自体外周血干细胞移植联合髓芯减压治疗早中期股骨头缺血性坏死的临床研究

目的对比研究单纯股骨头髓芯减压与联合自体外周血干细胞移植治疗早中期股骨头缺血性坏死（ANFH）的临床疗效。方法 2004年10月至2012年3月期间就诊于福建省龙岩市第一医院,经影像学检查及术后病理检查确诊为ANFH的患者90例。A组采用单纯髓芯减压共34例,男22例,女12例,年龄22~62岁（中位年龄41.5岁）。B组采用髓芯减压联合自体外周血干细胞移植（用rhG-CSF皮下注射4 d进行外周血干细胞动员,第5天分离外周造血干细胞混悬液。在髓芯减压基础上沿减压隧道注入自体外周血干细胞10~15 ml）56例,男35例,女21例,年龄21~62岁（中位年龄39岁）。按世界骨髓循环研究学会（ARCO）国际骨坏死标准：A组：Ⅰ期7髋,Ⅱ期26髋,Ⅲ期17髋;B组：Ⅰ期10髋,Ⅱ期50髋,Ⅲ期29髋。术后及随访期间进行Harris评分和疼痛视觉模拟（VAS）评分,对X线片、CT及MRI检查结果进行评估。两组Harris评分和VAS评分比较用成组t检验。结果 A组34例,B组49例随访13~89个月,平均38.5个月。术后3、6、12个月与术前的Harris评分比较有明显提高,VAS评分有明显的下降;术前、术后3个月两时间点的A、B组Harris评分比较差异无统计学意义（t=0.342、0.628,P=0.781、0.516）;术后6、12个月的B组评分优于A组（t=2.991、7.753,P=0.009、0.001）。术后12个月A、B两组T1相低信号区所占股骨头体积的比例分别为（17.24±3.71）﹪和（12.11±3.14）﹪,差异有统计学意义（t=4.360,P=0.001）。结论髓芯减压联合自体外周血干细胞移植治疗早中期ANFH,可显著减轻关节疼痛,改善股骨头血液供应,明显恢复关节功能,加速病灶区骨组织修复,有效防止股骨头进一步塌陷。     

髓芯减压联合干细胞移植治疗股骨头坏死患者的临床疗效及机制研究

目的:探讨采用髓芯减压与干细胞移植联合治疗股骨头坏死患者的临床疗效及可能机制。方法:选择我院确诊并治疗的股骨头患者76例作受试者,按随机数字表法分为两组,对照组38例采用干细胞移植治疗,治疗组38例在对照组基础上联合髓芯减压疗法。观察和比较两组患者的临床疗效、髋关节Harris评分及治疗前后血清PINP(Ⅰ型前胶原氨基端前肽)、CTX(Ⅰ型胶原C端肽)、OST(骨钙素)水平的变化情况。结果:治疗组总有效率及Harris评分均显著高于对照组(P0.05);治疗组患者血清PINP、CTX、OST水平较治疗前明显下降,并显著低于对照组,差异具有统计学意义(P0.05)。结论:髓芯减压与干细胞移植的联合应用可提高股骨头坏死患者的临床疗效和髋关节功能,可能与其降低患者血清PINP、CTX、OST水平有关。     

小针刀联合中药治疗痰瘀阻络型股骨头坏死骨髓水肿导致急性髋部疼痛的近期疗效观察

目的:观察小针刀联合内服中药治疗痰瘀阻络型股骨头缺血性坏死骨髓水肿导致急性髋部疼痛的近期疗效。方法:将60例辨证为痰瘀阻络型股骨头缺血性坏死骨髓水肿导致急性髋部疼痛患者随机分为2组,每组30例。治疗组给予小针刀治疗,对照组给予髓芯减压治疗,两组均联合内服中药治疗。治疗1月后,观察和比较两组的临床疗效,治疗前后视觉疼痛模拟(VAS)评分、Harris评分的变化并对比两组的围术期各项指标。结果:治疗后,治疗组总有效率、VAS评分和Harris评分分别为83.3%、2.85±0.32分、90.68±4.25分,对照组总有效率、VAS评分和Harris评分分别为86.7%、3.28±0.67分、92.16±5.62分。两组患者VAS评分均显著低于治疗前,髋关节Harris功能评分均显著高于治疗前(P0.05),但两组之间以上指标比较差异均无统计学意义(P0.05)。治疗组的术中出血量、住院时间和治疗费用均显著小于对照组(P0.05)。结论:小针刀联合内服中药治疗痰瘀阻络型股骨头坏死骨髓水肿导致急性髋部疼痛的近期疗效与髓芯减压联合内服中药治疗相当,但治疗简便、费用便宜。     

仙灵骨葆胶囊联合改良髓芯减压人工骨植入术对股骨头坏死患者血液流变学和生活质量的影响

摘要 目的：探讨仙灵骨葆胶囊联合改良髓芯减压人工骨植入术治疗股骨头坏死的疗效及对血液流变学和生活质量的影响。方法：选取2015年3月~2018年12月期间我院收治的股骨头坏死患者60例,上述患者根据随机数字表法分为对照组（n=30）和研究组（n=30）,对照组患者予以改良髓芯减压人工骨植入术治疗,研究组在对照组基础上联合仙灵骨葆胶囊治疗,对两组患者疗效、血液流变学、生活质量、髋关节功能及并发症情况进行比较。结果：研究组治疗后12个月的临床总有效率93.33%（28/30）高于对照组70.00%（21/30）（P<0.05）。两组患者治疗后Harris髋关节功能评分均升高,且研究组高于对照组（P<0.05）。两组患者治疗后12个月生活质量测定量表(SF-36)各维度评分均升高,且研究组高于对照组（P<0.05）。两组患者治疗后12个月全血黏度、红细胞压积、纤维蛋白原均降低,且研究组低于对照组（P<0.05）。两组并发症发生率比较无明显差异(P>0.05)。结论：仙灵骨葆胶囊联合改良髓芯减压人工骨植入术治疗股骨头坏死,疗效显著,可有效改善患者髋关节功能、血液流变学及提高生活质量,且安全性较好。     

髓芯减压联合自体骨髓间充质干细胞治疗45例股骨头无菌性坏死的临床疗效分析

目的：观察髓芯减压联合自体骨髓间充质干细胞治疗45例股骨头无菌性坏死的的临床效果及安全性。方法：采取随机原则对2011年11月至2012年3月期间在我院骨科住院治疗的54例患者分成两组,对照组接受髓芯减压治疗,治疗组接受髓芯减压联合自体骨髓间充质干细胞移植治疗治疗。结果：术后随访一年,治疗组的Harris评分为（86．78±9．48）分,对照组为（71．18±8．36）分,两组相互比较差异有统计学意义（P〈0．05）;治疗组的优良率为84．38％,对照组的优良率为55．17％,治疗组的优良率明显高于对照组,差异有统计学意义（P〈0．01）。结论：髓芯减压联合自体骨髓间充质干细胞移植治疗股骨头无菌性坏死效果显著,优于单纯髓芯减压治疗。     

全髋置换术在治疗成人髋臼发育不良伴股骨头坏死中的应用

探讨全髋置换术(THA)在治疗成人髋臼发育不良伴股骨头坏死中的临床应用。26例(29髋)施行全髋置换术治疗成人髋臼发育不良伴股骨头坏死,女性18例,男性8例,平均年龄55岁(39~62)。根据Crowe分类,Ⅰ型15例15髋,Ⅱ型7例8髋,Ⅲ型2例3髋,Ⅳ型2例3髋。髋臼缺损重建采用标准全髋置换术,自体骨植骨造盖和重建髋臼等方法。术前Harris髋关节功能评分平均49.1,下肢缩短2~4 cm,平均2.5 cm。随访26例(29髋),平均随访时间为3.5年(1.1~4.6)。随访期内未发现手术感染或神经、血管损伤、下肢深静脉血栓(DVT)等并发症。术后X线检查显示假体形态良好并且位置稳定,植骨块融合尚可。术后Harris评分平均86分。下肢短缩0~2.7 cm,平均1.0 cm。所有患者均疼痛明显缓解,步态显著改善,2例双下肢不等长仍超过2 cm,轻微跛行。全髋关节置换术是治疗成人髋臼发育不良伴股骨头坏死的一种理想的方法,能有效重建患者髋臼功能。     

铰刀刮除联合自体骨搬运微创治疗股骨头颈部良性肿瘤的临床疗效分析

目的:探讨铰刀刮除联合自体骨搬运技术微创治疗股骨头颈部良性肿瘤的临床疗效及安全性。方法:回顾性分析长海医院骨科2012年1月至2016年1月收治的股骨头颈部良性肿瘤患者,按纳入标准筛选出52例,并分为两组。其中,对照组27名患者使用传统经外侧入路开窗病灶刮除人工骨植骨内固定,微创组25名患者用微创铰刀刮除联合自体骨搬运及人工骨植骨支具外固定。比较两组患者手术时间、出血量、住院时间、住院费用以及术后不良事件发生、骨愈合情况、术后功能恢复情况等。结果:两组均未出现感染、内固定失效、肿瘤恶变、复发、股骨头坏死等并发症,微创组出现1例病理性骨折。微创组在手术时间、术中平均出血量、平均住院天数及住院花费中均低于或短于对照组(P0.05);微创组平均骨愈合时间短于对照组(P0.05);微创组术后1个月及3个月Harris评分高于对照组(P0.05),术后6个月Harris评分与对照组相当(P0.05)。结论:采用铰刀刮除联合自体骨搬运微创治疗股骨头颈部良性肿瘤具有手术及住院时间短,术中出血少,住院费用低,骨愈合时间短以及术后早期功能恢复更好等优点,其临床疗效显著。     

体外冲击波联合钻孔减压术对早期股骨头坏死患者关节功能、肌力及生活质量的影响

目的:探讨体外冲击波(ESWT)联合钻孔减压术对早期股骨头坏死患者关节功能、肌力及生活质量的影响。方法:回顾性分析2017年9月~2018年12月期间收治的80例早期股骨头坏死患者的临床资料,依据治疗方式将其分为A组(n=37,钻孔减压治疗)和B组(n=43,钻孔减压联合ESWT治疗),对比两组患者关节功能、肌力、生活质量及并发症情况。结果:两组治疗后3、6、9个月的视觉模拟评分(VAS)评分较治疗前降低(P<0.05),髋关节Harris评分较治疗前升高(P<0.05);B组治疗后3、6、9个月VAS评分低于A组,髋关节Harris评分则高于A组(P<0.05)。两组患者治疗后9个月生理功能、情感职能、躯体疼痛、生理职能、活力、社会功能、总体健康、精神健康这8个维度评分均较治疗前升高,且B组高于A组(P<0.05)。B组患者治疗后9个月肌力3级者少于治疗前及A组同时间点,肌力4级者多于治疗前及A组同时间点(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论:相比于单独采用钻孔减压术,ESWT联合钻孔减压术治疗早期股骨头坏死,可有效减轻患者疼痛症状,改善患者关节功能、肌力及生活质量,且不增加并发症发生率。     

骨保留型短柄假体行全髋关节置换手术早期疗效观察

目的:探讨骨保留型股骨短柄假体行全髋关节置换手术的近期疗效及临床体会。方法:自2013年1月~2015年3月,首次接受人工全髋关节置换术共30例患者(38髋),年龄38~70岁,均采用后外侧入路。通过比较术前、术后髋关节Harris评分、骨性关节炎指数可视化量表(WOMAC),评价手术疗效。结果:术后所有患者均获得随访,最少6月,最长33月,平均19.5月。术后髋关节疼痛均明显好转,随访期内无严重并发症发生。髋关节Harris评分:术前45.3±4.3,术后末次随访94.1±5.4。术后末次随访Harris评分较术前改善明显,差异有统计学意义(P0.05),术后3~4个月所有患者可以全负重行走。1例术中股骨近端骨折,术后愈合良好,未留后遗症。所有病例未发现假体松动或感染。结论:骨保留型股骨短柄假体行全髋关节置换手术近期临床效果满意,无严重并发症。新型短柄假体设计符合人体解剖特征,骨量保留多,术后疗效好,为髋关节置换提供了一种新的选择。     

人工髋关节置换术在320例股骨头缺血性坏死中的治疗体会

目的：探讨人工髋关节置换术在治疗股骨头缺血性坏死（ANFH）中的临床疗效。方法：选择2007年2月-2011年2月我院收治的320例（340髋）股骨头缺血性坏死患者,均采用人工髋关节置换术对患者进行治疗,其中160例（172髋）患者应用骨水泥型假体进行治疗,另外160例（168）患者采用非骨水泥型假体进行治疗。采用Harris评分对患者手术前后的髋关节功能情况进行评价,并比较骨水泥治疗组和非骨水泥治疗组的临床疗效。结果：患者均获得随访,随访时间为3～18个月。全部患者手术后的Harris评分明显高于手术前,差异有统计学意义（P〈0．05）。骨水泥治疗组和非骨水泥治疗组在术后出血量、术后Harris评分及住院时间方面的差异无统计学意义（P〉0．05）,但非骨水泥治疗组的并发症发生率明显低于骨水泥治疗组（P〈0．05）。结论：采用人工髋关节置换术治疗ANFH疗效显著,能明显改善患者的生活质量,骨水泥型假体与非骨水泥型假体的治疗效果相当,应根据患者的具体情况进行合理的选择。     

Anthropology and genetics of the caucasus peoples and the problem of the origin of the caucasoids

The electrophoretical polymorphisms of some blood proteins were studied in the Talysh population of Pirasora situated in South-East Azerbaidjan. We calculated the gene frequencies of these polymorphisms and determined the genetic distances between the Talyshes and some Iranian populations of North, Central and South Iran, Afghans, and three populations of Azerbaijan. The Talyshes are very close to Iranians of Shiraz, whereas they are distant from the Azerbaijanians. Anthropological investigations showed that the Caucasoids and Mongoloids lived in the Aragvi Basin since the Eneolithic period. This was stated by Alexeev (1974), who emphasized the mixture of the Caucasus populations from ancient times on. We calculated the genetic distances between the Caucasus populations and numerous populations of other geographic regions, considering 28 alleles of 12 loci of blood group, serum protein and red cell enzyme polymorphisms and constructed the dendrogram of these populations. The position of the Caucasus populations in the dendrogram corresponds on principle to the earlier anthropological observations. The clustering of the Caucasoid populations corresponds completely with anthropological and historical data, and supports our earlier hypothesis (Nazarova 1999) concerning the differentiation of Caucasoids, Northern Mongoloids and Amerinds from the populations, which inhabitated Asia in palaeolithic times.     

人类基因组及后基因组研究进展及其应用与开发研究现状

人类对自身基因组的研究,随着人类基因组工作草图的绘制完成和对基因功能研究的深入已加快进入了实质性、关键性的开发利用阶段。本文概述了人类基因组及后基因组的研究进展及依此开展基因治疗及基因（组）药物研制等应用开发研究的现状。     

Serology and systematics of the Ebenales and the Theales

The systematic position ofthe Ebenaceae, Sapotaceae, Styracaceae, Ochnaceae, Stachyuraceae, Dipterocarpaceae, Clusiaceae and Hypericaceae has been investigated using serological comparisons of sets of antigenic determinants. The results show that the Sytracaceae and Sapotaceae are undoubtedly more closely associated with the Actinidiaeceae and Theaceae, respectively, than with each other. We found no corresponding determinants betnween antigen systems from the Ebenaceae and systems from any other family whose relations to this family have been proposed. As discovered previously, investigations of antigen systems from the Ochnaceae, Dipterocarpaceae, Stachyuraceae, Clusiaceae and Hypericaceae are against the idea of a natural order “Theales” in which these families, or at least some of them, are combined with the Theaceae and Actinidiaceae. This paper completes our previous investigations which largely support a superorder Ericanae sensu Ehrendorfer and Takhtajan. We propose to include the Actinidiaceae and Theaceae in this superorder, assigning them a central position laong with the Sapotaceae and Sytracaeae on one side and the Primulales and Ericales on the other. Another most interesting finding is that there are corresponding determinants between antigen systems from the members of the Ericanae and representatives of the Polemoniaceae and Loasaceae.     

Kinematics and dynamics of the temporomandibular joint and of the movements of the mandible

In order to analyze the complicated movements of the mandible as the open-closing movement and the protrusio are, it is useful to evaluate the basic kinematic principles and reduce them to simple technical constructions. Both the open-closing movement and the protrusio could be reduced to 4-bar links, which were used to simulate the movements with help of a computer. Besides, the polodes and the curves of points in the muscular attachments could be constructed. The 2 entirely different 4-bar links have 3 things in common: The resting system - cranium, the moving system - mandibula, and 1 of the 2 arms connecting these 2 systems - the ligamentum laterale. As this ligament is taut during movements it can be considered a "guiding ligament" representing 1 of the 3 determining components of the mandibular movements. The other of the 2 arms has no anatomical equivalent; this arm, however, is "replaced" by the 2 other determining components of the mandibular movements: the joint and the muscles. The curves, which the Caput mandibulae describes, are practically identical for the open-closing movement and the protrusio despite of the different 4-bar links and these curves exactly correspond to the Discus articularis, taut by the upper part of the M. pterygoideus lateralis. The muscles do not only just move the mandibula, but they are also the component, which can choose between the different mandibular movements. By means of the curves, which points in the muscular attachments describe, the function of the masticatory muscles could be analyzed exactly.     

On the structure and dynamics of the complex of the nucleosome and the linker histone

Several different models of the linker histone (LH)–nucleosome complex have been proposed, but none of them has unambiguously revealed the position and binding sites of the LH on the nucleosome. Using Brownian dynamics-based docking together with normal mode analysis of the nucleosome to account for the flexibility of two flanking 10 bp long linker DNAs (L-DNA), we identified binding modes of the H5-LH globular domain (GH5) to the nucleosome. For a wide range of nucleosomal conformations with the L-DNA ends less than 65 Å apart, one dominant binding mode was identified for GH5 and found to be consistent with fluorescence recovery after photobleaching (FRAP) experiments. GH5 binds asymmetrically with respect to the nucleosomal dyad axis, fitting between the nucleosomal DNA and one of the L-DNAs. For greater distances between L-DNA ends, docking of GH5 to the L-DNA that is more restrained and less open becomes favored. These results suggest a selection mechanism by which GH5 preferentially binds one of the L-DNAs and thereby affects DNA dynamics and accessibility and contributes to formation of a particular chromatin fiber structure. The two binding modes identified would, respectively, favor a tight zigzag chromatin structure or a loose solenoid chromatin fiber.     

Biophysics and Structure of the Patch and the Gigaseal

Interpreting channel behavior in patches requires an understanding of patch structure and dynamics, especially in studies of mechanosensitive channels. High resolution optical studies show that patch formation occurs via blebbing that disrupts normal membrane structure and redistributes in situ components including ion channels. There is a 1-2 μm region of the seal below the patch where proteins are excluded and this may consist of extracted lipids that form the gigaseal. Patch domes often have complex geometries with inhomogeneous stresses due to the membrane-glass adhesion energy (E_a), cytoskeletal forces, and possible lipid subdomains. The resting tension in the patch dome ranges from 1-4 mN/m, a significant fraction of the lytic tension of a bilayer (∼10 mN/m). Thus, all patch experiments are conducted under substantial, and uneven, resting tension that may alter the kinetics of many channels. E_a seems dominated by van der Waals attraction overlaid with a normally repulsive Coulombic force. High ionic strength pipette saline increased E_a and, surprisingly, increased cytoskeletal rigidity in cell-attached patches. Low pH pipette saline also increased E_a and reduced the seal selectivity for cations, presumably by neutralizing the membrane surface charge. The seal is a negatively charged, cation selective, space with a resistance of ∼7 gigohm/μm in 100 mM KCl, and the high resistivity of the space may result from the presence of high viscosity glycoproteins. Patches creep up the pipette over time with voltage independent and voltage dependent components. Voltage-independent creep is expected from the capillary attraction of E_a and the flow of fresh lipids from the cell. Voltage-dependent creep seems to arise from electroosmosis in the seal. Neutralization of negative charges on the seal membrane with low pH decreased the creep rate and reversed the direction of creep at positive pipette potentials.     

Comparison of the Effects of Flexion and Extension of the Thumb and Fingers on the Position and Cross-Sectional Area of the Median Nerve

Objective

To assess the separate effects of thumb and finger extension/flexion on median nerve position and cross-sectional area.

Methods

Ultrasonography was used to assess median nerve transverse position and cross-sectional area within the carpal tunnel at rest and its movement during volitional flexion of the individual digits of the hand. Both wrists of 165 normal subjects (11 men, 4 women, mean age, 28.6, range, 22 to 38) were studied.

Results

Thumb flexion resulted in transverse movement of the median nerve in radial direction (1.2±0.6 mm), whereas flexion of the fingers produced transverse movement in ulnar direction, which was most pronounced during flexion of the index and middle fingers (3.2±0.9 and 3.1±1.0 mm, respectively). Lesser but still statistically significant movements were noted with flexion of the ring finger (2.0±0.8 mm) and little finger (1.2±0.5 mm). Flexion of the thumb or individual fingers did not change median nerve cross-sectional area (8.5±1.1 mm²).

Conclusions

Volitional flexion of the thumb and individual fingers, particularly the index and middle fingers, produced significant transverse movement of the median nerve within the carpal tunnel but did not alter the cross-sectional area of the nerve. The importance of these findings on the understanding of the pathogenesis of the carpal tunnel syndrome and its treatment remains to be investigated.