双侧钢板置入内固定治疗复杂胫骨平台骨折的效果探析

目的探讨分析对于复杂胫骨平台骨折患者应用双侧钢板置入内固定的治疗效果。方法对我院行双侧钢板置入内固定治疗的36例复杂胫骨平台骨折患者的临床资料进行回顾分析。结果骨折患者经治疗后,均全部愈合,无感染以及其他并发症发生。患者并未出现松动、断钉以及断板等情况。根据Merchant评分标准进行评定:优20例、良14例、中2例、差1例。结论对于复杂胫骨平台骨折患者来说,采用双侧钢板置入内固定是一种行之有效的方法,促进患者术后固定的稳定性以及早期功能恢复锻炼。     

Wrist arthrodesis with intercalated iliac crest graft in mutilans rheumatoid arthritis

In mutilans rheumatoid arthritis (RA) patients with major wrist destruction, wrist arthrodesis is recommended. This type of arthrodesis needs carpal reconstruction and stable fixation. The goal of this study was to assess the functional and anatomical outcomes of an iliac crest graft and internal fixation with two medullary pins. Six wrists in three patients suffering from RA were reviewed clinically and radiologically at an average follow-up of 25 months. We assessed the fusion of the iliac graft with the radius and the metacarpus, the preoperative and postoperative carpal height, and the bone stock in front of the thumb. All the patients had improved functionally. The iliac graft fused with the radius in all cases and fused with the metacarpus in 5 out of 6 cases; the non-union occurred in the wrist where only one pin was used. Restoration of carpal height was associated with improvements in hand function. The bone stock was sufficient to allow implantation of a trapezial cup during a total arthroplasty of the thumb trapeziometacarpal (TMC) joint. No major complications occurred. An iliac graft and two pins through the 2nd and 3rd metacarpals were used to reconstruct the carpal height and to obtain wrist fusion. Internal fixation with only one pin is not recommended. Functional improvement can be attributed to the normal tension within the extrinsic flexors and extensors of fingers and thumb being restored because the carpal height was restored. A secondary TMC arthroplasty is theoretically possible.     

单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果比较

目的：比较单侧和双侧内固定联合髓核摘除椎间融合术治疗腰椎间盘突出症的效果。方法回顾性分析本院2010年1月~2012年12月行髓核摘除椎间融合固定术治疗的49例单间隙腰椎间盘突出症患者。依据固定方式将患者分为单侧内固定组和双侧内固定组。比较两组的手术用时、术中出血量、住院时间、住院费用、疼痛VAS评分、Oswestry功能障碍指数（ODI）评分、融合率和并发症发生率等。结果两组术前的VAS、ODI评分比较差异无统计学意义（P>0.05）,末次随访时,两组的VAS、ODI评分均显著降低（P<0.05）,但两组比较差异无统计学意义（P>0.05）。单侧组的手术用时明显短于双侧内固定组,术中出血量明显少于双侧内固定组,住院费用明显低于双侧内固定组（P<0.05）。两组的融合率和并发症率发生率比较差异无统计学意义（P>0.05）。结论单侧与双侧内固定椎间融合对单间隙腰椎间盘突出症的治疗效果相当,但手术用时较短、术中出血量较少、住院费用较低。     

Are bilateral tibial shaft fractures associated with an increased risk for adverse outcome?

IntroductionLong bone fractures are assumed to be an independent risk factor for systemic complications and death after trauma. Multiple studies have identified an increased risk for mortality and morbidity in patients with bilateral femoral fractures. Data about bilateral tibial shaft fractures is rare. The aim of our study was to analyze if patients with bilateral tibial shaft fractures are at higher risk for systemic complications.MethodsWe performed a retrospective analysis of the TraumaRegister DGU^® from 1993 to 2008. Inclusion criteria were unilateral or bilateral tibial shaft fractures and an age ≥16. Additionally to the overall collective we analyzed different subgroups (divided into different injury severities and treatment periods).Results1899 patients with unilateral and 175 patients with bilateral tibial shaft fractures were included. Age, gender and mean ISS (25.8 vs. 26.2, p = 0.51) in the two groups were comparable. Regarding the entire study population, patients with bilateral tibial shaft fractures showed no significant higher incidence of respiratory organ failure (29.5% vs. 23.1%, p = 0.076) or mortality (20.0% vs. 16.3%, p = 0.203). However, subgroup analysis showed a significant higher rate of pulmonary organ failure for bilateral tibial shaft fractures as compared to unilateral tibial shaft fractures in the group ISS < 25 (20.7% vs. 11.7%, p = 0.023). Multivariate regression analysis identified the additional tibial shaft fracture as an independent risk factor for pulmonary organ failure (OR = 1.56) but not for mortality.DiscussionThe additional tibial shaft fracture is an independent risk factor for pulmonary organ failure but not for multiple organ failure or mortality. The impact of the additional tibial shaft fracture is especially pronounced in less severely injured patients (ISS < 25). These findings are comparable to results of bilateral femoral fracture studies and we therefore suggest to treat patients with bilateral tibial shaft fractures with the same caution as those with bilateral femoral fractures.     

Establishment of a bilateral femoral large segmental bone defect mouse model potentially applicable to basic research in bone tissue engineering

Background

To understand the cellular mechanism underlying bone defect healing in the context of tissue engineering, a reliable, reproducible, and standardized load-bearing large segmental bone defect model in small animals is indispensable. The aim of this study was to establish and evaluate a bilateral femoral defect model in mice.

Materials and methods

Donor mouse bone marrow mesenchymal stem cells (mBMSCs) were obtained from six mice (FVB/N) and incorporated into partially demineralized bone matrix scaffolds to construct tissue-engineered bones. In total, 36 GFP⁺ mice were used for modeling. Titanium fixation plates with locking steel wires were attached to the femurs for stabilization, and 2-mm–long segmental bone defects were created in the bilateral femoral midshafts. The defects in the left and right femurs were transplanted with tissue-engineered bones and control scaffolds, respectively. The healing process was monitored by x-ray radiography, microcomputed tomography, and histology. The capacity of the transplanted mBMSCs to recruit host CD31⁺ cells was investigated by immunofluorescence and real-time polymerase chain reaction.

Results

Postoperatively, no complication was observed, except that two mice died of unknown causes. Stable fixation of femurs and implants with full load bearing was achieved in all animals. The process of bone defect repair was significantly accelerated due to the introduction of mBMSCs. Moreover, the transplanted mBMSCs attracted more host CD31⁺ endothelial progenitors into the grafts.

Conclusions

The present study established a feasible, reproducible, and clinically relevant bilateral femoral large segmental bone defect mouse model. This model is potentially suitable for basic research in the field of bone tissue engineering.     

双侧去骨瓣减压术中脑组织医源性损伤原因分析

目的：探讨基层医院双侧去骨瓣减压术中脑组织医源性损伤的发生机制。方法回顾性分析2006年6月至2012年1月,本院133例双侧去骨瓣减压术患者的临床资料,其中97例采用气钻、铣刀开颅的患者作为观察组,另36例采用手摇颅钻、线锯开颅的患者作为对照组。记录两组患者的后手术侧手术时间,对比研究两组患者的非预期再次手术率及病死率。结果观察组术后行非预期再次手术22例,其中先手术侧再次手术17例（后手术侧手术时间118±21分钟）,后手术侧再次手术5例。对照组非预期再次手术15例,先手术侧再次手术12例（后手术侧手术时间144±25分钟）,后手术侧再次手术3例。观察组死亡25例,对照组19例。观察组的非预期再次手术率及病死率显著低于对照组。两组的先手术侧非预期再次手术率均显著高于后手术侧。差异有统计学意义（P〈0.05）。结论在双侧去骨瓣减压术中,“重力-时间”因素及后手术侧开颅时产生的暴力对先手术侧脑组织的损伤是导致术中医源性损伤的主要原因。先进手术器械的合理使用及脑保护理念的始终贯彻,能显著减少术中脑组织医源性损伤,降低术后非预期再次手术率及病死率。     

采用微创技术救治高血压性脑出血双侧脑疝形成患者的疗效

目的探究高血压性脑出血合并双侧脑疝患者采用微创技术治疗的临床效果。方法选取我院高血压性脑出血合并脑疝患者88例,按照治疗方式的不同分为治疗组和对照组,每组44例。对照组患者采用保守的内科治疗,治疗组患者采用微创技术治疗;观察两组患者治疗后的临床效果。结果两组患者治疗后病情均有改善,但治疗组的总有效率72.7%显著优于对照组的47.7%,结果具有统计学差异（P〈0.05）;两组患者治疗后,治疗组6、12个月的存活率显著高于对照组,结果具有统计学差异（P〈0.05）。结论高血压性脑出血合并双侧脑疝患者采用微创技术治疗,有效的清除了患者的血肿,减少了手术的时间,解除了占位效应,临床创口小,损伤轻,预后良好,效果显著,值得推广。     

带血管蒂骨瓣转移治疗双侧股骨头缺血性坏死的疗效分析

背景：非创伤性股骨头缺血性坏死（ONFH）常双侧发病,治疗更加困难,采用保留股骨头的治疗方法较为理想。目前,采用带血管蒂骨瓣转移治疗双侧ONFH疗效的报道甚少。 目的：探讨应用带血管蒂髂骨瓣转移治疗双侧ONFH的早中期临床疗效。 方法：2009年1月至2010年12月共收治双侧ONFH患者22例44髋,男10例,女12例;年龄22~41岁,平均32.6岁;体重指数（BMI）16.5~30,平均23.9。按ARCO分期标准分为：Ⅱb期9髋,Ⅱc期14髋,Ⅲa期8髋,Ⅲb期5髋,Ⅲc期8髋。术中所取血管蒂均为旋股外侧血管升支髂棘支骨瓣转移术。双髋分两次进行手术,手术间隔12~16个月,平均14个月。 结果：随访时间为36~47个月,平均40.3个月,单髋术中失血量200~500 ml,平均358 ml。双侧髋关节术后6个月、12个月的Harris髋关节评分（HHS）均较各自术前有明显提高;双侧髋关节术后相同时间点的HHS评分比较无统计学差异。初次手术侧1髋术后出现切口脂肪液化经换药痊愈,其余均无围手术期并发症。术后根据ARCO分期标准2髋由Ⅲb期病变进展至Ⅲc期;1髋由Ⅲc期进展至Ⅳ期,并于术后14个月进行人工关节置换手术。 结论：应用带血管蒂髂骨瓣转移分两次手术治疗双侧ONFH,合适的手术间隔对初次手术侧功能恢复影响较小,双侧髋关节术后早期临床功能评价较高,是治疗双侧ARCOⅡ~Ⅲ期ONFH的有效方法。     

Bilateral nephrectomy for uncontrolled hypertension in hemodialysis patient: A forgotten option?

Resistant arterial hypertension in chronic hemodialysis patients is still a therapeutical challenge despite the development of modern antihypertensive drugs and dialysis procedures. Bilateral nephrectomy seems to be a forgotten option, although it has given good results. We present a case of a 39-year-old female chronic hemodialysis patient, in whom the problem of uncontrolled renal parenchymal hypertension remained despite multiple drug therapy and the ultrafiltration intensification. The problem was solved by bilateral nephrectomy. We discuss the role of bilateral nephrectomy for arterial hypertension control in chronic hemodialysis patients and the surgical and non-surgical options of nephrectomy.