鼻骨外伤X线摄影技术探讨

本文通过分析鼻骨外伤X线成像特点,重点探讨了常规X线与DR检查在鼻骨外伤中的应用价值,旨在提高对鼻骨骨折诊断的准确率。结果表明DR摄影是鼻骨常规检查的理想手段。     

Electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic ischemic heart disease

BACKGROUND: Bone marrow cell injection has been introduced to treat patients with ischemic heart disease. However, focal application of bone marrow cells may generate an arrhythmogenic substrate. OBJECTIVES: To assess the electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic myocardial ischemia. METHODS: Bone marrow was aspirated in 20 patients (65+/-11 years, 19 male) with drug-refractory angina and myocardial ischemia. Electroanatomical mapping (NOGA, Biosense-Webster, Waterloo, Belgium) was performed during mononuclear cell isolation. Areas for cell injection were selected based on the localization of ischemia on SPECT. These areas were mapped in detail to evaluate local bipolar electrogram duration, amplitude and fragmentation. Mononuclear cells were injected in the ischemic area with the NOGA system. SPECT and electroanatomical mapping were repeated at 3 months. Holter monitoring was repeated at 3 and 6 months. RESULTS: SPECT revealed a decrease in the number of segments with ischemia (3.5+/-2.5 vs. 1.1+/-1.0 at 3 months; P<0.01) and an increased left ventricular ejection fraction (44+/-13% vs. 49+/-17% at 3 months; P=0.02). The number of ventricular premature beats remained unchanged (10+/-24x10(2)/24h vs. 8+/-23x10(2)/24h at 3 months (P=NS) and 12+/-30x10(2)/24h at 6 months (P=NS)). At 3 months follow-up, bone marrow cell injection did not prolong electrogram duration (15.9+/-4.6 ms vs. 15.6+/-4.0 ms; P=NS), decrease electrogram amplitude (3.8+/-1.5 mV vs. 3.8+/-1.5 mV; P=NS), or increase fragmentation (2.0+/-0.5 vs. 1.9+/-0.4; P=NS). CONCLUSION: Intramyocardial bone marrow cell injection does not increase the incidence of ventricular arrhythmias and does not alter the electrophysiological properties of the injected myocardium.     

透明质酸对BMP-2转染的羊BMSCs增殖、分化的影响

目的观察透明质酸（HA）对携带人骨形态发生蛋白-2的腺病毒（Adv-BMP-2）转染的羊骨髓基质干细胞（BMSCs）体外增殖、分化的影响。方法将羊骨髓体外分离、扩增BMSCs,分成5组：转染Adv-BMP-2的BMSCs＋HA组（Ⅰ组）,转染Adv-BMP-2的BMSCs组（2组）,BMSCs＋HA组（3组）,BMSCs组（4组）,转染携带β半乳糖苷酶的腺病毒（Adv-β-gal）的BMSCs组（5组）。采用细胞计数、绘制细胞生长曲线和流式细胞分析观测细胞增殖;采用碱性磷酸酶（ALP）检测以及RT-PCR检测Ⅰ型胶原（Col-Ⅰ）、骨连接素（ON）和骨涎蛋白（BSP）的mRNA表达。结果①细胞增殖：3 d后各组细胞增殖无显著差异,1周后第1组和第3组的细胞增殖明显高于其他组。②ALP活性：3 d后第3组ALP活性明显低于第4、5组,而第1、2组则显著高于第4、5组;7 d后前3组ALP活性较后两组均显著增加,而第1、2组ALP活性增加更为显著。③Col-Ⅰ、ON和BSP的mRNA表达：3 d和7 d后前3组较后两组均有不同程度的增多。结论HA与BMSCs体外复合培养后可促进BMSCs的增殖、增加ALP的活性以及Col-Ⅰ、ON和BSP基因的表达。     

用心肌灌注显像靶心图定量分析评价AMI患者骨髓干细胞移植术疗效

目的 探讨靶心图上心肌灌注缺损区定量分析方法的可靠性、重复性及应用价值。方法 16例急性心肌梗死（AMI）行自体骨髓单个核细胞移植治疗的住院患者，于治疗前、治疗后45和90d行^99Tc^m-MIBI静息心肌灌注显像。在靶心图上勾画缺损区（在左心室靶心图中放射性计数低于40％的区域），并进行定量分析。结果 （1）不同操作者所得ROI结果之间的差异无统计学意义（t=0．52，P〉0．05）。（2）治疗后45d心肌灌注缺损区面积较治疗前缩小34．32％，差异有统计学意义（t=2．83，P〈0．05）；治疗后90d心肌灌注缺损区面积较治疗后45d缩小14．77％，差异有统计学意义（t=2．51，P〈0．05）。示自体骨髓单个核细胞移植对缺血心肌的恢复有一定疗效，能够缩小梗死面积，且自体骨髓单个核细胞冠状动脉内移植治疗AMI的疗效在移植后早期（45d内）即有体现。（3）面积百分比是观察心肌灌注变化的重要定量指标。结论 该方法对心肌病变范围及严重程度能准确定量；对评价AMI骨髓于细胞移植术疗效有一定的价值。     

股骨近端纤维结构不良的手术治疗

目的探讨股骨近端纤维结构不良的手术治疗方式。方法对19例股骨近端纤维结构不良的不同手术治疗方式及术后疗效进行回顾性分析。结果1例术后3d引流管口渗出血清样物质，加强抗感染、营养支持及换药处理后愈合。19例均获随访，时间13—58个月。复查X线片见缺损修复区内有新骨生成改变，骨折处骨愈合；1例术后20个月因外伤致股骨转子下内固定物旁骨折再次手术发现肿瘤复发，行再次刮除植骨内固定术后14个月愈合；除1例未行内固定的病例外，余患者术后患肢功能均得到良好恢复，8—12个月可弃拐行走。结论股骨近端纤维结构不良应积极手术治疗，在彻底刮除病变和充分植骨的基础上，强调内固定的应用。     

改良应用股骨髓腔绞刀行腰椎椎间植骨融合术

目的探讨应用普通股骨髓腔扩大绞刀代替专用的椎间植骨器械,进行腰椎后路椎间植骨融合术的临床经验体会,评估治疗效果。方法对我院34例应用股骨髓腔绞刀进行腰椎后路椎间植骨融合术的病例资料,进行回顾性分析。结果本组34例无围手术期硬膜及神经根损伤,无伤感染和和植骨块松脱。随访5～6年,植骨全部于6～8个月愈合,无一例植骨塌陷。按Machnab标准评定：优21例,良11例,可2例,差0例,优良率94.12%。结论改良应用股骨髓腔扩大绞刀代替专用的椎间植骨器械,作椎间植骨床的准备,效果满意,安全方便。     

Intravenous Iloprost: A New Therapeutic Option for Patients with Post-Transplant Distal Limb Syndrome (PTDLS)

The purpose of this study was to investigate the application of intravenous iloprost as a novel therapy for the treatment of post-transplant distal limb syndrome (PTDLS). PTDLS is a benign but disabling complication in the first year after renal transplantation. It is characterized by bilateral, often incapacitating pain in the feet and or knees on motion and a significant rise in alkaline phosphatase levels on laboratory evaluation. On MRI, bone marrow edema of the affected bone regions can be demonstrated. PTDLS differs from steroid induced osteonecrosis of the hip in terms of localization, an average cumulative steroid dosage within expected limits, and a benign outcome, as PTDLS does not progress to overt cell necrosis. From August 2003 to April 2005 we treated 10 patients with MRI-proven diagnosis of PTDLS following a standardized regimen of intravenous iloprost over 5 days. Iloprost led to prompt pain relief measured on a visual analogous scale (VAS) ranging from 1 to 10 (5.6 +/- 1.5 before vs. 2.1 +/- 1.3 after treatment, p = 0.0004). PTDLS represents a benign but disabling complication following renal transplantation. Intravenous iloprost might be a promising therapeutic concept leading to a quick relief of symptoms without relevant side effects.     

可吸收性医用珊瑚人工骨的致突变性研究

目的评价珊瑚人工骨的遗传毒性。方法采用Ames试验;细胞染色体畸变试验和小鼠骨髓细胞微核试验。结果不同浓度的浸提液加与不加S9mix条件下Ames试验;细胞染色体畸变试验以及微核试验与阴性对照组比较无显著差异,结果为阴性。结论在本试验系统条件下,可吸收性珊瑚人工骨无致突变作用。     

BMP复合体在牙槽骨缺损修复中的作用

①目的　观察狗下颌牙槽骨缺损区植入天然骨形成蛋白 +Ⅰ型胶原 +天然珊瑚复合体 (BMP复合体 )后新骨形成情况。②方法　 4只成年狗右侧下颌牙槽骨建立 5mm× 3mm× 2mm大小骨缺损区作为实验侧 ,植入BMP复合体 ,左侧建立相同骨缺损作为对照侧 ,不植入任何材料。术后 8周处死动物并进行放射、组织学 (光镜及扫描电镜 )检查。③结果　 4只狗中的 3只实验侧较对照侧牙槽骨愈合更佳 ,1只狗实验侧与对照侧骨愈合无明显差别。光镜检查实验侧可见大量的成骨细胞 ,骨缺损区被新生骨充盈 ;对照侧则见大量的纤维母细胞 ,新生骨量较少。电镜下实验侧可见大量位于骨陷窝内的成熟的成骨细胞。④结论　BMP复合体可促进狗下颌牙槽骨缺损的修复 ,有可能成为临床治疗牙槽骨缺损的一种理想的材料