不同刀片制作老年患者准分子激光原位角膜磨镶术角膜瓣的比较分析

目的比较不同刀片制作老年患者准分子激光原位角膜磨镶术（LASIK）角膜瓣的差异。方法选择2008年1月-2012年1月82例行LASIK患者,随机分为二组。对照组40例80眼采用MoriaM2110刀头,观察组42例84眼采用MoriaM290刀头。观察二组制作角膜瓣厚度的差异,并评价其保留角膜基质床厚度及并发症差异。结果观察组术后角膜瓣厚度显著低于对照组,差异有统计学意义（P〈0．05）;观察组保留角膜基质床厚度高于对照组,差异有统计学意义（P〈0．05）;观察组手术并发症发生率为6．0％低于对照组20．0％,差异有统计学意义（P〈0．05）。结论不同刀片制作老年患者LASIK角膜瓣存在很大差异。MoriaM290刀头较MoriaM2110刀头制作角膜瓣厚度更薄,同时其保留角膜基质床也较厚,患者手术并发症发生率也较低,能够获得更好的矫正效果,安全性高,值得临床推广。     

A comprehensive update on current fixation options for two-part proximal humerus fractures: A biomechanical investigation

Background

Recent advancements in implant technology offer updated options for surgical management that have been rapidly adopted into clinical practice. The objective of this study is to biomechanically test and compare the current fixation options available for surgical fixation of two-part proximal humerus fractures and establish load to failure and stiffness values.

Methods

Sixteen match-paired (32 total) fresh-frozen, cadaveric specimens were randomized to receive 1 of 4 fixation constructs following creation of an AO/OTA Type 11A3 (two-part) proximal humerus fractures. Fixation constructs tested consisted of 3.5 mm fixed angle plate (3.5-FAP), 4.5 mm fixed angle plate (4.5-FAP), humeral intramedullary nail (IMN), and a humeral intramedullary nail with a fixed angle blade (IMN-FAB). Specimen bone density was measured to ensure no adequate, non-osteoporotic bone. Constructs were tested for stiffness and ultimate load to failure and compared via one-way ANOVA analysis with subsequent post hoc Tukey HSD multiple group comparison statistical analysis.

Results

The IMN-FAB construct was significantly stiffer than the 3.5-FAP construct (123.8 vs. 23.9, p < 0.0001), the 4.5-FAP construct (123.8 vs. 33.3, p < 0.0001) and the IMN construct (123.8 vs. 60.1, p = 0.005). The IMN-FAB construct reported a significantly higher load to failure than the 3.5-FAB construct (4667.3 N vs. 1756.9 N, p < 0.0001), and the 4.5-FAP construct (4667.3 N vs. 2829.4 N, p = 0.019, Table 2). The IMN construct had a significantly higher load to failure than the 3.5-FAP construct (3946.8 vs. 1756.9, p = 0.001, Table 2).

Conclusion

Biomechanical testing of modern fixation options for two-part proximal humerus fracture exhibited that the stiffest and highest load to failure construct was the IMN-FAB followed by the IMN, 3.5-FAP and then the 4.5-FAP constructs. However, prospective clinical trials with longer-term follow-up are required for definitive assessment of the ideal fixation construct for surgical management of two-part proximal humerus fractures.     

山银花茎、叶、花中绿原酸分布规律研究

目的 揭示山银花茎、叶及花中绿原酸的分布状况，为确定金银花药材合理的药用部位及良种选育特征提供依据。方法 利用荧光显微镜观察山银花茎、叶及花中有效成分绿原酸的分布规律。结果绿原酸在花中主要分布于萼筒一子房壁外表皮细胞及其下3～5层细胞、花冠外表皮细胞及其下1～2层细胞和花冠内表皮纤毛细胞；在叶片中主要分布于上表皮细胞和下表皮纤毛细胞；在茎中仅零星分布于次生韧皮部细胞。结论 花中绿原酸分布最为广泛、含量最丰富，叶片次之，茎中最少；花冠内表皮纤毛和花冠外表皮腺毛的密集程度，以及萼筒和花冠的长度可作为山银花的育种特征。     

防旋型股骨近端髓内钉微创治疗老年股骨粗隆间骨折

目的 探讨防旋型股骨近端髓内钉治疗老年股骨粗隆间骨折的效果.方法 对本院2012年1月至2016年2月收治的80例老年(70岁以上)的股骨粗隆间骨折患者进行回顾性分析,根据骨折AO分型:A1型15例,A2型49例,A3型16例.观察患者术后治疗效果.结果 术后对患者进行6～36个月(平均18个月)的随访,骨折一期愈合,无手术后再骨折,无内固定切割、髋内翻,主钉断裂及螺旋刀片退出.末次随访评定髋关节功能harris评分:优61例,良16例,可3例,优良率96.3％.结论 PFNA治疗股骨粗隆间骨折创伤小、愈合快,临床治疗效果显著.     

股骨转子周围骨折并股骨中上段骨折的手术治疗

[目的]探讨应用股骨近端髓内钉配合有限切开复位钛捆绑带内固定治疗股骨转子周围骨折并股骨中上段骨折的手术方法和疗效。[方法]对2002年1月～2006年10月收治的21例股骨转子周围骨折并股骨中上段骨折的病人，均采用股骨近端髓内钉固定或配合行有限切开复位钛捆绑带内固定技术治疗。[结果]21例病人全部获得9个月～5年的随访，平均13个月，所有病例均达临床骨性愈合，未出现内固定物折断、松动、脱出等情况。患肢髋膝关节功能均恢复良好。[结论]根据病人的年龄和骨折的类型，采用股骨近端髓内钉或配合行有限切开复位钛捆绑带内固定技术是一种良好的内固定方式，具有创伤小、操作简便易行、固定牢固可靠、利于骨折愈合等优点，良好的保留了患肢的功能。技术的主要关键是在微创的前提下达到解剖复位。     

锯叶棕提取物对人脑胶质瘤细胞凋亡和PI3K蛋白表达影响的研究

目的：通过锯叶棕提取物对人脑胶质瘤细胞的干预,观察人脑胶质瘤细胞中细胞凋亡和PI3K蛋白表达的变化。方法体外培养U251细胞,应用锯叶棕提取物进行预处理,应用TUNEL法检测细胞凋亡,应用Western Blot法检测PI3K蛋白表达水平的变化。结果TUNEL法染色检测锯叶棕提取物对人脑胶质瘤细胞凋亡的影响,24 h与48 h均可见TUNEL阳性反应细胞即凋亡细胞,胞体缩小,形态不规则,胞核固缩浓染,呈棕黄色或棕褐色;1.5μL/mL组48 h与24 h比较,凋亡数量显著增多（P＜0.01）;对照组24 h与48 h偶见凋亡细胞,2.0μL/mL组与1.5μL/mL组比较,凋亡率增大（P＜0.01）。用Western blot法检测锯叶棕提取物对人脑胶质瘤细胞PI3K蛋白表达的影响,锯叶棕提取物预处理U251细胞与对照组比较, PI3K蛋白表达水平显著降低（P＜0.01）。结论锯叶棕提取物能诱导人脑胶质瘤细胞凋亡;锯叶棕提取物诱导人脑胶质瘤细胞凋亡的机制可能是通过阻断PI3K/Akt信号转导通路。     

胫骨高位截骨Giebel刃形钢板与骑缝钉二种内固定方式的比较研究

目的：在应用胫骨高位截骨术(HTO)治疗膝关节骨性关节炎并膝内翻畸形的病例中,比较应用Giebel刃形钢板和骑缝钉二种不同的内固定方式的临床疗效。方法：15例行骑缝钉内固定术及石膏管型外固定,8例行Giebel刃行钢板内固定术。结果：所有病例均获得随访,两组术后6个月HSS评分相比并无统计学意义。在骑缝钉组1例出现断钉,2例丧失纠正角度。结论：Giebel刃形钢板与骑缝钉内固定均体现了满意的临床疗效,但Gieble刃形钢板术后能早期行功能锻炼,并发症更少．     

Quantification of cancellous bone-compaction due to DHS Blade insertion and influence upon cut-out resistance

Background

Compaction of cancellous bone is believed to prevent cut-out. This in vitro study quantified the compaction in the femoral head due to insertion of a dynamic hip screw-blade with and without predrilling and investigated the resulting implant anchorage under cyclic loading.

Methods

Eight pairs of human cadaveric femoral heads were instrumented with a dynamic hip screw-blade made of Polyetheretherketon. Pairwise instrumentation was performed either with or without predrilling the specimens. CT scanning was performed before and after implantation, to measure bone-compaction. Subsequently the implant was removed and a third scan was performed to analyze the relaxation of the bone structure. Commercial implants were reinserted and the specimens were cyclically loaded until onset of cut-out occurred. The bone-implant interface was monitored by means of fluoroscopic imaging throughout the experiment. Paired t-tests were performed to identify differences regarding compaction, relaxation and cycles to failure.

Findings

Bone density in the surrounding of the implant increased about 30% for the non-predrilled and 20% for the predrilled group when inserting the implant. After implant removal the predrilled specimens fully relaxed; the non-predrilled group showed about 10% plastic deformation. No differences were found regarding cycles to failure (P = 0.32).

Interpretation

Significant bone-compaction due to blade insertion was verified. Even though compaction was lower when predrilling the specimens, mainly elastic deformation was present, which is believed to primarily enhance the implant anchorage. Cyclic loading tests confirmed this thesis. The importance of the implantation technique with regard to predrilling is therefore decreased.