Trimed钩钢板固定外踝骨折

[目的]探讨Trimed钩钢板在Danis-WeberA型外踝骨折中的临床疗效。[方法]2019年7月-2021年1月,共收治Weber A型踝关节骨折患者20例,按医患沟通结果分为两组。10例采用Trimed钩形钢板固定外踝骨折(钩钢板组),10例采用无钩钢板固定外踝骨折(无钩钢板组)。比较两组临床与影像资料。[结果]两组患者均顺利完成手术,钩钢板组外踝部手术时间显著短于无钩钢板组(P<0.05)。两组患者随访10个月以上,随术后时间推移,两组患者A0FAS和Maryland评分均显著增加(P<0.05),相应时间点,钩钢板组的A0FAS和Maryland评分均显著优于无钩钢板组(PC0.05)。影像方面,钩钢板组术后影像显示的骨折复位质量显著优于无钩钢板组(P<0.05),钩钢板组影像显示骨折愈合时间显著早于无钩钢板组(P<0.05)。[结论]对于Danis-Weber A型外踝骨折,钩钢板内固定的临床效果明显优于无钩钢板。     

收缩压水平对2型糖尿病人群终末期肾病发病率影响的研究

目的观察不同SBP水平对T2DM人群终末期肾病发病率的影响。方法采用前瞻性队列研究,以参加2006~2007年度开滦集团职工健康体检的糖尿病患者9375例作为观察队列,根据不同SBP水平分为<130mmHg组、130~139mmHg组和≥140mmHg组。以进入规律血液透析定义为终末期肾病作为终点事件,采用COX回归模型分析影响发生终末期肾病的因素。结果 (1)观察队列平均随访时间(71.89±4.25)个月,新发血液透析者53例,其中<130mmHg组12例、130~139mmHg组8例和≥140mmHg组33例,各组发生率比较差异有统计学意义(χ2=7.78,P<0.05);(2)COX回归分析显示,与<130mmHg组比较,130~139mmHg组和≥140mmHg组发生终末期肾病事件的OR值分别为1.27(95%CI:0.50~3.23,P=0.615)、2.48(95%CI:1.19~5.16,P=0.015)。结论 SBP升高可增加糖尿病人群终末期肾病的发病风险,但并非SBP降得越低,获益越多。     

严重下肢创伤急诊显微外科修复的应用

37例下肢严重创伤濒临截肢肢体采用急诊显微修复与重建方法治疗，包括胫腓骨骨折MIPPO技术钢板内固定或外固定架固定＋血管神经修复＋游离皮瓣移植，桥式交叉吻合血管游离组织瓣移植＋血管神经修复，吻合血管的游离腓骨或髂骨块与游离皮瓣组合移植＋骨折钢板内固定或外固定架固定，断肢再植＋游离（肌）皮瓣移植。结果37例手术全部成功，皮瓣或骨瓣一期成活，其中2例侧胸皮瓣周缘约2cm浅层坏死，经换药2周而愈。伤肢均最大限度的恢复了外观及功能，能参加日常生活及工作。提示急诊显微修复与重建治疗严重肢体创伤效果良好。     

转录因子MZF-1对急性单核细胞白血病新抗原基因MLAA-34的转录调控研究

目的:探讨转录因子MZF-1对急性单核细胞白血病新抗原基因MLAA-34的转录调控作用。方法:利用双萤光素酶报告基因检测系统及定点突变技术分析MZF-1对MLAA-34基因启动子转录活性的影响。通过凝胶电泳迁移率变动检测(electrophoretic mobility slift assay,EMSA)和染色质免疫沉淀检测(chromatin immunoprecipitation,Ch IP)实验,验证MZF-1是否与MLAA-34启动子核心区直接特异性结合。构建MZF-1真核表达载体和干涉载体,转染U937细胞,应用RT-PCR和Western blot法检测MLAA-34基因的转录和表达变化。结果:转录因子MZF-1对MLAA-34基因表达具有调控作用,MZF-1结合序列点突变后,相对荧光素酶活性降低(P 0. 01)。EMSA和Ch IP实验从细胞内、外水平分别证明MZF-1可与MLAA-34启动子直接结合而发挥调控作用。在过表达试验中,MZF-1的增加可上调MLAA-34的表达(P 0. 05);在干涉试验中,MZF-1的降低可下调MLAA-34的表达(P 0. 05)。结论:转录因子MZF-1可与MLAA-34基因启动子上的转录调控区结合,并促进急性单核细胞白血病细胞中MLAA-34基因的转录。     

先天性无痛无汗症1例

<正>患者,女,6岁。因从2 m高处坠下致左肘部肿胀畸形入院。患者系足月顺产,父母非近亲结婚,否认家族病史。患者出生后发育迟缓,6岁智力相当于3岁儿童,语言幼稚,日常体温在38℃左右,反复发热、全身无汗、发热时烦躁不安,经吹冷风或冷水冲洗后方能安静。患者曾出现左足、右胫骨、右     

腓骨头复合组织瓣修复儿童内踝骨皮肤缺损四例

Objective To investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children. Methods From Aug. 2005 to Apr. 2009, 4 children cases(2 male, 2 famale, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm × 8-10 cm in size. Results All the 4 compostie flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint. Conclusions The fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

严重创伤对远期血压值及高血压发生率的影响

目的探讨创伤对远期血压值及高血压发生率的影响。方法采用回顾性队列研究方法,选择1997-01-1998-06在唐山6家医院重症病房住院的创伤患者497例(创伤组)及同期无创伤史的体检人员762例(对照组),对创伤组和对照组的基线资料、10年后高血压发生率进行分析。将创伤组按急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)评分值分为15～24分(n=283)、25～34分(n=162)及≥35分亚组(n=52),分析不同亚组受试者的血压值及高血压发生率。结果与对照组比较,创伤组收缩压、舒张压均增高[(135.1±23.0)/(86.7±14.1)比(118.4±16.1)/(77.6±9.5)mm Hg,均P<0.01]。创伤组高血压发生率也明显高于对照组(42.7%比20.6%,P<0.01)。随着APACHEⅡ评分值增加,收缩压、舒张压、高血压发生率均增高。Logistic回归分析显示,创伤是高血压的独立危险因素(RR=2.60,95%CI:1.99～3.40,P<0.01)。结论创伤是高血压的独立危险因素。创伤作为应激刺激增加患者远期血压值和高血压发生率。     

高敏C反应蛋白对新发缺血性脑卒中风险的预测价值

目的探讨基线血清高敏C反应蛋白(hsCRP)水平对缺血性脑卒中风险的预测价值。方法采用回顾性巢式病例对照研究,选择缺血性脑卒中患者842例,对照组1684例。比较两组间基线hsCRP水平,分析不同基线hsCRP水平者发生缺血性脑卒中的风险。结果缺血性脑卒中患者基线hsCRP水平高于对照组(1.63比0.79 mg/L,P<0.01);hsCRP四分位数水平较高者(>3.07 mg/L)发生缺血性脑卒中事件的风险是较低者(<0.34 mg/L)的3.73倍(95%CI2.87～4.86,P<0.01),对hsCRP以3 mg/L及以第80百分位点为临界值分组后进行统计分析,hsCRP与缺血性脑卒中事件相关性依然存在,OR值分别为2.65(95%CI2.16～3.25),2.85(95%CI2.29～3.55)(均P<0.01)。结论基线hsCRP对缺血性脑卒中风险有预测价值,hsCRP水平较高者发生缺血性脑卒中的风险增加。     

皮神经筋膜蒂岛状皮瓣修复再植后手指皮肤缺损

目的探讨应用掌指背皮神经筋膜蒂岛状皮瓣修复再植术后手指皮肤缺损的临床效果．方法设计包含掌指背神经的筋膜蒂岛状皮瓣，逆行旋转修复再植术后手指皮肤缺损19例，皮瓣面积：1．5cm×1．9cm-2．0cm×5．5cm。结果19例皮瓣全部成活，术后随访6～12个月，平均7．8个月，皮瓣外观良好、质地柔软、色泽正常、功能满意。结论掌指背皮神经筋膜蒂岛状皮瓣操作简单，不损伤手指主要血管、神经，创伤小，对再植手指血运影响小，外观满意，是处理手指再植术后皮肤缺损的良好选择。