Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

Objective： To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty （THA） for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fractures.
Methods： Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department. There were 10 males and 5 females with mean age of 48.2 years （ranging from 36 to 73 years）. Eight cases had the fracture at left hips, 7 at right hips. The average age at injury was 28 years （ranging from 18 to 68 years）. The mean follow-up period was 4.3 years （ranging from 2 to 7 years）. Results： Compared with mean 42 points （ranging from 10 to 62） of the preoperative Harris score, the survival cases at the final follow-up had mean 84 points （ranging from 58 to 98）. One patient had mild pain in the hip. No revision of the acetabular or femoral component was undertaken during the follow-up. Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side. All of them had a stable radiographic appearance. Progressive radiolucent lines were observed in Ⅰ,Ⅲ zones in 2 cases. One patient had a nonprogressive radiolucent line in zone Ⅲ. The cup prosthesis was obviously displaced （6 mm） in one patient, but had not been revised.
Conclusion： Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture, which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.     

椎间盘镜与胶原酶治疗腰椎间盘突出症的初步比较

目的　比较行椎间盘镜与胶原酶化学溶解术治疗腰椎间盘突出症的疗效等一系列问题。方法　随机抽取同期采用上述两种方法治疗病例各 97例 ,对其临床疗效 ,住院费用、住院天数、适应证及禁忌证等问题比较分析。结果　两种治疗方法总有效率分别为 95 %、87.6 % ,平均住院费分别为 86 5 8元和 2 746元 ,住院天数分别为 6 .5天和 5 .5天 ,前者适应证较后者广泛 ,禁忌证较少。结论　上述方法治疗腰椎间盘突出症均具有创伤小、出血少 ,脊柱力学结构完整 ,住院时间短、患者痛苦小 ,乐于接受等优点 ,前者费用较高 ,要求设备更先进昂贵、操作技术复杂 ,较难掌握 ,但有效率较高 ,适应证较广泛 ,作为两种现代微创治疗手段可根据适应证和禁忌证选择使用     

Follow-up Study on the Motion Range after Treatment of Degenerative Disc Disease with the Bryan Cervical Disc Prosthesis

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cer- vical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases re- ceived two-level replacement. Operation time of the single-level surgery averaged 130±50 min and the time of two-level surgery was 165±53 min on average (from skin incision to skin suturing). Neurological or vascular complications during or after surgery was not observed. Japanese Orthope- dic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially re- stored, being 4.68° (3.6°-6.1°) in flexion and extension position and 3.51° (2.5°-4.6°), 3.42° (2.6° -4.3°) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recov- ery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.     

Caspase-3在间质干细胞分化过程中的基因芯片分析及体外作用

目的 观察Caspase-3在小鼠胚胎肢芽间质干细胞分化过程中的作用,并将其运用于体外间质干细胞模型中进行验证.方法 用基因芯片技术检测Caspase-3在小鼠胚胎肢芽间质干细胞分化过程中的基因表达,分析其表达规律和可能作用;Yg用Caspase-3活性检测试剂盒,荧光比色法和Western blot法检测体外培养的骨髓间质干细胞诱导失巢凋亡中Caspme-3活性的改变;借助流式细胞仪分析骨髓间质干细胞凋亡的变化.结果 Caspase-3在小鼠胚胎肢芽间质干细胞向软骨分化的关键期(E12)出现显著的表达下调;Caspase-3的活性以及蛋白表达水平随诱导凋亡时间的延长而明显升高,且与细胞凋亡率相关.结论 Caspase-3蛋白在体内和体外诱导间质干细胞凋亡的过程中均发挥着重要作用;胚胎发育过程中,通过下调Caspase-3的表达以促进软骨形成,而抑制Caspase-3的活性可以有效降低细胞凋亡率.     

血液灌流联合大剂量骨化三醇冲击治疗继发性甲状旁腺功能亢进的临床疗效分析

目的:分析针对接受维持性血液透析(MHD)治疗继发甲状旁腺功能亢进(SHPT)患者实施血液灌流联合大剂量骨化三醇冲击治疗的效果.方法:将2019年3月—2020年12月我院收治的64例接受维持性血液透析(MHD)治疗继发甲状旁腺功能亢进(S H P T)患者作为研究对象并随机分组.在接受骨化三醇冲击治疗基础上,对照组3...     

严重髋臼骨折选择性早期全髋置换临床观察

目的对于严重的髋臼骨折,进行切开复位内固定术很难取得满意的疗效,探讨施行一期的全髋置换术。并对疗效进行了评价。方法1997～2003年间,对17例髋臼骨折移位的患者施行了一期全髋置换术。并对其随访平均2.1年(1～6年)。由损伤到关节置换手术时平均8d(5～21d)。平均年龄53岁(26～69岁)。进行紧急全髋置换的指征包括关节内粉碎性骨折,关节面软骨全厚磨损丧失,股骨头嵌插,髋臼压缩下陷波及超过40%关节面以及负重区。结果最后一次随访是根据Harris评分,平均为82分(69～100分);15例疗效为优良;1例发生异位骨化,直至结束随访时没有松动;1例发生髋臼杯严重中央移位。结论对严重类型的髋臼骨折病人,常规切开复位内固定术难以取得良好疗效,施行紧急全髋置换术是有效的。但手术最好由经验丰富的骨科医生施行。     

金属对金属髋关节表面置换术治疗强直性脊柱炎的临床研究

目的探讨金属对金属(MOM)髋关节表面置换术治疗强直性脊柱炎(AS)的早期临床疗效。方法对18例AS累及髋关节患者(23髋)行MOM髋关节表面置换术,术后定期随访,比较手术前后Harris评分、UCLA活动评分和影像学变化。结果术后平均随访20个月(6～36个月),Harris评分由术前(44±7)分上升到术后(89±6)分,UCLA活动评分由术前(2.4±1.15)分上升到术后(6.5±0.5)分,无感染、关节脱位、深静脉血栓形成、神经损伤和假体周围骨折等并发症的发生,术后X线检查假体无松动和移位。结论 MOM髋关节表面置换术治疗AS能够明显缓解患者症状,改善关节功能。     

HBV携带者中抗-TB治疗所致肝损伤的临床分析

目的研究HBV携带者中结核杆菌(TB)感染者抗-TB治疗所致肝损伤的临床及组织学特点.方法105例结核杆菌(TB)感染者,其中HBV携带者45例,非HBV携带者60例,均进行抗-TB治疗6mo～8mo;前2mo四联用药,异烟肼、利福平、吡嗪酰胺及乙胺丁醇,后4mo～6mo两联用药,异烟肼和利福平.男选择60例HBV携带者,无结核杆菌感染,未用药,作为对照组.所有病例均在治疗前检查肝功能、HBV标记物、腹部B超检查,HBV标记物阳性的,进行HBVDNA滴度测定.治疗后,每2wk～4wk复查上述指标肝功能异常者,再复查1次,谷丙转氨酶(ALT)仍高于正常上限1.5倍以上者作为观察对象,部分做肝穿刺行组织学检查.肝功能异常者,ALT≥3倍正常值的,暂停用抗-TB治疗,其中HBVDNA滴度高于1000ng/L的,给予拉米扶啶治疗加保肝治疗,其余的仅给予保肝治疗.结果结核杆菌(TB)感染者合并HBV携带者(A组)、TB感染者不合并HBV携带者(B组)、单纯HBV携带者(C组)肝功能异常者发生率分别为44.4%,13.3%,16.6%;发病年龄A组较B组年轻,P<0.05;e抗原转阴率,A组为20%,C组为10%;HBVDNA滴度增高时易出现肝功能异常;A组肝组织损伤较B,C两组严重;给予拉米扶啶治疗的10例患者肝功能正常后,再给予抗-TB治疗仅1例出现轻度肝功能异常.结论HBV感染可增加抗-TB药物治疗的肝毒性,尤其在HBVDNA滴度较高时(>1000ng/L),加用抑制HBV复制的药物可减少肝损伤的发生率;抗-TB治疗后HBeAg转阴率略增加,可能与肝细胞损伤后病毒ccDNA负荷量减少有关.     

国产超高分子聚乳酸可吸收螺钉治疗髌骨骨折术后下肢功能评定半年随访

目的：探讨国产超高分子聚乳酸可吸收螺钉治疗髌骨骨折的效果及安全性.方法：病例来源于2002/2003在华中科技大学同济医学院附属协和医院骨科住院的行手术切开复位超高分子聚乳酸可吸收螺钉内固定的髌骨骨折患者28例.术后第2～3天患肢置于下肢持续被动器上做持续被动屈伸功能锻炼,第5天开始进行床上练习患肢主动屈膝活动;1周后持拐下地患肢不负重行走并逐渐加大屈膝活动,术后6周可逐渐脱拐行走.术后1,2,4,12和24周进行定期随访,评定膝关节功能,观察骨折愈合时间.结果：全部病例平均随访11.7（6～20）个月.①远期膝关节功能评定：术后6个月对患者关节功能评定结果为：优17例,良9例,可2例,差0例.优良率93%.②骨折愈合时间：随访3,4个月时,患者无畸形及延迟愈合发生;股四头肌萎缩6例,术后6～12个月恢复4例,12～18个月恢复2例;无一例患者发生螺钉松动或移位.结论：超高分子聚乳酸可吸收螺钉具有良好的生物相容性及有效性;在早期能保证骨折端固定所需有强度,能达到安全、稳固牢靠的要求,且随着骨折的愈合,强度逐渐降低,和骨折愈合同步进行,不产生应力遮挡,有利于恢复骨的正常生物学结构和功能;固定强度维持时间长达6个月;最终能被人体完全吸收并排除体外.用于治疗髌骨骨折,膝关节功能恢复好,安全可靠,是髌骨骨折的理想内固定物.     

Budd-Chiari综合征的病因及发病机制

0引言Budd-Chiari综合征(BCS)为肝静脉或(和)下腔静脉肝段狭窄,闭塞引起肝静脉流出道阻塞而产生的一系列征候群.在世界各地均有发病,自首例BCS报道至今已一个半世纪,其发病率逐年增高,已并非少见病.但病因仍未明,随民族、地域、年龄、性别和病理类型不同而各异.血凝异常、感染、免疫异常、发育畸形、外伤、肿瘤等均可致BCS,仍有15-25%的病例为隐原性[1],日本学者报道隐原性者占89.8%[2].其发病机制有两种学说:(1)先天性血管发育畸形(2)血栓形成.1先天性血管发育畸形病理学家发现,肝段下腔静脉膜性梗阻(MOVC)的病变隔膜表面光滑,并移行…