体外冲击波促进成骨机制基础研究的相关进展

简介 　　体外冲击波(Extracorporeal Shock Wave,ESW)应用于肾结石治疗已有近20年的历史了.这种方法从根本上改变了泌尿系结石病的治疗.但是冲击波在医学领域中的应用不仅仅局限于泌尿外科.近几年,创伤和矫形外科开始渐渐将冲击波应用于骨不连、骨折延迟愈合和股骨头坏死的治疗,并取得了可喜的疗效,在世界范围内,已有数以万计的患者接受了这项治疗.然而体外冲击波对骨折后延迟愈合、骨不连以及无菌性骨坏死的治疗机制还尚不清楚.因此,阐明确定冲击波对于骨生长和骨形成的基本生物学效应是非常有意义的.以下是冲击波治疗促进成骨机制基础研究的相关进展. 　　……     

内陆部队晕船原因及对策

内陆部队人员渡海时极易发生晕船，这对保持和提高登陆部队的战斗力影响较大。为此，我们两次随船对参加演习人员的晕船情况进行了调查和观察，并分析晕船原因，探讨预防对策。1晕船原因1．1环境因素1．1．1风浪的影响我们最近两次演习乘坐相同型号的登陆舰，在风力2～3级。浪高1～1．4m时，21％乘员发生晕船；风力4～6级，浪高1．5～3m时，55％乘员发生晕船。两者比较，差异非常显著（P＜0．01）。1．1．2舰船吨位的影响我部参演某分队航渡阶段乘大型登陆舰，晕船为28％；换乘小型登陆舰（民用船）后，晕船率达68％，且眩晕、呕吐程度较乘…     

骨科医师选择骨肿瘤专科从业和继续教育现状

目的 了解骨肿瘤专科医师目前从业现状和继续教育情况,分析医师选择骨肿瘤专业的主要考虑因素及目前继续教育中存在的问题.方法 采用问卷星软件设计骨科住院/主治医师选择骨肿瘤专科问卷和骨肿瘤专科医生继续教育问卷.通过微信骨科专业群发放、回收问卷,对结果进行统计分析.结果 影响住院医生选择骨肿瘤专业的最主要因素为开展学术研究的...     

全程加速超分割放射治疗食管癌的临床研究

目的 探讨全程加速超分割放疗治疗食管癌的疗效.方法 180例食管癌患者,随机分为A组90例,全程加速超分割组,1.5Gy/f,2f/d,10f/w,间隔时间>6h,总Dt=51～60Gy/34f～40f/3.3～4.0w;B组90例,常规分割组,2Gy/f,1f/d,5f/w,总 Dt=60～70Gy/30f～35f/6～7w.结果 A组和B组的1、3、5年生存率分别为71.1%,40.6%,32,1%和51.1%,22.2%,14.4%,统计学处理后,两组有显著性差异(p<0.01),全程超分割组明显优于常规组;而放射性急性损伤和晚期损伤率,经卡方检验后,两组无显著性差异(p>0.05).结论 全程超分割治疗可以提高食管癌患者的长期生存率,而不明显增加放射性损伤,是目前一种切实可行的新的放射治疗方法.     

康复新液治疗食管癌术后吻合口瘘的疗效及对相关因子的影响

目的探讨康复新液在食管癌术后吻合口瘘治疗中的作用及对炎症指标、生长因子和氧化指标的影响。方法将72例胸外科食管癌术后吻合口瘘患者分为治疗组及对照组,观察记录并对比术后患者吻合口瘘愈合时间、术后住院时间、住院总花费及相关不良反应发生率。同时检测并对比以下指标:炎症指标:白细胞计数(WBC)、中性粒细胞百分比(NEUT%)、C反应蛋白(CRP)、白介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平;生长因子指标:血小板衍化生长因子(PDGF)和血管内皮生长因子(VEGF);氧化应激指标:超氧化物歧化酶(SOD)和过氧化脂质(LPO)含量。结果治疗组的吻合口瘘愈合时间及术后住院时间均短于对照组(P<0.05)。治疗组吻合口瘘1周时血清中炎症因子明显低于对照组(P<0.05),生长因子高于对照组(P<0.05),氧化应激指标优于对照组(P<0.05)。2组的不良反应比较差异无统计学意义。结论康复新液在食管癌术后吻合口瘘的治疗中效果确切,可以促进吻合口愈合,且能降低患者的机体炎症应激反应。     

New β Ti alloy mini-prosthesis with low elastic modulus resurfacing articular surface defect in dogs

Objective To assess the effect of a new β Ti alloy mini-prosthesis with low elastic modulus on resurfacing the full-thickness Surface defect of the knee joint in dogs.Methods A full-thickness osteochondral defect of 7 mm in diameter was created at the medial femoral condyle of both hind limbs in 8 healthy adult dogs.The titanium alloy mini-prostheses with high-modulus of elasticity were implanted on the right side(control group)and those with low-modulus of elasticity on the left side(experiment group)to repair the cartilage defects.After 3 months,all the 8 dogs were sacrificed to harvest the specimens.Radiographic,histologic and micro-CT examinations were conducted to observe stability of the mini-prostheses and growth of the bone and cartilage surrounding the implants. Results Radiographic evaluation revealed no indications of device disassembly or subsidence.Bone trabeculae surrounding anchoring screws in the experiment group was visibly more and denser compared with the control group.Micro-CT data revealed that the bone volume fraction,trabecular thickness,trabecular number and tissue mineral density were 0.389%±0.025%,0.049±0.002 μm,8.9±0.4 mm-1 and 652.7 ±12.6 mg/mm3 respectively in the experiment group,compare with 0.253%±0.024%,0.038±0.002 μm,5.9±0.4 mm-1 and 595.2±7.6 mg/mm3 in the control group,with statistically significant differences between the 2 groups(P<0.05).Cartilage around the cap grew well and the surface remained smooth.Periphery of the resurfacing implant was covered by an extension of the superficial cartilage emanating from the defect margins. Conclusions The new β Ti alloy mini-prosthesis with low elastic modulus is favorable toward resurfacing the articular surface defect.The low-modulus of elasticity can improve new bone formation on the implant-bone interface.     

带血管腓骨复合异体骨修复长骨肿瘤切除后骨缺损

目的 探讨带血管腓骨复合异体骨重建长骨恶性肿瘤切除后骨缺损的临床结果.方法 2006年4月至2009年10月对19例四肢长骨恶性骨肿瘤患者行保肢手术,男11例,女8例;年龄11～37岁,平均(18.5±7.6)岁.肱骨5例、股骨7例、胫骨7例.肿瘤切除后骨缺损长度(13.2±4.3)cm,采用带血管自体腓骨复合大段异体...     

计算机导航内半骨盆肿瘤切除及有限元分析辅助重建

目的 探讨计算机导航骨盆肿瘤精确切除与重建的安全性和有效性,评价有限元力学分析辅助骨盆环结构与力学重建的可行性.方法 2008年12月至2010年6月,采用有限元分析辅助肿瘤切除后的组配式假体设计,并通过计算机导航对12例内半骨盆恶性肿瘤患者行肿瘤切除与重建术.男8例,女4例;年龄25～53岁,平均39.7岁.软骨肉瘤4例,成骨肉瘤2例,Ewing肉瘤2例,恶性纤维组织细胞瘤1例,转移瘤3例(肾癌1例、甲状腺癌1例、乳腺癌1例).Enneking原发恶性肿瘤分期:ⅠA期1例,Ⅰ B期2例,ⅡA期2例,ⅡB期4例.术后评价肿瘤学结果和功能恢复情况.结果 术中未发生神经、血管和脏器损伤.术后X线片显示肿瘤切除范围与术前计划匹配,肿瘤切除彻底,组配式骨盆假体安放位置满意,固定钉位置满足术前有限元力学分析要求.全部病例随访8～26个月,平均18.2个月.肿瘤局部复发并肺转移1例,深部感染1例,深静脉血栓形成1例.无假体脱位及内固定松动、断裂,无肢体短缩.术后6个月时1993年美国骨肿瘤学会功能评分平均70%,6例随访超过20个月的患者功能评分平均68%.结论 计算机导航辅助骨盆肿瘤切除重建是一种安全有效的方法,有限元分析可为骨盆环重建提供精确的力学指导.

Abstract：

Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.