无骨折脱位型颈脊髓损伤的治疗

目的:探讨多节段无骨折脱位颈脊髓损伤的治疗。方法:多节段无骨折脱位型颈脊髓损伤21例,均行单开门颈椎管扩大减压成形术。采用JOA、Frankel分级及影像学进行疗效评价。结果:平均随访2年1个月,JOA评分术后改善率为37.81%,Frankel分级A→B 1例,B→C 7例,C→C 1例,C→D 10例,D→D 2例,D→E 4例。影像学检查提示颈椎生理曲度正常,未发现有再关门及不稳定现象。结论:单开门棘突重建颈椎管扩大成形术由于重建了颈后方韧带复合体,对于改善和维持颈椎的生理屈度、稳定性方面有重要的临床意义。     

GS23PPAEDIATRIC SURGERY PERFORMED BY GENERAL SURGEONS IN A PROVINCIAL NEW ZEALAND (NZ) HOSPITAL

Purpose To perform an audit of paediatric surgical patients in a provincial general surgical unit. Methodology Data was prospectively recorded using a standardized proforma on all children aged up to 15 yrs, seen between 11th December 2005 and 11th December 2006. Results There were 209 admissions (194 children), median age 8 yrs (6 wks–15 yrs) with 153 (73%) acutes. 37 children (18%) were under 2 yrs. Male : female ratio was 3 : 2. Procedures (n = 119) were appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy respectively. 51% of operations were acute. There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusseption (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (6 wks–14 yrs). Complications were wound infection (1), post‐operative ileus (2) and infarcted ovary (1). Conclusion There are increasing moves towards centralization in paediatric surgery. 1 With only 4 paediatric tertiary centres in NZ, many general surgeons routinely perform paediatric surgery. A large number of children presented to our surgical department. Around half of these children required surgery and half of operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.     

人工股骨头置换术治疗高龄非稳定性股骨转子间骨折

目的探讨高龄患者非稳定性股骨转子间骨折行人工股骨头置换术的临床疗效。方法本组74例，年龄75～89岁，平均80．3岁；骨折类型按Evans分类：ⅢA型31例，ⅢB型24例，Ⅳ型19例。其中3例为经内固定治疗失败病例，合并内科疾病者69例，在相关内科协同治疗后行双极骨水泥型人工股骨头置换术，术后早期进行康复锻炼。结果74例都顺利通过手术，住院期间无死亡病例；72例获得随访，随访时间3～16个月，平均9．2个月；无一例出现畸形，髋关节功能接近或恢复到受伤前水平，生活可自理；2例于出院后5个月、11个月死于其他疾病。结论人工股骨头置换术治疗高龄非稳定性股骨转子间骨折是一种效果确切的治疗方法，操作简单、创伤小、卧床时间短、并发症低、死亡率低，提高了高龄患者的生活质量。     

Klippel-Feil syndrome plus atretic meningocele in one identical twin and anencephaly in the other.

Klippel-Feil syndrome (KFS) is a heterogeneous entity, characterized by specific congenital anomalies of segmentation of the cervical spine. We report a case of KFS plus atretic meningocele in one identical twin and anencephaly in the other. These identical twins were both male with no chromosome defect. One of them had anencephaly diagnosed at the gestational age of 17 weeks and died soon after birth, whereas the co-twin had KFS with multiple congenital anomalies including short neck with low hairline, occipital atretic meningocele, butterfly vertebrae, hemivertebrae, cervico-thoracic scoliosis, left thumb preaxial polydactyly, and right undescended testis. He received rehabilitation during infancy and could walk at the age of 15 months. Both of these infants had preaxial polydactyly, which is an uncommon anomaly associated with KFS. In conclusion, iniencephaly and anencephaly are probably the extreme manifestations of KFS rather than different dysraphisms. Prompt clinical suspicion with early diagnostic imaging for spine lesions and occult opening of neural tube is mandatory for further intervention and rehabilitation.     

军队在职干部腰身指数与心血管危险因素相关性探讨

目的 研究用腰身指数（腰围/身高比值WHtR）作为腹型肥胖指标探讨与心血管危险因素的相关性。方法 对2005年3月～2006年12月入住广州疗养院的军队在职干部共495人进行身高、体重、腰围、血压、心率、生化等检测,并进行统计学分析。结果 腰身指数异常组的年龄、体重、SBP、DBP、FBS、TC、TG以及尿酸均显著高于腰身指数正常组,HDL-C的结果则相反（P〈0.01～P〈0.001）;同时腰身指数与年龄、体重、SBP、DBP、FBS、TC、TG呈显著正相关,与HDL-C呈显著负相关（P〈0.05～P〈0.001）。结论 腰身指数可作为有效的腹型肥胖参考指标,腰身指数异常者其心血管危险因素水平比正常者高,及时控制腰身指数可以有效改善人群的健康状况。     

17 β雌二醇通过丝裂原活化蛋白激酶抑制前列腺癌细胞系PC3增殖

目的探讨丝裂原活化蛋白激酶在17β雌二醇(E2)抑制前列腺癌PC3细胞生长中的作用。方法检测不同浓度E2作用不同时间后PC3细胞生长抑制率。流式细胞仪分析细胞周期分布,TUNEL染色检测凋亡。Western blot检测ERK1/2,JNK和p38活性。RT-PCR法检测雌激素受体(ER)α、ERβ、P21WAF1和cyclinD1的表达。结果E2抑制PC3细胞增殖,并且可以激活ERK1/2、JNK和p38。处理因素作用48h后,对照组、E2、E2 PD98059、E2 SP600125、E2 SB203580组细胞的凋亡率分别为(0.9±0.1)%;(23.0±1.4)%;(30.0±1.2)%;(10.6±0.8)%和(14.6±0.7)%,(P<0.05)。E2使细胞阻滞在G1期,PD98059、SP600125、SB203580分别预处理1h后细胞分别进一步阻滞在G1期;轻度阻滞在G1期和进入S期。RT-PCR发现PC3细胞表达ERα和ERβ,E2、E2 PD98059、E2 SP600125、E2 SB203580组中cyclinD1、P21WAF1基因表达分别为对照组的(0.42±0.03)、(3.13±0.02)倍;(0.21±0.03)、(3.08±0.05)倍;(0.43±0.01)、(1.31±0.04)倍;(2.81±0.02)、(3.14±0.02)倍(P<0.05)。结论E2激活JNK增加P21WAF1基因表达,并激活p38抑制cyclinD1表达,使细胞阻滞在G1期,JNK和p38通路还介导E2引起PC3细胞凋亡。同时E2又可激活ERK1/2,轻度拮抗上述作用。     

可吸收钉治疗四肢骨折18例体会

自可吸收钉发明并应用于临床以来．因该钉能在体内降解、吸收，免除了二次手术拆钉的痛苦，受到病人的普遍接受。本院自2003年6月以来应用可吸收螺钉治疗骨折18例，取得了较好的效果。报告如下。     

A CT-free, intra-operative planning and navigation system for minimally invasive anterior spinal surgery - an accuracy study.

OBJECTIVE: A comprehensive study was performed to evaluate the accuracy of a newly developed CT-free, intra-operative planning and navigation system for anterior spine surgery. MATERIALS AND METHODS: Instruments and an image intensifier were tracked using the SurgiGATE navigation system. A laboratory study was performed on 27 plastic vertebrae. Fiducial markers were implanted in the vertebrae for accuracy evaluation purposes, and a dynamic reference base was placed on the vertebrae to establish a patient coordinate system (P-COS). Two fluoroscopic images were used for intra-operative planning. The graft bed plan was recorded in P-COS, followed by surgical formation of the graft bed, which was visualized. To evaluate the accuracy, the vertebrae were scanned with CT, and the markers were used to calculate an accurate paired-point registered transformation between the CT coordinate system and P-COS. RESULTS: Using the new SPO module, accurate planning and navigation of a resection of the vertebral body is possible using two fluoroscopic images. The overall mean error between the planned resection volume and the actual resection was 0.98 mm. In addition, the module can serve as an educational tool for training spine surgeons. CONCLUSIONS: The new fluoroscopy-based system can be used safely for accurate performance of anterior resection during spondylodesis. New methods for safe and accurate registration during anterior spine surgery need to be developed.