人工半肩关节置换治疗肱骨近端粉粹骨折的疗效及影响因素分析

目的:探讨人工半肩关节置换治疗肱骨近端粉粹骨折的疗效及其影响因素。方法:选择2010年1月-2013年12月间我院收治的肱骨近端粉粹骨折患者80例,随机分为研究组和对照组,每组40例,研究组应用人工半肩关节置换治疗,对照组应用切开复位内固定治疗。对比两组的术中情况、术后疼痛强度以及不良情况发生情况,术后应用Constant-Murlay评分评价两组肩关节功能。应用多因素Logistic回归分析分析疗效影响因素。结果:研究组手术时间、术中出血量均显著低于对照组(P<0.05);研究组Constant-Murlay中疼痛、ADL、ROM和总分评分显著优于对照组(P<0.05);手术前,两组患者VAS评分无统计学差异(P>0.05),手术后两组患者VAS评分显著降低,术后5 d、15 d、30 d和60 d,研究组VAS评分显著低于对照组(P<0.05);对照组患者肌力不足、异位骨化等不良反应发生率显著高于对照组(P<0.05)。以Constant-Murlay总分为因变量,以年龄、性别、是否合并内科疾病、受伤原因、骨折分型、受伤时间为自变量,经Logistic分析显示,年龄、合并内科疾病、骨折分型、受伤时间是肱骨近端粉碎性骨折疗效的影响因素(P<0.05)。结论:人工半肩关节置换治疗肱骨近端粉粹骨折安全有效,具有很高的临床价值,值得临床推广,同时在手术中应对影响疗效的因素予以注意,提高治疗效果。     

Life and death in a civitas capital: Metabolic disease and trauma in the children from late Roman Dorchester,Dorset

The impact that “Romanization” and the development of urban centers had on the health of the Romano‐British population is little understood. A re‐examination of the skeletal remains of 364 nonadults from the civitas capital at Roman Dorchester (Durnovaria) in Dorset was carried out to measure the health of the children living in this small urban area. The cemetery population was divided into two groups; the first buried their dead organized within an east–west alignment with possible Christian‐style graves, and the second with more varied “pagan” graves, aligned north–south. A higher prevalence of malnutrition and trauma was evident in the children from Dorchester than in any other published Romano‐British group, with levels similar to those seen in postmedieval industrial communities. Cribra orbitalia was present in 38.5% of the children, with rickets and/or scurvy at 11.2%. Twelve children displayed fractures of the ribs, with 50% of cases associated with rickets and/or scurvy, suggesting that rib fractures should be considered during the diagnosis of these conditions. The high prevalence of anemia, rickets, and scurvy in the Poundbury children, and especially the infants, indicates that this community may have adopted child‐rearing practices that involved fasting the newborn, a poor quality weaning diet, and swaddling, leading to general malnutrition and inadequate exposure to sunlight. The Pagan group showed no evidence of scurvy or rib fractures, indicating difference in religious and child‐rearing practices but that both burial groups were equally susceptible to rickets and anemia suggests a shared poor standard of living in this urban environment. Am J Phys Anthropol, 2010. © 2009 Wiley‐Liss, Inc.     

生长激素-海藻酸钠-壳聚糖微胶囊促进骨折愈合的组织学研究

目的:观察生长激素-海藻酸钠-壳聚糖微胶囊促进兔挠骨骨折愈合的作用。方法:实验将新西兰兔80只,在制备新西兰兔右桡骨中段3mm骨缺损模型的基础上,随机分成四组:口服生长激素-海藻酸钠-壳聚糖微胶囊组、皮下注射生长激素组、口服空微胶囊组和生理盐水对照组。实验组口服生长激素-海藻酸钠-壳聚糖微胶囊和皮下注射生长激素,对照组口服空微胶囊。并于术后9、17、30、42d定期HE染色和地衣红染色观察各组的骨折愈合情况。结果:本实验HE染色结果表明,由于在骨缺损部位成纤维细胞产生的大量胶原纤维为基质,形成透明软骨及成骨细胞,骨小梁生长的基础,连接骨痂形成和骨髓腔贯通。而观察到生长激素微胶囊组各期提前生长及改建提前的形态。地衣红染色图像结果分析及直方图的分析表明:生长激素微胶囊组胶原纤维产生促进骨小梁提前形成,进而骨折处骨性骨痂的提前愈合和髓腔的提前贯通。结论:生长激素-海藻酸钠-壳聚糖微胶囊口服能促进骨折修复愈合。     

前内前外双切口双钢板治疗复杂胫骨平台骨折

目的:探讨双切口、双钢板切开复位内固定治疗胫骨平台骨折的手术技术及疗效。方法:我院于2004年至2008年间共收治胫骨平台骨折109例,其中Schatzker V、VI型骨折59例,均采用双侧切口双钢板固定骨折。结果:58例切口获得I期愈合,切口及关节腔感染1例,未发生内固定物断裂、深静脉血栓等并发症。术后1年随访50例,膝关节HSS评分平均91.9分(6l一98分),其中优41例,良8例,差1例,优良率98.0%,完全负重时间3～6个月。结论:术前系统的病情评估,准确地掌握手术指征和手术方法,可大大改善患者膝关节功能,获得满意疗效。     

益肾和络合剂对慢性肾衰竭实验室指标的影响(英文)

目的:探讨壮骨颗粒对骨折部位新生血管增殖的影响。方法:42只新西兰大白兔,行兔左侧桡骨中段做3mm骨缺损,随机分为壮骨颗粒组,伤科接骨片组,生理盐水组,术后1天开始给药,在第4、6、8周进行X线观察,4w、8w行病理组织学检查。结果:X线片评分半定量分析表明,壮骨颗粒组骨折愈合速度明显快于伤科接骨片组,生理盐水组(P<0.05);I型胶原蛋白免疫组化结果显示壮骨颗粒组I型胶原阳性结果明显比伤科接骨片组、生理盐水组强(P<0.05);壮骨颗粒组血管生成明显多于伤科接骨片组、生理盐水组。结论:壮骨颗粒有明显促进骨痂形成和促进新生血管形成作用。     

Occurrence and fate of fetal lumbar rib induced by Scutellariae radix in rats

BACKGROUND: This study was conducted to evaluate the occurrence and fate of fetal lumbar rib induced by Scutellariae radix (SR) in rats. METHODS: Water extracts of SR were orally administered to pregnant rats from day 7 to day 17 of gestation at a dose of 186 mg/kg/day, equivalent to 25 g/kg of starting material, representing a 100‐fold increase over typical human intake level. RESULTS: The incidence of fetal lumbar rib in the SR‐treated group was increased on gestational day 20 and then decreased on postnatal day 50. The weight of fetuses in the SR‐treated group tended to be less than that in the control group. Alkaline phosphatase in SR‐treated dams was increased on gestational day 20, but was decreased on postnatal day 50. There were no significant differences between the vehicle control and SR‐treated groups in maternal body weight, embryological, histopathological, hematological, and serum biochemical changes. CONCLUSIONS: The present data suggest that the appearance of lumbar rib induced by SR is a transient fetal variation rather than teratogenicity or maternal toxicity. Birth Defects Res (Part B) 89:201–206, 2010. © 2010 Wiley‐Liss, Inc.     

Resultados de un programa de rehabilitación domiciliaria tras hospitalización en pacientes con fractura de cadera

IntroductionHip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit.MethodsRetrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected.ResultsTwo hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission.ConclusionsThe home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained.     

Protein carbonylation after traumatic brain injury: cell specificity,regional susceptibility,and gender differences

Protein carbonylation is a well-documented and quantifiable consequence of oxidative stress in several neuropathologies, including multiple sclerosis, Alzheimer׳s disease, and Parkinson׳s disease. Although oxidative stress is a hallmark of traumatic brain injury (TBI), little work has explored the specific neural regions and cell types in which protein carbonylation occurs. Furthermore, the effect of gender on protein carbonylation after TBI has not been studied. The present investigation was designed to determine the regional and cell specificity of TBI-induced protein carbonylation and how this response to injury is affected by gender. Immunohistochemistry was used to visualize protein carbonylation in the brains of adult male and female Sprague–Dawley rats subjected to controlled cortical impact (CCI) as an injury model of TBI. Cell-specific markers were used to colocalize the presence of carbonylated proteins in specific cell types, including astrocytes, neurons, microglia, and oligodendrocytes. Results also indicated that the injury lesion site, ventral portion of the dorsal third ventricle, and ventricular lining above the median eminence showed dramatic increases in protein carbonylation after injury. Specifically, astrocytes and limited regions of ependymal cells adjacent to the dorsal third ventricle and the median eminence were most susceptible to postinjury protein carbonylation. However, these patterns of differential susceptibility to protein carbonylation were gender dependent, with males showing significantly greater protein carbonylation at sites distant from the lesion. Proteomic analyses were also conducted and determined that the proteins most affected by carbonylation in response to TBI include glial fibrillary acidic protein, dihydropyrimidase-related protein 2, fructose-bisphosphate aldolase C, and fructose-bisphosphate aldolase A. Many other proteins, however, were not carbonylated by CCI. These findings indicate that there is both regional and protein specificity in protein carbonylation after TBI. The marked increase in carbonylation seen in ependymal layers distant from the lesion suggests a mechanism involving the transmission of a cerebral spinal fluid-borne factor to these sites. Furthermore, this process is affected by gender, suggesting that hormonal mechanisms may serve a protective role against oxidative stress.     

Traumatic brain injury and bone healing: radiographic and biomechanical analyses of bone formation and stability in a combined murine trauma model

Introduction:The combination of traumatic brain injury (TBI) and long-bone fractures has previously been reported to lead to exuberant callus formation. The aim of this experimental study was to radiographically and biomechanically study the effect of TBI on bone healing in a mouse model.Materials and methods:138 female C57/Black6N mice were assigned to four groups (fracture (Fx) / TBI / combined trauma (Fx/TBI) / controls). Femoral osteotomy and TBI served as variables: osteotomies were stabilized with external fixators, TBI was induced with controlled cortical impact injury. During an observation period of four weeks, in vivo micro-CT scans of femora were performed on a weekly basis. Biomechanical testing of femora was performed ex vivo.Results:The combined-trauma group showed increased bone volume, higher mineral density, and a higher rate of gap bridging compared to the fracture group. The combined-trauma group showed increased torsional strength at four weeks.Discussion:TBI results in an increased formation of callus and mineral density compared to normal bone healing in mice. This fact combined with a tendency towards accelerated gap bridging leads to increased torsional strength. The present study underscores the empirical clinical evidence that TBI stimulates bone healing. Identification of underlying pathways could lead to new strategies for bone-stimulating approaches in fracture care.