保肢手术所面临的生物重建和机械重建问题

20世纪70年代以前,治疗恶性骨与软组织肿瘤的首要选择是截肢。这一选择基于人们注意到肿瘤切除后频繁的局部复发、再切除以及高死亡率[1]。外科技术、麻醉技术及放射技术的飞速发展使人们对保肢充满期望。     

双源CT诊断痛风性关节炎临床分析

目的 采用非侵入性双源CT观察关节及周围组织的尿酸盐结晶,以探索临床诊断痛风或鉴别诊断其他关节疾病。方法 选择近2周发作过单关节肿或（和）痛患者17例,均行病变关节双源CT检查。部分患者在B超下穿刺取关节液镜检。结果 13例痛风患者发现33处有尿酸盐结晶,最常沉积的关节部位为双侧足趾关节(7/33)、近端指关节(5/33)、远端指间关节周围(4/33)、跖关节(4/33)、胫骨下端(3/33)。发现尿酸盐结晶易沉积在近关节骨表面,肌肉、韧带等关节周边软组织。关节肿痛部位与尿酸盐结晶沉积部位一致。尿酸盐结晶大小可以测量。结论 双源CT可以清晰显示尿酸盐结晶,为无创检测手段。在鉴别诊断不明原因单关节肿痛方面有很好的价值。     

磁共振成像对类风湿关节炎诊断效率的荟萃分析

目的 系统评价磁共振成像(MRI)对于类风湿关节炎(RA)的诊断效能.方法 计算机检索国内外各主要数据库,辅以手工检索和其他检索方法,收集关于MRI诊断RA的对照试验,检索时间 1996-2009年.按照纳入标准筛选文献并提取资料,采用Meta-disc软件合并敏感性,特异性,阳性似然比,阴性似然比,诊断性试验比值比,进行异质性分析(Q-检验,I2),当P>0.10,且I2≤50%时无异质性.结果 共纳入12项随机对照试验.结果 显示病程≤2年的RA患者,滑膜炎、骨侵蚀和腱鞘炎诊断的敏感度分别为81%～100%、48%、100%~67%~96%,特异度分别为64%～89%、16%~100%~21%~74%.病程>2年的RA患者,滑膜炎、骨侵蚀诊断的敏感度分别为91%、84%,特异度分别为70%、81%.结论 MRI显示滑膜炎对于早期和中晚期RA有诊断意义,骨侵蚀和腱鞘炎对于早期RA的诊断意义有待进一步研究.纳入研究样本量小,对照组病例缺乏代表性,建议设计严谨且更大样本病例的临床研究.

Abstract：

objective To evaluate the diagnostic efficiency of magnetic resonance imaging(MRI)for rheumatoid arthritis(RA).Methods The major international databases was searched by computer and Other methods to collect control studies about MRI for the diagnosis of RA,the searching deadline was December 2009.Data were screened and extracted by inclusion criteria.Meta-disc software Was used for statistics,including sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio(OR)and heterogeneity analysis.Results Twelve random control tests were included.Meta-analysis indicated that sensitivities of vities of synovitis,bone-erosion and tendenosynovitis were 81%~100%,48%～100%and 67%～96%while specificities of them were 64%～89%,16%~100%and 21%-74%respectively for RA patients(≤2vears).Sensitivities of synovitis and bone-erosion were 91%and 84%while specificities of them were 70%and 81%for RA Datients (>2 years).Conclusion Synovitis shown by MRI is helpful for the diagnosis of earlv and med-to-late RA.Diagnostic values of bone-erosion and tendonosynovitis demonstrated by MRI for earlv RA were not clear.The sample size of the included studies is small and some studies lack of control groupsput the conclusion of this meta-analysis liable for bias.We suggest that better designed and larger sample clinical studies are necessary.     

三例不同类型肺动脉高压的临床分析

目的 通过3例肺动脉高压病例报道及文献复习,加深人们对3种类型肺动脉高压的认识.方法 对北京朝阳医院呼吸与危重症医学科2009年收治的3例肺动脉高压原因待查的患者进行临床资料、体格检查、实验室检查及影像学分析.结果 第1例患者因阵发性心房颤动行2次射频消融术,术前肺动脉压正常,术后逐渐出现肺动脉高压,经心脏彩超证实存在...     

带血管腓骨复合异体骨修复长骨肿瘤切除后骨缺损

目的 探讨带血管腓骨复合异体骨重建长骨恶性肿瘤切除后骨缺损的临床结果.方法 2006年4月至2009年10月对19例四肢长骨恶性骨肿瘤患者行保肢手术,男11例,女8例;年龄11～37岁,平均(18.5±7.6)岁.肱骨5例、股骨7例、胫骨7例.肿瘤切除后骨缺损长度(13.2±4.3)cm,采用带血管自体腓骨复合大段异体...     

计算机导航内半骨盆肿瘤切除及有限元分析辅助重建

目的 探讨计算机导航骨盆肿瘤精确切除与重建的安全性和有效性,评价有限元力学分析辅助骨盆环结构与力学重建的可行性.方法 2008年12月至2010年6月,采用有限元分析辅助肿瘤切除后的组配式假体设计,并通过计算机导航对12例内半骨盆恶性肿瘤患者行肿瘤切除与重建术.男8例,女4例;年龄25～53岁,平均39.7岁.软骨肉瘤4例,成骨肉瘤2例,Ewing肉瘤2例,恶性纤维组织细胞瘤1例,转移瘤3例(肾癌1例、甲状腺癌1例、乳腺癌1例).Enneking原发恶性肿瘤分期:ⅠA期1例,Ⅰ B期2例,ⅡA期2例,ⅡB期4例.术后评价肿瘤学结果和功能恢复情况.结果 术中未发生神经、血管和脏器损伤.术后X线片显示肿瘤切除范围与术前计划匹配,肿瘤切除彻底,组配式骨盆假体安放位置满意,固定钉位置满足术前有限元力学分析要求.全部病例随访8～26个月,平均18.2个月.肿瘤局部复发并肺转移1例,深部感染1例,深静脉血栓形成1例.无假体脱位及内固定松动、断裂,无肢体短缩.术后6个月时1993年美国骨肿瘤学会功能评分平均70%,6例随访超过20个月的患者功能评分平均68%.结论 计算机导航辅助骨盆肿瘤切除重建是一种安全有效的方法,有限元分析可为骨盆环重建提供精确的力学指导.

Abstract：

Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.     

二氧化铈复合生物玻璃颗粒在兔股骨缺损修复中的抗炎及成骨作用观察

目的观察二氧化铈复合生物玻璃颗粒植入兔股骨缺损后的抗炎及成骨能力。方法成年新西兰大白兔6只,双侧股骨髁部制造直径6mm的贯穿型缺损,然后在左右髁部随机植入生物玻璃颗粒或二氧化铈复合生物玻璃颗粒,于术后第2周和第4周处死动物(各3只),对缺损部位行组织学观察,了解有无炎性反应并计算新生骨及材料占缺损的百分比。结果两种材料缺损处均未观察到炎性反应。2周时缺损部位即可观察到新生骨形成,且两种材料新骨生成率无显著差异(P>0.05);4周时两种材料植入处的新生骨量均较2周时明显增加(P<0.05或P<0.01),但两种材料新骨生成率比较显著学差异(P>0.05),且与2周时比较材料均未见明显降解(P>0.05)。结论二氧化铈复合生物玻璃颗粒具有抗炎能力,且成骨能力与普通生物玻璃颗粒类似,有望用于骨缺损的修复。     

感悟心理落差

得了糖尿病,很多患者总会拿自己与周围的人相比,感叹生活的不幸,唏嘘命运的不公。实际上,面对落差,拥有良好的心理准备,学会荣辱皆泰然,其实就是一种正视自己和他人的最好的处世方式。     

皎皎玉兰 痴心不悔

她是一位平凡而伟大的共产党员。20年来,尽管生活拮据,但她倾其所有,为社会各界捐款逾20万元,资助100多名扮演儿童,救助下岗工人和困难群众,把7位“五保”老人认作“亲爹亲娘”……见到需要帮助的人,哪怕借钱也要奉献出自己的一份爱心。她就是曾令无数国人为之感动的“平民慈善家”李玉兰。     

胰岛素比口服药更安全吗？

有些患者持这样的观点,“口服西药降糖对肝肾都会有损伤,胰岛素属于生物体内的天然物质,是目前治疗糖尿病最安全、最稳定的方法。”那么,胰岛素一定比口服药更安全有效吗？记者就此采访了几位内分泌科专家,请他们谈了自己的观点。