IGF-1对IL-1诱导的兔关节软骨细胞NO和PGE2的影响

目的:检测合成性细胞因子胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)对损伤性细胞因子IL-1(interhukin-1)诱导的兔关节软骨细胞产生NO(nitric oxide)和前列腺素(prostaglandinE2,PGE2)的影响,探讨IGF-1在骨关节炎治疗中的作用机制.方法:实验分为IL-1β10μg/L组、IL-1β10 μg/L IGF-1 1μg/L组、IL-1β 10 μg/L IGF-1 10μg/L组、IL-1β 10 μg/L IGF-150 μg/L组、IL-1β 10 μg/L IGF-1 100 μg/L组、IGF-150 μg/L组和空白对照组.首先进行2月龄兔原代软骨细胞的培养并进行鉴定,然后将IL-1β 10 μg/L单独或与不同浓度的IGF-1共育于第2代兔关节软骨细胞,硝酸还原酶法测定实验组细胞上清液NO的含量,ELISA酶联免疫竞争法测定细胞上清液中PGE2含量,再对测定的NO和PGE＜2的浓度与IGF-1和IL-1的浓度进行有关的统计学分析.结果:IL-1β10μg/L组NO浓度为(89.971±10.224) μmol/L,PGE2浓度为(22.028±8.731)ng/L;空白组NO浓度为(12.404±8.809)μmol/L,PGE＜2浓度为(1.900±0.227)ng/L.IL-1β 10 μg/L组与空白组比较,NO和PGE＜2明显增加,差异有统计学意义(P＜0.05).在IL-1β均为10 μg/L时,IGF-1可以呈剂量依赖地降低IL-1诱导的兔关节软骨细胞NO和PGE2的升高,并且在50 μg/L时即可达到最佳浓度.结论:IL-1能增加软骨细胞培养中的NO和PGE2的产生.IGF-1在体外可以呈剂量依赖地降低IL-1诱导的兔关节软骨细胞NO和PGE2的升高,其最佳浓度为50 μg/L.     

The management of an old fused hip after the occurrence of paraplegia.

Two patients are reported who suffered traumatic paraplegia, and had a long-standing fused hip joint. Both required an excision (Girdlestone) arthroplasty to allow them to sit and one, who made a late but substantial neurological recovery, eventually underwent a total hip replacement. Both suffered thromboembolic and urinary complications. These may not have occurred if the procedures had been carried out earlier. Early mobilisation of the hip joint is recommended in these circumstances.     

兔胫骨干骺端骨膜外截骨对延长区成骨作用的影响

[目的]研究兔胫骨干骺端骨膜外截骨对延长区骨膜成骨作用的影响。[方法]取健康成年中国家兔48只随机分为两组,对照组:左胫骨干骺端骨膜下截骨。实验组:左胫骨干骺端骨膜外截骨。术后第7 d开始延长外固定架,分别于术后7、17、27、37 d拍摄X线片观察延长区成骨情况;同时段随机在两组动物活体取延长区再生骨组织,制作HE染色切片,光镜下观察组织学变化;术后17、27 d常规电镜取材、制片后透射电镜下观察延长区细胞内变化。比较两组间的差异。[结果]观察两组术后第7 d X线片,均可见外固定架延长后遗留一清晰的牵张间隙,随着时间的延长,牵张间隙内逐渐出现越来越多的新生骨组织,骨密度影像也由低向高逐渐增加,但肉眼观察在影像学上两组无显著差异。HE染色示各时段实验组较对照组均有更为明显的成骨现象,两组差异性随时间推移逐渐减小。透射电镜示术后17、27 d,在超显微细胞器水平上,实验组较对照组有更多的粗面内质网扩张、高尔基复合体及线粒体增生。两组差异性随时间推移逐渐减小。[结论]兔胫骨干骺端骨膜外截骨有利于骨膜早期活跃性成骨作用。     

桡骨远端泪滴角在桡骨远端中间柱骨折治疗中的重要性

目的探讨测量并恢复桡骨远端泪滴角在月骨窝关节面前侧塌陷的桡骨远端中间柱骨折治疗中的重要性。方法回顾性收集2018年1月至2020年1月2年收治的29例(31侧)泪滴角改变的桡骨远端骨折患者资料, 其中, 男20例, 女9例;年龄(44.9±15.1)岁(范围20～78岁)。2例双桡骨远端骨折的双腕均出现泪滴角改变, 均纳入本研究。29例受伤至手术时间(6.9±3.2) d(范围4～17 d)。除2例骨折单纯掌侧入路, 余病例应用掌背侧联合入路。均行桡骨远端骨折切开复位、钢板内固定、植骨治疗。术前及术后测量泪滴角, 比较手术恢复泪滴角的效果。用Gartland-Werley评分评价术后腕关节功能。结果所有患者切口均一期愈合, 无术后感染。29例随访时间(15.1±5.2)个月(范围7～31个月)。所有患者骨折愈合时间(10.3±2.9)周(范围8～16周), 无骨折不愈合或再移位。31侧术前泪滴角33.4°±5.83°(范围20°～45°), 术后58.9°±9.89°(范围35°～70°)°至末次随访, 29例(31侧)Gartland-Werley评分(4.7±4.6)分(范围0～1...     

Sheep model for osteoporosis: The effects of peripheral hormone therapy on centrally induced systemic bone loss in an osteoporotic sheep model

Hypothalamic-pituitary disconnection (HPD) leads to low bone turnover followed by bone loss and reduced biomechanical properties in sheep. To investigate the role of peripheral hormones in this centrally induced systemic bone loss model, we planned a hormone replacement experiment. Therefore, estrogen (OHE), thyroxin (OHT) or a combination of both (OHTE) was substituted in ovariectomized HPD sheep, as both hormones are decreased in HPD sheep and are known to have a significant but yet not fully understood impact on bone metabolism. Bone turnover and structural parameters were analyzed in comparison to different control groups – untreated sheep (C), ovariectomized (O) and ovariectomized + HPD sheep (OH). We performed histomorphometric and HR-pQCT analyses nine months after the HPD procedure, as well as biomechanical testing of all ewes studied. In HPD sheep (OH) the low bone turnover led to a significant bone loss. Treatment with thyroxin alone (OHT) mainly increased bone resorption, leading to a further reduction in bone volume. In contrast, the treatment with estrogen alone (OHE) and the combined treatment with estrogen and thyroxin (OHTE) prevented HPD-induced bone loss completely. In conclusion, peripheral hormone substitution was able to prevent HPD-induced low-turnover osteoporosis in sheep. But only the treatment with estrogen alone or in combination with thyroxin was able to completely preserve bone mass and structure. These findings demonstrate the importance of peripheral hormones for a balanced bone remodeling and a physiological bone turnover.     

The Wada test might predict postoperative fine finger motor deficit after hemispherotomy

IntroductionCerebral hemispherotomy is a surgical method with a high rate of seizure reduction in patients with intractable epilepsy. However, there is a probability of postoperative motor deficits. The objective of this study was to investigate whether the Wada test can help predict motor function outcomes after hemispherotomy and, therefore, may be useful in decision-making and patient selection.Patients and methodA total of 13 patients with hemispherical intractable epilepsy underwent hemispherical disconnection surgeries. Six of them underwent the Wada test to evaluate motor function and language function followed by peri-insula hemispherotomy. The patients’ age ranged from 11 to 45 years (mean 27 years).ResultsThree of six patients had reduced dexterity on the Wada test. The finger motor function in the other patients did not change on the Wada test. Postoperatively, all patients who had decreased fine motor movement on the Wada test showed postoperative clumsiness of their hands and fingers.ConclusionsThe Wada test might predict postoperative fine finger motor deficit after hemispherotomy. This study showed that gross motor function was compensated in the ipsilateral hemisphere, whereas fine finger motor movement function remained in the contralateral frontal cortex.     

锚钉固定位置与角度对肩关节前关节囊修复效果影响

目的探讨不同锚钉位置及角度对关节镜治疗复发性肩关节前向不稳临床疗效的影响。 方法回顾性分析85例于2018年1月至12月因复发性肩关节前向不稳在南部战区总医院接受肩关节镜手术治疗的患者排除严重骨缺损、翻修等其他损伤。使用术后肩关节CT测量锚钉位置及插入角度，采用视觉模拟评分系统(VAS评分)及Rowe评分系统对患者术后关节疼痛程度、稳定性、活动度及功能进行综合评价。不同锚钉位置及角度与VAS评分及Rowe评分的关系使用独立样本t检验分析。 结果在85例患者中，有57例患者的所有锚钉均在肩胛盂关节面上，28例患者的锚钉部分在肩胛盂关节面上，部分在肩胛盂边缘。两组的比较中，VAS评分差异无统计学意义(t ＝－0.829，P>0.05)；所有锚钉均在肩胛盂关节面上的患者Rowe评分较高(t＝－4.072，P<0.05)。通过术后Rowe评定分级对锚钉打入角度的反向比较中，2点、3点、4点和5点钟4个位点对应锚钉角度之间的比较均无统计学差异(t＝0.312、0.885、0.775、0.934，均为P>0.05)。 结论肩关节镜下缝合锚钉在合理插入角度范围内固定于肩胛盂边缘稍内侧的关节面上可以使复发性肩关节前向不稳的患者获得更好的近期疗效，而远期疗效需要进一步深入研究。