腰椎骨母细胞瘤伴动脉瘤样骨囊肿的诊断分析

目的探讨腰椎骨母细胞瘤及动脉瘤样骨囊肿的影像特征及鉴别诊断。方法分析1例腰椎骨母细胞瘤伴动脉瘤样骨囊肿病人的CT和MRI表现及临床病理特征,并复习相关文献。结果 CT示病变呈膨胀型骨质破坏区,周围可见硬化,病变内可见斑点样高密度影。MRI示L3-4右侧附件区可见类圆形异常信号区,T1WI上呈等低信号,T2WI上呈等高信号,并可见"液-液"平面分层,伴相应水平脊髓受压、椎管狭窄。动态增强扫描病变呈明显不均匀强化,L3椎体骨髓亦呈强化效应改变。手术病理为骨母细胞瘤。结论腰椎骨母细胞瘤及动脉瘤样骨囊肿临床虽少见但其CT及MRI表现具有一定特征,有助于本病的诊断及鉴别诊断。     

中国老年髋部骨折流行病学和疾病经济负担研究现状

:全球人口的老龄化，使骨质疏松的发生率迅速增加，而髋部骨折作为骨质疏松最严重的并发症，其发病率和相关经济负担也增长迅速。中国是目前世界上老龄化比较严重的国家之一，且呈逐年加快的趋势。本文通过对老年髋部骨折发病率、骨折的直接原因及疾病经济负担的近年研究现状进行文献综述，以期为中国老年髋部骨折的预防和治疗相关的资源分配提供依据。     

轴向载荷分担比指导外固定器动力化的临床应用

目的:探讨轴向载荷分担比用于胫腓骨骨干骨折术后指导外固定器轴向动力化促进骨折愈合的有效性。方法:选取外固定器治疗的胫腓骨骨干骨折患者100例,随机分为观察组50例,对照组50例。观察组在轴向载荷分担比指导下行外固定器轴向动力化治疗,对照组未行动力化,随访比较两组的治疗效果。结果:所有患者均获随访,随访时间4～12个月,平均6.5个月,治疗期间所有患者均未出现外固定针断裂、松动及再骨折等并发症,观察组1例骨搬移患者轴向载荷分担比5%,X线片显示骨折断端有连续性骨痂通过,拆除外固定器连接杆后发生移位,恢复原数值行轴向加压再动力化,现已愈合。观察组除外1例骨搬移患者,其余49例患者外固定器固定时间为[(24.4±4.7)周],骨折临床愈合时间为[(22.4±4.7)周],与对照组50例患者外固定器固定时间[(29.3±5.6)周],骨折临床愈合时间[(27.3±5.6)周]比较,显著减少(P0.05)。结论:外固定器轴向载荷分担比指导胫腓骨骨干骨折外固定术后轴向动力化可以加速骨折愈合,但不适合骨搬移截骨端已硬化患者。     

全髋关节置换术治疗强直性脊柱炎致髋关节强直的疗效及康复锻炼的意义

Objective To investigate the clinical effects of total hip arthroplasty (THA) for bony ankylosis in patients with ankylosing spondylitis and the significance of postoperative rehabilitation. Meth-ods From October 1998 to May 2007, 28 patients (46 hips) suffered from ankylosing spondylitis with hip bony ankylosis underwent THA. There were 27 males, 1 female, with the mean age of 38.9 years (range 22 to 58 years). Posterior lateral hip incision was performed in 34 hips, and modified anterior lateral combined with lateral hip incision in 12 hips. Forty hips applied cementless THA and 6 hips applied mixed THA. Har-ris scores, VAS scores and total hip range of motion in all patients were compared pre-and postoperatively to evaluate the clinical effects. Results All patients were followed up from 10 months to 64 months, with the mean time of 38.2 months. No paralysis, decubitus, and lung infection were found. Joint dislocation hap-pened in 1 case 2 weeks after operation, and was cured with close reduction. Heterotopic bone formation with Brooker Ⅰ was found in 6 hips and Brooker Ⅱ in 2 hips. Harris score increased from 28.3±10.3 preop-eratively to 82.7±7.6 postoperatively. VAS score changed from 3.5±1.4 preoperatively to 3.8±1.8 postopera-tively, and no significance was found. The hip movement range increased from 15.6°±9.3° preoperatively to 133.7°±17.6° postoperatively. Bony ankylosis in all patients disappeared and the hip function improved sig-nificantly after operation. Conclusion THA is the optimal method to treat the ankylosing spondylitis with hip bony ankylosis. Early rehabilitation is necessary to improve hip function.     

骨质疏松相关基因的研究进展

骨质疏松(osteoporosis,OP)在很大程度上受基因的影响。在OP的相关基因中,维生素D受体(VDR)基因、雌激素受体(ER)基因、Ⅰ型胶原基因及转化生长因子基因都是重要的候选基因。VDR基因中BB基因型者比Bb及bb基因型者的腰椎骨密度(bone mineral density,BMD)低,骨丢失率高。FokⅠ基因型与腰椎BMD降低有明显相关性,ff基因型者腰椎BMDXx基因型者>xx基因型者。Ⅰ型胶原基因与骨量呈显著相关性,COLIA1基因突变可致低骨量、骨脆性增加。转化生长因子β(TGF-β)基因对调节骨形成和骨吸收有重要作用,TGF-β基因中可发生碱基丢失,这种变异多见于OP患者。     

危重病患者血乳酸水平与APACHEⅡ评分相关性研究

目的探讨预测危重病患者病情及预后的简便易行而有实用价值的指标。方法对48例EICU患者在入住EICU24h内分别进行APACHEⅡ和血乳酸浓度测定，比较不同APACHEⅡ评分分值组与血乳酸浓度。结果APACHEⅡ评分21～30分组血乳酸浓度明显高于11～20分组（P〈0．05），APACHEU评分〉30分组血乳酸浓度明显高于21—30分组（P〈0.01），血乳酸水平与APACHEⅡ评分显著相关（r=0.682，P〈0.01），死亡组血乳酸水平明显高于存活组。结论随着APACHEⅡ评分增高，血乳酸浓度也相应增高；血乳酸浓度与危重病严重程度正相关，是危重病严重程度的早期、敏感、定量的指标。