经口咽前路寰枢椎复位钢板内固定的外科解剖学研究

目的为经口咽前路寰枢椎复位钢板内固定设计和应用提供解剖学依据。方法对10例新鲜的头颈部标本使用经口咽前入路进行逐层的显微外科解剖,观察咽后壁的层次、椎动脉的走行、寰枢椎的解剖毗邻关系和寰枢椎前路钢板内固定的相关解剖参数等。结果(1)咽后壁分两层和两个间隙粘膜层、椎前筋膜层,咽后间隙和椎前间隙;(2)经此入路可显露从枕骨大孔前缘至C3椎体的范围;(3)寰椎和枢椎椎动脉距中线的距离分别为寰椎(252±23)mm和枢椎(184±26)mm;(4)寰椎和枢椎可显露宽度分别为(394±22)mm和(390±21)mm,寰椎进钉点(侧块中点)间距(a)为(314±33)mm,寰椎进钉点连线与枢椎进钉点(枢椎前表面中部上关节面内缘连线与前唇下缘线之间的等距离线位于矢状中线两侧旁开3～4mm的位置)连线的垂直间距(b)为(187±27)mm,a/b比值为15～17。结论经口咽前入路行寰枢椎前路钢板内固定可行,钢板的设计应以上述测量数据为依据。     

Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip

The precise relationship between developmental dysplasia of the hip and dislocation among patients after total hip arthroplasty has not been well clarified. A total of 820 patients with developmental dysplasia of the hip who underwent total hip arthroplasty from January 2000 to December 2009 were categorized according to Crowe classification, and postoperative dislocation rates were analyzed among subgroups. The overall dislocation rate was 2.93%. No statistically significant differences in dislocation rates were observed between these with and without subtrochanteric osteotomy. Femoral head size was the only factor with significant difference between the dislocated and stable groups, especially when femoral head diameter increased from 28 to 32 mm. Of all dislocations, 69.6% were anterior dislocation, and the degree of cup anteversion and combined anteversion of anterior dislocators was higher than that of the posterior dislocators (P = .0082 and P = .001).     

利用噬菌体展示技术制备人血管生成素2单链抗体

目的 用纯化的人血管生成素2(Ang2)蛋白,通过噬菌体展示技术从非免疫小鼠噬菌体展示抗体库中淘选、鉴定Ang2单链抗体.方法 以纯化的人Ang2蛋白为抗原,对非免疫小鼠噬菌体展示抗体库进行富集和筛选,获得Ang2单链抗体,利用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)和Western blot法检测目的蛋白的表达并测序.结果 经过3轮富集和筛选,获得了1个能特异性识别Ang2蛋白的阳性噬菌体克隆,DNA测序表明其含有完整的单链抗体基因片段,大小约750 bp,表达蛋白相对分子质量约33.7×103;通过SDS-PAGE进一步实现Ang2单链抗体(phage-Ang2-scFv)的鉴定.结论 成功分离并鉴定人Ang2-scFv,为进一步的功能学研究奠定了基础.     

FGF and ERK signaling coordinately regulate mineralization-related genes and play essential roles in osteocyte differentiation

To examine the roles of FGF and ERK MAPK signaling in osteocyte differentiation and function, we performed microarray analyses using the osteocyte cell line MLO-Y4. This experiment identified a number of mineralization-related genes that were regulated by FGF2 in an ERK MAPK-dependent manner. Real-time PCR analysis indicated that FGF2 upregulates Ank, Enpp1, Mgp, Slc20a1, and Dmp1 in MLO-Y4 cells. Consistent with this observation, the selective FGF receptor inhibitor PD173074 decreased Ank, Enpp1, Slc20a1, and Dmp1 mRNA expression in mouse calvaria in organ culture. Since Dmp1 plays a central role in osteocyte differentiation and mineral homeostasis, we further analyzed FGF regulation of Dmp1. Similar to FGF2, FGF23 upregulated Dmp1 expression in MLO-Y4 cells in the presence of Klotho. Furthermore, increased extracellular phosphate levels partially inhibited FGF2-induced upregulation of Dmp1 mRNA expression, suggesting a coordinated regulation of Dmp1 expression by FGF signaling and extracellular phosphate. In MLO-Y4 osteocytes and in MC3T3E1 and primary calvaria osteoblasts, U0126 strongly inhibited both basal expression of Dmp1 mRNA and FGF2-induced upregulation. Consistent with the in vitro observations, real-time PCR and immunohistochemical analysis showed a strong decrease in Dmp1 expression in the skeletal elements of ERK1 ^−/− ; ERK2 ^flox/flox ; Prx1-Cre mice. Furthermore, scanning electron microscopic analysis revealed that no osteocytes with characteristic dendritic processes develop in the limbs of ERK1 ^−/− ; ERK2 ^flox/flox ; Prx1-Cre mice. Collectively, our observations indicate that FGF signaling coordinately regulates mineralization-related genes in the osteoblast lineage and that ERK signaling is essential for Dmp1 expression and osteocyte differentiation.     

椎体内裂隙征的形成机理、影像学特征及手术治疗

椎体内裂隙征（intravertebral cleft,IVC）由Maldague等[1]首次报道,因其被视为脊柱椎体动态不稳致患者长期疼痛的原因而引起医生的广泛关注[2-4]。随着对IVC了解的深入,人们发现IVC不仅出现在慢性骨质疏松性骨折患者中,     

Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases

OBJECTIVE: To better determine the role of portal vein resection and its effect on survival, as well as to appreciate the impact of portal vein invasion on prognosis in hilar cholangiocarcinoma. SUMMARY BACKGROUND DATA: Hepatectomy with portal vein resection is sometimes performed for locally advanced hilar cholangiocarcinoma. However, the significance of microscopic invasion of the portal vein has not been determined. METHODS: Medical records of 160 patients with hilar cholangiocarcinoma who underwent macroscopically curative hepatectomy with (n = 52) or without portal vein resection (n = 108) were reviewed. Invasion of the portal vein was assessed histologically on the surgical specimen, and results were correlated with clinicopathologic features and survival. RESULTS: Surgical mortality, including all hospital deaths, was similar in patients who did and did not undergo portal vein resection (9.6% vs. 9.3%), but the primary tumor was more advanced in patients who underwent portal vein resection. Histologically, no invasion was found in 16 (30.8%) of resected portal veins. However, dense fibrosis adjacent to the portal vein was common, and the mean distance between the leading edge of cancer cells and the adventitia of the portal vein was 437 +/- 431 mum. The prognosis was worse in patients with than without portal vein resection (5-year survival, 9.9% vs. 36.8%; P < 0.0001). The presence or absence of microscopic invasion of the resected portal vein did not influence survival (16.6 months in patients with microscopic invasion vs. 19.4 months in those without; P = 0.1506). Multivariate analysis identified histologic differentiation, lymph node metastasis, and macroscopic portal vein invasion as independent prognostic factors. CONCLUSIONS: Microscopic invasion of the portal vein may be misdiagnosed clinically in patients with hilar cholangiocarcinoma. However, the distance between tumor and adventitia is so narrow that curative resection without portal vein resection is unlikely to be possible. Gross portal vein invasion has a negative impact on survival, and hepatectomy with portal vein resection can offer long-term survival in some patients with advanced hilar cholangiocarcinoma.     

数字乳腺摄影与彩色多普勒超声及二者联合应用对乳腺癌的诊断价值

目的 用受试者操作特性(ROC)曲线评价数字乳腺摄影与彩色多普勒超声及二者联合应用对乳腺癌的诊断价值.方法 采用完全随机法选取经手术病理证实的50例女性乳腺癌和50例乳腺良性病变,患者术前均同时经数字乳腺摄影和彩色多普勒超声检查.患者全部数字乳腺像(100份)为第1组;彩色多普勒超声图像(100份)为第2组;每例患者的数字乳腺与其超声的组合图像(共100份),为第3组.3名诊断医师分别对3组图像进行诊断,用5分法:肯定是、可能是、不确定、可能不是、肯定不是,独立诊断是否为乳腺癌.将3名医师阅片结果的平均值用SPSS 11.0版ROC曲线软件进行统计分析,3种诊断方法的ROC曲线下面积(Az)行Z检验.结果 3名医师用数字乳腺像、彩色多普勒超声图像及组合图像诊断乳腺癌的平均例数分别为42、38、48例;诊断乳腺良性病变的平均例数分别为40、43、47例.数字乳腺像诊断乳腺癌的敏感度为84%(42/50),特异度为80%(40/50);彩色多普勒超声图像诊断乳腺癌的敏感度为76%(38/50),特异度为86%(43/50);组合图像诊断乳腺癌的敏感度为96%(48/50),特异度为94%(47/50).3种方法ROC曲线下平均面积(Az值)分别为0.852、0.825、0.952.2种方法联合应用诊断乳腺癌的ROC曲线Az值较单独使用数字乳腺摄影或单独使用彩色多普勒超声诊断乳腺癌的ROC曲线Az值显著增大(Z1=2.183,Z2=2.581,P值均＜0.01).结论 数字乳腺摄影与彩色多普勒超声联合应用对乳腺癌诊断的敏感度和特异度均最高,诊断价值最大,有助于乳腺癌的早期发现与诊断.     

锁骨下血管合并臂丛损伤的处理

目的 探讨锁骨下动脉合并臂丛神经损伤的诊断和处理。方法 5例锁骨下动脉损伤合并臂丛损伤，其中锁骨下动脉第一段损伤1例，第三段损伤4例；2例合并动脉瘤，1例动脉瘤加动静脉瘘．2例血管纤维化自行闭塞。根据锁骨下动脉损伤性质，分别采用静脉移植、直接缝合、血管结扎处理，损伤臂丛神经采取直接缝合、神经松解。结果 3例开放性损伤患者早期手术修复动脉和神经，术后伤肢无疼痛，神经功能有不同程度恢复；2例闭合钝器伤晚期患者，1例行血管、神经松解术，仅疼痛减轻，1例血管臂丛神经广泛粘连，神经松解术后无任何恢复。结论 除原发性损伤外，进行性增大的血肿或假性动脉瘤压迫可加重臂丛神经损害．如能早期处理血肿或动脉瘤，解除压迫，可减轻神经损害，有利于臂丛神经功能恢复。     

门奇联合断流术对门脉高压血液动力学的影响

目的 了解门奇联合断流术对门脉高压症(PHT)患者血液动力学的影响。方法 门脉高压症患者16例，于门奇联合断流术中测定开腹、脾动脉结扎、脾切除、贲门周围血管离断及食管下段横断后自由门静脉压(FPP)、中心静脉压(CVP)、心输出量(CO)、心率(HR)及平均动脉压(MAP)。结果 脾动脉结扎、脾切除、贲门周围血管离断及食管下段横断后FPP显著下降(P＜0．01)，而CVP、CO、HR、MAP无明显变化(P＞0．05)。结论 门奇联合断流术能显著降低自由门静脉压，对体循环血液动力学无明显影响。