胸背动脉穿支皮瓣在修复手背软组织缺损中的临床应用

目的 探讨胸背动脉动脉穿支皮瓣(TAP)在修复手背软组织缺损中的临床效果.方法 2015年6月至2018年6月,应用TAP修复手背软组织缺损12例,其中男7例,女5例;年龄24~58(41.5±3.0)岁.手背软组织缺损大小为7.0 cm×5.0 cm^15.0 cm×12.0 cm,创面污染严重.在急诊下行清创探查加VSD处理,骨折予以克氏针固定,术后7~14 d创面条件允许时,予以游离TAP修复,皮瓣大小为7.5 cm×5.5 cm^15.5 cm×12.5 cm.皮瓣血管蒂9例为胸背动脉外侧支,3例为胸背动脉内侧支.皮瓣供区均直接缝合,术后定期随访.结果 10例皮瓣顺利成活,2例术后出现静脉危象,经探查解除危象后皮瓣成活.3例皮瓣稍臃肿,在术后3个月二期修薄.随访3~18个月,皮瓣颜色与受区相似,外形美观,质地可,供区可见线形瘢痕.结论 TAP血供可靠,血管管径较粗,皮瓣供区隐蔽,修复手背软组织缺损可取得满意的临床效果.     

骨间后动脉近端穿支皮瓣游离移植修复手部软组织缺损

目的 探讨以骨间后动脉近端穿支皮瓣游离移植修复手部软组织缺损的临床疗效.方法 择期游离移植修复21例24处手部创面,皮瓣切取面积2.0 cm ×1.5 cm～7.0 cm×5.0 cm,最大皮瓣长度为9 cm.9例在切取皮瓣时解剖出1条浅静脉与受区浅静脉吻合.结果 19块皮瓣顺利成活,4块出现水泡,部分变紫,经拆线处理成活,1块皮瓣坏死.术后随访6～25个月,皮瓣色泽与受区相似,无明显臃肿,皮瓣供区瘢痕挛缩不明显.结论 以近端穿支血管为蒂的骨间后动脉穿支皮瓣解剖恒定、血供可靠,是修复手部皮肤软组织缺损的良好选择.     

吻合浅静脉的游离前臂骨间后动脉穿支皮瓣修复手背皮肤缺损

目的 探讨吻合浅静脉的游离前臂骨间后动脉穿支皮瓣修复手背皮肤软组织缺损的方法与疗效.方法 2009年1月至2011年1月,对手背皮肤软组织缺损的12例患者,应用游离前臂骨间后动脉穿支皮瓣进行修复,将穿支血管及其伴行静脉与受区动、静脉吻合,同时将皮瓣的皮下浅静脉与受区近端静脉吻合,观察其疗效.结果 术后12例皮瓣全部成活,无1例发生静脉危象,随访3～ 24个月.皮瓣色泽、质地及厚薄较满意,手指伸、屈功能恢复较满意.3例吻合神经者,感觉恢复良好,两点辨别觉5～7mm.结论 吻合浅静脉的前臂游离骨间后动脉穿支皮瓣修复手背皮肤软组织缺损可减少静脉危象的发生,获得较好的临床效果.     

游离桡侧副动脉穿支皮瓣修复手部软组织缺损

目的 探讨应用游离桡侧副动脉穿支皮瓣修复手部中小面积皮肤软组织缺损的方法和疗效。方法 2018年3月-2021年6月,收治合并深部组织外露的手部皮肤软组织缺损18例,软组织缺损面积：2.5 cm×5.0 cm～5.0cm×10.0 cm,应用游离桡侧副动脉穿支皮瓣修复。皮瓣轴线为三角肌止点至肱骨外上髁连线,同时解剖分离臂外侧或后侧皮神经分支重建皮瓣感觉,供区直接缝合。术后通过门诊和微信随访,观察皮瓣外形、感觉功能、患手活动功能及供区等恢复情况。结果 术后18例皮瓣全部成活,其中1例皮瓣术后血管蒂部血肿卡压,引起静脉危象,经拆线后,静脉危象解除,皮瓣顺利成活。18例均获得3～20个月随访,平均11个月。皮瓣外形美观,不臃肿,质地柔软,与受区相当。皮瓣感觉恢复S2～S3。患手各指屈伸功能恢复良好,供区仅遗留一线性瘢痕。按照中华医学会手外科分会功能评定：优15例,良3例。结论 游离桡侧副动脉穿支皮瓣修复手部软组织缺损,皮瓣外形美观,质地柔软,操作简便,解剖恒定,可重建皮瓣感觉,是修复手部软组织缺损较为理想的一种方法。     

趾腓侧皮瓣与腓动脉穿支皮瓣修复手部缺损疗效比较

目的：探讨游离趾腓侧皮瓣与腓动脉穿支皮瓣修复手部皮肤软组织缺损的设计切取方法及临床疗效。方法2009年2月—2013年1月,对46例手部不同部位、形态的皮肤软组织缺损,分别采用游离趾腓侧皮瓣修复25例,游离腓动脉穿支皮瓣修复21例,皮肤缺损范围为1.5 cm＆#215;2.5 cm～3.0 cm＆#215;6.5 cm,根据受区皮肤软组织缺损大小、形状设计和切取皮瓣。结果本组46例皮瓣全部成活,1例出现静脉危象,经小切口放血后危象解除,皮瓣成活。术后随访6～12个月,手部整体外观、功能恢复良好,皮瓣感觉部分恢复,供区无并发症。结论应用游离趾腓侧皮瓣或腓动脉穿支皮瓣修复手部皮肤软组织缺损,可恢复手部良好的外观与功能。趾腓侧皮瓣皮肤质地、外观更接近正常手部掌侧皮肤;腓动脉穿支皮瓣可根据手部创面大小灵活切取,二者均可作为理想的游离皮瓣修复手部皮肤软组织缺损。     

逆行岛状腓动脉穿支皮瓣修复足后跟部软组织缺损

目的探讨逆行岛状腓动脉穿支皮瓣修复足后跟部软组织缺损的临床疗效。方法应用逆行岛状腓动脉穿支皮瓣修复15例足后跟部软组织缺损患者。受区创面面积4 cm×5 cm^6 cm×12 cm,皮瓣设计面积5 cm×6 cm^7 cm×13 cm。结果患者均获得随访,时间3个月~2年。15例皮瓣全部成活,皮瓣色泽、弹性好,外形美观,踝关节功能恢复好,患者满意。结论应用逆行岛状腓动脉穿支皮瓣修复足后跟部软组织缺损皮瓣血供可靠,外形与质地良好,手术操作简单,是修复足后跟软组织缺损的可靠方法。     

改良动脉化静脉皮瓣修复手指软组织缺损

目的探讨一种改良动脉化静脉皮瓣修复手指软组织缺损的疗效。方法 2017年1月—2018年4月,收治16例手指软组织缺损患者。男12例,女4例;年龄24～74岁,平均41岁。软组织缺损原因:瘢痕挛缩切除后1例,机器绞压伤15例。拇指3例,示指5例,中指4例,环指2例,小指2例;手指掌侧缺损4例,背侧缺损12例。软组织缺损范围为3 cm×2 cm～10 cm×3 cm。于前臂掌侧设计并切取改良动脉化静脉皮瓣,皮瓣完全游离前在显微镜下剔除部分脂肪组织,并结扎皮瓣内2根静脉间的所有细小分支,游离移植修复创面。皮瓣切取范围为3.5 cm×2.5 cm～10.5 cm×3.5 cm。供区游离植皮修复(1例)或直接缝合(15例)。结果术后1例皮瓣发生静脉危象;15例皮瓣均顺利成活,其中3例皮瓣术后出现轻度至中度肿胀,未作特殊处理,1周后自行愈合。供区植皮成活,切口Ⅰ期愈合。术后13例获随访,随访时间8～16个月,平均11个月。患者皮瓣质地软、耐磨,外形满意。末次随访时,皮瓣感觉单丝触压觉测试为2.83～4.56 g,平均4.01 g;静态两点辨别觉为6～20 mm,平均12 mm。结论改良动脉化静脉皮瓣通过改善动脉化静脉皮瓣内的动静脉分流,减轻术后静脉回流不畅,修复手指软组织缺损可获得较好疗效。     

旋髂浅动脉穿支皮瓣的新应用及思考

目的利用多种形式的游离旋髂浅动脉穿支皮瓣(SCIAPF)修复软组织缺损,总结临床疗效,并评价SCIAPF的临床新价值。方法回顾性分析2015年1月-2019年5月在温州医科大学附属第二医院骨科收治的42例组织缺损患者,其中足部9例, 踝部8例, 小腿8例, 前臂7例, 手部9例, 口腔1例;均采用SCIAPF修复,单一软组织缺损创面28例,多个软组织缺损创面8例,多种组织复合缺损6例。创面面积1.2 cm×1.8 cm～14.0 cm×20.8 cm, 皮瓣面积1.5 cm×2.0 cm～15.3 cm×22.3 cm。术后采用复诊、电话等方式进行随访, 观察皮瓣成活情况和并发症。结果本组42例中,单一皮瓣共28例,其中旋髂浅动脉浅支皮瓣18例,旋髂浅动脉深支皮瓣2例,浅支加深支皮瓣8例;嵌合瓣6例,其中旋髂浅动脉浅支皮瓣加深支髂骨瓣4例,旋髂浅动脉皮瓣加缝匠肌肌瓣2例;分叶瓣8例。动脉吻合方式:端侧吻合35例,端端吻合7例;静脉吻合:与旋髂浅静脉吻合25例,与伴行静脉吻合12例,二者均吻合5例,其中静脉端端吻合27例,端侧吻合15例。所有皮瓣供区均一期直接缝合。本组皮瓣全部成活,其中...     

应用游离腓动脉穿支皮瓣修复手足软组织缺损16例

目的 探讨游离腓动脉穿支皮瓣修复手足软组织缺损的临床效果. 方法 应用腓动脉穿支皮瓣修复手背及虎口区软组织缺损伴肌腱外露5例,修复足背及趾区域软组织缺损伴骨、肌腱外露11例,皮瓣切取面积最小3cm×2 cm,最大10 cm×5 cm. 结果 术后移植皮瓣全部成活,其中1例术后发生血管危象,经手术探查处理皮瓣成活.手背3例、足背1例皮瓣略显臃肿,二期行皮瓣修整术,手、足功能恢复满意;供区肢体无功能障碍. 结论 游离腓动脉穿支皮瓣可修复手足中、小面积皮肤软组织缺损.     

桥式交叉胫后动脉或腓动脉穿支皮瓣修复对侧下肢软组织缺损

目的探讨采用健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉修复下肢软组织缺损的可行性。方法 2007年8月-2010年2月,收治15例下肢软组织缺损患者。男14例,女1例;年龄25～48岁,平均33.9岁。交通事故伤8例,机器伤4例,重物砸伤3例。1例踝部植皮后遗留22 cm×8 cm大小的瘢痕(伤后35个月);余14例软组织缺损位于踝部1例,小腿中下1/3处12例,小腿中上1/3处1例;创面范围8 cm×6 cm～26 cm×15 cm;受伤至入院时间为4～28 d,平均14.8 d。采用逆行胫后动脉穿支皮瓣(9例)或腓动脉穿支皮瓣(6例)桥式交叉修复,皮瓣切取范围为10 cm×8 cm～28 cm×17 cm。供区创面两端直接缝合,中部残留创面取游离皮片植皮修复。术后5～6周行皮瓣断蒂。结果术后2例腓动脉穿支皮瓣分别出现远端轻度淤血及边缘部分坏死,经换药后均成活;其余皮瓣断蒂后均顺利成活,受区创面Ⅰ期愈合。供区切口Ⅰ期愈合,植皮均成活。15例均获随访,随访时间7～35个月,平均19.5个月。皮瓣质地、色泽与受区相近,外形较满意。末次随访时根据美国矫形足踝协会(AOFAS)踝与后足功能评分标准,评分为81～92分,平均87.3分。结论健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉可较好修复对侧小腿或足部大面积皮肤软组织缺损,术中无需吻合血管,血管危象发生率低,手术成功率高。     

An evaluation of quality of life of mothers of children with enuresis nocturna

The aim of this study was to evaluate the impact of enuresis nocturna on quality of life of the mothers. Mothers who have a child with monosymptomatic nocturnal enuresis (n = 28) and mothers who have a child without any health problems (n = 38) were enrolled in the study. Groups were in balance for background variables (child’s age, gender, and number of siblings; mother’s age, marital status, highest year of education completed, and occupation; presence of health insurance; and type of residence). Short-Form Health Survey (SF-36) Questionnaire, the Beck Depression Inventory (BDI), and Spielberg’s State-Trait Anxiety Inventory (STAI) were applied to all mothers. The mothers of children with enuresis had significantly lower quality-of-life scores in the SF-36 for the bodily pain (p = 0.015) and role emotional (p = 0.014) subscales. We observed significant difference between groups according to BDI; mean score was higher in mothers who have a child with enuresis nocturna (p = 0.017). There was no significant difference between groups according to the STAI. Significant differences according to bodily pain and role emotional subscales of SF-36, and the BDI scores, show that the mothers were negatively affected by having a child with monosymptomatic nocturnal enuresis.     

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

Summary The authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean follow-up is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were also seen in those with a necrosis angle of less than 200°. No radiological improvement was seen although a high percentage showed no deterioration.The choice of treatment for the condition is discussed in the light of these results.

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Résumé Les auteurs présentent leur expérience de l'ostéotomie intertrochantérienne dans le traitement de la nécrose idiopathique de la tête fémorale. Ils analysent les résultats obtenus dans 102 ostéotomies, pratiquées sur 81 malades, avec un recul de 4.1 ans. Une amélioration clinique statistiquement significative a été observée après l'opération, spécialement dans les cas vus au stade II de Ficat et Arlet (91% des malades sont satisfaits). L'influence de l'angle de nécrose est également démontrée, les meilleurs résultats ayant été obtenus lorsque cet angle est inférieur à 200°. Il n'y a pas d'amélioration radiologique, mais une stabilisation de l'évolution dans un grand nombre de cas. A la lumière des résultats obtenus, les auteurs exposent leurs indications thérapeutiques dans le traitement de l'ostéonécrose de la tête fémorale.

     

Electrodiagnosis of compression of individual nerve roots of the cauda equina

Summary Segmental electrodiagnosis of compression of individual nerve roots of the cauda equina has been attempted in 45 patients, including cases of disc hernia, spondylosis and spondylolisthesis. The needle electrode was inserted into the nerve root either just lateral to the intervertebral foramen or through the posterior sacral foramen. The recordings made on stimulating a single nerve root were somatosensory evoked potential, the cauda equina action potential and the M and H waves. Mixed spinal nerve root action potentials were also recorded by stimulating the sciatic, peroneal and tibial nerves. It was shown that a diagnosis could be made from the somatosensory evoked potential, the H wave and root pain reproduction, and also the diagnosis of a subclinical compression involvement.In other words, the neurophysiological state of dysfunction of individual roots in each aspect of compression can be expressed.

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Résumé L'électrodiagnostic segmentaire de la compression des racines de la queue de cheval a été tenté chez 45 malades, comprenant des cas de hernie discale, de spondylarthrite et de spondylolisthésis. L'électrode est insérée dans la racine soit en dehors du trou de conjugaison, soit à travers le canal sacré postérieur. Les enregistrements consécutifs à la stimulation d'une seule racine sont le potentiel évoqué somatosensoriel, le potentiel d'action de la queue de cheval et les ondes M et H. Des potentiels d'action mixtes des racines nerveuses de la moelle sont également enregistrés en stimulant les nerfs sciatique, sciatique poplité externe et interne. On en déduit qu'un diagnostic est possible à partir du potentiel évoqué somatosensoriel de l'onde H et de la reproduction de douleur radiculaire et qu'ainsi peut être reconnue une compression infra-clinique.Autrement dit, l'état neurophysiologique du dysfonctionnement de chacune des racines dans chaque aspect d'une compression peut être exprimeé.

     

The results of reconstruction of the lateral ligaments of the ankle

Summary Eighty-one reconstructions of the lateral ligaments of the ankle were carried out at our clinics between 1967 and 1983. Three methods were used and 53 patients were followed up. The only two poor results followed infection after dural reconstruction. Peroneus brevis reconstruction, dural reconstruction and ligament advancement all had good results in over 80% of the patients. There was restriction of supination and an increase of osteoarthritis after the peroneus brevis reconstruction operations. Statistical analysis did not show that any one of these procedures was better than any other.

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Résumé De Janvier 1967 à Août 1983, 81 plasties ligamentaires externes ont été exécutées dans nos cliniques de Munich. A côté de la plastie de Viernstein utilisant le court péronier latéral, et de la plastie à la dure-mère de Jaeger, on a réalisé également des transferts ostéo-ligamentaires (Wirth), combinés avec des plasties périostées. 53 patients ont été analysés, 3,8 ans en moyenne après l'opération, sur le plan clinique et radiologique. Les deux seuls mauvais résultats sont consécutifs à une infection survenue après plastie à la dure-mère. Chacune de ces trois méthodes de traitement a donné plus de 80% de bons résultats. Dans les plasties à l'aide du court péronier latéral on a pu constater une limitation de la supination ainsi qu'une augmentation de l'arthrose. L'analyse statistique n'a cependant pas montré de supériorité de l'un de ces procédés par rapport à un autre.

     

Bipolar fixation of fractures of the distal end of the radius

Summary The frequency of secondary displacement in fractures of the distal end of the radius is very high and varies from 40 to 60% in various series. This results from the void in the epiphysis after reduction due to crushing of the cancellous bone. Secondary displacement can be easily avoided by the bipolar fixation method. This method is quite simple. Two strong Kirschner wires are driven into the radius and into the first metacarpal, and then incorporated in the cast after the reduction of the fracture. In this study we have followed 102 out of 250 patients treated by this method. The number of secondary displacements has been negligible. The functional results are excellent and we did not find any untoward effects attributable to our technique.

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Résumé Si la réduction des fractures de l'épiphyse inférieure du radius est assez facile à obtenir, son maintien est par contre fort aléatoire. On constate en effet un déplacement secondaire dans plus de la moitié des cas. Ceci résulte de ce que cette fracture comporte essentiellement un tassement du tissu spongieux qu'entoure une frêle corticale elle-même fragmentée: la réduction ne s'appuie donc sur rien. La fixation bipolaire, réalisée aisément par deux points d'appui placés respectivement dans la diaphyse radiale et le premier métacarpien, assure le maintien de la réduction et, par conséquent, une consolidation en bonne position. Cent-deux des 250 patients traités selon cette méthode ont été revus: les résultats anatomiques et fonctionnels ont été trouvés excellents. Le nombre de déplacements secondaires est négligeable, et aucun inconvénient imputable à la technique n'a été relevé.

     

The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients

BackgroundArteriovenous fistulae (AVFs) may remain patent after kidney transplantation (KTx), contributing to maladaptive cardiac remodeling. The flow in AVFs is associated with the diameter of its vessels and thus with the AVF location. The main objective of this study is to assess the influence of AVF location and its patency on the self-reported quality of life (QOL) of kidney transplant recipients (KTRs) with past history of hemodialysis.MethodsTo gain clinical data, during a scheduled visit, 353 KTRs were asked to fill out an anonymous questionnaire. From this group, 284 respondents were found eligible for analysis. The outcome was defined as prevalence of symptoms and health status, measured with the Left Ventricular Dysfunction-36 (LVD-36) Questionnaire in symptomatic patients.ResultsThe hemodialysis patients (n = 243) were divided into two groups according to AVF location, i.e., DAVF – distally located AVF – (n = 174) and PAVF – proximally located AVF – (n = 69). The proportion of patients with heart failure (HF) was higher in PAVF group (24% vs. 12%, p = 0.0482). In the multivariable regression, PAVF, serum creatinine levels, and the presence of HF or coronary artery disease (CAD) remained independent predictors of lower functional capacity. Among patients with heart disease, the presence of active AVF was independently associated with worse functional outcome (higher LVD-36 scores).ConclusionsThe influence of persistent PAVF in KTRs seems to be unfavorable, especially when coexisting with CAD or HF. Abbreviations: AVF arteriovenous fistula; BMI body mass index; CAD coronary artery disease; D-AVF distally-located arteriovenous fistula; EC exercise capacity; HD hemodialysis; HF heart failure; KTx kidney transplantation; KTR kidney transplant recipient; LVD-36 Left Ventricle Disfunction – 36; LVEF left ventricle ejection fraction; LVH left ventricle hypertrophy; NYHA New York Heart Association; P-AVF proximally located arteriovenous fistula; PD peritoneal dialysis; PRO patient-reported outcomes; QOL quality of life.     

Evaluation of the calcifying characteristics of biological fluids and inhibitors of calcification

The calcifying activities of biological fluids can be measured,in vitro andin vivo, by their ability to reharden softened blocks of tooth enamel. The activity is expressed in terms of the calcium (and phosphate) concentrations of synthetic calcifying solutions of known concentration and activity. A typical human plasma had an activity corresponding to that of a solution of the following concentration: calcium, 0.70 mM; Ca/P, 1.67 and fluoride, 0.05 mM.The relatively low activity of serums and plasmas was shown to arise from the presence of a number of ionic inhibitors. Pyrophosphate ion is one such inhibitor but cannot account for the major inhibition. Both anionic and cationic inhibitors were shown to be present, with the cations respresenting the major portion. The following ions at their reported physiological concentration were shown to be inhibitors in synthetic systems: P₇O ₇ ^4– , HCO ₃ ^– , SiO ₄ ^2– , CrO ₄ ^2– , Mg²⁺, Zn²⁺. In combination, these ions caused a total inhibition similar to those for plasmas.This work has been supported by a grant from the American Chicle Company, Division of Warner-Lambert Pharmaceutical Company.     

The radical treatment of tuberculosis of the spine

Summary The technique of radical treatment of tuberculosis of the spine at various levels is described. Eighty cases out of 158 of spinal caries underwent radical surgery over a period of 7 years. Caseous pus, sequestra, granulation tissue and discs were excised. Rib grafts were used in the dorsal spine and iliac strut grafts in the cervical and lumbar spine, through a direct anterior approach. Sound bony fusion was achieved in 90% of cases. The procedure is technically difficult but recovery is fast and the majority were fit to resume work within 6 months.

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Résumé Cet article décrit la technique utilisée pour l'abord chirurgical de la spondylite tuberculeuse à ses différents niveaux. Sur 158 maux de Pott observés au cours d'une période de 7 ans, 80 ont été traités chirurgicalement. Le caseum, les séquestres, le tissu de granulation et les débris discaux ont été excisés. Par une voie d'abord directe, antérieure, une greffe de renforcement a été mise en place, costale à l'étage dorsal, iliaque aux étages cervical et lombaire. Une fusion osseuse solide a été obtenue dans 90% des cas. Ces interventions sont techniquement difficiles, mais elles entraînent une guérison rapide et la majorité des opérés ont été capable de reprendre leur travail dans un délai de 6 mois.

     

Comparative study of three methods of estimation of creatinine clearance in critically ill patients

Background

At the bedside, the reference method for creatinine clearance determination is based on the measurement of creatinine concentrations in urine and serum (mCrCl). Several models are available to calculate the creatinine clearance from the serum creatinine concentration. This observational survey aimed at testing the hypothesis that the proposed equations are unreliable to determine accurate creatinine clearance in patients admitted to intensive care unit (ICU).

Method

Creatinine clearance was determined by the use of mCrCl. Then, we compared three equations: Cockcroft-Gault (CG), Simplified Modification of Diet in Renal Disease (MDRDs), and Chronic Kidney Disease Epidemiology (CKD-EPI) in 156 consecutive patients within the first 24 hours after ICU admission. We tested the hypothesis that the three equations were equivalent. The agreement between the three equations was evaluated by linear regression and Bland and Altman analysis.

Results

Bland and Altman analysis showed similar agreement between the three equations. The biases and precisions were –4.8 ± 51, –1.3 ± 50, and 8.2 ± 44 for CG, MDRDs, and CKD-EPI equations, respectively (P > 0.05). The precisions were similar for the three equations (P > 0.05). The percentages of outliers at ± 30% were 44%, 45%, and 49% for CG, MDRDs, and CKD-EPI, respectively (P > 0.05).

Conclusion

Regarding the high percentage of outliers, the use of these equations cannot be recommended in ICU patients.     

补肾活血方对沙鼠增龄过程中腰椎软骨终板钙化干预作用的初步研究

目的:探讨补肾活血方对腰椎软骨终板钙化的干预作用。方法:选取30只2月龄和7月龄健康雄性长爪沙鼠,分别喂养至2月龄(50~60 g)和12月龄(60~80 g)建立老龄沙鼠模型,采用随机数字表方法分为5组:正常组(n=6),模型组(n=6,给予生理盐水4 ml/kg,灌胃30 d),补肾活血方低剂量组(n=6,给予补肾活血方1.9×10-3 ml/g灌胃30 d),补肾活血方中剂量组(n=6,给予补肾活血方3.8×10-3 ml/g灌胃30 d),补肾活血方高剂量组(n=6,给予补肾活血方7.6×10-3ml/g灌胃30 d),干预组从7月龄开始连续给药1.36 g,30 d。正常组2月龄及其他组12个月龄时处死动物,取腰椎间盘组织,HE染色体视法分析腰椎体软骨终板组织形态学、血管芽面积、非钙化/钙化层比值,兔单克隆抗体免疫组化染色方法测定软骨终板X型胶原、BMPs的表达。结果:软骨终板血管芽相对面积测量显示,与模型组相比,补肾活血方中剂量组,正常组增高(P0.05),大、小剂量组虽各有不同程度的增加,但差异均无统计学意义(P0.05);软骨终板非钙化层/钙化层厚度比值测量显示,与模型组相比,补肾活血方中剂量、正常组增加,差异具有统计学意义(P0.05),而补肾活血方大、小剂量组虽各有不同程度的增加,但差异均无统计学意义(P0.05)。免疫组化染色软骨终板X型胶原的表达与模型组相比,正常组、补肾活血方低、中、高剂量组均降低,差异具有统计学意义(P0.01);BMPs的表达,与模型组相比,正常组、补肾活血方中剂量组升高,差异具有统计学意义(P0.01),大、小剂量组虽各有不同程度的升高,但差异均无统计学意义(P0.05)。结论:补肾活血方中剂量可延缓增龄过程中椎间盘软骨终板钙化,提示可作为早期椎间盘退变的预防用药。