骨性强直的髋关节转换人工全髋关节置换术

目的评估人工全髋关节置换术(totalhiparthroplasty,THA)治疗髋关节骨性强直的效果。方法自1987年8月~1998年2月,36例(38髋)行转换THA,平均术前融合时间20年1个月;平均随访8年11个月。结果Harris评分由(68·7±7·2)分提高到(87±6·1)分;髋关节总活动度增加180·7°±14·5°。关节疼痛缓解率为93·3%;平均肢体短缩由4·1cm降到1·6cm;人工关节存活率为86·8%。X线片示髋臼骨溶解6例,髋臼杯松动2例,股骨骨溶解4例,股骨柄松动1例。结论骨性强直的髋关节转换THA,可以缓解周围关节疼痛、增加髋关节的活动度、改善双下肢不等长和矫正髋关节畸形,提高生活质量。髋关节功能与臀中肌力量的恢复直接关联。     

硒蛋白与肾脏疾病的研究进展

硒是人体所必需的一种微量元素,硒蛋白是硒在机体内存在的主要功能形式,在维持机体的正常生理功能,以及肿瘤、免疫和代谢相关疾病等的发生发展过程中发挥着重要作用。近年来的研究提示硒蛋白参与了多种肾脏疾病的病理生理过程。我们对硒蛋白在肾缺血再灌注损伤、糖尿病肾病、慢性肾脏病及肾癌等肾脏疾病中的可能作用及机制,以及补硒治疗的最新进展进行综述,旨在为肾脏疾病的发病机制研究和诊治提供新的思路。     

精准胆道外科手术治疗胆囊癌的近远期疗效研究

目的 研究精准胆道外科手术治疗胆囊癌的近远期疗效。方法 前瞻性分析陆军特色医学中心 2014年2月至2017年2月收治的胆囊癌患者104例,采用随机数字法将其分为对照组和观察组,每组52例。对照组接受胆囊癌传统经验式外科手术,观察组接受精准胆道外科理论引导下手术。比较两组患者的手术效果、术后恢复指标、并发症发生率。术后随访3 年,比较两组患者的1 年、2 年及3 年生存率,并绘制 Kaplan-Meier生存曲线。结果 观察组较对照组淋巴结清扫数目[（23.48±7.20） vs（ 15.86±5.93）,t=16.64, P＜0.001]和阳性淋巴结数目[（9.94±3.50） vs（ 5.27±4.39）,t=7.51,P＜0.001]更高,R0切除率（76.92% vs 36.54%,χ2=16.37,P＜0.001）、胆囊癌扩大根治术率（34.62% vs 11.54%,χ2=5.13,P=0.02）及联合胰十二指肠切除术率（17.31% vs 3.85%,χ2=4.98,P=0.02）更高,术后排气时间[（1.05±0.38）d vs（ 1.93±0.46）d, t=5.39,P＜0.001]和首次下床活动时间[（2.85±1.16）d vs（ 6.26±1.92）d,t=7.88,P＜0.001]均明显更早;并发症发生率（23.08% vs 30.77%,χ2=0.78,P=0.38）无统计学差异。观察组术后1 年（61.54% vs 40.38%, χ2=4.66,P=0.03）、2年（44.23% vs 19.23%,χ2=7.50,P＜0.001）及3年（26.92% vs 7.69%,χ2=6.72,P＜0.001）生存率比对照组高,中位生存时间[（17.37±8.64）个月 vs（ 8.95±4.59）个月,t=14.96,P＜0.001]更长。结论 精准胆道外科手术有助于胆囊癌患者选取最佳术式,提高手术切除质量和R0切除率,并能有效控制手术并发症,从而延长患者术后生存期。     

克氏针钢丝与髌骨针钛缆两种张力带固定治疗髌骨骨折

目的比较克氏针钢丝与髌骨针钛缆张力带固定治疗髌骨骨折的疗效。方法将128例髌骨骨折患者按固定方式分为A组(克氏针钢丝张力带固定,65例)和B组(髌骨针钛缆张力带固定,63例)。比较两组住院费用、住院天数、并发症发生率以及关节功能优良率。结果患者均获得随访,时间12~24个月。两组住院费用、住院天数、并发症发生率比较差异均有统计学意义(P<0.05)。两组关节功能优良率比较差异无统计学意义(P>0.05)。结论克氏针钢丝张力带固定术后并发症发生率较高,但关节功能优良率与髌骨针钛缆张力带固定比较无明显差异,且具有缩短住院时间、降低住院费用等优点。     

Hospitalized osteoporotic vertebral fracture increases the risk of stroke: A population‐based cohort study

The association between osteoporosis and cardiovascular diseases has been demonstrated. Higher cardiovascular risk has also been correlated with vertebral fractures. However, the association between osteoporotic vertebral fracture and the possibly higher risk of stroke remains uncertain. This study aimed to evaluate the incidence, risk, and type of stroke in patients with osteoporotic vertebral fracture. Patients with osteoporotic vertebral fracture were identified (n = 380) and 10 age‐ and sex‐matched controls per case (comparison group, n = 3795) were chosen from a nationwide representative cohort of 999,997 people from 1998 to 2005. Both groups were followed‐up for stroke events for 3 years, matched by propensity scores with adjustments for covariates such as comorbidities (ie, hypertension, diabetes, arrhythmia, or coronary heart diseases) and exposure to medications (ie, aspirin, lipid lowering drug, or nitrates), and assessed by Kaplan‐Meier and Cox regression analyses. The incidence rate of stroke in the osteoporotic vertebral fracture group (37.5 per 1000 person‐years; 95% confidence interval [CI], 27.5–51.2) was significantly higher than in the comparison group (14.0 per 1000 person‐years; 95% CI, 12.0–16.4, p < 0.001). Stroke was more likely to occur in the osteoporotic vertebral fracture patients than in the normal controls (crude hazard ratio [HR] 2.68, 95% CI 1.89–3.79, p < 0.001; adjusted HR 2.71, 95% CI 1.90–3.86, p < 0.001). In conclusion, patients with osteoporotic vertebral fracture have a higher risk of stroke (ie, both ischemic and hemorrhagic) and require stroke prevention strategies. © 2013 American Society for Bone and Mineral Research.     

Hyperbaric oxygen treatment prevents nitric oxide‐induced apoptosis in articular cartilage injury via enhancement of the expression of heat shock protein 70

Heat shock proteins (HSPs), inflammatory cytokines, nitric oxide (NO), and localized hypoxia‐induced apoptosis are thought to be correlated to the degree of cartilage injury. We investigated the effect of hyperbaric oxygen (HBO) on (1) interleukin‐1β (IL‐1β)‐induced NO production and apoptosis of rabbit chondrocytes and (2) healing of articular cartilage defects. For the in vitro study, RT‐PCR and Western blotting were performed to detect mRNA and protein expressions of HSP70, inducible NO synthase (iNOS), and caspase 3 in IL‐1β‐treated chondrocytes. To clarify that the HSP70 was necessary for anti‐iNOS and anti‐apoptotic activity by HBO, we treated the cells with an HSP70 inhibitor, KNK437. For the in vivo study, cartilage defects were created in rabbits. The HBO group was exposed to 100% oxygen at 2.5 ATA for 1.5 h a day for 10 weeks. The control group was exposed to normal air. After sacrifice, specimen sections were sent for examination using a scoring system. Immunohistochemical analyses were performed to detect the expressions of iNOS, HSP70, and caspase 3. Our results suggested that HBO upregulated the mRNA and protein expressions of HSP70 and suppressed those of iNOS and caspase 3 in chondrocytes. KNK437 inhibited the HBO‐induced downregulation of iNOS and casapase 3 activities. The histological scores showed that HBO markedly enhanced cartilage repair. Immunohistostaining showed that HBO enhanced HSP70 expression and suppressed iNOS and caspase 3 expressions in chondrocytes. Accordingly, HBO treatment prevents NO‐induced apoptosis in articular cartilage injury via enhancement of the expression of heat shock protein 70. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 376–384, 2013     

A Comparative Reliability and Performance Study of Different Stent Designs in Terms of Mechanical Properties: Foreshortening,Recoil, Radial Force,and Flexibility

This study seeks to improve the mechanical performance of stents by conducting reliability performance testing and finite element method (FEM)‐based simulations for coronary stents. Three commercially available stent designs and our own new design were tested to measure the factors affecting performance, specifically foreshortening, recoil, radial force, and flexibility. The stents used in the present experiments were 3 mm in working diameter and 18 mm of working length. The results of the experiments indicate that the foreshortening of stents A, B, C, and our new design, D, was equivalent to 2.25, 0.67, 0.46, and 0.41%, respectively. The recoil of stents A, B, C, and D was 6.00, 4.35, 3.50, and 4.36%, respectively. Parallel plate radial force measurements were A, 3.72 ± 0.28 N; B, 3.81 ± 0.32 N; C, 4.35 ± 0.18 N; and D, 4.02 ± 0.24 N. Radial forces determined by applying uniform pressure in the circumferential direction were A, 28.749 ± 0.81 N; B, 32.231 ± 1.80 N; C, 34.522 ± 3.06 N; and D, 42.183 ± 2.84 N. The maximum force of crimped stent at 2.2‐mm deflection was 1.01 ± 0.08 N, 0.82 ± 0.08 N, 0.92 ± 0.12 N, and 0.68 ± 0.07 N for each of stents A, B, C and D. The results of this study enabled us to identify several factors to enhance the performance of stents. In comparing these stents, we found that our design, stent D, which was designed by a collaborative team from seven universities, performed better than the commercial stents across all parameter of foreshortening, recoil, radial force, and flexibility.