创伤性马德隆畸形并自发性伸指肌腱断裂1例报道

马德隆畸形和自发性伸指肌腱断裂均为临床少见病例。前者是一种由桡骨远端尺侧和掌侧骨骺发育障碍所引起的罕见畸形,多为先天性,临床仅见个案报道;而马德隆畸形与自发性伸指肌腱断裂同时存在更为罕见,游永刚报道2例原发性马德隆畸形并自发性伸指肌腱断裂病例报告,而创伤后马德隆畸形并自发性伸指肌腱断裂极为罕见,目前尚     

缺氧对乳鼠脊髓神经元低氧诱导因子-1α的影响

目的研究缺氧对脊髓神经元低氧诱导因子-1α(HIF-1α)表达和凋亡的变化,探讨HIF-1α在耐受缺氧和诱导凋亡机制中的作用。方法以体外培养的乳鼠脊髓神经元细胞为研究对象。采用激光共聚焦显微镜(LCSM)、DNA琼脂糖凝胶电泳观察缺氧诱导脊髓神经元凋亡的变化;免疫组化检测HIF-1α在缺氧脊髓神经元中的表达;流式细胞术(FCM)检测缺氧对脊髓神经元p53、Bcl-2蛋白水平表达的影响。结果持续缺氧显著抑制脊髓神经元细胞的生长;荧光显微镜下可见脊髓神经元细胞呈典型凋亡的形态学改变。脊髓神经元缺氧2、4 h时HIF-1α、P53、Bcl-2表达上调(P<0.01),8 h时其表达下调(P<0.05)。结论缺氧预处理诱导的HIF-1α的表达,在脊髓神经元的耐受缺氧和诱导凋亡机制中起着重要的作用。     

TSP-1及TP的表达与骨肉瘤新生血管生成的相关性

目的研究血小板反应蛋白-1(TSP-1)和胸苷磷酸化酶(TP)在骨肉瘤组织中的表达情况,探讨两者的平衡状态在新生血管生成中的作用。方法收集54例骨肉瘤手术切除标本,应用免疫组织化学法检测骨肉瘤组织中TSP-1及TP的表达,CD34单克隆抗体标记血管内皮细胞,计数骨肉瘤微血管密度(microvessel density,MVD)。结果骨肉瘤TSP-1的表达程度与MVD呈负相关(Spearman秩和检验:rs=-0.241,P=0.000);TP的表达与MVD计数呈正相关(Spearman秩和检验:rs=0.511,P=0.000);TSP-1、TP的表达与骨肉瘤临床病理因素无统计学意义(均P0.05),但都与肺转移显著相关(P0.05)。结论 TSP-1及TP在骨肉瘤发生发展中起重要作用,并影响血管形成及肿瘤侵袭性,两者表达的不平衡是骨肉瘤组织中新生血管生成的关键因素之一。     

微创经皮与传统开放椎弓根螺钉置入固定胸腰椎骨折的文献荟萃

BACKGROUND: Open reduction pedicle screw fixation for thoracolumbar fracture could obtain satisfactory effects, and has been extensively used. However, it has potential risk during and after repair. Minimally invasive percutaneous pedicle screw technique minimizes the trauma and complications of soft tissue. It remains poorly understood which is better minimally invasive percutaneous or conventional open pedicle screw fixation for the repair of thoracolumbar fracture. OBJECTIVE: To perform quality evaluation and meta-analysis on curative effect and postoperative complications of minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: A detailed search of several electronic databases, including Cochrane Library, PubMed, WanFang, CNKI, VIP and CBM, was undertaken. Simultaneously, Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, and Chinese Journal of Trauma were checked by hand to identify controlled trials regarding minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures published from inception to 2015, and the references of the included studies were checked. According to inclusion and exclusion criteria, references were screened, data were extracted and quality was evaluated by four investigators independently. Meta-analysis was conducted using RevMan 5.2 software. The quality of references of the included controlled trials was assessed with CONSORT statement and some surgery clinical evaluation indexes. RESULTS AND CONCLUSION: We included 28 studies, including 25 randomized controlled trials/quasi-randomized controlled trials and 3 retrospective comparative studies, with 1 285 patients. Meta-analysis results demonstrated that compared with the conventional open pedicle screw, minimally invasive percutaneous pedicle screw fixation could significantly reduce operation time, blood loss, hospital stays, postoperative complication rate and height loss (P < 0.05). No significant difference in postoperative pain grade was detected between them (P > 0.05). These results indicate that minimally invasive percutaneous pedicle screw fixation for thoracolumbar fracture was safe and reliable, had small trauma, less blood loss, rapid recovery, short hospital stay, and less postoperative complications. Nevertheless, methods and results of most studies are not detailed enough. We suggested reporting randomized controlled trials according to related standards in order to improve the report quality and authenticity of randomized controlled trials.       

前中柱垫高后路截骨钉棒固定治疗脊柱结核

目的回顾性分析中前中柱垫高、后路截骨矫形钉棒固定治疗脊柱结核临床疗效,并评价该技术的安全性、合理性及其手术适应症。方法自2015年1月至2017年5月,我院收治脊柱结核患者共30例,男16例,女14例;年龄16-70岁(平均40岁);病史12-96个月(平均52个月);术前脊柱结核病灶位于颈胸段椎体2例,胸椎8例,胸腰段6例,腰椎14例,其中累及一个椎体8例,2个椎体20例,2个椎体以上2例。术前后凸Cobb角45.864±10.536°;30例患者有脊髓损伤,根据Frankel分级:A级3例,B级5例,C级16例,D级6例。结果所有患者均获得随访12~36个月,平均22.5个月。手术时间200~260分钟,平均220分钟。术中出血量400~1260,平均569mL;术前后凸Cobb角45.864±10.536°,术后Cobb角10.364±4.564°,术前椎体前缘高度1.386±0.350cm,术后椎体前缘高度2.164±0.325cm,手术前后统计有明显差异(P0.01);术前椎体后缘高度2.375±0.256cm,术后椎体后缘高度2.182±0.423cm,手术前后统计有明显差异(P0.01);术后末期随访患者Frankel分级:A级6例,B级3例,C级2例,D级2例,E级1例。围手术期内脑脊液漏1例,结核复发2例,伤口愈合不良3例。结论脊柱前中柱垫高、后路截骨矫形钉棒固定治疗脊柱结核取得良好效果,创伤小,手术出血量少,并发症少,应用范围广泛,是一种安全有效治手术方法,治疗脊柱结核值得推广应用。     

双侧股骨髌骨粉碎型骨折1例

我院于１９９９年１１月收治１例双侧股骨、髌骨粉碎型骨折,现报告如下：临床资料患者范××,女,３２岁,无业。既往有精神病史。入院前１小时从８米高天桥上跳下,双膝部着地,当时神志清,双下肢疼痛,活动丧失,被他人抬送医院。查体：神志清,对答切题,无精神症状。面色苍白,BP９／５kPa,P１１０次／分,R３２次／分,T３６℃,下颌部皮肤裂伤,胸腹及脊柱、双上肢无畸形及损伤。双大腿肿胀,有成角畸形及异常活动,双膝肿胀、压痛,可触及髌骨碎块及骨擦感,双足血供、感觉及足趾运动良好。X光片示：双侧股骨,髌骨粉碎型骨折…     

颈椎减压术后C5神经根麻痹的中西医诊疗进展＊

颈椎减压术后C5神经根麻痹是发生在颈椎减压术后的主要以上肢感觉功能障碍为特征的手术并发症，该并发症严重影响手术效果，不利于良好的医患关系。本文基于近年来有关C5神经根麻痹的国内外文献，简要综述了其中的西医临床特点、发病机制假说、预防及现有治疗措施，为颈椎减压术后C5神经根麻痹的诊疗提供新思路。     

关节镜下清理结合胫骨高位截骨治疗膝关节骨性关节炎

关节镜手术因其创伤小、恢复快、并发症少等优点，越来越多地用于膝关节疾病的治疗。但对于合并有膝内翻畸形的膝关节骨性关节炎患单独实施关节镜清理术效果往往较差。2003年6月～2005年10月，对18例伴随内翻畸形的膝关节骨关节炎的病例，实施关节镜清理术后进行胫骨高位截骨术，取得满意疗效。     

原发性十二指肠恶性肿瘤10例报告

通过10例原发性十二指肠癌病例的讨论,认为该病早期症状隐诲,术前确诊的主要手段为纤维十二指肠镜及低张十二指肠造影检查,其预后与肿瘤类型、病程早晚有关,根治性胰十二指肠切除术较其它治疗方法效果为佳。     

肃南地区急诊外伤流行病学调查及预防对策

外伤是急诊科常见的病症，开展外伤预防医学的前提是进行外伤流行病学调查，为了探索其流行病学规律，为外伤的防治提供科学依据，作者现将肃南县医院及全县7所乡镇卫生院2007年10月1日至2008年9月30日接诊的外伤病人进行分析，报告如下。