Longitudinal diffusion tensor imaging of patients with degenerative cervical myelopathy following decompression surgery

Previous studies have reported the utility of diffusion tensor imaging (DTI) as an imaging biomarker for the severity of myelopathy and subsequent surgical outcome in patients with degenerative cervical myelopathy (DCM). We hypothesized that DTI may reflect neurological recovery following surgery. The purpose of this study was to evaluate the ability of DTI to assess the post-operative alteration of neural status in patients with DCM as well as to predict post-operative recovery. We enrolled 15 patients with DCM who underwent decompression surgery. The Japanese Orthopaedic Association (JOA) score was evaluated before and 1 year after surgery. The participants were examined using DTI on a 3.0 T magnetic resonance scanner before, and 1 year after surgery. Fractional anisotropy (FA) and mean diffusivity (MD) were assessed for both time points. The correlations between the pre- and post-operative FA and MD values and the pre- and post-operative JOA scores were analyzed. Although the JOA score improved significantly after surgery from 8.9 to 12.3, there was no significant change between the pre- and post-operative FA and MD values. The post-operative outcomes after 1 year moderately correlated with the pre-operative FA values (Spearman’s ρ = 0.55, p = 0.03 and Spearman’s ρ = 0.56, p = 0.03 for change and recovery rate of the JOA score, respectively). However, there was no correlation between the post-operative FA and post-operative JOA scores nor between MD and clinical outcomes. DTI cannot be utilized as a biomarker for post-operative alterations of neural status of the spinal cord; however, pre-operative DTI may be useful as a predictor of surgical outcomes.     

大鼠原位和异位小肠移植慢性排斥反应模型的制作与比较

目的  比较大鼠原位和异位小肠移植慢性排斥反应模型的建模效果。方法  采用F344(RT1^1vr)大鼠作为供体, Lewis (RT1¹)大鼠作为受体, 构建异系异位和原位大鼠小肠移植模型(各8只), 术后0~14 d给予皮下注射环孢素。观察术后受体的体质量变化及存活时间。采用苏木素-伊红(HE)染色观察肠组织病理学变化, 酒精苏木素染色后观察肠组织胶原纤维和弹性纤维的变化。计算两组受体大鼠的成模率。结果  异位和原位小肠移植大鼠均能长期存活, 大部分超过90 d。原位小肠移植组大鼠术后第3日恢复正常饮食, 于术后14 d左右体质量可恢复至术前水平, 之后缓慢增长, 但大部分原位小肠移植大鼠在术后150 d出现持续的体质量下降, 且不能被环孢素逆转。异位小肠移植组大鼠术后第1日恢复进食, 于术后25~30 d才能恢复至术前的体质量水平, 术后30~90 d期间, 体质量逐渐上升并保持在较高水平。原位小肠移植组大鼠术后90 d的小肠组织未出现慢性排斥反应的病理学改变且未见明显纤维化, 术后163 d和术后200 d的小肠组织出现慢性排斥反应的病理学改变, 且出现移植小肠系膜纤维化。异位小肠移植组大鼠术后90 d和术后200 d的小肠组织均出现典型的慢性排斥反应的病理学改变和移植小肠系膜纤维化。异位小肠移植组全部出现特征性病理改变, 成模率为100%, 与原位小肠移植组成模率75%比较, 差异无统计学意义(P > 0.05)。结论  应用F344→Lewis大鼠组合建立原位和异位小肠移植模型, 术后给予小剂量环孢素, 均可在术后不同时间点出现慢性排斥反应。与原位大鼠小肠移植模型相比, 大鼠异位小肠移植模型建模操作简单, 慢性排斥反应成模时间较短, 病理改变程度相对一致, 更适合用于实验研究。     

Total hip arthroplasty for posttraumatic osteoarthritis following acetabularfracture: A systematic review of characteristics, outcomes, and complications

Purpose: Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. Methods: Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords “acetabular”, “fracture”, “arthroplasty”, and “post traumatic arthritis” published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. Results: With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. Conclusion: Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.     

胚胎移植术后17例宫内外同时妊娠分析及文献复习

目的探讨胚胎移植术后宫内外同时妊娠的发生率、影响因素、诊断和治疗,以加强临床医生对宫内外复合妊娠的认识。方法回顾性分析我中心2011年1月1日至2014年12月31日胚胎移植术后发生宫内外同时妊娠的17例病例的临床资料。结果我中心2011年1月至2014年12月31日试管婴儿助孕中宫内外同时妊娠发生率为0.26%(17/6 623),全部17例宫内外同时妊娠均由阴道超声确诊。其中腹腔镜手术切除妊娠侧输卵管14例,腹腔镜下妊娠侧宫角楔形切除1例,经阴道穿刺减胎手术1例,宫内胎儿均存活;保守治疗1例,宫内胚胎停育。结论经阴道超声早期诊断、动态监测是提高宫内外同时妊娠诊断率的可行方法,腹腔镜手术是治疗宫内外同时妊娠的有效方法。     

单节段Bryan人工颈椎间盘置换术后异位骨化的发生率和疗效观察

目的评估单节段Bryan人工颈椎间盘置换术后异位骨化发生情况,分析异位骨化对术后疗效影响。方法回顾分析2005年10月-2007年10月48例行单节段Bryan人工颈椎间盘置换术患者临床资料。男27例,女21例;年龄33～51岁,平均40.5岁。脊髓型颈椎病8例,神经根型颈椎病27例,混合型颈椎病13例。病程2～14个月,平均10.3个月。病变节段:C3、43例,C4、56例,C5、630例,C6、79例。术后采用疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、置换节段活动度评价疗效;并将患者按术后是否发生异位骨化分为两组,比较术后1、2、3、4年以上各指标差异。结果患者术中及术后均无严重并发症发生。48例均获随访,随访时间48～72个月,平均56.6个月。术后各时间点VAS评分及NDI均较术前显著改善(P<0.05);除术后3 d,其余各时间点置换节段活动度与术前比较差异均无统计学意义(P>0.05)。术后4年共13例(27.08%)发生异位骨化,其中1级8例,2级3例,3级2例。异位骨化组和无异位骨化组患者术后各时间点置换节段活动度及VAS评分、NDI比较,差异均无统计学意义(P>0.05)。结论单节段Bryan人工颈椎间盘置换术后异位骨化发生率相对较高,异位骨化对人工颈椎间盘置换节段活动度影响较小,对术后疗效无明显影响。     

兔肢体软组织开放性损伤合并海水浸泡伤对骨膜的影响

目的 探讨兔肢体软组织开放性损伤合并海水浸泡伤对骨膜的影响.方法 新西兰大白兔48只,于兔双后肢制备肢体软组织开放性损伤模型,分为3组:单纯致伤组(A组)、海水浸泡30min组(B组)、海水浸泡1 h组(C组).分别于致伤后0、1、3、7 d时取骨膜做组织学观察及骨形态发生蛋白(BMPs)、血管内皮生长因子(VEGF)表达检测.结果 (1)肢体软组织开放性损伤合并海水浸泡伤后骨膜炎症反应明显重于单纯致伤组,浸泡时间越长,骨膜炎症反应越重.(2)海水浸泡30 min后,膜内成骨延缓不明显.浸泡1 h后,膜内成骨明显延缓.(3)C组BMPs及VEGF表达时间明显延迟且明显弱于A组、B组,B组BMPs及VEGF表达时间虽未延迟但弱于A组.结沦肢体软组织开放性损伤合并海水浸泡1 h后,可明显延迟并损害骨膜膜内成骨能力.     

小肠异位胰腺 1例报告及文献复习

目的探讨异位胰腺的诊治，提高对该疾病的认识以减少误诊。方法回顾性分析 1例小肠异位胰腺病人的临床表现、诊断及治疗经过，结合文献分析其组织病理分型、临床表现和治疗经验。结果病人因“突发腹痛 1d”入院。入院后在全麻下急诊行开腹探查术，于术中见“小肠表面可及一肿物，肿物穿孔可见小肠内容物溢出”。术后病理证实肿物为异位胰腺。术后恢复满意，术后第 90天随访无并发症及影像学检查异常。结论异位胰腺属于一种先天性异常，缺乏特异性诊断方法，早期多无症状，因此可保守治疗；如有症状或术中意外发现为异位胰腺组织时，可手术切除。     

手术联合超选择性动脉栓塞治疗异位骨化

目的根据创伤性异位骨化血管造影表现及供血特点,探讨超选择性动脉栓塞联合手术治疗异位骨化的有效性。方法随机选取25例异位骨化患者,12例给予手术+超选择性动脉栓塞(栓塞组),13例不予栓塞,按传统治疗方案在异位骨化成熟后给予手术切除(传统治疗组),比较两组手术中失血量、术后血红蛋白下降值、关节功能表现、复发率。结果12例患者血管造影显示,局部血管过度增生、微血管瘤形成是创伤性异位骨化形成和复发的病理基础。术中失血量栓塞组为(450±120)ml,与传统治疗组(800±130)ml比较,差异有统计学意义(P<0.01);术后血红蛋白下降值栓塞组与传统治疗组比较,差异有统计学意义(P<0.01);关节功能优良率栓塞组为83%,与传统治疗组46%比较,差异有统计学意义(P<0.05);1年复发率栓塞组为0,传统治疗组为15%(2例)。结论超选择性动脉栓塞联合手术治疗能够有效减少术中失血量,早期干预并提高异位骨化的治疗成功率,是一个有前景的治疗手段。     

骨化性气管支气管病的CT诊断

目的 探讨骨化性气管支气管病的CT特征，提高对该病的认识。方法 回顾分析6例经病理证实的骨化性气管支气管病的CT表现。结果 CT主要表现为气管、主支气管前壁和侧壁黏膜下散在或多发的斑块状小结节突起，突向管腔，部分结节钙化，大多数小结节直径在2～4mm，有2例在叶支气管可见；2例同时出现气管壁增厚，气管环变形，管腔狭窄。结论 气管、主支气管内多发的黏膜下小结节钙化影并突向管腔是骨化性气管支气管病较具特征性的CT表现。     

超声心动图评价大鼠异位移植心脏急性排斥反应的初步实验研究

目的:探讨高频超声心动图评价大鼠颈部异位移植心脏的急性排斥反应的价值。方法:采用高频超声心动图测量17只同种异体移植及6只同系移植心脏测量左室内径、心肌厚度、左室重量和心功能等。6只同系移植大鼠和9只同种异体移植大鼠,分别于移植术后第1、3、5天,采用高频超声对上述指标进行测量,第五天测量完毕后处死并做病理检查。另8只同种异体移植心脏,分别于移植术后第1、3天各测量一次,第3天测量完毕后处死做病理学检查,超声指标与病理结果相对照。结果:①同种异体移植术后,随着移植时间的延长,左室心肌厚度和左室重量逐渐增加,左室内径减小,射血分数无显著性改变;②术后第3天,组织学检查表明已有排斥反应发生,超声检查显示室壁厚度与左室重量明显增加,而常规心脏触诊未能及时发现排斥反应;③随着组织学分级加重显示的排斥,左室心肌厚度与左室重量有显著的增加。结论:室壁厚度和左室重量为超声评价排斥反应发生的敏感、准确指标。高频超声为心脏移植实验研究评价排斥反应提供了一种较为简便可靠的观察方法,为临床上心脏移植的排斥反应的超声评价提供了依据。