髋臼内壁内移截骨全髋置换治疗成人髋臼发育不良的有限元分析及临床意义

目的 通过计算机辅助设计有限元分析,找寻髋臼内壁截骨的合适内移范围,为临床工作提供理论依据.方法 利用SolidWorks 2005软件,建立髋臼发育不良骨盆的三维模型,模拟髋臼内壁内移截骨术式,使髋臼内壁骨从未完全陷入盆腔内保持2 mm骨性接触处开始,逐渐内移至完全陷入盆腔内7 mm处,每隔1 mm为1个实验组,分成10个实验组.每组髋臼人为划成4个象限,分别对各组假体臼-骨界面间进行计算机模拟对比力学实验分析,测量出髋臼假体-骨界面间的Mises应力及剪切应力值,找寻出应力分布较为均匀的实验组.结果 Mises应力及剪切应力均有1个象限内的值较大,通过2次统计学分析计算,得出实验结果.结论 当髋臼内壁内移至未完全陷入盆腔内1 mm处到完全陷入盆腔内1 mm处的范围内,髋臼假体-骨界面间的应力分布均匀,最佳位置在完全陷入盆腔内1 mm处.     

Cementless total hip arthroplasty in the treatment of severe hip dysplasia or dislocated hips

We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20–69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1–6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy.     

胃粘膜癌前病变的形态定量研究——胃粘膜核腺比值的定量分析

应用自动化图象分析仪对131个胃粘膜肠型病灶(单纯性肠化27个;异型增生:轻度30,中度35个,重度20个;肠型胃癌19个)进行定量分析。以单个腺管内细胞核总面积与细胞面积之比(ING)作为反映细胞核大小、数量及覆层排列程度的客观定量指标。结果发现:单纯性肠化(对照组)0.165±0.025,轻度异型增生0.21±0.023,中度异型增生0.259±0.026,重度异型增生0.32±0.028,分化型胃癌0.371±0.052,各组ING值呈正态,各组间的均值有非常显著的差异(P<0001)。因而,ING可作为胃粘膜癌前病变诊断的指标。     

Neonatal osteofibrous dysplasia: a case report

We describe a case of neonatal osteofibrous dysplasia that was diagnosed 3 days after birth. Osteofibrous dysplasia is a fibro-osseous lesion rarely seen in long bones. It is also known as congenital osteitis fibrosa or ossifying fibroma of bones. Although it occurs in children under 10 years of age, it is extremely rare in newborn babies. It must be differentiated from adamantinoma due to their radiological appearance, predilection for tibia and fibula, clinical picture, and certain histological similarities.     

金地鼠颊囊癌前病变的细胞增殖动力学研究

目的研究口腔上皮组织癌和癌前病变的细胞动力学变化特征。方法采用Ｓａｌｅｙ的ＤＭＢＡ涂布诱导法，建立金地鼠颊囊癌前病变模型，并用溴脱氧尿苷流式细胞动力学检测方法，对３０只叙利亚种金地鼠进行分组对照研究。结果涂药组光镜下的细胞病变程度随涂药时间延长而逐渐加重，而空白对照组无变化；ＦＣＭ检测显示涂药组与对照组在Ｓ期阳性细胞检出率存在显著差异。即使在光镜下表现为轻度不典型增生时，ＦＣＭ检测结果也有显著差别。结论金地鼠颊囊癌前病变具有细胞异常增殖的细胞动力学特征     

微波对白斑上皮异常增生12项病理特征出现率的影响

上皮异常增生是白斑癌变的必经阶段，深入研究其镜下形态的特征性改变，不仅对加深认识白斑癌变规律有利，而且可以籍以研究治疗手段的有效性，本文采用ｓｅｌｌｙ法白斑动物模型，以微波辐射为阻断手段，采集金地鼠颊囊标本，行光镜下肉眼观察，并按照ＷＨＯ提出的上皮异常增生１２项病理特征进行观察记录，结果发现：特征性改变的出现颊率不同，为１５．５－６０．６％，微波处理与否对病理的出现率存在影响，与细胞增殖有关的改变     

口腔黏膜下纤维性变S100蛋白表达

目的 :研究口腔黏膜下纤维性变中S10 0蛋白的表达水平及其与正常口腔黏膜上皮、异常增生上皮的比较。方法 :应用免疫组织化学 (SP)法 ,检测 10例口腔黏膜下纤维性变、10例上皮异常增生、8例正常口腔黏膜上皮S10 0蛋白表达水平 ,并作对比研究。结果 :S10 0蛋白在正常口腔黏膜上皮中无表达 ,口腔黏膜下纤维性变上皮中和异常增生上皮中S10 0的阳性表达率为 5 0 %,后两者的阳性表达率明显高于正常黏膜组上皮 (P <0 .0 5 ) ;口腔黏膜下纤维性变组与异常增生上皮组比较 ,差异无显著性 (P >0 .0 5 )。结论 :口腔黏膜下纤维性变发生发展与S10 0蛋白过表达密切相关 ,S10 0蛋白表达强度与异常增生上皮表达强度一致。     

Adrenocortical responsiveness in neonates weaned from the ventilator with dexamethasone

Adrenocortical responsiveness was assessed in eight very low birthweight neonates who had bronchopulmonary dysplasia and had been weaned from mechanical ventilation using dexamethasone. Three of the eight infants did not respond to ACTH stimulation during the first week after cessation of dexamethasone, but all three responded normally when retested at least 1 month later. The present authors have thus demonstrated that some infants have at least temporary adrenocortical unresponsiveness after prolonged courses of glucocorticoid therapy, and suggest that adrenocortical function should be assessed in all infants who are weaned from mechanical ventilation using dexamethasone.     

唇腭裂患者上颌骨牵引成骨术后发音方式的变化

目的:通过对行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)唇腭裂患者治疗前后的错误发音数量变化、不同发音部位、不同发音方法以及不同类型错误发音发生特点及其变化评价,分析上颌骨RED对患者发音方式的影响。方法:1999年至2001年行上颌骨RED的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED前后进行语音测听并分类。治疗前后错误发音的差异性用非参数检验。结果:RED术后42.9%患者错误发音数较RED前增加,19.0%减少,38.1%无变化。从发音部位,舌尖前音错误发音发生率最高,其次为舌面音。从发音方法,错误发音多发于塞擦音。错误发音类型以咽喉摩擦/爆破音为主,其次为腭化构音和声门爆破音。上颌骨RED后腭化构音累及音节数减少,但咽喉摩擦/爆破音和声门爆破音反而增加,尤其是咽喉摩擦/爆破音。结论:唇腭裂患者经RED前移上颌骨后,会对患者发音方式产生影响,在行语音治疗前需考虑全面。     

Success determining factors in percutaneous transluminal balloon valvuloplasty of pulmonary valve stenosis

Twenty-two percutaneous transluminal balloon valvuloplasty procedures were performed on 21 patients with congenital pulmonary valve stenosis. The peak systolic pressure gradient was immediately reduced from 79.1 +/- 7.4 to 22.2 +/- 1.8 mmHg, (P less than 0.0001) and follow-up cardiac catheterization at 5.3 +/- 0.4 months in 19 patients revealed no further significant change in gradient (23.5 +/- 3.2 mmHg). The best results were obtained when balloons larger than the pulmonary annulus were used, i.e. an immediate residual transvalvular gradient of 22.0 +/- 2.2 mmHg with a balloon/annulus ratio greater than 1, as opposed to 44.2 +/- 5.4 with a balloon/annulus ratio = 1 (P less than 0.001). The angiographically determined cusp thickness of the stenotic pulmonary valves was significantly greater than that of the control group of 24 patients without pulmonary valve stenosis (1.21 +/- 0.09 vs 0.59 +/- 0.02 mmHg, P less than 0.00001). The relationship between this parameter and the residual transvalvular gradient at follow-up was found to be significant (r = 0.77, P less than 0.001). It is concluded that balloon size is a determinant factor in achieving good results with percutaneous balloon valvuloplasty although cusp thickness, a factor to which scant regard has hitherto been paid, also plays a significant role in the residual transvalvular gradient measured at follow-up.