9 例盖氏骨折术后骨不连合并下尺桡关节炎的疗效分析

目的:探讨手术治疗盖氐骨折术后骨不连合并下尺桡关节炎的方法和临床疗效。方法:对2010年1月至2015年6月收治的9例盖氐骨折术后骨不连合并下尺桡关节炎患者的临床资料进行回顾性分析,评价其骨不连愈合率、前臂旋转活动度,采用DASH问卷评估上肢功能,记录术中及术后并发症的发生情况。结果:9例患者随访13-78个月,平均45.4个月所有骨不连在24周都获得愈合,愈合时间12-24周;术后前臂旋转功能平均115.56±26.74°,显著高于术前(P0.01);而DASH评分从术前48.56±8.71分降至20.11±8.08分(P0.05);根据Anderson前臂功能评分标准,优2例,良5例,中2例,优良率为77.8%所有患者均对手术效果十分满意。结论:尺骨头切除术联合桡骨切开植骨内固定术操作简单有效,可显著改善盖氐骨折术后骨不连合并下尺桡关节炎患者的上肢功能。     

背侧单切口与桡尺侧双切口钢板内固定治疗尺桡骨中上段双骨折

目的:研究成人尺桡骨中上段双骨折使用背侧单切口与桡尺侧双切口钢板内固定的治疗效果。方法:选择我院2011年3月至2014年7月行双钢板治疗成年尺桡骨中上段双骨折患者41例,其中手术入路选择背侧单切口患者25例,选择背侧双切口患者16例。比较两种手术方式的临床效果。结果:背侧单切口入路组患者在手术出血、切口长度等方面要优于背侧双切口组(P0.01);两组在术前时间、骨折愈合时间方面未见明显差异(P0.05)。单切口组的疼痛VAS评分在术后1周和术后12周时要优于双切口组(P0.05);单切口组的膝关节HSS评分在术后1周时要优于双切口组(P0.01),而在术后12周时两组未见明显差异(P0.05)。结论:选择背侧入路单切口和双切口双钢板治疗尺桡骨中上段双骨折均有较好的临床效果,而背侧单切口入路,手术操作相对简单易行,创伤较小,术后恢复较好。     

不同入路手术对骨盆髋臼骨折患者骨折复位质量、髋关节功能及炎症因子的影响

目的:探讨不同入路手术对骨盆髋臼骨折患者骨折复位质量、髋关节功能及炎症因子的影响。方法:回顾性分析2016年7月～2018年12月期间我院收治的91例骨盆髋臼骨折患者的临床资料,根据入路方式的不同将其分为A组(n=44,髂腹股沟入路)和B组(n=47,改良Stoppa入路),比较两组患者复位质量、围术期指标、髋关节功能及炎症因子水平,记录两组患者随访期间并发症发生情况。结果:B组术中出血量少于A组,手术切口长度短于A组(P0.05);两组手术显露时间比较差异无统计学意义(P0.05)。B组的骨折复位优良率为85.11%(40/47),高于A组的65.91%(29/44)(P0.05)。与术前相比,两组患者出院时、术后6个月的改良Postel评分成逐渐升高趋势(P0.05);两组患者术前、出院时、术后6个月的改良Postel评分组间比较差异无统计学意义(P0.05)。两组患者术后7 d血清白介素-6(IL-6)、降钙素原(PCT)水平均高于术前,但B组低于A组(P0.05)。B组随访期间并发症发生率低于A组(P0.05)。结论:改良Stoppa入路手术与髂腹股沟入路手术均可改善骨盆髋臼骨折患者髋关节功能,但经改良Stoppa入路手术者骨折复位质量更佳,创伤更小,炎症反应更轻,同时还可减少并发症发生率。     

超声乳化联合不同术式对青光眼合并白内障患者视力、血流动力学及生活质量的影响

目的:探讨超声乳化联合不同术式对青光眼合并白内障患者视力、血流动力学及生活质量的影响。方法:回顾性分析2015年1月～2019年8月期间我院收治的青光眼合并白内障患者56例(66眼)的临床资料,根据手术方式的不同分为A组(n=27,超声乳化联合小梁切除术)和B组(n=29,超声乳化联合房角分离手术),比较两组患者视力、眼压、血流动力学及生活质量情况,统计两组并发症发生情况。结果:两组术后1个月、术后3个月、术后6个月视功能指数量表(VF-14)评分呈升高趋势,且B组高于A组(P0.05)。两组患者术后1个月、3个月、6个月视力呈先升高后降低,且术后1个月、3个月、6个月均高于术前(P0.05),B组术后3个月、术后6个月视力均高于A组(P0.05);两组患者术后1个月～术后6个月眼压均呈不断下降趋势,且B组低于A组(P0.05)。两组术后6个月舒张末期流速(EDV)、收缩期峰值流速(PSV)均升高,且B组高于A组(P0.05);阻力指数(RI)均降低,且B组低于A组(P0.05)。两组并发症发生率比较差异无统计学意义(P0.05)。结论:与超声乳化联合小梁切除术相比,超声乳化联合房角分离手术治疗青光眼合并白内障患者,在改善患者视力、眼压、血流动力学及生活质量方面效果较佳,且不增加并发症发生率。     

骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后关节疼痛的影响

目的:探讨骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后患者关节疼痛的影响。方法:回顾性分析2012年2月-2013年8月我院收治的股骨颈骨折患者的临床病历资料,按照假体类型将其分为骨水泥型髋关节置换术(A组)和生物型髋关节置换术(B组),通过Harris与分项百分制髋关节疼痛评分比较两组患者术后髋关节的疼痛情况。结果:两组患者的手术时间、术中出血量以及术后引流量比较,差异无统计学意义(P0.05),A组的住院时间短于B组,差异有统计学意义(P0.05)。A组术后3、6个月的髋关节疼痛率均低于B组,术后12、24个月则高于B组,差异有统计学意义(P0.05);经x2趋势分析,A组患者术后髋关节疼痛率随时间增加呈逐渐上升趋势,差异有统计学意义(x2=10.837,P=0.001),B组患者术后髋关节疼痛率随时间增加呈逐渐下降趋势,差异有统计学意义(x2=9.842,P=0.002)。A组患者术后3、6个月的髋关节疼痛评分高于B组,术后12、24个月则低于B组,差异有统计学意义(P0.05);A组术后3、6个月的髋关节疼痛评分高于术后12、24个月,B组3、6个月的髋关节疼痛评分低于术后12、24个月,差异有统计学意义(P0.05)。结论:骨水泥型假体缓解髋关节疼痛近期效果优于生物型假体,而生物型假体远期效果优于骨水泥型假体。     

不同入路人工全髋关节置换术对髋关节疾病患者康复进程、髋关节功能和生活质量的影响

目的:探讨不同入路人工全髋关节置换术(THA)对髋关节疾病患者康复进程、髋关节功能和生活质量的影响。方法:回顾性分析2016年4月～2018年11月期间到我院行THA治疗的髋关节疾病105例患者的临床资料。根据入路方式的不同将其分为A组(n=54,后外侧入路)和B组(n=51,SuperPATH入路),术后行1年的随访,比较两组患者康复进程、髋关节功能和生活质量,记录两组术后并发症发生情况。结果:B组术中失血量、术后引流量少于A组,切口长度、术后第一次下地时间短于A组(均P0.05);B组手术时间长于A组(P0.05)。两组术后1个月、3个月、6个月、12个月髋关节屈曲活动度、髋关节功能Harris评分、髋关节外展活动度均较术前呈先升高后趋于平稳趋势(P0.05);B组术后1个月髋关节屈曲活动度及外展活动度、髋关节功能Harris评分高于A组(P0.05);B组术后3个月、6个月、12个月髋关节屈曲活动度及外展活动度、髋关节功能Harris评分与A组比较无差异(P0.05)。两组末次随访时SF-36各维度评分均较术前升高,且B组高于A组(P0.05)。两组术后并发症发生率比较无差异(P0.05)。结论:与后外侧入路方式相比,髋关节疾病患者THA中采用SuperPATH入路,可促进患者早日康复,有利于患者早期髋关节功能的恢复,对生活质量的改善更为显著,且不增加并发症发生率。     

腹腔镜子宫肌瘤剔除术与开腹手术对子宫肌瘤患者内分泌状态、免疫功能和预后的影响

目的:探讨腹腔镜子宫肌瘤剔除术与开腹手术对子宫肌瘤患者内分泌状态、免疫功能和预后的影响。方法:选取2014年1月～2019年1月期间我院收治的子宫肌瘤患者90例,根据手术方式的不同将患者分为A组(n=44)和B组(n=46),A组予以开腹手术,B组予以腹腔镜子宫肌瘤剔除术,比较两组患者临床指标、内分泌状态、免疫功能、并发症及预后。结果:两组手术时间对比未见统计学差异(P0.05);B组术中出血量少于A组,住院时间、术后肛门排气恢复时间短于A组(P0.05)。两组术后1个月卵泡刺激素(FSH)、促黄体生成激素(LH)均较术前升高,雌二醇(E2)较术前降低(P0.05);B组术后1个月FSH、LH低于A组,E2则高于A组(P0.05)。两组术后1 d CD3~+、CD4~+、CD4~+/CD8~+均较术前降低,但B组高于A组(P0.05);CD8~+较术前升高,但B组低于A组(P0.05)。B组的并发症发生率低于A组(P0.05)。两组子宫形态正常率、复发率、月经转归正常率对比无差异(P0.05)。结论:与开腹手术相比,腹腔镜子宫肌瘤剔除术可明显减轻对子宫肌瘤患者机体内分泌状态、免疫功能的损害,促进患者术后恢复,减少并发症发生情况,同时还可获得与开腹手术相当的近期预后。     

空心钉加内侧支撑钢板与单纯空心钉治疗PauwelsⅢ型股骨颈骨折的疗效比较研究

目的:比较PauwelsⅢ型股骨颈骨折分别经单纯空心钉、空心钉加内侧支撑钢板治疗的临床疗效。方法:回顾性分析2016年3月～2019年2月期间收治的113例PauwelsⅢ型股骨颈骨折患者的临床资料,根据手术方式分为A组(n=55,单纯空心钉内固定治疗)和B组(n=58,空心钉加内侧支撑钢板治疗),比较两组患者围术期指标、髋关节功能、术后疼痛及复位质量,记录两组患者随访期间并发症发生情况。结果:B组术中出血量多于A组,手术时间长于A组(均P0.05);B组骨折愈合时间、完全负重时间短于A组(P0.05)。两组患者术后3个月、术后6个月髋关节Harrris评分呈升高趋势,视觉模拟评分量表(VAS)评分呈下降趋势(P0.05);B组术后3个月、术后6个月髋关节Harrris评分高于A组,VAS评分则低于A组(P0.05)。与术后3 d相比,A组患者术后6个月正位、侧位Garden指数降低(P0.05);B组术后6个月正位、侧位Garden指数评分高于A组(P0.05)。B组并发症发生率低于A组(P0.05)。结论:与单纯空心钉内固定治疗PauwelsⅢ型股骨颈骨折相比,空心钉加内侧支撑钢板虽然术中出血量多,手术时间略长,但其术后恢复效果更佳,且并发症发生率更低,临床应用价值较高。     

关节镜下不同固定方法治疗胫骨髁间嵴骨折的临床对比研究

目的:对比关节镜下缝合法和钢丝固定治疗胫骨髁间嵴骨折的临床效果。方法:收集我院2012年1月至2014年12月年收治的87例胫骨髁间嵴骨折患者根据手术固定方法:不同分为A组(40例)组(37例),其中A组患者使用缝线法固定组患者使用钢丝固定,分别于术后3、6、12个月后随访患者影像学资料观察两组患者骨折骨折复位愈合情况,包括愈合时间、膝关节功能进行评估关节屈伸活动度,手术时间以及并发症发生情况等。结果:术前Lysholm评分组间差异无统计学意义(P0.05),术后3个月术Lysholm评分组间差异亦无统计学意义(P0.05),术后6、12个月差异具有统计学意义(P0.05);两组术后Lysholm评分与术前相比均逐渐升高差异具有统计学意义(P0.05);两组手术时间差异无统计学意义(P0.05),术后随访第12个月两组患者膝关节屈伸活动度比较A组患者显著优于B组患者A组愈合时间短于B组差异均具有统计学意义(P0.05)。结论:使用关节镜下缝合线固定治疗胫骨髁间嵴骨折具有创伤小、操作简便、固定稳固、利于关节早期的康复,可推广使用。     

关节镜下清理术联合腓骨截骨术治疗膝关节骨性关节炎的疗效及对炎性因子的影响

目的:探讨采用关节镜下清理术联合腓骨截骨术治疗膝关节骨性关节炎(KOA)的疗效及对炎性因子的影响。方法:选取2015年3月～2017年12月期间右江民族医学院附属河池医院收治的KOA患者99例,根据手术方式的不同将患者分为A组(n=46,关节镜下清理术治疗)和B组(n=53,关节镜下清理术联合腓骨截骨术治疗),比较两组患者手术时间、术中出血量、住院时间,比较两组术前、术后6个月、术后1年疼痛情况、膝关节功能恢复情况、膝关节相关角,比较两组术前、术后1个月炎性因子变化,记录两组术后并发症发生情况。结果:B组手术时间长于A组(P0.05),两组术中出血量、住院时间比较无差异(P0.05)。B组术后6个月、术后1年视觉疼痛模拟(VAS)评分低于A组,美国特种外科医院(HSS)、膝关节评分及美国膝关节协会(KSS)评分则高于A组(P0.05)。两组患者术后1个月白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均较术前降低,且B组低于A组(P0.05)。B组术后6个月、术后1年膝关节相关角[股骨干与股骨双髁连线夹角(F角)、股骨胫骨角(FT角)、胫股关节间隙角(JS角)]均低于术前以及A组同时间点(P0.05)。两组术后并发症发生率比较差异无统计学意义(P0.05)。结论:KOA患者经关节镜下清理术、腓骨截骨术联合治疗后,疗效显著,可有效改善患者疼痛及膝关节功能,降低炎性因子水平,手术方案安全且可改善患者下肢力线。     

Quantitative finger dermatoglyphics in the Mediterranean region of Murcia,Spain

Quantitative finger dermatoglyphics have been analyzed in a Spanish population on the Mediterranean coast, from a sample of 347 individuals (163 males and 184 females) whose four grandparents were born in the studied region (Murcia). From the prints of the sampled individuals, radial, ulnar, and maximal ridge counts have been examined using classical methodology according to the pattern orientation. Kolmogorov test was used to evaluate the normality of the count values. Paired t-test, t-test for two samples, and Wilcoxon and Mann-Whitney non-parametric U test were used to explore bimanual and sexual differences. Maximal and radial ridge counts show similar distributions fitting into a normal distribution. Instead, ulnar values show a particular distribution clearly different from normality. The bilateral and sexual differentiation patterns reveal the divergence between the ulnar counts and the maximal and radial values. In comparison to other Iberian populations our results show a particular position of Murcia with the lowest TFRC values in the Spanish variation ranges.     

鱼类三叉神经运动核的形态学研究

目的:应用生物胞素法观察罗非鱼三叉神经运动核的形态及细胞分布特征.方法:本实验用罗非鱼,15只(性别不限),体长12～16 cm,动物浸入140 mg/L三卡因间氨苯酸乙脂甲磺酸盐{tricaine methanesulfonate (MS222)}溶液中麻醉,在手术显微镜下暴露神经,通过生物胞素(Biocytin)结晶追踪技术研究定位硬骨鱼类三叉神经运动核的形态及细胞分布.结果:①硬骨鱼类罗非鱼的三叉神经运动核分为腹侧和背侧两组细胞群.②三叉神经根注入列中两组细胞群都能观察到被标记的细胞.下颌神经注入列中被标记的细胞以背侧群为主.上颌神经及眼神经注入列中两群细胞都没有发现被标记细胞,但上颌神经组中能观察到神经终末及突触联系.结论:硬骨鱼类罗非鱼的三叉神经运动核分为两组细胞群.三叉神经运动核发出的纤维走行于下颌神经内.     

美西螈胚胎鳃神经发育的形态学

在约25℃温度下孵化并选用第30～44期的美西螈(Ambystoma mexicanum)胚胎标本,用4%多聚甲醛溶液固定,进行整体标本免疫染色,体视显微镜观察.结果显示,胚胎30期,可观察到鳃神经节短小的鳃神经本干;胚胎35期,已能观察到较明显的部分分支和交通支;胚胎37期,形成上颌神经及下颌神经;胚胎38期,可观察到舌咽神经的背支、咽头支;胚胎40期,可观察到舌咽神经的鳃裂前支.因而,美西螈鳃神经在胚胎早期遵循祖先型排列的特点,之后随胚胎的发育,出现随鳃器官演化而重新分布的趋势;其舌咽神经基本保持了鳃神经的原始形态特点.     

Fine structure,origin, and distribution density of the autonomic nerve endings in the tarsal muscle in the eyelid of the mouse

Summary The fine structure, origin, and distribution density of the autonomic nerve endings in the tarsal muscle of the mouse were studied by histochemistry and electron microscopy. With histochemical methods, the fine nerve plexus in the normal muscle shows both catecholamine-positive varicose fibers and acetylcholinesterase-active varicose fibers. The former are distributed more densely than the latter. After superior cervical ganglionectomy, the catecholamine-positive fibers disappear, while after pterygopalatine ganglionectomy, the acetylcholinesterase-active fibers vanish. In electron micrographs, the varicosities appear as expansions containing many synaptic vesicles. The axonal expansions partly lack a Schwann sheath and directly face the pinocytotic vesicle-rich zones of the smooth muscle cells. A relatively wide space, 0.1 to 1.0 m in width, lies between nerve expansion and muscle cell. The expansions can be classified into two types: Type I having small granular synaptic vesicles, and Type II having agranular vesicles instead of small granular synaptic vesicles. Type I undergoes degeneration after superior cervical ganglionectomy, while Type II degenerates after pterygopalatine ganglionectomy. This indicates that Type I corresponds to the synaptic ending of the adrenergic fiber originating from the superior cervical ganglion, and Type II to the synaptic ending of the cholinergic nerve fiber derived from the pterygopalatine ganglion. Type I is more frequent (88/10⁴ m² area of muscle) than Type II (17/10⁴ m²).     

Non-thermal plasma application enhances the recovery of transected sciatic nerves in rats

This experimental research aimed to investigate the effects of non-thermal plasma on nerve regeneration after transected nerve damage using the sciatic nerve in Wistar albino (A) rats. The experiments were performed on 27 Wistar A rats. The rats underwent surgery for right sciatic nerve exposure and were divided into three groups (each group, n = 9) according to sciatic nerve transected injury (SNTI) and non-thermal plasma application: a non-nerve damage (non-ND) group, a only nerve damage without non-thermal plasma application (ND) group, and a nerve damage with non-thermal plasma application (ND + NTP) group. Subsequent to SNTI and immediate suture, non-thermal plasma was administered three times per week for eight weeks. Evaluation for functional recovery was performed using the static sciatic index measured over the full treatment period of eight weeks. The sciatic nerve specimens were obtained after euthanasia and third day from the last non-thermal plasma application. The sciatic nerve tissues were subjected to histological analysis. Behavior analysis presented that the ND + NTP group showed improved static sciatic index compared with the nerve damage group. Histopathological findings demonstrated that the ND + NTP group had more dense Schwann cells and well-established continuity of nerve fibers, greater than the nerve damage group. Immunohistochemistry showed that the ND + NTP group had increased levels of markers for microtubule-associated protein 2 (MAP2), tau, S100 calcium-binding protein B, and neurofilament-200 and regulated the overexpression of CD68 and MAP2. These results indicated that non-thermal plasma enhanced the motor function and restored the neuronal structure by accelerating myelination and axonal regeneration. Additionally, non-thermal plasma was confirmed to have a positive effect on the recovery of SNTI in rats.     

Septal aperture of the humerus in a mediaeval human skeletal population

Humeral septal aperture is studied in a large Mediaeval skeletal series from England. The aims are to investigate associations between septal aperture and sex, age, side and humeral robusticity; and to evaluate any associations with relative projection of ulna coronoid and olecranon processes. In this way, it is hoped to shed light on age at occurrence and the causation of the trait. Results showed a paucity of cases in juveniles. In adults, the trait was more common in left bones and in females. No association was found with humeral robusticity or humero-ulnar conformation. Detailed morphological study of humeral septa of individuals with and without apertures suggested that septal aperture forms via resorption from the anterior surface of the septum. In this group, apertures appear generally to form in early adult life. It is suggested that in the study group septal aperture generally arises from impingement on the humeral septum by the coronoid and olecranon processes, chiefly the former. It is tentatively suggested that frequency of septal aperture may be an index of joint hypermobility in earlier populations.     

Regeneration of an adult peripheral nerve preparation in culture

The methods used to maintain the vagus nerve from the adult rat in culture and how regeneration is studied in this preparation are described. A hypothesis is presented on the triggering of the cell body reaction. It is suggested that this reaction is initiated by proteins synthesized in nonneuronal cells at the site of a nerve lesion. These proteins, referred to as regenerins, reach the nerve cell body by retrograde axonal transport, where they initiate the regeneration process.     

New techniques in female pudendal somatosensory evoked potential testing

Objective—The primary nerves innervating the female genitalia are the dorsal nerve of the clitoris (DNC) and the perineal nerve, which innervate the clitoris and the external genitalia/distal vagina, respectively. We describe two novel electrodiagnostic techniques for evaluating the integrity of these female genital somatosensory pathways.

Subjects and methods—Seventy-seven healthy women (mean age 29.3 years) were enrolled for this study. We performed DNC somatosensory evoked potentials (SEPs), stimulating through self-adhesive disk electrodes on either side of the clitoris. Perineal nerve SEPs were evoked through a vaginal probe. Cortical responses were measured through cup electrodes affixed to the scalp at Cpz and Fpz. Stimulus parameters were duration 0.1?ms, frequency 4.1?Hz, filters 5–5,000?Hz, at three times sensory threshold.

Results—DNC and perineal nerve SEPs from both the right and left sides were reproducible and easily discerned. The mean P1 latencies were: right DNC 39.4?ms (SD 2.8?ms), left DNC 39.3?ms (SD 3.3?ms), right perineal nerve 37.8?ms (SD 3.4?ms), left perineal nerve 37.6?ms (SD 3.1?ms). We recorded SEP responses from 90 to 92% of subjects for the DNC, and 69% for the perineal nerve.

Conclusions—We are able to evoke somatosensory potentials from the four primary somatic nerves that mediate female genital cutaneous sensation. In healthy subjects, the DNC responses are robust and maintain laterality. The perineal nerve responses are less consistently obtained, but when recorded, are easily discerned. These preliminary data provide a foundation from which to study female genital innervation, particularly as it applies to sexual function.     

Investigations on the Incorporation of a Tritiated Ganglioside, GM1, in the Injured and Intact Sciatic Nerves of the Rat

Following injury of their left sciatic nerves by means of a standardized procedure, male rats received intravenous injections of a tritiated ganglioside. GM1, on different days during the process of regeneration. The rats were killed at two different times after the injection and the concentrations of the total radioactivity, nonvolatile radioactivity, and labelled GM1 were estimated in six segments of the crushed and intact sciatic nerves. The segments of the damaged nerves showed higher concentrations of radioactivity and a higher content of GM1 than the corresponding segments of the contralateral nerves. Within the immediate area of the lesion the highest levels were found on the 3rd and 6th days after the injury; the segments distal from the lesion showed the highest levels of activity on days 9 and 12. The nerve segments proximal to the site of the injury showed a low rate of radioactivity incorporation. The higher concentrations of [3H]GM1 in damaged nerves as well as the rate of incorporation as a function of time indicate that exogenous gangliosides may be involved in the processes of regeneration and have a bearing on the latter.