胸锁钩钢板治疗锁骨近端骨折伴胸锁关节脱位

目的： 探讨新型胸锁钩钢板治疗锁骨近端骨折伴胸锁关节脱位的临床疗效。方法： 回顾性分析2011年6月至2019年1月采用新型胸锁钩钢板进行内固定治疗的13例锁骨近端骨折伴胸锁关节脱位患者的临床资料,其中男9例,女4例;年龄26~78（54.08±13.91）岁。记录患者的手术时间、出血量、住院时间、术后并发症等情况。术后根据X线和CT评估骨折复位以及愈合情况。术后12个月采用Constant-Murley评分和Rockwood胸锁关节评分评定患肢功能恢复情况。结果： 13例患者均获得随访,时间12~24（16.77±4.63）个月。切口均Ⅰ期愈合,愈合时间9~13（11.00±1.75） d,骨性愈合时间3~4（3.65±0.46）个月。手术时间50~76（54.08±13.91） min,术中出血量20~56（46.08±11.15） ml,住院时间6~14（8.31±2.32） d。术后未出现感染、内固定失败、神经损伤等并发症。术后12个月Constant-Murley评分为（87.83±11.26）分;Rockwood评分（13.70±1.85）分,其中优11例,良1例,可1例。结论： 采用新型胸锁钩钢板治疗锁骨近端骨折伴胸锁关节脱位,可以早期进行关节功能锻炼,患者功能恢复优良,是治疗锁骨近端骨折伴胸锁关节脱位的有效方法。     

新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的疗效观察

目的:探讨新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折脱位的临床疗效。方法 :自2011年6月至2013年12月,应用胸锁钩钢板对32例成年胸锁关节骨折脱位患者进行手术治疗。其中男24例,女8例;年龄25~76岁,平均42岁;胸锁关节前脱位12例,胸锁关节后脱位5例,锁骨内侧端骨折10例,骨折合并脱位5例。胸锁关节前骨折脱位采用标准胸锁钩钢板,后脱位则在钢板钩的远端,即胸骨柄前方加用螺母和垫片,预防术后再脱位。根据Rockwood评分法评定疗效。结果 :患者手术过程中无并发症发生。术后复查X线片及CT显示胸锁关节解剖位置正常,内固定位置良好。32例均获得随访,时间6~24个月,平均10个月。术后3~6个月骨折达Ⅰ期愈合,胸锁关节无再脱位,锁骨内侧端解剖结构均恢复,功能满意,其中9例患者胸锁关节周围存在肿胀,但无疼痛等症状。Rockwood评分结果12.78±1.43;疗效优24例,良8例。结论:使用该新型胸锁钩钢板治疗胸锁关节周围不稳定性骨折,内植物固定确实可靠,安全性高,操作简便,为治疗此类创伤提供了一种可靠的方法。     

经腓骨骨折端辅助复位治疗外后踝合并关节面压缩骨折的病例对照研究

目的 :比较经腓骨骨折端辅助复位和经跟腱内侧辅助复位结合外后侧内固定治疗外后踝合并关节面压缩骨折的临床疗效。方法:自2012年1月至2015年1月,治疗外后踝合并关节面压缩骨折52例,采用经腓骨骨折段辅助复位内固定治疗24例(A组),男16例,女8例;年龄20~65岁,平均(35.2±6.4)岁;经跟腱内侧入路辅助复位内固定治疗28例(B组),其中男18例,女10例;年龄22~62岁,平均(36.4±4.8)岁。观察并比较两组患者的手术时间、出血量、切口长度、X线暴露次数及并发症发生情况,术后采用美国足踝外科协会踝-足(AOFAS)评分对两组患者的功能进行评价。结果:所有患者均获得随访,A组随访时间13~55个月,平均(27.5±2.5)个月;B组随访时间12~54个月,平均(28.5±2.4)个月。所有患者获得骨性愈合,愈合时间10~16周,平均12周。B组有2例出现切口感染,1例出现螺钉松动;A组无切口感染发生,1例出现螺钉松动。两组手术时间、出血量、X线暴露次数及并发症情况比较差异有统计学意义;两组踝关节AOFAS功能评分比较差异无统计学意义。结论:与经跟腱内侧辅助复位相比,经腓骨骨折端辅助复位治疗外后踝合并关节面压缩骨折具有出血少、手术时间短、X线暴露次数少、踝关节功能恢复好的优点,特别在处理常规入路难以复位的嵌夹的后外侧关节面压缩骨块,优势明显。     

Corona Mortis血管解剖学研究及其临床意义

目的:探讨闭孔血管和髂外血管在腹股沟区的分支,为减少髂腹股沟入路术中出血提供解剖学基础。方法:对25具新鲜中国成人尸体标本共50侧半骨盆进行解剖学研究,观测闭孔血管和髂外血管在腹股沟区的分支及其吻合支(CoronaMortis血管)的大小、出现率、吻合血管行径和吻合血管至耻骨联合的距离。结果:72%(36侧)耻骨上支表面至少存在1条血管吻合支,其中28%(14侧)存在2条或3条血管吻合支,24%(12侧)同时存在动脉吻合支和静脉吻合支。耻骨上支表面的血管吻合支平均直径2.6mm(2.0～4.2mm)。血管吻合支紧贴耻骨上支或髂耻隆起,几乎垂直地下行于髋臼窝壁或耻骨支后方,经闭膜管出盆腔,血管吻合支与耻骨联合的平均距离52mm(38～68mm)。在此区域手术以及髋臼或骨盆前环骨折极易损伤CoronaMortis血管。结论:闭孔血管和髂外血管的吻合支较粗,出现率高,位于耻骨上支表面。髂腹股沟手术入路应特别注意CoronaMortis血管的存在。     

促红细胞生成素对急性脊髓损伤大鼠脊髓功能保护的实验研究

目的探讨促红细胞生成素(erythropoietin,EPO)在大鼠急性脊髓损伤后抑制凋亡相关蛋白caspase-3的表达。方法 30只SD大鼠,随机分为假手术对照组、脊髓损伤组和脊髓损伤EPO治疗组。其中脊髓损伤组和EPO治疗组采用改良A llen′S打击法制作脊髓损伤动物模型,假手术对照组同法显露脊髓,但不打击。EPO治疗组大鼠于术后1h腹腔一次性注射重组人促红细胞生成素(1000 IU/kg),其余两组大鼠则腹腔注射等量生理盐水。术后24h,3组大鼠均麻醉处死,切取损伤段脊髓,用HE染色观察损伤脊髓组织病理变化,同时检测其凋亡相关蛋白caspase-3的表达。结果术后24h,HE染色发现该段脊髓出现大量囊腔,伴炎症细胞浸润和胶质细胞增生,神经元亦出现水肿以及部分溶解消失,而EPO治疗组上述病理变化程度较轻微。免疫组化结果发现,损伤组凋亡相关蛋白caspase-3的表达显著增加,EPO治疗组该蛋白表达亦比假手术组增加,但比脊髓损伤组大鼠表达减少,差别有显著性意义(P<0.01)。结论急性脊髓损伤后,损伤处脊髓发生明显的组织坏死和炎性反应,而EPO治疗能明显减轻上述反应,同时凋亡相关蛋白caspase-3的表达亦明显减少,而这可能是其脊髓损伤的保护机制之一。     

Yikang decoction facilitates embryo implantation in mice with implantation dysfunction via upregulation of LIF expression

ObjectiveThe present study investigates the effects and mechanisms of Yikang decoction on embryo implantation in mice.MethodsTotally, mature female mice were randomly divided into four groups: normal, implantation failure (mifepristone treatment), Yikang decoction treatment (mifepristone and Yikang decoction treatment), and control (mifepristone and physiological saline treatment) groups. The efficacy of Yikang decoction was evaluated by the adhesion of uterine endometrial cells. The expression of leukemia inhibitory factor (LIF) and integrin αvβ3 in the endometrium were detected by real-time quantitative PCR and western blot. In addition, mouse endometrial cells were transfected with LIF specific siRNA-1, and the expression of LIF and αvβ3 were detected.ResultsThe number of embryos markedly decreased after mifepristone treatment. The adhesion of endometrial cells in the Yikang decoction treatment group significantly increased, when compared to the control group. The expression of LIF and integrin αvβ3 was significantly reduced by mifepristone, but the attenuated expression of LIF and αvβ3 was markedly reversed by treatment with Yikang decoction. In addition, after LIF siRNA-1 transfection, the expression of integrin αvβ3 significantly decreased (P < 0.01). The correlation analysis revealed a significant positive correlation between LIF and αvβ3 protein expression.ConclusionYikang decoction can regulate the expression of αvβ3 and increase cell adhesion by upregulating the expression of LIF, thereby improving embryo implantation in mice. These data suggest that Yikang decoction may have therapeutic effect in treating infertility.     

拇指尺背侧逆行皮瓣修复拇指末节软组织缺损

随着经济发展,手外伤患者越来越多,其中拇指外伤对患者的劳动力影响最大,临床上对其修复办法进行了大量研究,有较多修复办法,但各有利弊。我们应用拇指尺背侧逆行皮瓣修复拇指远节软组织缺损患者3例,疗效满意,报告如下。     

Change in Urinary Markers of Osteoclast Activity Following Palliative Radiotherapy for Bone Metastases

AimsTo examine the effect of radiotherapy for bone metastases on urinary markers of osteoclast activity.Materials and methodsPatients with radiological evidence of bone metastases planned for palliative radiotherapy were eligible for the study. A urine specimen was collected before and 1 month after radiotherapy to assess levels of calcium, creatinine, magnesium, phosphate, N-telopeptide and pyridinoline. The Brief Pain Inventory was completed in person at baseline and by telephone follow-up at 1 month after radiotherapy. Patients were classified as responders (complete or partial pain response) or non-responders (stable or progressive pain) to radiotherapy based on the International Bone Metastases Consensus Criteria for end point measurements. Absolute values of urine markers were compared between responders and non-responders, or between responders and patients with progression.ResultsOur study population consisted of 74 men and 51 women. A single 8 Gy or 20 Gy in five daily fractions were commonly employed. At the 1 month follow-up, all Brief Pain Inventory functional interference scores showed a highly significant decrease from baseline (P < 0.01). From our study population, 58 (64%) were classified as responders and 57 (46%) as non-responders to radiotherapy. We compared the urinary markers between the responders and the non-responders. There were no statistically significant differences between the two groups either in terms of baseline markers or in terms of month 1 follow-up markers. There was no significant change from baseline to the 1 month follow-up in responders or in non-responders to radiotherapy.ConclusionBaseline levels of urinary markers could not predict which patient would benefit from palliative radiotherapy.