特大面积烧伤后期关节挛缩畸型部位功能整形后疗效分析

FromSeptember１９９８toDecember２０００，weperformfunc－tionalanaplastywithde－cellxenomadermalandchinau－to－pachydermaonarthrogryposisanddeformationpositionduringthelateperiodof４caseswithsuper－largeburnandthetherapeuticeffectwassatisfactory．Reportedasfollowing．１Subjectandmethod１．１Subject４patientswithsuper－largedeepburn，３malesand１females，aged２５～４２years（mean３３．５years）．Themeanburnareawas（９０．５±３．６）％，andthemeanⅢ°burnareawas（６２．５±３．０）％．Themalfu…     

微波理疗对乳癌术后康复的作用

１SubjectandMethods１．１SubjectFromSeptember１９９４toSeptember１９９９４００pa－tientsofbreastcancerstagingfromstageItostageIIIaafterradicalormodifiedradicalmastectomyweredividedintotestandcontrolgroups．１．２Methods（１）Equipment：MultifunctionalmicrowavetreatingmachineforphysiotherapyofTianjinLY－IItypeused，withworkfre－quencyof２４５０MHzandcontinuousadjustablepowerbetween５～６０W．S＝１．２９whenradiatinginthemuscletissue．（２）Allthepatientswereadministrated５－Fuof０．７５…     

He-Ne激光重复照射抑制培养增生性瘢痕成纤维细胞胶原合成的实验研究

Hypertrophicscar（HS），atypeoffibrosisdiseaseofskinwhichischaracterizedbyhyperproductionanddepositionofcolla－genmatrix．So，inhibitionofcollagensynthesisanddepositionofcollageninfibroblastsareimportantforpreventionofHS犤１犦．Inthecurrentstudy，He－NelaserofvariouspowerdensitywasusedtoirradiateculturedfibroblastsderivedfromHStostudythepre－ventingeffectsofHe－NelaseronHS．１Materialsandmethod１．１Cellcultureandgrouping５casesofHSwereincludedinthisstudyaged１２～３１yearsold（２males，…     

外源性神经节苷脂对脑损伤的保护作用

INTRODUCTIONWeinjectedectogenesisganglioside（GM１）intoabdominalcavityofepilepsyratsinducedbysulfo－semicarbazideandobserveditsprotectivefunctiontobraininjury．MATERIALSANDMETHODSMaterials３８wistarrats（male），weight１８０－２２０g，weredividedinto４groupsrandomly：５inAnormalgroup，５inBsalinegroup，１４inCepilepsygroup，１４inDGM１interventiongroup．GroupCandDreceivedsulfo－semicarbazideinjection（７．５mg／kg）．MethodsEvaluationcriteriaofepilepsyⅠgrade：facialtic，mast…     

大鼠脊髓5－羟色胺1A受体和1C／2受体亚型参与高频电针镇痛

通过脊髓蛛网膜下腔慢性埋植导管分别注射５－ＨＴ受体的多种拮抗剂，分析了大鼠脊髓５－ＨＴ受体的三个主要类型５－ＨＴ１、５－ＨＴ２和５－ＨＴ３受体在高频电针镇痛中的作用。实验结果表明：ｉ．ｔ．注射５－ＨＴ１Ａ受体拮抗剂ｓｐｉｐｅｒｏｎｅ２５μｇ不影响１００Ｈｚ电针的平均针效（Ｐ＞０．０５），但可阻断电针后效应（Ｐ＜０．０１）；ｉ．ｔ．注射５－ＨＴ１ｃ／２受体拮抗剂ｍｉａｎｓｅｒｉｎ５０μｇ可阻断１００Ｈｚ电针的平均针效，也可阻断电针后效应（Ｐ＜０．０１）；ｉ．ｔ．注射５－ＨＴ２受体拮抗剂１－ＮＰ２０μｇ和５－ＨＴ３受体拮抗剂ＩＣＳ２０５－９３０１００μｇ对１００Ｈｚ电针镇痛没有显著影响（Ｐ＞０．０５）。提示大鼠脊髓５－ＨＴ１Ａ受体和５－ＨＴ１ｃ／２受体参与介导１００Ｈｚ电针镇痛，而５－ＨＴ３受体可能不起主要作用。     

Clinical value of X-ray and DSA examination for malignant tumors underwent inactivating replant surgery

Wecarriedoutlimbssalvageoperationin８casesofmalignantbonetumorsusingpartialtumors－incisionandalcoholinactivationsurgery．Theeffectsweresatisfying．Inthisstudy，weretrospec－tivelyanalyzedfindingsofX－rayandDSAexaminationandin－vestigatedtheirclinicalvalues．１Subjectsandmethods８subjectswereincludedinthisstudy（５men，３women）agedfrom９yearsoldto７１yearsold．Allpatientssufferedfrommalig－nantbonetumorsincluding６casesofosteosarcoma，１Ewing＇ssarcomaand１chondrosarcoma．５tumorswerelocate…     

心理、行为疗法治疗慢性前列腺炎的效果分析

１Subjectandmethod１．１SubjectFromMay１９９９toJune２００１，４８６consecutivepatientssufferedfromchronicprostatitis（CP）andcomplicatedmooddisorderincluding２１９withnon－bacterialprostatitis，６３withsimpleprostatitispain，and２１９withchronicbacterialprostati－tis．Thesepatientsarerandomlydividedintostudygroupandcon－trolgroupeuqually．Theyare１９～４１yearsofage（meanage：３４years）．Diseasecourselastedfor０．５～４years，meanly２．５years．Mooddisorderischaracterizedbylackadaisicalne…     

颈总动脉交感神经网剥脱术治疗脑性瘫痪的探讨

１Subjectsandmethods１．１SubjectsTherewere１２４patientsinthisgroup，５９males，６５females，age１yearand５monthsto２８yearsold，averageage６．５yearsold．１０９patients（childgroup）werebetween１and１３yearsold（８８％），１５patients（non－childgroup）werebetween１４and２８yearsold（１２％）．６６patientswithdifficultlabor，intrauterineasphyxiaandpostnatalasphyxiahistory，１３patientswithinflamma－tionofcerebralpart，２１patientswithhighfever，spasmhistory，３patientswithjaundicehistory，５…     

Repair of residualupper limb dysfunction following burn:2cases report

１MaterialsCase１：Female，１６yearsold，peasantwasadmittedtoourhospitalduetoupperlimbsdysfunction１yearafterleftarmpitburn．Physicalexaminationshowedgoodstatus，contracturedhardscar（１４cm×１８cm）withirregularsurfaceinleftarmpit．Movementrangeofshoulderjointis１０degreesunderfor－wardflexionposition，５degreesunderbackwardextensionposition，５degreesinoutwardextension．PreoperativeX－rayshowednoab－normalchangesinbonematrixofleftshoulderjoint．Scarwasex－cisedunderpamplegiaduringselectiv…     

血清1,5脱水葡萄糖醇全酶的测定

目的 建立一种测定血中１，５－脱水葡萄糖醇（１，５－ＡＧ）的方法，辅助诊断糖尿病。方法 采用葡萄糖激酶去除血清样品内源葡萄糖干扰，以吡喃糖氧化酶（ＰＲＯＤ）氧化血清１，５－ＡＧ，生成１，５－脱水果糖和Ｈ２０２，后者用Ｔｒｉｎｄｅｒ反应进行比色测定。结果 该方法ＰＲＯＤ用量为８０ＫＵ／Ｌ，反应（终点）时间１０分钟，最低检测限为１．９８μｍｏｌ／Ｌ，１，５－ＡＧ在６３３．３μｍｌｏ／Ｌ以内线性良好。高     

Biomechanical comparison of a 3D-printed sacrum prosthesis versus rod-screw systems for reconstruction after total sacrectomy: A finite element analysis

BackgroundReconstruction after total sacrectomy is a difficult problem in the field of orthopedic oncology. Current reconstruction methods have not completely solved the problems associated with instrumentation failure. The purpose of this study was to evaluate the biomechanical properties of a 3D-printed total sacrum prosthesis and to conduct biomechanical comparisons between the total sacrum prosthesis and rod-screw systems for lumbosacral reconstruction after total sacrectomy.MethodsThree types of reconstruction were explored, and corresponding finite element models were simulated: four-rod reconstruction, four-rod plus anterior column reconstruction, and 3D-printed total sacrum prosthesis reconstruction. A vertical load of 600 N was applied to the L4 vertebra, and the bilateral acetabula were set as the boundary with six degrees of freedom fixed, simulating the bipedal standing position.FindingsThe order of the reconstructions according to decreasing maximum von Mises stress was as follows: four-rod reconstruction > four-rod plus anterior column reconstruction >3D-printed total sacrum prosthesis reconstruction. The order of reconstructions according to decreasing L5 shift-down displacement was as follows: four-rod reconstruction >3D-printed total sacrum prosthesis reconstruction > four-rod plus anterior column reconstruction.InterpretationCompared with the rod-screw systems, the total sacrum prosthesis reconstruction has the biomechanical advantages of a more uniform stress distribution, a lower peak stress and better stability and can thus serve as an alternative choice for reconstruction after total sacrectomy.     

前后路联合手术治疗胸腰椎肿瘤的疗效分析

【目的】探讨前后路联合一期椎体切除脊柱重建治疗胸腰椎肿瘤的疗效及优越性。【方法】术前先介入栓塞肿瘤供血动脉,再应用前路椎体切除、钛笼加自体小髂骨植骨或骨水泥椎体重建和后路椎弓根钉系统内回定治疗胸腰椎肿瘤18例。【结果】术后随访5～32个月,平均10．5个月。术后13例腰背部疼痛及放射性疼痛基本缓解,不完全截瘫的8例患者均有不同程度的恢复。所有随访达10个月的15例复查显示骨性融合,无内固定松动、断裂发生。【结论】前后路联合一期椎体切除脊柱重建治疗胸腰椎肿瘤能有效切除肿瘤、重建脊柱稳定性、提高病人生活质量。     

骶骨肿瘤的手术治疗

[目的]探讨骶骨肿瘤术前选择性数字减影血管造影（DSA）血管栓塞,肿瘤切除术后前路用重建钢板加骨水泥和（或）联合后路钉棒系统重建脊柱和骨盆稳定性的疗效。【方法】骶骨肿瘤19例,术前均采用选择性DSA血管栓塞、术中尽可能保留S1～S3神经,肿瘤切除后前路用重建钢板加骨水泥和（或）联合后路钉棒系统重建骨盆稳定性。【结果】随访6～52个月,所有患者均安全度过围术期,4例因复发及远处转移分别于术后12个月、14个月、20个月及36个月死亡,13例患者腰骶部疼痛及神经功能有不同程度改善,其中7例恢复正常负重及行走,2例术后6个月失访。13例重建者随访期间X线片检查见所有病例骨盆稳定性好,无腰椎下沉及移位,亦无骨水泥脱落。【结论】术前选择性DSA血管栓塞止血效果好,骶骨肿瘤切除术后前路用重建铜板加骨水泥和（或）后路钉棒系统联合重建脊枉和骨盆稳定性的疗效可靠。     

选择性责任节段减压并椎弓根螺钉系统置入内固定治疗腰椎退变性疾病

背景：腰椎退变性疾病的患者经保守治疗无效,感觉运动功能障碍、马尾综合征,疼痛难忍而影响：[作和生活的情况,需要通过手术的方法来治疗。 目的：分析腰椎退变性疾病的植入物置入内咧定治疗效果,深入了解腰椎退变性疾病患者的临床症状检食方法,吲顾腰椎退变性疾病采用植入物置入内固定治疗的相关文献。 方法：选取2010年12月29日至2011年1月27日在解放军第306医院骨科治疗的腰椎滑脱合并相邻节段和,或跳跃性节段退变性疾病的患者23例,存全麻下行后路腰椎管减压椎间融合器植入植骨融合椎弓根螺钉系统内周定,采用VAS、JOA和ODI评分对患者术前和术后进行评定,加用临床症状改善程度作为手术疗效的判定标准。并检索腰椎退变性疾病采用植入物置入内固定治疗的相关研究文献,对文献的实验方法和实验结果进行深入分析。     

骶骨S2椎弓根外进钉固定的生物力学分析

背景:模拟骶骨骨折S2椎弓根钉外进钉固定拔出力与在拔出椎弓钉时的应变电测分析鲜有报道。目的:测量S2椎弓根外进钉固定拔出力与骶骨应变分布,为临床提供生物力学参数。方法:取正常国人新鲜尸体骶骨标本,以椎弓根钉外进钉方法固定于S2椎弓根,以小型力传感器与椎弓根钉固定装置连接测量椎弓根钉的拔出力,同时以动静态电阻应变仪,对预先粘贴在4个椎弓根螺栓固定边缘部位和骶骨不同部位的应变片进行应变电测量。1号进钉点位置为左侧第1骶后孔下缘最低点,2号进钉点位置为右侧第1骶后孔下缘最低点,3号进钉点为左侧第1骶后孔连线与骶外侧嵴的交点,4号进钉点为右侧第1骶后孔连线与骶外侧嵴的交点。测量椎弓根螺钉最大拔出力和骶骨各测点应变值。结果与结论:外进钉1号螺钉拔出力为(399.0±7.2)N,2号螺钉拔出力为(281.0±5.2)N,3号螺钉拔出力为(196.0±4.3)N,4号螺钉拔出力为(220.1±4.6)N。应变电测量最小应变发生在2号螺钉8号测点,应变为(13.5±1.1)με;最大应变发生在1号螺钉1号测点,应变为(96.8±6.5)με。提示S2椎弓根钉外进钉固定方法符合生物力学原理。     

Open reduction and internal fixation of a displaced transverse fracture of the sacrum with a locking compression plate

Isolated fractures of the distal sacrum are usually caused by direct trauma. Undisplaced fractures are easily missed on conventional X-ray films. CT scans can disclose the full extent of the fracture. Undisplaced, or minimally displaced fractures can be treated conservatively with analgesics and a restriction to seat for six weeks. In cases of major displacement or neurological symptoms, a digital transanal reduction of the fracture under local or regional anaesthesia can be attempted. If this manoeuvre fails, open reduction and internal fixation are required. Stabilisation is challenging because of the thin bone and the complex shape of the sacrum. In a 15 year old girl with major horizontal displacement and comminution of S4, following a snowboard accident, we achieved sufficient and stable fixation with the new LCP (Locking Compression Plate) system. For six weeks after the operation, the patient was not allowed to sit down. Thereafter, she was free of pain and unrestricted in daily activities and sport. The LCP system has a number of advantages in the fixation of fractures in osteoporotic or thin bone, but clinical experience/skill and careful planning of the operation are crucial.     

滑槽钉生长棒内固定系统的极限加载实验研究

【目的】采用极限加载实验对滑槽钉生长棒内固定系统与通用脊柱内固定系统的进行比较，为该系统的进一步改进及将来的临床应用提供理论依据。【方法】将新鲜猪脊柱标本12具，共3个胸椎功能单位，随机分成两组，滑槽组（固定螺钉固定标本第3椎体，滑槽螺钉固定标本第1椎体），固定组（固定螺钉固定标本1、3椎体），分别应用通用脊柱内固定系统和滑槽钉生长棒内固定系统测试标本在前屈状态及旋转状态的极限加载。所得数据采用SPSS 18．0软件进行统计学分析。【结果】前屈状态时滑槽组在400 N左右出现钉道松动，固定组在1800 N左右出现钉道松动，两组相比较差异有显著性（ P＜0．05）；旋转状态时滑槽组在5度左右出现钉道松动，固定组在10度左右出现钉道松动，两组相比较差异有显著性（P＜0．05）。【结论】滑槽钉生长棒内固定系统的极限加载要小于通用脊柱内固定系统，说明滑槽钉生长棒内固定系统的研究存在一定不足，需进一步优化，增加固定强度。     

骨质疏松患者椎弓根螺钉稳定性的随访

背景：骨质疏松患者置入椎弓根螺钉后,易发生螺钉松动和复位矫正丢失等固定不稳现象,因此,骨质疏松被认为是椎弓根螺钉的相对禁忌证。目的：观察骨质疏松患者提高椎弓根螺钉稳定性方法的临床应用效果。 方法：34例骨质疏松患者行椎弓根螺钉内固定,术中采用了提高椎弓根螺钉稳定性方法。骨折患者14例（骨折组）,骨病患者20例。20例骨病患者和5例骨折患者行脊柱后外侧或椎间植骨融合（融合组）。骨质疏松按Jikei分级,初级8例,Ⅰ级11例,Ⅱ级8例,Ⅲ级7例。对19例初级和Ⅰ级骨质疏松患者,采用较粗和较长螺钉,同时结合采用螺钉与连接棒强直性连接,且有两根横向连接装置,左右、上下椎弓根螺钉分别在水平面和矢状面以较大成角置入螺钉等方法提高螺钉固定相对稳定性对15例Ⅱ级和Ⅲ级骨质疏松患者,钉道注入骨水泥以提高螺钉固定绝对稳定性。结果与结论：随访9-26个月,平均14个月,无螺钉断裂,骨折组仅2例Jikei Ⅰ级患者固定后五六个月时发生螺钉松动、部分复位矫正丢失等固定不稳,但无明显其他不良影响。骨折组复位矫正丢失平均5%,融合组植骨融合率100%。对于骨质疏松患者,根据骨质梳松程度采用不同的提高螺钉固定稳定性方法,可以减少螺钉松动和复位矫正丢失等固定不稳并发症。     

Osteoporotic fracture of the sacrum: Sacroplasty and physical medecine

ContextTraditional treatment of sacrum osteoporotic fractures is mainly based on antalgics and rest in bed. But complications are frequent, cutaneous, respiratory, thrombotic or digestive and mortality at 1 year significant.The aimsWe wanted to define the interest of sacroplasty when treating osteoporotic fracture of sacrum.MethodWe reviewed literature while studying a clinical case in an elderly patient.ResultsSacroplasty was efficient at short and mean delay to control the pain due to osteoporotic sacrum fracture. Rate of complications is low in the centers mastering the procedure.ConclusionSacroplasty is of evident interest for elderly patients suffering of an osteoporotic fracture of sacrum. It reduces decubitus complications, secondary effects of antalgics and allows an early reeducation.     

胸腰椎椎弓根钉内固定并发症分析及对策

目的探讨胸腰椎椎弓根钉内固定并发症原因及预防措施。方法回顾性分析2006年12月一2010年12月行胸腰椎经椎弓根钉内固定治疗失败的21例患者临床资料。手术均采用经椎弓根钉内固定。误人椎管或穿出椎弓根外壁4例,螺钉断裂4例,定位失误3例;术后1～23个月内固定松动9例,其中术后1～2个月第1次X线片检查发现松动3例,术后1～3个月内固定松动并感染2例;误诊1例（腰椎肿瘤、病理性骨折诊断为骨质疏松骨折）。19例再次手术。结果21例均获随访,随访时间3～34个月,平均18．5个月。12例重新固定、植骨融合患者内固定位置良好,未发现内固定松动、断裂或脱出,植骨获得骨性愈合。8例内固定物取出,5例无腰、背部疼痛,腰部活动正常,3例述偶感腰、背部不适,腰部活动尚好,1例感腰、背部疼痛,影响日常活动。1例死亡。结论椎弓根螺钉内固定并发症多方面因素引起的,应充分认识,有效的骨折节段融合、术中仔细操作、预防感染、正确的康复锻炼等,可有效减少胸腰椎椎弓根内固定失败。