人工关节假体不同材料及材料表面粗糙度对表皮葡萄球菌粘附能力的影响

目的探讨人工关节假体材料及表面粗糙度对表皮葡萄球菌粘附能力的影响。方法制作超高分子聚乙烯、钛合金和钴铬钼合金试样，表皮葡萄球菌经FITC标记，人工关节材料试样消毒后接种FITC标记的表皮葡萄球菌，试样表面分为光滑表面和粗糙表面，每组各6个试样，将含有细菌和试样的24孔板在37℃下孵育30min后，用荧光显微镜观察，试样用扫描电镜观察。结果对于光滑的人工关节常用材料表面，表皮葡萄球菌对超高分子聚乙烯（UHMWPE）的粘附能力显著高于钛合金和钴铬钼合金（P〈0．001），对钴铬钼合金的粘附能力要高于钛合金（P〈0．05）；粗糙的超高分子聚乙烯和钴铬钼合金表面比光滑的表面更易引起表皮葡萄球菌的粘附（P〈0．01），而细菌对粗糙钛合金的粘附仅轻微高于光滑钛合金（P〉0．05）。荧光照相观察及扫描电镜观察显示细菌在粗糙表面的划痕内聚集粘附。结论本研究结果表明细菌对人工关节材料表面的粘附能力不但取决于细菌本身，也和材料性质和表面粗糙度有关。     

脊柱结核内固定的生物学基础

目的观察结核杆菌与不同内固定材料的粘附情况,以期初步探讨在脊柱结核病灶清除后植入内固定选择何种材料的问题。方法在结核杆菌的菌液分别加入四种不同的内固定材料（不锈钢、钛、钛合金、聚醚醚酮）,通过碘-125标记测量,比较细菌与材料之间的粘附情况。结果四种材料中,细菌在聚醚醚酮上的粘附最多,在纯钛上粘附最少,在不锈钢的粘附多于钛合金（P〈0.05）。结论在脊柱结核患者内固定材料的选择上,以纯钛为首选,钛合金次之,碳纤维材料慎用。     

脊柱结核病灶清除前路植骨内固定护理

目的：探讨脊柱结核一期病灶清除植骨内固定术的护理。方法：对30例行一期病灶清除植骨内固定术的脊柱结核患者进行护理。术后进行防褥疮，防尿路及肺部感染，防便秘的护理和进行股四头肌锻炼，戴支具活动等康复护理，结果：30例患者都得到了不同程度的恢复。结论：防止并发症及康复锻炼的护理对一期病灶清除植骨内固定术的脊柱结核患者的顺利康复起着重要作用。     

人工瓣膜材料细菌粘附与细菌生长的关系

目的通过体外实验,评价人工瓣膜材料细菌粘附与细菌生长的关系。方法采用平板菌落计数法、１２５Ⅰ标记细菌放射性测定法测定金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌和绿脓杆菌的生长曲线,同时测定４种细菌对人工瓣膜材料涤纶、热解碳、聚四氟乙烯的粘附情况。结果４种细菌对３种人工瓣膜材料粘附能力与细菌生长曲线基本一致。细菌在体外生长不受人工瓣膜材料存在的影响,不同时间同一细菌对同一材料粘附不同。结论细菌对材料粘附与细菌生长曲线基本一致,细菌对人工瓣膜材料的粘附是一个动态变化过程     

pRNA纳米微粒对脊柱结核分枝杆菌生长影响的实验研究

目的:观察pRNA-3WJ-siLNA gapmer(Mce4)-aptamer(CD40)纳米微粒(简称pRNA纳米微粒)在脊柱结核细胞模型中对结核分枝杆菌生长的影响.方法:利用荧光结核分枝杆菌感染人成骨细胞建立脊柱结核细胞模型.先培养及准备人成骨细胞,人成骨细胞培养至第三代;然后构建培养荧光结核分枝杆菌;将培养良好...     

胸膜外入路同一切口联合后方内固定术在胸椎结核中的应用

[目的]探讨胸膜外入路同一切口联合后方内固定术治疗胸段脊柱结核的效果。[方法]对2006年以来18例患T5~12椎体结核的病例,抗结核治疗2周后,进行同一切口前路病灶清除植骨术联合后路椎弓根固定术,观察脊柱稳定性及脊髓功能恢复情况。[结果]所有患者经术后随访植骨部位均骨性愈合,感觉、运动功能均有不同程度改善,胸背部疼痛或不适明显缓解,无复发,近远期疗效均较满意。[结论]前路手术可有效清除病灶、植骨,后路手术可固定多节段胸段脊柱,胸膜外入路同一切口联合后方内固定术治疗胸段脊柱结核效果满意。     

全国脊柱结核治疗专题座谈会纪要

近年脊柱结核发病率有逐年上升的趋势，有关脊柱结核的治疗原则、手术适应证、手术时机、术式选择、化疗方案的制定仍存在很多争议。目前脊柱结核治疗中存在的主要问题有（1）结核分枝杆菌和非结核分枝杆菌及其它细菌引起的脊柱感染鉴别困难；（2）抗结核用药、化疗疗程针对性不强；（3）复治、复发、耐药病例的治疗不规范；（4）手术指征、手术时机选择及围手术期处理不规范；[第一段]     

布鲁氏菌及结核分枝杆菌侵染大鼠成骨细胞对肿瘤坏死因子-α及白细胞介素-1β表达的影响

【摘要】 目的：测定绵羊布鲁氏菌与结核分枝杆菌分别侵染成骨细胞后肿瘤坏死因子-α（tumor necrosis factor，TNF-α）及白细胞介素-1β（interleukin，IL-1β）的表达水平，初步探讨布鲁氏菌性脊柱炎相较于脊柱结核骨损伤程度不同的原因。方法：取新生2～5d的SD大鼠颅骨提取原代成骨细胞并培养至第3代，用碱性磷酸酶（ALP）染色法对成骨细胞进行鉴定。用制备好的细菌培养基分别培养绵羊布鲁氏菌及结核分枝杆菌并计数以配制转染液；荧光显微镜观察并记录荧光标记结核分枝杆菌在转染复数（MOI）为1∶10、1∶20时的成骨细胞，提取绵羊布鲁氏菌以MOI为1∶100侵染的成骨细胞在不同时间的裂解液，使用平板接种法进行计数，确定结核分枝杆菌及布鲁氏菌能否侵染成骨细胞。分别用绵羊布鲁氏菌及结核分枝杆菌以不同MOI及时间侵染成骨细胞，采用CCK-8检测两种细菌侵染后细胞的存活率，选择最佳MOI及时间。将成骨细胞分为三组，结核分枝杆菌侵染组（用最佳MOI结核分枝杆菌侵染）、绵羊布鲁氏菌组侵染组（用最佳MOI绵羊布鲁氏菌侵染）和阴性对照组，采用细胞免疫组化染色观察三组细胞表面TNF-α及IL-1β表达情况；采用酶联免疫吸附实验（ELISA）测量三组细胞培养上清液中TNF-α及IL-1β表达水平；采用蛋白免疫印迹（Western Blot）检测三组细胞中TNF-α及IL-1β蛋白表达水平。采用单因素方差分析和t检验比较三组间的差异，P<0.05为差异有统计学意义。结果：分离培养的成骨细胞ALP染色后细胞质呈蓝色，细胞核呈绿色，符合成骨细胞特点。绵羊布鲁氏菌及结核分枝杆菌均可以侵染成骨细胞；结核分枝杆菌组在MOI为1∶20、24h，绵羊布鲁氏菌组在MOI为1∶100、24h细胞存活率均为50%，以此作为最佳对比MOI及时间。细胞免疫组化、ELISA及Western Blot结果显示结核分枝杆菌及绵羊布鲁氏菌侵染成骨细胞后均能导致TNF-α及IL-1β的表达高于阴性对照组（P<0.05），且结核分枝杆菌组的表达水平明显高于绵羊布鲁氏菌组（P<0.05）。结论：结核分枝杆菌侵染成骨细胞后TNF-α及IL-1β的表达水平高于绵羊布鲁氏菌侵染的成骨细胞，可能导致脊柱结核与布鲁氏菌性脊柱炎骨质损伤程度不同。     

溴代呋喃酮对胸心外科聚氯乙烯材料表面表皮葡萄球菌生物膜形成的影响

目的探讨溴代呋喃酮对胸心外科聚氯乙烯(PVC)材料表面表皮葡萄球菌生物膜形成的影响,为生物材料表面改性研究及临床生物材料植入感染的防治提供新思路。方法选用化学结构具有代表性的三种溴代呋喃酮分为3组,呋喃酮1组:3,4-二溴基-5-羟基-呋喃酮;呋喃酮2组:4-溴-5-(4-甲氧基苯基)-3-(甲氨基)-呋喃酮;呋喃酮3组:3,4-二溴基-5,5-二甲苯基-2(5H)-呋喃酮;对照组:PVC材料用酒精浸泡5min;分别对4组PVC材料进行表面涂层改性,将改性过的PVC材料与表皮葡萄球菌共同培育;分别于培养6h、12h、18h和24h时用激光共聚焦显微镜动态观察PVC材料表面细菌群落及细菌生物膜厚度的形成,扫描电子显微镜观察PVC材料表面细菌生物膜表面结构。结果激光共聚焦显微镜观测结果显示:呋喃酮2组各时间点PVC材料表面表皮葡萄球菌群落数量和细菌生物膜厚度明显小于对照组(P0.05),呋喃酮1组、呋喃酮3组表皮葡萄球菌群落数量和细菌生物膜厚度与对照组比较差异无统计学意义(P0.05)。扫描电子显微镜观察显示:与对照组比较,呋喃酮2组6h时PVC材料表面细菌群落附着数量较少;18h时对照组PVC材料表面细菌生物膜结构初步形成,而呋喃酮2组无明显细菌生物膜结构形成。结论不同溴代呋喃酮对PVC材料表面表皮葡萄球菌生物膜形成的影响不同,呋喃酮2可以抑制PVC材料表面表皮葡萄球菌群落数量和细菌生物膜厚度的形成。     

脊柱结核的治疗应遵循个体化综合治疗原则

近十余年来,随着治疗理念的进步和手术方式的改进,脊柱结核的治疗效果大大提高。但目前国内对脊柱结核的治疗原则、手术适应证、手术时机、术式选择、化疗方案的制定等仍存争议。目前脊柱结核治疗中存在的主要问题包括：（1）结核分枝杆菌和非结核分枝杆菌及其他细菌引起的脊柱感染鉴别困难;（2）抗结核用药、化疗疗程针对性不强;（3）复治、复发、耐药病例的治疗不规范;（4）手术指征、手术时机选择、围手术期处理不规范;（5）手术方法、内固定应用未能个体化;（6）疗效评估、停药指标、治愈标准不一。[第一段]     

Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials

OBJECTIVES: Evaluation of bacterial adhesion to pure tantalum and tantalum-coated stainless steel versus commercially pure titanium, titanium alloy (Ti-6Al-4V), and grit-blasted and polished stainless steel. DESIGN: Experimental in vitro cell culture study using Staphylococcus aureus and Staphylococcus epidermidis to evaluate qualitatively and quantitatively bacterial adherence to metallic implants. METHODS: A bacterial adhesion assay was performed by culturing S. aureus (ATCC 6538) and S. epidermidis (clinical isolate) for one hour with tantalum, tantalum-coated stainless steel, titanium, titanium alloy, grit-blasted and polished stainless steel metallic implant discs. Adhered living and dead bacteria were stained using a 2-color fluorescence assay. Adherence was then quantitatively evaluated by fluorescence microscopy and digital image processing. Qualitative adherence of the bacteria was analyzed with a scanning electron microscope. The quantitative data were related to the implant surface roughness (Pa-value) as measured by confocal laser scanning microscopy. RESULTS: Bacterial adherence of S. aureus varied significantly (p = 0.0035) with the type of metallic implant. Pure tantalum presented with significantly (p < 0.05) lower S. aureus adhesion compared to titanium alloy, polished stainless steel, and tantalum-coated stainless steel. Furthermore, pure tantalum had a lower, though not significantly, adhesion than commercially pure titanium and grit-blasted stainless steel. Additionally, there was a significantly higher S. aureus adherence to titanium alloy than to commercially pure titanium (p = 0.014). S. epidermidis adherence was not significantly different among the tested materials. There was no statistically significant correlation between bacterial adherence and surface roughness of the tested implants. CONCLUSIONS: Pure tantalum presents with a lower or similar S. aureus and S. epidermidis adhesion when compared with commonly used materials in orthopedic implants. CLINICAL IMPLICATION: Because bacterial adhesion is an important predisposing factor in the development of clinical implant infection, tantalum may offer benefits as an adjunct or alternative material compared with current materials commonly used for orthopedic implants.     

An in vitro study of the properties influencing Staphylococcus epidermidis adhesion to prosthetic vascular graft materials.

This study examines the influence of the properties of various vascular graft materials on the bacterial adherence process of two different strains of Staphylococcus epidermidis (mucous and normucous producing). Dacron grafts (both knitted and woven), Teflon grafts, and Dacron grafts coated with one and two layers of silicone were studied because these materials differ significantly in porosity, hydrophobicity, and surface charge (zeta potential). Graft segments were immersed in 3H-labeled bacteria solution for periods ranging from 5 to 180 minutes and liquid scintillation techniques were used to quantify bacterial adherence. The porous knitted Dacron material had a significantly higher rate of bacterial adherence than either the woven Dacron or Teflon (p less than 0.05). Silicone coating (either one or two layers) reduced adherence by a factor of four for the knitted Dacron (p less than 0.05) and by a factor of two for woven Dacron (p less than 0.05). The mucous producing strain of S. epidermidis displayed significantly better adherence to woven and knitted Dacron than the normucous producing strain, but only when 0.25% dextrose was added to the bacteria solution. These findings indicate that the highly porous knitted Dacron grafts have the highest propensity for bacterial adhesion. Graft materials with the most negative zeta potentials are more resistant to bacterial adherence. Silicone coating of Dacron material significantly changed adherence characteristics, suggesting that this may be a viable strategy for protecting implantable medical devices containing materials to which bacteria readily adhere.     

病灶清除植骨融合联合内固定治疗脊柱结核

目的：探讨不同节段脊柱结核外科治疗的手术策略及内固定适应证的选择。方法：回顾性分析2000年1月至2003年9月期间接受病灶清除、植骨融合及内固定手术治疗并获得随访的39例脊柱结核患者的临床资料．其中16例颈椎、胸椎和胸腰椎及2例腰椎结核患者接受前路-期病灶清除、植骨融合、内固定术，21例腰椎和腰骶椎结核患者接受后路经椎弓根固定、后外侧植骨融合联合前路病灶清除、椎间植骨融合术。观察术后和随访期间患者结核中毒症状和神经功能的改善情况、植骨融合情况及治愈率。结果：术后结核中毒症状明显缓解，神经功能明显改善，22个月时94．9％（37／39）植骨融合，治愈率为94．9％。结论：脊柱结核手术治疗中内固定的应用是安全、有效的；手术策略的制定和内固定的选择应根据病变节段、脓肿大小、范围等综合判断。     

Affinity of Staphylococcus epidermidis to various prosthetic graft materials.

BACKGROUND: Abdominal wall hernias have always been a major problem for general surgeons. The techniques of repairing primary, recurrent, and incisional hernias have evolved throughout the years at an accelerating trend, especially after production of prosthetic graft materials. Although looked upon with suspicion due to infection, fistula formation, and foreign body reaction, prosthetic graft materials are used deliberately in primary and recurrent hernias. The present study was designed to evaluate bacterial adherence to frequently used prosthetic graft materials. MATERIALS AND METHODS: The study was carried out in five different groups with each group consisting of 10 identical samples of the same kind of prosthetic graft material. The prosthetic graft materials used in the study were polypropylene, polyglactin 910, polyester fibers, steel, and polytetrafluoroethylene (PTFE). These prosthetic graft materials were incubated in vitro with a Staphylococcus epidermidis strain which was ++++ adhesion positive. The degree of adhesion of S. epidermidis to prosthetic graft materials was assessed by the ELISA method. RESULTS: Vicryl grafts showed significantly minimal bacterial adhesion whereas PTFE grafts tended to have more adhesion but this did not reach a statistical significance. Other graft materials did not show any difference for bacterial adhesion (Table 3). CONCLUSION: These results suggest that in vitro S. epidermidis adhesion to Vicryl grafts is less than other types of prosthetic graft materials (P < 0.05 for all comparisons). Further in vitro and in vivo studies are required to confirm these results and to understand the complex interactions among bacteria, graft material, microenvironment, and surgical technique.     

术前短期化疗对脊柱结核手术安全性的实验研究

目的通过巢式聚合酶链式反应（polymerase chain reaction,PCR）动态检测脊柱结核患者围手术期外周血的MTB-DNA的IS6110基因的含量,评估术前短期化疗对脊柱结核患者的手术安全性。方法根据IS6110基因设计两对特异性硫化修饰引物,结合高效保真聚合酶建立的巢式PCR,动态检测25例术前短期化疗的脊柱结核患者术前1天、术后1天、术后7天、术后14天外周血MTB-DNA的IS6110基因的含量变化,对外周血扩增产物IS6110基因含量进行比较分析。结果脊柱结核患者围手术期外周血IS6110基因含量变化的两种趋势：（1）15例患者伴随术后结核病灶的清除,外周血中的结核杆菌IS6110基因的从术后1天就开始逐渐减少;（2）10例患者术后1天时外周血中结核杆菌IS6110基因有短暂回升,但与术前1天外周血中结核杆菌IS6110基因含量比较无显著性差异（P〉0.05）,随着术后持续抗痨治疗,结核杆菌IS6110基因含量在术后1～2周均减少,均未发生结核杆菌血行播散并发症。结论如果脊柱结核患者一般情况好,术前短期化痨后行手术治疗安全有效。     

A prospective study comparing three different all-posterior surgical techniques in the management of thoracolumbar spinal tuberculosis

BackgroundPosterior only surgery has been widely performed in the treatment of thoracic and lumbar spinal tuberculosis. Surgical options include debridement with posterior instrumentation only or combined with anterior reconstruction. The aim of this study is to investigate and compare the clinical, functional and radiological outcomes using a single-stage posterior only surgery in thoracolumbar spinal tuberculosis by three different surgical techniques.MethodsPatients undergoing posterior only surgery for thoracic and lumbar spinal tuberculosis were followed up prospectively and included. Three different procedures, Group-A: Posterior instrumentation with anterior cage reconstruction (n = 49), Group-B: Posterior instrumentation and anterior autologous bone-grafting (n = 21) and Group-C: Posterior column shortening without anterior-reconstruction (n = 52) were compared for kyphosis correction achieved, kyphosis at final follow-up and degree of correction lost. Neurological assessment was done using ASIA impairment Scale(AIS) grades. Functional assessment was done using Visual analogue score (VAS), Modified McNab criteria and NASS satisfaction score.ResultsA total of 122 patients were included in the study, Group-A (49), Group-B (21) and Group-C (52). Radiological correction of kyphotic deformity in anterior reconstruction, Group-A (20.17 ± 9.25⁰) was higher than 13.97⁰ ± 6.06⁰ and 14.27⁰ ± 6.47⁰ achieved in Groups B and C respectively. There was no significant difference in correction lost amongst the three groups (p-value, 0.76). Surgical duration, blood loss and hospital stay were significantly higher in the anterior reconstruction group (p-value, 0.001). Similarly, no significant difference was noted between the three groups in neurological and functional outcomes at 2 years.ConclusionPosterior only approach is eminently satisfactory for treating Thoracolumbar Spinal Tuberculosis (STB). All three groups had similar functional and neurological outcomes. However there was a better correction of deformity in patients with anterior cage reconstruction.     

胸椎结核椎管内外病灶清除同期后路内固定矫形

目的:探讨胸椎结核Ⅰ期病灶清除及后路短节段椎弓根螺钉系统重建脊柱稳定性的外科治疗方法。方法:对1999年2月以来收治的15例合并椎管内外脓肿的胸椎结核患者,采用后路Ⅰ期双侧肋骨横突切除病灶清除、短节段椎弓根螺钉矫正脊柱后凸畸形、取髂骨植骨的综合性手术方法进行治疗,并对其疗效进行分析。结果:术后随访6个月-2年5个月,平均1年8个月,本组15例术后胸部症状均完全消失,术后脊柱后凸角度为6°-15°,平均矫正度数为17°。术后脊髓神经功能均有不同程度的改善,植骨全部骨性融合,植骨融合时间平均3.2个月。结论:经后路可Ⅰ期有效地进行胸椎结核的彻底病灶清除及脊柱稳定性的重建。     

One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis

There are few articles in the literature concerning anterior instrumentation in the surgical management of spinal tuberculosis in the exudative stage. So we report here 23 cases of active thoracolumbar spinal tuberculosis treated by one-stage anterior interbody autografting and instrumentation to verify the importance of early reconstruction of spinal stability and to evaluate the results of one-stage interbody autografting and anterior instrumentation in the surgical management of the exudative stage of throracolumbar spinal tuberculosis. Twenty-three patients, including two children (9 and 15 years old, respectively) and 21 adults with thoracolumbar spinal tuberculosis were treated surgically. T9 to L4 spinal segments were affected, and MRI/CT showed evident collapse of the vertebrae because of tuberculous destruction and paravertebral abscess. Neurological deficits were found in 15 patients. Before surgery, patients received standard anti-tuberculosis chemotherapy for 2 to 3 weeks. Under general endotracheal anaesthesia, the patients were placed in right recumbent positions, and a transthoracic, lateral extracavitary or extrapleural approach was chosen according to the tuberculosis lesion segment. After exposure, the tuberculous lesion region, including the collapsed vertebrae and in-between intervertebral disc, was almost completely resected in order to release the segmental spinal cord. Then, autologous iliac, rib or fibular graft was harvested to complete interbody fusion, and an anterior titanium-alloy plate-screw system was used to reconstruct the stability of the affected segments. Anti-tuberculosis chemotherapy was continued for at least 9 months, and the patients were supported with thoracolumbosacral orthosis for 6 months after surgery. All patients were followed up for an average of 2 years. All 23 cases were healed without chronic sinus formation or any recurrence of tuberculosis during the follow-up period. Spinal fusion occurred at a mean of 3.8 months after surgery. Of all patients with neurological deficits, 14 patients showed obvious improvement; only one patient with Frankel C lesion remained unchanged, but none of the patients got worse. During the follow-up period, a mean of 18 degrees of kyphosis correction was achieved after surgery in the adult group. Moderate progressive kyphosis because of this procedure fusion occurred postoperatively in a 9-year-old child after 2 1/2 years; another 15-year-old child did not demonstrate this phenomenon. Except for the early loosening of one screw in two cases (which did not affect the reconstruction of spinal stability), no other complications associated with this procedure were found during follow-up. Early reconstruction of spinal stability plays an important role in the surgical management of spinal tuberculosis. One-stage anterior interbody autografting and instrumentation in the surgical management of the exudative stage of spinal tuberculosis show more advantages in selected patients, but supplementary posterior fusion should be considered to prevent postoperative kyphosis when this procedure is performed in children.This article was presented at the Conference of Eurospine 2001, Gothenburg, Sweden.