股骨粗隆间骨折术后早期负重在适宜人群中的效果

目的 观察股骨粗隆间骨折术后早期负重在适宜人群中的康复疗效。方法 2017年4月至2018年12月,本院骨科Evans-Jensen Ⅱ型股骨粗隆间骨折行股骨近端防旋髓内钉(PFNA)内固定术后,且骨折复位符合股内侧皮质阳性支撑(PMCS)的患者45例随机分成对照组( n= 22)和试验组(n = 23)。对照组于术后6周行耐受性负重,试验组于术后48 h内行耐受性负重,均由每次10 min、每天3次逐渐递增至每次20 min、每天5次,直到骨折临床愈合。比较两组的住院时间、住院费用、骨折临床愈合时间和并发症,术后6周、3个月、6个月比较疼痛视觉模拟评分(VAS)和Harris髋关节评分。结果 试验组住院时间明显短于对照组(t =3.716, P < 0.01);住院费用低于对照组,但无显著性差异( t = 1.540,P > 0.05);骨折临床愈合时间显著短于对照组( t =6.248, P < 0.001)。试验组并发症发生率低于对照组,但无显著性差异( χ² = 2.198, P > 0.05)。术后6周、3个月和6个月,两组VAS均无显著性差异( t < 1.330, P > 0.05)。试验组术后6周Harris髋关节评分显著高于对照组( t = -5.115, P < 0.001),两组术后3个月和6个月无显著性差异(| t| < 1.799, P > 0.05)。 结论 Ⅱ型股骨粗隆间骨折PFNA内固定术后,且骨折复位符合PMCS的患者于术后48 h内行耐受性负重可减少住院时间,促进骨折愈合和早期髋关节功能的康复。     

4-甲酚减轻糖尿病大鼠心肌缺血/再灌注损伤

目的 旨在研究4-甲酚对糖尿病(diabetic mellitus, DM)大鼠心肌缺血/再灌注（myocardial ischemiareperfusion, MI/R）损伤的保护作用,并初步探讨其机制。方法 取雄性SD大鼠,分为正常对照组和糖尿病组。利用高脂饲料联合链脲霉素诱导2型糖尿病大鼠模型。造模成功后,随即分为3组：糖尿病假手术组（DM+Sham）、糖尿病心肌缺血/再灌注组（DM+MI/R）和糖尿病心肌缺血/再灌注+4-甲酚组（DM+MI/R+4-cresol）。4-cresol组采用植入式胶囊渗透压泵给药（5.5 mmol/L 4-cresol,0.15μL/h）,其余给予生理盐水。6周后,采用结扎冠状动脉左前降支30 min再灌注3 h的方法建立心肌缺血/再灌注模型。再灌注结束处死大鼠,检测心肌梗死和细胞凋亡。检测心肌氧化应激程度。测定心肌双底物特异性酪氨酸磷酸化调节激酶1a(dual specificity tyrosinephosphorylation-regulated kinase 1A, Dyrk1A)表达以及细胞凋亡信号调节激酶1(apoptosis sign...     

超声波对痉挛性神经源性膀胱的治疗效果

<正>痉挛性神经源性膀胱指骶段以上脊髓损伤后失去大脑高级排尿中枢调控表现为高张力、高反射的膀胱,多伴有排尿和储尿功能障碍,继而反复泌尿系感染、结石、肾功能衰竭及膀胱癌的发生^[1-3]。研究发现膀胱逼尿肌长期高张力使其内表面膀胱小梁增生,细菌隐藏于膀胱黏膜皱襞中,通过普通膀胱灌注不易清洁继而出现逆行性上尿路感染^[4]。该病的治疗主要为降低高张力逼尿肌,实现低压储尿、低压排尿,控制并消除尿路感染,为膀胱功能恢复创造条件,因其病因复杂,     

补阳还五汤冲洗联合负压封闭引流技术治疗四肢软组织缺损创面的临床研究

目的:探讨补阳还五汤冲洗联合负压封闭引流技术(VSD)治疗四肢软组织缺损创面的临床疗效。方法:将57例慢性四肢软组织缺损创面患者行VSD治疗后随机分为补阳还五汤冲洗组(A组,n=29)和生理盐水冲洗组(B组,n=28),术后观察并比较两组患者的炎症指标变化、细菌培养结果、1周后肉芽组织覆盖率和首次植皮成活率情况。结果:两组患者术后及术后3 d的CRP比较,差异无统计学意义(P0.05),而术后7 d及14 d,A组患者CRP低于B组(P0.05)。两组患者术后即刻、术后3 d、7 d的ESR及白细胞计数比较,差异无统计学意义(P0.05);A组患者术后14 d的ESR及白细胞计数明显低于B组(P0.05)。术后1周A、B组平均肉芽组织覆盖率分别为(81.86±5.74)%和(73.11±4.19)%,两组差异有统计学意义(P0.05)。拆除VSD后细菌培养结果显示:A组阴性为20例(70.0%),明显高于B组的11例(39.3%),差异有统计学意义(P0.05)。A组有24例(82.8%)首次植皮或皮瓣转移成功闭合创面,B组有16例(57.1%)首次植皮成活,两组首次植皮成活率比较,差异有统计学意义(P0.05)。结论:补阳还五汤冲洗联合VSD治疗四肢软组织缺损创面能降低炎症反应、促进肉芽组织生长、缩短植皮时间,提高植皮成活率。     

急性脊髓损伤动物模型的建立与评估

BACKGROUND: There are a variety of methods for modeling spinal cord injury at home and abroad, showing their own advantages and disadvantages, but not yet a kind of objective and standardized model meeting the clinical research. OBJECTIVE:To design a simple impactor used for establishing the spinal cord injury model, then to evaluate the parameters and stability of the Allen’s spinal cord injury model through comparing with the New York University (NYU) impactor established model. METHODS: Female rats were equivalently allotted into five groups: sham-operation group (group A), self-made impactor 5 and 10 cm groups (group B1 and B2) and NYU 1.25 and 2.5 cm groups (group C1 and C2). All groups except group A were subjected to striking at different heights. Behavioral scores were detected at 1, 3, 5 and 7 days after modeling. Nissl staining was used to observe the morphological changes after freezing section and semiquantitative analysis. RESULTS AND CONCLUSION:(1) At the same time point, the behavioral scores, damaged area ratio of spinal cord and semiquantitative analysis of dorsal horn neurons showed significant differences in the group A compared with the other groups, also between groups B1 and B2, and groups C1 and C2 (P < 0.05), but no significant differences were found between groups B1 and C1, as well as groups B2 and C2 (P > 0.05). (2) In the group A, there was a clear boundary between the grey and white matter in a butterfly shape, numerous neurons with large nucleus and obvious nucleolus, and plaques or tabby of Nissl body appeared in the cytoplasm. In contrast, in the other four groups, there were few neurons, different degrees of Gore focal, swelling, demyelinating, and vacuole of cellula could be found, and Nissl body was fuzzy or disappeared. These results administrate that the self-made impactor can establish different damage degrees of spinal cord inury models, which are close to the NYU-made models. Moreover, it can be helpful for study on spinal cord injury for reasons of good stability, low cost, and operated easily. 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程