改良以聚羟基乙酸为支架同种异体组织工程化塑形软骨的构建

OBJECTIVE: To improve the method for constructing allogeneic molded cartilage by means of tissue engineering techniques. METHODS: The chondrocytes from the rib and articular cartilage of infant rabbits were harvested by type II collagenase digestion, followed by in vitro cell culture for 3 to 4 passages. The chondrocytes were then prepared into cell suspension and seeded onto C -and O -shaped pre-molded polyglycolic acid (PGA) scaffolds form chondrocyte-PGA composites, which were subsequently cultured in vitro for 7 to 10 d before implanted subcutaneously into adult rabbits. Improvement was made upon conventional shaping and implantation procedures. Morphological observation and cartilage regeneration assessment were conducted at different time points following the implantation, in comparison with the observation by conventional shaping and implantation methods. RESULTS: During in vitro cell culture, the rate of viable chondrocytes in the final cell suspension was (92+/-2)% after well-controlled prolongation of digestion trypsin, similar to the viable cell rate (93+/-2) % by traditional procedures (P>0.05). Gross observation found milk-white, newly generated cartilage which had good flexibility 4 weeks after implantation, and after 8 weeks and later, the cartilage took on the color of porcelain-white. Histological examination showed a few inflammatory cells around the newly generated immature cartilage 4 weeks after implantation, and the inflammation abated when the newly generated cartilage acquired similar histological properties to that of the original cartilage 8 weeks postoperatively and later. After 16 weeks, no blood vessel or capillaries were visible within the new cartilage. CONCLUSION: The chondrocyte viability is not affected when the cells are treated with well-controlled prolonged digestion with trypsin during in vitro cell culture. Improved PGA scaffolds shaping and the implantation procedure facilitate the regeneration of the cartilage after the implantation of the composites.     

前路枕骨髁至枢椎螺钉内固定技术

该文作者报道一种前路自枢椎经两侧寰枢关节至枕骨髁螺钉内固定的枕颈融合技术,并与传统的后路枕颈融合内固定技术进行生物力学比较研究。具体方法是:采用6具新鲜成人完整标本,将枢椎齿突予以切除造成枕寰枢不稳,分别采用后路钢丝结扎、后路C1/C2经关节螺钉加钢板内固定和前路枢椎至枕骨螺钉内固定技术进行枕颈融合,每组各2具标本。运用光电测定系统对三组标本进行生物力学测定,主要检测各运动节段(Oc～C1、Cl～2)之间的运动范围(ROM)和中立区(NZ)的运动参数。对实验数据进行统计学分析。结果显示:在屈曲和伸展运动时,后路经关节螺钉加钢板内固定具有最大的力学稳定性,优于后路钢丝结扎和前路枢椎一枕骨螺钉技术。在侧屈和旋转运动时,前路枢椎一枕骨螺钉技术与后路经关节螺钉加钢板内固定技术在生物力学稳定性上无显著差异,均优于后路钢丝结扎技术。该文作者认为,前路枢椎一枕骨螺钉技术在枕颈融合时,可提供足够的力学稳定性;其技术设计简单,符合微创原则,尤其适用于后路枕颈融合失败后的翻修手术。     

臀位孕期矫治的临床探讨

1 资料与方法1.1 资料 从1990年6月至1995年12月,我院产科门诊孕期检查为臀位,孕28～37周采用综合治疗1401例设甲组,矫治无效,排除禁忌症,术前B超检查,口服硫酸舒喘灵4.8mg,行改良式臀位外侧转术105例为乙组。1.2 方法1.2.1 综合治疗 艾炙、姜炙双足至阴穴,膝胸卧位,甩臀法等,单用或两法同用,7天为1疗程。1.2.2 改良臀位外倒转术 术前B超了解臀位分类、胎方位、羊水量,胎盘附着、脐带有无缠绕,排除禁忌症,术前30min至1h口服硫酸舒喘灵4.8mg,排尿后仰卧床上,常规产检后,稍抬高头部,双腿屈曲使腹壁松弛,术者一手从耻上上托胎臀使其离开骨盆入口平面,另一手握住胎头向胎儿腹侧俯曲下推,两手交替托不放开。胎位转成横位时可稍停,利用胎儿自身活动轻推胎头可转为头位,其间可监护胎心2     

单纯后路复位及固定治疗自发性寰枢椎脱位

目的 利用单纯后路复位,同时行内固定治疗寰枢椎脱位的方法,既不需要颅骨牵引,也不需经口腔齿状突切除.方法 2004年5月至2007年12月,收治自发性寰枢椎脱位病人20例,手术前后利用CT及MRI进行影像学测量,评价脱位及脊髓延髓受压程度.根据是否合并寰枕融合分别采用C1侧块～C2椎弓根螺钉技术3例及C2椎弓根～枕骨螺钉技术17例.手术中向前推压C2棘突或通过C2椎弓根及枕骨螺钉间撑开将齿状突向前、下牵拉以恢复齿状突与C1前弓的解剖关系.结果 20例病人随访6-48个月,1例术后1周因基底动脉内血栓形成死亡,其余19例均明显改善.手术后影像学检查见脊髓延髓均获彻底减压,合并脊髓空洞的5例病人,空洞均明显缩小;各项影像学测量指标均明显好转(P<0.01).1例于术后3个月时CT提示复位部分丢失,但螺钉位置良好,脊髓延髓减压良好,脊髓空洞继续缩小,6个月时骨性融合.结论 首先选择后路复位及固定,而不是前路经口腔齿状突切除减压,是治疗寰枢椎脱位简单有效,相对安全的方法.     

一株曲霉果糖转移酶的发酵条件及转果糖基活性

对一株曲霉果糖转移酶菌株的产酶培养条件进行了研究。确定了最佳培养基组成：初始蔗糖质量浓度15～18g／dL，氮源为酵母膏，K2HPO4对果糖转移酶的产生具有明显的促进作用，添加0．2g／dLCMC能够使果糖转移酶活力提高到原来的1．3倍，在pH5．5，30℃条件下，果糖转移酶最高酶活力为30．42U／mL。HPLC分析结果表明，转糖基产物为总质量的55．8％。     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

寰枢椎间侧方穿刺定位和定深的观测

目的为寰枢椎间侧方穿刺提供解剖学依据及穿刺点和穿刺深度的确定方法。方法观测40例头部正中矢状切标本的寰枢椎间孔逆向穿刺点、舌骨平面的横径半宽及穿刺深度、寰枢椎间孔的上下径和前后径、穿刺点距下颌角点和乳突尖的距离。结果穿刺点在以O点为圆心,半径为0.5cm范围内的占87.5%,在范围以外的占12.5%;穿刺深度为(5.17±0.83)cm。结论以O点为穿刺点,穿刺针尖指向椎管后1/3,穿刺方向垂直于矢状面,穿刺深度为4.40～6.30(5.17±0.47)cm较为安全。     

应用枢复宁治疗15例自体骨髓移植预处理的呕吐

应用枢复宁治疗１５例自体骨髓移植预处理的呕吐福建医学院附属协和医院血液病研究所净化室赖尾兰枢复宁作为一种新型的止吐药物，对肿瘤化疗引起的呕吐有明显的止吐作用。但在自体骨髓移植患者中，由于其在两天内使用超大剂量的化疗药物，故应用枢复宁有其独特的作用，现...