应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连疗效观察

目的观察应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连的疗效。方法53例股骨髁上骨不连患者随机分为两组：对照组（26例）和治疗组（27例）,两组均应用动力髁螺钉治疗,治疗组加用骨肽注射液治疗。随访,进行疗效评价,记录骨愈合时间和测定疼痛指数。结果治疗组疗效优于对照组。结论应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连可提高疗效。     

锁定肱骨近端接骨板治疗肱骨近端骨折

目的探讨锁定肱骨近端接骨板治疗肱骨近端骨折的临床价值：方法采用切开复位AO锁定肱骨近端接骨板(LPHP)内固定治疗肱骨近端骨折12例。结果所有患随访3～13个月，平均7．5个月。临床疗效评估：优7例，良3例，进步2例，优良率为83．3％。结论LPHP具有固定可靠、减少软组织损伤、保护血运、利于关节囊和肩袖修复、有助于骨折愈合和肩关节功能恢复的特点，值得提倡。     

Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures

Abstract Surgical treatment of proximal humeral fractures still remains a challenge. This is primarily due to the fact that sufficient implant fixation in humeral head fractures is often not achieved due to substantial bone tissue loss with increasing age. In the last few years the locking plates and locking nails have been introduced into clinical practice with varying results. The biomechanical studies have focused on locking plate osteosynthesis as well. The following paper focuses on bone quality, biomechanical studies and biology of proper osteosynthesis and reviews the most recent literature.     

股前外侧区穿支动脉的形态学研究及皮瓣设计

目的探讨以旋股外侧动脉降支为蒂的皮瓣设计方法，以便增加术前多普勒定位的准确性。方法6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本，解剖观测股前外侧区穿支，通过血管造影术和拍摄X线片测量其直径、行程、分支和定位。用3D—doctor和Scion Image软件分别测量穿支供血的趋向性、三维重建和单穿支供血面积。结果股前外侧区共有外径大于0．5mm穿支16支，平均外径0．8mm，平均供血面积45．61cm^2，其中20％为肌间隙穿支，80％为肌皮穿支。平均蒂长为（3．15±1．43）cm。自旋股外侧动脉降支发出的穿支在浅筋膜中的平均长度为2．63cm。结论改良的氧化铅-明胶灌注技术可以为皮动脉和穿支皮瓣的研究提供高质量的血管造影图像。本研究发现股前外侧单穿支皮瓣的最大供血面积是30cm×20cm。以股前外侧区穿支设计的穿支皮瓣可以移植到下肢或身体其他部位。     

Improved Performance of Hip DXA Using a Novel Region of Interest in the Upper Part of the Femoral Neck: In Vitro Study Using Bone Strength as a Standard of Reference

We tested the hypothesis that bone mineral density (BMD) and bone mineral content (BMC) in proximal human femur specimens in the upper neck region of interest (ROI) and femoral neck axis length (FNAL) provide a significantly better prediction of femoral bone strength than standard ROIs in vitro. BMD and BMC were measured in 110 proximal femur specimens using a standard dual-energy X-ray absorptiometry (DXA) scanner. The analysis included a new ROI in the upper neck as well as the standard ROIs. FNAL was obtained from the scan images. The specimens' failure-load was measured in a mechanical loading device, simulating a fall on the greater trochanter. For the standard ROIs, correlations between failure-load and BMD ranged from R2 = 0.64 (shaft ROI) to R2 = 0.70, p < 0.001 (femoral neck). Prediction of strength by BMD did not significantly differ from those of BMC (R2 ranging from 0.65 to 0.75, p < 0.001). In the upper neck ROI, for both BMD and BMC correlations with failure-load were higher (R2 = 0.76 and 0.81, respectively; p < 0.001). A lower, yet still significant, correlation was found between FNAL and bone strength (R2 = 0.23, p < 0.001). Normalization of failure-load with respect to FNAL did not significantly increase the correlations with densitometric measures. This study provides in vitro evidence indicating that among the ROIs of the proximal femur the newly defined upper neck ROI provides the best prediction of bone strength. Only a weak association was observed between failure load and FNAL.     

带旋髂深血管蒂髂骨瓣移植与加压螺钉治疗青壮年股骨颈骨折

本文报告了自１９８５年￣１９９５年间采用带旋髂深血管蒂髂骨瓣移植与加压螺纹钉内固定治疗青壮年囊内型股骨颈骨折２６例。随访时间平均５年５个月。结果，２６例骨折痊愈，骨折愈合率为１００％。骨折愈合时间平均４个月。仅１例骨折愈后后股骨头发生缺血坏死。股骨头缺血坏死率为４％。     

股骨颈骨折粗细双螺钉内固定生物力学研究

股骨颈骨折内固定方法繁多。本文采用一粗一细加压螺纹钉，采用先进电阻应变仪方法，对股骨颈的应力分布规律在中立、外展、内收不同位置上施加50kg荷载压力．通过电阻应变计测定一耗一细两钉所承受拉、压应力优于其它内固定形式。     

THE INCREASE OF FEMORAL ARTERIAL FLOW BY STIMULATING THE DORSAL AND VENTRAL MEDULLA IN CATS

1. In chloralose-urethane anaesthetized cats, the dorsal cardiovascular reactive area (DCRA) in the parvocellular reticular nucleus dorsomedial to the facial nucleus, and the ventral cardiovascular reactive area (VCRA) ventromedial to the facial nucleus, were stimulated by microinjections of sodium glutamate (100–200 nmol) or electric current. 2. Stimulation of DCRA, with a long latency of 15–20 s, elicited a marked increase of blood flow in the contralateral femoral artery with little change to moderate increase in systemic arterial blood pressure (ABP). In the relatively dorsal portion of DCRA, however, a smaller increase of blood flow in the ipsilateral femoral artery was elicited. 3. On the other hand, stimulation of VCRA with a short latency (3–5 s) evoked an increase of blood flow in both femoral arteries which was more prominent on the contralateral side. The responses were accompanied with decreases in the blood flow of other vascular beds with only a slight increase or minimal change in ABP. 4. The data suggest that DCRA and VCRA are both viscerotopically organized to alter the resistance of individual vascular beds for redistribution of blood flow.     

Characterization of a highly polymorphic marker adjacent to the SLC4A1 gene and of kidney immunostaining in a family with distal renal tubular acidosis.

BACKGROUND: Mutations in the human SLC4A1 (AE1/band 3) gene are associated with hereditary spherocytic anaemia and with distal renal tubular acidosis (dRTA). The molecular diagnosis of AE1 mutations has been complicated by the absence of highly polymorphic genetic markers, and the pathogenic mechanisms of some dRTA-associated AE1 mutations remain unclear. Here, we characterized a polymorphic dinucleotide repeat close to the human AE1 gene and performed an immunocytochemical study of kidney tissue from a patient with inherited dRTA with a defined AE1 mutation. METHODS: One CA repeat region was identified in a phage P1-derived artificial chromosome (PAC) clone containing most of the human AE1 gene and the upstream flanking region. We determined its heterozygosity value in multiple populations by PCR analysis. Genotyping of one family with dominant dRTA identified the AE1 R589H mutation, and family member genotypes were compared with the CA repeat length. AE1 and vH(+)-ATPase polypeptides in kidney tissue from an AE1 R589H patient were examined by immunocytochemistry for the first time. RESULTS: This CA repeat, previously reported as D17S1183, is approximately 90 kb upstream of the AE1 gene and displayed considerable length polymorphism, with small racial differences, and a heterozygosity value of 0.56. The allele-specific length of this repeat confirmed co-segregation of the AE1 R589H mutation with the disease phenotype in a family with dominant dRTA. Immunostaining of the kidney cortex from one affected member with superimposed chronic pyelonephritis revealed vH(+)-ATPase-positive intercalated cells in which AE1 was undetectable, and proximal tubular epithelial cells with apparently enhanced apical vH(+)-ATPase staining. CONCLUSIONS: The highly polymorphic dinucleotide repeat adjacent to the human AE1 gene may be useful for future studies of disease association and haplotype analysis. Intercalated cells persist in the end-stage kidney of a patient with familial autosomal dominant dRTA associated with the AE1 R589H mutation. The absence of detectable AE1 polypeptide in those intercalated cells supports the genetic prediction that the AE1 R589H mutation indeed causes dominant dRTA.     

Effects of mycophenolic acid on IL-6 expression of human renal proximal and distal tubular cells in vitro.

BACKGROUND: Interleukin-6 (IL-6) is a multifunctional cytokine which regulates immune responses and host defence mechanisms. IL-6 has been found to be increased in certain inflammatory conditions of the kidney, in which tubular epithelial cells play a pivotal role. Human renal tubular cells express IL-6. Until now no data about the effect of the immunosuppressant drug mycophenolic acid (MPA) on IL-6 expression were available. METHODS: Proximal and distal tubular epithelial cells (PTC/DTC) have been isolated immunomagnetically. Confluent monolayers were stimulated with interleukin-1beta (IL-1beta; 25 U/ml), IL-1beta+ MPA (0.25-50 micro M) or MPA alone for 48 h. Release of IL-6 protein into the supernatant was evaluated with an enzyme immunoassay, IL-6 mRNA expression was evaluated using the Quantikine mRNA kit. RESULTS: After IL-1beta stimulation, a highly significant 2.6- (PTC) and 3.8-fold (DTC) upregulation of IL-6 expression was detectable. IL-6 mRNA was upregulated by IL-1beta [1.57- (PTC) and 2.03-fold (DTC)]. MPA inhibited this cytokine-induced IL-6 expression in a dose-dependent manner. Incubation with the lowest MPA concentration had no effect on the stimulated upregulation, whereas all higher doses significantly decreased IL-6 expression. Dexamethasone significantly inhibited the cytokine-induced IL-6 protein release in PTC, but not in DTC. CONCLUSIONS: In this study we demonstrated for the first time an inhibitory effect of MPA on the stimulated IL-6 expression of renal tubular epithelial cells. In contrast to older data, which showed a synergistic upregulation of the expression of a CC-chemokine by a combination of cytokines and MPA, in the present study we could demonstrate an immunosuppressive effect of MPA on the expression of an important cytokine.