关节镜下人工韧带重建前交叉韧带的临床初步体会

目的探讨关节镜下应用LARS人工韧带重建前交叉韧带的可行性及近期疗效. 方法用法国产LARS人工韧带对16例前交叉韧带(anterior cruciate ligament,ACL)损伤行关节镜下ACL重建术.等距点钻胫骨、股骨骨道,将肌腱拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚螺钉固定韧带,合并损伤同期处理. 结果手术时间51～86 min,平均64 min.术后无滑膜炎、韧带断裂、活动明显受限等并发症.16例均随访1.5～6个月,平均3.8月.按照IKDC评分标准:术前C级6例,D级10例;术后A级6例,B级9例, C级1例(χ2=6.264,P<0.05).Lysholm膝关节功能评分术前36～76分,(63.7±7.3)分;术后86～97分,(94.8±9.6)分(t=10.356,P<0.05). 结论关节镜下LARS人工韧带重建ACL,操作简便,可使膝关节获得即时稳定性,早期康复锻炼,最大限度的防止关节功能受限,近期疗效满意.     

锁骨下动脉损伤的外科处理

目的 探讨锁骨下动脉损伤的外科治疗特点。方法 1990年7月～2006年1月，对12例锁骨下动脉损伤患者，取锁骨上下联合切口，充分显露锁骨下动脉全段，分别采用动脉破口修补、包裹修复、血管吻合及人造血管移植修复重建损伤动脉。均为男性，年龄18～36岁，平均22.6岁。损伤部位：锁骨下动脉第1段1例，第2段4例，第3段7例。损伤类型：均为不完全断裂及破损，其中动脉破损区小于动脉周径1／3者4例，小于动脉周径2／3者5例，大于动脉周径2／3者3例。伴全臂丛神经损伤1例，神经干缺损5cm；部分臂丛神经损伤3例，其中2例仅前束损伤，神经缺损分别为4cm和6cm；正中神经完全损伤及尺神经不完全损伤1例，神经缺损4cm。损伤至手术时间3h～1.5个月。结果 术后无死亡及肢体坏死。获随访2个月～12年，平均5年2个月。10例桡动脉搏动恢复良好，2例桡动脉搏动不明显，均为动脉直接吻合者。4例合并臂丛神经损伤患者，前束损伤者术后肢体功能基本恢复正常，屈肘肌力Ⅳ级；全臂丛神经完全损伤者术后上肢功能基本无改善。结论 锁骨下动脉解剖位置特殊，动脉损伤后显露、修复均较困难。锁骨上下联合切口可在直视下显露动脉全段，修复重建安全可靠。     

CO2气腹对结肠癌细胞侵袭能力影响的体外研究

目的研究不同压强持续性CO2气腹处理对结肠癌细胞侵袭能力的影响。方法建立体外气腹模型,选用人结肠癌细胞株SW1116,分别在不同压强(6、9、12及15mmHg)99.5%医用CO2气体以及常规培养条件下暴露1h,取各压强组处理后0h和72h细胞,使用体外细胞侵袭实验模型进行体外侵袭实验。结果气腹处理后即刻(0h),15mmHg压强组结肠癌细胞侵袭荧光强度(11.36±0.861)明显低于处理前(13.43±1.113),差异有统计学意义(P=0.019),且明显低于其他各组(6mmHg组:15.58±1.015,P=0.000;9mmHg组:13.49±0.750,P=0.011;12mmHg组:13.37±0.949,P=0.016;常规培养组:13.43±2.027,P=0.014);6mmHg压强组处理后细胞侵袭荧光强度(15.58±1.015)高于处理前(14.42±1.491),但差异尚未达到统计学意义(P=0.056),且显著高于其他各压强组(9mmHg组:P=0.013;12mmHg组:P=0.009;15mmHg组:P=0.000;常规培养组:P=0.011)。气腹处理后72h,各压强组处理前、后的结肠癌细胞侵袭荧光强度差异无统计学意义(P>0.05);处理后各压强组间的结肠癌细胞侵袭荧光强度差异亦无统计学意义(P>0.05)。结论CO2气腹能对结肠癌细胞的侵袭能力产生一过性影响,随着CO2气腹压强的增高,结肠癌细胞的侵袭能力可能受到抑制。     

人工韧带用于前交叉韧带修复重建：目前产品与经验

人工韧带产品自20世纪70年代开始用于临床重建前交叉韧带(anterior cruciate ligament,ACL),经历了较为坎坷的发展历程。早期人工韧带产品重建ACL疗效欠佳,大多以失败告终。近20年来随着新人工韧带产品的出现,临床应用其重建ACL逐渐增多,常用人工韧带包括Leeds-Keio TM、LARSTM(Ligament Advanced Reinforcement System)、Trevira HochfestTM,其中LARSTM应用较多。上述人工韧带具有优越的力学性能,累积失败和并发症发生率较早期产品有显著改善,但也有各自不足之处。     

Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions

PurposeTo compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol.Materials and methodsThirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3 ± 14.4 (SD) years (range: 22–91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area.ResultsDosimetric values were significantly reduced by −56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P < 0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P < 0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported.ConclusionSemi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.     

3D打印技术应用于脊柱个性化椎体定制的实验研究

目的阐述应用3D打印技术制作猪脊柱个性化椎体的过程,探讨3D打印技术在脊柱外科应用的可行性,并为进一步进行人工椎体的生物相容性与生物力学性能测试提供实体。方法通过对20头紫金蓝塘草猪的腰椎进行连续断层CT影像采集,获得猪腰椎DICOM影像数据,将所获得的影响数据导入MIMICS软件中,并应用该软件对断面影像进行修补和擦除,得到满意的3D图像,并以STL格式保存,应用Solid Works软件优化设计具有不同孔隙大小、孔隙率等特征的复杂多孔结构,再通过选择性激光熔化(SLM)技术打印出最终的人工椎体。然后,手术取出猪的整个7节腰椎,并将对应节段置换成人工椎体。观察人工椎体与猪脊柱椎体形态差异及椎体置换后整个腰椎形态变化。结果通过3D打印的人工椎体与手术取出的猪的相应节段椎体形态结构完全相符,置换后脊柱形态与术前未发生明显变化。结论应用3D打印技术能够实现复杂结构的椎体个性化制作,为被破坏的椎体实现个性化人工椎体置换提供新的思路。     

Liposome‐Encapsulated Hemoglobin Ameliorates Ischemic Stroke in Nonhuman Primates: Longitudinal Observation

Liposome‐encapsulated hemoglobin (LEH) is protective early after brain ischemia in rats and nonhuman primates, but it remains unclear whether the protection persists and confers any benefits beyond the acute phase of brain ischemia and reperfusion. Ten monkeys underwent middle cerebral artery occlusion, received LEH (2 mL/kg, n = 5) or saline (2 mL/kg, n = 5) 5 min later, and reperfusion 3 h later. Positron emission tomography studies were repeated for the cerebral metabolic rate of O₂ (CMRO₂) as well as glucose (CMRglc) up to 8 days after reperfusion, when the animals were euthanized for morphological studies. There was no difference in O₂ metabolism until 3 h after reperfusion, when CMRO₂ was significantly better preserved in the cortex, but not in basal ganglia, on Day 0 in LEH‐treated monkeys. The extent of cortical infarction (saline 68 ± 10% vs. LEH 38 ± 9%, P < 0.05) and CMRO₂ (mild suppression: saline 34 ± 10% vs. LEH 14 ± 4%, P < 0.05) remained significantly better preserved 8 days later, when CMRglc showed a similar pattern of cortical protection (mild suppression: saline 49 ± 15% vs. LEH 37 ± 4%, P < 0.05) in LEH‐treated monkeys, together with regained body weight. Somatic weight control, morphological integrity, CMRO₂, and CMRglc were better preserved immediately, as well as 8 days after occlusion and reperfusion of the middle cerebral artery in monkeys receiving LEH early after onset of ischemia.     

Respiratory outcome in preterm ventilated infants: importance of early respiratory system resistance

Since severity of acute respiratory distress syndrome (RDS) has been decreasing, the aetiology of long-term respiratory problems may have changed in preterm infants. We investigated whether early neonatal respiratory resistance (Rrs) and compliance (Crs) were important determinants of respiratory morbidity and lung function abnormalities during the 1st year of life in ventilated preterm infants. In 70 infants of less than 37 weeks gestation, mechanically ventilated within 24 h after birth, Rrs and Crs were assessed daily during the first 3 days of life and medians were calculated subsequently (Rrs_neo and Crs_neo). Rrs and Crs were reassessed 1 year later in 57 of 70 infants (Rrs_{1 year} and Crs_{1 year}). After correction for endotracheal tube size, increased Rrs_neo was significantly related to respiratory morbidity during the 1st year of life (OR 1.20, 95% CI 1.04 to 1.38; P =0.013), increased Rrs_{1 year} (multiplicative per kPa/l·s 1.017, 95% CI 1.000 to 1.034; P =0.045), and decreased Crs_{1 year} (multiplicative per kPa/l·s 0.986, 95% CI 0.974 to 0.998; P =0.023). Associations were not adversely affected by degree of prematurity, neonatal disease and treatment. Crs_neo did not show any significant associations. In the current surfactant era, increased Rrs_neo, and not Crs_neo was associated with poor respiratory outcome during the 1st year of life in preterm ventilated infants. Relationships were not adversely affected by measures reflecting degree of prematurity, neonatal disease, and ventilator conditions. Conclusion: our results indicate that inborn properties of the respiratory system have become increasingly important in relation to respiratory outcome instead of neonatal disease and treatment conditions.Abbreviations CLD chronic lung disease of the neonate - Crs respiratory system compliance - Crs _neo median respiratory system compliance of the first 3 days of life - Crs _{1 year} respiratory system compliance at 1 year of age - CV coefficient of variance - ERS European Respiratory Society - FiO₂ inspiratory oxygen fraction - PIP peak inspiratory pressure - RDS respiratory distress syndrome - Rrs respiratory system resistance - Rrs _neo median respiratory system resistance of the first 3 days of life - Rrs _neoC Rrs_neo corrected for endotracheal tube size - Rrs _{1 year} respiratory system resistance at 1 year of age - SBT single breath occlusion technique