32 mm、36 mm、40 mm)球头HXLPE髋臼内衬。比较两组患者髋关节功能评分、髋臼外展角、假体获稳定的骨长入固定比率、股骨头累积穿透位移值和髋臼内寸衬线性磨损率。结果两组术后髋关节功能评分较术前明显改善(P0.05);两组术前、术后3个月、6个月、1年、2年、3年髋关节功能评分比较差异无统计学意义(P0.05)。手术后,X线片显示A组髋臼外展角与B组差异无统计学意义(t=0.554,P=0.587)。A组末次随访时34髋(94.44%)假体获稳定的骨长入固定与B组的30髋(93.75%)比较,无统计学差异(χ~2=1.773,P=0.872);稳定的纤维长入固定见剩余2髋;未见髋臼假体移位和股骨假体移位、下沉影像。两组于术后3年发现髋臼1、2、3区X线透亮带(均1 mm)影像各1例(1髋);未见股骨假体周围透亮带。两组手术后,股骨头累积穿透位移值为正,且术后3年内股骨头累积穿透位移值两组比较,无显著性差异。A组术后线性磨损率为(0.025±0.004)mm/年,B组线性磨损率为(0.024±0.003)mm/年,组间比较,差异无统计学意义(t=1.7778,P=0.1033)。结论人工髋关节置换术中股骨头直径对HXLPE髋臼内衬磨损率无明显影响,HXLPE髋臼内衬是人工关节面理想的手术材料。     

全髋关节置换术中髋臼横韧带对髋臼假体前倾定位的作用

目的 分析全髋关节置换术中将髋臼横韧带作为髋臼假体前倾定位解剖参照标志的可靠性及临床疗效.方法 98例(98髋)初次行人工全髋关节置换术患者,手术中将髋臼横韧带作为解剖参照标志定位髋臼假体前倾角度,术后对其髋臼假体前倾角度进行测量,并与正常前倾角度进行比较.结果 本组术后切口均Ⅰ期愈合;随访12～18个月,均未发生髋关节脱位;术后髋臼假体前倾角度为(15.16士4.00).,与正常前倾角度比较差异无统计学意义(P＞0.05).结论 髋臼横韧带在全髋关节置换术中可作为确定髋臼假体前倾定位角度的理想参照标志.     

前外侧肌间隙入路微创全髋关节置换术治疗35例股骨颈骨折的临床疗效观察

选取2008年5月~2013年5月我院收治的70例股骨颈骨折患者。所有患者均行全髋关节置换术。随机分为微创手术组和传统手术组各35例。比较两组手术时间、出血量、切口长度、术后住院时间、术前及术后Harris评分、术前及术后VAS评分、术后复查X线测量髋臼外展角、髋臼前倾角。结果微创手术组在切口长度、围手术期出血量出血量、术后住院时间、术后3dVAS评分、术后1wHarris评分优于传统手术组(P0.05),而手术时间、末次随访Harris评分、VAS评分、髋臼外展角、髋臼前倾角两组之间比较,无统计学差异(P0.05)。前外侧肌间隙入路微创全髋关节置换术手术创伤小,切口小,出血少,术后功能恢复快,是一种安全有效的手术方式。     

个性化导航模板在髋关节置换术中的应用

目的 依据髋臼的解剖形态制作个性化的导航模板,观察其在全髋关节置换术中应用的效果。 方法选择2014年3~11月期间,在福建医科大学附属泉州第一医院行全髋关节置换术的15位病人,根据围手术期间是否使用数字化导航模板分为实验组(n=8)和对照组(n=7)。评价两组病人手术时间、术中出血量、术后影像学指标。所有患者,术后均随访3个月以上。 结果与对照组相比较,实验组平均手术时间缩短,术中出血量少,但没有统计学上差别;实验组髋臼假体的前倾角及外展角与髋臼前倾角及外展角吻合性较好,两种方法在髋臼假体型号选择方面差别无统计学意义。 结论数字化导航模板的应用可提高全髋关节置换手术效率,减少手术风险,提高假体放置的准确性。      

多层螺旋CT三维重建测量髋臼外展角及前倾角的实验研究

目的探讨应用多层螺旋CT(multi-slice spiral CT,MSCT)三维重建精确测量髋臼外展角及前倾角的新方法。方法选用30具成人完整骨盆标本共60个髋臼为研究对象,应用放射学方法及实际测量法分别对其外展角、前倾角进行测量,放射学方法采用数字化X线摄影(digital X-ray radiography,DR)及MSCT三维重建两种方法,实际测量采用量角器及数显角度仪两种方法。结果 MSCT重建法测得的髋臼外展角为48.61°±2.31°,前倾角为15.82°±4.62°,与实际测量结果比较,差异均无统计学意义(P>0.05);放射学方法与实际测得的髋臼外展角、前倾角分别比较,差异均无统计学意义(P>0.05)。结论 MSCT三维重建测量髋臼外展角及前倾角的结果准确,是一种可利用的全髋关节置换术前髋臼位相参数测量新方法。     

髋横韧带定位方法在髋臼假体安装中的临床使用效果分析

<正>人工全髋关节置换术(total hip arthroplasty,THA)是治疗类风湿性髋关节炎、股骨头无菌性坏死和股骨颈骨折等髋部疾病的治疗方法,具有较好的手术效果^[1]。在THA中髋臼假体的正确安装是手术成功及降低术后并发症的关键^[2,3]。因此,在临床上髋臼假体安装时其外展角与前倾角十分重要。本次研究选取80例接受THA治疗的患者,分别采用常规目测定位法和髋横韧带定位方法,对比观察两种方法手术时间、术后1个月髋关节Harris评分以及髋臼外展角和前倾角与标准值之间的差异,现报道如下。     

髋关节置换术影像学的预测与评估

[目的]探讨采用计算机辅助设计 (CAD )技术对髋关节置换术患者影像学预测定位及术后疗效的评价.[方法]选择髋关节置换患者230例(249髋),拍摄骨盆正位片和(或)髋关节CT片,应用AutoCAD软件测量外展角和前倾角,分析其与手术操作和疗效的关系.[结果]骨性髋臼的外展角为(51.8±7.3)°;前倾角(15.2±3.1)°,髋臼杯的外展角为(49.7±8.7)°,前倾角为(11.23±4.25)°,股骨头和髋臼杯的放大率是1.123;骨性髋臼直径(5.19±0.57)cm与髋臼锉直径(5.13±0.25)cm 比较无显著性差异( P >0.05);随访时间(24.3±3.9)个月,Harris评分(83.3±7.8)分,外展角(35～55)°的168例患者Harris评分(87.5±8.6)分与外展角大于60° 21例患者的Harris评分(75.9±6.8)分比较有显著性差异( P <0.05).[结论]预测臼杯的大小对指导手术操作方面具有可操作性、可重复性、准确度可信;髋臼杯与骨性髋臼完全吻合的病例获得了非常好的疗效.     

Loxin polymorphism is associated with increased resistin levels and with oxidative status

Objectives

We hypothesized that LOX-1 polymorphism may impact on inflammation and cardiovascular risk by modulating systemic resistin expression.

Design and methods

276 men were randomly selected from a population-based cohort. Metabolic and inflammatory markers were evaluated at baseline and after 6-years follow-up, OLR1 (loxin) IVS4-14 A>G polymorphism was assessed.

Results

Mean plasma resistin and nitrotyrosine values were significantly higher, and TAS was significantly lowered in homozygous for the G allele. The G allele was significantly and directly associated with resistin and nitrotyrosine values.

Conclusion

Enhanced oxidized-LDL uptake by LOX-1 G-allele carriers is associated with increased pro-oxidant status and resistin levels, suggesting a major uptake of ox-LDL by macrophages, smooth muscle cells, and monocytes.     

Extracorporeal Membrane Oxygenation with rituximab‐combined chemotherapy in AIDS‐associated primary cardiac lymphoma: A case report

Although effective combination of antiretroviral medications is being developed, the incidence of non‐Hodgkin lymphoma (NHL) with human immunodeficiency/acquired immunodeficiency syndrome (HIV/AIDS) still remains significantly higher than that in individuals without infection. Primary cardiac lymphoma (PCL) is an NHL that involves the heart and/or the pericardium. PCL is very rare and often causes serious complications, which can be a diagnostic challenge. To our knowledge, no study has reported the measurement of rituximab concentration under venoarterial extracorporeal membrane oxygenation (VA‐ECMO). Herein, we report the case of a 54‐year‐old male patient with AIDS‐associated primary cardiac NHL who developed right ventricular outflow tract obstruction. The patient experienced fatigue and dyspnea on exertion. Contrast‐enhanced computed tomography showed a bulky tumor mass in his right atrium and ventricle, and an echocardiogram revealed severe hypokinesis of his heart and poor cardiac output. A biopsy was performed, and immunohistochemistry revealed diffuse large B‐cell lymphoma. Therefore, he was treated with rituximab‐combined chemotherapy under VA‐ECMO. Blood levels of rituximab were measured during chemotherapy with VA‐ECMO. Thereafter, he was temporarily discharged from the hospital. This clinical case suggests that VA‐ECMO and rituximab‐combined chemotherapy are useful in rescuing patients with severe cardiopulmonary failure due to AIDS‐associated PCL.     

Measurement of cystatin C in human urine by particle-enhanced turbidimetric immunoassay on an automated biochemistry analyzer

Background

Cystatin C (CysC), is produced by all the nucleated cells of the human body, is freely filtered by the kidney glomerulus and reabsorbed by the tubules. It is widely accepted that no tubular secretion of CysC occurs. Raised urinary levels are believed to indicate tubular damage.

Methods

We report here the validation of a quantitative assay to measure urinary cystatin C (uCysC) using a commercial CysC kit based on a latex particle-enhanced turbidimetric immunoassay (PETIA), on an automated biochemistry analyzer. The clinical relevance of this assay was tested on several kidney disease patients and a reference range was determined using healthy controls.

Results

The assay is precise (total CV < 4%), and sensitive (limit of quantification = 0.06 mg/dL, and limit of detection = 0.02 mg/L). Calibration is stable for at least 30 days. The assay showed very good linearity over the studied interval (0.02 to 2.25 mg/L). Recovery ranged from 101.62 to 106.49%. The analyte is stable, at 4 °C for at least 2 days, and at 20 °C for 48 h. The upper reference value was 0.12 mg/L Median uCysC concentration in 30 acute kidney injury patients (1.47 mg/L, interquartile range = 0.27–3.87 mg/L) and was significantly higher than that in 25 patients with normal kidney function (0.05, 0.03–0.12; p < 0.0001), 30 patients with chronic kidney disease (0.13, 0.05–0.77; p < 0.0001) and 15 patients with pre-renal azotemia (0.15, 0.08–0.31; p < 0.0001).

Conclusion

Our data indicate that uCysC can be processed on automated biochemistry analyzers and its measurement could easily be added to a standard panel to screen kidney diseases.     

The effects of glutamate receptor agonists and antagonists on mouse hypothalamic and hippocampal neuronal activity shown through manganese enhanced MRI

Manganese enhanced MRI (MEMRI) is an imaging paradigm that can be used to assess neuronal activity in vivo. Here we investigate, through the use of MEMRI, the influence of receptor dynamics on neuronal activity in the hypothalamus and hippocampus focusing on the glutamate receptor signalling system. We demonstrate that intraperitoneal (i.p.) administration of monosodium glutamate (MSG) and the ionotropic glutamate receptor (iGluR) agonists NMDA and AMPA resulted in significantly increased signal intensity (SI) in the arcuate nucleus (ARC), the suprachiasmatic nucleus (SCN) and the CA3 region of the hippocampus of mice consistent with increased neuronal activity. Administration of the NMDA receptor antagonist MK-801 resulted in significantly decreased SI in the paraventricular nucleus (PVN) consistent with decreased neuronal activity. Co-administration of MSG and the AMPA receptor antagonist NBQX attenuated the increase in SI observed in the ARC from MSG alone, suggesting MEMRI may be applicable to the study of receptor dynamics in vivo. We also observed that administration of the various iGluR agonists and antagonists modulated SI in the lateral ventricle and that high dose MSG (300 mg) caused a hitherto unseen enhancement in SI in the entire cortical/subarachnoid region. In conclusion, MEMRI reveals changes in neuronal activity in response to iGluR agonists and antagonists in the CNS in vivo as well as revealing multifaceted effects beyond those attributable to neuronal activity alone.     

Association between serum lactate dehydrogenase and 60‐day mortality in Chinese Hakka patients with acute myeloid leukemia: A cohort study

BackgroundThere is evidence that a high level of serum lactate dehydrogenase (LDH) is associated with poorer overall survival in acute myeloid leukemia (AML), but its link to 60‐day mortality of AML remains unclear.MethodsAll patients newly diagnosed with AML were included in this cohort study. LDH was measured for the first time after admission. Multivariable logistic regression was used to explore the association between serum LDH and 60‐day mortality. Interaction and stratified analyses were conducted including age, sex, albumin, glucose, myoglobin, and standard chemotherapy.ResultsThree hundred and seventy‐one patients ≥15 years of age, who were newly diagnosed with AML, were consecutively selected. The total prevalence of 60‐day mortality was 27.2% (101/371), while it was 32.1% (42/131) and higher than in the LDH ≥570U/L compared with the LDH<570U/L, with the prevalence of 24.6% (59/240); however, the difference was not statistically significant. In multivariate regression models, odd ratios and corresponding 95% confidence intervals (CIs) for Log₂ and twice limit of normal (ULN) of LDH were 1.46 (1.0, 2.14) and 2.76 (1.24, 6.16), respectively. Interaction analysis revealed no interactive role in the association between LDH concentration and 60‐day mortality.ConclusionsSerum LDH level was associated with 60‐day mortality, especially for the patients with LDH ≥570U/L.     

Patterns of intestinal activity with Meckel's scintigraphy

Three patterns of intestinal activity were noted in a review of 64 patients studied with Tc-99m sodium pertechnetate for suspected Meckel's diverticulum: no bowel activity seen (37.5%), bowel activity visualized after stomach activity (39.1%), and diffuse bowel activity seen simultaneously with stomach activity (23.4%). The latter pattern, which is relatively common, could mask a true Meckel's diverticulum and lead to either a false-negative or indeterminate diagnosis. A series of 10 dogs was also studied to evaluate the effects of fasting and feeding on the intestinal pattern. No definite relationship was observed.     

小儿脑性瘫痪患者腰骶段选择性后根神经切断术的麻醉处理

Selectiveposteriorrhizotomy（SPR）atlumbarandsacralregions（L＆S）isoneofsurgicalmethodsthatcaneffectivelyreleasethespasmoflowerextremitiesincerebralpalsy（CP）patients犤１犦，whichpossessescertainfeaturesthatarejuvenilepatientsdominateinpop－ulation；operationsshouldbeperformedwithpatientsinpronepositionandnerverootelectricstimulus（NRES）isrequiredasaconvention－ality，etc犤２犦．１４４CPpatientsbelow１０yearshavebeensuccessfullyperformedSPRatL＆Sundercombinedintravenousandinhalationan…     

Case report: Inflammatory myofibroblastic tumor of pancreatic origin in a patient with down syndrome: The role of diagnostic ultrasound

Introduction

Inflammatory myofibroblastic tumor (IMT) is a benign solid tumor of uncertain etiology.

Materials and methods

We report a case of a 4-year-old Down syndrome affected child, who had a pancreatic mass identified by ultrasonography (US) and confirmed by computed tomography (CT).

Results

Monitoring of IMT was performed by serial US studies, and at follow-up after 4 years there was no relapse.

Discussion

As radical removal of the lesion was not possible, the patient was successfully treated with nonsteroidal anti-inflammatory drugs (NSAIDs). It was decided to monitor the lesion by serial US in order to reduce the number of CT examinations and thereby avoid excessive exposure to ionizing radiation. It is widely reported in the literature that repeated CT scans are associated with increased exposure to radiation which may cause cancer, a fact which should not be overlooked in children.     

人骨髓间充质干细胞的分离培养和向神经细胞分化的研究

目的　分离骨髓后培养人骨髓间充质干细胞 (hMSCs) ,进行体外传代扩增 ,并探索体外诱导分化为神经元样细胞的方法。方法　抽取人骨髓血 ,percoll paque液 (1 0 73g/ml)分离 ,DMEM/2 0 %FCS培养传代 ,至第 3～ 5代时加入巯基乙醇 (BME) ,观察hMSCs分化为神经元样细胞的形态学变化。结果　hMSCs在体外可以实现数目扩增 ,在特定诱导剂的作用下向神经元样细胞分化。结论　采用少量骨髓样本 ,经培养获得充足的细胞量 ,满足定向诱导和细胞移植的需要。