交锁髓内钉和动力外固定支架治疗胫骨骨折的疗效比较

目的:评价交锁髓内钉和动力外支架对胫骨骨折的治疗效果及其差异.方法:对栽胫骨151例骨折进行回顾性分析.首先根据AO分型标准对患者进行分型;使用x2检验对两种固定方法的疗效差别进行显著性分析;同时计算两组病人的平均手术时间、平均出血量和平均住院时间.结果:经过8～19个月的随访,带锁髓内钉治疗组骨折总体优良率为93.2%,平均愈合时间为4.3个月;动力外固定支架组总体优良率和平均愈合时间分别为87.5%和4.1个月;在分型组内两种固定方法的治疗效果差别统计学无显著意义(P＞0.05).但二者在平均手术时间、平均出血量和平均住院时间指标上的差别具有统计学显著意义(P＜0.05).结论:DAF和交锁髓内钉治疗胫骨骨折的疗效相似,但DAF的手术操作更为简单,手术创伤更小,更符合微创的原则.     

腺病毒介导的人骨形态发生蛋白2基因转染骨髓间充质干细胞

背景：骨髓间充质干细胞作为骨、软骨创伤缺损及退变修复的种子细胞越来越受到关注。目的：分析人骨形态发生蛋白2基因转染对白色封闭群大鼠（SD大鼠）骨髓间充质干细胞的影响。方法：分离纯化SD大鼠骨髓间充质干细胞并体外扩增,通过腺病毒载体介导人骨形态发生蛋白2基因转染骨髓间充质干细胞,分别通过荧光显微镜观察荧光表达情况及蛋白质水平来测定转染后人骨形态发生蛋白2的表达,碱性磷酸酶定量测定鉴定成骨活性及MTT法评估人骨形态发生蛋白2转染对骨髓间充质干细胞的影响。结果与结论：从SD大鼠骨髓提取物中分离培养的细胞形态为梭形,呈铺路石状、漩涡状生长,经流式细胞仪检测及多项分化能力鉴定符合骨髓间充质干细胞的特征;经转染人骨形态发生蛋白2基因后,骨髓间充质干细胞表达人骨形态发生蛋白2、碱性磷酸酶;MTT法检测转染人骨形态发生蛋白2基因后,骨髓间充质干细胞增殖能力明显增强（P〈0．05）。说明人骨形态发生蛋白2基因转染骨髓间充质干细胞后可以持续、高效表达入骨形态发生蛋白2和碱性磷酸酶,在体外明显促进骨髓间充质干细胞的增殖。     

羧甲基壳聚糖/环丙沙星植入缓释微球防治局部感染的实验研究

目的:探索局部植入抗菌药缓释微球防治术后局部感染的可行性及效果.方法:以羧甲基壳聚糖为缓释辅料,通过乳化交联工艺制备负荷盐酸环丙沙星的植入缓释微球;建立模拟体内释放环境的体外释放系统,评价微球体外释放特性和抑菌能力;利用高效液相色谱法检测药物的体内释放特性;利用透射电镜和病理检查检测微球的体内降解和组织相容性.结果:羧甲基壳聚糖环丙沙星植入缓释微球在体外的释放达7 d以上;微球植入体内后局部药物浓度维持在金葡菌MIC90以上约10 d,无明显突释现象;微球植入动物体内后无局部感染和切口愈合不良;透射电镜和病理结果发现微球和组织之间无明显的炎性异物反应.结论:羧甲基壳聚糖环丙沙星植入缓释微球在体内具有良好的生物相容性和释药行为,可用于植入体内防治局部感染.     

交锁髓内钉和动力外固定支架治疗胫骨骨折的疗效比较

目的：评价交锁髓内钉和动力外支架对胫骨骨折的治疗效果及其差异。方法：对胫骨151例骨折进行回顾性分析。首先根据AO分型标准对患者进行分型；使用X^2检验对两种固定方法的疗效差别进行显著性分析；同时计算两组病人的平均手术时间、平均出血量和平均住院时间。结果：经过8～19个月的随访，带锁髓内钉治疗组骨折总体优良率为93，2％，平均愈合时间为4．3个月；动力外固定支架组总体优良率和平均愈合时间分别为87．5％和4．1个月；在分型组内两种固定方法的治疗效果差别统计学无显著意义(P＞0．05)。但二者在平均手术时间、平均出血量和平均住院时间指标上的差别具有统计学显著意义(P＜0．05)。结论：DAF和交锁髓内钉治疗胫骨骨折的疗效相似，但DAF的手术操作更为简单，手术创伤更小，更符合微创的原则。     

TACE联合~(125)碘粒子植入治疗原发性肝癌的疗效观察

目的探讨经皮导管动脉化疗栓塞术(TACE)联合CT导向下125碘粒子植入与TACE联合125碘粒子植入联合顺铂瘤内注射治疗肝癌的疗效。方法选择100例原发肝癌患者,随机分成2组,50例TACE+125碘粒子植入术为对照组,与治疗组50例TACE+125碘粒子植入+顺铂瘤内注射术,术后行肿瘤体积、血AFP值、T淋巴细胞亚群CD3、CD4、CD8,血常规、肝肾功能指标、种植性转移、随访生存期对比。结果所有患者均于术后1、2、6、12个月后复查,结果显示对照组50例肿瘤体积平均缩小27.4%,治疗组肿瘤体积平均缩小38.6%;两组血AFP值均下降,治疗组下降明显;对照组发现7例远处转移,治疗组3例远处转移;肝肾功能及T淋巴细胞亚群检测,对照组与治疗组无显著差异;术后一年死于远处转移者,对照组8例,治疗组2例,对照组与治疗组对比差异有统计学意义(P0.05)。结论 TACE+125碘粒子植入+顺铂瘤内注射治疗肝癌的疗效观察证明,TACE联合粒子植入及顺铂瘤内注射治疗肝癌较TACE联合粒子植入方法治疗更为有效。     

自锚式腰椎侧方融合器在斜外侧椎间融合术治疗腰椎融合术后邻近节段病中的应用

目的 :评价自锚式腰椎侧方融合器在斜外侧椎间融合(oblique lateral interbody fusion,OLIF)术治疗腰椎融合术后邻近节段病中的应用效果。方法:2014年3月～2020年3月在我院治疗的腰椎融合术后症状性邻近节段退变患者35例,其中采用自锚式腰椎侧方融合器行斜外侧椎间融合术13例(OLIF组),男7例,女6例;年龄48～75岁(56.2±15.4岁)。采用后方经椎间孔腰椎椎间融合(transforaminal lumbar interbody fusion,TLIF)术22例(TLIF组),男12例,女10例;年龄38～76岁(48.2±24.5岁)。比较两组患者的手术时间、术中出血量、术后引流量、住院时间和并发症发生率,在术前、术后3个月和末次随访时采用视觉模拟评分(visual analogue scale,VAS)评定腰痛和腿痛情况、Oswestry功能障碍指数(Oswestry disability index,ODI)评定临床疗效。结果:OLIF组的手术时间、术中出血量、术后引流量、住院时间均小于TLIF组,差异均有统计学意义(P0.05)。OLIF组术后出现并发症3例(23.1%),TLIF组术后出现并发症5例(22.7%),两组并发症发生率无统计学差异(P0.05)。术后随访12～72个月(35.4±21.9个月),OLIF组术前、术后3个月和末次随访时的腰痛、腿痛VAS评分和ODI分别为7.6±1.1分、7.8±1.1分、(58.9±10.8)%,1.7±0.3分、1.8±0.2分、(19.6±1.5)%和0.7±0.3分、0.7±0.3分、(18.3±0.7)%;TLIF组分别为8.0±1.0分、8.0±1.0分、(57.4±11.5)%,1.8±0.3分、1.9±0.3分、(20.9±1.2)%和0.5±0.1分、0.5±0.2分、(19.2±0.8)%;两组术后3个月及末次随访时的腰、腿痛VAS评分及ODI均较术前显著性改善(P0.05),两组同时间点比较差异均无统计学意义(P0.05)。结论:应用自锚式腰椎侧方融合器行OLIF治疗腰椎融合术后邻近节段病安全、有效,并能够缩短手术时间和住院时间,有利于早期康复。     

锁骨骨髓炎的诊断和治疗（附4例报告和文献复习）

目的：总结锁骨骨髓炎的诊断和治疗方法。方法：回顾1993－1999年间治疗的4例锁骨骨髓炎患者的临床资料和治疗方法,并对相关文献进行复习。结果：3例术后病人后切口一期愈合,经7－18个月的随访,锁骨骨髓炎无复发,肩关节功能无明显受限。结论：锁骨骨髓炎发病率低,诊断上比较困难,必要时可行活检以便确诊。治疗上血源性锁骨骨髓炎可长期（6－8周）静脉内使用抗生素,锁骨慢性骨髓炎以手术清除病灶为主,辅助性使用抗生素。病灶清除后造成的骨及软组织缺损可用胸大肌或背阔肌肌（皮）瓣堵塞。     

周围神经损伤的治疗失误（附6例报告）

目的：探讨周围神经损伤治疗失误的原因和预防措施。方法：对1993年1月－2000年7月收治的6例周围神经误接病人的临床资料进行分析,根据1954年英国医学研究院颁布的感觉、运动分级标准评定疗效。结果：周围神经损伤治疗失误主要发生在腕部,多为神经和肌腱的误接。再次手术后,经10月－4年的随访,神经功能优2例,良2例,可1例,差1例。结论：腕部的解剖结构复杂,术者的经验欠缺是造成周围神经误接的主要原因。如果手术后较长时间吻合的神经功能仍毫无恢复,应积极地再次手术探查。     

人骨形态发生蛋白2基因重组腺病毒的构建与鉴定

BACKGROUND:Bone morphogenetic protein 2 plays a key role in inducing osteogenesis. It involves in a series of bioprocess, including cell proliferation, determining the differentiation direction of germ line and cell death.  OBJECTIVE: To construct and identify the recombinant adenovirus vectors encoding human bone morphogenetic protein 2 gene by using AdMax system. METHODS:First, human bone morphogenetic protein 2 gene sequencing was amplified by PCR from human cDNA template and then cloned. Second, the recombinant shuttle plasmid was constructed and transformed into Escherichia coli competent cells DH5α. After the positive colonies were identified by colonies PCR and sequencing, the expression vectors were amplified and extracted. Next, the adenovirus expression vectors with target gene and the helper packaging plasmid carrying a majority of adenovirus genes were co-transfeced into 293 cells for virus packaging and amplification. Finally, target genes were detected by PCR, and target protein was detected by Western blot method, as well as infectious titer of the recombinant adenovirus was detected by end point dilution method. RESULTS AND CONCLUSION:Gene fragment of a length of 1 223 bp human bone morphogenetic protein 2 was obtained by PCR. The expression vectors constructed by homologous recombination techniques were identified by PCR cloning and sequencing; the results were correct. After virus packaging and amplification in 293 cells were identified by Western blot and PCR methods, the virus titer of recombinant adenovirus was 5×1013 pfu/L. These results suggest that the recombinant adenovirus vectors carrying human bone morphogenetic protein 2 gene have been constructed successfully.     

Use of a self-designed bladder controller for restoring bladder function in paraplegic dogs

Objective: To evaluate the results of a self-designed bladder controller for restoring micturition function in paraplegic dogs. Methods : The spinal cords of 4 dogs were transected above the cone. Electrodes were implanted in S2 bilaterally and connected to the subcutaneous receivers for external activation. Microsurgical technique was employed to perform dorsal rhizotomy of S1-3 intradurally. The dogs were stimulated daily to observe micturition. Urodynamic testing and vesicography were performed. Results: All the dogs acquired micturition under the control of electric stimulation, with urine volume 80-140 ml per time. The mode of micturition was post-stimulus voiding. Vesicography revealed that the bladder was rifled well and the bladder neck was open in the micturition course of electric stimulation. Residual urine volume was 15-20 ml. Urodynamic testing found that the bladder pressure and intraurethral pressure increased simultaneously, but when the intraurethral pressure was greater than the bladder pressure, no micturition occurred.The pressure decreased to baseline rapidly and the bladder pressure decreased slowly between two bursts. Micturition occurred when the bladder pressure was greater than the intraurethral pressure. Conclusions: The self-designed bladder controller together with a sacral deafferentation procedure can restore micturition function of paraplegic dogs.