不同种类骨移植在青少年特发性脊柱侧凸后路矫形术中的中长期疗效评价

背景:脊柱侧凸矫正术中植骨融合技术是决定矫形治疗结果的关键因素之一。因自体骨应用受限,同种异体骨移植已广泛应用于临床。但同种异体皮质骨颗粒与同种异体松质骨颗粒在脊柱矫形患者中应用的实际效果是否一致?目的:比较不同种类骨移植在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用效果。方法:2004年1月至2007年1月107例青少年特发性脊柱侧凸患者接受经后路脊柱侧凸矫形植骨融合手术。根据植骨材料不同分为A组(同种异体松质骨植骨,57例)和B组(同种异体皮质骨植骨,50例),比较两组患者随访第6、9、12、18、24、36个月的植骨融合情况、术后Cobb角变化情况及并发症等。结果:两组患者年龄、性别、主弯Cobb角、融合节段数及植骨量均无明显差异。平均随访时间为39.8个月。所有病例畸形明显矫正,术后1周总体矫正率为74.2%,最终随访总体矫正率72.1%。术后1周Cobb角及畸形矫形率,最终随访Cobb角、畸形矫形率及矫形度数丢失方面,两组相比均无明显统计学差异(P>0.05)。所有病例最终达到植骨骨性融合,A组平均融合时间15.0个月(6～36个月),B组平均融合时间15.9个月(6～36个月)。术后第6、9、12、18、24、36个月,两组骨性融合率均无明显统计学差异(P>0.05)。两组均未发生螺钉松动、断裂、断棒、假关节等并发症。术后A组4例(7.0%)、B组3例(6.0%)患者出现脑脊液漏,A组1例(1.8%)患者出现切口局部愈合障碍,均得到合理处理。结论:同种异体松质骨或皮质骨骨移植是脊柱侧凸后路矫形植骨融合术中较为理想的植骨方法之一,尤其是后者更是具有来源广泛、骨量大的优点。但在使用时,需根据同种异体骨骨愈合机制来制定术后治疗和康复计划,确保发挥复合骨移植在脊柱矫形术中的优势。     

前路病灶清除植骨融合内固定治疗胸腰椎结核

目的探讨前路植骨融合内固定治疗胸腰椎结核的临床效果。方法回顾总结2001年1月-2004年2月行前路结核病灶清除,植骨融合加前路Z-Plate钢板固定治疗胸腰椎结核13例,包括切口愈合率、植骨融合率、截瘫恢复情况和后凸畸形矫正状况。随访时间8个月至3年,平均26个月。结果无1例出现切口感染和窦道形成,切口均一期愈合。11例合并截瘫的患者,神经症状均有明显改善。术后8个月至1年所有植骨均显示骨性融合,未见植骨块脱落、吸收及死骨形成。术前后凸Cobb角<30°者,均基本矫正至正常,30°～60°者,矫正至10°～20°,>60°者,矫正至20°～30°,近期随访后凸角与术后相比较丢失2°～4.3°,平均丢失2.4°。结论前路病灶清除植骨融合加内固定治疗胸腰椎结核能使脊柱获得即刻稳定,促进骨融合和截瘫恢复,矫正后凸畸形。     

同种异体骨移植联合内固定治疗脊柱结核

目的探讨病灶彻底清除后同种异体髂骨块移植联合内固定治疗脊柱结核的可行性和安全性。方法对36例彻底清除脊柱结核病灶后,植入带三面皮质骨的异体髂骨块重建前柱,根据情况选择前方或侧前方内固定,术后支具保护6个月,正规抗结核化疗12个月。根据术前、术后及最后一次随访的X线平片分析融合情况和畸形矫正的进展。结果随访5～72个月,平均16个月,结核病灶均无复发,内固定牢靠无松动。19例患者椎间植骨均获I级骨性愈合,愈合时间9～12个月,5例患者获II级骨性愈合,其余患者待进一步随访观察;术前、术后及最后一次随访Cobb角分别为36.8°,17.2°,20.6°。结论尽管异体髂骨块移植达到骨性愈合的时间比用自体骨相对较长,但当与前路内固定器械结合应用时,可有效治疗及控制结核病变复发,维持畸形的矫正,使脊柱拥有良好的稳定性,经初步临床观察疗效满意。     

后路截骨矫形固定融合治疗强直性脊柱炎假关节并脊柱后凸畸形

目的:探讨后路截骨矫形固定融合术治疗强直性脊柱炎(ankylosingspondylitis,AS)假关节并后凸畸形的可行性。方法:30例AS患者,年龄29￣55岁,平均41.7岁,行后路张开式楔形截骨矫正后凸畸形及内固定,平均随访4.7年(2.2￣9.1年),根据影像学资料、临床结果与并发症情况评估治疗效果。结果:3例术前有神经压迫症状患者术后均得到改善。脊柱后凸Cobb角从平均45.5°(37°￣68°)矫正到7.5°(0°￣4°),平均矫正38°。随访时假关节处均已融合,矫正无明显丢失,亦无严重并发症发生。结论:后路张开式楔形截骨矫形内固定融合是治疗AS并假关节和脊柱后凸畸形的有效方法,不需施行前路骨融合手术即可达到假关节处的骨融合。     

同种异体骨融合技术在脊柱侧凸手术治疗中的应用

目的　观察同种异体骨在治疗脊柱侧凸时的有效性和安全性。方法　对 5 4例脊柱侧凸患者采用同种异体骨植骨融合 ,随访 4 1例 ,平均随访 16个月。观察同种异体骨的临床反应及脊柱融合情况。结果　术后存在一定的排斥反应 ,但没有明显的临床意义 ;1例出现急性深层感染 ,无晚期感染者。均未因同种异体骨移植发生疾病感染。X线观察发现术后 4个月 ,开始出现新骨 ,最后随访时 ,矫正角度平均丢失 3 4°,最小者为 - 1°,最大者为 6°。内置物无脱位、折断。结论　在治疗脊柱侧凸植骨融合时 ,采用同种异体骨移植是安全、有效的。     

手术治疗胸腰椎结核合并后凸畸形

目的:探讨单切口双入路椎弓根系统内固定、后外侧植骨同期病灶清除、椎间植骨治疗胸腰椎结核合并后凸畸形的疗效。方法:对78例胸腰椎结核合并后凸畸形患者采用单切口双入路行后外侧植骨椎弓根系统内固定,同期病灶清除、椎间植骨治疗,观察患者症状及截瘫改善情况,后凸畸形矫正情况及植骨融合情况。结果:所有患者症状均明显改善,48例合并截瘫的患者中,25例完全恢复正常,7例ASIA分级改善1￣3级;植骨均在术后6个月￣1年融合,治愈率52.08%,好转率14.58%。后凸Cobb角平均矫正28.7°,随访1.4￣6.5年,平均2.6年,后凸角平均丢失2.9°。结论:单切口双入路后外侧椎弓根系统内固定同期病灶清除、椎间植骨可恢复脊柱的即刻稳定性,有利于植骨融合,后凸畸形矫正满意。     

一期前路病灶清除植骨内固定治疗胸腰椎结核

目的:总结一期前路病灶清除、自体骨椎间植骨融合、前路或后路内固定治疗胸腰椎结核的临床效果。方法:2002年2月～2006年2月手术治疗胸、腰椎结核86例,均采用一期前路病灶清除、自体骨椎间植骨,侧前方内固定52例,后路内固定34例。根据术前、术后X线平片分析植骨融合及脊柱后凸畸形矫正效果。结果:随访8个月～4年,平均23个月。除1例术后2周出现切口皮下血肿、4例1年后仍存在髂骨供骨区疼痛外,无其他并发症;无复发。均获骨性愈合,愈合时间3～7个月,平均4.5个月,无内固定松动、脱出及断裂;术前Cobb角平均为33.6°,术后1周及末次随访时Cobb角分别为平均15.6°、18.6°。结论:对胸、腰椎结核患者行一期前路病灶清除、自体骨椎间植骨融合、前路或后路内固定治疗可有效矫正脊柱后凸畸形,重建脊柱稳定性,获得良好的骨性融合,临床效果良好。     

全脊椎多平面截骨矫正脊柱后凸畸形

目的总结全脊椎多平面截骨矫正脊柱后凸畸形结果。方法自1985年以来,采用全脊椎一次性截骨术矫正脊柱后凸畸形780例,其中男642例,女138例,发病时间平均11.6年,年龄15￣52岁。强直性脊柱炎后凸畸形620例;脊柱压缩骨折46例;脊柱结核12例;先天性脊柱后凸畸形59例;休门氏病43例。结果术前后凸角度50￣120,°平均68,°手术矫正30￣100,°平均58.5,°平均矫正率82%,截骨部位最多三个平面,全脊柱截骨部分最高达胸10。结论该手术优于传统手术方法。     

椎弓根系统内固定前路植骨融合治疗脊柱结核合并后凸畸形

目的 :总结应用椎弓根系统内固定加前路植骨融合术治疗脊柱结核合并后凸畸形的临床效果。方法 :回顾分析 1997年 3月～ 2 0 0 0年 10月行椎弓根系统内固定加前路植骨融合术治疗的脊柱结核合并后凸畸形患者 44例 ,对于胸椎或胸腰椎结核 ,采用单切口双入路 ,以使病灶和内固定器隔开。观察内容包括植骨融合率、后凸畸形矫正状况及截瘫恢复情况。随访时间 1.5～ 4.5年 ,平均 3 .0年。结果 :术后 1年患者均显示骨性融合 ;术后后凸畸形平均矫正 2 6 .7°。1.5～ 4.5年后随访 ,后凸角度平均丢失 3 .0° ;2 8例合并截瘫患者中 ,症状改善 2 5例 ,改善率 89.3 %。结论 :后路椎弓根系统内固定加前路植骨融合能矫正后凸畸形 ,阻止后凸畸形进一步发展 ,加强脊柱的稳定性 ,促进截瘫恢复。     

一期前路植骨融合内固定治疗相邻多椎体结核

目的探讨一期前路病灶清除钛网植骨内固定治疗相邻多椎体结核的临床疗效。方法2002年4月至2004年5月对24例胸腰椎相邻多椎体结核患者行一期前路病灶清除钛网植骨内固定治疗。男15例,女9例;年龄23￣62岁,平均42岁。病变节段最高T4,最低L3;胸椎12例,胸腰椎3例,腰椎9例;病变破坏2个椎体5例,3个椎体11例,4个椎体8例,造成椎体间缺损6￣9cm。所有患者均有不同程度的后凸畸形,融合节段后凸角27.5°±3.5°;6例伴不完全截瘫。术前强化抗痨2￣4周,术中彻底清除病灶、钛网填充自体肋骨植骨及椎体侧前方内固定,术后规则抗痨治疗1年。结果全部病例随访1.5￣2.5年,平均1.9年。切口均一期愈合,术后1￣6个月血沉逐渐恢复正常。术后融合节段后凸角5°±2.5°,8周时钛网两端下沉总和为(3.5±0.5)mm,终末随访时畸形矫正角度丢失4.1°±1.0°。钛网植骨于术后3个月开始融合,随访期间未发生松动、移位。6例不完全截瘫患者术后6个月神经功能完全恢复正常。无术中、术后并发症。结论一期前路病灶清除钛网植骨内固定治疗相邻多椎体结核可彻底清除病灶、矫正后凸畸形、重建脊柱的稳定性。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.