甲状旁腺激素联合降钙素对大鼠骨质疏松性骨折骨生长因子的影响

目的探讨甲状旁腺素联合降钙素对大鼠骨质疏松性骨折骨相关生长因子及骨折愈合的影响。方法75只雌性SD大鼠随机分为:假手术组、去势组、甲状旁腺素组、降钙素组、联合用药组,15只/组,首先构建去卵巢大鼠骨质疏松性骨折动物模型。观察并评估骨折愈合,测定骨痂BMD和BMC,检测血清BMP-2、VEGF、TGF-β、IGF-1水平和骨痂蛋白表达,观察骨痂形态结构变化。结果去势组较假手术组骨折愈合评分、骨痂BMD和BMC、血清BMP-2、VEGF、TGF-β、IGF-1水平和骨痂蛋白表达均显著降低(P均<0.05),而联合用药组较去势组上述指标均显著升高(P均<0.05)。去势组骨痂骨小梁明显减少,生长稀疏,排列紊乱,大量间充质干细胞及纤维软骨细胞,成骨细胞及微血管少见;联合用药组骨痂大量骨小梁,生长旺盛,互相交错网状,排列致密有序,可见较多成熟的骨细胞及成骨细胞。结论甲状旁腺素联合降钙素通过介导提高相关骨生长因子表达,提高骨质疏松性骨折骨密度和矿物含量,改善骨组织形态学,加快骨折愈合。     

仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子及骨折愈合的影响

目的 探讨仙灵骨葆胶囊对骨质疏松性骨折大鼠骨生长因子BMP-2、IGF-1表达及骨折愈合的影响。方法 48只雌性SD大鼠随机分为：假手术组、模型组、雌二醇组、仙灵骨葆组，12只/组，采用“双侧卵巢切除术+右侧股骨干骨折髓内固定术”构建骨质疏松性骨折大鼠模型，评估骨折愈合情况，检测股骨骨痂BMD、股骨骨生物力学指标和血清骨代谢相关指标，检测骨痂BMP-2、IGF-1蛋白表达。结果 模型组较假手术组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标（最大载荷、最大应力、最大位移）、骨痂BMP-2和IGF-I阳性表达均显著降低（P<0.05），雌二醇组、仙灵骨葆组较模型组骨折愈合评分、股骨痂BMD、股骨骨生物力学指标、骨痂BMP-2和IGF-I阳性表达均显著升高（P<0.05），均以仙灵骨葆组最高。模型组较假手术组血清骨代谢指标（BGP、PICP、TRACP-5b）均显著升高（P<0.05），雌二醇组、仙灵骨葆组较模型组血清骨代谢指标均显著降低（P<0.05），以仙灵骨葆组最低。结论 仙灵骨葆胶囊可能通过介导提高骨质疏松性骨折大鼠骨生长因子BMP-2和IGF-1表达，改善骨代谢，加速骨痂形成，增加骨密度，提高骨生物力学，促进骨折愈合。     

葛根素对去卵巢大鼠骨质疏松性骨折骨痂血管形成的影响

目的探讨葛根素对骨质疏松性骨折骨痂血管形成的影响及对骨折愈合的作用。方法60只雌性SD大鼠分为3组:假手术组、去势组、葛根素组,20只/组,去卵巢大鼠骨质疏松性骨折动物。观察评估骨折愈合情况,检测血清BMP-2和VEGF浓度,观察骨痂形态结构变化,检测骨痂BMP-2和VEGF表达。结果去势组较假手术组骨折愈合评分、血清BMP-2和VEGF浓度、骨痂BMP-2和VEGF表达、微血管数均显著降低(P<0.05),葛根素组较去势组上述指标均显著增高(P<0.05)。去势组骨痂组织可见少量骨小梁,生长稀疏,排列紊乱,大量纤维软骨细胞等纤维组织,成骨细胞及新生小血管少见;葛根素组骨痂可见较多骨小梁,生长较旺盛,排列有序,可见较多成熟的骨细胞,新生微小血管较多。结论葛根素通过介导去卵巢大鼠骨质疏松性骨折骨痂BMP-2和VEGF表达,促进骨痂血管形成,改善骨组织形态学,加快骨折愈合。     

雷尼酸锶促进大鼠股骨骨质疏松性骨折愈合的研究

目的 探讨雷尼酸锶(strontium ranelate,SR)对大鼠股骨骨质疏松性骨折愈合的影响。方法 6个月龄Wistar雌性处鼠66只,切除双侧卵巢制作骨质疏松动物模型,模型建立成功后,在大鼠股骨中段横行截骨,制作大鼠股骨骨质疏松性骨折动物模型,术后死亡6只,然后将剩余60只大鼠随机分为实验组(SR干预治疗组）和空白对照组,每组30只。骨折术后第一天起,实验组给予SR 400 mg/(kg d)灌胃,对照组给予同等体积的生理盐水灌胃。通过影像学、组织学和免疫组织化学（骨形态发生蛋白-2,BMP-2)观察,骨组织形态计量学、骨密度（bone mineral density,BMD)和生物力学测量,观察骨折愈合情况。结果 实验组腰4、5椎体BMD、BMP-2阳性表达细胞数、骨小梁面积比、骨小梁平均宽度、最大负荷和最大桡度高于同时期对照组,差异有统计学意义(P <0. 01);骨小梁平均间隔小于同期对照组,差异有统计学意义(P <0. 01)。结论 SR具有抑制骨吸收和促进骨形成的双重作用,能增加BMD,加快骨痴形成,促进骨质疏松性骨折愈合,改善骨的显微结构,提高骨折愈合后骨的生物力学特性。     

氟伐他汀对骨质疏松大鼠骨折愈合过程中血管内皮生长因子的影响

目的探讨氟伐他汀对骨质疏松大鼠骨折愈合过程中血管内皮生长因子（VEGF）的影响。方法卵巢切除后3个月已经出现骨质疏松的SD大鼠72只,于股骨中段制造骨折模型,再随机分为给药组和对照组,每组36只,给药组手术次日给予10mg/kg.d氟伐他汀灌胃,疗程为6w,对照组给予安慰剂。利用免疫组化及原位杂交检测骨折愈合过程中给药组和对照组骨折后3、7、14、21、28和42d骨痂中VEGF、VEGF mRNA的表达,并用真彩色图像分析仪作图像分析。结果给药组和对照组在骨折愈合过程中VEGF及VEGF mRNA基因表达的细胞定位无差别,且表达模式基本相似。术后14d,阳性细胞的阳性程度给药组比对照组显著性强（P〈0.05）。结论氟伐他汀对骨质疏松大鼠骨折愈合过程中VEGF的合成分泌有一定促进作用。     

低强度超声波促进骨折愈合过程中I、X型胶原蛋白的基因表达

目的 研究低强度超声波刺激下骨折处I、X型胶原的基因表达规律,从分子水平探索低强度超声波促进骨折愈合的作用机制.方法 应用兔双侧桡骨骨折模型,采用左右自身对照.36只新西兰雄性大白兔,分为6组.右侧骨折处每日行超声刺激20rain,左侧不行刺激.分别于术后3、7、10、14、21、28d取骨折处骨痂及纤维组织,进行骨痂厚度的测量和组织学观察.RT-PCR方法半定量分析I、X型胶原mRNA的表达规律.结果 自术后10d开始至28d,实验侧的骨痂厚度明显高于对照侧.术后10、14、21、28d HE染色显示成软骨细胞及成骨细胞提早出现而且量多,细胞外基质合成增加.I型胶原mRNA表达于术后14、21d含量明显高于对照侧,软骨内细胞外基质蛋白合成增加,增加新骨基质的含量.X型胶原mRNA表达于术后14d明显高于对照侧,术后21d达高峰,然后下降.结论 低强度超声波作用可以增加骨折处骨痂含量,其加快骨折愈合通过刺激骨痂增生,使矿化过程提前发生所致.低强度超声波刺激可以增加I、X型胶原的mRNA含量,促使软骨内成骨过程中软骨细胞的增多和细胞外基质的钙化.     

甲状旁腺激素联合阿仑膦酸钠对大鼠骨质疏松性骨折骨痂血管形成的影响

目的探讨甲状旁腺激素联合阿仑膦酸钠对大鼠骨质疏松性骨折骨痂血管形成及骨折愈合的影响。方法 75只雌性SD大鼠随机分为5组:假手术组、去势组、甲状旁腺素组、阿仑膦酸钠组、联合用药组,每组15只,首先行双侧卵巢切除术,术后4周行右侧股骨干骨折髓内固定术,以构建大鼠骨质疏松性骨折动物模型。观察并评估骨折愈合,检测骨痂生物力学和骨密度(bone mineral density,BMD),检测血清血管内皮生长因子(vascular endothelial growth factor,VEGF)和骨形成发生蛋白-2(bone morphogenetic protein-2,BMP-2)浓度,观察骨痂形态结构,检测骨痂VEGF表达。结果去势组较假手术组骨折愈合评分、骨痂生物力学强度、骨痂BMD、血清BMP-2和VEGF浓度、骨痂VEGF蛋白表达、骨痂微血管数均显著降低(P0.05),甲状旁腺素组、阿仑膦酸钠组、联合用药组较去势组上述指标均升高,其中以联合用药组升高最显著(P0.05)。结论甲状旁腺激素联合阿仑膦酸钠通过介导VEGF,上调BMP-2表达,促进骨质疏松性骨折大鼠骨痂血管形成,增加骨密度,改善生物力学强度及骨组织形态学,加快骨折愈合。     

大豆异黄酮对去势大鼠骨质疏松性骨折愈合的影响

目的研究大豆异黄酮在大鼠骨质疏松性骨折愈合过程中的干预效果。方法将50只6月龄雌性SD大鼠随机分成5组:正常对照组、骨折组、骨质疏松组、骨质疏松性骨折组、骨质疏松性骨折治疗组,每组10只。正常对照组、骨折组只进行手术入路而不切除卵巢。骨质疏松组、骨质疏松性骨折组、骨质疏松性骨折治疗组摘除双侧卵巢制备骨质疏松模型。8周后,骨折组、骨质疏松性骨折组、骨质疏松性骨折治疗组制备右侧股骨干中段横行骨折模型。骨质疏松性骨折治疗组每日灌胃大豆异黄酮50 mg/kg(剂量1.5 ml/kg),骨折组、骨质疏松性骨折组灌胃等量生理盐水,连续8周。结果去卵巢后8周,骨质疏松组的骨密度显著低于正常对照组(P0.05),说明骨质疏松模型制作成功。灌胃8周后,骨质疏松性骨折组骨痂组织骨小梁数量及致密度、骨密度、血管内皮细胞生长因子的表达均显著低于骨折组和骨质疏松性骨折治疗组(P0.05)。结论大豆异黄酮在大鼠骨质疏松性骨折愈合过程中具有积极促进作用。     

甲状旁腺素促进骨质疏松骨折大鼠Ⅰ型胶原代谢的研究

目的监测骨质疏松性骨折愈合过程中甲状旁腺素(parathyroid hormone,PTH)影响下Ⅰ型胶原代谢的变化,及Ⅰ型胶原在骨痂组织的表达状态。方法切除成年雌性大鼠双侧卵巢,构建骨质疏松模型。3个月后将大鼠双侧胫骨锯断,并以克氏针髓内固定,建立大鼠双侧胫骨骨折愈合模型。术后即将大鼠分为两组,A组(PTH组)予以特立帕肽[PTH(1-34)]3 ug/(100 g·d)皮下注射,每天一次;B组(NS组)予以等量生理盐水皮下注射,每天一次。分别于给药后第1、2、4、8周取大鼠胫骨标本,一部分利用荧光定量PCR检测骨痂附近骨组织COL1A1 mRNA的表达水平;另一部分行骨痂附近组织的HE染色及Ⅰ型胶原免疫组化染色。结果 HE染色及Ⅰ型胶原免疫组化染色显示,自第2周起,PTH组大鼠骨痂内Ⅰ型胶原的表达状态即优于NS组,至第4周时表现最为明显;到第8周,PTH组大鼠骨痂中已经观察不到成束的Ⅰ型胶原纤维,仅见大片已修复良好的骨基质;而NS组大鼠骨痂内尚可见部分Ⅰ型胶原表达。荧光定量PCR检测显示,第1周时PTH组大鼠COL1A1mRNA表达量为17.258±1.006,NS组大鼠为10.022±0.308(P0.001);第2周时PTH组为19.548±0.767,NS组为10.208±0.619(P0.001);第4周时PTH组为20.892±1.140,NS组为10.182±0.624(P0.001);第8周时PTH组为20.708±1.249,NS组为10.560±0.453(P0.001)。结论 PTH可以增加骨折端COL1A1 mRNA的表达,促进Ⅰ型胶原的合成和重塑,有效增加骨痂组织Ⅰ型胶原的含量和结构排列。     

四种中药对骨愈合过程中相关基因表达的影响

目的:探索中药水蛭、海螵蛸、阿胶、骨碎补在骨折愈合过程中的干预作用,了解它们各自的调节靶点,探索建构其基因组学的途径。方法:通过在大鼠胫骨打孔的方法建立单因素干扰模型,并将300只大鼠随机分为正常组、模型组和给药组(分别用4种中药给药),每组50只,分别在实验的第4、7、14、21、28天不同时间点采用原位杂交方法对各类mRNA的变化进行动态观察,分析骨愈合过程中Ⅰ、Ⅱ、Ⅲ型前胶原mRNA、转化生长因子TGF-β1mRNA、骨形态发生蛋白BMP-2mRNA以及血管内皮生长因子VEGF-mRNA的表达情况。结果:不同中药对不同基因的作用不同,作用的时间点不同,作用强度也存在差异。其中海螵蛸在骨折早期对Ⅰ、Ⅲ型前胶原mRNA、VEGF-mRNA、BMP-2mRNA的表达升高,后期Ⅱ、Ⅲ型前胶原mRNA表达水平下降,VEGF-mRNA、TGF-β1mRNA表达量维持于较高水平;骨碎补组较模型组在BMP-2mRNA、TGF-β1mRNA、Ⅰ型前胶原mRNA的表达上差异有显著性统计意义;阿胶对骨愈合早、中期Ⅰ、Ⅱ、Ⅲ型前胶原mRNA和TGF-β1mRNA的表达与模型组比较差异存在显著性统计意义;水蛭对VEGF-mRNA的表达具有一定的促进作用。结论:海螵蛸、水蛭对血管形成有促进作用,阿胶、骨碎补和海螵蛸对骨折软骨形成早期具有促进骨诱导的作用,并对成骨细胞的增殖及合成活性有较大影响。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.