骨水泥型加长柄关节置换治疗高龄不稳定型股骨转子间骨折

目的 评价采用骨水泥型加长柄关节置换治疗高龄不稳定型股骨转子间骨折的临床疗效.方法 回顾性分析2008年6月至2012年6月于赤峰市医院采用骨水泥型加长柄关节置换术治疗53例高龄不稳定型股骨转子间骨折患者的资料,男18例,女35例,年龄75～93岁,平均年龄为80.2岁.股骨转子间骨折按Evans-Jensen分型：ⅡB型36例,Ⅲ型17例.骨质疏松按Singh指数分级：Ⅲ级32例,Ⅱ级21例.损伤至手术时间2～11d,平均3.8d.全部患者均采用骨水泥型加长柄股骨假体.根据Harris评分评价髋关节功能.结果 47例患者获得随访,其中5例患者在此期间死于内科系统疾病,实际随访人数42例.随访时间12 ～ 60个月,平均33个月.其中2例发生下肢深静脉血栓,经过血管外科抗凝、溶栓治疗后痊愈;5例患者于术后发生呼吸系统感染,经抗感染、化痰、机械通气等治疗后痊愈;2例患者大转子向近端移位出现跛行步态;2例患者于术后再次受外伤致假体周围骨折,给予更换生物型加长柄假体,捆扎带固定后骨折愈合;4例患者小粗隆部骨折不愈合,但并不影响行走功能;其余27例患者均未发生并发症.无一例患者发生假体脱位、感染及下沉松动迹象.Harris评分从术前平均（30.21 ±5.23）分,提高到末次随访时平均（86.21 ±6.12）分;其中优14例,良21例,可5例,差2例,优良率83.3％ （35/42）.结论 采用骨水泥型加长柄关节置换术治疗高龄不稳定型股骨转子间骨折近期效果令人满意,是一种可靠的选择.     

冲击波对成肌细胞增殖分化的影响

目的:探讨体外冲击波对成肌细胞增殖分化的影响,为进一步开展冲击波在体内骨骼肌损伤中的作用研究奠定基础,为临床应用冲击波治疗提供理论依据。方法:将原代分离培养好的成肌细胞,利用冲击波进行刺激,将实验对象分为空白组、实验组(冲击波刺激)、阳性对照组(成肌诱导剂)。形态学检测肌管形成情况;MTT法检测成肌细胞增殖;流式细胞仪检测成肌细胞凋亡;Western Blot检测肌调节标志物Pax7、MyoD、Myf5、Myf6和Myogenin蛋白;免疫荧光检测Desmin、Pax7、MyoD的表达。结果:(1)结果显示成肌细胞的活力对冲击波刺激呈现剂量依赖性,能流密度高于0.16 mJ/mm~2时细胞的存活率降低,凋亡率高于空白组(P0.05),能流密度为0.08 mJ/mm~2时,冲击次数为500时细胞最高活力。(2)免疫荧光结果显示冲击波可促进MyoD蛋白表达升高,降低Pax7的表达。(3)Western Blot结果显示冲击波可促进MyoD、Myf5、Myogenin、Myf6蛋白表达水平显著增高(P0.05),Pax7蛋白表达随着时间的延长呈递减趋势(P0.05)。MyoD蛋白在实验组和对照组随着时间延长蛋白表达水平都逐渐升高,且实验组的表达水平均高于对照组(P0.05)。(4)细胞形态学观察肌管融合结果显示,成肌细胞在冲击波刺激下呈现多核,实验组、对照组与空白组相比差异具有显著性意义(P0.05)。结论:本实验证实了体外冲击波对成肌细胞的生物学功能有影响,可提高成肌细胞的活力,促进其向肌分化。     

股骨近端防旋髓内钉-Ⅱ治疗31-A3型股骨转子间骨折扩髓与否的有限元分析

背景：针对股骨转子间骨折是否需要扩髓的问题尚有争议，一些人认为不扩髓缩短手术时间、减少出血、降低高龄患者术中风险，但此举是否会降低髓内钉支撑效果，尚无依据。另一些人认为扩髓可选择直径更粗的髓内钉，获得更好的力学支撑，但基础研究显示此方法存在脂肪栓塞、破坏骨质(尤其高龄骨质疏松患者)等风险。目的：通过有限元分析股骨近端防旋髓内钉-Ⅱ治疗31-A3型股骨转子间骨折时扩髓与不扩髓的力学分布特点。方法：纳入一名健康志愿者，CT扫描其股骨获取DICOM格式文件，顺序导入Mimics、Geomagic Wrap、SolidWorks、Hypermesh、Ansys软件处理文件，得到A3.1型、A3.2型及A3.3型股骨转子间骨折模型，分别与9,11 mm直径、170 mm长度的股骨近端防旋髓内钉-Ⅱ进行装配，赋予材料属性，设定各接触面相互作用关系及定义载荷及边界条件，之后进行求解。观察不同模型中股骨应力分布、内固定应力分布、股骨位移及内固定位移情况。结果与结论：(1)各型骨折采用扩髓髓内钉固定时股骨应力均小于非扩髓髓内钉固定，A3.3型骨折股骨最大应力值大于A3.1型和A3.2型；(2)各型骨折采...     

糖尿病的急性并发症处理

文章介绍糖尿病急性并发症的处理。     

干细胞移植改善股骨头坏死缺血状态的实验及临床效应：20只模型兔及188例患者资料分析

BACKGROUND: Ischemic femoral head necrosis is caused by local vascular injury and blood-supply insufficiency. There exists no optimal treatment for the ischemic femoral head necrosis. Thus, the improvement of the blood supply to the femoral head seems to be a key point for the treatment. OBJECTIVE: To verify the curative effects of autologous bone marrow mesenchymal stem cell transplantation induced vascular regeneration on the improvement of ischemic femoral head necrosis via animal experiments and clinical observations. DESIGN: Contrast animal experiment and self-controlled clinical observation. SETTING: Cell Therapy Center, the 463 Hospital of Chinese PLA. MATERIALS AND PARTICIPANTS: ① Animals: Twenty Japanese white rabbits in either gender and weighing 3.0-4.0 kg were purchased from Animal Experimental Center, General Hospital of Shenyang Military Area Command of Chinese PLA. The animal experiments were coincident with the ethical standards. ② Participants: 188 patients with ischemic femoral head necrosis (335 hips) having whole following-up data were selected from Cell Therapy Center, the 463 Hospital of Chinese PLA from July 2004 to July 2007. There were 113 males and 75 females, and their ages ranged from 18 to 72 years. Diagnosis was done by using X-ray photographs, nuclide scanning, MRI and CT examinations. All patients provided the informed consent, and the study was approved by the local research ethics committee. METHODS: ① Animal experiments: The experiment was carried out at the Animal Experiment Center, General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2004. Ischemic femoral head necrosis models were established at both hindlimbs by using liquid-nitrogen refrigeration. The right side was regarded as transplantation group and the left one as control group. Mononuclear cells extracted from bone marrow were poured in the right femoral artery, while saline was poured in the left femoral artery. ②Clinical observations: Mononuclear cells were separated from autologous bone marrow of patients with ischemic femoral head necrosis after density gradient centrifugation. MAIN OUTCOME MEASURES: ①Four weeks later, angiogenesis at both femoral arteries was observed by arteriography by using digital subtraction anglography (DSA). Moreover, bilateral femoral head samples underwent pathological sections to observe bone regeneration and repair of femoral head 4 and 12 weeks later. ②Items including hip pain, walking distance and gait, abduction and internal rotation function changes of hip joint were observed in 3, 6, 12 and 24 months after stem cell transplantation in media femoral circum flex artery, lateral femoral circum flex artery and obturator artery. In 6 months after stem cell transplantation, angiogenesis and blood supply of femoral head were observed by using arteriography. In 6, 12 and 24 months after stem cell transplantation, morphological and ischemic changes of femoral head were observed by using CT, X-ray and MRI examinations. Harris scores were used to evaluate function of hip joint before and in 3, 6, 12 and 24 months after stem cell transplantation. RESULTS: Animal experiment: Twenty rabbits were involved in the final analysis. ① DSA-arteriography results: In 4 weeks after transplantation, blood-supply arteries in femoral head of right hindlimb in the transplantation group were more than those in the control group. ② Pathological results: In 12 weeks after transplantation, cartilage, lamellar bone and bone trabecula in the left femoral head were repaired remarkably, but left femoral head necrosis was not improved. Clinical observations: 188 patients were involved in the final analysis. ① Improvement of symptoms: Among 188 patients, 164 (87.3%) had remission of hip pain, 147 (78.4%) had function improvement, and 150 (80.0%) had elongation of walking distance. ② Imaging changes: At 6 months after transplantation, DSA-arteriography in 12 patients demonstrated that blood-supply arteries in femoral head were increased and thickened remarkably as compared with those before transplantation, and the blood flow was rapid. At 12-24 months after transplantation, lesion of bone matrix in 24 patients was improved under the X-ray, CT and MRI examinations. ③ Harris scores of hip joint: The scores at 6, 12 and 24 months after transplantation were significantly higher than those before transplantation (t= -3.423, -6.714, -9.039, P < 0.01). CONCLUSION: Autologous bone marrow mesenchymal stem cell transplantation can effectively improve and treat ischemic femoral head necrosis.     

食品微生物学教学新模式探讨

根据食品微生物学的课程特点，阐述了在教学过程中所采用的“课堂小竞赛”的方法、规则和所需注意的问题。这种教学方法和模式旨在加深学生对所学知识的理解和掌握，拓展学生的知识面，培养学生的创新精神和创新能力。     

肩难产的防范与处理

产妇在正常分娩与助产中会遇到肩难产,对母儿都会产生不良影响。肩难产是指胎头娩出后,双肩娩出困难者,多因胎儿巨大、肩周径显著增大所致胎儿肩嵌顿在产妇耻骨联合上方,使肩不能在耻骨支下方旋转,用常规手法不能娩出双肩而造成的。肩难产是不常遇到的产科急症,发病率为0.2％～0.6％。由于胎头娩出后,情况紧急,易措手不及,处理不当,可引起母儿严重并发症。肩难产产妇可伴有     

全身麻醉和腰硬联合麻醉对老年下肢骨折手术患者认知功能的影响

目的比较全身麻醉和腰硬联合麻醉对老年下肢骨折手术患者认知功能的影响。方法按照麻醉方式不同将80例老年下肢骨折手术患者分为腰硬联合麻醉组(腰硬组,44例)和全身麻醉组(全麻组,36例)。使用简易智力状态检查量表(MMSE)比较术后不同时段两种麻醉对认知功能的影响。结果腰硬组患者术后认知功能障碍发生率显著低于全麻组,差异有统计学意义(P0.05);腰硬组患者术后即刻和术后3 d MMSE评分均显著高于全麻组,差异有统计学意义(P0.05)。结论与全身麻醉比较,腰硬联合麻醉对老年下肢骨折患者认知功能影响更小,认知功能障碍发生率更低,可能为更好的麻醉方式。     

自体骨髓单个核细胞经介入途径移植治疗股骨头坏死54例：12个月疗效随访

目的:观察经介入途径移植自体骨髓单个核细胞在股骨头坏死治疗中的应用,并评价其疗效。方法:选择2004-07/2005-11在解放军四六三院细胞治疗中心住院的,具有完整随访资料的股骨头坏死确诊患者共54例91髋。纳入确诊股骨头坏死,有关节疼痛、功能障碍等症状患者,性别、年龄不限;排除有严重心力衰竭、严重肾功能异常等不能耐受手术者。符合纳入标准54例,男45例,女9例,12～68岁。按ARCO分期Ⅱ期42髋,Ⅲ期47髋,Ⅳ期2髋。实验对象对治疗的相关内容知情同意并签知情同意。干预措施:抽取患者髂后上嵴骨髓进行单个核细胞悬液的制备。在DSA监视下将采集的单个核细胞混悬液经股动脉行Seldinger法穿刺,穿刺成功后,置入4F动脉鞘,经动脉鞘置入Cobra导管,将导管超选择至闭孔动脉及旋股内外侧动脉,平均注入单个核细胞悬液。术后定期随访症状变化情况,1年后复查X射线或CT,随访疼痛、关节活动度等情况。实验评估:①疼痛指数:无疼痛症状为3分,Harris髋关节评分疼痛分级A级;时有隐痛2分,Harris髋关节评分疼痛B级;轻度疼痛为1分,Harris髋关节评分疼痛C级;中度疼痛为0分,Harris髋关节评分疼痛D级。②功能指数:髋关节屈、伸、展、收、旋转度评分达Harris髋关节活动范围评分4～5分为3分;3～4分为2分;2～3分为1分;小于2分为0分。③X射线平片指数:股骨头形态无变化,应力骨小梁清晰,坏死区明显缩小为3分;坏死区略缩小为2分;治疗前后无明显变化为1分;坏死区扩大为0分。④血管指数:治疗后旋股内、外侧动脉及其分支增粗、增多,延长1cm以上者3分;1～0.5cm者2分;小于0.5cm者1分,无变化者0分。结果:54例患者均完成疼痛症状、关节功能及影像学随访1年。①术后12个月复查疼痛消失9髋,缓解61髋,无缓解21髋,缓解率为76.9%。②关节功能缓解33髋,无缓解58髋,缓解率为36.3%。③1年后X射线平片或CT、MRI示股骨头区可见不同程度的股骨头坏死区骨质密度改变,坏死区有吸收、缩小,股骨头形态变圆滑规整,改善28髋,无缓解或加重63髋,缓解率为30.1%。④12例24髋完成术后12个月复查股骨头供血动脉数字减影血管造影,好转18髋,好转率为72.2%。结论:经介入途径移植自体骨髓单个核细胞治疗股骨头坏死损伤小,可缓解临床相关症状。