三种内固定治疗上肢长骨干骨折的临床比较研究

目的观察天鹅记忆接骨器(swan-likememoryconnector,SMC)治疗上肢长骨干骨折的疗效,并与加压接骨板(dynamiccompressiveplate,DCP)和带锁髓内针(lockedintramedullarynail,LIN)进行临床对比研究。方法随机选择1997年8月～2001年8月入院的新鲜上肢长骨干骨折148例,分别采用SMC(49例)与DCP(50例)、LIN(49例)进行内固定治疗,术后常规抗炎治疗1周,定期拍片并随访患肢功能恢复情况。结果SMC组的手术时间明显低于LIN组与DCP组(P<0.05),三组伤口感染率无差异。SMC组骨愈合时间和骨不连发生率显著短于DCP组和LIN组(P<0.05),而术后功能优良率高于DCP组和LIN组。在SMC固定下,骨折愈合直接由解剖型或类解剖型的骨样骨板状直接替代连接,固定段无应力遮挡和骨质疏松。结论SMC是治疗上肢长骨干骨折的有效方法,优于DCP和LIN。SMC的几何构形和力学特性有利于骨折愈合。在本器固定下,可能存在一种新的尚未被认知的骨折愈合方式。     

Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing

Nineteen patients (20 feet) with severe hindfoot and ankle deformity underwent tibiotalocalcaneal fusion with a retrograde locked intramedullary nail as a limb-salvage procedure. The purpose of this study was to compare the complication rates of this procedure in diabetic versus nondiabetic patients. There were 8 men and 11 women with preoperative diagnoses including Charcot neuroarthropathy, primary osteoarthritis, rheumatoid arthritis, equinocavovarus, posttraumatic osteoarthritis, gouty arthritis, and ankle malunion. Ten of 20 procedures were performed in patients with diabetes. The average patient age was 56 years, and the average postoperative follow-up was 19.8 months. Nineteen of 20 ankles (95%) achieved successful fusion with an average time of 4.1 months. Four patients (21%) required either a fracture brace or an ankle foot orthosis at final follow-up. Five patients (25%) had major complications and 11 patients had minor complications. Major complications included osteomyelitis (n = 2), Charcot arthropathy (n = 2), failure of fixation (n =1), soft-tissue necrosis (n = 1), cardiac arrest (n = 1), cerebral vascular accident (n = 1), and fatal pulmonary embolus (n = 1). All patients with major complications were diabetic, and 14 of 20 combined major and minor complications occurred in patients with diabetes. The complication rate was found to be high in diabetic patients with end-stage deformity undergoing a limb salvage     

端脑髓突的断面解剖学观测

目的：通过对端脑髓突支数及其分支的研究，探讨端脑髓突与脑回的对应关系，指导脑回的医学影像学定位。材料与方法：随机采用３０个颅脑标本，经ＣＴ扫描后锯切出相应断面，结合断面标本及其相应的ＣＴ影像表现对端脑髓突进行综合观测。结果：端脑髓突清晰而易于辨认，各髓突对应相应的脑回皮质。端脑髓突的支数在不同端脑层面上明显变化，但侧别差异无显著性意义。结论：只有熟悉端脑髓突的支数及其分支等情况，才能认准端脑髓突，     

Early gastric cancer manifested as brain metastasis: Report of a case

A case of early gastric cancer, limited to submucosal layer, which was manifested as cerebral metastasis is presented herein. A 47-year-old man was admitted to Nagaoka Chuo General Hospital with convulsions and a disturbance in consciousness, where a computed tomography (CT) scan revealed a cerebral tumor in the left temporal lobe. The resected tumor was identified as a metastatic adenocarcinoma. Further investigation revealed gastric cancer involving the posterior wall of the cardia. At laparotomy, multiple and small metastases of the liver and a jejunal metastasis were found, and a palliative total gastrectomy was performed. The surgical specimen revealed a protruding, poorly differentiated medullary adenocarcinoma, with invasion of the submucosal layer. The patient died 4 months after undergoing the laparotomy. This case report is presented to make clinicians aware of the possibility that early gastric cancers may present as brain metastasis.     

In search of the central respiratory neurons: II. Electrophysiologic studies of medullary fetal cells inherently sensitive to CO2 and low pH.

Although extensively pursued, the central respiratory neurons have remained elusive. We departed from the more conventional physiologic and morphologic methods of system and tissue examination and cultured dissociated fetal rat cells (Fitzgerald et al., J Neurosci Res 33:579-589, 1992) from the area of the nucleus ambiguus and the nucleus tractus solitarius located within the 2 mm rostral to the obex. Pacemaker-like cells, with a regular single or bursting activity, studied at 3-5 weeks of age, responded to very small pulses of CO2 (50 ms) and low pH with an increase in spike frequency and a decrease in spike amplitude. Other irregularly beating or silent cells did not respond or else required very large pulses (> 200 ms) to do so. The pacemaker cells also responded to hypoxia induced by administration of sodium hydrosulfite with an increase in spike frequency and amplitude; high oxygen (> 600 torr) and adenosine produced a decrease in electrical activity. Most of these cells were multipolar after staining with antibodies to neuron-specific enolase (NSE) and Fragment C of tetanus toxin. They did not stain for choline acetyltransferase (ChAT). The results suggest that these cultured cells, expressing a phenotype inherently responsive to CO2 and low pH, have the characteristics of central respiratory chemoreceptors, and may be involved in the generation of the respiratory rhythm.     

椎弓根钉内固定治疗胸腰椎骨折

目的：探讨脊柱胸腰段骨折椎弓根钉内固定治疗效果。方法：临床收治脊柱胸腰段骨折72例，均采用后路减压，Dick或RF系统钉内固定手术治疗。比较手术前后骨折复位及神经功能恢复情况。结果：术后椎体高度完全或基本恢复占95．8％，神经功能有Frankel一级以上改善，不完全截瘫占90％，完全截瘫占53．1％。随访3—38个月，无螺钉折断、后退及脊柱矫正度丢失。结论：开放复位后路椎弓根钉内固定是治疗胸腰椎骨折的有效方法。     

Age-related changes in cortical porosity of the midshaft of the human femur

Complete cross-sections from the femoral midshaft of 180 individuals of known height and weight, aged 21–97 y, from a modern Australian population were examined using automatic video image analysis to quantify total subperiosteal porosity (TSPP). More specifically, the aim was to investigate whether age changes were similar in both sexes in (1) total subperiosteal area (TSPA), cortical area (CA) and medullary area (MA), (2) intracortical porosity (ICP), and (3) the respective contributions to TSPP made by MA and intracortical void area (ICVA). Our findings indicated that both sexes showed a significantly greater height normalised TSPA in the 70s as compared with the 20s. Males had consistently larger bones with a greater height normalised CA. In both sexes CA showed a tendency to increase till the 7th decade and then to decline, more so in females. MA approximately trebled in females and doubled in males over the age range studied. Although ICP also increased, from 4–6% in young adults to over 9% in the elderly, it showed a significant difference between the sexes only in the 3rd decade, being greater in males at this stage. By contrast, TSPP became significantly greater in females (from that recorded in the 3rd decade) by the time they reached the 50s, while in males this did not occur till the 80s. It increased from ∼25% in young adults of both sexes to ∼50% in females and ∼37% in males in their 80s. However, in the elderly there was great variability in both sexes in the appearance of bones from individuals of similar chronological age. Some bones differed little from those in younger subjects, others showed greatly increased ICP, still others displayed reduced cortical widths with low ICP. The femoral midshaft resembles other skeletal sites in that age changes in TSPP are more marked in females than males.     

Operative treatment of intertrochanteric hip fractures: an overview of modern advances and techniques

Hip fractures have been one of the most studied injury pattern in adults. The number of hip fractures is increasing exponentially; furthermore, the cost of treatment places great economic strain on society. There have been recent developments in hip-fracture treatment, particularly involving the intertrochanteric region, with emphasis on deformity prevention to try to optimize patient functional outcomes. In this article, we outline some of these developments with an emphasis on changes in implant design.     

股骨转子周围骨折的髓内钉固定

目的探讨带锁髓内钉固定在股骨转子周围骨折中的应用价值以及相关并发症的防治。方法回顾分析了自1993年12月至2001年9月间作者收治的180例(181髋)经髓内钉治疗的转子周围骨折,其中应用亚太型Gamma钉96例(97髋)、股骨重建钉54例、股骨近端钉(PFN)30例。结果平均手术时间65分钟,术中术后输血患者仅占15.6%;平均随访时间为16个月,96%的骨折获得愈合,平均愈合时间为3.5个月;按黄公怡评价标准,髋关节功能优良率为90.2%;发生9种类型的并发症。结论髓内钉固定在治疗股骨转子间骨折中具有较大的临床价值,但仍存在一定的并发症,应引起足够重视。     

Diet salinity and vasopressin as reproduction modulators in the desert-dwelling golden spiny mouse (Acomys russatus)

The time for reproduction in mammals largely depends on the availability of water and food in their habitat. Therefore, in regions where rains are limited to definite seasons of the year, mammals presumably will restrict their breeding correspondingly. But while mammals living in predictable ecosystems would benefit by timing their season to an ultimate predictable cue, such as photoperiod, in unpredictable ecosystems (e.g., deserts) they will need to use a more proximate signal. We suggest a mechanism by which water shortage (low water content in plants) could act as a proximate cue for ending the reproductive season. The golden spiny mouse (Acomys russatus), a diurnal rodent living in extreme deserts, may face an increased dietary salt content as the summer progresses and the vegetation becomes dry. Under laboratory conditions, increased diet salinity lead to reproductive hiatus in females, notable in imperforated vagina, and a significant decrease in the ovaries, uteri, and body masses. In females treated with vasopressin (VP), a hormone expressed during water stress, the uteri and body masses have decreased significantly, and the ovaries exhibited an increased number of atretic follicles. VP has also led to a significant decrease in relative medullary thickness (RMT) of the kidney. It is thus suggested that VP could act as a modulator linking the reproductive system with water economy in desert rodents, possibly through its act on the energetic pathways.