从钢板固定失效看术后正规康复锻炼的重要性

目的：探讨钢板内固定失效的原因及防治措施。方法：对5年间本院治疗的骨折钢板内固定失效病例进行回顾性研究及追踪随访。结果：55例中36例经再次手术和植骨愈合。16例经外固定保护和康复锻炼愈合，3例转外院治疗。结论：钢板内固定失效与钢板的材料、设计、使用不合理、锻炼不当、医患合作差等因素有关，改进钢板的制造工艺，正规康复锻炼，早期发现夫效迹象，及时处理，可促进骨折愈合，减少并发症。     

改进的体外冲击波技术对骨组织影响的实验及临床研究

采用改进的体外冲击波作用于骨组织。通过动物实验，骨膜组织体外培养Ｈ３－ＴｄＲ掺入放射性自显影研究，证实冲击后１、２周实验侧骨膜组织Ｈ３－ＴｄＲ标记率明显高于对照侧（Ｐ＜０．０５），表明实验侧骨膜成骨细胞有丝分裂明显加强，骨膜成骨作用增强。通过体外冲击波治疗骨不连１６例及骨折延迟愈合１６例。治疗后１６周，１６例骨折延迟愈合均愈合。１６例骨不连中１３例愈合。文中还对体外冲击波治疗疾病的作用机理、疗效及治疗方法等进行了探讨。     

羟基磷灰石代用骨移植材料的实验研究

用羟基磷灰石颗粒植入山羊骨缺损内和皮下组织,实验表明,羟基磷灰石是一种较理想的骨移植代用材料,具有强度大,不变性,能与骨组织形成化学结合的特性。并且有良好的生物相容性,不引起炎症和免疫排斥反应。植入骨缺损内有骨再生现象,但缺乏骨诱导作用。     

Pathological study of rabbits＇ femoral arteries subjected to gunshot wounds combining with seawater immersion

To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits‘ femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group Ⅰ, n = 10), gunshot wound with seawater immersion for 30 mins (Group Ⅱ, n = 10), and 60 mins group (Group Ⅲ, n =10). Femoral arteries were impacted by 0.38 g steel spheres fired with a 7.62 mm rifle. After being wounded, rabbits in Groups Ⅱ and Ⅲ were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy. Results : The potterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group Ⅰ, the primary-wound-tract and contused areas in Group Ⅱ manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group Ⅱ and Ⅲ. The pathological changes in the shocked area were similar in 3 groups. Conclusions : For gunshot wounds concomitant seawater immersion in rabbits‘ femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.     

腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损

作者自行设计使用腓骨长肌及胫骨后肌联合修复陈旧性跟腱断裂伴缺损48例,获得完整随访资料43例。跟腱缺损长度为8～10cm,自身已无修复条件。手术方法的优点:联合转移的肌腱弥补了长距离跟腱缺损,保持了原有肌肉的动力,弥补了小腿三头肌的挛缩无力。保持了足内、外翻的肌力平衡,足外形正常。肌肉的血循环不受干扰,增加了修复跟腱后愈合的机会。手术后6周都能逐渐下地行走,肌力一般都能达到Ⅳ级～V级,功能恢复良好,未发生因愈合不良再次发生断裂。     

腰椎间盘突出症术后复发临床分型及病理基础

总结３８例腰椎间盘突出术后症状复发者，全部经再次手术，从病理角度分析发病原因，并结合临床表明，提出分型意见，认为分型对再次手术有指导作用，同时从术式选择及规范方面及从术后指导康复训练方面，探讨预防的可能性。     

含药血清对体外培养成骨细胞的影响

目的 研究中药骨康吸收后不同浓度血清对离体大鼠成骨细胞增殖的影响及其对成骨细胞分泌IL-6的影响。方法 采用胶原-胰蛋白酶消化法获得新生大鼠的成骨细胞，然后以中药骨康吸收后血清，加入体外培养成骨细胞中进行培养，MTT法测成骨细胞增殖，ELISA法测培养上清中IL-6含量。结果 发现中药吸收后血清能促进成骨细胞的增殖和分化，各种浓度中以正常剂量药物灌胃后5h取血清含10％药物浓度最佳。同时，新生大鼠体外培养成骨细胞能够分泌IL-6，体外培养成骨细胞在培养后9d左右，IL-6的分泌达到高峰值，随后分泌IL-6的能力逐步下降，中药骨康含药血清可作用于成骨细胞，使其分泌IL-6的能力下降。结论 中药骨康含药血清能够促进成骨细胞的增殖与分化，从而促进骨形成同时可抑制成骨细胞分泌IL-6，这可能是中药骨康抑理骨吸收的机制之一。     

骨巨细胞瘤的影像学诊断探讨

目的:分析骨巨细胞瘤的X线平片、CT和MRI影像学表现,评价其诊断价值。方法:对52例经临床手术后病理学证实的骨巨细胞瘤病例的X线平片、CT和MRI影像学资料进行回顾性分析评估。结果:CampanacciX线分型和Jaffe病理分级分别为Ⅰ级10?15例,Ⅱ级28?25例,Ⅲ级14?12。结论:大多数骨巨细胞瘤依据X线表现可作出正确的诊断和鉴别诊断,CT和MRI能提供更多的信息提高鉴别诊断能力,对制订手术方案有重要意义。     

聚碳酸亚丙酯电纺纤维的取向性对大鼠背根神经节生长的影响

目的聚碳酸亚丙酯[poly(propylene carbonate),PPC]是一种具有良好生物降解性和生物相容性的新型生物材料。探讨PPC电纺丝在周围神经组织工程应用的可行性,比较取向性和无序性PPC纤维对大鼠背根神经节(dorsal root ganglion,DRG)生长的影响。方法采用电纺丝技术制备取向性和无序性PPC纤维,扫描电镜观察其表面结构特点。3只新生1～2日龄SD大鼠,雌雄不限,体重4～6 g。取SD大鼠DRG,分别接种至含取向性和无序性PPC纤维的12孔板中,作为实验组及对照组,每组6孔。倒置显微镜下观察DRG生长情况,并于培养7 d行免疫荧光染色和扫描电镜观察,定量比较神经轴突生长长度和雪旺细胞迁移距离。结果电纺丝技术成功制备取向性和无序性PPC纤维,每根纤维直径为800～1 200 nm,形成具有亚微米尺度的结构。取向性PPC纤维约90%纤维丝在其长轴方向,而无序性PPC纤维丝呈各个角度分布。倒置显微镜观察,DRG均在两组PPC纤维生长良好。免疫荧光染色和扫描电镜观察示:实验组轴突和雪旺细胞沿纤维丝方向生长,具有一致的方向性;对照组轴突生长末端呈多方向生长。实验组轴突生长长度为(2 684.7±994.8)μm,对照组为(504.7±52.8)μm,组间比较差异有统计学意义(t=—5.360,P=0.000)。实验组雪旺细胞迁移距离为(2 770.6±978.4)μm,对照组为(610.2±56.3)μm,组间比较差异有统计学意义(t=—5.400,P=0.000)。实验组及对照组内雪旺细胞迁移距离均大于轴突生长长度。结论 PPC纤维与DRG有良好亲和性,亚微米尺度PPC纤维的取向结构决定了DRG轴突和雪旺细胞生长方向,可作为周围神经损伤的修复材料。