扬显微外科之魅力展中青年专家风采——中华医学会2012年显微外科中青年学术会议召开

由中华医学会显微外科学分会主办,解放军总参谋部总医院(309医院)全军骨科中心和重庆长城医院承办的国家级继续教育项目——中华医学会2012年显微外科中青年学术会议于2012年10月12日至14日在山城重庆隆重召开,中华医学会显微外科学分会主任委员、青年委员会主任委员、本届大会主席裴国献教授致开幕词.青年委员会副主任委员、解放军总参谋部总医院(三○九医院)全军骨科中心赵东升教授任大会执行主席,青年委员会副主任委员、解放军四○一一医院丁小珩教授和中山大学第一附属医院朱庆棠教授任学术委员会主席,上海复旦大学附属华山医院徐雷教授和重庆长城医院阮圣幸副院长任组织委员会主席,第四军医大学附属西京医院孟国林教授任秘书长.     

影响腰痛患者腰椎活动范围危险因素的多元分析

背景：曾有学者应用单因素分析方法研究了年龄和退变等因素对腰椎活动范围的影响,但是尚缺少多元分析的结果,尤其是针对腰痛患者尚没有该方面的研究报道。 目的：应用多元回归方法探讨影响腰痛患者腰椎屈伸活动度的危险因素。 方法：纳入120例腰痛患者,男88例,女32例,平均年龄51.13岁(23~74岁)。依据修订后的Kellgren评分标准分别对其X射线平片进行分析。应用多元回归方法分别对各个节段进行分析。分析因素包括：①年龄。②性别。③身高。④体质量。⑤体质量指数。⑥待测量节段的腰椎活动范围。⑦上邻节段的腰椎活动范围。⑧下邻节段的腰椎活动范围(L5~S1除外)。 结果与结论：对于L1~5各个节段,体质量指数是影响腰痛患者腰椎活动范围的显著因素。对于L3~5各个节段,年龄是影响腰椎活动范围的显著因素。测量节段的Kellgren 评分只有在L5~S1节段与该节段的腰椎活动范围显著相关。对于L4~5节段,下邻节段的Kellgren 评分是影响腰痛患者腰椎活动范围的显著因素。相邻节段的Kellgren 评分、性别、体质量及身高在任何节段均与腰椎活动范围无显著相关性。结果提示,体质量指数和年龄是影响腰痛患者腰椎活动范围的显著性因素,退变只在L5~S1节段与腰椎活动范围有显著相关性。     

Effects of Fufang Shenhua Tablet(复方肾华片) on the Expression of Toll-Like Receptors during Acute Kidney Injury Induced by Ischemia-Reperfusion in Rats

<正>Objective:To investigate the impact of a traditional Chinese medicinal compound known as Fufang Shenhua Tablet(复方肾华片,SHP) on the expression of Toll-like receptors(TLRs) during renal ischemia-reperfusion injury(IRI)-induced acute kidney injury(AKI) in rats.Methods:A total of 28 Wistar rats were randomly divided into five groups:(1) pseudo-operation control group,(2) ischemia-reperfusion model group, (3) Astragaloside group,(4) high-dose SHP group,and(5) low-dose SHP group.There were four rats in the pseudo-operation group and six rats in each of the other groups.The accepted ischemia-reperfusion model was established after a 7-day gavage intervention,and pathological changes and renal function were observed,using an enzyme-linked immunosorbent assay(ELISA) to detect interleukin 8(IL-8) and interferon gamma(IFN-γ) levels,as well as immunohistochemical staining to detect altered levels of TLR2 and TLR4 expression in renal tissue.Results:After 24 h,renal pathological damage and the expression levels of serum creatinine(Scr),IL-8, IFN-γ,TLR2,and TLR4 were significantly higher in the model group as compared with the pseudo-operation group(P0.05).In addition,at 24 h the above indicators decreased significantly in the Astragaloside group,high-dose SHP group and low-dose SHP group as compared with the ischemia-reperfusion model group(P0.05). TLR2 and TLR4 expression levels were significantly reduced in the SHP treatment and Astragaloside group as compared with the pseudo-operation group(P0.05).Further,the high-dose SHP group showed significantly less renal damage score and decreased levels of TLR expression than those of low-dose SHP group and Astragaloside group(all P0.05).Conclusion:SHP can alleviate the renal structural and functional damage caused by IRI-induced AKI in rats by reducing the damage of renal pathology,which may reduce inflammatory cytokine levels by downregulating the expression of TLRs in renal tissue in a dose-dependent manner.     

维持性血液透析患者外周血T细胞Annexin Ⅴ和FasL的表达研究

目的 :研究维持性血液透析患者外周血T细胞AnnexinⅤ和FasL的表达。　 方法 :应用流式细胞术分别检测未透析肾衰 (ND)患者、醋酸纤维膜透析 (CA)患者、聚砜膜透析 (PS)患者及健康自愿者 (C)各 10名的外周血T细胞培养 2 4h后AnnexinⅤ和FasL的表达。　 结果 :ND组和CA组外周血T细胞计数显著低于C组 ,而PS组与C组间差异不显著 ,ND组和CA组T细胞上AnnexinⅤ和FasL表达显著高于C组和PS组 ,各组AnnexinⅤ和FasL呈显著正相关 (P <0 0 5 )　 结论 :终末期肾衰 (ESRF)患者的低T淋巴细胞血症可能与T细胞凋亡增加有关。     

抑制一氧化氮合酶对 Heymann肾炎大鼠的肾脏影响

目的　观察抑制一氧化氮合酶对Heymann肾炎大鼠的肾脏影响。 　方法　将NOS抑制剂Nw 硝基 L 精氨酸 (Nw nitro L arginine,L NNA)和氯沙坦应用于Heymann肾炎大鼠 ,2 1d后测定血压 ,尿蛋白 ,计算肌酐清除率 (creatinineclearancerate ,Ccr) ,观察肾脏形态学改变 ,免疫组化法检测转化生长因子 β1(TGFβ1)的表达。　结果　抑制NOS后 ,Heymann肾炎大鼠血压升高 ,尿蛋白增加 ,Ccr降低 ,肾小管间质炎性细胞浸润 ;部分肾小球缺血 ,TGFβ1表达增加 (P <0 0 1)。加用氯沙坦后均改善。　结论　抑制NOS加重Heymann肾炎大鼠肾脏损害 ,同时应用氯沙坦具有肾脏保护作用     

老年患者游离组织瓣的临床应用分析

近年来,显微外科技术取得了长足的发展。据报道,显微外科手术的成功率已超过90％,各种游离组织瓣的移植在临床上、尤其是矫形外科广泛开展。但是对于老年患者,游离组织瓣移植的适应证选择在临床上仍存在较多争议。为探讨该方面的问题,对我院1998年1月～2005年1月间所完成的39例老年     

外固定器在前臂复合组织缺损修复中的应用

Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.     

老年人胸主动脉夹层的治疗

目的探讨老年人胸主动脉夹层的治疗方法。方法回顾性分析46例老年胸主动脉夹层患者的临床资料。全组患者按DeBakey法分类,Ⅰ型5例,Ⅱ型16例,Ⅲ型25例。其中24例行主动脉置换术（置换组）,17例行腔内隔绝术（隔绝组）,5例采用保守治疗（保守治疗组）。结果全组患者手术死亡2例（8.3%）。随访9～21个月,术后近期死亡3例（6.8%）,余康复良好,移植物通畅,无扭曲及移位。结论对于老年胸主动脉夹层患者这一高危人群,需根据其不同情况,采用适合的治疗方法,以提高治疗效果。     

血液透析预防和救治老年造影剂相关肾病

采用预防性血液透析为1名老年肾功能不全患成功进行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）；采取血液透析和综合内科治疗成功抢救1名急性冠脉综合征PCI后造影剂相关肾病（contrast mediumassociated nephropathy，CAN）致急性肾衰高龄患。     

大粗隆外侧壁的完整性与股骨粗隆间骨折疗效的关系

目的探讨股骨大粗隆外侧壁的完整性与股骨粗隆间骨折疗效的关系。方法 2006年1月至2010年1月,随机选取46例不稳定型顺向股骨粗隆间骨折手术患者,其中男性20例,女性26例;年龄43～88岁,平均74.7岁。大粗隆外侧壁破坏者为19例,完整者为27例。外侧壁破坏组有17例采用股骨近端防旋髓内钉（proximal femo-ral nail antirotation,PFNA）固定,2例采用DHS固定。外侧壁完整组18例采用PFNA固定,9例采用DHS固定。疗效评定采用Harris髋关节功能评分。外侧壁的完整性与临床疗效之间的相关性采用Spearman等级相关分析。结果所有患者随访13.5～62个月,平均21.4个月。末次随访采用Harris髋关节功能评分,其中外侧壁破坏组优10例,良5例,中3例,差1例,优良率为78.9%;外侧壁完整组优19例,良5例,中3例,差0例,优良率为88.9%。Spearman等级相关结果提示外侧壁的完整性与临床疗效密切相关。结果股骨大粗隆外侧壁的完整性与临床疗效密切相关,术前评估应明确外侧壁的完整性,选择合适的内固定方法,术中应避免医源性的损伤。