海水浸泡对开放性骨折组织修复的影响研究

目的：观察海水浸泡对开放性骨折组织修复的影响。方法：将新西兰兔46只,随机分为观察组25只和对照组21只,均造成桡骨横行1．5mm缺损完全开放性骨折。观察组用海水浸泡伤口3h,对照组旷置3h,之后依次缝合伤口。观察第1、3、7、14、21、28天两组在骨折愈合中的骨痂形成过程及骨痂中骨形态发生蛋白（BMP）的表达。结果：第28天观察组骨折断端形成骨性骨痂6例、软骨骨痂14例,对照组形成骨性骨痂8例、软骨骨痂4例,观察组骨痂形成较对照组显著延迟（P〈0．01）;观察组愈合过程中新生骨痂的BMP表达主要在骨祖细胞、新生软骨细胞和成骨细胞上,与对照组愈合过程一致。结论：海水浸泡可延缓骨痂形成,但对愈合中BMP的表达无显著影响。     

海水浸泡兔桡骨开放性骨缺损最佳植骨时间的研究

目的 探讨海水浸泡兔桡骨开放性骨缺损最佳自体骨移植时间.方法 取新西兰大白兔48只,采用数字表法随机分为0、3、7、14d植骨组,每组12只.于兔双侧桡骨中段截除15mm骨段后人工海水浸泡伤口3h.分别于清创后立即(0 d)及浸泡后3、7、14 d于骨缺损处植入自体髂骨.各组于植骨后第4、8、12周分批处死(每批4只兔,共8肢).通过影像学、组织学观察植骨后的愈合情况.结果 (1)0d植骨组肢体感染率为4.17％ (1/24),3d植骨组肢体感染率为29.17％ (7/24),7d植骨组肢体感染率为16.67％ (4/24),14 d植骨组肢体无感染情况发生.(2)植骨后第8周时,0d植骨组断端间为新骨者6肢,为软骨者2肢;14 d植骨组断端间为新骨者4肢,为软骨者4肢.(3)植骨后第8周时,0d植骨组断端间骨痂灰度值为194.78±5.86,14 d植骨组为183.99±5.97,2组比较差异有统计学意义(P＜0.05).结论 (1)海水浸泡兔桡骨开放性骨缺损,伤后3、7d植骨组感染发生率较高;伤后0、14 d植骨组感染发生率低.(2)植骨后第8周,0d植骨组骨痂灰度值明显高于14 d植骨组.由此可见,海水浸泡兔桡骨开放性骨缺损最佳植骨时间为清创后立即,即Ⅰ期植骨.     

丹参对大鼠胫骨骨折早期愈合过程中血清、骨痂及骨组织中钙、锌含量的影响

目的：探讨大鼠胫骨闭合性骨折早期愈合过程中血清、骨痂及骨组织中钙、锌的变化以及应用丹参治疗后的影响。方法：２０只 Ｗｉｓｔａｒ种大白鼠,随机分成两组,实验组和对照组各１０只,用定点手法折骨术造成大鼠左胫腓骨中段闭合性骨折。实验组按０．０６ｍｌ／１０ｇ体重,腹腔注射丹参注射液（３ｇ／ｍｌ）１次／ｄ。对照组注射同等量的生理盐水。两组动物于术前、术后第４、８、１２天时自眼球采血１ｍｌ。术后第１３天处死,取骨痂及骨标本,采用原子吸收测定钙、锌含量。结果表明丹参可明显增加血清和骨痂中钙、锌含量,降低骨折断端邻近骨组织中锌的含量。提示：丹参促进骨折愈合的作用与其提高血清锌含量,加强骨折断端邻近骨组织中锌的动员,以及通过提高骨痂中锌含量来加速骨痂组织生长和钙化过程有关。     

MEBO治疗传统疗法难于收效创面的临床报告

目的 :观察湿润烧伤膏 (MEBO)治疗传统疗法难于收效创面的疗效。方法 :将 1990— 2 0 0 1年临床治疗的残余创面、植皮创面、骨裸露创面及中途改换MEBO治疗焦痂创面的临床疗效进行对比治疗观察。结果 :残余创面治疗组 2 0天治愈率与治愈天数分别为 10 0 %和 8 6± 3 6天 ,对照组为 6 5 %和 14 5± 4 8天 ,组间相比无为P <0 0 1;植皮创面治疗组昼夜愈合速度与痊愈天数分别为 5 6 1± 1 19%和 15 6 4± 2 2 7天 ,对照组为 3 86± 1 2 1%和19 85± 4 4 7天 ,组间相比均为P <0 0 1;骨裸露创面早期实行MEBO治疗痊愈天数为 4 8 6 1± 7 4 7天 ,后期改用MEBO治疗者骨膜与骨皮质广泛坏死 ,愈合天数明显延长 ;伤后 4周改用MEBO治疗的焦痂创面仍能产生新生“皮丁”或“皮岛”组织 ,最终实现再生愈合。结论 :MEBO能为多种类型创面提供生理性湿润环境和有效地治疗传统疗法难于收效创面的病象 ,提示干细胞可能参与了多种不同类型创面的愈合过程     

胸腔灌洗法综合治疗犬海水浸泡胸部开放伤的实验研究

目的 探讨加用胸腔灌洗法对犬海水浸泡胸部开放伤的治疗效果.方法 采用数字表法将成年杂交犬随机分为实验组(胸腔灌洗组)和对照组(常规救治组),每组10只,制成海水浸泡胸部开放伤动物模型.对照组采用常规救治,实验组在常规救治的基础上给予胸腔灌洗.观察2组部分血生化指标及肺组织病理改变的情况.结果 伤后1.0 h,对照组血清钠为(157.80±3.70) mmol/L,实验组为(146.25±4.14) mmol/L,2组比较差异有统计学意义(P＜0.05);对照组渗透压为(345.46±6.18)mmol/L,实验组为(320.53±6.91) mmol/L,2组比较差异有统计学意义(P＜0.05);在伤后8 h,对照组血清钠为( 146.80±2.87) mmol/L,实验组为(138.50±3.21) mmol/L,2组比较差异有统计学意义(P＜0.05);对照组渗透压为(331.42±4.68)mmol/L,实验组为(312.24±5.23)mmol/L,2组比较差异有统计学意义(P＜0.01).海水浸泡胸部开放伤后,2组血清钠及血浆渗透压明显升高,经过治疗血清钠及血浆渗透压均降低,其中实验组的改善更明显,实验组肺组织的病理改变程度也小于对照组.结论 加用胸腔灌洗法是一种治疗海水浸泡胸部开放伤的有效方法.     

海水浸泡对兔胫骨开放性骨折愈合进程的影响

目的 观察海水浸泡对兔胫骨开放性骨折愈合进程的影响.方法 44只新西兰兔按数字表法随机分为实验组和对照组,每组22只,均造成双侧胫骨横行骨折.实验组伤口浸泡于人工海水中3 h,对照组旷置3 h,清创后依次缝合伤口.电镜和光镜下观察2组第7、14、21、28天成骨细胞损伤情况、组织中血管内皮生长因子(VEGF)、转移生长因子-β1(TGF-β1)的表达及骨痂形成过程.结果 (1)电镜下,实验组骨折处成骨细胞在骨折后第7～14天可见明显损害,表现为胞膜及核膜破坏、线粒体肿胀空泡变、胞核溶解坏死,第21天及第28天成骨细胞形态恢复正常.(2)免疫组化显示,对照组VEGF及TGF-β1的表达于骨折后逐渐增强,至第14天时达到高峰,之后呈减弱趋势;实验组表达未见延迟,但各时段表达强度均明显弱于对照组.(3)第28天时,对照组骨痂完全为骨性骨痂者共15肢,占75%;为混合性骨痂(即软骨骨痂与骨性骨痂共存)者共5肢,占25%.实验组骨痂完全为骨性骨痂者共6肢,占30%;为混合性骨痂者共14肢,占70%.2组比较差异有统计学意义(χ2=8.12,P<0.01).结论 肢体开放性骨折经海水浸泡3 h后,膜内成骨及软骨内成骨进程延缓,骨折愈合延迟.

Abstract：

Objective To observe the effects of seawater immersion on the healing process of open tibial fracture in rabbits.Methods Forty-four New Zealand rabbits were randomly divided into two groups: the experimental group (group A) and the control group (group B), each consisting of 22 animals. The 2 groups of animals all had bilateral open fracture of tibia. The wounded limbs of the animals in group A were immersed in the artificial seawater for 3 hours. And the animals in group B were left there untended for 3 hours. Following debridement, wounds were sutured. Lesion of osteoblast, vascular endothelial growth factor (VEGF),the expression of transforming growth factor-β1 (TGF-β1) and the process of porosis in the animals of both groups were observed on the 7th,14th,21st and 28th days respectively under the electron and optical microscopes.Results (1) Under the electron microscope, obvious lesion of osteoblast in the animals of group A was observed at the fractured sites, 7-14 days after the fracture, displaying cell membrane and nuclear membrane damage, mitochondrial swelling and vacuolation, cell nucleus dissolution and necrosis. On the 21st and 28th days, morphology of osteoblasts in the animals of group A returned to normal. (2) Immunohistochemistry indicated that the expression of VEGF and TGF-β1 in the animals of group A increased and gradually rose to the peak on the 14th day after fracture, and then decreased. The expression of VEGF and TGF-β1 was not delayed in the animals of group A, but their expression intensity at various times was all obviously weaker than that of group B.(3)On the 28th day, for the animal in group B, 15 limbs were of complete osseous callus, accounting for 75%, while 5 limbs were of mixed type osseous callus, accounting for 25%. For the animal in group A, 6 limbs were of complete osseous callus, accounting for 30%, while 14 limbs were of mixed type osseous callus, accounting for 70%. Significant statistical differences could be seen, when a comparison was made between the groups(P<0.01).Conclusions The process of intramembranous/cartilaginous ossification and fracture healing delayed, following open fracture of limbs coupled with 3-hour seawater immersion.     

大黄素对兔实验性骨折一氧化氮合成酶表达的影响

目的：观察大黄素对骨折愈合过程骨痂中一氧化氮合成酶（NOS）活性的的影响，探讨大黄素对骨折愈合的促进作用。方法：选用40只新西兰白兔，建立桡骨中下段骨折模型，随机分为2组，每组20只，大黄素组腹腔注射大黄素，对照组腹腔注射生理盐水；分别于骨折后4、7、14、21d收集骨痂，通过HE染色行形态学观察，采用Western—blot方法检测骨痂中NOS蛋白表达量，采用NOS酶活性分型试剂盒检测NOS酶活性。结果：大黄素组和对照组骨痂存在明显的形态学差异；大黄素组eNOS表达及活性显著高于对照组；两组间iNOS表达无显著性差异。结论：大黄素通过对eNOS活性表达调控，可以使骨折断端血管增生和成骨能力增强，促进骨折愈合。     

益气生血汤对创伤性胫腓骨骨折手术患者中医症候积分及骨折愈合的影响

目的探讨益气生血汤对创伤性胫腓骨骨折手术患者中医症候积分及骨折愈合的影响。方法选取2018年4月-2019年4月80例创伤性胫腓骨骨折手术患者,随机数字表法分为观察组、对照组,各40例。对照组予以常规治疗,观察组在此基础上增加益气生血汤,比较两组中医症候积分及以及骨折愈合情况。结果治疗后,观察组中医症候积分低于对照组,差异有统计学意义(t=20.009,P=0.000);观察组治疗后断端边缘、骨痂边缘、骨痂量、骨痂密度均明显高于对照组,差异有统计学意义(t=16.000、10.391、6.863、6.829,P=0.000)。结论益气生血汤能有效改善创伤性胫腓骨骨折手术患者的中医症候积分,增强其骨折愈合情况,加速创伤性胫腓骨骨折的康复进程。     

双能X线骨密度仪测定骨痂骨密度变化的实验研究

目的: 研究骨折愈合过程中骨密度的动态变化,判断双能X线骨密度仪评估骨痂骨密度的可行性.材料和方法:30只犬造成右胫骨中段骨折并分断端距离4mm,单边外固定支架固定.分别在术后4、6、8、10、12周取双侧胫骨,以双能X线骨密度仪测定骨折端1cm的骨密度,分析骨密度变化及骨密度增长率的变化.结果:骨折端骨密度随时间呈一定规律增加,在不同时间组间差异有显著意义(P<0.01).自身对照的骨密度比率也随时间增加,在各组间差异有显著意义(P<0.01).12周时骨折端骨密度达到正常侧水平.结论:在犬骨折愈合过程中骨痂骨密度持续增加,双能X线骨密度仪可用于骨愈合中骨痂的骨密度判断.     

海水浸泡对伤口愈合时间影响的动物实验观察

目的 观察创伤合并海水浸泡对兔伤口愈合时间的影响.方法 以家兔为实验动物,建立背部双侧圆形创伤模型,伤后随机分为对照组和实验组,每组8只,对照组不浸泡,实验组伤后置海水中浸泡20 min.观察2组创面肉芽组织的生长状况,采用直尺测量法及照相法记录各组伤口大小的变化及最终愈合时间.结果 对照组伤口愈合时间为12～13 d,实验组伤口愈合时间为16～18 d.对照组的肉芽组织形成时间早于实验组.结论 创伤后合并海水浸泡可导致伤口愈合时间明显延长.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.