Association between facial measurements and polymorphisms in human epidermal growth factor and transforming growth factor β1

The aim of the study was to evaluate the association between genetic polymorphisms in human epidermal growth factor (EGF) (rs4444903) and transforming growth factor β1 – (TGF-β1) (rs1800470) with facial measurements in patients with dentofacial deformities. A total of 144 adult patients with dentofacial deformities were included. Facial linear and angular measurements were traced in lateral cephalometric radiographs used Dolphin 2D software. Cells from oral mucosa were collected for DNA to be extracted. The polymorphisms were genotyped using real-time polymerase chain reaction (PCR). Probabilites of less than 0.05 were accepted as significant. The rs4444903 heterozygous patients had a decrease in the mandibular length (p = 0.043) and the length of the mandibular base (p = 0.008), and homozygous A patients also had a reduction in the length of the mandibular base (p = 0.013) compared with homozygous G patients. Patients AG had an increase in measurement of the anterior facial height (p = 0.032) and in ANS-Me distance (p = 0.022) when compared with homozygous A. To the rs1800470, heterozygous patients had an increase in the length of the mandibular base (p = 0.043) when compared with homozygous A. Heterozygous AG patients had an increase in angular measurements in TGF-β1 polymorphism for the upper gonial angle, when compared with the homozygous AA (p = 0.032). Genetic polymorphisms in EGF and TGF-β1 are associated with facial measurements in a Brazilian population of patients with dentofacial deformities.     

短长骨畸形胎儿脐血 BALP 、IGF-1的测定及其临床意义

[目的]探讨脐血骨碱性磷酸酶（BALP）水平和活性、胰岛素样生长因子-1（IGF-1）水平、血清钙、血清磷与胎儿短长骨畸形的关系。[方法]选择短长骨畸形胎儿19例（观察组）,正常胎儿26例（对照组）,检测两组胎儿脐血BALP水平和活性及脐血IGF-1、血清钙和磷水平并比较。[结果]观察组BALP水平、血清磷显著低于对照组,血清钙显著高于对照组,其差异均有统计学意义（ P ＜0．05）,但两组BALP活性、IGF-1水平比较无显著性差异（ P ＞0．05）;BALP水平与血磷呈正相关（ r ＝0．343,P＜0．05）。[结论]短长骨畸形胎儿的钙磷代谢出现异常,BALP水平降低可能是胎儿短长骨畸形的影响因素。     

两种带蒂骨瓣在青壮年股骨颈骨折治疗中的应用观察

目的比较股骨大转子骨瓣和股方肌骨瓣两种不同带蒂骨瓣转移在治疗新鲜青壮年股骨颈骨折中的临床效果。方法两组患者均为青壮年,均采用髋关节后外侧入路行切开复位中空拉力螺钉内固定。股方肌骨瓣组15例,采用股方肌骨瓣转移至股骨颈后方;大转子骨瓣组9例,采用带血管蒂大转子骨瓣转移至股骨颈后方。比较两组病例切口长度、手术时间、手术失血量,以及转移骨块与股骨颈的融合时间、股骨颈骨折愈合时间、股骨头坏死发生率、髋关节Harris评分等。结果股方肌骨瓣组的手术失血量多于大转子骨瓣组,平均多出120 mL;转移骨瓣与受区融合时间,大转子骨瓣组比股方肌骨瓣组平均缩短1.6个月;骨折愈合时间,大转子骨瓣组比股方肌骨瓣组平均缩短1.9个月;差异均有统计学意义（P〈0.05）。结论带血管蒂大转子骨瓣比股方肌骨瓣更适用于存在有股骨颈后方塌陷缺损的严重类型的股骨颈骨折。     

Techniques for 3D foot bone orientation angles in weight-bearing from cone-beam computed tomography

BackgroundFor the diagnosis and treatment of foot and ankle disorders, objective quantification of the absolute and relative orientation angles is necessary. The present work aims at assessing novel techniques for 3D measures of foot bone angles from current Cone-Beam technology.MethodsA normal foot was scanned via weight-bearing CT and 3D-model of each bone was obtained. Principal Component Analysis, landmark-based and mid-diaphyseal axes were exploited to obtain bone anatomical references. Absolute and relative angles between calcaneus and first metatarsal bone were calculated both in 3D and in a simulated sagittal projections. The effects of malpositioning were also investigated via rotations of the entire foot model.ResultsLarge angle variations were found between the different definitions. For the 3D relative orientation, variations larger than 10 degrees were found. Foot malposition in axial rotation or in varus/valgus can result in errors larger than 5 and 3 degrees, respectively.ConclusionsNew measures of foot bone orientation are possible in 3D and in weight-bearing, removing operator variability and the effects of foot positioning.     

高危老年骨质疏松症患者骨代谢生化指标检测的临床意义

【目的】探讨高危老年骨质疏松症（0P）患者多种骨代谢生化指标检测的临床意义。【方法】选取本院收治的老年OP患者（B组,n=67）、高危老年OP患者（A组,n=75）及同期入院体检无OP的老年人（对照组,n=52）为研究对象,测量比较其腰椎L2～4正位和股骨颈骨密度（BMD）,测定骨代谢指标血清钙（Ca）、磷（P）、β胶原特殊序列（β-CTX）、N端骨钙素（N—MID）、总Ⅰ型胶原氨基端前肽（PINP）、25-羟基维生素D[25-（OH）D3]水平。【结果】三组Ca、P水平相比较差异无显著性（P〉0．05）;B组PINP、β-CTX高于A组和对照组,N-MID、腰椎L2～4及股骨颈BMD低于A组和对照组,且差异有显著性（P〈0．05）,其余指标比较差异均无显著性（P〉0．05）;A组PINP高于对照组,且差异有显著性（P〈0．05）;B组、A组25-（OH）D3低于对照组,差异有显著性（P〈0．05）,B组、A组组间比较差异无显著性（P〉0．05）。【结论】临床可通过动态监测PINP、25-（OH）D3水平变化辅助筛查高危老年OP。     

骨搬移技术治疗下肢长骨干慢性骨髓炎伴骨缺损术后骨性愈合不良的原因分析及对策

目的:探讨骨搬移技术治疗下肢长骨干慢性骨髓炎伴骨缺损术后出现骨性愈合不良的原因及其相应对策。方法:回顾性分析2012年6月至2015年12月采用骨搬移技术治疗的38例下肢长骨干慢性骨髓炎伴骨缺损患者的临床资料,男23例,女15例;年龄20~56岁,平均36.5岁;股骨5例,胫骨33例;受伤至骨搬移时间2~19个月,平均7.4个月;骨缺损长度4~12 cm,平均7.3 cm;术后均经过1周"待机期"开始骨搬移,搬移方向由近端向远端30例,由远端向近端3例,双向搬移5例;并及时调整力线及骨搬移速度,患者坚持负重。定期随访,拍摄X线片,观察是否存在搬移间隙矿化成骨不良,对合端不愈合以及再发骨折等并发症;并采用Paley评分标准进行临床评价。结果:38例获得随访,时间12~36个月,平均23.1个月。骨髓炎无复发,但出现多种骨性愈合不良相关的并发症,其中骨搬移过程中发生搬移间隙矿化成骨不良3例,对合端不愈合17例,发生搬移间隙骨折5例,尚未拆除外固定架时发生骨折1例,拆除外固定架后发生骨折4例。带架时间9~27个月,平均16.3个月;外固定指数为1.7~2.7个月/cm,平均2.24个月/cm;根据Paley评分标准评定疗效:骨性结果优12例,良16例,中3例,差7例;功能结果优14例,良18例,中3例,差3例。结论:骨搬移技术有效解决了长骨干骨髓炎伴大段骨缺损的临床难题,但治疗周期长,对预后的影响因素多。因此,应严格适应证选择,同时应细致操作,全程监控,及时随访,并积极指导患者相应的预防策略,以期得到更满意的临床疗效。     

羟基磷灰石材料结合牵拉成骨技术修复骨缺损的实验研究

 目的 探讨羟基磷灰石（hydroxyapatite/tri-calcium phosphase,HA/TCP）材料结合牵拉成骨技术是否能减少治疗骨缺损所需的时间并促进骨的矿化过程。方法 将36只健康雄性新西兰大白兔（20~24周,体重2.2~2.8 kg）随机分为3组,每组12只。于左胫腓关节下方做1 cm的胫骨缺损。A组：将骨缺损两端靠拢,外固定架加压固定。B组：将1 cm长的HA/TCP材料填入1 cm的骨缺损中,外固定架加压固定。C组：将骨缺损两端拉近至间距0.5 cm,将0.5 cm长的HA/TCP材料填入剩余的0.5 cm骨缺损中,外固定架加压固定。除B组外,A、C组均于术后7 d开始延长胫骨,A组延长10 d,C组延长5 d。在术后即刻、12、17、27、37 d用“C”型臂X线机观察各组新生骨的矿化过程。所有动物于术后37 d处死,取新生骨样本测量骨矿物质含量（BMC）和组织矿物质含量（TMC）,行胫骨扭转实验及组织病理学分析。结果 C组BMC为（454.44±89.98） mg和TMC为（454.40±89.97） mg显著高于A、B两组。C组新生骨的最大扭矩、新生骨的成熟度均明显高于A、B两组,骨的矿化和重塑也较快。C组在观察期总共37 d内骨愈合良好,但A、B两组在37 d内并未达到骨愈合。结论 在兔胫骨缺损延长模型中,与单一疗法相比,联合应用羟基磷灰石材料和牵拉成骨技术可减少治疗时间并促进骨的矿化。     

甲状腺癌骨转移的外科治疗及预后因素分析

 目的 探讨甲状腺癌骨转移的临床特点、外科治疗策略及影响预后的因素。方法 回顾性分析1999年1月至2011年7月间接受外科治疗且有完整随访资料的46例甲状腺癌骨转移患者的临床资料,男20例,女26例;年龄40~87岁,平均56.87岁。中轴骨转移占91.3%,四肢骨转移占8.7%。分化型甲状腺癌占76.1%,低分化型占23.9%。19例为单发骨转移,27例为多发骨转移。应用Kaplan-Meier生存分析和COX回归对性别、年龄、病理类型、骨转移病灶数目、转移部位、内脏转移、骨科并发症、转移时长、首诊时已发生骨转移、原发病灶手术、接受131I治疗、原发病灶接受放化疗、术前一般情况、手术方式、病灶性质、术中出血量、应用预防出血措施、围手术期并发症、远期并发症19项因素进行分析。结果 78.3%的患者接受了切除性手术,平均出血量为2603.26 ml,术后5年生存率为37.3%,10年生存率为12.4%。分化型甲状腺癌、单发骨转移、接受131I治疗、术前一般情况良好为预后良好因素,其中单发骨转移和接受131I治疗为独立影响因素。结论 明确甲状腺骨转移患者的预后因素有助于确定手术适应证,从而进一步提高甲状腺癌骨转移患者的治疗效果和生存期。