经椎弓根螺钉内固定翻修术的生物力学研究

目的探讨不同直径与长度螺钉翻修及骨水泥强化后椎弓根固定的强度,评价其生物力学效果.方法采用10具新鲜成人尸体T10～L5节段共80个椎体标本.首先置入5.5mm/45mm椎弓根螺钉作为对照组.再将脊椎标本随机平分为Ⅰ、Ⅱ两大组.Ⅰ组中40个椎体各随机选择一侧椎弓根应用6.25mm/45mm螺钉翻修(Ⅰ a组),另一侧椎弓根应用7.0mm/45mm螺钉翻修(Ⅰ b组);Ⅱ组中40个椎体各随机选择一侧椎弓根应用6.25mm/55mm螺钉翻修(Ⅱa组),另一侧椎弓根应用7.0mm/55mm螺钉翻修(Ⅱb组).再随机选择56个椎弓根分别行细小螺钉及粗大螺钉骨水泥强化固定翻修(Ⅲa组、Ⅲb组).在858Mini-MTS生物力学实验机上测试最大拔出力及最大扭力矩,并进行统计分析.结果①6.25mm/45mm螺钉翻修5.5mm/45mm螺钉置入后的椎弓根,其拔出力及扭力矩无明显增加(P＞0.05);应用7.0mm/45mm、6.25mm/55mm及7.0mm/55mm螺钉翻修,把持力及扭力矩均明显增加(P＜0.05).②骨水泥强化固定后,螺钉把持力远大于单纯螺钉翻修组,且与螺钉粗细无关.③在对照组及螺钉翻修组,螺钉把持力与扭力矩间有明显相关性,相关系数r=.86.结论①椎弓根螺钉翻修时,单纯螺钉直径增加1.5mm或直径增加0.75mm、长度增加l0mm以及骨水泥强化均可达到翻修固定的生物力学要求,以骨水泥强化固定更为明显.②增加螺钉直径与长度的翻修中,把持力与扭力矩是一致的;而应用骨水泥强化固定时,螺钉把持力主要取决于骨水泥本身及添加物-骨界面结合强度.     

膝关节置换术中应用螺钉与骨水泥修复胫骨平台骨缺损效果观察

目的观察膝关节置换术中应用螺钉与骨水泥修复胫骨平台骨缺损的效果。方法在53例膝关节置换术中,应用螺钉与骨水泥修复胫骨平台骨缺损。统计并发症发生率,并比较术前、术后6个月AKS评分和膝关节活动度。结果本组并发症发生率为1.89%(1/53)。术后6个月AKS评分及膝关节活动度均高于术前,差异具有统计学意义(P0.05)。结论螺钉与骨水泥应用于膝关节置换术胫骨平台骨缺损的修复,并发症较少,可显著改善患者膝关节功能。     

TKA术中螺钉附加骨水泥结合髓内延长杆修复胫骨平台骨缺损重建关节稳定性

目的探讨初次人工全膝关节置换术采用支撑螺钉附加骨水泥结合髓内延长杆修复胫骨平台非包容性骨缺损重建关节稳定性的早期临床疗效。方法 2012年5月至2015年10月,对16例21膝胫骨平台非包容性骨缺损进行初次全膝关节置换术,男4例5膝,女12例16膝;骨关节炎13例16膝,类风湿性关节炎2例4膝,大骨节病1例1膝;年龄65~76岁,平均70.5岁;体重68.5~92 kg,平均75.6 kg;身高155~180 cm,平均171.1 cm。膝关节活动度(69.8±9.8)°。术前美国膝关节协会(American knee society score,KSS)评分系统临床评分(31.9±8.8)分,功能评分(33.1±9.1)分。术中测量胫骨平台缺损平均深度19.8 mm,使用标准切模行胫骨平台截骨10.0 mm,截骨后残余骨缺损平均深度10.5 mm,清除骨缺损处硬化骨并于骨缺损处钻孔,拧入2~3枚支撑螺钉,加压填充骨水泥修复骨缺损,安装带延长杆的胫骨假体。结果随访26.5个月(3~36个月),术后下肢畸形改善,疼痛完全缓解,1个月后弃拐行走,日常生活均可自理;膝关节KSS临床评分(90.3±9.0)分,功能评分(91.4±8.3)分,较术前明显提高;活动度(115±8.8)°,较术前明显提高;术后末次随访复查影像学示假体位置均良好,假体周围及骨水泥填充区未发现透亮带及感染征象,支撑螺钉未见松动和移位等并发症。结论初次人工全膝关节置换术中胫骨平台较大范围非包容性骨缺损,采用支撑螺钉附加骨水泥能修复骨缺损,恢复关节线水平,髓内延长杆能增加膝关节稳定性,膝关节功能良好,早期临床疗效满意。     

骨水泥并椎弓根螺钉脊柱内固定的力学效应

目的通过用骨水泥强化椎弓根螺钉固定新鲜尸体胸腰段脊椎标本,在电子万能力学试验机上进行生物力学测试,探讨骨水泥对椎弓根钉固定强度的影响。方法选用30个新鲜胸腰段椎体作为实验对象,随机分2组,每组15个,每个椎体自身对照,第一组一侧椎弓根用聚甲基丙烯酸甲酯强化椎弓根螺钉固定;另一侧椎弓根作为对照单纯椎弓根螺钉固定,第二组一侧椎弓根扩大钻孔,然后用聚甲基丙烯酸甲酯强化椎弓根螺钉固定（模拟骨水泥强化翻修侧）;另一侧椎弓根作为对照,扩大钻孔后用粗大螺钉固定（模拟粗大螺钉翻修侧）。将标本固定于特制的模具上,用电子万能力学试验机,沿人体纵轴线作向上螺钉受力测试,至椎骨损坏或螺钉拔出时受力即为耐受负荷临界值,对所得数据进行分析。结果骨水泥强化侧耐受负荷临界值为（1 198±122）N,单纯螺钉固定侧耐受负荷临界值为（805±64）N,两组比较存在显著性差异（P〈0.05）;骨水泥强化翻修侧耐受负荷临界值为（1 775±203）N,粗大螺钉翻修侧耐受负荷临界值为（953±97）N,两组比较存在显著性差异（P〈0.05）。说明骨水泥在耐受螺钉对椎体切割破坏方面有明显的加强作用,骨水泥强化翻修的效果优于粗大螺钉翻修的效果。结论经骨水泥强化及强化翻修的椎弓根内固定有更强的力学效应,有一定的防止螺钉对椎骨损坏的作用,可提高骨质疏松患者脊椎内固定及脊椎内固定翻修手术的疗效。     

磷酸钙骨水泥加固颈椎前路单皮质骨螺钉的生物力学研究

[目的]评价磷酸钙骨水泥（calcium phosphate cement，CPC）对颈椎前路单皮质骨螺钉固定的加固作用。[方法]单皮质骨螺钉固定于C3-6椎体标本，行轴向拔出实验，周期抗屈实验，抗剪切力测试。[结果]修复组、强化组螺钉的最大轴向拔出力（POS）明显高于对照组，强化组周期抗屈后位移明显小于对照组，而最大抗剪切力明显大于对照组。[结论]磷酸钙骨水泥能显著提高螺钉的最大轴向拔出力及抗剪切能力，对颈椎前路螺钉的固定有明显的加强作用。     

全膝关节翻修术中应用金属垫片修复非包容性骨缺损的中期随访

目的探讨在全膝关节翻修术中采用金属垫片修复股骨及胫骨侧非包容性骨缺损的临床效果。方法对1992~2001年间227例全膝关节翻修术中使用金属垫片修复AORI-Ⅱ型非包容性骨缺损而获得随访的62例患者进行回顾性分析,男28例,女34例;年龄42~87岁,平均67.8岁;假体松动翻修30例,感染后假体二期植入19例,假体周围骨溶解3例,假体位置、下肢力线不佳或关节不稳定10例。采用金属垫片来修复骨缺损及恢复关节线水平,并使用髓内假体柄来增加翻修假体的稳定性。结果术后随访13~132个月,平均60.8个月。根据膝关节协会评分,膝评分从术前平均25分(15~60分)增加到随访时的平均76分(30~95分);功能评分从术前的40分(15~65分)增加到随访时的62分(25~90分);膝关节活动度从术前的78°(30°~100°)增加到随访时的87°(40°~130°)。2例感染后二期假体植入的病例由于感染复发而失败。11例股骨后侧、4例胫骨内侧可见金属垫片下骨水泥与骨界面有透亮带,但均未呈进行性发展。结论采用金属垫片修复全膝关节翻修术中非包容性骨缺损,尤其适用于老年患者,既可以方便手术操作,获得即刻稳定性,又可以提高翻修成功率。     

延长柄假体在植骨术后吸收导致假体松动的人工膝关节翻修术中应用

膝关节严重内翻畸形的骨关节炎患者或者膝关节翻修手术时常常伴有胫骨平台内侧结构性骨缺损。恢复对骨缺损的支持和关节的稳定性是全膝关节置换术（total knee arthroplasty,TKA）手术的主要挑战。当骨缺损为包含性时,采用打压植骨可以取得很好的临床效果。当骨缺损较大或者缺损累及皮质骨支撑边缘时,就要考虑使用大块结构性自体或异体骨移植或者采用金属垫片来进行治疗。     

颗粒骨打压植骨结合非骨水泥臼固定在髋臼翻修中的应用

目的 探讨颗粒骨打压植骨结合非骨水泥臼在髋臼翻修中的临床应用.方法 应用颗粒骨打压植骨结合非骨水泥臼技术重建髋臼骨缺损10例,术中使用异体颗粒骨直径4～6 mm,髋臼假体均为生物型髋臼,上2或3枚螺钉固定,内衬均为高交联聚乙烯.结果 切口均一期愈合,无感染、脱位等并发症发生.随访9～28个月,平均19.5个月,X线片上髋臼骨床、颗粒骨及假体界面未见明显透亮带存在,原骨缺损区修复良好.Harris评分术前平均38.1分,术后平均85.5分.结论 颗粒骨打压植骨结合非骨水泥臼固定方法可有效修复髋关节翻修中髋臼AAOSⅡ、Ⅲ型骨缺损,恢复骨量,并能提供良好的早期稳定性.     

腰骶椎弓根螺钉翻修及强化固定后稳定性比较

[目的]从生物力学角度评价腰骶椎弓根螺钉翻修及强化固定的稳定性。[方法]采用7具新鲜成人尸体L5S1椎体标本,于L5椎体首先置入5.5mm/45mm椎弓根螺钉,然后再置入7.0mm/55mm螺钉翻修,最后应用骨水泥强化固定;S1椎弓根置入初始螺钉为6.25mm/35mm、翻修螺钉为8.0mm/45mm、最后同样行骨水泥强化固定。在858MiniMTS生物力学实验机上分别测试各状态轴向最大拔出力及最大扭力矩。[结果](1)在L5,初始、翻修及骨水泥强化固定状态的最大把持力分别为(1680.7±242.8)N、(2410.3±366.1)N、(3273.0±688.5)N(P<0.05),最大扭力矩分别为(1006.1±205.3)N·mm、(1432.6±213.7)N·mm、(590.7±83.5)N·m(P<0.05);(2)在S1,初始、翻修及骨水泥强化的把持力分别为(926.3±274.2)N、(957.5±336.3)N、(1825.3±199.9)N,最大扭力矩分别为(667.6±88.3)N·mm、(681.4±79.4)N·mm、(558.8±97.2)N·mm;其中初始及翻修状态把持力及扭力矩均无明显差别(P>0.05),骨水泥强化固定后把持力明显增加、扭力矩明显减小(P<0.05)。[结论](1)L5椎弓根螺钉翻修时,螺钉直径增加1.5mm、长度增加10mm或骨水泥强化均可达到翻修固定的生物力学要求,增加脊椎稳定性,以骨水泥强化固定更为明显;(2)S1椎弓根螺钉翻修时,单纯增加螺钉直径和长度不能获得理想的稳定性,而骨水泥强化螺钉固定效果明显。     

初次全膝关节置换术中骨水泥螺钉技术修复胫骨内侧平台骨缺损的早期疗效分析

目的总结骨水泥螺钉技术修复初次全膝关节置换术(total knee arthroplasty, TKA)中胫骨内侧平台骨缺损的早期随访疗效。方法对2016年2月至2019年2月我院15例胫骨内侧平台骨缺损患者初次TKA中采用骨水泥螺钉技术修复,其中男6例,女9例;年龄57～76岁,平均(65.3±7.5)岁。左膝8例,右膝7例;胫骨平台骨缺损采用Rand分型均为Ⅱ型。术后随访评估患者美国特种外科医院(the hospital special surgery, HSS)膝关节评分、美国膝关节协会评分(knee society score, KSS)、膝关节活动度和并发症等,影像学评估有无假体及螺钉下沉、松动、骨溶解及骨水泥断裂等情况。结果采用门诊定期复查或电话方式随访,15例患者均获得随访,随访时间10～45个月,平均(35.5±8.3)个月。切口均I期愈合,无假体周围感染、下肢深静脉血栓及关节僵硬等并发症。末次随访时,HSS评分由术前(46.47±3.02)分提升至(91.27±1.83)分,KSS评分由术前(45.73±3.28)分提升至(91.47±1.88)分,膝关节活动度由术前(85.33±5.81)°提升至(123.67±6.40)°,差异均有统计学意义;影像学评估均未出现假体及螺钉松动、下沉、骨溶解及骨水泥断裂等。1例术后6个月出现骨水泥-胫骨假体界面非进展性放射透亮线,继续随访2年,患者膝关节无明显不适,放射性透亮线无明显进行性加重。结论采用骨水泥螺钉技术修复初次TKA中胫骨内侧平台骨缺损,手术操作简便,假体固定牢靠,并发症少,是理想的手术方式之一。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.