钢丝内固定治疗后交叉韧带胫骨止点撕脱骨折

目的:应用钢丝通过钻孔牵拉内固定治疗后交叉韧带胫骨止点撕脱骨折,评价疗效。方法:2003年1月至2009年6月,28例膝关节后交叉韧带胫骨止点撕脱骨折患者,男19例,女9例;年龄16～55岁,平均35.3岁。X线检查示骨折移位:Ⅱ度10例,Ⅲ度18例。采用膝关节后内侧倒"L"形入路切开复位,以钢丝内固定治疗,术后可调节支具固定,术后2周在CPM辅助下膝关节被动伸屈训练,4周在支具保护下下地部分负重,术后6周拆除支具。结果:25例患者获随访,时间6～24个月,平均15个月。X线片示骨折复位满意,所有患者获得骨性愈合,膝关节稳定,Lachman试验阴性,未发生骨折不愈合和关节僵硬等并发症。伸膝活动度正常,屈膝活动度(136±12)°。采用Lysholm膝关节评分法评估,术前(41.80±6.16)分,术后6个月(94.10±8.26)分,术前术后比较,差异有统计学意义(t=26.667,P<0.01)。术后评定优22例,良2例,可1例。结论:应用膝后内侧倒"L"形入路以钢丝内固定治疗后交叉韧带胫骨止点撕脱骨折具有安全有效、内固定可靠、费用少等优点,可有效重建膝关节的稳定,恢复膝关节功能,是治疗后交叉韧带胫骨止点撕脱骨折较理想的选择。     

Study on chondrogenic differentiation of canine mesenchymal stem cells induced by Type 2 recombinant adeno-associated viral mediated transfer of hTGF-β1

Objective To investigate the potential application of human transforming growth factor-beta-1 (hTGF-β1) gene mediated by type 2 recombinant adeno-associated virus (rAAV2) vector inducing chondrogenic differentiation of canine mesenchymal stem cells (MSCs) in vitro. Methods Canine MSCs from bone marrow were isolated and cultured in vitro by density gradient centrifngation and adherence screening methods. The morphology of MSCs was observed by inverted phase contrast microscope and Giemsa stain. Flow eytometry was used to detect surface antigens of MSCs, The third generation of MSCs were transfected by rAAV2-hTGF-β1 with or without MOI of 1 ×105 v.g./cell or 5×105 v.g./cell. The expression of hTGF-β1 was detected by Western blot after 10 days, and TGF-β1 synthesis was determined by ELISA at 3, 6 and 9 day, respectively. After 2 weeks of culturing, mRNA expressions of type Ⅱ collagen and aggrecan were determined by RT-PCR and the collagen Ⅱ protein was detected by immunocytochemistry. Results The MSCs appeared to be morphologically spindle-shaped and showed active capability of proliferation both in primary and passage generations. Flow cytometry analysis indicated that MSCs were universally positive for CD29, CD44 and CD105, but negative for CD34 and CD45. TGF-β1 expression can be observed by Western blot after 10 days in two transfection groups, MOI of 5 × 105 group and MOI of 1× 105 group. With the extension of time, the contents of hTGF-β1 increased in the two groups detected by ELISA, while there was a significant difference between them two (P < 0.01). After 2 weeks of transfection of MSCs by rAAV2-hTGF-β1, the expression of collagen Ⅱ and Aggreacan mRNAs were positive. It also showed positive of collagen Ⅱ detected by immunocytochemistry. Conclusion Canine MSCs show chondrogenesis differentiation after induction by Type 2 rAAV mediated transfer of TGF-β1 gene. The process is a potential application for cartilage tissue engineering.     

Study on chondrogenic differentiation of canine mesenchymal stem cells induced by Type 2 recombinant adeno-associated viral mediated transfer of hTGF-β1

Objective To investigate the potential application of human transforming growth factor-beta-1 (hTGF-β1) gene mediated by type 2 recombinant adeno-associated virus (rAAV2) vector inducing chondrogenic differentiation of canine mesenchymal stem cells (MSCs) in vitro. Methods Canine MSCs from bone marrow were isolated and cultured in vitro by density gradient centrifngation and adherence screening methods. The morphology of MSCs was observed by inverted phase contrast microscope and Giemsa stain. Flow eytometry was used to detect surface antigens of MSCs, The third generation of MSCs were transfected by rAAV2-hTGF-β1 with or without MOI of 1 ×105 v.g./cell or 5×105 v.g./cell. The expression of hTGF-β1 was detected by Western blot after 10 days, and TGF-β1 synthesis was determined by ELISA at 3, 6 and 9 day, respectively. After 2 weeks of culturing, mRNA expressions of type Ⅱ collagen and aggrecan were determined by RT-PCR and the collagen Ⅱ protein was detected by immunocytochemistry. Results The MSCs appeared to be morphologically spindle-shaped and showed active capability of proliferation both in primary and passage generations. Flow cytometry analysis indicated that MSCs were universally positive for CD29, CD44 and CD105, but negative for CD34 and CD45. TGF-β1 expression can be observed by Western blot after 10 days in two transfection groups, MOI of 5 × 105 group and MOI of 1× 105 group. With the extension of time, the contents of hTGF-β1 increased in the two groups detected by ELISA, while there was a significant difference between them two (P < 0.01). After 2 weeks of transfection of MSCs by rAAV2-hTGF-β1, the expression of collagen Ⅱ and Aggreacan mRNAs were positive. It also showed positive of collagen Ⅱ detected by immunocytochemistry. Conclusion Canine MSCs show chondrogenesis differentiation after induction by Type 2 rAAV mediated transfer of TGF-β1 gene. The process is a potential application for cartilage tissue engineering.     

基于智能模拟人的医学模拟教学效果评价

目的研究某三级医院医学生对基于高端智能模拟人的医学模拟教学效果评价,进一步推动教学改革,创新医学教育方式。方法采用学习成效量表和教学设计量表,以某医院临床内科学36名研究生为研究对象,采用美国国家护理联盟的学习成效量表和中文版Jeffries模拟教学设计量表在模拟教学前后各进行一次问卷调查,分析学生对教学效果和课程设计态度。结果36人均现场完成两次问卷填写,近90%的学生听说过模拟教学并感兴趣,但仅58%了解过模拟教学。在学习成效调查评价中,模拟教学设备与资源、引导性反馈、临床能力、自信心、解决问题能力和合作能力等6个维度均高于传统临床教学模式(P<0.05),教学方法5个维度评价也高于传统临床教学(P<0.05),但两种教学模式在课程安排上差别无统计学意义(P>0.05)。结论模拟教学在学习成效和教学方法上总体优胜于传统临床教学,学生收获更多,满意度更高。     

1990—2019年中国髋部骨折疾病负担与趋势变化分析

目的 分析1990—2019年中国髋部骨折的疾病负担变化及趋势,为髋部骨折预防提供参考。方法 收集全球健康数据交换（Global Health Data Exchange,GHDx）数据库中我国1990—2019年的骨折的疾病负担数据,包括发病率、患病率、过早残疾损失健康生命年（Years Lived with Disability,YLDs）、致伤原因。采用熵权法求出各骨折类型的熵权值,并根据性别和年龄对权重最大的骨折类型进行分层,利用Joinpoint回归模型,获得其发病率、患病率、YLDs的平均年度变化率（Average Annual Percent Change,AAPC）。结果 1990—2019年间,髋部骨折是对疾病负担影响最大的骨折类型。中国髋部骨折患者的发病率、患病率整体均呈上升趋势（AAPC值分别为1.6%、1.7%,P值均小于0.05）;中国女性患者负担水平高于男性患者,年龄标化的发病率、患病率、YLDs分别为121.16/10万、151.84/10万、13.50/10万;年龄组中,45岁以上的年龄组的发病率、患病率整体呈上升趋势,80岁以上患者的疾病负担持续加重（AAPC值分别为2.9%、3.1%、0.9%,P值均小于0.05）;在各致伤原因中,“意外伤害”导致的发病率、患病率的AAPC最高（分别为1.7%、1.3%,P值均小于0.05）,且YLDs下降幅度有限（AAPC值为-0.2%,P<0.05）。结论 随着我国老龄化的加剧,应当加大对高龄患者尤其是女性高龄患者的髋部骨折预防力度,以骨折疏松诊疗为抓手,重点防止意外伤害的发生。     

基于GBD大数据中国膝骨关节炎疾病负担现状与趋势分析

目的 分析中国1990—2019年膝骨关节炎的疾病负担以及变化趋势,为我国膝骨关节炎的防控和治疗工作提供参考依据。方法 利用GBD2019年的数据库,采用标化发病率、标化患病率及标化DALYs率对我国膝骨关节炎的疾病负担以及变化趋势进行分析,并与美国和全球膝骨关节炎的疾病负担情况进行对比。结果 1990—2019年,中国膝骨关节炎新发病人数从368.39万人增至842.58万人,患病人数从4 257.08万人增至10 812.01万人,DALYs从136.52万人年增至346.48万人年,经过年龄标准化后的发病率、患病率、DALYs率呈上升趋势,增长率分别为6.65%、6.85%和7.18%（AAPC均为0.2%,t分别为6.9、6.1和6.7,P均＜0.05）。年龄组方面,1990—2019年,45岁以上的人群的膝骨关节炎的患病率、DALYs率呈缓慢上升趋势,两项指标均在70岁以上年龄组达最高;而发病率的高峰在50～54岁年龄段。性别组方面,2019年的女性膝骨关节炎标化发病率、标化患病率、标化DALYs率分别为男性的1.64倍、1.72倍、1.70倍。另外,中国膝骨关节炎的标化DALYs率的平均水平高于美国和全球。结论 我国膝骨关节炎的疾病负担较重。应加强中老年人膝骨关节炎的预防,重点关注女性中老年人。     

骨形态发生蛋白和纤维蛋白复合物修复关节软骨全层缺损

目的　探讨骨形态发生蛋白/纤维蛋白载体(BMP/FG)复合物修复关节软骨缺损的效果。方法　30只新西兰种成年兔随机分为A,B,C三组,每只兔子左膝股骨髁间凹做一大小为4mm×5mm×25mm的全层关节软骨缺损。A,B组缺损内分别填充BMP/FG及FG,C组为空白。术后16周对缺损修复情况行大体形态和组织学观察。结果　BMP/FG组,植入物完全被吸收并被新生软骨替代,新生软骨特征与邻近正常软骨相似,而FG组和空白组大体形态和组织学特征基本相似,以纤维组织修复为主。结论　BMP/FG能在关节腔内诱导软骨再生,并能以透明软骨修复全层关节软骨缺损     

硫酸氨基葡萄糖和透明质酸钠治疗髌股关节骨关节炎的研究

目的：观察硫酸氨基葡萄糖和透明质酸钠治疗膝关节髌股关节骨关节炎的疗效及安全性。方法：86例髌股关节骨关节炎病人随机分为硫酸氨基葡萄糖组（A组）和透明质酸钠组（B组）,每组43例。A组口服硫酸氨基葡萄糖胶囊每次2粒,每日3次,连续服用12周。B组关节内注射透明质酸钠2mL,1次/周,共5次。随访半年观察其临床疗效及不良反应。结果：硫酸氨基葡萄糖治疗骨关节炎总有效率为83.7%,透明质酸钠组总有效率为86%,两组病人生活质量明显提高,经比较差异无统计学意义（P〉0.05）。A组和B组不良反应发生率分别为2.3%和9.3%,两组差异有统计学意义（P〈0.05）。结论：硫酸氨基葡萄糖和透明质酸钠治疗膝关节髌股骨关节炎均可以改善临床症状,硫酸氨基葡萄糖不良反应较少。     

掺锶聚磷酸钙的细胞相容性

摘要 背景：研究显示，以可降解生物陶瓷聚磷酸钙为基材，加入微量锶元素，通过调控材料结构如孔径、孔隙率等性能，可制备出有足够力学强度并可控降解的掺锶聚磷酸钙。 目的：观察成骨细胞与掺锶聚磷酸钙的细胞相容性。 方法：将兔成骨细胞与不同含锶质量分数(0~100%)的掺锶聚磷酸钙体外复合培养，进行形态学和功能测定。MTT法检测掺锶聚磷酸钙中成骨细胞的活力，并测定成骨细胞碱性磷酸酶活性。 结果与结论：在倒置显微镜、扫描电子显微镜和激光共聚焦显微镜下观察到成骨细胞在掺锶聚磷酸钙的表面和孔隙内大量黏附、增殖和生长，并且分泌细胞外基质及细胞表面的大量微绒毛，显示成骨细胞在掺锶聚磷酸钙材料上生长形态良好；同时通过MTT和碱性磷酸酶测定表明细胞功能良好，其中含锶1%掺锶聚磷酸钙细胞增殖活性及碱性磷酸酶活性最高，对成骨细胞无毒性，具有良好的细胞相容性。 关键词：掺锶聚磷酸钙；成骨细胞；锶；细胞相容性；生物材料 doi:10.3969/j.issn.1673-8225.2010.42.013