下胫腓螺钉固定技术治疗Maisonneuve骨折的疗效分析

［摘要］　目的　分析下胫腓螺钉固定技术治疗Maisonneuve骨折的疗效。方法　回顾性分析2014-10～2018-11深圳市人民医院骨关节科收治的21例Maisonneuve骨折患者的临床资料。术前均完善患侧踝关节和胫腓骨全长X线片、踝关节CT三维重建以及踝关节MRI检查。合并三角韧带损伤者14例,内踝骨折者7例,下胫腓后韧带损伤者15例,后踝骨折者6例。手术均采用2枚皮质骨位置螺钉固定下胫腓关节,予2枚螺钉固定内踝骨折以及累及关节面超过25%面积的后踝骨折,术后予短腿石膏固定踝关节4周,术后12周手术将下胫腓螺钉取出。术后门诊随访12～29个月,平均18.31个月,定期复查X线片。于术前和术后行视觉模拟评分法（VAS）评分和美国足踝外科协会（AOFAS）踝-后足评分,评价治疗效果。结果　术后踝关节均获得解剖复位,关节匹配正常,未发生切口感染、下胫腓螺钉断裂等并发症。定期复查X线片见骨折均骨性愈合,踝关节匹配关系正常,未出现复位丢失。术后患者VAS评分呈下降趋势,AOFAS踝-后足评分呈上升趋势,疼痛缓解及足踝活动功能改善显著（P<0.05）。结论　下胫腓螺钉固定技术治疗Maisonneuve骨折能够恢复踝关节的正常解剖关系,疗效满意。     

股骨近端防旋髓内钉与经皮加压钢板微创治疗股骨粗隆间骨折的疗效对比

目的对比分析经皮加压钢板(percutaneous compression plating,PCCP)和股骨近端防旋髓内钉(proximal femur nail antirotation,PFNA)内固定治疗股骨粗隆间骨折的优缺点。方法按治疗方法将70例股骨粗隆间骨折患者分为PFNA组(38例,采用PFNA系统固定)和PCCP组(32例,采用PCCP系统固定),比较2组手术时间、术中出血量、骨折愈合时间、下地负重时间、髋关节Harris评分和并发症的发生率。结果 2组骨折愈合时间和并发症发生率比较差异无统计学意义(P>0.05)。术后髋关节Harris评分:PFNA组为(82.62±4.76)分,PCCP组为(81.49±4.29)分,2组比较差异无统计学意义(P>0.05)。2组手术时间比较差异无统计学意义(P>0.05)。PCCP组术中出血量和伤口引流量显著少于PFNA组、PFNA组下地负重时间少于PCCP组(均P<0.05)。结论PCCP和PFNA均是治疗股骨粗隆间骨折较好的内固定材料。需根据患者的具体情况,合理地选择内固定方式治疗股骨粗隆间骨折。     

不同幅度周期性拉伸形变对软骨细胞凋亡细胞因子基因水平的影响

目的 探讨兔软骨细胞受到拉伸机械形变后金属蛋白酶(MMP)及转化生长因子-β1(TGF-β1)的影响.方法 取兔原代关节软骨细胞培养方法,利用FLEXERCELL-5000T细胞拉伸系统对单层培养细胞施加拉伸形变,其中分为对照组、低幅度(5%)拉伸组及高幅度(15%)拉伸组,每天作用8 h,拉伸5 d,分别取3、5 d时细胞行实时定量PCR(qRT-PCR)检测MMP3、MMP13、ADAMTS-5、TGF-β1的基因表达.结果 拉伸组MMP3、ADAMTS-5基因水平3 d时拉伸形变导致MMP3、ADAMTS-5均显著升高(P=0.002),5 d时各组差异有统计学意义.3 d时各拉伸组中MMP13均高于对照组,5 d时高幅度拉伸组高于低幅度拉伸组.5 d时拉伸组中TGF-β1均高于对照组,低幅度拉伸组高于高幅度拉伸组.结论 本实验结果明确了软骨细胞中凋亡细胞因子及TGF的基因水平受不同拉伸幅度而旱现不同趋势.TGF-β1在软骨细胞拉伸形变的修复中起到重要作用.

Abstract：

Objective To explore the effects of cyclic tensile stresses of different magnitudes on expressions of apoptosis cytokines and transforming growth factors (TGF) in chondrocytes. Methods Classical methods were used to culture primary chondrocytes in New Zealand rabbits. Mechanical stresses were exerted onto the mono-layer cells cultured by the FLEXERCELL-5000T system. The experiment was conducted in 3 groups: low magnitude stress group (5% ), high magnitude stress group (15% ) and control group. The stresses were applied for 5 days and 8 hours per day. The cultured cells were harvested on days 3 and S to measure gene copies of MMP3 (matrix metalloproteinases), MMP13, ADMATS-5 (a disintegrin and metalloproteinase with thrombospondin motifs), and TGF-β1 by quantitative RT-PCR. Results Expressions of ADMATS-5 and MMP3 were significantly enhanced in each stress group on day 3 but weakened on day 5 ( P = 0. 002). Expressions of MMP13 were significantly higher in the stress groups than in the control group on day 3, and significantly higher in the high magnitude stress group than in the low one on day 5 ( P = 0. 002) .Levels of TGF-β1 on day 5 were significantly higher in the stress groups than in the control group, and higher in the low magnitude stress group than in the high one (P = 0. 002). Conclusions Gene expressions of apoptosis cytokines and TGF in chondrocytes are differently influenced by cyclic tensile stresses of different magnitudes. TGF -β1 may play an important role in pathological repair of the deformed chondrocytes following tensile stress.     

Sheffield足踝U型外固定支架治疗重度跟腱挛缩畸形

目的 探讨Sheffield足踝U型外固定架矫治跟腱挛缩畸形的临床疗效.方法 2010年9月至2011年1月共收治6例重度跟腱挛缩患者,男4例,女2例;年龄18～43岁,平均27岁.手术安置外固定牵引架,定期调整外固定支架矫治跟腱挛缩、足内收及内翻畸形,踝关节过度矫正,达到背屈15°、外翻0°后,可拆除外固定支架.结果 所有患者术后均获3～7个月(平均4.5个月)随访,跟腱挛缩畸形均得到良好的矫治,均无血管、神经损伤等并发症,术后加强功能锻炼,均能站立行走,功能基本正常.按Garceau评价标准:优5例,良1例,优良率为100%.结论 采用Sheffield足踝U型外固定牵引架矫正重度跟腱挛缩畸形,创伤小,可避免血管神经损伤等并发症,能较快地矫正踝关节跖屈畸形及相应的足部软组织挛缩畸形,患者短时间内可恢复下地行走,是跟腱挛缩、尤其是重度畸形的理想治疗方法之一.     

不同频率的机械振动与白细胞介素-1β刺激对兔软骨细胞iNOS及COX-2基因表达的作用

目的 研究不同频率的机械振动与白细胞介素-1β(IL-1β)刺激对兔软骨细胞分解代谢基因表达的作用.方法 体外培养兔软骨细胞,应用自制复合振动仪,将振动强度0.5 g,不同频率0、45、90 Hz的机械振动分别作用于不同类别的软骨细胞,实时PCR(RT-PCR)检测软骨细胞中iNOS、COX-2的含量.结果 炎性反应介质IL-1β使软骨细胞中的iNOS、COX-2基因表达升高,差异有统计学意义(P<0.01).在炎性反应介质IL-1β存在的条件下,频率为45、90 Hz振动能使软骨细胞中iNOS、COX-2的表达量下降,差异有统计学意义(P<0.05).在无炎性反应介质IL-1β存在的条件下,振动对软骨细胞产生iNOS、COX-2的表达量差异无统计学意义(P>0.05).结论 炎性反应介质IL-1β能加速兔软骨细胞的去分化,合适频率的机械振动能抑制IL-1β诱导的软骨细胞分解代谢基因iNOS、COX-2的表达.

Abstract：

Objective To investigate the effects of mechanical vibration frequency and IL-1 (interleukin-1) on expressions of catabolism genes in cultured rabbit chondrocytes. Methods Chondrocytes were obtained from the joints of a freshly killed 2-month-old rabbit. Six-well plates, half of which contained IL-1β, were used to culture samples. The well plates were vibrated at the frequency and amplitude 0/45/90 Hz and 0. 5 nm, respectively. After culture and mechanical stimulation, the levels of iNOS and COX-2 in the samples were measured by RT-PCR. Results IL-1β promoted expressions of the iNOS and COX-2 genes in the rabbit chondrocytes ( P < 0. 01). In the presence of IL-1β, mechanical vibrations of 45 and 90 HZ inhibited expression levels of iNOS and COX-2 mRNA, with a significant difference ( P < 0. 05). However, in the absence of IL-1β, mechanical vibrations of 45 and 90HZ made no significant impact on expressions of iNOS and COX-2 ( P > 0. 05). Conclusion Mechanical vibration may play an important role in curbing expressions of iNOS and COX-2 genes in the presence of IL-1.