上游处理前后正常形态精子百分率与体外受精-胚胎移植结局的关系

目的:探讨取卵当日上游处理前后精子形态与体外受精-胚胎移植(IVF-ET)治疗结局的关系。方法:选取因单纯输卵管因素不孕而拟行IVF-ET治疗的夫妇94对。使用Kruger标准评价取卵当日上游处理前后的精子形态。以正常精子形态百分率10%为界,分别将上游处理前后的精子分成两组:B1组上游处理前正常形态≥10%,B2组<10%;A1组上游处理后正常形态≥10%,A2组<10%。分别比较B1和B2组以及A1和A2组的IVF-ET治疗结局。结果:上游处理前,B1组的受精率、卵裂率、优质胚胎率、妊娠率和胚胎种植率分别为(72.90±4.23)%、(95.20±2.61)%、(23.35±5.19)%、39.58%、18.35%;B2组分别为(71.33±5.10)%、(95.71±2.88)%、(20.18±6.15)%、41.86%、21.28%;各项指标两组之间差异均无统计学意义(P>0.05)。上游处理后,A1组受精率、卵裂率、优质胚胎率、妊娠率、胚胎种植率分别为(72.72±3.35)%、(95.64±2.04)%、(24.39±4.57)%、50.00%、23.87%;A2组分别为(70.27±8.82)%、(94.82±4.94)%、(13.45±7.39)%、9.52%、6.25%;两组之间受精率及卵裂率差别无统计学意义(P>0.05),但A1组的优质胚胎率、妊娠率及种植率明显高于A2组(P<0.05)。结论:取卵当日经上游处理后的正常精子形态百分率对IVF-ET结局有较好的预测价值。     

先天性髌骨外脱位1例

正患者,男,19岁,因右膝关节无痛性跛行15年于2014年2月18日来我院就诊。15年前患者无明显诱因出现快速行走后跛行,跑动时易跌跤,不能跑步,就诊于当地医院,考虑为先天性髌骨外脱位(图1a),于当地医院在关节镜下行外侧关节囊松解、内侧关节囊紧缩术治疗,术后症状有所缓解。为求进一步治疗,1年后在当地医院第2次手术行半腱肌转位成形术,术后6个月膝关节伸直位髌骨位置恢复     

Individual assessment of sperm morphology of single spermatozoa used for intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is an integral part of assisted reproduction. Although many papers have shown that global sperm count, sperm motility and sperm morphology of the ejaculate play no role in the fertilization rate after ICSI, embryologists who carry out ICSI, try to use the 'best looking' spermatozoa. The aim of the study was to investigate whether those spermatozoa with the best morphology really achieve the highest fertilization rate. In the present study, a total of 798 spermatozoa used for ICSI were documented by high-resolution photo. After ICSI the oocytes were cultured in single droplets and the formation of pronuclei was assessed 16 h later. The spermatozoa (all normal according to WHO criteria) were classified into four groups of different morphology. Group 1: normal head shape (approximately 5 microm diameter), group 2: like group 1, but with 15-20% smaller diameter, group 3: like group 1, but with 15-20% larger diameter, and group 4: like group 1, but with slight mid-piece cytoplasmic irregularities. Using the Pearson chi-square test, no significant difference in terms of fertilization was found among the different groups, showing that marginal sperm differences do not alter the fertilization process in ICSI.     

关节镜下经皮张力带钢丝固定治疗髌骨骨折

目的探索髌骨骨折错位在关节镜下复位、内固定的新方法。方法对56例新鲜闭合性横断型髌骨骨折病例,在关节镜下冲洗关节腔积血,清除骨折断端凝血块,去除小的骨碎片,进行髌骨复位,直接观察关节面复位对合情况。应用胥氏张力带钢丝固定原理,经皮穿入克氏针及钢丝,针孔做1cm小切口,完成内固定。结果术后2周绝大部分患者屈膝可达90°以上,骨折在6～10周达到临床愈合,出现针尾触痛者8例,克氏针松动上移2例,无钢丝断裂及脱落。治疗效果按膝关节损伤患者的功能评定法,优良率为96.4%。结论本术式两枚克氏针各有一根钢丝固定,在关节镜导引下,经皮穿针钢丝固定,不会因两根针位置不对称而产生扭距。操作方法简便、有效,有利于术后早期功能锻炼,为髌骨骨折提供了一种新的手术方法。     

Cardiac-type total anomalous pulmonary venous return is not benign

ObjectiveThe objective of this study was to investigate the association between morphological variation and postsurgical pulmonary vein (PV) stenosis (PPVS) in patients with cardiac total anomalous pulmonary venous connection (TAPVC).MethodsThis single-center, retrospective study included 168 pediatric patients who underwent surgical repair of cardiac TAPVC from 2013 to 2019 (connection to the coronary sinus [CS], n = 136; connection directly to the right atrium [RA], n = 32). Three-dimensional computed tomography modeling and geometric analysis were performed to investigate the morphological features; their relevance to the PPVS was examined.ResultsThe connection type had no association with PPVS (CS type: 18% vs right atrial type: 19%; P = .89) but there was a higher incidence of PPVS in patients with a single PV orifice than > 1 orifice (P < .001). Confluence-to-total PV area ratio (hazard ratio, 4.78, 95% CI, 1.86-12.32; P = .001) and length of drainage route (hazard ratio, 1.22; 95% CI, 1.14-1.31; P < .001) had a 4- and 1-fold increase in the risk for PPVS in the CS type after adjustment for age and preoperative pulmonary venous obstruction. In the right atrial type, those with anomalous PV return to the RA roof were more likely to develop PPVS than to the posterior wall of the RA (P < .001).ConclusionsThe number of inter-junction PV orifice correlated with PPVS development in cardiac TAPVC. The confluence-to-total PV ratio, length of drainage route, and anomalous PV return to the RA roof are important predictors for PPVS. Morphological subcategorization in this clinical setting can potentially assist in surgical decision-making.     

Subrupture tendon fatigue damage

The mechanical and microstructural bases of tendon fatigue, by which damage accumulates and contributes to degradation, are poorly understood. To investigate the tendon fatigue process, rat flexor digitorum longus tendons were cyclically loaded (1–16 N) until reaching one of three levels of fatigue damage, defined as peak clamp‐to‐clamp strain magnitudes representing key intervals in the fatigue life: i) Low (6.0%–7.0%); ii) Moderate (8.5%–9.5%); and iii) High (11.0%–12.0%). Stiffness, hysteresis, and clamp‐to‐clamp strain were assessed diagnostically (by cyclic loading at 1–8 N) before and after fatigue loading and following an unloaded recovery period to identify mechanical parameters as measures of damage. Results showed that tendon clamp‐to‐clamp strain increased from pre‐ to post‐fatigue loading significantly and progressively with the fatigue damage level (p ≤ 0.010). In contrast, changes in both stiffness and hysteresis were significant only at the High fatigue level (p ≤ 0.043). Correlative microstructural analyses showed that Low level of fatigue was characterized by isolated, transverse patterns of kinked fiber deformations. At higher fatigue levels, tendons exhibited fiber dissociation and localized ruptures of the fibers. Histomorphometric analysis showed that damage area fraction increased significantly with fatigue level (p ≤ 0.048). The current findings characterized the sequential, microstructural events that underlie the tendon fatigue process and indicate that tendon deformation can be used to accurately assess the progression of damage accumulation in tendons. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:264–273, 2009     

髌骨上皮样血管肉瘤的X线与病理对照(附一例报告并文献复习)

目的　提高对髌骨上皮样血管肉瘤的X线及病理的认识。方法　报告 1例髌骨上皮样血管肉瘤的X线平片和光学显微镜、电子显微镜的病理所见 ,并做文献复习。结果　肿瘤原发于髌骨中心 ,呈椭圆形破坏区 ,4个月后髌骨内发生广泛骨质破坏。病理示瘤细胞间有桥粒样连接及瘤细胞围成的微腔。结论　该病很少见 ,与滑膜肉瘤、纤维肉瘤及巨细胞瘤很难鉴别 ,确诊依靠病理检查。     

Surgical approaches to intramedullary nailing of the tibia: Comparative analysis of knee pain and functional outcomes

IntroductionPost-operative knee pain is common following intramedullary nailing of the tibia, regardless of surgical approach, though the exact source is controversial. Historically, the most common surgical approaches position the knee in hyperflexion, including patellar tendon splitting (PTS) and medial parapatellar (MPP). A novel technique, the semi-extended lateral parapatellar approach simplifies patient positioning, fracture reduction, fluoroscopic assessment, and implant insertion. It also avoids violation of the knee joint capsule. However, this approach has not yet been directly compared against the historical standards. We hypothesised that in a comparison of patient outcomes, the semi-extended approach would be associated with decreased knee pain and better function relative to knee hyperflexion approaches.MethodsA trauma patient database from a Level I centre was queried for patients who underwent intramedullary nailing of the tibia between 2009 and 2013. Patients were surveyed for knee pain severity (NRS scale 1 to 10) and location, and completion of the Lysholm Knee Scale (LKS). Data was compared between the semi-extended lateral parapatellar, medial parapatellar, and tendon splitting groups regarding knee pain severity, location, total LKS, and individual knee function scores from the Lysholm questionnaire. Pre-hoc power analysis determined the necessary sample size (n = 34). Post-hoc analysis utilised two-way ANOVA analysis with a significance threshold of p < 0.05.ResultsComparison of knee pain severity between the groups found no significant difference (p = 0.69), with average ratings of: semi-extended (3.26), PTS (3.59), and MPP (3.63). Analysis found no significant differences in total LKS score (p = 0.33), with average sums of: semi-extended (75.97), MPP (77.53), and PTS (81.68). Individual knee function scores from the LKS were similar between the groups, except for limping, with MPP being significantly worse (p = 0.04). There was no significant difference in knee pain location (p = 0.45).ConclusionIn this adequately-powered study, at minimum 1 year follow-up there were no significant differences between the 3 approaches in knee pain severity, location, or overall function. The three were significantly different in post-operative limping, with medial parapatellar having the lowest score. The semi-extended lateral parapatellar approach vastly simplifies many technical aspects of nailing compared to knee hyperflexion approaches, and does not violate the knee joint.     

精索静脉曲张不育患者的精液质量和精子形态学观察

目的:观察不育伴精索静脉曲张(VC)患者的精液质量和精子形态学变化。方法:98例不育伴VC患者精液按WHO标准常规分析并对精子形态学进行评价。130例正常供精者精液检测结果作为对照。结果:VC患者正常形态精子和前向运动精子明显低于对照组(P<0.001),精子畸形的类型以梨形、锥形和不定型头部畸形为主。结论:VC可导致精子畸形率升高,后者可能是男性生育力受损的重要标志之一,经染色后的精子形态学分析是判定VC患者精子受损的一个敏感指标。