两种术式治疗迟发性下尺桡关节脱位疗效的回顾性分析

目的比较闭合复位经皮克氏针内固定与旋前方肌部分转位经皮克氏针内固定治疗迟发性下尺桡关节背侧脱位的疗效。方法回顾性分析自2007-03—2016-06诊治的28例迟发性下尺桡关节背侧脱位,15例采用闭合复位经皮克氏针内固定(对照组),13例采用旋前方肌部分转位经皮克氏针内固定(观察组)。比较2组术后16、28、48周腕关节功能Cooney评分,以及并发症情况。结果 28例均获得48周随访。2组术后16周腕关节功能Cooney评分比较差异无统计学意义(P0.05)。观察组术后28、48周腕关节功能Cooney评分高于对照组,差异有统计学意义(P0.05)。2组术后并发症发生率比较差异无统计学意义(P=0.430)。结论与闭合复位经皮克氏针内固定比较,采用旋前方肌部分转位经皮克氏针内固定治疗的迟发性下尺桡关节背侧脱位患者腕关节功能恢复快且更满意,而且手术安全、并发症少。     

Barton骨折术后联合应用鹿瓜多肽疗效观察

目的观察鹿瓜多肽注射液在Barton骨折术后患者中应用的临床疗效。方法33例Barton骨折术后患者,分为二组：术后应用鹿瓜多肽组15例,根据说明书推荐剂量鹿瓜多肽注射液组应用鹿瓜多肽注射液8～12ml＋生理盐水250ml静脉滴注1次／d,15d为1个疗程。单纯手术组18例。术后二组均辅以腕关节功能练习,术后观察骨折愈合时间及术后1,3,6,12个月观察腕关节功能评分。结果33例患者均获得随访12个月,鹿瓜多肽注射液组骨折愈合时间明显短于单纯手术组（P〈0．05）,Cooney腕关节评分在1,3个月时差异有统计学意义（P〈0．05）,6,12个月差异无统计学意义（P〉0．05）。结论鹿瓜多肽注射液能够缩短骨折愈合时间,减轻术后患肢肿痛,可加快早期关节功能锻炼,从而早期改善腕关节活动功能,但长期观察无明显差异。     

颈椎病前路手术中体感诱发电位监护临床研究

目的探讨体感诱发电位监护(SSEP)在颈椎病前路手术中的应用价值。方法收治颈椎病前路手术患者142例,年龄37~75岁,男96例,女46例。神经根型颈椎病35例,脊髓型颈椎病107例。对照组83例无SSEP监护,监护组59例。在麻醉诱导后和摆放体位前确立SSEP基线,波幅降低50%或潜伏期延长10%为报警标准。记录SSEP报警因素及改善措施,术后明确有无医源性神经损伤。结果对照组无医源性神经损伤。监护组:真阳性2例出现报警,采取措施后解除报警;假阳性0例;真阴性56例SSEP无报警,无医源性神经损伤;假阴性1例SSEP无报警,术后右侧三角肌麻痹;SSEP监护医源性神经损伤的敏感性和特异性分别为66.7%和100%。结论 SSEP在颈椎病前路手术中监护脊髓损伤方面较敏感,对神经根损伤不敏感。     

还原型谷胱苷肽对骨髓基质干细胞增殖及向神经样细胞分化的影响

BACKGROUND:As bone marrow stromal stem cells can be easily obtained and have multi-directional differentiation potential, it is an important approach to obtain neural stem cells for treatment of spinal cord injury through induced differentiation of bone marrow stromal stem cells. OBJECTIVE:To observe the effects of different concentrations of reduced glutathione on proliferation and neuronal differentiation of bone marrow stromal stem cells. METHODS:Bone marrow stromal cells were isolated and cultured by limited dilution method. The cloned bone marrow stromal cells were stimulated with reduced glutathione at different concentrations (0, 5, 10, 20, 40 mmol/L) respectively. After 72 hours of culture, proliferation of bone marrow stromal cells was examined by MTT assay. The morphology of bone marrow stromal cells was observed under inverted microscope and the cells were identified by immunofluorescence staining of microtubule associated protein-2 and glial fibrillary acidic protein. RESULTS AND CONCLUSION:We found that 5 mmol/L reduced glutathione medium could promote the proliferation of bone marrow stromal cells (P < 0.05), but reduced glutathione at 20 and 40 mmol/L inhibited the cell proliferation (P < 0.05). The number and size of cell colonies in the 10 mmol/L reduced glutathione group had no obvious difference from the control group. Reduced glutathione at 10 mmol/L was powerful to induce the neuronal differentiation of bone marrow stromal stem cells, and most cells expressed microtubule associated protein-2 and glial fibrillary acidic protein. A random selection of 5 fields of view was conducted and percentage of bone marrow stromal cells differentiating into neuron-like cells was calculated as (62.0±4.8)%. These results confirmed that low-concentration (5 mmol/L) reduced glutathione can promote the proliferation of bone marrow stromal cells, while 10 mmol/L reduced glutathione has a strong induction of bone marrow stromal cells differentiating into neuron-like cells.