残肢超声图像重建及骨骼与皮肤特征提取

目的针对假肢接受腔设计过程中，常规CT获取扫描残肢断层数据成本高和电离辐射大等问题，设计用超声波测量方法获取残肢骨骼皮肤轮廓。方法首先开发超声波测量装置测量残肢，得到残肢超声图像，再设计复合算法对超声图像进行二维重建，完成残肢骨骼与皮肤的特征提取。结果和结论与同类断层扫描技术相比，超声波测量方法极大地降低了成本和减少了辐射，为假肢康复工程领域等图像的断层扫描提供了一种新的手段。     

改良跗骨窦切口解剖型锁定钢板内固定治疗Sanders Ⅲ-Ⅳ型跟骨骨折

目的:探讨改良跗骨窦切口解剖型锁定钢板内固定治疗SandersⅢ-Ⅳ型跟骨骨折临床疗效。方法:2015年2月至2016年10月采用改良跗骨窦切口解剖型锁定钢板内固定治疗SandersⅢ-Ⅳ型跟骨骨折35例,其中男22例,女13例;年龄22～68(42.3±12.7)岁;根据Sanders分型,Ⅲ型23例,Ⅳ型12例。观察术后并发症情况,比较手术前后跟骨B?hler角、Gissane角改变情况,并于术后12个月时采用Maryland足功能评分标准评价患足功能恢复情况。结果:35例患者获得随访,时间12～20(14.5±2.0)个月。切口长度4.0～5.5(4.7±0.4)cm。1例切口浅表感染,2例切口延迟愈合,腓肠神经损伤1例,随访无钢板外露、松动,无骨折复位丢失并发症。切口愈合时间14～28(15.4±4.7)d,骨折愈合时间8～14(9.8±1.9)周。B?hler角由术前的(9.81±14.28)°恢复至术后3 d的(26.35±11.04)°、术后12个月的(25.96±10.79)°,差异有统计学意义(P0.05)。Gissane角由术前的(122.54±16.79)°恢复至术后3 d的(120.85±11.88)°、术后12个月的(120.62±11.44)°,差异有统计学意义。Maryland评分由术前的12.66±4.10提高至术后12个月的92.20±7.82,其中优32例,良2例,可1例。结论 :改良跗骨窦切口解剖型锁定钢板内固定治疗SandersⅢ-Ⅳ型跟骨骨折,切口小,软组织损伤程度低,并可获得良好的骨折复位与固定,是SandersⅢ-Ⅳ型跟骨骨折有效的微创治疗方法。     

无头加压螺钉辅助富血小板血浆局部应用治疗陈旧性跖骨头关节内骨折的临床疗效观察

目的:探讨采用无头加压螺钉辅助富血小板血浆(platelet-rich plasma,PRP)局部应用治疗陈旧性跖骨头关节内骨折的临床疗效。方法:自2010年1月至2016年6月,采用切开复位无头加压螺钉内固定辅助PRP局部应用治疗7例陈旧性跖骨头关节内骨折患者,其中男5例,女2例;年龄21～52岁;摔伤5例,硬物砸伤2例;受伤时间3～6周。术前行足部X线片及三维CT重建检查,其中第2跖骨2例,第3跖骨2例,第4跖骨3例。术后观察骨折愈合情况,并采用美国足踝骨科协会(AOFAS)足踝评分进行临床疗效评价。结果:7例患者获得随访,时间6～15个月。所有患者伤口达到Ⅰ期愈合,未出现伤口感染、皮瓣坏死、神经血管损伤等软组织并发症。影像学检查均达到骨性愈合,愈合时间3～6个月。7例患者中1例在随访中出现跖趾关节僵硬。AOFAS评分由术前的40.5±4.2提高至术后12个月的85.0±10.5;优4例,良2例,可1例。跖趾关节活动范围:背伸35°～40°,跖屈25°～35°。结论:采用无头加压螺钉内固定辅助PRP局部应用治疗陈旧性跖骨头关节内骨折,可恢复跖骨头关节面平整,提高跖趾关节活动度,促进骨折断端愈合,无须二次手术,配合早期功能锻炼,疗效满意。     

Essence of "Shen (Kidney) Controlling Bones": Conceptual Analysis Based on Hypothalamic-Pituitary-Adrenal-Osteo-Related Cells Axis

As a traditional concept of Chinese medicine (CM), the theory of “Shen (Kidney) controlling bones” has been gradually proven. And in modern allopathic medicine, the multiple mechanisms of bone growth, development and regeneration align with the theory. Shen deficiency as a pathological condition has a negative effect on the skeleton of body, specifically the disorder of bone homeostasis. Present studies indicate that Shen deficiency shares a common disorder characterized by dysfunction of hypothalamic-pituitary-adrenal (HPA) axis. HPA axis may be an important regulator of bone diseases with abnormal homeostasis. Therefore, we posit the existence of hypothalamic-pituitary-adrenal-osteo-related cells axis: cells that comprise bone tissue (osteo-related cells) are targets under the regulation of HPA axis in disorder of bone homeostasis. Chinese herbs for nourishing Shen have potential in the development of treatments for disorder of bone homeostasis.     

The Bones in Chronic Liver Disease

Patients with chronic liver disease have been studied for evidence of osteomalacia ro osteoporosis. No evidence of osteomalacia was found in eleven patients with chronic hepatocellular jaundice of four months to four years duration, nor in ten other patients with chronic liver disease who were not jaundiced. In these subjects, and in an additional seventeen non-jaundiced patients with cirrhosis of the liver, there was evidence of osteoporosis as judged by measurements of the thickness of the metacarpal cortex.     

核素骨显像中影响椎体转移瘤检出率的因素

目的 探讨核素骨显像中影响脊椎转移瘤检出率的因素。方法 回顾性分析110例经病理或临床证实的脊椎转移瘤患者的核素骨显像、CT和MRI,观察并记录单纯椎体受累的椎体内病灶的数目、位置、体积、转移类型、有无压缩等。结果 CT和MR显示单纯椎体受累脊椎356个。核素骨显像对于髓内型、 皮质下型及皮质型病灶的检出率分别为2.00%(1/50)、25.00%(38/152)、58.78%(77/131),3组间差异有统计学意义(χ²=63.31,P<0.001);对小(体积<523 mm³)、中(体积523~4186 mm³)、大病灶组(体积>4186 mm³)的检出率分别为5.98%(7/117)、41.76%(71/170)和84.78%(39/46),3组间差异有统计学意义(χ²=96.47,P<0.001)。在中等病灶组,核素骨显像对于溶骨性和成骨性转移病灶的检出率分别为28.42%(27/95)、51.72%(30/58),差异有统计学意义(χ²=8.37,P<0.005)。对于压缩和非压缩骨折,核素骨显像的检出率分别为95.65%(22/23)、34.83%(116/333),组间差异有统计学意义(χ²=33.52,P<0.001)。结论 脊椎转移病灶的位置、体积、转移类型及椎体有无压缩骨折是影响核素骨显像检出率的重要因素。     

外固定架在膝及小腿血管损伤修复中的应用

 目的 探讨外固定架在膝、小腿血管损伤中的应用效果。方法 回顾性分析2004年5月至2010年10月应用外固定架治疗的208例（234侧）膝及小腿血管损伤患者资料,男192例（217侧）,女16例（17侧）;年龄14~67岁,平均39.6岁。损伤血管：腘动脉84例（86侧）,胫前动脉36例（46侧）,胫后动脉41例（49侧）,胫前后动脉47例（53侧）。伤肢远端完全缺血129例（141侧）,不完全缺血79例（93侧）。所有患者均行急诊手术。采用AO通用外固定架164例,创生镶嵌式外固定架37例,组合式外固定器7例。血管采用直接或大隐静脉桥接吻合。创面采用一期包扎、植皮、皮瓣移植和VSD负压吸引治疗。结果 194例保肢成功, 14例因伤肢毁损严重及全身情况差于术后2~4 d截肢。术后43例患者创面自行愈合,127例二期行手术清创植皮或皮瓣治疗,24例一期行游离皮片或皮瓣移植覆盖。148例获得8个月~3年的完整随访,其中6例因患肢功能严重受限且伴发骨髓炎而自愿要求截肢。拆除外固定架时间1~18个月,平均7.2个月。102例骨折获得愈合,时间为3~13个月,平均5.6个月;40例出现骨折不愈合、骨缺损,行骨折内固定+植骨术或骨段滑移术,骨折均愈合。结论 外固定架具有固定可靠,可在短时间内复位骨折,减少肢体缺血时间等优点,利于膝、小腿血管损伤的修复。     

高效液相色谱法测定生骨散中柚皮苷的含量

目的：建立测定生骨散中柚皮苷含量的HPLC 方法,用以更好地控制其质量。方法采用HPLC 法, Warters-C18（250mm×4.6mm,5μm）色谱柱,流动相为甲醇-水（33∶67）,流速为1.0mL·min-1,紫外检测波长为283nm,柱温为25℃。结果柚皮苷在0.0705～1.4100μg线性关系良好, r=1.0000,平均回收率98.35%, RSD=0.97%。结论本方法准确、简便、快速,可作为生骨散中柚皮苷的含量测定方法。     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

Sonography of acute osteomyelitis in rabbits with pathologic correlation

RATIONALE AND OBJECTIVES: Ultrasonography (US) has a potential role in the diagnosis of osteomyelitis. The purpose of this study was to determine the characteristic sonographic features of acute osteomyelitis and correlate them with pathologic findings. MATERIALS AND METHODS: An experimental model of acute osteomyelitis was produced in the tibiae of 20 rabbits. Daily US and plain radiography were performed for 2 weeks. The authors evaluated periosteal reaction, subperiosteal fluid collection, and soft-tissue changes seen with US. A hypoechoic band and a hyperechoic line lying along the cortex were considered positive signs of subperiosteal fluid collection and periosteal reaction, respectively. The findings of periosteal reaction were compared for US and radiography, and pathologic findings were also correlated. RESULTS: The most common sonographic finding was a hypoechoic band along the cortex (21 [75%] of 28 tibiae), usually associated with a linear periosteal reaction (20 [71%] of 28). This juxtacortical abnormal echogenicity corresponded to periosteal elevation with loose fibrovascular connective tissue and granulation, associated with subperiosteal abscess formation. The periosteal reactions were detected with US before they were seen on radiographs. The periosteum showed gradual thickening during the disease process. In 50% of infected tibiae, inflammation or abscess formation was observed in the surrounding soft tissue. CONCLUSION: US readily demonstrates juxtacortical abnormal echogenicity and soft-tissue infection related to acute osteomyelitis. The abnormal echogenicity correlated well with the pathologic findings of periosteal reaction and subperiosteal abscess.