肩锁钩板治疗不稳定性锁骨外侧段骨折的临床研究

目的：比较肩锁钩板和传统克氏针内固定治疗不稳定性锁骨外侧段骨折的疗效。方法：54例不稳定性锁骨外侧段骨折的患者接受了手术治疗，内固定分别是锁骨钩板或克氏针，根据国外的锁骨外侧段骨折肩部功能评价标准进行6－12个月的术后随访，随访结果运用统计学方法进行分析处理，结果：克氏针内固定组的手术优良率为77．3％，并发症发生率为27．3％，骨折愈合率为81．8％；锁骨钩板内固定组的手术优良率为100％，并发症发生率为3．1％，骨折愈合率100％。两组数据统计学差异有显著性，结论：在不稳定性锁骨外侧段骨折的手术治疗中，锁骨钩板较传统克氏针内固定有较高的手术优良率和骨折愈合率，且并发症的发生率较低，因此，它是一种疗效满意的内固定方法。     

外固定支架在治疗桡骨远端粉碎性骨折中的应用

近年来，随着桡骨远端骨折的治疗观念不断更新，传统闭合复位石膏固定和切开复位内固定术在治疗桡骨远端粉碎性骨折中的局限性越来越突出，而外固定支架则显示出其独特的优势。本文笔者就有关外固定支架治疗桡骨远端粉碎性骨折的基本原理、临床疗效、发展及其并发症作一综述。     

In Vitro Evaluation of Platelet/Biomaterial Interactions in an Epifluorescent Video Microscopy Combined with a Parallel Plate Flow Cell

Abstract: Suitable evaluation systems are critical for ranking various biomaterials in order to develop a method to design and synthesize nonthrombogenic biomaterials. We have recently developed an in vitro test system to evaluate platelet/biomaterial interactions in whole blood. The system consists of a parallel plate flow cell and epifluorescent video microscopy (EVM). A glass coverslip coated with a polymer was incorporated into the flow cell, and blood was perfused using a syringe pump via a polymer–coated PVC tubing connected to the flow cell. Whole human blood was anticoagulated with heparin (2 U/ml), and the platelets were labeled with the fluorescent dye mepacrine (5 μM). This system permitted real–time and dynamic observations of platelet/biomaterial interactions in whole blood under a defined flow condition. In order to evaluate the feasibility of this system, two different segmented polyether–polyurethanes (SPEUs), PU–PTMG(650) and PU–PTMG(2000), were chosen as test polymers. Surface characteristics verified with electron spectroscopy for chemical analysis (ESCA) and contact angle measurements showed similar results in both SPEUs. Blood was perfused at a wall shear rate of 200 s^–1 for 20 min. Excitation light was applied for 2 s at 1 min intervals. The real–time image was then analyzed at each time point for the percentage of surface area of platelet coverage. Plasma β–thromboglobulin (β–TG) levels were also measured before and after each run. PU–PTMG(650) showed a significantly higher number of adhered platelets than PU–PTMG(2000) at each time point. β–TG levels of PU–PTMG(650) were also higher than those of PU–PTMG(2000), which is comparable to the results of EVM. Thus, this EVM system has been proven to be an excellent and highly sensitive in vitro analytical method for evaluating platelet/biomaterial interactions.     

肢体不同延长速度对局部血流量的影响

本文报告20只兔胫骨以不同速度延长时用末梢微循环测定系统动态连续监测局部血流量变化的结果,发现一次延长>1 mm时,局部肌肉血流量开始急骤下降,恢复延长前血流量所需的时间>8 h。作者认为肢体的血管、肌肉等组织对1 mm/次/d延长速度有相当大的生物适应性。延长速度>1 mm/次/d易造成局部血流量大幅度减少。延长肢肌肉萎缩、肌力减弱可能与血流量减少有关。     

Treatment of resistant distal intestinal obstruction syndrome with a modified antegrade continence enema procedure

We report a case of a patient with CF who had a long history of recurrent distal intestinal obstruction syndrome. She had been treated with conventional treatment including gastrografin, n-acetyl cysteine, Klean prep and Picolax. She underwent a modified antegrade continence enema procedure. She currently irrigates her conduit every 2-3 days. She has had no further symptoms of distal intestinal obstruction syndrome.     

胫腓骨下段开放性粉碎骨折的治疗(附20例临床报告)

目的探讨胫腓骨下段开放性粉碎骨折的综合治疗。方法20例胫腓骨下段开放性粉碎骨折采用半环槽式外固定器固定、皮瓣转移、腓骨内移、骨折端加压并同期行上干骺端骨延长等综合治疗方法。结果伤口均一期愈合，所有皮瓣均成活，骨折临床愈合平均时间19周，7例因严重骨缺损经骨折端加压并同期行上干骺端骨延长后肢体均恢复正常长度。无1例针眼感染和血管、神经损伤。临床优良率为90％(18／20)。结论a)半环槽外固定器能克服胫腓骨下段开放性粉碎骨折的治疗困难，具有立体均衡固定。刚性可调，避免肢体受压。便于再次创面处理以及同期行骨折端加压和肢体延长等优点。b)半环槽式外固定器结合皮瓣转移、腓骨内移以及骨折端加压并同期行上干骺端骨延长等综合治疗方法是胫腓骨下段开放性粉碎骨折可选择的较好治疗措施之一。     

骺板软骨细胞复合三维支架体外构建组织工程软骨的研究

目的探讨将骺板软骨细胞复合三维支架经体外培养,构建组织工程软骨的效果及其生物学特点. 方法将3周龄幼兔第1代骺板软骨细胞与液态的生物凝胶混合,接种于聚磷酸钙纤维/L-聚乳酸(CPPF/PLLA)三维支架材料,构建组织工程软骨组织块,连续培养4周.行大体、倒置显微镜及组织学、Ⅰ型和Ⅱ型胶原免疫组织化学光镜观察,定量检测硫酸糖胺多糖(GAG)含量. 结果构建的组织工程软骨块在培养过程中能保持其初始外形,种子细胞呈稳定的三维均相分布,外观逐渐呈乳白色、半透明,硬度亦不断增加.培养1周有软骨细胞陷窝形成,2周后形成富含Ⅱ型胶原和蛋白聚糖、具有典型软骨组织结构的工程化软骨,且Ⅰ型胶原逐渐转为阴性.4周时构建软骨的组织结构与天然骺板软骨相类似,硫酸GAG含量平均为天然骺板软骨的34%以上. 结论骺板软骨细胞复合三维支架体外培养可生成典型软骨,且可形成类似天然骺板软骨的组织结构,能满足修复骺板缺损的基本要求.体外培养1～2周可能是植入体内修复骺板缺损的较佳时机.     

改良上颌平面导板矫正青少年深覆颌的临床观察

目的观察改良上颌平面导致矫正青少年深覆颌的效果。方法制作上颌平面导板,下颌双侧尖牙与其接触,后牙抬高3.0 mm。分为昼夜戴用导板及仅夜间戴用导板两组,观察疗效。结果深覆颌总矫正率72.2%,昼夜戴用该改良上颌平面导板组的深覆颌矫正率100%。结论改良上颌平面导板制作简单,戴用方便,效果明显。     

非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果

Objective Intra-articular fractures of the distal radius in young adults comprise a distinet fracture pattern that is diffficuh to manage and associated with a high frequency of post-traumatic arthritis.Restoration of articular congruency and alignment should improve the outcome.Methods In this study we prospectively re- viewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction.Results 3 patients were lost to follow-up.For the rest of 18 patients,follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results.The final volar tilt averaged 4.9°;radial inclination 23.9°;radial length 14mm;and articular incongruity,0.1 mm.Wrist motion at final follow-up examination aver- aged flexion 62°,extension 60°,radial deviation 16°,ulnar deviation 27°,pronation 77°and supination 74°.Grip strength averaged 83% of the uninjured side.The overall outcome of 18 patients(94.4%)had a good or excellent result according to the system of Gartland and Werley and 18 patients(72.2%)had a good result according to the modified system of Green and O'Brien at the most recent evaluation.The only complication in this series was a superficial pin tract infection,which was rapidly resolved with removal of pins at 5th week of external fixation. Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.     

肘关节脱位与肱骨远端关节内骨折

Objective To describe dislocation of the elbow with articular fracture of the distal humerus,a type of elbow fracture-dislocation about which little has been written.Methods Four patients with a dislocation of the elbow and fracture of the distal humerus were identified.Three had dislocation and complex intraarticular fracture of the capitellum,trochlea,and lateral epicondyle.Results Two patients(one treated with a second operation to address avascular necrosis of the capitellum)achieved a functional arc of elbow motion and one patient was lost after removal of the implants 3 months after fracture with documented healing.The fourth patient had a complex open fracture dislocation involving the entire articular surface.An attempt to salvage the articular surface resulted in deep infection.Extensive heterotopic bone led to arthrodesis of the elbow.Conclusions Dislocations of the elbow with articular fracture of the humerus are uncommon.Most injuries involve the capitellum,lateral trochlea,and lateral epicondyle.Open reduction and internal fixation of the distal humerus fracture can restore stability without repairing the medial collateral ligament.