切开复位内固定治疗26例Pilon骨折疗效分析

目的：探讨切开复位内固定治疗Pilon骨折的手术疗效。方法：对26例Pilon骨折患者的临床资料进行回顾性分析,采用切开复位内固定的方法对26例患者进行治疗,评价治疗效果。结果：26例患者中优6例,良13例,差7例,总优良率达73.1%。4例出现伤口并发症,7例术后出现创伤性关节炎。结论：切开复位内固定治疗Pilon骨折效果良好,病残率较低。充分的术前准备和计划,熟练、精细的操作技术,固定可靠的材料,早期功能练习是获得满意疗效的基础和保证。     

跟腱愈合过程中的力学生物学*☆

跟腱断裂修复后采用传统的重力垂足位长腿石膏固定,势必使跟腱处于无张力甚至是“失用性”的负性平衡体系下愈合,这种状态可能会抑制跟腱愈合过程中感应“主动”机械信号刺激的关键时机,在此过程中给予的超声波、振动等治疗,也只能使跟腱“被动、间歇”地接受机械刺激。如果在术后采用早期功能锻炼的运动疗法,可以提高跟腱在组织修复过程中功能维持及再塑形的能力,有助于跟腱生物力学特性的恢复。蛋白质组学技术便于从高通量的分子水平揭示运动疗法促进跟腱愈合的机制。     

Kazakh therapy on differential protein expression of Achilles tendon healing in a 7-day postoperative rabbit model

Objective: To compare the effect of cast immobilization with that of early Kiymil arkili emdew (Kazakh exercise therapy) on the post-operative healing of Achilles tendon rupture in rabbits,and to observe the influence of early Kiymil arkili emdew on the differentially expressed proteins in the healing tendon.Methods: Forty-five New Zealand white rabbits were randomly divided into three groups (Arm A: control group;Arm B: postoperative immobilization group; and Arm C: postoperative early Kiymil arkili emdew group).After tenotomy,the rabbits of the two experimental groups received microsurgery to repair the ruptured tendons,and then received either cast immobilization or early Kiymil arkili emdew treatment.Achilles tendon tissue samples were collected 7 days after the surgery,and two-dimensional gel electrophoresis and MALDI-TOF-MS technique were used to analyze differentially expressed proteins in the tendon tissue of the three Arms.Results: A total of 462.67+11.59,532.33+27.79,and 515.33+6.56 protein spots were detected by the two-dimensional polyacrylamide gels in the Achilles tendon samples of the rabbits in Arms A,B,and C,respectively.Nineteen differentially expressed protein spots were randomly selected from Arm C.Among them,7 were unique,and 15 had five times higher abundance than those in Arm B.These included annexin A2,gelsolin isoforms and α-1 Type Ⅲ collagen.It was confirmed by western blot that gelsolin isoform b,annexin A2,etc.had specific and incremental expression in Arm C.Conclusions: The self-protective instincts of humans were overlooked in the classical postoperative treatment for Achilles tendon rupture with cast immobilization.Kiymil arkili emdew induced the specific and incremental expression of proteins in the repaired Achilles tendon in the early healing stage in a rabbit model,compared with those treated with postoperative cast immobilization.These differentially expressed proteins may contribute to the healing of the Achilles tendon via a mechanobiological mechanism caused by the application of Kiymil arkili emdew.     

胸腰段骨折前、后路重建术的临床疗效比较

目的:比较分析胸腰段骨折前、后路重建手术的临床疗效。方法:随机选择30例胸腰段骨折脊柱重建手术治疗患者,其中行前路手术15例(前路组),行后路手术15例(后路组)。随访15-50个月,平均21个月。神经功能评价采用Frankel分级和ASIA评分,通过影像学检查脊柱畸形角(Cobb’s角)的纠正、植骨融合情况。结果:前路组术后平均2周下床活动,胸腰椎(Cobb’s角术前、术后及随访时分别为(24.6±7.6)°、(1.8±7.3)°、(1.1 ±7.2)°,术前与术后及随访时比较差异均有统计学意义(P<0.01)。全部患者得到矫正并骨性融合,截瘫者神经功能平均提高1.35级。后路组术后平均1个月下床活动,胸腰椎Cobb’s角术前、术后及随访时分别为(23.5±7.6)°、(2.0±7.3)°、(5.1±7.2)°,差异均有统计学意义(P<0.01),截瘫者神经功能平均提高1.2级。结论:胸腰段骨折经胸膜外前路减压、复位、植骨、内固定重建术可有效地纠正脊柱骨折后畸形,并维持矫正度,改善神经功能,可早期活动。     

病灶清除植骨融合内固定术治疗胸腰椎结核临床疗效

目的:观察同期病灶清除植骨融合内固定术治疗胸腰椎结核的临床疗效。方法:自1998年8月~2003年9月应用同期病灶清除植骨融合内固定术治疗胸腰椎结核并随访46例,平均随访2.5年,按Moon植骨成功的观察标准及胸腰椎结核的治愈标准,对胸腰椎结核患者术前、术后的疼痛、结核中毒症状及并发症等情况进行评价。结果:胸腰椎后凸畸形全部矫正(P<0.05)。平均12 d后下床活动。术后6个月骨性融合率为60%、12~18个月骨性融合率为90%。28例合并截瘫患者神经功能平均恢复3级(Frankel分级);结核治愈率为98%。结论:同期病灶清除植骨融合内固定术可有效地治疗胸腰椎结核,并能够同时矫正胸腰椎后凸畸形,患者可早期下床活动。     

伞式经跟骨缝合法修复跟腱断裂的实验研究与临床应用

目的:将伞式经跟骨缝合法作临床实验,并与其他不同缝合组合作应力分析,从而为临床提供术后无须石膏固定修复技术的科学依据。方法:临床实验于2001-05/2006-08在新疆医科大学第一附属医院骨科完成。对急性跟腱断裂患者7例、陈旧性跟腱断裂患者4例,共11例,进行前瞻性手术治疗,端对端运用伞式经跟骨缝合法采用0-0普迪斯缝线、腱周采用交叉缝合法采用3-0无创缝线,术后随访平均36个月。应力实验于2002-11/2003-05在上海大学生物力学工程研究所完成。按L(1465)正交实验设计,对32只健康新西兰白兔跟腱断裂模型,以4种不同端对端缝合方法(伞式经跟骨缝合法、改良Kirschmayer缝合法、Motta缝合法、Kakiuchi缝合法)、4种不同缝合材料(0-0薇乔线、2-0慕丝线、3-0薇乔线、0-0攀状尼仑线)、4种不同腱周缝合方法(连续缝合法、城垛样缝合法、交叉缝合法、间断缝合法),在局部麻醉下组合修复、修复后分笼喂养,术后4种不同愈合时间(0,7,14,21d)对离体跟腱进行应力分析,正常对照组为16只同种单侧跟腱。结果:临床实验:11例患者术后均获得随访,按Arner-Lindholm法评定优良率100%,10例跟腱断裂患者切口均I/甲愈合。应力实验:32条跟腱模型均进入结果分析。①伞式经骨缝合法的极限强度平均为(3.09±0.35)N/mm2,Kirschmayer法,Motta法,Kakiuchi法平均分别为(1.61±15.5)N/mm2,(1.54±0.13)N/mm2,(1.31±0.11)N/mm2,前者分别比后者平均高48%,50%,58%。②伞式经骨缝合法刚度平均达(282.47±18.31)N/mm,Kirschmayer法,Motta法,Kakiuchi法平均分别为(229.38±17.41)N/mm,(238.98±15.27)N/mm,(225.81±22.07)N/mm,分别相差19%,15%,20%。③伞式经骨缝合法的比能平均为(0.92±0.06)J/mm3,Kirschmayer法为(0.66±0.04)J/mm3,Kakiuchi法和Motta法平均为(0.36±0.03)J/mm3,与前者相差60%,28%。④伞式经骨缝合法的最大拉伸载荷平均为(159.38±16.00)N,Kirschmayer法,Motta法,Kakiuchi法平均分别为(138.13±14.00)N,(109.38±8.20)N,(98.13±15.00)N,高于后3者13%,31%,38%,平均高于27.3%。但与正常组相比(367.14N),两者相差50%以上。⑤伞式经骨缝合法载荷-应力强度增长速率比其他缝合方法快。以上所有指标差别均具有统计学意义(P<0.05)。结论:临床应用伞式经跟骨缝合方法术后无须石膏固定,且有利于术后早期功能锻炼。实验中伞式经跟骨缝合方法生物力学明显优于其他3种方法。为进一步研究在运动状态下跟腱愈合的方向打下了基础。     

Cardiac multi-marker strategy for effective diagnosis of acute myocardial infarction

BackgroundHeart-type fatty acid-binding protein (H-FABP) is a heart-specific and highly sensitive biomarker for early diagnosis of acute myocardial infarction (AMI). We investigated the effectiveness of H-FABP for diagnosis of AMI in patients with different ethnic background and different time from symptom onset.MethodsVenous blood was withdrawn from consecutive patients with acute chest pain admitted to the First Affiliated Hospital of Xinjiang Medical University. The blood samples were used for measurement of creatine kinase MB (CK-MB) and cardiac troponin I (cTnI) using Beckman Coulter DC-800 analyzer, and detection of H-FABP using a one-step bedside immunotest.ResultsTwo hundred and eighty-nine patients admitted within 12 h after the onset of symptoms were recruited in the study. The H-FABP immunotest was found to have higher diagnostic accuracy than cTnI and CK-MB in patients admitted within 3 h. The combination of H-FABP and cTnI was found to have the highest diagnostic accuracy (91%) among different cardiac markers and the other combinations. It gave the highest sensitivity [96% (95% CI: 91–98%)] and a comparable specificity [84% (95% CI: 76–89%)] to cTnI alone.ConclusionA cardiac panel consisting of H-FABP and troponin is recommended.