老年骨质疏松性股骨粗隆间骨折的内固定器选择

目的 探讨不同类型老年骨质疏松性股骨粗隆间骨折的内固定器选择.方法 回顾性分析我院于2013年6月至2015年6月收治的252例老年骨质疏松性股骨粗隆间骨折病人的临床资料.病人均采取闭合复位内固定手术,根据内固定器不同分为股骨近端防旋髓内钉(proximal femoral nail antiro-tation,PFNA)-Ⅱ组(154例)和InterTan组(98例).对比分析两组病人的骨折类型情况、术中情况、术后骨折愈合、患髋功能恢复情况和并发症等.结果 病人均顺利完成手术及随访.PFNA-Ⅱ组病人手术时间为(44.17±6.75)min、术中出血量为(140.34±15.68)ml,均显著少于InterTan组的(60.32±7.39)min和(178.26±18.25)ml(均P=0.000).术后PFNA-Ⅱ组病人股骨干骨折率显著高于InterTan组(P=0.032),股骨颈缩短长度多于InterTan组(P=0.000),髋关节或大腿疼痛发生率(15.58%)显著高于InterTan组(5.10%)(P=0.011).两组病人骨折愈合时间、远端钉尖位置、Harris髋关节评分及其他并发症比较,差异均无统计学意义(均P>0.05).结论 PFNA-Ⅱ操作相对简单,但InterTan钉疗效更好,对于简单的骨质疏松性股骨粗隆间骨折可选择PFNA-Ⅱ或InterTan钉;对于Evans-JensenⅡB或Ⅲ型等稳定性较差的复杂骨折,选择InterTan钉更有优势;老年病人如果基础情况较差,且需尽快完成手术,选择PFNA-Ⅱ钉可缩短手术时间.     

老年骨质疏松性股骨粗隆间骨折PFNA与InterTan内固定术后影像学改变的比较

目的比较股骨近端防旋髓内钉(PFNA)与InterTan髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折术后影像学改变情况,评价两种内固定物临床应用效果。方法回顾性分析自2016-01—2018-12诊治的195例老年骨质疏松性股骨粗隆间骨折,97例行PFNA内固定(PFNA组),98例行InterTan内固定(InterTan组)。结果 PFNA组87例获得随访,InterTan组83例获得随访,随访时间平均13.6(12～18)个月。末次随访时PFNA组11例螺旋刀片切出,4例内固定物松动失效;InterTan组3例螺钉切出,2例内固定物松动失效;InterTan组内固定失败发生率低于PFNA组,差异有统计学意义(P 0.05)。术后3、6、12个月随访时,所有患者均出现了不同程度的髋内翻与股骨颈短缩,PFNA组股骨颈轴角改变程度、股骨颈短缩程度大于InterTan组,差异有统计学意义(P 0.05)。结论 InterTan髓内钉具有抗髋内翻、抗股骨颈短缩及术后低内固定失败率的优点,更适用于治疗老年骨质疏松性股骨粗隆间骨折。     

PFNA与国产InterTan髓内钉内固定治疗老年股骨粗隆间骨折的比较

目的比较股骨近端防旋髓内钉(PFNA)与国产InterTan髓内钉内固定治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析自2012-05—2016-08诊治的62例老年股骨粗隆间骨折,30例采用PFNA内固定治疗(PFNA组),32例采用国产InterTan髓内钉内固定治疗(InterTan组)。比较2组术中透视次数、术中出血量、手术时间、骨折愈合时间及末次随访时髋关节功能Harris评分。结果 62例均获得随访,PFNA组随访时间平均18.5(12~48)个月,InterTan组随访时间平均16.2(12~36)个月。PFNA组在术中透视次数、手术时间、术中出血量方面优于InterTan髓内钉组,差异有统计学意义(P0.05)。但2组骨折愈合时间及末次随访时髋关节功能Harris评分差异无统计学意义(P0.05)。结论 PFNA和InterTan髓内钉内固定治疗老年股骨粗隆间骨折均能取得较好的临床疗效,但对于身体条件差或基础疾病较多的患者,为减少手术创伤,可优先选择PFNA内固定。     

InterTan髓内钉与动力髋螺钉内固定治疗老年股骨粗隆间骨折疗效比较

目的比较InterTan髓内钉与动力髋螺钉(DHS)内固定手术治疗老年股骨粗隆间骨折的临床疗效。方法纳入自2013-11—2018-11诊治的86例老年股骨粗隆间骨折,43例采用InterTan髓内钉内固定治疗(InterTan组),43例采用DHS内固定治疗(DHS组)。比较2组切口长度、手术时间、术中出血量、住院时间、骨折愈合时间、并发症发生率,以及术后髋关节功能Harris评分。结果 86例均获得至少1年随访。InterTan组仅1例(2.3%)出现术后再骨折,DHS组术后出现8例(18.6%)并发症;InterTan组并发症发生率明显低于DHS组,差异有统计学意义(P 0.05)。与DHS组比较,InterTan组切口长度更短,手术时间、住院时间、骨折愈合时间更短,术中出血量更少,术后1个月、6个月髋关节功能Harris评分更高,差异有统计学意义(P 0.05);2组术后12个月髋关节功能Harris评分比较差异无统计学意义(P0.05)。结论 InterTan髓内钉内固定治疗老年股骨粗隆间骨折具有创伤小、固定可靠、骨折愈合快的优点,有助于患者髋关节功能早期恢复正常,而且手术安全性高,术后并发症发生率低。     

InterTan与PFNA内固定治疗老年Evans Ⅳ型股骨粗隆间骨折的疗效分析

目的比较InterTan钉与股骨近端防旋髓内钉(PFNA)内固定治疗老年Evans Ⅳ型股骨粗隆间骨折的临床疗效。方法回顾性分析自2014-01—2015-12诊治的64例老年Evans Ⅳ型股骨粗隆间骨折,30例采用InterTan钉内固定治疗(InterTan组),34例采用PFNA内固定治疗(PFNA组)。结果与InterTan组比较,PFNA组手术时间更短,术中出血量更少,差异有统计学意义(P0.05);但2组术后至下床时间差异无统计学意义(P0.05)。64例均获得至少6个月随访,均未发生股骨头切割、内固定松动断裂、髋内翻、股骨干骨折等并发症。InterTan组术后1个月疼痛VAS评分、髋关节功能Harris评分优于PFNA组,差异有统计学意义(P0.05);但2组术后3、6个月时疼痛VAS评分及髋关节功能Harris评分差异无统计学意义(P0.05)。结论InterTan钉和PFNA内固定治疗老年EvansⅣ型股骨粗隆间骨折均可取得满意的疗效,而InterTan钉内固定具有更好的加压与抗旋转效果,更有利于患者术后早期功能锻炼。     

PFNA与InterTan内固定治疗老年不稳定股骨粗隆间骨折疗效比较

目的比较分析股骨近端防旋髓内钉(PFNA)与InterTan钉内固定治疗老年不稳定股骨粗隆间骨折的临床疗效。方法回顾性分析自2013-02—2017-02诊治的52例老年不稳定股骨粗隆间骨折,26例采用PFNA内固定治疗(PFNA组),26例采用InterTan钉内固定治疗(InterTan组)。结果52例均获得随访,随访时间4~12个月,平均8个月。PFNA组在手术时间、术中出血量、术后引流量、X线透视次数方面均优于InterTan组,差异有统计学意义(P0.05);但2组住院时间、临床疗效比较差异无统计学意义(P0.05)。PFNA组螺钉切出的发生率明显高于InterTan组,差异有统计学意义(P0.05)。结论PFNA与InterTan钉内固定治疗老年不稳定股骨粗隆间骨折的临床疗效无明显差异,PFNA内固定操作更简单,手术时间更短,创伤相对更小,但其抗股骨头旋转力可能更小。     

抗旋髓内钉与动力髋部螺纹钉治疗股骨粗隆间骨折疗效比较

目的比较股骨近端抗旋髓内钉(PFNA)和动力髋部螺纹钉(DHS)治疗老年骨质疏松性股骨粗隆间骨折的疗效。方法选择老年骨质疏松性股骨粗隆间骨折患者80例,随机分为PFNA组40例和DHS组40例。比较两种方法的治疗效果和术后并发症发生情况。结果对于稳定型骨折,两组疗效比较差异无统计学意义(P>0.05);对于不稳定型骨折,PF-NA组的优良率显著高于DHS组(χ2=3.9720,P<0.05);PFNA组患者切口长度、手术时间、术中出血量、负重时间、骨折愈合时间均优于DHS组(P<0.05或P<0.01);术后12个月内PFNA组并发症发生率显著低于DHS组(χ2=4.0205,P<0.05),差异有统计学意义。结论 PFNA比DHS操作简单,手术时间短,创伤少,内固定可靠,恢复快,并发症少,适应证广,尤其是治疗股骨粗隆间不稳定型骨折的理想方法。     

InterTan与PFNA内固定治疗老年股骨粗隆间骨折的比较

目的比较髋部联合加压交锁髓内钉(InterTan)与股骨近端防旋髓内钉(PFNA)内固定治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析自2015-01—2016-10诊治的72例老年股骨粗隆间骨折,38例采用PFNA内固定治疗(PFNA组),34例采用InterTan内固定治疗(InterTan组)。比较2组手术时间、术中出血量、住院时间、骨折愈合时间、术后至开始下床时间、末次随访时髋关节功能Harris评分。结果 72例均获得随访,随访时间平均14.3(1～24)个月。与PFNA组比较,InterTan组手术时间更长、术中出血量更多,但术后至开始下床时间更短,差异有统计学意义(P 0.05);2组住院时间、骨折愈合时间、末次随访时髋关节功能Harris评分比较差异无统计学意义(P0.05)。结论 InterTan与PFNA内固定治疗老年股骨粗隆间骨折均可取得满意的临床疗效,PFNA内固定在缩短手术时间、减少术中出血量方面具有优势,而InterTan内固定在骨折端稳定性、术后早期功能锻炼、降低并发症发生率方面具有优势。     

PFNA-II、LCP及股骨头置换三种方法治疗A2型股骨粗隆间骨折的比较

[目的]比较股骨近端防旋髓内钉(PFNA-II)、股骨近端解剖型锁定钢板(LCP)及股骨头置换三种方法治疗31-A2型股骨粗隆间骨折的临床疗效。[方法]选取2012年9月~2015年3月本院收治的112例31-A2型股骨粗隆间骨折患者作为研究对象,按照手术方式的不同分为PFNA-II组(38例)、LCP组(34例)及股骨头置换组(40例)。比较三组手术时间、术中出血量、引流量、术后开始负重时间、髋关节功能Harris评分优良率、生活质量及并发症发生情况。[结果]PFNA-II组手术时间、术中出血量均低于LCP组、股骨头置换组;LCP组术后开始负重时间明显长于PFNA-II组、股骨头置换组,差异具有统计学意义(P0.05);引流量:三组差异无统计学意义(P0.05);PFNA-II组、股骨头置换组Harris评分、SF-36评分均明显高于LCP组,差异具有统计学意义(P0.05)。LCP组并发症发生率明显高于PFNA-II组,差异具有统计学意义(P0.05)。[结论]PFNA-II内固定术治疗31-A2型股骨粗隆间骨折手术时间短、出血量少、术后髋关节功能恢复快、安全,同时可明显提高患者生活质量,较LCP、股骨头置换术优势更明显,为目前临床较为理想的术式。     

PFN与InterTan内固定治疗股骨粗隆间骨折的比较研究

目的回顾性对比分析2种股骨近端髓内钉PFN与InterTan内固定治疗股骨粗隆间骨折的临床疗效。方法 160例股骨粗隆间骨折行PFN和InterTan内固定,其中A组(PFN内固定)78例,B组(InterTan内固定)82例,比较两组平均手术时间、术中失血量、切口长度、术中透视次数、骨折愈合时间、术后髋关节WOMAC评分。结果 B组在平均手术时间、术中出血量、切口长度、术中透视次数方面优于A组,差异有统计学意义(P<0.05);但两组平均骨折愈合时间及术后3、6、12个月髋关节WOMAC评分差异无统计学意义(P>0.05)。结论 PFN与InterTan髓内钉内固定治疗股骨粗隆间骨折术后疗效方面无明显差异,但InterTan内固定手术操作较简单、创伤较小。     

Deficiency of TBL1XR1 causes asthenozoospermia

Transducin (β)-like 1 X-linked receptor 1 (TBL1XR1) is an evolutionarily conserved protein related to spermatozoa. To clarify its role and mechanism of action in spermatozoa, qRT-PCR was used to analyse the expression of TBL1XR1 in human spermatozoa and mouse testes. The mice were established as an animal model by injecting the mice testes with small interfering RNA against TBL1XR1 or control siRNA. Our results indicated that deficiency of TBL1XR1 in mice reduced the motility of spermatozoa and disrupted the histone-to-protamine transition. We also found the decreased expression of TBL1XR1 in the spermatozoa of human patients with asthenozoospermia (AZ) compared with that in the spermatozoa of healthy males. Moreover, we carried out chromatin immunoprecipitation analyses and found that genes downstream of TBL1XR1 were related to sperm motility. Thus, TBL1XR1 might be related to sperm motility and might function through its downstream genes. Our data highlight the role of TBL1XR1 involved in spermatozoa and provide new molecular insights into the intricate systems required for male fertility.     

Alpha1-antitrypsin deficiency. 1: epidemiology of alpha1-antitrypsin deficiency

The protein and molecular characteristics of variants of the alpha1-antitrypsin (AAT) gene are described, and available data on the genetic epidemiology of AAT deficiency are presented.     

IgA肾病患者C1GALT1C1基因的体细胞突变筛查

目的 探讨IgA肾病（IgAN）患者β1,3半乳糖转移酶的分子伴侣Cosme编码基因C1GALT1C1基因体细胞突变情况。方法 27例IgA肾病患者及19例正常健康对照作为研究对象。提取研究对象外周血基因组DNA,扩增C1GALT1C1基因的编码区,采用PCR产物直接测序的方法进行突变筛查。然后,分离其中15例IgA肾病患者及7例健康男性对照的外周血B淋巴细胞,提取DNA。对C1GALT1C1基因编码区进行扩增,PCR产物进行克隆,各挑选平均8～10个克隆进行体细胞突变筛查。结果 46例个体全血基因组DNA的PCR扩增产物测序发现,2例患者及1例健康对照存在外显子T393A变异,次等位基因频率（MAF）为6．9%[SNP数据库（dbSNP）报告为9．5%]。B淋巴细胞DNA序列分析显示,在22例个体（15例IgA肾病患者,7例健康对照）送检的总共202个克隆中,未发现新的突变和多态性位点。结论 C1GALT1C1基因编码区T393A多态位点在本研究人群中为唯一发现的多态性位点,其次等位基因频率（MAF）较既往报道略低。本研究尚未发现IgA肾病患者B淋巴细胞存在体细胞突变。     

Genetic polymorphisms of CYP1A1, CYP2E1, GSTM1, and GSTT1 associated with head and neck cancer

BACKGROUND: Alcohol intake and tobacco smoke, in addition to other environmental and genetic factors, have been associated with head and neck cancer. We evaluated the role of metabolic enzyme polymorphisms on the risk of head and neck cancer in a hospital-based case-control study. METHODS: CYP1A1MspI, CYP2E1PstI, GSTM1, and GSTT1polymorphisms were evaluated in 103 histologically confirmed head and neck cancer cases and 102 controls by means of polymerase chain reaction-restriction fragment length polymorphism methods. RESULTS: GSTM1null increased the risk of head and neck cancer (odds ratio [OR], 2.2; 95% confidence interval [95% CI], 1.24-3.79), oral cancer (OR, 2.8; 95% CI, 1.28-5.98), and pharyngeal cancer (OR, 2.2; 95% CI, 1.08-4.63). CYP2E1PstI polymorphism indicated a risk for oral cancer (OR, 3.6; 95% CI, 1.29-11.56). The joint effect of GSTM1 null and CYP1A1 polymorphism increased the risk of head and neck cancer (OR, 2.4; 95% CI, 1.13-5.10). CONCLUSIONS: GSTM1 null alone or associated with CYP1A1 increased the risk of head and neck cancer; the CYP2E1PstI mutated allele increased the risk for only oral cancer.     

手术创伤中腹膜组织Sp1、COL1A1和TIMP-1的表达

目的　探讨人手术创伤腹膜组织中核转录因子Sp1激活 ,COL1A1和TIMP 1表达变化与腹膜纤维化之间的关系。方法　采用凝胶电泳迁移率改变分析法 (EMSA)检测手术创伤后不同时间的腹膜组织核转录因子Sp1的表达水平 ,WesternBlot检测COL1A1和TIMP 1蛋白表达 ,Masson染色观察腹膜组织中胶原纤维的变化。结果　Sp1在手术创伤后 0 .5h被活化 ,随着手术时间延长Sp1活性逐渐增强 ,至创伤后 4h时达高峰 ,同时创伤腹膜组织中的COL1A1和TIMP 1蛋白表达水平逐渐升高 ,存在差异显著性 (P <0 .0 1)。在手术创伤期内随手术时间的延长腹膜组织中胶原纤维增加。结论　核转录因子Sp1活化导致Ⅰ型胶原合成增加 ,细胞外基质降解减少 ,从而启动腹膜纤维化进程。     

Evaluation of the influence of polymorphic variants CYP1A1 2B, CYP1B1 2, CYP3A4 1B, GSTM1 0, and GSTT1 0 in prostate cancer

Background/objectiveGenetic polymorphisms in cytochrome P-450 (CYPs) and glutathione S-transferase (GSTs) genes can influence the appearance of tumors by the formation of new enzymes with altered activities. In the present study, 5 polymorphic variants were examined in 154 patients with prostate carcinoma and in 154 controls.Materials and methodsDNA analysis was carried out through PCR-based methods. The statistical methods used were odds ratio and confidence interval (95% CI), χ², Fisher, and Mann-Whitney.ResultsThe study showed absence of association for CYP1A1*2B, CYP1B1*2, GSTM1*0, and GSTT1*0. The statistical analysis implied a positive association of variant CYP3A4*1B for prostate cancer. The combined analysis of CYP1A1*2B, CYP1B1*2, and CYP3A4*1B genotypes showed positive association. The analysis of histopathologic parameters detected statistically significant differences for Gleason score and biochemistry recurrence risk. The presence of the GSTT1*0 genotype in red meat consumers increased the risk for this disease.ConclusionSome polymorphic variants analyzed can influence the development and the progression of prostate cancer.     

压力-流率测定中尿道内置测压导管对尿流率的影响

目的　探讨尿道内置测压管在压力 流率测定中对尿流率的影响。　方法　对 4 4例良性前列腺增生 (BPH)患者进行自由尿流率和压力 流率测定。压力 流率测定中尿道内放置 7F测压导管。统计学分析比较自由尿流率和置管后尿流率的变化。　结果　 4 4例患者自由尿流率和带管尿流率的排尿量分别为 (174 .72± 74 .6 2 )ml和 (186 .4 8± 6 9.71)ml(P >0 .0 5 )。最大自由尿流率(9 .5 5± 4 .10 )ml/s ,最大带管尿流率 (7.32± 3.2 8)ml/s(P =0 .0 0 0 )。最大尿流率下降值为 (2 .2 2± 3.0 7)ml/s。膀胱出口梗阻 (BOO) 0～Ⅰ级、Ⅲ级和Ⅳ级时自由尿流率和带管尿流率两者差异有显著性意义 (P <0 .0 5 ) ,BOOⅡ级、Ⅴ～Ⅵ级时自由尿流率和带管尿流率差异无显著性意义 (P >0 .0 5 )。　结论　尿道内置 7F测压导管可影响最大尿流率测定值。     

The HLA-DPB1--associated component of the IDDM1 and its relationship to the major loci HLA-DQB1, -DQA1, and -DRB1

The major histocompatibility complex (MHC) HLA region on chromosome 6p21 contains the major locus of type 1 diabetes (IDDM1). Common allelic variants at the class II HLA-DRB1, -DQA1, and -DQB1 loci account for the major part of IDDM1. Previous studies suggested that other MHC loci are likely to contribute to IDDM1, but determination of their relative contributions and identities is difficult because of strong linkage disequilibrium between MHC loci. One prime candidate is the polymorphic HLA-DPB1 locus, which (with the DPA1 locus) encodes the third class II antigen-presenting molecule. However, the results obtained in previous studies appear to be contradictory. Therefore, we have analyzed 408 white European families (200 from Sardinia and 208 from the U.K.) using a combination of association tests designed to directly compare the effect of DPB1 variation on the relative predisposition of DR-DQ haplotypes, taking into account linkage disequilibrium between DPB1 and the DRB1, DQA1, and DQB1 loci. In these populations, the overall contribution of DPB1 to IDDM1 is small. The main component of the DPB1 contribution to IDDM1 in these populations appears to be the protection associated with DPB1*0402 on DR4-negative haplotypes. We suggest that the HLA-DP molecule itself contributes to IDDM1.