同种异体骨支撑架微创治疗股骨头坏死的临床研究

目的应用改良髓芯减压术结合同种异体骨支撑架加自体骨和脱钙骨基质（decalcified bone matrix，DBM）治疗早期股骨头坏死，探索早期股骨头坏死的微创治疗方法。方法2004年1月～2005年4月，23例24个髋关节采用经大转子下通过股骨颈钻隧道至股骨头骨坏死区，将装有自体松质骨和DBM的同种异体骨支撑架经隧道拧入骨坏死区直至软骨下骨约5mm处，隧道远端用自体髂骨填塞。观察手术前后Harris评分变化、x线影像学表现及是否需进一步治疗。结果本组所有患者均获得随访，平均随访19（12—27）个月，以最后一次随访资料作为最终评价依据。Harris评分，术前优良率为43．5％（10／23）。术后优良率为91．3％（21／23）。22侧髋关节影像学表现保持稳定，无明显并发症发生。结论同种异体骨支撑架植入结合自体松质骨和DBM治疗成人股骨头坏死，增加了股骨头负重区软骨下骨的机械支撑，成骨作用强，有利于股骨头坏死的修复与重建，同时，不破坏患者股骨头本身的血液供应，创伤小，操作简单，值得临床推广使用。     

复杂胸椎骨折中CT图像三维重建的应用探讨

目的直观立体地显示复杂胸椎骨折的图像，探讨螺旋CT医学图像三维重建在复杂胸椎骨折诊断中的价值及其对手术的指导意义。方法对92例胸椎骨折患者采用螺旋CT进行薄层扫描和三维重建进行诊断。CT扫描全部采用Siemens SOMATOM Sensation16型多排高速螺旋CT机，1．0mm层厚。扫猫所得断层资料通过网络传送至计算机工作站进行处理，采用Window．NT3．51平台上Insisht三维重建软件进行三维重建。结果三维CT图像能够围绕X轴和Z轴任意旋转、切割以从不同角度观察，能够清晰显示复杂的胸椎骨折和狭窄椎管的解剖形态特点。结论三维CT重建在胸椎骨折方面具有很大的临床应用价值，有助于提高脊柱骨折手术的安全性和精确性并对患者预后的估计提供帮助。     

智能医学教学实践中存在的问题与对策

从智能医学的影响力、课堂评价体系的漏洞、智能医学教学地区差异等方面,剖析智能医学教学过程中所面临的关键问题,并结合部分高校医学院智能医学建设的探索与实践,分析目前我国高校在智能医学教学方面的现状,提出了一系列具体措施,包括加强智能医学重要性宣传教育、完善课堂评价体系、缩小智能医学教学的地区差异等针对性措施。     

混合现实技术在耳内镜中耳手术中的应用

混合现实（mixed reality,MR）技术是虚拟现实技术的进一步发展,该技术通过在虚拟环境中引入现实场景信息,在虚拟世界、现实世界和用户之间搭建一个交互反馈的信息回路,以增强用户体验的真实感。本研究探索了MR技术在耳内镜手术中的应用及价值。本研究选取中耳胆脂瘤拟行耳内镜手术患者为研究对象,知情同意后,使用颞骨CT获取临床数据信息,利用在线编辑平台构建3D模型,配合VR头盔现实环境中观看3D数字模型,对模型进行移动、旋转、缩放、测量等操作。借助于MR技术的全息影像学数据,医师得以全面观察病灶细节、深度挖掘影像信息,了解面神经、听骨链与胆脂瘤病灶的关系,进而规划出更加安全合理的手术方案。MR技术在耳内镜手术中的应用,能规划制定出合理的经耳道入路手术方案,促进医患之间的有效沟通,还可以帮助年轻医师的外科技术训练。     

人工智能技术在创伤救治中的应用及研究进展

创伤引起的多发伤致残率和致死率高,救治难度大但目前创伤救治的医疗模式仍然存在不足,创伤患者的救治面临巨大挑战。人工智能(AI)是基于机器学习、强化学习和深度学习等基础算法的智能技术,现已应用于创伤患者的救治工作中,其高效精准的计算机视觉、规划决策以及大数据统计分析等技术方向既提高了创伤患者救治的安全性和效率,同时也降低了临床医师的工作负荷,弥补了传统创伤救治模式的不足。笔者对AI在创伤急诊分诊、诊断、治疗及战创伤预防等方面的应用及研究进展进行综述,为AI的临床应用提供参考。     

外固定器治疗股骨干开放性骨折

目的 评价外固定器治疗成人及少儿股骨干开放性骨折的临床效果。方法选择31例股骨干开放性骨折,将其分为少儿组及成人组,均采用单边外固定器治疗。术前、后3天内和术后1、3、6个月时分别拍摄平片检查,术后嘱进行适当的功能锻炼,并在取出外固定后的3、6个月时再次随访。结果成年组术中进行切开复位、骨折延迟愈合、不愈合及治疗过程中有并发症比例明显较少儿组高,满意程度及疼痛情况两组无明显统计学差别。除1例较重的患者尚未恢复外,其余患者均得到较好的恢复。结论外固定器能有效治疗股骨干开放性骨折。严格掌握适应证,术中良好复位、固定,术后合适的处理并配合适当的功能锻炼是取得成功治疗的关键。     

短发夹状RNA对PC-3M细胞端粒酶逆转录酶基因表达和端粒酶活性的影响

目的:研究短发夹状RNA(shRNA)对PC 3M细胞中端粒酶逆转录酶(hTRT)基因表达及端粒酶活 性的影响。方法:构建针对hTRT基因的shRNA表达质粒psilencer TRT,在质脂体介导下转染人前列腺癌PC 3M细胞,应用RT PCR及免疫组织化学检测hTRTmRNA及蛋白表达水平,应用SYBR Green染色法检测端粒 酶活性的变化。结果:重组体psilencer TRT转染细胞24h和48h后显著下调hTRTmRNA及蛋白水平,作用 48h后,其抑制率分别为85.39%和79.17%,较空白对照组差异有统计学意义(P<0.01)。同时,随着时间的延 长,端粒酶活性亦有明显下降(P<0.01)。结论:利用短发夹状RNA干扰技术能有效抑制靶基因的表达,为前 列腺癌的基因治疗提供新思路。     

Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep

Objective： To evaluate the effects and mechanism of radiation-sterilized allogeneic bone sheets in inducing vertebral plate regeneration after laminectomy in sheep. Methods ： Twelve adult male sheep （ aged 1.5 years and weighing 27 kg on average ） provided by China Institute for Radiation Protection underwent L3-4 and L4-5 laminectomy. Then they were randomly divided into two groups： Group A （n =6） and Group B （n =6）. The operated sites of L4-5 in Group A and L3-4 in Group B were covered by ＂ H-shaped＂ freeze-drying and radiationsterilized allogeneic bone sheets （ the experimental segments）, while the operated sites of L3-4 in Group A and L4-5 in Group B were uncovered as the self controls （ the control segments ）. The regeneration process of the vertebral plate and the adhesion degree of the dura were observed at 4,8,12,16,20 and 24 weeks after operation. X- ray and CT scan were performed in both segments of 1.34 and L4-5 at 4 and 24 weeks after operation. Results： In the experimental segments, the bone sheets were located in the anatomical site of vertebral plate, and no lumbar spinal stenosis or compression of the dura was observed. The bone sheets were absorbed gradually and fused well with the regenerated vertebral plate. While in the control segments, the regeneration of vertebral plate was not completed yet, the scar was inserted into the spinal canal, compressing the dura and the spinal cord, and the epidural area almost disappeared. Compared with the control segments, the dura adhesion degree in the experimental regenerated segments was much milder （ P 〈 0. 01 ）, the internal volume of the vertebral canal had no obvious change and the shape of the dura sack remained well without obvious compression. Conclusions： Freeze-drying and radiation-sterlilized allogeneic bone sheets are ideal materials for extradural laminoplasty due to their good biocompatibility, biomechanical characteristics and osteogenic ability. They can effectively reduce formation of post-laminectomy scars, prevent recurrence of post-lamlnectomy spinal stenosis, and induce regeneration of vertebral plates.     

Tumor Necrosis Factor-related Apoptosis Ligand Induces Apoptosis in Prostate Cancer PC-3M Cell Line

Summary： To study the effect of tumor necrosis factor-related apoptosis inducing ligand （TRAIL） on PC-3M cell line, PC-3M cell line was incubated with gradient concentrations of TRAIL for 4-24 h. Annixin-V fluorescence staining and TUNEL method were employed to detect the apoptosis of PC-3M cells. The morphology of apoptotic PC-3M cells was observed by electron microscopy. The relationship between TRAIL concentrations and the percentage of apoptotic cells was evaluated by flow cytometry. The proliferation inhibitory ratio was calculated by using MTT colorimetry. Our results showed that apoptosis of PC-3M cells could be induced by treatment with TRAIL for at most 4 h. The results of flow cytometry and MTT colorimetry demonstrated a time-and concentration-dependent relationship between cell apoptosis rate and TRAIL concentration. It is concluded that apoptosis of PC-3M cells can be induced by TRAIL. Because of the selective killing effect of TRAIL on tumor cells, it may become a potential alternative for the treatment of advanced prostate cancer.     

同种异体骨板覆盖预防椎板切除术后硬膜外粘连临床应用

目的探讨同种异体骨板覆盖在预防椎板切除术后硬膜外粘连方面的疗效。方法对58例腰椎间盘突出或腰椎管狭窄患者,行全椎板切除,“H”形同种异体冻干辐照骨板覆盖。观察临床症状及CT、MR I表现。结果术后随访6个月~2.5年,CT、MR I椎管扩大,骨板无倾斜、移位,脊髓无压迫,无排异反应;术后椎管内容物形态良好,骨板两侧已与相邻接触骨组织融合,密度相等。结论同种异体冻干辐照骨板具有良好的生物相容性、生物力学性能和诱导成骨作用,是一种良好的硬膜外覆盖材料,能有效阻止硬膜外粘连,防止椎管术后再狭窄,可用于节段性椎管覆盖成型术。