先天性输精管缺如患者生育问题的研究

自1988年至1991年共收治25例先天性输精管缺如患者,在20例行手术诊治术中15例用自体睾丸精索鞘膜制成人工精池囊,5例又在囊内放置用微涤纶制成的异质管。术中抽吸10例附睾内精子进行快速活化,其中5例活化成功,行人工授精,结果2例怀孕,1例已生育一女孩。认为该症是有生育可能的,但需要解决3个问题:(1)采用显微外科技术把附睾内部活着的精子取出一定数量;(2)选配好快速活化剂使精子快速活化成功;(3)用患者的精浆培养自己的精子。建议对梗阻性无精子症在用手术疏通精路的同时可以采用快速活化精子技术行人工授精,以提高生育的效果。     

胚胎颅骨骨膜移植修复髋关节软骨大面积缺损

１９９０年５月～１９９４年４月，对４２例（４７个髋）关节软骨全厚缺损患者采用冷冻保存胚胎颅骨骨膜移植进行修复，其中１４例股骨头骨质Ⅳ期坏死者，同时施行带旋髂深血管蒂髂骨植骨。对３４例（３８个髋）进行了２年～６年（平均４０个月）随访。结果表明，按照吴之康髋关节人工置换术后疗效评定标准，优良２５例，很好５例，好３例，尚可１例。认为，与自体移植物修复关节软骨大面积缺损相比，这种方法无附加损伤，具有移植材料、形态与股骨头相似等特点，是治疗髋关节软骨大面积缺损的一种有效方法。     

抗感染重组合异种骨对犬污染性桡骨缺损的一期植骨修复作用

目的探讨抗感染重组合异种骨(anti-infective reconstituted bone xenograft,ARBX)对犬污染性桡骨缺损的一期植骨修复的效果. 方法在重组合异种骨(reconstituted bone xenograft,RBX)基础上,结合抗生素局部缓释技术,制备具有较强抗感染能力和较高成骨作用的ARBX.取成年杂种犬8只,于双侧桡骨中上段制成15 mm节段性骨缺损,在缺损处注入5×106 CFU/ml金黄色葡萄球菌1 ml,静置15分钟后,于双侧缺损区分别植入ARBX、RBX,并用钢板固定.术后6个月对存活的6只犬进行取材,通过解剖学、X线片、组织学及细菌学检查,比较ARBX和RBX一期植骨修复犬污染性桡骨缺损的效果. 结果术后6个月,ARBX侧有5只完全修复,1只中央部3 mm缺损未修复,均无骨髓炎表现,标本细菌培养均为阴性.RBX侧有1只部分修复,5只未能修复,残留8～13 mm缺损,均有明显骨髓炎表现,标本细菌培养均为阳性. 结论 ARBX具有较高成骨活性和较强的抗菌能力,能够一期植骨修复细菌污染性骨缺损.     

异体跟骨移植及腓肠神经营养血管皮瓣修复跟骨缺损

目的　探讨应用同种异体跟骨移植及腓肠神经营养血管逆行岛状皮瓣 ,修复跟骨缺损的临床效果。　方法　 1996年 2月～ 2 0 0 2年 12月 ,采用同种异体跟骨移植及吻合腓肠神经营养血管皮瓣修复足跟骨缺损 6例。致伤原因为车祸伤 3例 ,机器绞扎伤 2例 ,砸伤 1例。其中跟骨后 1/ 3缺损 3例 ,后 1/ 2缺损 2例 ,后 2 / 3缺损 1例 ,均伴有足跟软组织不同程度缺损和跟腱断裂。皮瓣范围 6 cm× 7cm～ 12 cm× 17cm。急诊手术 2例 ,择期手术 4例。采用异体骨修复跟骨缺损 ,跟腱“Z”字形延长钢丝固定于再造跟骨粗隆处 ,修复软组织缺损。　结果　 4例皮瓣全部成活 ,2例皮瓣远端部分坏死 ,经换药后创面愈合。术后 X线片显示 :移植异体骨对位良好 ,恢复了足跟结构。术后 3～ 6个月足跟部皮瓣感觉恢复。所有患者均获随访 6个月～ 3年 ,植入的异体骨骨性愈合 ,未见明显吸收、感染和排斥反应等并发症。足外形饱满 ,可负重行走。　结论　应用同种异体跟骨修复跟骨缺损 ,取材方便 ,且符合人体自然结构及功能要求。采用腓肠神经营养血管皮瓣 ,不牺牲肢体的主要血管 ,手术风险小 ,操作简便、外形好、有感觉 ,可恢复行走功能     

骨水泥和种植体同期植入修复颌骨和牙列缺损的实验研究

目的：探讨高分子材料和种植体同期植入缺损区进行同步骨缺损修复和牙列缺损修复的可行性。方法：以4只杂种狗为研究对象，制备下颌骨长约2．5cm的缺损的动物模型(保留下颌骨下缘)，将骨水泥(聚甲基丙烯酸酯)植入骨缺损，同时将牙种植体植入骨水泥中并调整长轴方向，立即关闭术创。至术后3个月摄X线片，然后处死动物，局部巨检以了解骨水泥同骨组织的结合情况，并制备骨组织切片进行苏木精一伊红染色和甲苯胺蓝染色，以了解植入材料周边骨的生长情况及其对植入材料的反应。结果：术后3个月X线检查见骨缺损区充满骨水泥，骨水泥周边的骨小梁清晰，未见骨吸收或炎症表现，形成良好的骨-骨水泥界面，种植体则依赖其表面的螺纹结构与骨水泥间紧密的机械性嵌合而牢固的成为一体，植入的骨水泥块与周边天然骨结合紧密，无松动现象。植入材料周边局部脱钙骨的苏木精-伊红染色和甲苯胺蓝染色见骨结构正常，同时骨-骨水泥界有新骨形成。结论：骨水泥作为颌骨修复替代材料同期植入种植体是可行的。     

PRENATAL DIAGNOSIS Ⅰ. EARLY DIAGNOSIS OF OPEN NEURAL TUBE DEFECTS BY QUALITATIVE ACETYLCHOLINESTERASE ISOENZYME IN AMNIOTIC FLUID

The measurement of amniotic fluid (AF) acetylcholinesterase isoenzyme (AChEI) is a relatively new method for early diagnosis of open neural tube defects (NTDs). As quantitative methods are of unproven reliability at present, the authors used a high resolving power qualitative method-vertical slab polyaerylamide gel electrophoresis. The benefits of this technique are: simplicity of operation, accuracy, unsophisticated equipment, and easily available reagents. Combined results of 9 NTDs studies revealed that samples from early pregnancy gave more accurate results than those from late pregnancy.     

连续浅缝法修补膜周型室间隔缺损

目的探讨连续浅缝法修补单纯膜周型室间隔缺损(pVSD)法的效果。方法选取2002年1月至2004年10月我院收治的体重10kg以内(≤10kg)50例单纯膜周型室间隔缺损患者,均采用自体心包连续浅缝法修补。结果主动脉阻断时间32±21min(14-52min),体外循环时间56±35min(29-69min)。无°房室传导阻滞发生,9例发生右束支传导阻滞,2例结性心律。2例膜周偏流出道型VSD患者因前上缘残余分流分别为0.4cm和0.3cm,再次手术修补;1例后下缘残留细束样分流,直径0.15cm,随访6个月后自愈;10例膜周偏流出道型VSD患者剪开三尖瓣,8例垂直瓣环,2例平行瓣环;1例三尖瓣中度反流,随访无加重;5例轻度反流,4例轻微反流,随访均无加重;1例心包积液;1例再次进入手术室止血。结论连续浅缝法是修补单纯膜周型室间隔缺损的有效外科纠治方法。     

心脏跳动下修补小儿室间隔缺损的临床研究

目的　探讨在浅低温体外循环心脏跳动下完成小儿室间隔缺损修补术的可行性。方法　 18例小儿室间隔缺损随机分为观察组和对照组 ,观察组在浅低温体外循环心跳下修补室间隔缺损 ,对照组为常规心脏停跳下修补室间缺损。测定心肌同功酶释放和三磷酸腺苷 ,观察左室压力 ,评价术野显露及气栓预防效果等。结果　观察组心肌同功酶释放明显低于对照组 ,三磷酸腺苷含量明显高于对照组 ,心肌超微结构基本正常 ,术中左室压力低于主动脉压力 ,术后无气栓发生。结论　浅低温体外循环心脏跳动下行小儿室间隔缺损修补术能更好地保护心肌。术野显露技术和防气栓的方法简便可行。     

关节镜下应用“微骨折”方法修复关节软骨缺损

目的:探讨关节镜下应用“微骨折”技术对膝关节全层关节软骨缺损修复的效果。方法:对68例全层关节软骨缺损患者进行随机分组:实验组(35例),男17例,女18例,平均年龄35.1岁,采用关节清理后应用“微骨折”技术进行处理,即利用骨刀设计的特性和适度的锤击力量造成软骨下的骨组织微小骨折,刺激软骨生长。对照组(33例),男17例,女16例,平均年龄31.6岁,仅作关节清理术。结果:术后随访6~18个月,平均8.6个月,按Lysholm评分标准,实验组明显优于对照组(P<0.01)。结论:关节镜下应用“微骨折”技术能够显著减轻关节疼痛,增加关节活动度,改善关节功能,是一种简单有效的修复全层关节软骨缺损方法。     

Safety of, and biological and functional response to, a novel metallic implant for the management of focal full-thickness cartilage defects: Preliminary assessment in an animal model out to 1 year.

Focal full-thickness cartilage lesions of the human medial femoral condyle (MFC) can cause pain and functional impairment. Affected middle-aged patients respond unpredictably to existing treatments and knee arthroplasty may be required, prompting risk of revision. This study assesses the safety of, and biological and functional response to, a metallic resurfacing implant which may delay or obviate the need for traditional arthroplasty. The anatomic contour of the surgically exposed MFC of six adult goats was digitally mapped and an 11 mm diameter full-thickness osteochondral defect was created. An anchor-based Co-Cr resurfacing implant, matching the mapped articular contour, was implanted. Each goat's contralateral unoperated femorotibial joint was used as a control. Postoperative outcome was assessed by lameness examination, radiography, arthroscopy, synoviocentesis, necropsy, and histology up to 26 (n = 3) or 52 (n = 3) weeks. By postoperative week (POW) 4, goats demonstrated normal range of motion, no joint effusion, and only mild lameness in the operated limb. By POW 26 the animals were sound with only occasional very mild lameness. Arthroscopy at POW 14 revealed moderate synovial inflammation and a chondral membrane extending centrally across the implant surface. Radiographs at POWs 14 to 52 implied implant stability in the operated joints, as well as subchondral bone remodeling and mild exostosis formation in the operated and contralateral unoperated joints of some goats. By POW 26, histology revealed new trabecular bone abutting the implant. At POWs 26 and 52 MFC cartilage was metachromatic and intact in the operated and unoperated femorotibial joints. Proximal tibiae of some operated and unoperated limbs demonstrated limited subchondral bone remodeling and foci of articular cartilage fibrillation and thinning. The chondral membrane crossing the prosthesis possessed a metachromatic matrix containing singular and clustered chondrocytes. Our data imply the safety, biocompatibility, and functionality of the implant. Focal articular damage was documented in the operated joints at POWs 26 and 52, but lesions were much reduced over those previously reported in untreated defects. Expanded animal or preclinical human studies are justified.