Deluxe-PS型与PFC Sigma RP型假体在膝关节置换中的比较

BACKGROUND: During artificial knee replacement for all kinds of severe knee disease or conservative treatment for end-stage knee disease, Deluxe-PS knee prosthesis and PFC Sigma RP knee prosthesis have their advantages. OBJECTIVE:To compare and analyze the matching of the Deluxe-PS and PFC Sigma RP knee prostheses with bone cross section. METHODS: According to the use of the knee prosthesis, 87 gonarthritis patients undergoing bilateral knee replacement were divided into two groups. 46 cases in the test group received Deluxe-PS knee prosthesis replacement. 41 cases in the control group received PFC Sigma RP knee prosthesis replacement. Operation time and intraoperative blood loss were compared between the two groups. American Knee Society score, knee score of American Special Surgical Hospital and knee joint range of motion were used to evaluate knee joint function before replacement, 3 months after replacement and during final follow-up. Anteroposterior X-ray films were obtained after replacement to measure valgus angle and flexion angle of femoral prosthesis. RESULTS AND CONCLUSION:(1) Operation time and intraoperative blood loss were significantly better in the test group than in the control group (P < 0.05). (2) No significant difference in American Knee Society score, knee score of American Special Surgical Hospital and knee joint motion was detected between the two groups before replacement and 3 months after replacement (P > 0.05). Above indexes were significantly improved in both groups at 3 months after replacement and during final follow-up (P < 0.05). (3) No significant difference in valgus angle and flexion angle of femoral prosthesis was identified between test and control groups during final follow-up (P > 0.05). (4) These findings indicate that effect of Deluxe-PS type artificial knee prosthesis was identical to that of PFC Sigma RP knee prosthesis in knee osteoarthritis patients receiving bilateral knee joint replacement. Deluxe-PS type artificial knee prosthesis can perfectly realize high-accuracy combination of the prosthesis and the bone cross section, and enhance the fusion suitability of the prosthesis and the bone surface. Deluxe-PS type artificial knee prosthesis has the advantage of operation. This advantage is possibly because Deluxe-PS type artificial knee prosthesis is more in line with the anatomical structure of the knee joint of Chinese.  中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

关节镜下保留残端重建前交叉韧带与不保留残端重建的Meta分析

BACKGROUND: There are controversies about preserving the remnant in the anterior cruciate ligament reconstruction procedure because of its uncertain therapeutic effects. OBJECTIVE:To compare the efficacy and safety of preserving-remnant with removing-remnant for arthroscopic anterior cruciate ligament reconstruction using a meta-analysis. METHODS: A computer-based online search was conducted in PubMed, Embase, the Cochrane Library, CDSR, CBM, and CNKI databases by using the English key words of “anterior cruciate ligament AND remnant (OR stump) AND randomized controlled trial (RCT) OR quasi-RCT” and the Chinese key words of “anterior cruciate ligament reconstruction, preserving-remnant, removing-remnant” to screen the relevant articles published from 1995 to July 2015. Meta-analysis was performed using Review Manager 5.3 software. RESULTS AND CONCLUSION:A total of 13 randomized controlled trials were included. The meta-analysis results showed that there were no statistically significant differences in KT1000/2000 scores (OR=-0.28, 95%CI: -0.76-0.20, P=0.25), the good rate of synoveal coverage (OR =-0.30, 95%CI: -0.30-0.90, P=0.32), and the incidence of cyclops leions (OR=0.87, 95%CI: 0.63-2.90, P=0.44). Postoperative Lysholm scores (OR=2.45, 95%CI: 0.52-4.39, P=0.01), proprioceptive function (OR=-1.72, 95%CI: -3.32 to 0.13, P=0.03), tunnel enlargement (OR=-0.66, 95%CI: -1.08 to -0.23, P=0.002) in preserving-remnant were superior to removing-remnant for arthroscopic anterior cruciate ligament reconstruction. These results suggest that both preserving-remnant and removing-remnant for arthroscopic anterior cruciate ligament reconstruction can obtain satisfactory antero-posterior stability of the knee. Preserving-remnant exhibits superiority in post-operative scores of the knee, proprioceptive function, tunnel enlargement. Further high-quality randomized controlled trials are warranted because of some low-quality studies and the existing biases. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

钛板与丝线悬吊固定在颈椎后路单开门椎管扩大成形中应用的Meta分析

背景：目前有关颈椎后路单开门椎管扩大成形中微型钛板固定与丝线悬吊固定比较的文献较多,但大多研究的样本量存在局限,对于微型钛板应用的优缺点缺乏客观评价。 目的：系统评价颈椎后路单开门椎管扩大成形中微型钛板固定与传统丝线悬吊固定对颈椎疾患的修复效果和安全性。 方法：由2名评价员检索中/英文公开发表的随机对照试验。计算机检索the Cochrane Central Register of Controlled Trials(CENTRAL)、PubMed、EMbase、the ISI Web of Knowledge Database、CNKI、CMB、VIP、万方数据库公开发表的有关颈椎后路单开门椎管扩大成形中微型钛板固定与传统丝线悬吊固定的随机对照试验。检索时间均为建库时间至2015年3月1日。同时,手检纳入文献的参考文献。Meta分析采用Cochrane 协作网提供的Rev-Man 5.3软件进行。 结果与结论：共纳入9个研究,642例患者。Meta分析结果显示：①在安全性方面：两组手术时间[SMD=-0.02,95%CI(-0.57,0.54),P=0.95 > 0.05]、术中出血量[SMD=0.07,95%CI(-0.26,0.40),P=0.69 > 0.05]差异无显著性意义。②在有效性方面：与传统丝线悬吊固定相比,微型钛板固定术后JOA评分较高[SMD=0.26,95%CI(0.10,0.42),P=0.001< 0.05]、椎板开门角度较大[SMD=0.25,95%CI(0.02,0.48),P=0.04 < 0.05]、颈椎曲度维持较好[SMD=0.46,95%CI(0.27,0.65),P < 0.000 01]、轴性症状发生率较低[RR=0.40,95%CI(0.29,0.56),P < 0.000 01]。提示临床上采用单开门椎板扩大成形修复颈椎病时,使用微型钛板固定与丝线悬吊固定均能取得较好的临床效果,但微型钛板固定组在JOA评分、椎板开门角度方面优于丝线悬吊固定组,并能有效的防止颈椎曲度丢失及降低轴性症状的发生率;但因原始研究质量不高,样本不大,建议临床上谨慎使用,尚需要更多高质量大样本的随机对照试验进一步论证。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

肝移植及腹部多器官移植手术的成分输血

BACKGROUND: The liver transplantation and abdominal multiple organ transplantation are complicated surgeries, characterized by massive blood loss and high blood transfusion requirements. OBJECTIVE: To explore the characteristics of blood loss and blood transfusion in liver transplantation and abdominal multiple organ transplantation and post-operative survival rate. METHODS: Clinical data from 192 patients were retrospectively analyzed, including blood transfusion data with the first 24 hours after surgery and post-operative survival rate. RESULTS AND CONCLUSION: These 192 patients included 177 patients receiving liver transplantation,    2 patients receiving liver and kidney transplantation and 13 patients receiving abdominal multiple organ transplantation. The average intra-operative blood loss of each patient was (2 401.5±3 239.5) mL. The average infusion of red blood cells, platelet, cryoprecipitate and frozen plasma of each patient at the first 24 hours after surgery was (11.3±11.9), (0.8±0.9), (10.7±11.7) U and (2 805.5±1 393.1) mL, respectively. All kinds of blood infusion in the liver cancer group were obviously less than those in the hepatic failure group. The infusion of cryoprecipitate and frozen plasma in the cirrhosis group was obviously less than that in the hepatic failure group, but the infusion of platelet in the cirrhosis group was significantly more than that in the liver cancer group. The infusion of red blood cells from July 2013 to June 2015 was significantly less than that from July 2012 to June 2013. The blood loss, infusion of red blood cells and frozen plasma in the liver transplantation group of cirrhosis were significantly more than those in the abdominal multiple organ transplantation group of cirrhosis (all P < 0.05). In conclusion, diagnosis of liver diseases, and the maturity of surgery exert an effect on the blood loss and blood infusion. As the development of liver transplantation and abdominal multiple organ transplantation, both the blood loss and blood infusion are decreased. Besides, compared with liver transplantation, the blood loss and blood infusion show no increase in the abdominal multiple organ transplantation. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

异氟醚抑制海马神经干细胞增殖并可促其向神经元分化

BACKGROUND: Isoflurane cannot only induce a wide range of large neuronal apoptosis, but also inhibit hippocampal neurogenesis in neonatal rats, thereby resulting in hippocampus-dependent learning and memory defects.OBJECTIVE: To investigate the isoflurane effect on proliferation and differentiation of the hippocampal neural stem cells.METHODS: Twenty-six Sprague-Dawley rats were randomly divided into air group and isoflurane group (n=13 per group). Rats in the isoflurane group were subjected to 2.5% isoflurane inhalation for 3 minutes followed by 1.5% isoflurane inhalation for 4 hours. Rats in the air group only breathed in air. After the intervention, blood glucose and arterial blood gas changes were detected in the two groups. Additionally, rats in the two groups were given intraperitoneal injection of 5-bromodeoxyuridine before and after intervention. At 24 hours after the last injection of 5-bromodeoxyuridine, brain tissues were taken to make frozen sections for immunofluorescence staining.RESULTS AND CONCLUSION: There were no significant difference in pH, PaO₂, PaCO₂, HCO₃, BE and SaO₂ levels between the two groups (P > 0.05). Compared with the air group, the number of BrdU⁺ cells was significantly less in the isoflurane group (P < 0.05), while the number of NeuroD⁺/BrdU⁺ cells was significantly higher in the isoflurane group (P < 0.05). The incidence of adverse reactions was 23% in the isoflurane group, which was significantly higher than that in the air group (7.7%; P < 0.05). These findings indicate that isoflurane can inhibit the proliferation of neural stem cells in the hippocampal dentate gyrus, and promote their differentiation into neurons.    中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

间充质干细胞对再生障碍性贫血患者造血支持及T淋巴细胞分泌功能的影响

BACKGROUND: Recently, the role of mesenchymal stem cells in aplastic anemia has been widely explored. However, its underlying mechanism remains unclearly.OBJECTIVE:To study the effect of umbilical cord blood and bone marrow mesenchymal stem cells on hematopoietic support and secretory function of T lymphocytes in patients with aplastic anemia.METHODS:Cord blood and bone marrow samples from 48 cases of aplastic anemia and 48 healthy lying-in women to isolate mesenchymal stem cells using flow cytometry. Mesenchymal stem cells from the cord blood and bone marrow were respectively co-cultured with cord blood mononuclear cells to count burst forming units-erythroid and colony forming units-granulocyte/macrophage. Mesenchymal stem cells were co-cultured with T lymphocytes from aplastic anemia patients undergoing phytohemagglutinin stimulation, and ELISA was used to detect interleukin-2, interleukin-4 and interferon-γ levels secreted from T lymphocytes.RESULTS AND CONCLUSION: The number of burst forming units-erythroid and colony forming units-granulocyte/macrophage significantly increased in normal bone marrow or umbilical cord blood mesenchymal stem cells co-cultured with cord blood mononuclear cells (P < 0.05), but reduced remarkably in umbilical cord blood mesenchymal stem cells from aplastic anemia patients co-cultured with cord blood mononuclear cells (P < 0.05). Levels of interleukin-2, interleukin-4 and interferon-γ from T lymphocytes were inhibited significantly after co-culture with normal bone marrow mesenchymal stem cells compared with phytohemagglutinin-induced T lymphocytes (P < 0.05). There was a similar inhibitory effect after co-culture with normal umbilical cord blood mesenchymal stem cells. There was a significantly reduction in the capacity of inhibiting interleukin-2, interleukin-4 and interferon-γ levels from T lymphocytes after co-culture with bone marrow mesenchymal stem cells from aplastic anemia patients (P < 0.05). Aplastic anemia patients show some functional defects in their bone marrow mesenchymal stem cells that have a weaker inhibitory role than normal bone marrow or umbilical cord blood mesenchymal stem cells in the hematopoietic support and secretory function of T lymphocytes. These findings indicate that mesenchymal stem cells from aplastic anemia patients can influence the pathological progress through weakening hematopoietic support and secretory function of T lymphocytes.  中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

白细胞介素10启动子基因多态性与强直性脊柱炎的易感性

背景：在强直性脊柱炎患者中,基因多态性很可能影响细胞因子的分泌模式。 目的：在中国胶东半岛地区汉族人强直性脊柱炎患者中,探讨白细胞介素10启动子基因的单核苷酸多态性和单体型与强直性脊柱炎易感性的相关性。 方法：用酶联免疫吸附测定法测定血清中白细胞介素10的水平,用聚合酶链反应和限制性片段长度多态性方法对白细胞介素10基因启动子中的-1082A/G、-819C/T和-592C/A位点的单核苷酸多态性进行分析。 结果与结论：收集了110例强直性脊柱炎患者和120例同种族的健康人,强直性脊柱炎患者组血清中白细胞介素10水平明显高于健康对照组(Z=10.9,P < 0.001),单核苷酸多态性分析显示：在强直性脊柱炎患者组和健康对照组之间-592A/C位点基因型分布和等位基因频率没有明显差异,该研究中没有发现-1082GG基因型。强直性脊柱炎患者-1082G等位基因频率较健康对照组增加(P=0.047),通过logistic回归分析,强直性脊柱炎患者-1082AG基因型的比值比为1.993(95%CI：1.046-3.800,P=0.034 ),而-819CC基因型的比值比为3.125(95%CI：1.246-7.836,P=0.015),此外,单体型分析显示与ATA 基因型相比,GCC基因型显著增加了患强直性脊柱炎的风险(OR=2.19,95%CI：1.13- 4.26,P= 0.020)。结果表明白细胞介素10的基因单体型与中国胶东半岛地区汉族人强直性脊柱炎的易感因素相关。     

锁骨骨折植入物内固定与保守治疗效果比较的Meta分析

背景：关于锁骨骨折选择植入物内固定亦或保守治疗,目前尚存争议。目的：以Meta分析方法探讨植入物内固定治疗和保守治疗对锁骨骨折疗效的影响。方法：在PUBMED、EMBASE、OVID、Cochrane图书馆、Science Direct、Springer Link、中文学术期刊全文数据库(CNKI)和万方医学网中检索2000年1月到2013年12月有关锁骨骨折治疗方面的文献,按照特定的纳入和排除标准筛选,对所选文献进行质量评价,并提取所需的原始数据,用Review Manager 5.0软件进行Meta分析。结果与结论：共纳入6篇随机对照研究,共570例患者。Meta分析结果表明,对于锁骨骨折,植入物内固定治疗可以降低骨不连率[RR=0.16,95%CI(0.07,0.38),P < 0.000 1]、畸形愈合率[RR=0.15,95%CI(0.07,0.34),P < 0.000 01]、延迟愈合率[RR=0.20,95%CI(0.06,0.70),P=0.01]及治疗后1年残余疼痛发生率[RR=0.24,95%CI(0.12,0.51),P=0.000 2],可以提高Constant Score(CS)评分[MD=3.68,95%CI(1.61,5.76),P=0.000 5],然而尚不能认为内固定治疗可以降低神经并发症发生率[RR=0.63,95%CI(0.06,0.70),P=0.22]。提示在锁骨骨折的治疗方面,植入物内固定治疗能够取得较好的临床效果。但是由于所选文献还有一定的局限性,尚需高质量的多中心随机对照试验进一步验证结论。故在临床上选择锁骨骨折治疗方法时,仍需根据患者的自身情况来决定。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

髋关节置换后引流对患者康复影响的系统评价

背景：目前,已有研究表明置换后引流可减少置换后伤口渗液、血肿、感染等并发症的发生,但仍有较多研究者认为引流不但不能降低并发症发生率,还会增加患者对伤口的恐惧,降低患者舒适度,因此,对于髋关节置换后引流与不引流一直是临床骨科医师争论的焦点。 目的：比较髋关节置换后引流与不引流对患者康复的影响。 方法：计算机检索the Cochrane Library、PubMed、中国知网、中国科技期刊全文、中国万方、中国生物医学文献数据库从建库至2013年2月28日的相关文献,纳入行髋关节置换患者置换后引流与不引流的的随机对照试验和半随机对照试验,按Cochrane协作网系统评价的方法进行评价;用RevMan5.1.2软件进行统计学分析。 结果与结论：共纳入17个研究,共1 838例患者,均为随机平行对照试验。Meta分析结果显示,引流组患者输血人数(RR=1.36,95%CI：1.03-1.79,P=0.03)、输血量(MD=0.59,95%CI：0.14-1.05,P=0.01)、失血量(MD=355.14,95%CI：204.93-505.35,P < 0.000 1)和住院时间(MD=1.04, 95%CI：0.62-1.47,P <  0.000 01)均高于不引流组,但并发症发生率在两组差异无显著性意义(RR=0.91,95%CI：0.64-1.30,P=0.62)。Meta分析的结果证实,髋关节置换后不放置引流管对患者的康复无影响。     

计算机导航技术辅助全髋关节置换的系统分析

背景：传统手术方法依赖术者的经验和目测解剖标志来安置髋臼假体往往会产生偏差,而在术中应用计算机导航技术可以很好地提高髋臼假体位置的精确度。 目的：研究全髋关节置换应用计算机导航系统对髋臼假体植入位置精度的影响及临床意义。 方法：计算机检索Cochrane Library、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库,手工检索相关的中文杂志,纳入符合要求的临床试验,用RevMan5.0.18软件进行统计分析。 结果与结论：共纳入9篇临床试验合计695例。Meta分析结果显示：与传统手术相比,计算机导航技术在全髋关节置换后髋臼假体位置放置更精准超[RR=0.22,95%CI(0.14~0.34),P < 0.000 01]、双下肢不等长较传统手术轻[RR=-4.61,95%CI(-7.74~-1.48),P=0.004];而外展角度[RR=-1.76,95%CI(-5.02~1.50),P=0.29]、前倾角度[RR=-1.28,95%CI(-5.68~3.12),P=0.57]、术后脱位率[RR=1.25,95%CI(0.05~31.66),P=0.89]差异均无显著性意义。提示导航技术与传统手术在髋臼位置的精确度方面差异并无显著性意义。