罗哌卡因局部浸润用于显微内镜腰椎间盘切除术后镇痛

目的：评价罗哌卡因切口周围局部浸润在显微内镜腰椎间盘髓核摘除术后镇痛中的作用。方法：83例行显微内镜腰椎间盘髓核摘除术患者随机分成2组，A组（n=43）手术开始前以0．75％盐酸罗哌卡因10mL于切口周围肌层和皮下局部浸润；B组（n=40）手术开始前以0．9％生理盐水10mL于切口周围肌层和皮下局部浸润。对手术后患者的疼痛指数、阿片类镇痛药物使用量以及切口愈合情况等进行统计观察。结果：A组患者的结果明显优于B组，A组患者术后疼痛反应轻、阿片类镇痛药物使用量少、胃肠道反应发生率低、住院时间更短。所有患者未出现切口愈合不良等并发症。结论：罗哌卡因切1：2周围局部浸润对于缓解显微内镜腰椎间盘髓核摘除术后疼痛具有优良的效果，能明显缩短患者术后恢复的时间，值得临床推广使用。     

Study on chondrogenic differentiation of canine mesenchymal stem cells induced by Type 2 recombinant adeno-associated viral mediated transfer of hTGF-β1

Objective To investigate the potential application of human transforming growth factor-beta-1 (hTGF-β1) gene mediated by type 2 recombinant adeno-associated virus (rAAV2) vector inducing chondrogenic differentiation of canine mesenchymal stem cells (MSCs) in vitro. Methods Canine MSCs from bone marrow were isolated and cultured in vitro by density gradient centrifngation and adherence screening methods. The morphology of MSCs was observed by inverted phase contrast microscope and Giemsa stain. Flow eytometry was used to detect surface antigens of MSCs, The third generation of MSCs were transfected by rAAV2-hTGF-β1 with or without MOI of 1 ×105 v.g./cell or 5×105 v.g./cell. The expression of hTGF-β1 was detected by Western blot after 10 days, and TGF-β1 synthesis was determined by ELISA at 3, 6 and 9 day, respectively. After 2 weeks of culturing, mRNA expressions of type Ⅱ collagen and aggrecan were determined by RT-PCR and the collagen Ⅱ protein was detected by immunocytochemistry. Results The MSCs appeared to be morphologically spindle-shaped and showed active capability of proliferation both in primary and passage generations. Flow cytometry analysis indicated that MSCs were universally positive for CD29, CD44 and CD105, but negative for CD34 and CD45. TGF-β1 expression can be observed by Western blot after 10 days in two transfection groups, MOI of 5 × 105 group and MOI of 1× 105 group. With the extension of time, the contents of hTGF-β1 increased in the two groups detected by ELISA, while there was a significant difference between them two (P < 0.01). After 2 weeks of transfection of MSCs by rAAV2-hTGF-β1, the expression of collagen Ⅱ and Aggreacan mRNAs were positive. It also showed positive of collagen Ⅱ detected by immunocytochemistry. Conclusion Canine MSCs show chondrogenesis differentiation after induction by Type 2 rAAV mediated transfer of TGF-β1 gene. The process is a potential application for cartilage tissue engineering.     

壳聚糖与Ⅱ型胶原复合制作组织工程软骨支架及其性能研究

目的探讨采用壳聚糖与Ⅱ型胶原复合制作新型组织工程软骨三维多孔支架的方法,并对其理化性能进行检测. 方法将精制88%脱乙酰度壳聚糖溶于0.2 mol/L醋酸溶液制成2%溶液,高纯度猪Ⅱ型胶原溶于0.5 mol/L醋酸溶液制成1%溶液,两者按4∶1(重量比)充分搅拌混合,采用冷冻干燥法制成壳聚糖与Ⅱ型胶原复合支架.采用碳化二亚胺/ N-羟基琥珀酰亚胺对支架进行交联,力学测定比较支架交联前后的强度变化,扫描电镜观察其超微结构,于2、4、6和8周经溶菌酶体外降解实验测定其体外降解性. 结果制备的复合支架成形良好,交联后其力学强度明显增加.扫描电镜显示壳聚糖与Ⅱ型胶原成分在支架内分布均匀,支架内孔洞相互连通似海绵状,孔径100～250 μm.各时间段复合支架体外降解较单纯壳聚糖支架快. 结论壳聚糖与Ⅱ型胶原复合成功地制作成了三维多孔复合支架.其理化性能及体外降解测定,可以作为支架载体,应用于组织工程软骨的构建.     

猪去抗原半月板体外降解的实验研究

目的 研究猪去抗原半月板在体外的降解规律，以进一步调整其合适降解速度。方法选用4～6月龄健康小型猪5只，取其双膝关节半月板。一部分采用环氧化物进行去抗原处理，制备成去抗原半月板；另一部分不作任何处理，为新鲜半月板。将两种半月板冻干处理后，置于含胶原酶、木瓜蛋白酶、透明质酸酶和胰酶的PBS液中，于37C酶解3、7、15、30d。另取两种半月板在PBS液37℃下水解30d。采用失重法、紫外光谱分析及扫描电镜测定其降解特性，并测定两种半月板的亲水性。结果两种半月板于4种酶中的酶解效果显著，其中以胰酶最明显，但去抗原半月板酶解程度低于新鲜半月板。新鲜半月板及去抗原半月板水解率分别为0．76％、0．81％。两种半月板在4种酶的降解液中紫外吸收值范围大致相同，为200～300nm。扫描电镜观察，去抗原半月板的空间结构改变不及新鲜半月板明显。去抗原半月板的亲水性较新鲜半月板稍低：吸水率为157％、188％；保水率为152％、167％。结论去抗原半月板降解较新鲜半月板慢，为调整去抗原半月板在体内降解速度提供依据。     

关节镜下冷融切松解治疗臀肌筋膜挛缩症的护理

我院2004年7月-2005年3月,对6例住院患者尝试采用关节镜监视下冷融切松解术治疗臀肌筋膜挛缩症.术后随访6个月,患儿患髋功能恢复良好,效果满意,现报道如下.     

TGF-β1缓释载体体外构建组织工程软骨

目的制备负载TGF—β1壳聚糖缓释微球的三维多孔壳聚糖支架，检测TGF—β1缓释载体对软骨细胞功能的影响．方法乳化交联法制备TGF—β1壳聚糖缓释微球并将其与壳聚糖支架复合，检测其体外降解并通过ELISA法检测微球的载药、释药性能。将软骨细胞置于复合载体中立体培养，通过苏木素伊红染色、Ⅱ型胶原免疫组化染色、扫描电镜观察复合载体对细胞的增殖、功能的影响。结果缓释微球的TGF—β1包封率达90．1％，并具有良好的药物缓释性能，软骨细胞在复合载体中增殖良好，并能够保持其表型及Ⅱ型胶原分泌功能。结论负载TGF—β1壳聚糖缓释微球的壳聚糖支架作为软骨细胞的载体在组织工程软骨的构建及软骨损伤的修复中有良好的应用前景。     

壳聚糖与型胶原复合制作组织工程软骨支架及其性能研究

目的　探讨采用壳聚糖与 型胶原复合制作新型组织工程软骨三维多孔支架的方法,并对其理化性能进行检测。　方法　将精制88%脱乙酰度壳聚糖溶于0 .2 mol/ L 醋酸溶液制成2 %溶液,高纯度猪 型胶原溶于0 .5 m ol/ L醋酸溶液制成1%溶液,两者按4∶1(重量比)充分搅拌混合,采用冷冻干燥法制成壳聚糖与 型胶原复合支架。采用碳化二亚胺/ N-羟基琥珀酰亚胺对支架进行交联,力学测定比较支架交联前后的强度变化,扫描电镜观察其超微结构,于2、4、6和8周经溶菌酶体外降解实验测定其体外降解性。　结果　制备的复合支架成形良好,交联后其力学强度明显增加。扫描电镜显示壳聚糖与 型胶原成分在支架内分布均匀,支架内孔洞相互连通似海绵状,孔径10 0～2 5 0 μm。各时间段复合支架体外降解较单纯壳聚糖支架快。　结论　壳聚糖与 型胶原复合成功地制作成了三维多孔复合支架。其理化性能及体外降解测定,可以作为支架载体,应用于组织工程软骨的构建。     

髓核低温消融术治疗颈性眩晕(附48例分析)

目的评价髓核低温消融术对颈性眩晕的临床治疗效果。方法回顾性分析采用颈椎间盘髓核低温消融术治疗48例颈性眩晕病人的手术经验。消融间隙:C3,4 21例,C4,5 15例,C5,6 4例,C6,7 1例,C3,4、C4,5同时消融3例,C3,4、C5,6同时消融4例。消融过程在G臂X-线机下进行,套管针穿刺到目的间隙后,插入特殊等离子刀头对椎间盘髓核进行低温消融。术后采用抗生素、地塞米松静脉滴注2 d。戴颈围7 d。随访时间3～5年,采用视觉模拟评分(VAS)系统记录病人治疗前后以及随访时的症状情况。结果病人术后当天即可戴颈围下地。眩晕及头痛症状术后即刻消失29例,术后1～2周逐渐缓解18例,改善不明显1例;VAS术前(6.92±0.87)分,术后即刻(2.94±0.63)分,术后3个月(2.36±0.61)分,术后1年(3.43±0.80)分,术后3年(3.73±0.71)分。术后出现Horner综合征1例,2周后自行缓解。结论颈椎间盘髓核低温消融术治疗颈性眩晕具有较好的近期和远期疗效,对于保守治疗无效而又不适宜手术治疗的病人,是一个值得推荐的治疗选择。     

Concurrent arthroscopic bicruciate ligament reconstruction using Achilles tendon-bone allografts: experience with 15 cases

Objective： To evaluate the clinical outcome of arthroscopically assisted combined anterior and posterior cruciate ligament （ACL/PCL） reconstructions using Achilles tendon-bone allografts.
Methods： Associated meniscus injuries were treated according to established methods prior to ligament reconstructions during arthroscopic surgery. Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees. At postoperative follow-up, all knees were graded using the modified IKDC and the Lysholm scoring systems just as done preoperatively. Results were analyzed compared with the contralateral healthy knees.
Results： Eleven men and 4 women with a minimum of 3-year follow-up （mean 38 months） were included in the study. Preoperatively, the group ratings by the modified IKDC standards were all severely abnormal. Twelvebicruciate reconstructions were performed in subacute or chronic stage （〉3-8 weeks）, 3 for acute ligamentous deficiencies （≤ 3 weeks）. The noticeable early complication was transitory local fever combined with joint effusion in one case. At postoperative follow-up, 9 knees were normal, 5 nearly normal and 1 abnormal. On Lysholm score the difference was statistically significant （ttest, P〈0.001） before and after operation. Conclusions： Achilles tendon-bone allograft offers an alternative for simultaneous arthroscopic ACL/PCL reconstructions. However, further investigation is needed to eradicate its potential immunogenicity for better use.