山羊颈椎次全切除减压非融合后生物力学特性

目的 探讨山羊颈椎次全切除减压非融合后生物力学特性.方法 选取成年雄性山羊6只造模(模型组),术前行颈椎X线检查,排除骨性结构异常,并测量节段性Cobb角(SCA)和颈椎Cobb角(CCA)于C4行颈椎次全切除术,并植入可动人工颈椎(ACV).术后行颈椎正侧位X线检查,再次测量SCA和CCA.术后6个月处死山羊,并以6...     

内固定与假体置换治疗Mason Ⅲ型桡骨头骨折的比较研究

目的比较切开复位内固定术与双极桡骨头假体置换术治疗MasonⅢ型桡骨头骨折的疗效。方法对17例MasonⅢ型桡骨头骨折患者采用Tornier骨水泥柄、双极桡骨头假体进行置换,其中新鲜Ma- sonⅢ型骨折15例,陈旧性MasonⅢ型骨折2例。手术均采用肘关节后外侧入路,17例均行环状韧带修复。术后48 h开始关节逐步被动功能操练。另外8例MasonⅢ型桡骨头骨折患者采用肘后外侧入路切开复位空心钉与多枚克氏针内固定作为对照。结果假体置换组14例患者得到6～27个月(平均12．5个月)随访,按照Broberg和Morrey的肘关节功能评分标准进行评分：优9例,良4例,可1例,优良率为92．8%；3例出现异位骨化,下尺桡关节未见异常改变。8例MasonⅢ型桡骨头骨折内固定患者均得到10～21个月(平均14个月)随访,肘关节功能评分：良1例,可4例,差3例,优良率为12．5%。两组间优良率比较差异有极显著性意义(O＜0．01)。结论采用双极桡骨头假体置换的方法治疗MasonⅢ型桡骨头骨折比切开复位内固定的方法更有利于恢复肘关节的稳定、伸屈活动及前臂的旋转活动。     

颈前路椎体切除植骨融合术后钛网沉陷的临床研究

目的探讨颈前路椎体切除植骨融合术后钛网沉陷的风险因素以及钛网沉陷对临床疗效的影响。方法 2003年5月～2007年8月采用颈前路椎体切除植骨融合术治疗颈椎疾病患者300例。分析患者的年龄、性别、切除节段、固定钢板的类型以及是否使用垫片这5个因素是否为钛网沉陷的风险因素,研究钛网沉陷对颈椎曲度及其他临床疗效的影响。结果随访1年,239例（79.7%）患者发生钛网沉陷,其中182例（60.7%）发生轻度沉陷（1～3mm）,57例（19.0%）发生严重沉陷（〉3mm）。双节段切除较单节段切除更易发生严重钛网沉陷。发生严重钛网沉陷的患者术后神经功能恢复率明显低于未发生钛网沉陷的患者。同时,钛网严重沉陷增加了患者颈肩部疼痛、神经症状复发以及内固定失败的发生率。结论钛网沉陷在颈前路椎体切除钛网植骨融合术后发生较为普遍。多节段切除是发生严重钛网沉陷的危险因素,严重钛网沉陷可导致手术疗效下降及相关并发症的发生。     

Dislocation after total hip arthroplasty with 28 and 32-mm femoral head

Background

Dislocation after primary total hip arthroplasty (THA) is a significant complication that occurs in 2–5% of patients. It has been postulated that increasing the femoral head diameter may reduce the risk of dislocation. The purpose of this paper is to report our experiences with a change from a 28 to a 32-mm femoral head.

Materials and methods

The retrospective cohort study includes 2572 primary THA performed with a 28 or 32 mm diameter femoral head in the period February 2002 to July 2009. All patients were operated with a posterolateral approach, and all except 18 were operated because of osteoarthritis. Cemented stems were used in 1991 cases and uncemented stems in 581 cases. Cemented cups were used in 2,230 cases and uncemented cups in 342 cases. The patients have been routinely followed for 1–8 years in the 28-mm femoral head group and from 0.5–7.5 years in the 32 femoral head group. We defined a dislocation as an event in which the hip required reduction by a physician.

Results

Dislocation occurred in 49 hips with a 28-mm femoral head and in 4 hips with a 32-mm femoral head with an odds ratio of 6.06 (95% CI = 2.05–17.8) (P < 0.001). Otherwise, there were no significant associations between sex, age, diagnosis and type of prosthesis.

Conclusions

Multivariate analyses of patients operated at our hospital indicate a significant association between femoral head diameter and dislocation after THA. There were no significant associations between dislocation and sex, age, diagnosis, or type of prosthesis.     

降钙素防治骨质疏松模型兔的人工假体无菌性松动的实验研究

[目的]探讨降钙素对已行人工假体植入骨质疏松模型免的假体无菌性松动防治作用的实验研究。[方法]将30只假体植入模型的骨质疏松症兔随机分成实验组和对照组，各15只。实验组给予鲑鱼降钙素治疗（6U／kg，肌注，隔日1次），而对照组给予等量的生理盐水肌注，持续治疗半年。两组均分别于术前、术后4、8、12和24周检测假体周围感应区（ROI）骨密度（BMD）；于术前及术后4、12、24周行血清骨代谢指标检测：骨特异性碱性磷酸酶（BALP）、骨钙素（BGP）、抗酒石酸酸性磷酸酶-5b（TRAP-5b）；所有动物于术后24周处死，分别行假体拔出实验与扭转实验测定和假体周围骨组织形态计量学分析。[结果]术后24周，实验组假体周围局部感兴趣区BMD增加近5％，而对照组假体周围局部感兴趣区BMD下降了6％，两组比较有显著性差异（P〈0．01）；骨代谢指标中，术后24周实验组的BALP、BGP稍有下降，但组内无显著性差异（P〉0．05），而TRAP-5b有明显下降（P〈0．05），这些指标与对照组比较差异显著（P〈0．05或P〈0．01）；生物力学检测显示，实验组的假体拔出实验较对照组提高了约50％，扭转实验提高近1倍，且两组比较差异显著（P〈0．01）；骨组织形态计量学显示，实验组中反映骨吸收的Oc．No／Tb．Pm、ES／BS明显减少；反映骨量和微结构的％Tb．Ar、Tb．N明显增多，而Tb．Sp明显变窄：反映骨形成与骨矿化的OS／BS、MAR、BFR／TV及％L．Pm也均明显增多；这些指标与对照组比较差异显著（P〈0．01或P〈0．05）。[结论]鲑鱼降钙素能明显减少人工假体周围骨量的丢失和抑制骨溶解；并加快假体周围的骨形成，提高骨密度，促进生理性骨矿化；还能改善骨质量，促进骨微结构改变，提高骨的生物力学特性并增加假体四周的支撑力。其对骨质疏松症兔的假体松动有明显的预防和治疗作用。这对临床预防和治疗人工关节的无菌性松动有很好的指导意义。     

Left ventricular mass regression following aortic valve replacement with mechanical valves

Objective The degree of Left Ventricular Mass Index (LVMI) regression following aortic valve replacement correlates with long-term survival. This study aims to assess the extent of LVMI regression at 3 months following aortic valve replacement (AVR) with different types and sizes of mechanical valves in rheumatic aortic valve disease. Methods The LVMI regression was studied in 34 consecutive patients, undergoing elective AVR for rheumatic aortic stenosis and/or regurgitation. They were grouped in A and B, matched in age, body surface area and pre-operative LVMI, receiving respectively a tilting disc and a bileaflet mechanical valve. The LVMI was calculated by M-mode echocardiography using the Devereux' formula pre-operatively and three months post-operatively. The trend of LVMI reduction was compared between the two groups and amongst the patients with stenotic, regurgitant and mixed aortic valve, pathologies; and receiving different sizes of valves. Results The mean preoperative LVMI was 199g±79.5 g/m². At three months post aortic valve replacement, the mean LVMI was 130g±49.0 g/m². There was a significant reduction of LVMI post-operatively (p=0.001) at three months follow-up. The extent of LVMI regression following surgery amongst the groups A and B did not vary significantly (p=0.92). The extent of LVMI regression did not vary significantly in patients with different aortic valve pathology nor with different sizes of the valves implanted. Conclusions There is a significant early LVMI regression following aortic valve replacement in rheumatic aortic valve disease. The type and the size of the mechanical prosthesis or the rheumatic pathology do not appear to influence this regression.     

裸鼠肾被膜下阴茎海绵体组织和盆神经节移植的可行性

目的：基于组织异体移植技术,研究将正常SD（Sprague-Dawley）大鼠阴茎海绵体组织和盆神经节移植到Nu/Nu裸鼠肾被膜下的可行性。方法：无菌条件下获取SD大鼠阴茎组织和盆神经节,在手术显微镜下将上述组织移植到Nu/Nu裸鼠肾被膜下,分别于移植后1周和4周检测移植物的组织病理学变化及移植物内部细胞增殖情况。结果：移植1周后,移植到Nu/Nu裸鼠肾被膜下的阴茎海绵体组织与正常阴茎海绵体组织形态一致,在阴茎海绵体窦内充满血液;移植4周后,靠近肾的阴茎海绵体组织接近正常组织形态,而远离肾的阴茎海绵体组织表现为纤维化,仍可在阴茎海绵体窦观察到血液。盆神经节移植后1周,移植物内部组织结构与正常盆神经节相近,可见多个“细胞团”样结构存在,在靠近肾的部位有新生血管样结构形成;移植后4周,在远离肾的盆神经节组织内观察到血管存在,“细胞团”样结构仍较明显。此外,移植后4周,移植到Nu/Nu裸鼠肾被膜下的海绵体组织和盆神经节中可见ki67阳性的细胞存在,提示移植物内部分细胞仍存在增殖活性。结论：将正常SD大鼠阴茎海绵体组织和盆神经节移植到裸鼠肾被膜下后,至少可以存活4周,移植物内部组织结构与正常SD大鼠阴茎海绵体和盆神经节组织结构基本一致,可能与肾被膜下提供了移植物所需的局部微环境及移植物内部逐渐形成血液循环有关。     

Visión global de las guías clínicas en cirugía de la disfunción eréctil: EUA-AUA

IntroductionThe implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used.Material and methodsWe reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction.ResultsThe recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended.ConclusionsThe use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences.     

行气活血利水方联合低分子肝素钙注射液预防老年股骨头置换术后下肢深静脉血栓形成临床观察

目的观察行气活血利水方联合低分子肝素钙注射液预防老年股骨头置换术后下肢深静脉血栓形成(DVT)的临床疗效。方法将148例患者随机分为2组,治疗组75例采用内服行气活血利水方口服联合低分子肝素钙注射液皮下注射;对照组73例采用单纯皮下注射低分子肝素钙注射液。术后记录伤口引流量,于术后第3、7、12 d分别行下肢血管彩色多谱勒超声检查,评价深静脉通畅情况。结果 2组病例手术后48 h刀口引流量均在正常范围,比较差异无统计学意义(P>0.05);治疗组均未发生深静脉血栓形成,对照组发生深静脉血栓形成4例(5.4%),2组比较差异有统计学意义(P<0.05)。2组均未发生明显的出血并发症。结论行气活血利水方联合低分子肝素钙注射液可安全、有效预防老年股骨头置换术后下肢深静脉血栓形成。