腰骶椎前路螺旋笼在椎弓峡部裂模型上的生物力学表现

目的 制成近似临床腰骶椎峡部裂的病理模型，定量测试前路螺旋融合笼（ＡＦＣ）对该模型的稳定效果。方法 使用４具人尸腰骶椎骨制成空白运动节段标本，用线锯锯断椎弓峡部法制成峡部裂模型标本，再分别用单纯骨块、ＡＦＣ置入模型标本椎间隙以固定该节段，测试以上４种状态下节段标本的应变、位移、刚度。结果 该模型标本较对照空白标本刚度显著下降，ＡＦＣ固定后刚度显著增加。结论 （１）该峡部裂模型基本符合本试验的要求；     

经腹椎间盘切吸术在CT下L4／5间盘的探讨与L5／S1间盘的临床应用

目的：研究与探讨CT下L4/5椎间盘前入路经腹穿刺切吸术的可行性，适应症的范围。前入路经腹穿刺L5/S1椎间盘摘出术的临束应用。方法：146椎间盘经腹穿刺切吸术5例患者全部在CT下完成手术。经腹穿刺L5/S1椎间盘切吸术238例患者多数在DSA下完成手术。结果：CT下146椎间盘经腹穿刺切吸术的5例患者均获得成功，成功率有效率为100％，一年追踪回访突出部位基本回纳；解除突出部位对神经根的压迫，临床症状消失。经腹穿刺L5/S1椎间盘切吸术238例患者，手术成功率100%总有效率96．6％，显效率86．9%。结论：通过5例患者的临床应用证实CT监控下146经腹穿刺切吸术的可行性，经腹穿刺L4／5．L5/S1椎间盘切吸术具有创伤小、康复快、有效率高等优势。     

前路钢板与后路侧块螺钉治疗颈髓损伤疗效比较

到目前为止，对于不稳定性的颈髓损伤采用前路钢板还是后路侧块螺钉治疗，尚无定论。通常，手术入路的选择，取决于疾病本身的病理基础，即要看神经受压在前方或是在后方，而采取相应的手术策略。     

经皮穿刺腰椎间盘切割术治疗L5S1椎间盘突出症

目的：介绍我院所用直套管，非髂骨钻孔法行L5S1椎间盘切割术治疗腰椎间盘突出症的经验。材料和方法：本组43例，男30例，女13例，年龄为22～61岁。介绍该方法的操作要点及分析影响L5S1椎间盘穿刺成功的因素．结果：本组穿刺成功率为97.6%，有效率为85．7%。无明显并发症,术后CT图像上的椎间盘改变与临床症状，体征的改善不成比例。分年龄组的随访中，≥50岁年龄组患者的有效率较低，仅为33.3%。结论：经皮穿刺L5S1椎间盘切割术是一种安全、简便、有效的治疗L2S1椎间盘突出症的方法，值得推广应用。     

侧后路进针法经皮穿刺切除髓核治疗L5—S1椎间盘突出症56例临床研究

侧后路进针法经皮穿刺切除髓核治疗Ｌ５～Ｓ１椎间盘突出症５６例临床研究武警河南总队医院放射科（郑州４５００５２）赵朝贵王建华徐荣庚杨常年王亚楠朱卉敏关键词腰椎椎间盘移位Ｌ５～Ｓ１椎间盘经皮穿刺术经皮腰椎间盘切除术（ＰＬＤ）治疗腰椎间盘突出症已应用于临床...     

经皮穿刺L5—S1椎间盘髓核摘除术前入路的应用解剖

目的为经皮穿刺L5-S1椎间盘髓核摘除术前入路提供解剖学基础.方法在32具成人尸体标本上解剖观察L5-S1椎间盘前方的毗邻关系.结果L5-S1椎间盘前方存在一个由左、右髂血管和骶岬上缘平面围成的"△"相对安全区,该区的面积是11.59±3.34(7.40～17.42)cm2,在该区内没有大的血管和神经干.结论用穿刺导管从腹前壁经腹膜直抵椎间盘前面,椎间盘前方的小肠被"T"型杵状压腹器自动推开,从而可经双侧髂血管之间由前面较安全地穿入椎间盘中点.     

乙型肝炎前S1、S2抗原与HBV-DNA的相关性分析

 目的 对比分析乙型肝炎(乙肝)前S1、S2抗原和HBV-DNA的相关性,探讨乙肝前S1、S2抗原的临床应用价值。方法 随机选取乙肝患者420例,采用ELISA法对前S1、前S2抗原进行检测,采用荧光定量PCR对HBV-DNA进行检测,从血清学标志类型、HBV-DNA载量和HBV感染类型角度对HBV-DNA和前S1、S2抗原检测结果进行分析。结果 乙肝大三阳患者乙肝前S1、S2抗原和HBV-DNA阳性率分别为98.48%、95.45%、100.0%;小三阳患者乙肝前S1、S2抗原和HBV-DNA阳性率分别为53.25% 、45.45% 、46.75%。HBsAg(+)HBcAb(+)患者乙肝前S1、S2抗原和HBV-DNA阳性率分别为53.75%、43.28%、44.78%。在高HBV-DNA载量组中乙肝前S1、S2抗原检出率较高。结论 乙肝前S1、S2抗原与HBV-DNA有较好的相关性,可作为反映病毒感染与复制的指标。     

不同手术入路及钢板放置位置治疗外踝骨折的临床研究

目的探讨不同手术入路及钢板放置位置治疗外踝骨折的优缺点以及适应证。方法贵州省赤水市人民医院骨科2014年1月—2016年1月共收治52例累及外踝的踝关节骨折患者,其中男性22例,女性30例;年龄18~72岁,平均39.8岁。按治疗方法不同分为腓骨外侧入路组和腓骨后侧入路组,其中采用腓骨外侧入路并将钢板固定于外侧的共29例,腓骨后侧入路并将钢板固定于后侧的共23例,对术后并发症、踝关节功能等进行比较。结果 52例均在术后6个月内获得骨性愈合。外侧入路组中1例出现切口浅表感染,1例出现伤口边缘坏死,钢板外露,经再次手术转移皮瓣覆盖后切口愈合。后侧入路组1例出现切口浅表感染,1例术后出现足外侧皮肤感觉麻木,随访期间有好转但未完全恢复正常;2例术后并发腓骨肌腱腱鞘炎。根据美国足踝外科协会踝与后足评分标准对术后12个月踝关节功能进行评分,外侧组为(84.83±7.26)分,其中优9例,良15例,可5例,差0例;后侧组为(84.26±6.44)分,其中优7例,良13例,可3例,差0例。两组术后并发症及踝关节功能比较差异无统计学意义(P0.05)。结论外踝外侧入路手术操作简捷,但其存在切口坏死、钢板外露等并发症,外侧钢板远端螺钉单皮质固定不够稳定。后侧入路具有的优势包括软组织条件好、固定牢固以及利于早期康复锻炼,但因后侧入路解剖结构较复杂,术中可能会损伤腓肠神经及小隐静脉,亦存在腓骨肌腱腱鞘炎等远期并发症。两种手术入路的选择应综合考虑骨折分型、局部软组织条件等因素,采取个体化方案治疗。     

前路钢板与后路经皮骶髂螺钉治疗新月形骨盆骨折的比较研究

目的比较前入路钢板与后入路经皮骶髂螺钉治疗骨盆新月形骨折的疗效。方法回顾性研究2011年12月~2015年1月收治的28例新月形骨盆骨折患者,经前路钢板治疗17例(A组),其中男性14例,女性3例;年龄21~62岁,平均33.5岁;后路经皮骶髂螺钉治疗11例(B组),其中男性7例,女性4例;年龄20~59岁,平均32岁。骨折按照Tile分型:B2.2型18例,B2.3型10例。术后采用Majeed评分。结果 28例获得随访,A组平均随访14.5(12~17)个月,B组平均随访13.2(11~20)个月。两组手术纠正骨盆后环移位分别为(11.1±4.9)mm和(11.7±5.4)mm,差异无统计学意义(P0.05);手术时间分别为(214±23.5)min和(153±25.5)min,失血量分别为(460±109.5)m L和(189±98.5)m L,比较差异均有统计学意义(P0.05)。疗效参照Majeed评分:A组优13例(76%),良3例(18%),差1例(6%);B组优8例(73%),良2例(18%),可1例(9%),两组优良率比较差异无统计学意义(P0.05)。结论前路钢板和后路经皮骶髂螺钉治疗新月形骨盆骨折均可取得良好效果,应根据患者个体情况选择手术方式;后路经皮置钉创伤小、手术时间短、出血量少,但有严格的手术适应证和禁忌证。     

在普外科应用5S护理服务模式的效果分析

目的探讨5S护理服务模式在普外科的综合应用效果。方法选取2010年1月～2011年7月于本院普外科进行治疗的88例患者为研究对象,将其按照随机数字表法分为对照组44例和观察组44例,对照组进行常规护理模式护理,观察组采用5S护理服务模式护理,将两组患者的住院时间、满意度及护理前后的治疗积极性、依从性、SCL-90评分进行统计及比较。结果观察组住院时间短于对照组,患者满意率高于对照组,治疗积极性及依从性均优于对照组,SCL-90评分各项目均低于对照组,P<0.05,均有显著性差异。结论 5S护理服务模式在普外科中的综合应用效果好,对于促进患者痊愈及改善患者的生存质量均有重要的作用。     

Population genetic data on D1S80, D17S5, ApoB, COL2A1 and Ig-JH in Northeastern Thais

Allele frequency distributions at five VNTR loci namely; D1S80, D17S5, ApoB, COL2A1 and Ig-JH were examined in Northeastern Thais. The number of alleles at each locus were 19, 13, 14, 6 and 8 with the heterozygous frequencies of 0.814, 0.818, 0.676, 0.579 and 0.288, respectively. No significant deviations were found by statistical tests for Hardy-Weinberg equilibrium. The combined power of discrimination for all five loci was 0.99998.     

前入路经腹L5／S1椎间盘髓核摘除术的穿刺技术

目的 探讨前入路经腹L5／S1椎间盘髓核摘除术（TALD）的穿刺技术和方法。方法 尸体标本2具,解剖暴露L5／S1椎间盘前缘,用细针行多角度穿刺,探讨L5／S1椎间盘前路穿刺的进针方向。腰骶椎骨标本30套,摄片观察L5／S1椎间盘穿刺的影像标志。钡餐检查时,随机选取200例被检者,观测各骨性标志的显示率。TALD治疗L5／S1椎间盘脱出68例进行回顾。结果 TALD关键的步骤是穿刺针与腰骶间隙平行刺入椎间盘,必须确定皮肤进针点和椎间盘前缘进针点,椎间盘邻近的5个骨性标志对穿刺定位有重要帮助。结论 正确的穿刺方法对TALD的开展有重要意义。     

有氧运动对大鼠外周血EPCs G_1/S转换信号通路相关基因mRNA表达的影响

目的:研究有氧运动对EPCs细胞周期关键转换点G1/S转换信号通路相关基因mRNA表达的影响,从分子水平探讨有氧运动影响外周血EPCs增殖的机制。方法:两月龄雄性SD大鼠20只,按体重分层随机分为空白对照组和有氧运动组.。采用递增负荷跑台运动,每天训练1次,每周6天,由15 m/min(持续25 min)递增至26 m/min(持续50 min),跑台坡度为10%,共训练8周。运动方案结束后,采集大鼠外周血得到单个核细胞并诱导其分化获取EPCs,培养12天后收集贴壁EPCs进行全基因组检测,检测结果采用GeneSpring11.0芯片软件进行分析,对运动组与对照组相比差异表达基因进行信号通路分析。运动组/对照组基因差异表达倍数大于2倍视为表达具有差异,且表达上调;对照组/运动组基因差异表达倍数大于2倍视为表达具有差异,且表达下调。结果:在G1/S转换信号通路的10个相关基因中,Fbxo5 mRNA、Ccne1 mRNA、Orc1lmRNA、Dhfr mRNA、Pola1 mRNA、Pcna mRNA表达上调,Tyms mRNA、Cdc45l mRNA、Cdc6mRNA、Cdt1 mRNA无明显改变。结论:有氧运动可通过改变EPCs细胞周期G1/S转换相关基因Fbxo5、Ccne1、Orc1l、Dhfr、Pola1、Pcna mRNA表达,促使细胞增殖的关键点由DNA合成前期向DNA合成期转化,并为DNA的复制做充分准备,有利于EPCs细胞周期的缩短。     

“Children with cerebral palsy experience greater levels of loading at the low back during gait compared to healthy controls”

Excessive trunk motion has been shown to be characteristic of cerebral palsy (CP) gait. However, the associated demands on the lower spine are unknown. This study investigated 3-dimensional reactive forces and moments at the low back in CP children compared to healthy controls. In addition, the impact of functional level of impairment was investigated (GMFCS levels). Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited to the study. Three-dimensional thorax kinematics and reactive forces and moments at the low back (L5/S1 spine) were examined. Discrete kinematic and kinetic parameters were assessed between groups. Thorax movement demonstrated increased range for CP children in all 3 planes while L5/S1 reactive forces and moments increased with increasing level of functional impairment. Peak reactive force data were increased by up to 57% for GMFCS I and 63% for GMFCS II children compared to controls. Peak moment data were increased by up to 21% for GMFCS II children compared to GMFCS I and up to 90% for GMFCS II compared to control. In addition, a strong correlation was demonstrated between thorax side flexion and L5/S1 lateral bend moment (r = 0.519, p < 0.01) and medial/lateral force (r = 0.352, p < 0.01). Children with CP demonstrated increased lower spinal loading compared to TD. Furthermore, GMFCS II children demonstrated significantly more involvement. Intervention should be aimed at reducing excessive thorax movement, especially in the coronal plane, in order to reduce abnormal loading on the spine in this population.     

Oxotechnetium TcO[SN(R)S][S] complexes as potential 5-HT1A receptor imaging agents

A series of ^99mTcO[SN(R)S][S] complexes carrying the 1-(2-methoxyphenyl)piperazine moiety on the tridentate ligand [SN(R)S] was synthesized. For structural characterization and for in vitro binding assays the analogous oxorhenium complexes were prepared. As demonstrated by appropriate competition binding tests in rat hippocampal preparations, all oxorhenium analogues showed affinity for the 5-HT_1A receptor binding sites with IC₅₀ values at the nanomolar range (IC₅₀= 5.8–103 nM). All ^99mTcO[SN(R)S]/[S] complexes showed significant brain uptake in rats at 2 min p.i. (0.24–1.31% ID). However, a clear correlation between distribution of radioactivity in the brain and distribution of 5-HT_1A receptors could not be established.     

A Spanish population study of the STR loci HumLPL, D5S818, D7S820 and D13S317

Allele and genotype frequencies for four tetrameric short tandem repeat loci were determined in a Spanish population sample (N = 193-225) using PCR. All loci met Hardy-Weinberg expectations and the results demonstrated the assumption of independence of the loci analysed. The allele frequency data can be used in identity testing to estimate the frequency of a multiple PCR-based DNA profile in the Spanish population. Received: 16 December 1997 / Received in revised form: 9 March 1998     

Polymorphism analysis of the VNTR locus D17S5 in Central Spain

The fragment length polymorphism YNZ22 (D17S5) was analysed for a sample of 207 unrelated individuals living in Madrid (Spanish Caucasians) using PCR-methodology and high resolution separation. Hardy-Weinberg expectations (HWE) were calculated after pooling alleles into four groups. No deviations from HWE were detectable using the conventional ²-test. The power of discrimination was estimated as 0.96 and the mean paternity exclusion chance as 0.7587. A comparison of the allele frequency distribution with those of other Caucasian groups revealed no major differences.     

下坡跑对生长期去卵巢小鼠骨BMP-2、Smad1/5和Runx2表达的影响

目的:研究下坡跑对生长期去卵巢后骨质疏松小鼠骨形成蛋白BMP-2及其信号转导蛋白Smad1/5和靶基因Runx2基因表达的影响.方法:24只4周龄雌性C57BL/6小鼠,适应性喂养1周后随机分为安静去卵巢组(C+OVX组)、运动去卵巢组(D+OVX组)和安静假手术组(C+SHAM组)3组.D+OVX组进行8周下坡跑,训练结束后C+OVX组和D+OVX组行去卵巢手术,C+SHAM组行假手术.术后正常喂养6周处死小鼠,采用RT-PCR检测骨BMP-2、Smad1/5和Runx2 mRNA表达;采用比色法检测血液生化指标;使用Hologic Discovery A骨密度仪检测前肢骨BMD.结果:与C+OVX组相比,D+OVX组BMP-2(P＜ 0.01)、Smad1 (P＜0.05)、Smad5(P＜0.01)和Runx2(P＜0.01)mRNA表达显著上调,磷离子浓度和BMD显著升高(P＜0.05),钙离子浓度显著降低(P＜0.05).与C+SHAM组相比,D+OVX组Runx2和Smad1mRNA表达显著下调(P＜0.05),ALP活性显著降低(P＜0.05),磷离子浓度显著升高(P＜0.05).与C+SHAM组相比,C+OVX组BMP-2(P＜0.05)、Runx2(P＜0.01)和Smad5 (P＜0.01)mRNA表达显著下调,ALP活性(P＜0.05)和BMD (P＜0.01)显著降低,磷离子浓度显著升高(P＜0.01).结论:BMP-2及其信号转导蛋白Smad1/5、靶基因Runx2基因表达水平较高可能是促进骨形成的生物学机制,下坡跑上调生长期去卵巢后小鼠BMP-2、Smad1/5和Runx2基因表达,可能与早期运动训练防治骨质疏松的机制有关.     

The influence of crouch gait on sagittal trunk position and lower lumbar spinal loading in children with cerebral palsy

BackgroundCrouch gait is a common pattern in children with CP. Little investigation has been performed as to the role of the trunk during crouch gait. A compensatory movement of the trunk may alter the position of the ground reaction force with the effect of reducing the moment arm about the knee or hip. While this may benefit these joints in the context of reduced loading, there may be implications further up the kinematic chain at the level of the lumbar spine.Research QuestionAre compensatory movements of the trunk present during crouch gait in children with CP and are levels of loading at the lower lumbar spine affected?MethodsA full barefoot lower limb and trunk 3-dimensional kinematic and kinetic analysis, with kinetics estimated at the spinal position of L5/S1, was performed on 3 groups of children, namely CP Crouch, CP No-Crouch and TD. Differences in trunk position and L5/S1 loading were compared between groups.ResultsMean trunk position in relation to the pelvis and laboratory was not statistically significant between groups. At the level of the spine, no differences were present in mean position between groups for L5/S1 sagittal moment or anterior/posterior force.SignificanceCrouch gait does not elicit a compensatory response of the trunk in children with CP and, consequently, reactive forces and moments at the lower lumbar spine remain within normal limits. With this in mind, it is unlikely that a crouch gait pattern will affect the health of the spine over time in these children.