硫酸软骨素酶ABC对大鼠脊髓损伤后轴突髓鞘化和胶质瘢痕的影响

目的探讨硫酸软骨素酶ABC(chondroitinase ABC,ChABC)对大鼠脊髓损伤后轴突再生、髓鞘化和胶质瘢痕形成的影响。方法将72只雄性SD大鼠随机分为ChABC治疗组(A组)、生理盐水治疗组(B组)和假手术组(C组),每组24只。A、B组采用改良Allen撞击法制作大鼠T9中度脊髓损伤模型,分别在伤后1 h和之后连续7 d每天1次经蛛网膜下腔注射6μL浓度为1 U/mL ChABC和生理盐水;C组仅打开椎管,不损伤脊髓。术后1、7、14、28 d,采用BBB评分评定大鼠后肢运动功能恢复情况;取出损伤段脊髓组织,行HE染色和Nissl染色,并采用免疫组织化学染色检测髓鞘碱性蛋白(myelin basic protein,MBP)、生长相关蛋白43(growth associated protein 43,GAP-43)和胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)的变化情况。结果术后各时间点C组BBB评分均明显高于A、B组(P<0.05);术后随时间延长A、B组BBB评分逐渐增加,14、28 d时A组BBB评分明显优于B组(P<0.05)。HE和Nissl染色显示术后各时间点A组脊髓组织形态和神经元数量均优于B组。术后各时间点A、B组MBP和GAP-43的积分吸光度(IA)值及GFAP染色阳性面积均高于C组(P<0.05),术后7、14、28 d时A组MBP和GAP-43的IA值明显高于B组(P<0.05),GFAP染色阳性面积明显小于B组(P<0.05)。结论 ChABC能有效改善大鼠脊髓损伤区域微环境,提高MBP和GAP-43表达并抑制GFAP表达,促进轴突再生与髓鞘化,抑制胶质瘢痕形成,促进神经功能恢复。     

铁蓄积骨质疏松模型凝血状态及微血栓和血管密度变化的研究

目的：了解铁蓄积骨质疏松模型中凝血状态、微血栓、微血管床及骨密度的变化,探讨骨质疏松范畴铁蓄积对凝血功能、血管方面的影响。方法：选取健康24只6月龄雄性SPF级SD大鼠,体重（250±20）g,随机分为对照组和铁蓄积组,每组12只。铁蓄积组用枸橼酸铁（ferric ammonium citrate,FAC）90 mg/kg腹腔注射干预,对照组采用等体积生理盐水腹腔注射,每周2次,干预9周。干预完成后,检测两组血清铁蛋白、凝血功能、微血栓、血管密度及股骨远端骨小梁三维形态重建和空间结构参数,并进行统计学分析。结果：铁蓄积组血清铁蛋白（136.36±35.41）μg/L较对照组（68.44±16.86）μg/L显著升高,铁蓄积组骨密度（0.167±0.024）g/cm³较对照组（0.400±0.030）g/cm³显著下降;铁蓄积组的纤维蛋白原（2.03±0.13）g/L较对照组（1.78±0.46）g/L明显升高,D-二聚体含量（534.95±31.81）ng/ml较对照组（329.02±84.99）ng/ml明显增高（P<0.05）,而凝血酶时间（39.64±2.18）s和凝血酶原时间（8.70±0.39）s较对照组（44.92±2.98）s、（9.44±0.49）s明显缩短（P<0.05）;墨汁染色后,铁蓄积组的微血管密度（17.46±2.07）%较对照组（23.81±2.98）%明显缩小（P<0.05）。HE和MSB染色均显示铁蓄积大鼠骨髓中存在微血栓,同时在心肌中也存在微血栓。结论：在铁蓄积影响的骨质疏松模型中,铁蓄积对凝血功能有显著影响,血液相对呈高凝状态,骨血管床减少,骨髓中有微血栓存在,血液的高凝状态及微血栓的形成可能是铁蓄积骨质疏松症发生的重要影响因素。     

Muscle metabolism during tibial lengthening with regular and high distraction rates

Introduction Muscle regeneration is promoted when the Ilizarov method is used for limb lengthening and deformity correction, but the regenerative ability of muscles decreases when achieving large amounts of elongation. Much research has been dedicated to studying the capabilities of muscles under lengthening, but no reports are available that investigate the muscle metabolism. We supposed that energy turnover would be activated in skeletal muscles under lengthening as a response to distraction, and the activity of the energy turnover would grow in proportion to the increase in the distraction rate or amount.Materials and methods We compared the metabolism of canine anterior tibial muscles (ATMs) by regular and 3-mm high-frequency bone distraction in 30 dogs to obtain 14.5 ± 0.8 % lengthening from the initial tibial length. Group 1 (n = 12) had manual lengthening with a rate of 1 mm per day. Three millimeters per day was produced with 120 increments in automated mode in group 2 (n = 12). An intact group (n = 6) served as controls. ATMs were harvested at the end of distraction, after 30 days of fixation, and 30 days after frame removal. We assessed the activity of lactate dehydrogenase, creatine phosphokinase, glucoso-6-phosphate dehydrogenase, and catalase and calculated the concentration of malone dialdehyde, sarcoplasmic and contractile proteins in the ATM extract.Results Energy turnover reactions were activated in the ATM as a response to distraction forces, but the activity of the energy turnover did not grow proportionally to the increased distraction rate. Levels of sarcoplasmic and contractile proteins in the ATM decreased insignificantly in both groups.Conclusions High-frequency 3-mm daily lengthening results in compensatory energy turnover changes in the muscle, sufficient for prevention of catabolic processes.     

创伤性上颈椎损伤的外科治疗

目的：探讨上颈椎损伤的分型以及外科治疗的临床效果。方法：2005年1月至2007年3月收治的16例创伤性上颈椎损伤患者,男11例,女5例;年龄24-75岁,平均44岁。其中齿状突骨折5例,寰椎骨折3例,Hangman骨折5例,寰枢椎脱位3例。颈椎MR检查：5例颈髓有不同程度受压和T2相高信号改变。根据其损伤机制、影像学表现、骨折分型选择合适的手术方式。结果：非手术治疗7例,手术治疗9例,均获随访,时间7～34个月,平均10．5个月。骨折均愈合或植骨融合,内固定无松动,未发生神经根椎动脉或脊髓损伤。结论：X线片、CT扫描及MR检查是上颈椎损伤必要的诊断措施,选择最佳的手术方式牢固固定上颈椎,同时又最大程度保留患者的颈椎活动度。     

组织工程支架材料在脊髓损伤修复中的应用

背景：脊髓损伤最初往往会导致细胞和组织的不断丢失,组织工程支架可以模拟细胞外基质的生理状态,从而有利于细胞的黏附、迁移、扩增和分化。目的：总结近年来组织工程支架材料联合细胞和/或细胞因子修复脊髓损伤的新进展。方法：应用计算机检索PubMed、OvidMedline及CBM数据库中2000-10/2010-10与组织工程支架材料修复脊髓损伤相关的文章。结果与结论：组织工程材料治疗脊髓损伤需要3因素：种子细胞、组织工程支架、细胞因子。组织工程支架对于损伤脊髓断端起到桥接作用,而种植于材料的种子细胞和/或细胞因子可以促进神经轴突的生长和迁移。可用于组织工程支架的材料可分为天然材料和人工合成材料,包括胶原、壳聚糖、琼脂糖/藻酸盐、聚乳酸、纤连蛋白、聚羟基乙酸/聚乳酸、聚β羟丁酸等,动物实验已经取得一些成果,显示组织工程支架材料联合细胞移植修复效果更好,但临床上目前尚无开展组织工程支架材料修复脊髓损伤的研究。     

DHS治疗老年人股骨粗隆间骨折的疗效观察

目的观察动力髋螺钉（DHS）治疗老年人股骨粗隆间骨折的疗效。并分析手术失败原因及预防，为DHS治疗老年人股骨粗隆间骨折提供依据。方法我院自2004年1月～2006年1月对70例老年人股骨粗隆间骨折行切开复位DHS内固定术，对手术方法及疗效进行分析。结果70例患者66例获得随访，所有骨折病例骨折均愈合，愈合时间7～12周，平均9周，4～8周开始负重。按照董纪元等。根据老年人特点制定的疗效评定标准进行评价，优50例，良8例，可5例，差3例。结论老年人股骨粗隆间骨折应用DHS早期内固定效果可靠。     

槲寄生多糖促进小鼠颅骨前骨细胞系MC3T3-E1的增殖及抑制凋亡的机制

目的 检测槲寄生多糖对小鼠颅骨前骨细胞（MC3T3-E1）增殖、凋亡的影响并探讨其机制。 方法 提取槲寄生多糖,分别配置成不同质量浓度（0.625 g/L,1.25 g/L,2.5 g/L,5 g/L）作用MC3T3-E1小鼠颅骨前骨细胞及对照组。流式细胞术检测细胞周期及凋亡情况,用BrdU和碱性磷酸酶（ALP）试剂盒分别检测细胞增殖及细胞外碱性磷酸酶分泌变化,通过Real-time PCR检测成骨细胞相关基因mRNA的表达水平。 结果 与对照组相比,药物处理组随槲寄生多糖浓度的上升,细胞周期S期和G₂/M的占比增多,在Annexin Ⅴ+/PI-象中的细胞百分数明显下降,细胞数量明显递增,细胞外ALP的活性呈明显递减,Runt相关转录因子2（Runtx2）、Ⅰ型胶原α1（COL1A1）链转录水平升高,且递增、递减效果都在2.5 g/L浓度之后趋于平稳。而骨钙素（OC）mRNA表达水平逐渐升高,在1.25 g/L之后平稳。 结论 槲寄生多糖能促进成骨细胞MC3T3-E1的增殖,抑制其凋亡,其机制可能与抑制碱性磷酸酶分泌以及促进骨钙素、Runt相关转录因子2、Ⅰ型胶原α1链的mRNA表达水平有关。     

Total hip arthroplasty cemented femoral component distal stem centralizer: Effect on stem centralization and cement mantle

The effectiveness, benefits, and potential risks of employing a total hip arthroplasty cemented femoral component distal centralizer were evaluated. First postoperative (6-week) radiographs of 100 primary hybrid total hip arthroplastics in consecutive groups of 50 patients without and 50 patients with a femoeral stem distal centralizer were retrospectively reviewed. Femoral stems with a distal centralizer were more centralized within the femoral canal (center of stem tip to center of intramedullary canal: mean, 1.1 mm with a centralizer, 3.2 mm without; P < .0001) and more neutrally aligned (mean, 0.7° valgus with a centralizer, 1.3° valgus without; P < .01). Femoral stems with a distal centralizer were less likely to have a cement mantle with suboptimal thickness, that is, less than 2 mm at the medial distal femoral stem (3 of 50 stems with a centralizer, 22 of 50 stems without; chi-square, P < .0001). There were no complications, adverse effects on the cement mantle, radiographic evidence of loosening, or implant failures associated with the use of a distal centralizer, with a minimum follow-up period of 2 years.     

Short-term morbidity factors associated with length of hospital stay (LOS): Development and validation of a Hip Fracture specific postoperative morbidity survey (HF-POMS)

BackgroundWe aimed to describe and quantify postoperative complications in the older hip fracture population, develop and validate a hip fracture postoperative morbidity survey tool (HF–POMS).MethodsA prospective clinical observation study of patients (≥ 70 years) admitted for emergency hip fracture surgery, was conducted across three English National Health Service hospitals. Outcome data items were developed from the Postoperative Morbidity Survey (POMS), Cardiac-POMS, hip fracture postoperative literature and orthogeriatric clinical team input. Postoperative outcome data were collected on days 1, 3, 5, 8 and 15; 341 patients participated.ResultsA 12-domain HF-POMS tool was developed with acceptable construct validity on all HF–POMS days. Patients with high perioperative risk scores as measured by the NHFS and ASA grade were more prone to develop HF–POMS defined morbidities. High morbidity rates occurred in the following domains; renal, ambulation assistance, pain and infectious. Presence of any morbidity on postoperative days 8 and 15 was associated with subsequent length of stay of 3.08 days (95% CI 0.90–5.26, p = 0.005) and 15.81 days (95% CI 13.35–18.27, p = 0.001) respectively. Observed average length of stay was 16.9 days. HF–POMS is a reliable and valid tool for measuring early postoperative complications in hip fracture patients. Additional domains are necessary to account for all morbidity aspects in this patient population compared to the original POMS.ConclusionMany patients remained in hospital for non-medical reasons. HF-POMS may be a useful tool to assist in discharge planning and randomised control trial outcome definitions.     

改良前外侧入路联合改良后内侧入路治疗三踝骨折疗效的病例对照研究

目的:比较改良前外侧入路联合改良后内侧入路和传统后外侧入路辅助内侧切口治疗三踝骨折的临床效果。方法:自2015年1月至2017年8月选取108例三踝骨折患者分为改良入路组(试验组)和传统入路组(对照组)。试验组53例,男31例,女22例;年龄18～67(40.2±16.4)岁;左侧19例,右侧34例;旋后外旋型39例,旋前外旋型14例;术前等待时间6～14(9.6±3.1) d;手术采用改良前外侧入路联合改良后内侧入路。对照组55例,男34例,女21例;年龄19～69(42.1±15.3)岁;左侧18例,右侧37例;旋后外旋型42例,旋前外旋型13例;术前等待时间7～16(10.3±3.4) d;手术采用传统后外侧入路辅助内侧切口。对比两组手术时间、术中出血量、术后引流量、切口并发症例数及复位质量评定、骨折愈合时间、神经损伤例数、屈肌挛缩例数和切口并发症总例数;术后1年采用美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分进行临床疗效评价。结果 :108例患者均获得随访,时间12～24(16.4±7.5)个月。试验组手术时间(95.3±22.6) min,术中出血量(114.7±68.7) ml,术后引流量(127.5±87.8) ml,切口并发症1例,均少于对照组(112.5±53.8) min、(155.2±79.6) ml、(178.4±73.8) ml和3例。试验组复位质量优36例,良14例,差3例;对照组优30例,良15例,差10例;试验组优于对照组。试验组骨折愈合时间(5.5±1.6)个月,2例出现切口并发症;对照组骨折愈合时间(6.7±2.1)个月,12例出现切口并发症;试验组少于对照组。术后1年试验组AOFAS评分(92.9±18.4)分,高于对照组(80.3±38.3)分;根据AOFAS评分标准,试验组优32例,良17例,可3例,差1例;对照组优25例,良18例,可8例,差4例;两组比较差异有统计学意义。结论:改良前外侧入路联合改良后内侧入路和传统后外侧入路辅助内侧切口治疗三踝骨折均能取得良好的疗效。相比传统后外侧入路辅助内侧切口,改良前外侧联合改良后内侧入路治疗三踝骨折符合局部软组织血供特点,具有手术创伤小、操作安全、显露清楚有效等优点。