肋骨固定型人工全肩关节的研制和临床应用

作者报告了一种用于肱骨近端、肩胛胸壁间大块切除（ｔｉｋｈｏｆ－ｌｉｎｂｅｒｇ）术后使用的全肩关节假体。这种假体没有类似解剖学的肩胛骨，由胸部组件和肱骨组件组成。胸部组件直接固定到２、３肋骨的侧面。术后上肢的稳定性明显优于胸壁或锁骨悬吊者。还可以依肩胛带区残留肌肉的情况，恢复不同的功能。本法改变了Ｔｉｋｈｏｆ－Ｌｉｎｂｅｒｇ术式后无法施行关节成形术的观念。本假体结构简单，植入物少、安全、操作简便和固定牢靠。对肺功能无影响。适用于肩胛带区低度恶性肿瘤。还讨论了后斜角肌的生理作用。本组２例，平均随访２年，肿瘤无复发，上肢稳定、无痛，功能满意。     

新型微创椎弓根钉-板固定系统的生物力学测试

目的 :评估新型微创椎弓根钉-板内固定系统的生物力学强度。方法:根据美国材料测试协会(ASTM)标准构建单钉-棒测试组件,在万能材料试验机上分别对微创椎弓根钉-板、单向椎弓根钉-棒和万向椎弓根钉-棒组件进行生物力学强度测试。测试内容包括静态侧压测试和疲劳测试。在静态侧压测试中使用6套组件,记录组件屈服载荷、屈曲刚度以及失效模式。在疲劳测试中记录完成250万次循环负荷的最大应力数值。结果:微创椎弓根钉-板组件的屈服载荷和屈曲刚度显著低于单向椎弓根钉-棒组件(834.6±74.5N vs 1087.7±59.0N,218.1±22.4N vs 300.0±14.9N,P0.001)。微创椎弓根钉板组件的屈服载荷与万向椎弓根钉-棒组件比较无显著性差异(834.6±74.5N vs 762.8±88.6N,P=0.118);而钉-板组件的刚度显著低于万向钉-棒组件(218.1±22.4N/mm vs 389.5±37.2N/mm,P0.001)。单向椎弓根钉-棒组件的失败模式为连接棒发生塑性形变,万向椎弓根钉-棒组件为"球窝偶联"结构失效,微创椎弓根钉-板组件为钛板的塑性形变和钉-板连接部位失效。在250万次动态侧压疲劳测试中,单向椎弓根钉-棒组件、微创椎弓根钉-板组件和万向椎弓根钉-棒组件分别在450N、450N和350N循环载荷下完成测试。结论:新型微创椎弓根钉-板内固定系统可耐受250万次450N循环载荷作用,同时具有高屈服载荷和低屈曲刚度的特点。     

膝关节内侧固定平台单髁假体放置位置优化的有限元分析

目的探讨股骨组件及胫骨组件冠状面位置变化对股骨及胫骨生物力学的影响。方法取1名汉族男性志愿者的左侧膝关节CT及MRI图像,建立正常膝关节三维有限元模型(finite elemental model,FEM)。设计股骨组件及胫骨组件内翻6°、内翻3°、0°、外翻3°、外翻6°,组合成25个膝内侧单髁置换FEM。沿股骨机械轴加载1000 N载荷,观察von Mises云图应力分布,测量外侧间室载荷比例,测量胫骨组件下方松质骨及内侧皮质骨、聚乙烯衬垫上表面、外侧间室股骨软骨高接触应力值。将与中立位(胫骨及股骨假体内外翻0°、胫骨假体后倾5°)比较有统计学意义的指标通过散点图标识,找出点项目密集区和稀疏区,比较两区有统计学意义的项目数量,确定股骨组件、胫骨组件优化位置。结果股骨组件0°位放置时,胫骨从内翻6°至外翻6°各组合的胫骨组件下方松质骨高接触应力差异无统计学意义;胫骨组件0°位放置时,股骨组件内翻6°、外翻6°组件下方松质骨高接触应力值与中立位比较增加(9.21±3.38)MPa和(9.08±4.13)MPa(P<0.05)。股骨、胫骨组件从内翻6°至外翻6°变化时,胫骨下方内侧皮质骨高接触应力值逐渐下降(P<0.05)。股骨组件0°位放置时,胫骨组件从内翻6°至外翻6°各组合聚乙烯衬垫上表面高接触应力值的差异无统计学意义;胫骨组件0°位放置时,股骨组件内翻6°、外翻6°组与中立位组比较分别增加(2.88±2.53)MPa和(3.47±2.86)MPa(P<0.05);股骨及胫骨组件从内翻6°至外翻6°变化时,外侧间室载荷比例及外侧间室股骨软骨高应力值逐渐下降(P<0.05)。稀疏区(股骨或胫骨从内翻3°至外翻3°的所有组合的集合)有统计学意义的指标比例(2.8%,1/36)明显小于密集区(去除稀疏区以外的所有组合的集合)的比例(57.8%,37/64),差异有统计学意义(χ^2=29.61,P<0.001)。结论在下肢力线正常、关节线不变的条件下,膝关节内侧固定平台单髁假体放置位置为股骨组件、胫骨组件内翻、外翻角度不宜超过3°。     

血液透析颈内静脉导管固定组件的设计与应用

目的探讨自制血液透析颈内静脉导管固定组件临床应用效果。方法自行创新设计颈内静脉导管固定组件,应用于31例血液透析颈内静脉留置导管维护固定,并评价患者导管牢固性、局部皮肤反应、颈部活动度。结果固定组件应用后患者颈部活动度、局部皮肤反应、导管牢固性明显优于传统固定方法。结论颈内静脉导管固定组件可使血液透析患者在颈内静脉导管留置期间,保持颈部皮肤清洁、减轻痛苦、增进舒适,其操作简单、安全稳妥。     

Pro/E的自适应功能在建立螺纹型牙种植体骨块仿真数据库的应用

目的探讨利用Pro／E软件自适应功能建立螺纹种植体体部、基桩、中央螺丝、皮质骨、松质骨和牙冠的实体模型数据库方法，以方便对不同参数组合的分析研究。方法使用Pro／E软件建立包含各组件牙种植体的下颌骨骨块三维实体模型，选取某一参数模型导入Ansys Workbench 9．0有限元分析软件中，进行力学验证分析。结果建立了一种包含了各组件牙种植体的下颌骨骨块三维实体模型，各组件参数可灵活调整，力学分析结果与文献报道一致。结论利用Pro／E软件自适应功能建立含有牙种植体的下颌骨骨块实体模型数据库，提高了模型的灵活性、准确性，自适应功能保障各组件完全配合，可以为不同种植体参数组合的比较研究提供平台。     

人工腕关节研究进展

人工全腕关节从第一代硅胶假体的出现,已经经历了40余年的发展。第一、二代人工腕关节应用于临床后存在人工关节易脱位、假体组件易松动等问题,一直未得以广泛应用。第三代人工腕关节的设计旨在通过改善软组织平衡问题改善关节稳定性,解决人工腕关节容易脱位的问题。它包括Trispherical人工全腕关节、Biaxial人工全腕关节和Universal人工全腕关节等。而第四代人工腕关节使用了腕骨螺钉的固定方式,并且在组件上增加了多孔涂层,使得假体组件的固定更加牢固,延长了使用寿命,并有效地降低了并发症发生率。相对于腕关节融合术,全腕关节置换术具有同样的缓解疼痛效果,并能有效改善关节活动度,使患者日常生活更加便利。该文就人工腕关节研究进展作一综述。     

掌指骨髓腔内骨整合式纯钛种植体的设计及界面生物力学研究

目的:自行开发设计掌指骨髓腔内骨整合式纯钛螺旋状种植体组件,通过动物实验对种植体-骨组织结合界面进行生物力学研究,为临床中种植体式手指赝复体修复指缺损提供依据。方法:根据成人正常掌骨和近节指骨及其髓腔的解剖学测量及特点,借鉴Branemark螺旋形牙种植体,研制开发临床用于掌指骨髓腔内植入的骨整合式纯钛螺旋状种植体。将此种种植体植入家兔胫骨髓腔内,术后分别于2、4、8、12、16周处死动物取材,进行大体观察和抗拉力测试。结果:制备出适合于成人掌指骨髓腔内植入的骨整合式纯钛螺旋型种植体组件及配件,种植体与骨可以形成良好的骨性结合,术后12周种植体-骨界面结合强度达到最大,与术后16周无明显差异。结论:该掌指骨髓腔内骨整合式纯钛螺旋状种植体组件自行开发设计,符合我国成人正常掌骨和近节指骨及其髓腔的解剖学特点,髓腔内植入后12周可与骨组织发生骨整合,达到最大结合强度。     

移植肾缺血再灌注损伤后间质纤维化

本文讨论了缺血再灌注损伤导致移植肾间质纤维化的相关分子机制, 重点是血管功能障碍、上皮细胞和周细胞在这一过程中的作用, 讨论了不同方式的动物实验模型构建及其影响, 并介绍了近年来一些针对这一过程进行预防及治疗的新的方案。     

3D打印钛合金骨小梁金属臼杯及组件重建Paprosky Ⅱ、Ⅲ型髋臼骨缺损的中期疗效分析

目的:Paprosky Ⅱ型和Ⅲ型髋臼缺损是全髋关节翻修术中常见的缺损。在髋臼侧翻修手术中重建骨丢失时,3D打印钛合金骨小梁组件包括金属臼杯和各种组件是一种选择。本研究的目的是分析使用3D打印钛合金骨小梁臼杯和组件修复Paprosky Ⅱ型和Ⅲ型髋臼缺损的中期结果。方法:2015年1月至2018年12月在郑州市骨科医院...     

原位肝脏隔离灌注行肝脏恶性肿瘤区域性化疗的实验研究进展(综述)

本文以肝脏隔离灌注行肝脏区域化疗的实验研究为重点,讨论动物模型的建立,灌注液成分与灌注途径及其实验研究的发展方向。     

内窥镜技术在脂肪抽吸手术中的应用

目的：探索防止和减少脂肪抽吸手术并发症的方法。方法：采用内窥镜技术观察脂肪抽吸前、抽吸后及抽吸过程中术区的局部情况。包括脂肪抽吸前抽吸区域主要血供情况，抽吸后的局部创面情况，脂肪抽吸过程中可疑抽吸位置的即时内窥镜观察，利用内窥镜技术进行内窥镜下的治疗及操作。结果：利用内窥镜辅助脂肪抽吸手术73例。观察研究发现，内窥镜辅助脂肪抽吸手术可在抽吸前大体了解脂肪层内较大血管分布情况，有计划地指导脂肪抽吸手术，减少和防止手术中血管损伤。结论：内窥镜辅助脂肪抽吸手术，可使原来脂肪抽吸的盲视性操作变为可计划性操作，同时可以进行内窥镜下的可视性操作，如止血、缝合等，降低了手术创伤，防止和减少了该手术并发症的发生。     

Editorial Commentary: It's Not the Age; It's the Story: Acetabular Labral Repair

The major factor separating a good from a poor outcome in any study is appropriate indications. We don't operate on x-rays, magnetic resonance images, or computed tomography scans alone; we operate on clinical symptoms. With proper patient selection, we can achieve good outcomes from hip arthroscopic surgery in many older patients. There is no controversy involved in performing hip arthroscopy for an older patient. The key is to prospectively identify the proper candidates.     

The capsule coupeur for automated anterior capsulectomy

We present a mechanical automated anterior capsulectomy device that can operate from its own power source or from several pre-existent automated cataract and vitreous surgical systems.     

Microradiography and macroradiography with an industrial X-ray inspection-apparatus (author's transl)]

Bone specimens of different thickness from 100 mum ground sections to whole bones can be examined with an industrial X-ray inspection-apparatus, which is versatile, easy to operate and less expensive equipment especially made for microradiography.     

Ruptured aortic aneurysm: the decision not to operate.

Despite published criteria predicting poor survival after operation for ruptured abdominal aortic aneurysm (RAAA), little is known about the factors which influence surgeons not to operate. Questionnaires were sent to all 404 members of the Vascular Surgical Society of Great Britain and Ireland, posing questions about their practices, and factors influencing the decision not to operate (no influence; may influence; seldom operate; never operate). There were 323 responses (81%) and 97% decided not to operate on selected patients. Age over 80 years influenced 77%, and 54% seldom or never operate over age 85 years. The single most influential factor was severe neurological disease (75% seldom or never operate), while cardiac, pulmonary and renal disease influenced 22%, 28%, and 21%, respectively, to operate seldom or never (74% if two or more of these). Other factors which had some influence for most surgeons were cardiac arrest (85%), loss of consciousness (74%), prolonged hypotension (73%), and long-term nursing care (87%). By contrast, factors which influenced few surgeons were haemoglobin < 9 g/dl (30%), absence of a close relative (33%), and medicolegal considerations (22%). These data help to inform the debate about case selection for repair of RAAA.     

Usefulness of a single trocar for intrathoracic anastomosis during open thoracic surgery for esophageal cancer

When patients with esophageal cancer undergo intrathoracic anastomosis after esophagectomy in our institution, we resect the lesser curvature in the thorax using a surgical instrument after circular-stapled esophagogastric anastomosis. We then place the trocar in the seventh intercostal space on the midaxillary line, except in fifth intercostal anterolateral thoracotomy. A linear stapler applied through the thoracotomy sometimes blocks the operator's view, and so it is not so easy to operate with a rather big head in the thorax. We operate a linear cutter for laparoscopic surgery through the trocar. With this method, the instrument is used in good position in respect to the operator's view, and access to the gastric tube is easy. Moreover, we can adjust the resectional angle with this instrument by using the bending mechanism in its shaft. Furthermore, we can reuse the trocar site for the chest tube.     

SMAS下层分离除皱术

采用ＳＭＡＳ下层分离全颜面除皱术１８例，重点介绍了手术操作时应注意的问题，对额区切除一帽状键膜组织和对所谓“羊腮”患者在直视情况下用美国生产的小型脂肪抽吸器抽吸后再行提紧手术疗效十分肯定。强调只要手术操作仔细，并发症可以避免。     

Prescription and positioning: evaluating the physically disabled individual for wheelchair seating.

Within the past 10 years, technology has provided members of the seating team with new approaches in dealing with severely physically disabled children and adults. Positioning is often the first step in overall provision of technical aids. Before physically disabled individuals can operate augmentative communication devices, computer keyboards or other assistive or rehabilitative devices, they should be provided with the optimum seated posture from which to operate. The proximal stability provided by a therapeutically designed seating system will enhance motor potential. Presently, there are many approaches to providing dynamic seating. A thorough evaluation, with input from all team members including the client and his family is necessary to define clearly the goals for the seating device. Once these goals are defined, the team can investigate the possible technical solutions. Thorough ongoing re-evaluation and follow-up of both the client's needs and the possible technical solutions will ensure that persons with physical disabilities will be in the best possible posture to perform the tasks of daily living.     

Editorial Commentary: Early Surgery and Restricted Rehabilitation Are Recommended for High-Grade Acromioclavicular Joint Dislocation

Despite acromioclavicular (AC) joint injuries being common, there are still controversies about the treatment; nonoperative versus surgical, who to operate, when to operate, which technique to use, and which rehabilitation protocol to use. Orthopaedic surgeons are often faced with these patients fearing not regaining normal function and to some degree acceptable cosmetic outcomes. Despite increasing interest in surgical management of type 3 AC joint injuries, surgical management has not been demonstrated to yield superior functional outcomes compared with nonoperative treatment. Interestingly, studies have demonstrated that good outcomes are achieved with most surgical techniques even though they are all associated with loss of initial reduction. This brings into question whether surgery is necessary in the early phase and how we can mitigate the effects of gravity to maintain reduction. Studies that can aid surgeons in patient selection for treatment protocols (nonoperative versus surgical) and timing of surgery are needed. We recommend early surgery, and restricted rehabilitation, for high-grade acromioclavicular joint dislocation.     

微生物生物工程的3个基本观点

工业发酵是微生物群体活动的动态过程.此过程靠如下3种流动来维系伴随能量形式的转换而发生的电子流动;伴随异化和同化作用而发生的物质流动;伴随不同水平上的代谢调节而发生的信息流动.在分析以上3种流动的运行规律,以及归纳工业发酵和生物制药的大量信息的基础上,提出了关于微生物生物工程的三个基本观点生物能支撑观点;代谢网络观点;细胞经济观点.这些观点揭示了工业发酵的生物学属性,工业发酵的能力和潜力,以及工业发酵的行为规范.