胫骨远端内侧入路钢板螺钉危险区解剖研究

目的明确胫骨远端内侧钢板固定操作时对胫前动脉的风险。方法对10具新鲜小腿标本行胫骨远端内侧入路微创钢板固定实验,模拟术中操作以确定钢板螺钉与胫前动脉之间的解剖关系。结果胫骨远端内侧入路钢板螺钉固定对胫前动脉的危险区域在胫骨内踝上(15.4±3.3)cm,换算成胫骨长度百分比位置即胫骨内踝上(40.0±8.4)%;双侧99%的可信区间为(36.6,42.4)%。结论胫骨远端内侧入路时,钻孔及螺钉固定操作可能会损伤胫前动脉,笔者提出胫骨远端内侧入路钢板螺钉危险区的概念,指导临床手术,减少术中的医源性损伤。     

益气活血通络汤联合神经节苷脂对外伤性颅脑出血患者血清SOD、D-D、CRP及预后影响

目的:探讨益气活血通络汤联合神经节苷脂对外伤性颅脑出血患者血清超氧化物歧化酶(SOD)、D-二聚体(D-D)、C-反应蛋白(CRP)及预后的影响。方法:将130例外伤性颅脑出血患者按照数字表法随机分为两组。对照组65例给予神经节苷脂治疗,试验组65例在对照组基础加用益气活血通络汤。比较两组临床预后、格拉斯哥昏迷(GCS)评分及SOD、D-D、CRP的差异。结果:试验组患者治愈率、总有效率分别为64.6%、95.4%高于对照组36.9%、76.9%(P0.05);治疗4周后、治疗8周后试验组GCS评分升高,也高于同期对照组,呈逐渐升高趋势(P0.05);治疗4周后、治疗8周后试验组D-D、CRP水平降低,也低于同期对照组,呈逐渐降低趋势(P0.05);治疗4周后、治疗8周后试验组SOD水平升高,也高于同期对照组,呈逐渐升高趋势(P0.05)。结论:益气活血通络汤联合神经节苷脂对外伤性颅脑出血患者效果佳,其可有效降低D-D、CRP水平,升高SOD水平,改善患者临床症状,临床有效率也较高,值得临床选择。     

应用钛板修复髋臼大面积骨缺损的生物力学研究

[目的]比较应用钛板修复髋臼不同面积骨缺损与初次全髋关节置换术时髋臼周围生物力学变化及初始稳定性的研究。[方法]选取12具30~50岁男性尸体骨盆。随机分成四组,每组3具,于髋臼负重区人工制造出占整个髋臼50%、60%、70%的三种混合型骨缺损(AAOSⅢ型),作为骨缺损组;应用钛板+植骨+骨水泥+高分子聚氯乙烯杯固定,对三种程度的骨缺损进行髋臼重建;无骨缺损组行单侧骨水泥型假体髋关节置换术。试验模拟人体单足直立位,在CSS-44020型生物力学试验机上进行。应用双页型压敏纸测定各标本在轴向加载,持续加压下,髋臼顶负重区在不同程度骨缺损应用钛板修补与正常初次髋关节置换的应力变化情况。[结果](1)载荷200 N时,骨缺损组50%,60%,70%和无骨缺损组平均应力分别为267.628 6 N;268.635 2 N;270.691 4 N,266.463 8N。经方差分析,F=0.715,P>0.05,按α=0.05水准,各组应力值无明显差异;(2)以钛板重建髋臼严重骨缺损,臼顶负重区的应力变化规律相同。在50%骨缺损组,载荷200 N,400 N,600 N受到应力分别为267.628 6 N,507.831 4 N,693.177 1 N。[结论](1)在同一载荷下,应用钛板重建修复50%~70%髋臼缺损组间与初次髋关节置换组髋臼应力变化无明显差异。随加载负荷的增加,臼顶负重区压应力随之增加。在生物力学方面未出现应力集中及假体不稳等现象;(2)钛板具有良好的生物相容性和力学性能,强度高,可根据髋臼缺损修剪,使其完全贴附于缺损臼壁,金属网孔能够刺激并且允许新生骨组织长入形成"锚固效应",使金属网架和髋臼壁合为一整体,既增加髋臼抗压强度,又降低金属网架的断裂和疲劳的可能性。     

异维A酸凝胶治疗痤疮的疗效

目的：探讨异维A酸凝胶和维胺脂维E乳膏分别用于治疗痤疮的效果。方法：回顾性分析我院2011年1月～2014年12月期间收治的74例痤疮患者的临床资料,随机分为两组。对照组37例患者,患处涂抹维胺脂维E乳膏进行治疗;观察组37例患者,涂抹异维A酸凝胶治疗。两组患者经治疗后采取相同的护理措施,对比分析两组患者的临床治疗效果。结果：从治疗的总有效率而言,观察组患者具有明显优势（p＜0.05）差异显著具有统计学意义。从治疗过程不良反应的出现情况而言,两组患者差异性不大（p＞0.05）,无统计学意义。结论：相比维胺脂维E乳膏而言,异维A酸凝胶的治疗痤疮的效果更为明显,临床应用价值较高,可作为治疗痤疮的首选药物。     

人血管内皮细胞生长因子121基因修饰材料修复桡骨火器性骨缺损

BACKGROUND: Bone defects are the leading cause of nonunion after firearm injury. Firearm injury is relatively special. Autograft and allograft all have big drawbacks, which cannot meet the requirements of basic-level hospitals. Using tissue-engineered bone with good blood vessels and osteogenic capability in repair of firearm bone defect will be an ideal and feasible restoration method.OBJECTIVE:To explore the application of human vascular endothelial growth factor 121 gene-modified materials in the repair of firearm-induced radial injury in rabbits.METHODS:A total of 128 rabbits were randomly divided into surgical injury group and firearm injury group (n=64 per group). In the firearm injury group, 0.25 g steel ball was launched using 56-style musket to establish a firearm radial injury model; in the surgical injury group, surgical methods were used to produce a 1.2 cm radial injury model. Human vascular endothelial growth factor 121 gene-modified materials were used. The related histocytes from rabbits were harvested to obtain bone marrow stromal cells for culture. A porous scaffold material was prepared. The obtained materials were respectively implanted into radial defect sites in the surgical injury and firearm injury groups. The application of human vascular endothelial growth factor 121 gene-modified materials in rabbit radial defect repair was analyzed.RESULTS AND CONCLUSION:Compared with the surgical injury group, at 8, 12 and 16 weeks after repair, the gray level ratio of bone defect site and the anti-compression mechanical ratio at the healthy and repairing sides of the radius in the firearm injury group were decreased (P < 0.05), and the new bone area increased (P < 0.05). At 2 and 4 weeks after repair, the local blood flow at the repair area was significantly increased (P < 0.05). These results suggest that compared with the surgical injury group, the curative effect of human vascular endothelial growth factor 121 gene is more ideal in the firearm injury group because of the emergence of local ischemia and hypoxia in the process of radial defect repair. Human vascular endothelial growth factor 121-modified material can repair bone marrow stromal cells. The application of human vascular endothelial growth factor 121 in firearm burns can enhance the synthesis and secretion of angiogenic factors, improve the local blood flow, reduce anti-compression mechanical ratio, and increase the new bone area. 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

彩色多普勒超声在钬激光治疗大隐静脉曲张手术中的应用

钬激光近年在微创外科中应用较多．笔者应用钬激光治疗大隐静脉曲张患者20例．并在围手术期应用彩色多普勒超声进行术前诊断、术中监测及术后随访．取得满意疔教．现报告如下。     

置管引流加无水乙醇硬化治疗肝肾囊肿52例

本研究对传统的超声引导下肝肾囊肿穿刺抽液无水乙醇注射硬化治疗方法进行一定的改良,应用带侧孔的深静脉导管置管引流囊液,无水乙醇硬化囊壁对52例肝肾囊肿患者进行治疗,取得满意疗效,现报道如下.