Ilizarov技术治疗儿童下肢畸形

目的 介绍Ilizaro技术治疗儿童下肢畸形的临床经验。方法 采用Ilizaro技术治疗31例下肢畸形患儿，2例为先天性胫骨假关节以往植骨内固定治疗失败，4例为骨髓为后骨不连，植骨后短缩，11例为下肢短缩，8例为先天性马蹄内翻足，4例为下肢骨折，1例为骨纤维发育异常，1例为软骨发育不全性侏儒。结果 31例均达到预期目的。结论 应用Ilizaro技术可以在修复骨缺损的同时矫正肢体不等工，假关节切除后延长与加压可以同时进行。Ilizaro三维相结合可矫正足内翻下垂畸形。双下肢同步延长可治疗软骨发育不全性侏儒。     

Crowe Ⅲ及Ⅳ型髋关节发育不良全髋关节置换术的软组织松解与平衡探讨

目的探讨分步髋周软组织松解与平衡重建髋臼后,行全髋关节置换术（THA）治疗成人CroweⅢ～Ⅳ型髋关节发育不良的效果。方法2001年1月至2006年1月,对29例（31髋）CroweⅢ～Ⅳ型成人髋关节发育不良患者行THA,其中男性7例,女性22例,患者平均年龄53岁（38～65岁）。CroweⅢ型22髋,Ⅳ型9髋,Harris评分术前平均42．6分。全部患者均为手术外侧人路,采用分步髋周软组织松解延长患肢,真臼位置重建髋臼后,行THA。结果患肢延长2．5～4．5cm,1例因髋臼外展角稍大出现术后脱位。29例患者术后随访1～5年,平均3．2年。Harris评分术后平均85．4分,关节疼痛缓解,活动功能满意,元假体松动和翻修病例。结论在重度髋关节发育不良THA中,通过有效的软组织松解和平衡,在真臼位置重建关节,可以最大程度地恢复患髋解剖形态和生理功能。     

全胰切除术21例疗效评价

目的对全胰切除术的疗效进行评价。方法对2003年4月至2006年6月21例接受全胰切除术的患者的临床资料进行回顾性分析。结果21例行全胰切除术的患者中1例联合横结肠切除,1例联合全胃切除,9例行门静脉．肠系膜上静脉部分切除端端吻合术,9例行门静脉-肠系膜上静脉部分切除人造血管间置术,其中联合腹腔干切除8例,联合腹腔干、肝固有动脉切除4例,联合腹腔干、肝总动脉切除和肠系膜上动脉部分切除端端重建1例。12例（57．1％）发生术后并发症;5例（23．8％）术后30d内死亡。术后每日胰岛素用量18～28U,均能较好地控制血糖。生活质量较术前有明显提高。16例获得随访,中位生存期为9．2个月（1．2～13．0个月）,其中胰腺导管癌中位生存期为7个月（1．2～9．0个月）,侵袭性导管内乳头状黏液性肿瘤中位生存期为11．3个月（10．0～13．0个月）。结论全胰切除术不提高生存期,而并发症和手术死亡率增加,但可改善生活质量,可作为胰管内乳头状黏液性肿瘤的手术选择,对胰腺导管腺癌则必须考虑手术的必要性。全胰切除术后糖尿病是可控的。     

Genetic effects on age-dependent onset and islet cell autoantibody markers in type 1 diabetes

Age-dependent associations between type 1 diabetes risk genes HLA, INS VNTR, and CTLA-4 and autoantibodies to GAD65 (GADAs), ICA512/IA-2, insulin, and islet cells were determined by logistic regression analysis in 971 incident patients with type 1 diabetes and 702 control subjects aged 0-34 years. GADAs were associated with HLA-DQ2 in young but not in older patients (P = 0.009). Autoantibodies to insulin were negatively associated with age (P < 0.0001) but positively associated with DQ8 (P = 0.03) and with INS VNTR (P = 0.04), supporting possible immune tolerance induction. ICA512/IA-2 were negatively associated with age (P < 0.0001) and with DQ2 (P < 0.0001) but positively associated with DQ8 (P = 0.04). Males were more likely than females to be negative for GADA (P < 0.0001), autoantibodies to islet cells (P = 0.04), and all four autoantibody markers (P = 0.004). The CTLA-4 3' end microsatellite marker was not associated with any of the autoantibodies. We conclude that age and genetic factors such as HLA-DQ and INS VNTR need to be combined with islet autoantibody markers when evaluating the risk for type 1 diabetes development.     

腹腔镜手术治疗输卵管妊娠100例

目的　探讨腹腔镜手术在输卵管妊娠治疗中的应用。　方法　回顾分析 10 0例输卵管妊娠经腹腔镜手术的治疗效果。　结果　 10 0例腹腔镜手术成功 ,未发生并发症。　结论　腹腔镜手术能完成剖腹手术治疗输卵管妊娠所进行的手术操作 ,并且达到相应疗效 ,具有微创 ,术后恢复快的优点     

Treatment of osteonecrosis of the femoral head with hBMP-2-gene-modified tissue-engineered bone in goats

The efficacy of beta-tricalcium phosphate (beta-TCP) loaded with bone morphogenetic protein-2 (BMP-2)-gene-modified bone-marrow mesenchymal stem cells (BMSCs) was evaluated for the repair of experimentally-induced osteonecrosis of the femoral head in goats. Bilateral early-stage osteonecrosis was induced in adult goats three weeks after ligation of the lateral and medial circumflex arteries and delivery of liquid nitrogen into the femoral head. After core decompression, porous beta-TCP loaded with BMP-2 gene- or beta-galactosidase (gal)-gene-transduced BMSCs was implanted into the left and right femoral heads, respectively. At 16 weeks after implantation, there was collapse of the femoral head in the untreated group but not in the BMP-2 or beta-gal groups. The femoral heads in the BMP-2 group had a normal density and surface, while those in the beta-gal group presented with a low density and an irregular surface. Histologically, new bone and fibrous tissue were formed in the macropores of the beta-TCP. Sixteen weeks after implantation, lamellar bone had formed in the BMP-2 group, but there were some empty cavities and residual fibrous tissue in the beta-gal group. The new bone volume in the BMP-2 group was significantly higher than that in the beta-gal group. The maximum compressive strength and Young's modulus of the repaired tissue in the BMP-2 group were similar to those of normal bone and significantly higher than those in the beta-gal group. Our findings indicate that porous beta-TCP loaded with BMP-2-gene-transduced BMSCs are capable of repairing early-stage, experimentally-induced osteonecrosis of the femoral head and of restoring its mechanical function.     

腹腔镜在诊治闭合性腹外伤中的应用

目的 :探讨腹腔镜在诊治腹部闭合性损伤中的价值。方法 :经腹腔镜对 4 8例原因不明闭合性腹外伤进行诊断和治疗。结果 :4 7例通过腹腔镜明确诊断 ,33例在腹腔镜下得到治疗 ,12例中转开腹手术 ,无并发症和手术死亡病例。平均手术时间 34min ,平均住院 5 8d。结论 :腹腔镜不仅是安全且准确的诊断方法 ,而且是良好的治疗手段     

腹膜透析患者症状评估表的制订及信效度检验

目的探讨腹膜透析患者症状评估表的适用性,并检验其信效度。方法通过查阅国内外文献、结合对临床腹膜透析患者、临床医护人员的结构性访谈及医护专家函询的结果,对中文版腹膜透析患者症状评估表进行修订,最终删除6个条目,新增5个条目,形成腹膜透析患者症状评估表。对河南省3所腹膜透析中心330例腹膜透析患者进行调查,评价其信效度。结果腹膜透析患者症状评估表的内容效度为0.923;该量表共提取5个公因子,累积方差贡献率为64.153%;总Cronbach′sα系数为0.947,各维度Cronbach′sα系数0.795~0.904;各因子的重测信度系数r值>0.7。结论腹膜透析患者症状评估表具有良好的信效度,可用于我国腹膜透析患者症状的评估。     

适形切除保肛术与经括约肌间切除术治疗低位直肠癌的临床疗效

目的:探讨适形切除保肛术（CSPO）与经括约肌间切除术（ISR）治疗低位直肠癌的临床疗效。方法:采用回顾性队列研究方法。收集2011年8月至2020年4月2家医学中心收治的183例（海军军医大学附属长海医院117例、复旦大学附属华山医院66例）低位直肠癌病人的临床病理资料;男110例,女73例;年龄为（57±11）岁。...