警惕下肢内固定术中主干动脉损伤

下肢骨折内固定术中动脉损伤很容易漏诊和延误治疗,并造成严重残废[1].2002年3月～2005年3月,笔者共收治4例下肢内固定术中并发主干动脉损伤病例.现报道并分析原因,旨在提高对这种损伤的警惕,最大限度地避免该并发症的发生.     

Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing

Nineteen patients (20 feet) with severe hindfoot and ankle deformity underwent tibiotalocalcaneal fusion with a retrograde locked intramedullary nail as a limb-salvage procedure. The purpose of this study was to compare the complication rates of this procedure in diabetic versus nondiabetic patients. There were 8 men and 11 women with preoperative diagnoses including Charcot neuroarthropathy, primary osteoarthritis, rheumatoid arthritis, equinocavovarus, posttraumatic osteoarthritis, gouty arthritis, and ankle malunion. Ten of 20 procedures were performed in patients with diabetes. The average patient age was 56 years, and the average postoperative follow-up was 19.8 months. Nineteen of 20 ankles (95%) achieved successful fusion with an average time of 4.1 months. Four patients (21%) required either a fracture brace or an ankle foot orthosis at final follow-up. Five patients (25%) had major complications and 11 patients had minor complications. Major complications included osteomyelitis (n = 2), Charcot arthropathy (n = 2), failure of fixation (n =1), soft-tissue necrosis (n = 1), cardiac arrest (n = 1), cerebral vascular accident (n = 1), and fatal pulmonary embolus (n = 1). All patients with major complications were diabetic, and 14 of 20 combined major and minor complications occurred in patients with diabetes. The complication rate was found to be high in diabetic patients with end-stage deformity undergoing a limb salvage     

Proximal myotonic myopathy

Three Swedish patients with proximal muscle weakness, myotonia and lack of CTG expansion on genetical analysis are presented. Clinical neurological and neurophysiological examination and muscle biopsy were performed. There was an indication of autosomal dominant inheritance in 2 of the 3 patients. The main symptoms and clinical findings in the 3 patients were weakness of the proximal muscles, myotonia, muscle stiffness, muscle pain and muscle atrophy. Neurophysiological examination showed myotonic bursts and muscle biopsy snowed a variation of fibre sizes, an increased number of muscle fibres with centralized nuclei and scattered atrophic muscle fibres. Laboratory data showed elevated CK, GT and LD in 1 patient. Before genetical analysis was performed, all 3 patients had been diagnosed as atypical cases of myotonic dystrophy. However, the symptoms, clinical signs, laboratory data, electrophysiological and muscle biopsy findings were compatible with proximal myotonic myopathy (PROMM).     

椎弓根钉内固定治疗胸腰椎骨折

目的：探讨脊柱胸腰段骨折椎弓根钉内固定治疗效果。方法：临床收治脊柱胸腰段骨折72例，均采用后路减压，Dick或RF系统钉内固定手术治疗。比较手术前后骨折复位及神经功能恢复情况。结果：术后椎体高度完全或基本恢复占95．8％，神经功能有Frankel一级以上改善，不完全截瘫占90％，完全截瘫占53．1％。随访3—38个月，无螺钉折断、后退及脊柱矫正度丢失。结论：开放复位后路椎弓根钉内固定是治疗胸腰椎骨折的有效方法。     

交锁髓内钉治疗股骨远端骨折

目的　观察带锁髓内钉治疗股骨远端骨折的效果。方法　从 1998年 4月～ 2 0 0 2年 3月 ,用带锁髓内钉17例 ,男性 13例 ,女性 4例 ,平均年龄 3 6.8岁 (范围 14～ 79岁 ) ,3例逆行穿钉 ,余 14例顺行穿钉固定。结果　随访 7个月以上的 14例 ,术后没发生脂肪栓塞、深静脉栓塞等并发症 ,亦无断钉病例。用改良膝关节功能评分 ,10例优、2例良、2例可。结论　带锁髓内钉扩大了髓内钉手术适应证 ,用于股骨远端骨折治疗 ,固定牢固、确实 ,术后可早期功能锻炼 ,疗效满意。     

NF-κB对尿白蛋白诱导肾小管上皮细胞骨桥蛋白转录的影响

目的研究NF-κB对尿白蛋白诱导肾小管上皮细胞骨桥蛋白转录的影响。方法去脂的小牛血清白蛋白(BSA)20mg/ml分别加入到体外培养的肾小管上皮细胞和加入NF-κB抑制剂(PDTC)共同培养半小时的肾小管上皮细胞内,EMSA、RT-PCR检测不同时限NF-κB活性、骨桥蛋白mRNA表达情况。结果去脂的小牛血清白蛋白可刺激肾小管上皮细胞内NF-κB活性增加,骨桥蛋白mRNA表达上调,而提前加入NF-κB抑制剂(PDTC)共同培养半小时的肾小管上皮细胞内NF-κB活性、骨桥蛋白mRNA表达明显下降。结论尿白蛋白诱导小管上皮细胞损伤的机制与诱导肾小管上皮细胞内NF-κB活性、骨桥蛋白mRNA增加有关,而且骨桥蛋白转录由NF-κB调控。     

伽马钉治疗股骨粗隆间不稳定型骨折68例

目的分析伽马钉（Gamma-Nail）治疗股骨粗隆间不稳定骨折的疗效.方法自1997～2004年治疗68例股骨粗隆间不稳定型骨折,按Tronzo-Evans分类,其中Ⅲ型36例,Ⅳ型22例,Ⅴ型10例.采用闭合复位,透视下穿针,伽马钉内固定.结果病人术后1～2周不负重下地活动,平均12周负重,13.4周骨折愈合.半年后随访,能独立行走59例,扶杖行走4例,借助轮椅行走2例,死亡3例.按照X线评定标准,86.8%疗效满意.结论伽马钉治疗股骨粗隆间不稳定型骨折,创伤小,手术时间短,恢复快,疗效满意,是治疗此类骨折的有效方法.     

髂股静脉血栓形成血浆降钙素基因相关肽测定的临床意义

目的　探讨降钙素基因相关肽对髂股静脉血栓形成的影响。方法　回顾性分析 5 0例髂股静脉血栓形成患者降钙素基因相关肽 (CGRP)的水平 ,以及对比研究联合应用尿激酶和复方丹参注射液治疗前后CGRP的变化。结果　急性髂股静脉血栓形成患者均存在高水平的CGRP ,与对照组比较具有显著性差异 (P <0 0 1) ;治疗后 6h血浆CGRP水平明显升高 ,3d达到最高峰 ,15d接近正常水平。结论　CGRP可以作为髂股静脉血栓形成的诊断指标之一 ,联合应用尿激酶和复方丹参注射液对髂股静脉血栓形成有较好的疗效。     

猪肾近端小管的超微结构

目的 研究猪肾近端小管的超微结构。方法 树脂包埋一超薄切片、透射电子显微镜技术。结果 猪肾近端小管可分S1、S2、S3和S4段构成，其中S1、S2段构成了近端小管曲部，S3、S4段构成了近端小管直部。本文对各段细胞超微结构特点进行详细的描述。结论 猪肾近端小管的超微结构与人肾近端小管最接近。     

MANAGEMENT OF CHONDROSARCOMA INCLUDING MODULAR CERAMIC AND ALUMINA PROSTHETIC REPLACEMENT

Forty-one cases of chondrosarcoma from varying sites throughout the body, and treated exclusively by one of the authors (R. L. H.) from 1972 to 1990 were reviewed. The symptoms, signs, location of tumours, treatment and progress are presented. Particular attention was paid to modular bone replacement techniques. Excision and reconstruction of the bone or joint were carried out in 17 femora, five tibia and six humeri. Comparison between this method of management and other techniques is discussed. Titanium and alumina prostheses for the hip, femur, tibia, shoulder and humerus have been designed by the senior author. These are both inert and modular, and have been found to be superior to other methods of treatment in both function and cosmesis. They do not possess the same potential donor infection risks and other disadvantages of allograft replacement. Immediate postoperative weight bearing and mobilization are possible with these systems. The Huckstep prostheses allow for bony in growth into their porous coated alumina sleeves, spacers and stems. In addition, the titanium alloy locking component for the femoral stems has an elasticity half that of other metal alloys and this was found to minimize stress shielding.