导航下与传统方法应用动力髋螺钉治疗老年股骨转子间骨折的疗效比较

Objective To compare the navigational and traditional dynamic hip screw (DHS) fix-ations in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was conducted to analyze the elderly patients with intertrochanterie fracture who had been treated in our de-partment from April 2005 to April 2007 and whose clinical data were complete. Enrolled in the present study were 25 cases that had received navigational DHS fixation and 31 cases who had received traditional DHS fixation. In navigational group, there were 10 males and 15 females, with an average age of 82. 1 years. They were 14 eases of Evans type Ⅰ and 11 Evans type Ⅱ. In traditional group, there were 12 males and 19 fe-males, with an average age of 82. 8 years. They were 16 cases of Evans type Ⅰ and 15 Evans type Ⅱ. The 2 groups were compared in incision length, operation time, bleeding volume, X-ray exposure time, bed-ridden time, medical and implant complications, and one-year functional recovery. Results In navigational group, 23 patients were followed for 11 to 20 (average, 14) months and 2 were lost. In traditional group, 30 patients were followed up for 14 to 23 (average, 18) months and 1 died from cardiovascular disease within 1 year. Compared with traditional group, navigational group had a smaller incision, less blood loss, shorter bed-ridden time and less X-ray exposure time, a higher rate of fracture healing at 3 months, with statistically significant differences (P <0.05). The Harris hip function scores at postoperative 1 year were of no significant difference between the 2 groups (P > 0.05) . In navigational group there were 3 medical and 1 implant complications. In traditional group there were 9 medical and 5 implant complications. There was no significant difference between the 2 groups (P > 0.05). Conclusion In the treatment of intertrochanteric fractures for the elderly patients, the navigational DHS fixation is superior to traditional DHS fixation due to its ad-vantages of smaller incision, less blood loss, shorter bed-ridden time, faster fracture healing and betterfunctional recovery.     

BMP-2对人退变椎间盘髓核细胞影响的实验研究

[目的]探讨BMP -2对人退变髓核细胞合成细胞外基质的影响.[方法]分离、培养人退变椎间盘髓核细胞,取第2代髓核细胞,随机将退变推间盘髓核细胞分为2组.A组:加入100 ng/ml BMP -2,B组:加入200 ng/mlBMP -2,C组:对照组,不加干扰因素.通过对试验组和对照组髓核细胞采用光镜、电镜等形态学方法进行大体形态和超微结构观察,细胞Ⅱ型胶原和糖胺多糖的mRNA表达.ELISA检测细胞培养上清中人Ⅱ型胶原含量,DMMB比色法检测细胞培养上清中糖胺多糖含量.[结果]髓核细胞中Ⅱ型胶原、糖胺多糖表达水平实验组均高于对照组.[结论] BMP-2蛋白可促进退变腰椎间盘细胞分泌蛋白多糖和Ⅱ型胶原,增加细胞活性,恢复椎间盘的功能和活性,因此运用BMP-2椎间盘内注射有望成为椎间盘退变疾病生物治疗的方法之一.     

导航下与传统方法应用动力髋螺钉治疗老年股骨转子间骨折的疗效比较

Objective To compare the navigational and traditional dynamic hip screw (DHS) fix-ations in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was conducted to analyze the elderly patients with intertrochanterie fracture who had been treated in our de-partment from April 2005 to April 2007 and whose clinical data were complete. Enrolled in the present study were 25 cases that had received navigational DHS fixation and 31 cases who had received traditional DHS fixation. In navigational group, there were 10 males and 15 females, with an average age of 82. 1 years. They were 14 eases of Evans type Ⅰ and 11 Evans type Ⅱ. In traditional group, there were 12 males and 19 fe-males, with an average age of 82. 8 years. They were 16 cases of Evans type Ⅰ and 15 Evans type Ⅱ. The 2 groups were compared in incision length, operation time, bleeding volume, X-ray exposure time, bed-ridden time, medical and implant complications, and one-year functional recovery. Results In navigational group, 23 patients were followed for 11 to 20 (average, 14) months and 2 were lost. In traditional group, 30 patients were followed up for 14 to 23 (average, 18) months and 1 died from cardiovascular disease within 1 year. Compared with traditional group, navigational group had a smaller incision, less blood loss, shorter bed-ridden time and less X-ray exposure time, a higher rate of fracture healing at 3 months, with statistically significant differences (P <0.05). The Harris hip function scores at postoperative 1 year were of no significant difference between the 2 groups (P > 0.05) . In navigational group there were 3 medical and 1 implant complications. In traditional group there were 9 medical and 5 implant complications. There was no significant difference between the 2 groups (P > 0.05). Conclusion In the treatment of intertrochanteric fractures for the elderly patients, the navigational DHS fixation is superior to traditional DHS fixation due to its ad-vantages of smaller incision, less blood loss, shorter bed-ridden time, faster fracture healing and betterfunctional recovery.     

正常与退变椎间盘纤维环细胞相关基因的差异表达

目的: 研究人正常和退变椎间盘纤维环细胞椎间盘退变相关基因表达量的差异,探讨这些相关基因与椎间盘退变的关系,筛选明显差异基因作为退变纤维环细胞体外刺激因子,逆转椎间盘退变。方法: 实时荧光定量PCR(real-time qRT-PCR,SYBR Green)技术检测人正常和退变纤维环细胞TGF-β、IGF-1、bFGF、IL-1、TIMP-1、COL1A1、BMP-14、PDGF、aggrecan、COL2A1、SOX 9、BMP-2、iNOS、 EGF、 MMP3、BMP-4和BMP-7 mRNA表达水平。结果: 与正常纤维环细胞相比,退变纤维环细胞TGF-β、IL-1、PDGF和IGF-1 mRNA表达量降低(P<0.01,P<0.05);bFGF、TIMP-1、BMP-14和COL1A1 mRNA表达升量高(P<0.01);正常纤维环细胞aggrecan和BMP-2 mRNA高表达,退变纤维环细胞两者表达阴性;COL2A1、iNOS和MMP3在正常纤维环细胞mRNA有表达,在退变纤维环细胞表达阴性;EGF在正常纤维环细胞mRNA 表达阴性,而在退变纤维环细胞有表达。Sox-9、BMP-4和BMP-7在正常和退变纤维环细胞mRNA表达均为阴性。结论: 椎间盘纤维环退变与TGF-β、IL-1、PDGF、IGF-1、aggrecan和BMP-2 mRNA低表达,bFGF、TIMP-1、BMP-14和COL1A1 mRNA高表达相关;BMP-2、TGF-β、PDGF和IGF-1可作为退变纤维环细胞体外刺激因子,用于逆转椎间盘退变的研究;bFGF、TIMP-1和BMP-14 可能是椎间盘纤维环细胞退变的标志物。     

人端粒酶反转录酶重组绿色荧光表达载体转染椎间盘正常髓核细胞

背景：椎间盘髓核细胞分离培养困难,老化较快,迫切需要一种标准细胞株用于实验研究。目的：探讨人端粒酶反转录酶重组绿色荧光表达载体的构建及其转染正常髓核细胞构建永生化细胞的可行性研究。方法：通过目的基因克隆、真核表达质粒中目的基因序列测定、目的基因真核表达质粒的构建、转染人端粒酶反转录酶表达检测等步骤进行实验。结果与结论：构建出人端粒酶反转录酶重组绿色荧光表达载体,成功转染正常髓核细胞并在细胞中稳定表达。结果表明运用人端粒酶反转录酶转染椎间盘髓核细胞构建永生化细胞是一种可行的方法。     

X线透视导航下运用Gamma钉治疗股骨转子间骨折18例

目的 探讨在X线透视导航下运用Gamma钉治疗股骨转子间骨折的疗效.方法 回顾性分析接受X线透视导航下与传统方法 应用Gamma钉治疗且具有完整资料的38例老年股骨转子间骨折患者资料.导航下Gamma钉内固定组(导航组)18例,骨折按Evans分型:Ⅰ型10例,Ⅱ型8例.传统Gamma钉内固定组(传统组)20例,骨折按Evans分型:Ⅰ型14例,Ⅱ型6例.比较两组患者的切口长度、手术时间、术中出血量、X线暴露时间、内植物并发症、3个月内骨折愈合率及术后1年关节功能状况等.结果 与传统组比较,导航组切口小、术中出血少,差异有统计学意义(P<0.05).导航组18例患者术后获18～26个月[平均(24±6)个月]随访.传统组20例患者术后获16～24个月[平均(20±6)个月]随访.两组患者全部获骨性愈合,3个月内骨折愈合者导航组12例,传统组15例,差异无统计学意义(P>0.05).导航组X线平均采集图像3～5(4±1)次,传统组6～10(8±2)次,差异有统计学意义(P<0.05).导航组优7例,良10例,可1例,优良率为94.4%.传统组优8例,良8例,可4例,优良率为80.0%,两组间差异无统计学意义(P>0.05).两组患者均无内植物相关并发症.结论 与传统Gamma钉内固定治疗老年股骨转子间骨折比较,导航下Gamma钉内固定可以精确地保证尖顶距<25 mm,且具有切口小、术中出血量少及术后髋关节功能恢复好等优点,值得在临床推广.     

一种可注射自固化含锶复合胶原磷酸钙骨水泥的结构和性能

背景:骨科学界正致力于磷酸钙骨水泥的改性研究,通过向磷酸钙骨水泥中加入不同的添加剂,包括固化促进剂、增塑剂、抗水,血溶剂、致孔剂、增强剂,或是将生物活性物质或药物复合到磷酸钙骨水泥中,以提高其理化和生物学性能是目前该领域的研究热点.目的:了解一种新型可注射可降解的磷酸钙骨水泥的理化性能.设计、时间及地点:重复测量试验,于2008-12/2009-05在华南理工大学材料学院国家重点实验室完成.材料:采用部分结晶的磷酸钙,部分结晶的磷酸锶和二水磷酸氢钙,添加改性淀粉、Ⅰ型胶原制备了新型可注射自固化磷酸钙骨水泥.方法:采用X'Pert Pro型X射线衍射仪对磷酸钙骨水泥固化体进行相分析.采用HITA2-GHIH-800型透射/扫描电子显微镜对磷酸钙骨水泥固化体的形貌进行观察.用维卡仪根据美国材料与试验协会A S TM C190203标准进行凝结时间的测试.使用Instron 5567型万能电子材料试验机来测试固化样品的抗压强度.用注射器测试材料的可注射性,针头内径为1.6 mm.通过浸泡摇动定性测试材料的抗溃散性.主要观察指标:①骨水泥水化产物的相组成和显微结构.②骨水泥的凝固时间、可注射性和抗压强度.③骨水泥的抗溃散性.结果:研究表明该材料具备优良的可注射性能;添加改性淀粉显著的改善了骨水泥的抗溃散性.随着骨水泥液固比的增大,骨水泥的抗压强度下降,当骨水泥的液固比为0.3时,骨水泥的抗压强度为(48.0±2.3)MPa,当骨水泥的液固比为0.6时,骨水泥的抗压强度下降为(21.0±2.5)MPa.骨水泥的水化产物为类骨羟基磷灰石结晶,从X射线衍射图谱还可以看出,因骨水泥的水化不完全,基线水平波动较大,说明了在充分水化的条件下,骨水泥的压缩强度还能进一步提高.结论:制备的可注射含锶复合胶原磷酸钙骨水泥符合人体生物力学强度,能满足手术条件要求.     

导航下与传统方法应用动力髋螺钉治疗老年股骨转子间骨折的疗效比较

Objective To compare the navigational and traditional dynamic hip screw (DHS) fix-ations in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was conducted to analyze the elderly patients with intertrochanterie fracture who had been treated in our de-partment from April 2005 to April 2007 and whose clinical data were complete. Enrolled in the present study were 25 cases that had received navigational DHS fixation and 31 cases who had received traditional DHS fixation. In navigational group, there were 10 males and 15 females, with an average age of 82. 1 years. They were 14 eases of Evans type Ⅰ and 11 Evans type Ⅱ. In traditional group, there were 12 males and 19 fe-males, with an average age of 82. 8 years. They were 16 cases of Evans type Ⅰ and 15 Evans type Ⅱ. The 2 groups were compared in incision length, operation time, bleeding volume, X-ray exposure time, bed-ridden time, medical and implant complications, and one-year functional recovery. Results In navigational group, 23 patients were followed for 11 to 20 (average, 14) months and 2 were lost. In traditional group, 30 patients were followed up for 14 to 23 (average, 18) months and 1 died from cardiovascular disease within 1 year. Compared with traditional group, navigational group had a smaller incision, less blood loss, shorter bed-ridden time and less X-ray exposure time, a higher rate of fracture healing at 3 months, with statistically significant differences (P <0.05). The Harris hip function scores at postoperative 1 year were of no significant difference between the 2 groups (P > 0.05) . In navigational group there were 3 medical and 1 implant complications. In traditional group there were 9 medical and 5 implant complications. There was no significant difference between the 2 groups (P > 0.05). Conclusion In the treatment of intertrochanteric fractures for the elderly patients, the navigational DHS fixation is superior to traditional DHS fixation due to its ad-vantages of smaller incision, less blood loss, shorter bed-ridden time, faster fracture healing and betterfunctional recovery.     

导航下与传统方法应用动力髋螺钉治疗老年股骨转子间骨折的疗效比较

Objective To compare the navigational and traditional dynamic hip screw (DHS) fix-ations in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was conducted to analyze the elderly patients with intertrochanterie fracture who had been treated in our de-partment from April 2005 to April 2007 and whose clinical data were complete. Enrolled in the present study were 25 cases that had received navigational DHS fixation and 31 cases who had received traditional DHS fixation. In navigational group, there were 10 males and 15 females, with an average age of 82. 1 years. They were 14 eases of Evans type Ⅰ and 11 Evans type Ⅱ. In traditional group, there were 12 males and 19 fe-males, with an average age of 82. 8 years. They were 16 cases of Evans type Ⅰ and 15 Evans type Ⅱ. The 2 groups were compared in incision length, operation time, bleeding volume, X-ray exposure time, bed-ridden time, medical and implant complications, and one-year functional recovery. Results In navigational group, 23 patients were followed for 11 to 20 (average, 14) months and 2 were lost. In traditional group, 30 patients were followed up for 14 to 23 (average, 18) months and 1 died from cardiovascular disease within 1 year. Compared with traditional group, navigational group had a smaller incision, less blood loss, shorter bed-ridden time and less X-ray exposure time, a higher rate of fracture healing at 3 months, with statistically significant differences (P <0.05). The Harris hip function scores at postoperative 1 year were of no significant difference between the 2 groups (P > 0.05) . In navigational group there were 3 medical and 1 implant complications. In traditional group there were 9 medical and 5 implant complications. There was no significant difference between the 2 groups (P > 0.05). Conclusion In the treatment of intertrochanteric fractures for the elderly patients, the navigational DHS fixation is superior to traditional DHS fixation due to its ad-vantages of smaller incision, less blood loss, shorter bed-ridden time, faster fracture healing and betterfunctional recovery.     

维生素C对TNF-α及血清剥夺诱导的人髓核细胞凋亡的作用

目的探讨维生素C(Vitamin C,Vit C)在TNF-α及血清剥夺诱导人椎间盘髓核细胞凋亡中的作用及机制。方法取脊柱矫形手术患者的髓核组织,消化法获得正常髓核细胞,取第3代细胞按不同处理因素分为Vit C作用组(A组)、TNF-α诱导组(B组)和血清剥夺组(C组),每组再分为以下亚组:A组分为A1组(基础培养液)、A2组(100μg/m L Vit C)、A3组(200μg/m L Vit C);B组分为B0组(对照组)、B1组(100 ng/m L TNF-α)、B2组(100μg/m L Vit C+100 ng/m L TNF-α)、B3组(200μg/m L Vit C+100 ng/m L TNF-α);C组分为C0组(对照组)、C1组(FBS浓度由8%降低为2%)、C2组(2%FBS+100μg/m L Vit C)、C3组(2%FBS+200μg/m L Vit C)。各组作用24 h后,采用流式细胞术检测各组膜联蛋白V、碘化丙啶双染后髓核细胞凋亡率;实时荧光定量PCR检测p53(基因编码相对分子质量为53×103的蛋白质)、脂肪酸合成酶(fatty acid synthase,FAS)、半胱氨酸天冬氨酸蛋白酶3(Caspase3)、Ⅰ型胶原、Ⅱ型胶原、Sox9和糖胺多糖(Aggrecan)m RNA表达。结果 A组:与A1组比较,A2、A3组的Vit C均能降低髓核细胞凋亡及p53、FAS、Caspase 3 m RNA表达(P0.05),但A2、A3组间比较差异无统计学意义(P0.05);A2、A3组的Vit C可促进髓核细胞Ⅰ型胶原、Ⅱ型胶原、Aggrecan、Sox9 m RNA表达,且A3组促进作用显著大于A2组(P0.05)。B组:与B0组比较,B1组TNF-α促进了髓核细胞凋亡,增加了髓核细胞p53、FAS、Caspase 3 m RNA表达(P0.05);与B1组比较,B3组的Vit C能降低髓核细胞凋亡及p53、FAS、Caspase 3 m RNA表达,而B2组的Vit C则增加其凋亡及p53、FAS、Caspase 3 m RNA表达,差异均有统计学意义(P0.05)。C组:与C0组比较,C1组2%FBS能诱导髓核细胞凋亡,但降低了髓核细胞p53、FAS、Caspase 3 m RNA表达(P0.05);与C1组比较,C3组的Vit C能降低髓核细胞凋亡及p53、FAS、Caspase 3 m RNA表达,而C2组的Vit C则增加其凋亡及p53、FAS m RNA表达,差异有统计学意义(P0.05)。结论 Vit C能延缓或降低髓核细胞凋亡、促进细胞外基质合成与分泌,200μg/m L Vit C可延缓或降低100 ng/m L TNF-α和2%FBS诱导的凋亡,而100μg/m L Vit C则促进其诱导的凋亡。