持续封闭负压引流治疗小面积皮肤缺损伴钢板外露

目的研究持续封闭负压引流用于小面积的皮肤缺损并钢板外露的可行性。方法选择2009年至2012年间小面积皮肤缺损伴钢板外露面积患者4例,男3例,女1例,年龄24⁵4岁,平均37岁,皮肤缺损面积分别为9、9、12、16 cm2,其中胫腓骨远端骨折3例,胫腓骨近端骨折1例。除外严重感染和骨髓炎及血供障碍者,接受清创手术后,进行持续封闭负压引流治疗,每周更换一次,直至新鲜肉芽覆盖钢板及创面。结果经平均3周(分别为2、2、3、5周)治疗,所有患者创面及钢板均被新鲜肉芽填充,没有感染患者。结论持续封闭负压引流治疗可用于小面积皮肤缺损并钢板外露患者,具有治疗简单,避免多次手术的优点。     

自体骨植骨在治疗髋关节发育不良CroweⅢ型和Ⅳ型髋臼缺损中的应用研究

目的:观察自体骨植骨在治疗髋关节发育不良CroweⅢ、Ⅳ型髋臼缺损中的效果。方法:2010年3月至2013年5月采取全髋关节置换术(total hip arthroplasty,THA)治疗22例25髋CroweⅢ、Ⅳ型成人髋关节发育不良继发骨性关节炎,25髋均进行自体骨植骨改善髋臼骨缺损,其中男3例4髋,女19例21髋;年龄43～67岁,平均55岁;CroweⅢ型6髋,Ⅳ型19髋。术前所有患者髋关节疼痛,肢体短缩,髋关节功能受限。术后12个月观察患者肢体长度恢复情况、功能恢复、自体骨植骨融合情况。结果:22例均获随访,时间1年3个月～4年,平均3年9个月。所有患者无不良反应发生,植骨均融合。术后12个月Harris评分88.30±6.13,优18例,良4例。双下肢长度差由治疗前的(3.20±0.81) cm减小到术后12个月(0.92±0.23) cm(t=14.864,P<0.05).结论:髋关节发育不良继发骨关节炎采取全髋关节置换术时,采用自体骨植骨能有效改善髋臼骨缺损,有利于恢复髋臼旋转中心,提供良好髋臼固定,明显提高手术治疗效果。     

Platelet derived growth factor stimulates chondrocyte proliferation but prevents endochondral maturation

Platelet-derived growth factor (PDGF) is a cytokine released by platelets at sites of injury to promote mesenchymal cell proliferation. Since many bone wounds heal by endochondral bone formation, we examined the response of chondrocytes in the endochondral lineage to PDGF. Confluent cultures of rat costochondral resting zone cartilage cells were incubated with 0–300 ng/mL PDGF-BB for 24 h to determine whether dose-dependent changes in cell proliferation (cell number and [³H]-thymidine incorporation), alkaline phosphatase specific activity, [³⁵S]-sulfate incorporation, or [³H]-proline incorporation into collagenase-digestible protein (CDP) or noncollagenase-digestible protein (NCP), could be observed. Long-term effects of PDGF were assessed in confluent cultures treated for 1,2,4,6,8, or 10 d with 37.5 or 150 ng/mL PDGF-BB. To determine whether PDGF-BB could induce resting zone chondrocytes to change maturation state to a growth zone chondrocyte phenotype, confluent resting zone cell cultures were treated for 1, 2, 3, or 5 d with 37.5 or 150 ng/ml PDGF-BB and then challenged for an additional 24 h with 1,25-(OH)₂D₃. PDGF-BB caused a dose-dependent increase in cell number and [³H]-thymidine incorporation at 24 h. The proliferative effect of the cytokine decreased with time. PDGF-BB had no effect on alkaline phosphatase at 24 h, but at later times, the cytokine prevented the normal increase in enzyme activity seen in post-confluent cultures. This effect was primarily on the cells and not on the matrix. PDGF-BB stimulated [³⁵S]-sulfate incorporation at all times examined, but had no effect on [³H]-proline incorporation into either the CDP or NCP pools. Thus, percent collagen production was not changed. Treatment of the cells for up to 5 d with PDGF-BB failed to elicit a 1,25-(OH)₂D₃ responsive phenotype typical of rat costochondral growth zone cartilage cells. These results show that committed chondrocytes can respond to PDGF-BB with increased proliferation. The effect of the cytokine is to enhance cartilage matrix production, but at the same time to prevent progression of the cells along the endochondral maturation pathway.     

肱骨远端C型骨折手术治疗的研究进展

肱骨远端C型骨折是一少见而又复杂的关节内损伤,非手术治疗难以准确复位骨折和重建关节面,切开复位内固定则是目前最理想的治疗选择。尺骨鹰嘴截骨入路可以提供充足的术野显露,是最常用的手术入路,但存在截骨处不愈合、内固定失败等并发症。为避免牺牲鹰嘴的完整性,肱三头肌内外侧入路、肱三头肌翻转入路、肱三头肌-肘肌瓣翻转入路、肱三头肌劈开入路及肱三头肌腱膜舌形瓣入路等则应用到骨折的显露中,但不同入路的局限性,使得入路选择在术野暴露与伸肘功能受影响之间存在一定矛盾性。随着"双柱"理论的推广,双钢板固定C型骨折比单钢板具有显著力学优势。在体外生物力学试验中,即便平行双钢板较垂直双钢板更有优势,但目前尚不清楚两者在临床运用中是否存在差异。对于关节面无法重建的C型骨折,肘关节置换术可能是最终的选择,由于技术水平限制,其长期疗效还有待观察。     

脊髓损伤患者在低强度运动中最大脂肪氧化速率研究

目的:探究脊髓损伤患者在不同强度运动下的脂肪氧化速率。方法:选取30例无运动习惯的脊髓损伤(SCI)患者,所有受试者接受两次使用上肢功率车的递增运动负荷试验:基准测试(baseline test)和脂肪氧化强度测试(Fatmaxtest),两次测试中均进行呼吸气体分析。baseline test中起始功率5W,每3min递增10W,转速60rpm,直至患者力竭,测定此过程摄氧量(VO_2)和呼吸商(RQ)的变化。Fatmaxtest包括五级递增负荷,每级持续6min,起始负荷为5W,第五级负荷为baseline test中呼吸商为1时对应的负荷,其他三级按照两者之差的平均值进行计算,测算脂肪代谢速率的变化。结果:随着运动强度的增加,SCI患者脂肪氧化速率呈先升高后下降的趋势。在34.9%±2.3%VO_2peak运动强度下达到脂肪氧化率峰值(5.46±0.75)μmol/kg/min,之后随着运动强度的增加脂肪氧化率出现明显下降,在41.83±2.18、52.29±1.73、61.32±1.98%VO_2peak运动强度下脂肪氧化率依次为(3.92±0.69)μmol/kg/min、(2.85±0.61)μmol/kg/min、(0.58±0.19)μmol/kg/min(P0.05)。结论:在脊髓损伤患者的康复过程中,应当注重低强度运动的干预,使脂肪氧化速率最大化,降低肥胖在SCI患者中的发生率。     

An Image Rendering Technique for Sliced-geometries Using MITK

Software for medical image analysis and visualization is an important tool in medical research and diagnosis.Development and usage of medical image processing toolkit have become an important research trend.It is a fundamental task to master their image rendering principles and data organization mode in order to use these toolkits.MITK(Medical Imaging Toolkit,from www.mitk.net) with the important characteristics of inheritance and virtual function uses the Object-Oriented design approach.This paper researches the data organization mode and coordinate translation of MITK and presents an algorithm based on OpenGL to rewrite the image-rendering function of MITK.Using the algorithm,the rewritten rendering function has the same rendering effect as the one in MITK.By rewriting the virtual image-rendering function and using the capability that a view window can load many data model,users can neatly render various graphics and images.Though the researches of this paper are based on the mitkImageModel class,the algorithm also is fit for 2D "widgets"class.     

Cumulative industrial trauma as an etiology of seven common disorders in the foot and ankle: what is the evidence?

The concept of cumulative industrial trauma as an etiology of orthopaedic disease has recently generated considerable attention in both the medical and legal communities. To clarify the current state of knowledge about the issue as applied to the foot and ankle, we critically reviewed the literature on the etiology of seven foot and ankle disorders commonly involved in compensation litigation in the practice of the senior author: hallux valgus, interdigital neuroma, tarsal tunnel syndrome, lesser toe deformity, heel pain, adult acquired flatfoot, and foot and ankle osteoarthritis. Koch's postulates were appropriately modified and used as a logistic framework to analyze the potential for cumulative industrial trauma to cause foot pathology. In none of the disorders analyzed could cumulative industrial trauma reasonably satisfy even one of Koch's three postulates. We conclude there is currently no unequivocal literature support upon which to invoke cumulative industrial trauma as a clear etiology of these disorders of the adult foot and ankle. The superb evolutionary adaptation of the human foot to prolonged ambulation and the absence of industrial demands that significantly differ from this task likely account for this dramatically reduced vulnerability of the foot to industrial repetitive motion disorders compared to the upper extremity.     

LCP钢板治疗老年肱骨近端复杂骨折

[目的]分析老年肱骨近端复杂骨折的特点以及研究和探讨运用LCP钢板治疗老年肱骨近端复杂骨折的方法和评定疗效。[方法]2004年10月～2006年6月本院骨科收治老年肱骨近端复杂骨折16例,均采用切开复位LCP钢板内固定,术后均定期门诊随访,并评定其疗效。[结果]16例病人术后均获得门诊随访,随访时间为6～18个月,平均12.3个月,骨折均已愈合,功能评定采用Neer评分,优11例,良2例,可2例,差1例,总优良率为81.3%。X线检查复位结果,解剖复位6例,近似解剖复位6例,3例复位可,1例差。[结论]运用LCP钢板治疗老年肱骨近端复杂骨折具有创伤少、骨折固定牢靠、功能恢复良好等优点,目前仍然是一种对老年肱骨近端复杂骨折比较理想的治疗方式。     

经皮穿刺颈椎间盘切除术前术后伸屈动力性X线分析

目的:探讨经皮穿刺颈椎间盘切除术(PCD)对颈椎稳定性的影响。方法:对30 例患者术前术后拍摄颈椎过屈过伸侧位片,术前X线显示无颈椎失稳,分别测量椎体角度位移和椎体水平位移情况。平均随访5 年(1~9 年)。对以上术前和术后测量数据,运用统计学检验方法进行t检验。结果:PCD术后出现1 例颈椎失稳,椎体角度位移值13°。但椎体角度位移和椎体水平位移在手术前后差异无显著性意义。结论:PCD术后对颈椎稳定性没有显著影响,PCD是一项安全、可靠、创伤少的手术。     

A new technique for medial-end comminuted clavicle fractures

Fractures of the medial comminuted clavicle are rare injuries but are associated with significant morbidity and mortality. Although rare, such injuries deserve rapid diagnosis and effective treatment to avoid future complications. An optimal, standardized operative treatment has not yet been established. We presented a medial-end comminuted clavicle fracture and demonstrated successful results using a bridging plate technique across the sternum maintaining reduction and achieving union. We aim to provide an alternative technique to fix a displaced periarticular medial clavicle fracture, which we believe is simple, safer and promising.