基于三维多模态影像的3D打印技术辅助肢体恶性骨肿瘤手术研究北大核心CSCD

目的 探讨基于三维多模态影像的3D打印技术用于肢体恶性骨肿瘤手术的临床疗效。方法 回顾分析2016年1月—2019年1月符合选择标准的15例肢体恶性骨肿瘤患者临床资料。男6例,女9例;年龄17~73岁,中位年龄34岁。骨肉瘤5例,软骨肉瘤3例,尤文肉瘤2例,血管肉瘤1例,造釉细胞瘤1例,转移性癌3例。肿瘤部位:肱骨5例,尺骨2例,股骨3例,胫骨5例。病程2~8个月,中位病程4个月。术前基于三维多模态影像进行术前规划、计算机模拟手术、个性化假体及手术导板设计,3D打印骨肿瘤及重建模型、个性化假体及手术导板,并基于模型进行体外模拟手术。术中行膝关节置换2例,半肩关节置换2例,尺骨近端置换2例,保留关节干假体置换9例。观测肿瘤切除的外科边界、手术时间、术中失血量、手术并发症发生情况以及美国肌肉骨骼肿瘤学会(MSTS)评分、肿瘤局部复发情况。结果 15例患者均按术前规划完成手术,外科边界均获得广泛切除边界。手术时间80~240 min,中位数150 min。术中失血量100~400 mL,中位数200 mL。无术中重要血管、神经损伤导致肢体功能明显受限发生。1例切口浅表感染,经换药后愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6~48个月,中位数24个月。2例患者因肺转移分别于术后6、24个月死亡。随访期间未出现局部复发,无假体脱位及松动等并发症发生。末次随访时MSTS评分为23~30分,平均25分。结论 基于三维多模态影像的3D打印技术能辅助肢体恶性骨肿瘤的精确切除和重建,从而获得良好肿瘤学及功能预后。     

芦山地震与汶川地震骨科伤员伤情比较分析

目的:分析芦山地震和汶川地震伤员损伤特点,探讨地震伤员的救援及治疗方法。方法:以华西医院骨科收治的汶川地震和芦山地震骨科伤员为对象,分析比较伤员的年龄、性别、致伤原因、损伤部位、就医时间以及伤员转运速度等信息。结果:两次地震伤员的年龄分布及性别构成比差异没有统计学意义。芦山地震伤员从受伤到入院平均2.1天,收治高峰出现早、持续时间短,而汶川地震伤员从受伤到入院平均8.3天,收治高峰出现晚且持续时间长。汶川地震挤压综合征、截肢、气性坏疽、血管损伤及多器官功能衰竭的发生率高于芦山地震。汶川地震以倒塌建筑及滚落山石砸伤/掩埋为主,占所有受伤原因的79.6%,而芦山地震砸伤/掩埋占所有受伤原因的39.2%,低于高坠伤和跌伤(56.8%)的发生率。芦山地震足部、脊柱骨折及多发骨折的发生率高于汶川地震,而开放性骨折、小腿骨折的发生率低于汶川地震。结论:快速的现场救援和病员转运是救治成功的关键,早期救援和病员转运可以显著降低创面感染、挤压综合征、多器官功能衰竭及截肢的发生率,而正确的地震应急避难知识的普及有利于降低因地震而盲目跳楼、逃跑等逃生引起的损伤。     

Fe3O4纳米粒子的组织相容性及组织分布研究

BACKGROUND: Ferroferric oxide (Fe₃O₄) nanoparticles are a research hotspot in drug delivery system, which can transport antineoplastic drugs to the lesion under external magnetic field. Additionally, its submicrons even can reach the tumor site several centimeters far away from the magnetic source. OBJECTIVE: To investigate the histocompatibility and in vivo distribution of Fe₃O₄ nanoparticles and to explore its application prospect and limitations as a drug carrier in the chemotherapy of osteosarcoma. METHODS: 10.0 mg/kg Fe₃O₄ nanoparticles were administrated into Wistar rats via tail vein, then the rats were executed at 15, 60 and 120 minutes, respectively, and the rat lung, brain, heart, liver, kidney, hind limb and skeletal muscle were removed. The ferric ion content in each tissue was determined by atomic absorption spectrometer, and the morphological changes of different tissues were observed by hematoxylin-eosin staining at each time point. RESULTS AND CONCLUSION: After administrated for 15 minutes, the concentration of Fe₃O₄ nanoparticles in the liver and kidney reached peak, followed by a decrease at 60 and 120 minutes, but still remained a high level. The concentration of Fe₃O₄ nanoparticles at three time points showed significant difference compared with the control group (P < 0.05), demonstrating that the nanoparticles can be quickly enriched and long-term persistent in the liver and kidney. After administrated for 15 minutes, the concentration of Fe₃O₄ nanoparticles in the heart, lung, skeletal muscle and bone reached peak, which had significant difference compared with the control group (P < 0.05), and significantly decreased subsequently except that in the bone. This significant difference still displayed at 60 minutes between groups (P < 0.05), indicating that the nanoparticle can reach a high concentration but persist short time in the high blood perfused tissues. Compared with the control group, the concentration of Fe₃O₄ nanoparticles in the brain tissue showed no significant difference at each time point (P > 0.05), suggesting that the blood-brain barrier can inhibit the nanoparticle penetration. No overt morphological changes were found in each tissue after hematoxylin-eosin staining. In conclusion, the distribution of Fe₃O₄ nanoparticles conjugate sodium oleate in organism is influenced by the blood perfusion and mononuclear phagocyte system, and they cannot penetrate the blood-brain barrier and make no significant effect on tissues, but maintain a high level in the liver kidney and bone for a long-term, thus providing a theoretical basis for the drug delivery system in the magenetic hyperthermia therapy of malignant tumors.     

注射型可吸收聚氨基酸/硫酸钙复合材料动物体内降解吸收及促成骨作用*

背景：注射型人工骨可经皮穿刺注射植入体内,对机体创伤较小,同时该型材料可以任意塑形,能较好地充填骨缺损,但目前临床上尚无在体内能完全降解吸收且具有较好促成骨作用的注射型人工骨产品。 目的：评估注射型可吸收聚氨基酸/硫酸钙复合材料(硫酸钙含量70%)动物体内的降解吸收及促成骨作用,观察其修复骨缺损的能力。 方法：取48只新西兰大白兔,在股骨外髁处制备直径为5 mm、深10 mm的骨缺损模型,以随机数字表法分为实验组和对照组,实验组将注射型可吸收聚氨基酸/硫酸钙复合材料植入骨缺损处,对照组未予干预。 结果与结论：X射线平片示：实验组骨缺损逐渐被骨痂填充,术后16周,骨缺损处恢复正常松质骨密度,塑形完成;对照组骨缺损处修复不明显。组织学检查(苏木精-伊红、MASSON染色)示：术后4周,材料开始降解,新生原始骨小梁长入材料内;术后12周,编织骨开始转化为板层骨;术后16周,材料完全被降解吸收,新生骨组织完全修复骨缺损。结果显示注射型聚氨基酸/硫酸钙复合材料在动物内能够完全降解、吸收,具备一定的成骨活性,可望用作骨修复材料。     

地震后一月与地震前ICU革兰阴性杆菌医院感染病原菌分布及耐药特点

目的 总结5.12汶川大地震后一月内我院ICU病房医院感染革兰阴性菌的菌群分布和耐药特点,并且同既往的数据资料对比分析,了解耐药变迁情况.方法 回顾分析2008年5月12日至6月12日汶川地震后一月内我院ICU病房住院患者革兰阴性菌医院感染病原菌分布及药敏情况,并同地震前相关资料进行比较分析;通过MicroScan Walk away 96SI或PHOENIX~(TM)100全自动细菌鉴定及药敏分析系统,同时进行手工鉴定.结果 地震后一月内伤口感染所占比重明显增加,从地震前的7.9%上升到20.2%,但呼吸道感染仍然是最主要的医院感染.地震后一月ICU病房分离率最高的前三位医院感染革兰阴性杆菌依次为不动杆菌属细菌(36.2%),铜绿假单胞菌(22.7%),克雷伯菌属细菌(12.3%).与地震前相比,地震后一月各菌属的耐药性有不同程度的变化,亚胺培南仍是治疗大肠埃希菌和克雷伯菌属细菌的最敏感药物;铜绿假单胞菌对头孢他啶的耐药率明显增加,但对阿米卡星有较高的敏感性;不动杆菌属细菌对亚胺培南的耐药率呈上升趋势,但对加替沙星和头孢西丁有较高的敏感性.克雷伯菌属和大肠埃希菌超广谱β-内酰胺酶(ESBLs)的发生率从地震前的52.6%和48.8%升高到地震后一月的55.0%和87.5%.结论 地震后一月与地震前ICU病房病原菌的耐药性均有一定程度变化,因此应动态监测细菌耐药性,根据药敏试验结果选用有效抗菌药.大量的外伤伤员可能是导致地震后一月ESBLs发生率增加的原因之一,这提示在重大灾难事故中要注意预防医院感染,尤其是产ESBLs细菌在重症监护室的扩散.     

Treatment for 332 cases of lower leg fracture in ＂5.12＂ Wenchuan earthquake

Objective： To retrospectively analyze the medical treatment of 332 patients with lower leg fracture in Wenchuan earthquake admitted in West China Hospital. Methods： From May 12, 2008 to June 15, 2008, 332 patients with lower leg fracture injured in Wenchuan earthquake were treated in our hospital. The data on trauma condition and clinical treatment were collected and analyzed. Results： Among the 332 cases of lower leg fracture, there were 179 eases of open fracture, accounting for 53.9%, in which 91% belonged to Gustilo Ⅱ or Ⅲ injury with serious pollution. Many patients had posttraumatic complications, vascular and nerve injury, wound infection or osteofascial compartment syndrome. After medical treatment, blood vessels were reconnected, wound surface was repaired and wound infection was under control. Conclusion： For the patients with lower leg fracture in earthquake, we followed the principle of ＂complete debridement - restoring the continuity of bone bracket - timely recovering blood supply of limbs and repairing nerve damage - repair the wound surface at stage Ⅰ or Ⅱ ＂ so as to reduce the incidence of amputation and infection.     

纳米羟基磷灰石／聚酰胺66修复肢体良性骨缺损的疗效观察

目的初步评估和分析纳米羟基磷灰石／聚酰胺66（nano—hydroxyapatitepolyamide66,n—HA／PA66）修复良性骨肿瘤术后骨缺损的疗效和安全性。方法2007年11月至2010年12月,应用n—HA／PA66骨填充材料修复114例良性骨肿瘤术后骨缺损,肿瘤刮除、灭活及人工骨植入70例,28例加用内固定,16例加用异体骨板和内固定。结果除10例失随访外,104例获得随访,随访时间3—33个月,平均8．2个月。伤口均I／甲愈合,无1例发生切口感染、非特异炎症反应和排斥反应;术前、术后的血常规、免疫、肝、肾功能检查均无明显异常。x线和CT检查示：术后1个月,病灶区密度逐渐升高,可见植骨周闸与自体骨结合处模糊,少量新生骨痂形成;术后3个月,病灶区从颗粒植骨周围间隙开始向中心融合成片,更多新生骨痂影融合;术后6个月,病灶区密度明显升高,病灶区大量新生骨痂形成。骨愈合时间为术后2—6个月,3个月时植骨愈合率65％,6个月为96．2％。结论n—HA／PA66骨填充材料的生物相容性良好,无明显排斥反应和非特异炎症反应,修复曩性良性骨肿瘤和瘤样病变效果良好。     

股骨髁上内翻截骨治疗髌骨软骨软化症

髌骨软骨软化症发病率与Ｑ角呈直线回归关系，Ｑ角越大，发病率越高。作者自１９８９～１９９５年收治１０例（１１个髌骨）因Ｑ角偏大或／及股胫角偏小所致的髌骨软骨软化症，采用股骨髁上楔形内翻截骨及髌外侧支持带松解术或加关节软骨削平术治疗，经平均２．９年随访，优良率８１．８％，满意率１００％。本文就该术与其它手术方法（胫骨结节抬高术、髌韧带止点内移术和经关节镜手术）进行比较分析。详细介绍了该术的适应证和手术方法     

外周血淋巴细胞和骨肉瘤细胞体外化疗药敏相关性研究

目的:研究外周血淋巴细胞和骨肉瘤细胞体外化疗药敏的相关性。方法:采用MTT法体外药敏试验检测30例骨肉瘤患者外周血淋巴细胞和其肿瘤细胞对14种化疗药物的敏感性。结果:经统计学处理,骨肉瘤患者外周血淋巴细胞与其肿瘤细胞的体外药敏试验对14种化疗药物的敏感性差异无显著性(P>0.05)。两种细胞药敏试验对CBP、DDP、EADM、MTX、THP、VM26中度敏感;对ADM、BLM、MMC、VCR低度敏感;对HCPT、DTIC、Vp-16不敏感。结论:骨肉瘤患者外周血淋巴细胞与其肿瘤细胞对化疗药物的敏感性具有良好的正相关性,外周血淋巴细胞化疗药敏检测对临床选择化疗药物具有重要的参考价值。     

碱性磷酸酶在骨肿瘤诊断中的价值

目的检测骨肿瘤患者血清中总碱性磷酸酶(TALP)和骨特异性碱性磷酸酶(BALP)活性,观察TALP和BALP在骨肿瘤诊断中的价值。方法对我院收治的384例骨肿瘤患者血清TALP和BALP进行检测,将所有患者分成10~岁、20~岁和50岁以上3个年龄组,每个年龄组按骨肿瘤性质进一步分成骨肉瘤及尤因肉瘤组、其他恶性骨肿瘤组、良性骨肿瘤组、骨巨细胞瘤组和骨转移瘤组,每一年龄组均设立正常对照组,对各组血清TALP和BALP的测定结果进行比较。结果10~岁组TALP和BALP在各肿瘤组之间及其与对照组比较差异均无统计学意义。20~岁组中骨肉瘤及尤因肉瘤组和骨转移瘤组TALP和BALP与良性骨肿瘤组、骨巨细胞瘤组和对照组比较升高(P<0.05),其他恶性骨肿瘤组与良性骨肿瘤组、骨巨细胞瘤组和对照组比较差异无统计学意义。50岁以上各组间TALP和BALP水平差异无统计学意义。结论血清TALP和BALP测定在10~岁年龄组对恶性骨肿瘤的诊断价值有限;20~岁年龄组骨肿瘤患者血清TALP和BALP升高有助于恶性骨肿瘤的诊断;血清TALP和BALP的检测在50岁以上骨肿瘤患者中无助于肿瘤性质的判断。