弓形记忆加压接骨器的研制与治疗上肢管状骨骨折和骨不连（附57例报告）

本文报告了弓形记忆加压接骨器的研制和５７例临床应用结果。该器具有２个纵轴加压枝，２～８个半环固定枝。其超弹、记忆效应作用于上肢管状骨时，可为骨断端提供一种轴向的、动态的和持续的加压力（２４～５６ｋｇ）直至骨愈合。临床应用骨折３１例，骨不连２６例，术后弃用外固定，早期活动。随访４～３２个月，平均１３．７个月。骨折组术后平均２．２个月，骨折处为板状替代；骨不连组术后平均３．６４个月，不连处为板状替代。两组均未发现术后感染、骨不连等并发症，其中４６例于术后半年左右取出本器，随访中未见板状替代部再骨折。     

The role of endoluminal self-expanding stents in the management of pediatric tracheal stenosis

OBJECTIVE: Review of our experience in the management of pediatric tracheal stenosis using endoscopic techniques and self-expanding intraluminal stents. METHODS: Thirteen children (aged 1 week to 14 years) with various causes of tracheal stenosis were treated. A total of 15 stents were used, 13 self-expanding nitinol stents and 3 silicone self-expanding stents. Follow-up ranged from 6 month to 8 years. RESULTS: There were no stent related mortalities. Serious complications occurred in 4 patients [30.7%] but all were managed successfully. The most frequent problem was granulation tissue formation. Patient follow-up ranged from 6 months to 8 years. In the short-term (18-24 months) 12 stents remained patent and functional. On the longer term (5 years) 3 stents required removal, one required replacement and another resulted in stenosis. CONCLUSION: Endoluminal stenting can have an increasing role in the management of selected cases pediatric tracheal stenosis with acceptable morbidity and stable long-term results.     

Three-dimensional photoelasticity analysis of Nitinol Patellar Concentrator for treating patellar fractures

ood results are got when the patellar fractures aretreated by Nitinol Patellar Concentrator (NT-PC )L','],and the NT-PC is appraised to .be the idealest one amongall the methods on treating patellar fractu.,L3]. The objective of our experiment is to study the distribution of stressin patellar when it is fi-cated by NT-PC, which is made ofNi-Ti shape memory alloy. The biomechanical elements ofit in treating codrinuted patellax fractUres and distal polecoconuted patellar fractIJres is il…     

体外观察壳聚糖/重组水蛭素共价包被先天性心脏病介入封堵材料的生物相容性

目的:体外评价壳聚糖/重组水蛭素(Chi/r-Hir)共价包被先天性心脏病介入封堵材料镍钛合金的生物相容性。方法:①实验分6组:对照组(未接触镍钛合金的血液)、未包被组、Chi组和Chi/r-Hir低浓度、中浓度和高浓度组;②血液相容性实验:包括血液溶血试验和动态全人血接触试验。观察实验各组镍钛合金片溶解红细胞的特性;检测动态全人血接触后实验各组血液APTT、PT和TT,观察其抗血栓性能;扫描电子显微镜观察动态全人血接触后实验各组镍钛合金片表面血小板黏附、聚集和纤维蛋白吸附情况。③细胞相容性实验:将体外培养人脐静脉内皮细胞株(HUVECs)种植于实验各组镍钛合金表面,孵育72h,分别应用Fn和Ki67免疫荧光抗体标记,在荧光显微镜下观察HUVECs在镍钛合金表面的黏附、增殖情况并进行半定量分析。结果:①实验各组溶血率均小于1.7%;②动态全人血接触后,实验各组红细胞、白细胞、血小板计数均在正常值范围内且组间未见差异;与未包被组和Chi组相比,Chi/r-Hir包被明显延长APTT和TT(P<0.001);Chi/r-Hir包被延长APTT和TT作用与重组水蛭素浓度有关,低、中、高浓度组间相比存在差异(方差不齐采用Dunnetts法P<0.05);③扫描电镜结果显示,Chi/r-Hir组与Chi组相比,镍钛合金表面血小板黏附、聚集和纤维蛋白吸附明显减少。④细胞相容性实验:经过72h孵育,镍钛合金片边缘细胞生长和移行良好。Fn荧光标记观察HUVECs在镍钛合金片表面黏附依次为:Chi组>未包被组>Chi/r-Hir组,Chi/r-Hir包被不同浓度组间HUVECs黏附未见差异;Ki67免疫荧光标记观察HUVECs在镍钛合金表面增殖依次为:未包被组=Chi组>Chi/r-Hir组,Chi/r-Hir包被不同浓度组间HUVECs增殖未见差异。结论:Chi/r-Hir包被先天性心脏病介入封堵材料镍钛合金后,具有良好抗凝性能,但不利于HUVECs黏附和增殖。     

ENDOSTAB: An Endoscopic Pressure Stabiliser for Minimally-Invasive Cardiac Surgery using Specially Etched Superelastic NiTi Wires for Joint-like Behaviour

For a long time, the only way to access the heart for a bypass operation was to sever the sternum (median sternotomy). Encouraged by the successes achieved by minimally-invasive surgery in other fields, cardiosurgery underwent rapid development, which eventually enabled thoracoscopic operations of the heart. Only with the development of complex robot systems and telesurgery, however, did it become possible to perform exclusively endoscopic bypass operations. Today, the heart-lung machine (HLM) is used as a standard device for bypass operations, with cardiac arrest induced by an infusion. Studies have shown that the HLM may lead to a significant inflammatory reaction and that it is advantageous, particularly for patients with bad cardiac function, to avoid cardiac arrest and keep the heart continuously supplied with blood. ‘Stabilisers’ have been developed to enable bypass operations on the beating heart without using an HLM. For operations on the beating heart using an exclusively endoscopic robot system, an endoscopic stabiliser has been developed, in cooperation with the Leipzig Cardiovascular Institute. The stabilisers that are already available are rigid and, hence, only suitable for an ‘open’ intervention, in conjunction with a retractor. Based on a flexible, superelastic unit made of NiTi, a stabiliser has now been developed that allows endoscopic insertion via a tube of 10 mm in diameter. Joint-like behaviour is achieved by the shaping of the NiTi wires and the specific removal of material in the curved areas. In the operating state, the stabiliser IS still rigid enough to immobilise the desired vascular section. The ENDOSTAB endoscopic stabiliser has already been successfully used in animal experiments at the Leipzig Cardiovascular Institute. The way is thus paved for exclusively endoscopic bypass operations on the beating heart without the use of an HLM.     

Mechanical comparative analysis of stents for colorectal obstruction

The goal of this work is the mechanical comparison of different types of stents for colorectal obstructions. We consider self‐expanding and balloon‐expanding stents made of two different materials such as stainless steel and shape memory NiTi alloy. The mechanical parameters are expansion rate, shortening, radial compression resistance, longitudinal and perimetral adaptability, and buckling resistance. This analysis results in a better understanding of global mechanical behavior and also allows better design and device selection for colonic lesions.     

国产镍钛支架治疗恶性胆道梗阻的临床分析

目的:探讨经皮肝穿胆道植入国产镍钛支架治疗恶性梗阻性黄疸的价值和临床效果。方法:在X线监视下,22例恶性梗阻性黄疸患者经皮肝穿植入国产镍钛合金自膨式裸支架24枚,恶性梗阻的原因分别为胆管细胞癌8例,胰头癌6例,肝癌3例,壶腹癌2例,肝门转移性病变3例。结果:22例患者共24枚支架全部成功植入,术后21例患者症状缓解,总胆红素明显降低。1例患者术后1天出血死亡,30天生存率为95.5%.4个月和7个月后分别有3枚支架堵塞,通过支架内支架和钢丝疏导解除。结论:国产镍钛合金自膨式裸支架性能良好,临床疗效满意。     

镍钛合金支架治疗股浅动脉粥样硬化闭塞症

目的 探讨镍钛合金支架治疗股浅动脉粥样硬化闭塞症(Atherosclerosis Obliterans,ASO)的疗效。 方法 回顾性分析自2009年1月至2013年2月采用动脉支架植入治疗的132例（139条肢体）股浅动脉ASO的临床病例。股浅动脉病变的长度2.4―25.9cm,平均12.6±8.8cm。Fontaine分级：Ⅱa26条,Ⅱb52条,Ⅲ43条,Ⅳ18条。TASC-Ⅱ( Trans Atlantic Inter-Society Consensus, 泛大西洋介入学会联盟) 分型A 型33条, B 型51条, C型40条, D型15条。术后第6个月 12个月,24个月,36个月进行门诊随访患者临床症状、踝肱指数（ankle-brachial index,ABI）、彩色多普勒超声检查(color duplex ultrasonography,CDU),动脉CTA(Computed Tomography Angiography,CT血管显像)和（或）动脉造影评估支架的通畅情况,利用生存分析来统计支架的通畅率和保肢率,观察临床症状的改善情况。 结果 ABI由术前0.31±0.22增至术后0.80±0.28;流出道有3支通畅的有41条,2支的是55条,1支的是43条。随访时间14 -36个月,术后6个月、12个月、24个月、36个月的一期通畅率分别为97.0%、81.1%、75.3%、65.1%,二期通畅率分别为98.6%、88.6%、77.8%、73.7%。闭塞长度≥15cm和＜15cm的3年通畅率分别为50.8%、73.1%;1支流出道和流出道≥2的3年通畅率分别为59.2%、71.4%;TASC-ⅡA、B和C、D型的3年通畅率分别为75.6%、57.1%;Fontaine分级Ⅱ和Ⅲ、Ⅳ3年通畅率分别为76.8%、50.3%。3年保肢率为93.5%。 结论 镍钛合金支架治疗股浅动脉ASO安全、有效,病变长度越短,Fontaine分级越早,流出道越多越有利于保持较高通畅率。     

应用钛镍合金－硅橡胶组合式人工食管研究食管重建

目的 探讨食管部分切除后,食管重建的过程及机制。方法 本实验以钛镍合金、硅橡胶作材料制成组合式人工食管,以普通家猪作动物实验,切除一段长约7cm的胸段食管,以人工食管替代,分别于术后第1、2、3、4、5、6、7、8周及3、4、6、8、10、12个月处死动物,动物尸体解剖,标本作连续切片病理观察,分析食管缺损部分重建情况,结果 1.1周时间人工食管周围形成假道,即“新生食管”,包绕人工食管;2.“新生食管”起初以肉芽组织为主(约2周),2周后代以纤维结缔组织;3. 约4周后,食管上皮细胞爬行并可完全覆盖“新生食管”内腔;4.本实验可观察到新生的平滑肌细胞,但未见到腺体再生;5. 人工食管脱落后“新生食管”中间段均见不同程度的狭窄,随着时间的增加（约6个月后）,狭窄段趋于稳定。结论 一定长度下的食管缺损可通过自身重建修复。