颞部Gillies切口在颧骨复合体骨折手术中的应用

目的:颞部Gillies切口在颧骨复合体骨折手术中的应用效果。方法:运用颞部Gillies切口治疗25例病人颧骨复合体骨折,观察手术进路,显露术区,在直视下行颧骨骨折复位内固定术。结果:25例患者应用此术式均可显露骨折区域,满足颧骨复合体骨折的手术显露需要,而且与常规颧骨复合体骨折(头皮冠状切口)手术相比,减小了出血及损伤神经的可能。结论:颞部Gillies切口在颧骨复合体骨折手术中优于其它手术路径,值得临床推广。     

两种联合切口手术治疗眶- 上颌- 颧骨复合体骨折的对比研究

目的:对比研究冠状-睑下缘-口内联合切口手术与冠状切口联合口腔前庭沟切口手术治疗眶-上颌-颧骨复合体骨折的治疗效果。方法:选取2006年10月～2010年12月眶-上颌-颧骨复合体骨折患者136例,69例患者行冠状-睑下缘-口内联合切口手术,67例行冠状切口联合口腔前庭沟切口手术,分别命名为A组和B组,比较两组患者治疗效果,治疗效果用甲级、乙级和丙级表示。结果:A组治疗效果甲级、乙级、丙级分别为65.2%、30.4%、4.4%,B组治疗效果甲级、乙级、丙级分别为46.3%、29.8%、23.9%,A组治疗效果优于B组;A组术后并发症少于B组。结论:冠状-睑下缘-口内联合切口手术比冠状切口联合口腔前庭沟切口手术更好地治疗眶-上颌-颧骨复合体骨折,治疗效果好,并发症少,能更好地实现颧骨复位。     

两种联合切口手术治疗眶-上颌-颧骨复合体骨折的对比研究

目的：对比研究冠状-睑下缘-口内联合切口手术与冠状切口联合口腔前庭沟切口手术治疗眶-上颌-颧骨复合体骨折的治疗效果。方法：选取2006年10月-2010年12月眶-上颌-颧骨复合体骨折患者136例,69例患者行冠状-睑下缘-口内联合切口手术,67例行冠状切口联合口腔前庭沟切口手术,分别命名为A组和B组,比较两组患者治疗效果,治疗效果用甲级、乙级和丙级表示。结果：A组治疗效果甲级、乙级、丙级分别为65．2％、30．4％、4．4％,B组治疗效果甲级、乙级、丙级分别为46．3％、29．8％、23．9％,A组治疗效果优于B组;A组术后并发症少于B组。结论：冠状-睑下缘-口内联合切口手术比冠状切口联合口腔前庭沟切口手术更好地治疗眶-上颌-颧骨复合体骨折,治疗效果好,并发症少,能更好地实现颧骨复位。     

冠状- 睑下缘- 口内联合切口手术治疗眶- 上颌- 颧骨复合骨折

目的:探讨经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折坚强内固定术的临床应用价值。方法:回顾性分析69例患者经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折解剖复位,钛板坚强内固定。结果:69例均一期愈合,68例治疗效果优良,1例治疗效果欠佳;2例轻度睑外翻,两周后恢复正常,无额纹变浅、面神经损伤等其他并发症。结论:冠状-睑下缘-口内联合切口具有切口隐蔽、面部疤痕不明显、显露充分、并发症少等优点,是治疗眶-上颌-颧骨复合骨折的良好手术进路。     

冠状-睑下缘-口内联合切口手术治疗眶-上颌-颧骨复合骨折

目的：探讨经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折坚强内固定术的临床应用价值。方法：回顾性分析69例患者经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折解剖复位,钛板坚强内固定。结果：69例均一期愈合,68例治疗效果优良,1例治疗效果欠佳;2例轻度睑外翻,两周后恢复正常,无额纹变浅、面神经损伤等其他并发症。结论：冠状-睑下缘-口内联合切口具有切口隐蔽、面部疤痕不明显、显露充分、并发症少等优点,是治疗眶-上颌-颧骨复合骨折的良好手术进路。     

微创后入路治疗肩胛骨骨折的临床研究

目的:探讨微创后入路手术治疗肩胛骨骨折的临床疗效。方法:选取2009年6月~2014年1月在我院接受后路内固定手术治疗的40例肩胛骨骨折,治疗组20例,行微创后入路内固定术,对照组20例,行Judet入路内固定术。比较两组间手术时间、术中出血量、切口总长度及术后肩关节功能Constant评分。结果:40例患者均获随访,随访时间12~36个月,平均16.5个月。治疗组手术时间、术中出血量、切口总长度均优于对照组(均P0.05),术后6个月肩关节功能:治疗组优15例,良3例,可1例,差1例,优良率90%,对照组优14例,良2例,可3例,差1例,优良率80%。两组优良率比较,差异有统计学意义(P0.05)。两组均无感染、骨折延迟愈合或不愈合。对照组1例发生肩胛上神经卡压。结论:微创后入路手术操作简单,创伤小,恢复快,是一种安全有效的肩胛骨骨折手术入路。     

颧骨颧弓骨折的分类及诊治

颧骨颧弓骨折是最常见的面中部骨折之一,迄今为止,在其分类及诊治的选择上仍然存在一定争议,本文对目前颧骨颧弓骨折的分类及诊治的现状和进展作一综述,以期对临床工作提供参考。     

补锌对兔实验性颧骨骨折愈合影响的生物力学研究

通过对１８只实验性颧骨骨折新西兰兔在骨折愈合过程中采用补锌和未补锌两种方法,来比较研究补锌对骨折部位的生物力学影响,进而阐明锌对骨折愈合的作用。     

胫骨平台后侧骨折的手术治疗

目的：探讨对于胫骨平台后侧骨折患者的手术治疗方法及治疗效果。方法：选取本院2010年4月至2012年1月间采用手术治疗的胫骨平台后侧骨折患者23例设为治疗组,本组所有患者均采用后外侧入路的内固定手术治疗方法。另选取同期采用保守治疗的胫骨平台后侧骨折患者20例设为对照组。两组患者治疗后均获得12个月以上的随访。针对两组患者治疗后骨愈合时间、膝关节功能评分以及治疗总有效率等情况进行回顾性对比分析。结果：所有两组患者经治疗后,治疗组患者骨愈合时间明显低于对照组（P〈0．05）,其结果具有统计学意义。且经随访后,治疗组患者膝关节功能评分显著高于对照组（P〈0．05）。而两组患者经综合评价其治疗总有效率对比差异也具有显著性（P〈0．05）,且结果具有统计学意义。结论：对于胫骨平台后侧骨折患者采用后外侧入路的内固定手术治疗拥有显著的临床疗效。此术式具有对骨折部位起到很好的显露及复位稳定等优点,且在治疗效果及患者膝关节功能恢复情况等方面明显优于其它治疗方式。故此方法安全、有效,不失为治疗胫骨平台后侧骨折的首选治疗方法。     

胫骨平台后侧骨折的手术治疗

目的:探讨对于胫骨平台后侧骨折患者的手术治疗方法及治疗效果。方法:选取本院2010年4月至2012年1月间采用手术治疗的胫骨平台后侧骨折患者23例设为治疗组,本组所有患者均采用后外侧入路的内固定手术治疗方法。另选取同期采用保守治疗的胫骨平台后侧骨折患者20例设为对照组。两组患者治疗后均获得12个月以上的随访。针对两组患者治疗后骨愈合时间、膝关节功能评分以及治疗总有效率等情况进行回顾性对比分析。结果:所有两组患者经治疗后,治疗组患者骨愈合时间明显低于对照组(P0.05),其结果具有统计学意义。且经随访后,治疗组患者膝关节功能评分显著高于对照组(P0.05)。而两组患者经综合评价其治疗总有效率对比差异也具有显著性(P0.05),且结果具有统计学意义。结论:对于胫骨平台后侧骨折患者采用后外侧入路的内固定手术治疗拥有显著的临床疗效。此术式具有对骨折部位起到很好的显露及复位稳定等优点,且在治疗效果及患者膝关节功能恢复情况等方面明显优于其它治疗方式。故此方法安全、有效,不失为治疗胫骨平台后侧骨折的首选治疗方法。     

The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozygomatic deformities

Collapse of the zygomatic arch following trauma results in inadequate anteroposterior projection of the zygomatic body and an increase in facial width. Accurate assessment of the position of the zygomatic arch in relation to the cranial base posteriorly and the midface anteriorly is the key to the acute repair of complex midfacial fractures and the secondary reconstruction of posttraumatic deformities of the orbitozygomaticomaxillary complex. Loss of projection of the zygomatic arch may occur with injuries confined to the orbitozygomaticomaxillary region or in association with complex midfacial fractures. A safe anatomic approach to the zygomatic arch allows exact anatomic restoration of the zygomatic arch using miniplates and screws and results in the reconstruction of an outer facial frame with a correct anteroposterior projection and facial width. The zygomatic arch injury is diagnosed using axial CT scanning. Three-hundred and seventeen arches have been exposed through a coronal incision following acute trauma and 47 arches have been exposed in patients requiring late correction of a posttraumatic orbitozygomaticomaxillary deformity. Permanent palsy to the frontal branch of the facial nerve has occurred in one patient following the exact definition of the anatomy of this region.     

壳聚糖磷脂复合物对老年性痴呆患者脑功能的影响

目的：观察壳聚糖磷脂复合物（CPC）对老年性痴呆患者脑功能的影响。方法：采用脑电超慢涨落图仪（ET）分别测定对照组和试验组的S谱线,分析脑内神经递质的含量。结果：服用CPC2月后,经ET检测,S1、S5谱线明显增高（P〈0．01）,S2谱线增高（P〈0．05）。结论：CPC能改善老年性痴呆患者的脑功能。     

A scanning electron microscopic study of the luteo-follicular complex

Summary As observed by SEM, the repair of an ovulated mammalian follicle is accompanied by a sequence of morphogenetic processes. In the initial phase, a mass of cells and coagulated fluids forms at the site of rupture. Shortly thereafter, connective cells, recruited from the adjacent and subjacent connective tissue stroma begin to proliferate and to migrate over this mass such that in the rabbit, the entire site of disruption is covered by a layer of connective cells by approximately 2 days following ovulation. Coincident with the migration of the connective tissue, superficial cells from undisturbed lateral and basal areas of an ovulated follicle also proliferate and begin to migrate over the newly established connective tissue matrix. By approximately 4 days following ovulation in the rabbit, the surface of an ovulated follicle is repopulated by elements of the superficial epithelium. The formation of the underlying corpus luteum (corpora luted) involves characteristic morphological changes as granulosa cells transform into steroid secreting luteal cells. The luteal cells become organized into cords of cells which usually surround capillary vessels. When examined by SEM, the smooth-surfaced endoplasmic reticulum of the luteal cell is quite apparent and is observed to form a three-dimension network of anastomosing tubules which are continuous with the nuclear membrane. Variations in the appearance of the surface of the ovary which directly overlies corpora lutea were observed when the mouse, rat and rabbit were compared. The regression of corpora lutea involves the infiltration of the luteal mass by connective tissue and both degeneration and vacuolization of the luteal cells. The regressing corpus luteum is a honey-comb-like structure in which each space is occupied by a degenerating luteal cell.This work was supported by grants from the National Institutes of Health, Public Health Service (to J.V.B., no. HD-04274), and from Consiglio Nationale delle Ricerche (C.N.R., contracts nos. CT 76.01288.04 and CT 77.01921.4)     

The effect of microcracking in the peritubular dentin on the fracture of dentin

Dentin is a biocomposite possessing elegant hierarchical structure, which allows it to resist fracture effectively. Despite the considerable efforts to unravel the peculiar fracture behavior of dentin, the effect of microstructural features on the fracture process is largely unknown. In this study, we explore the interaction between the primary crack with crack tip located in intertubular dentin (ITD) and microcracking of peritubular dentin (PTD) ahead of the primary crack. A micromechanical model accounting for the unique composite structure of dentin is developed, and computational simulations are performed. It is found that the microcracking of PTD located in the crack plane in front of the primary crack tip can promote the propagation of the primary crack, increasing the propensity of coalescence of primary crack and microcracks nucleating in PTD. We show that the two-layer microstructure of dentin enables reduction in driving force of primary crack, potentially enhancing fracture toughness. The high stiffness of PTD plays a critical role in reducing the driving force of primary crack and activating microcracking of PTD. It is further identified that the microcracking of PTD arranged parallel to the crack plane with an offset could contribute to the shielding of primary crack.     

早期伤口切开对血循毒蛇咬伤患者预后的影响

目的探讨血循毒类毒蛇咬伤患者早期伤口切开对预后的影响。方法回顾性分析我院2011年3月~2014年3月诊治的血循毒类毒蛇咬伤患者223例的临床资料,总结并比较其临床特点及预后。结果本组患者轻度肿胀97例中,伤后12h内切开21例,未溃疡12例,Ⅰ°溃疡7例,Ⅱ°溃疡2例;晚期切开或未切开76例,未溃疡15例,Ⅰ°溃疡41例,Ⅱ°溃疡16例,Ⅲ°溃疡4例。中度肿胀患者85例中,伤后12h内切开32例,未溃疡8例,Ⅰ°溃疡21例,Ⅱ°溃疡2例,Ⅲ°溃疡1例;晚期切开或未切开53例,未溃疡6例,Ⅰ°溃疡16例,Ⅱ°溃疡24例,Ⅲ°溃疡7例。重度肿胀患者41例中,伤后12h内切开17例,Ⅰ°溃疡11例,Ⅱ°溃疡4例,Ⅲ°溃疡2例;晚期切开或未切开24例,Ⅰ°溃疡2例,Ⅱ°溃疡6例,Ⅲ°溃疡16例。在蛇伤后12h内切开的患者坏死溃疡的形成、肿胀程度的改善均明显优于晚期切开或未切开的患者,差异有显著统计学意义(P0.05)。结论随着患者凝血功能的改善,早期伤口切开对血循毒类毒蛇伤患者局部伤口状况有较好的改善作用。     

Biosystematic studies on Adenophora potaninii Korsh. complex (Campanulaceae) V. A taxonomic treatment

Abstract Adenophora is an extremely variable genus, and its taxonomy is very controversial. Of the genus, Adenophora potaninii complex, including A. potaninii, A. bockiana, A. wawreana, A. lobophylla, A. biformifolia, A. polydentata, and A. wawreana var. lanceifolia, is a typical group with different taxonomical treatments due to high level of morphological diversity. We carried out extensive biosystematic studies based on population sampling, transplantation experiments and offspring tests, cluster analysis, and a crossing experiment. The results reveal four main findings. (i) Leaf forms of the A. potaninii complex were extremely polymorphic; the leaf form of A. potaninii and A. bockiana, and that of A. wawreana and A. biformifolia could be found, respectively, on a single population or among the offsprings of a single plant. (ii) Cluster analysis and a crossing experiment indicated that A. bockiana and A. polydentata could not be separated from A. potaninii, nor A. biformifolia from A. wawreana. (iii) Adenophora potaninii and A. wawreana were gradational in morphology and their compatibility value was slightly reduced compared to that within each entity. (iv) Adenophora lobophylla was distinct from the other members of the complex in shape and size of corolla, relative length of style, and shape of capsule. This species was incompatible reproductively with the other members of the complex, but partly compatible with A. stenanthina, a species in another section. Therefore, we recognized only one species with two subspecies in the complex, A. potaninii subsp. potaninii and subsp. wawreana, moved A. lobophylla out of the complex, and reduced all the other names as new synonyms.     

Biosystematic studies on Adenophora potaninii Korsh.complex (Campanulaceae) V.A taxonomic treatment

Adenophora is an extremely variable genus,and its taxonomy is very controversial.Of the genus,Adenophora potaninii complex,including A.potaninii,A.bockiana,A.wawreana,A.lobophylla,A.biformifolia,A,polydentata,and A.wawreana var.lanceifolia,is a typical group with different taxonomical treatments due to high level of morphological diversity.We carried out extensive biosystematic studies based on population sampling,transplantation experiments and offspring tests,cluster analysis,and a crossing experiment.The results reveal four main findings.(i) Leaf forms of the A.potaninii complex were extremely polymorphic; the leaf form of A.potaninii and A.bockiana,and that ofA.wawreana and A.biformifolia could be found,respectively,on a single population or among the offsprings of a single plant.(ii) Cluster analysis and a crossing experiment indicated that A.bockiana and A.polydentata could not be separated from A.potaninii,nor d.biformifolia from A.wawreana.(iii) Adenophora potaninii and A.wawreana were gradational in morphology and their compatibility value was slightly reduced compared to that within each entity.(iv) Adenophora lobophylla was distinct from the other members of the complex in shape and size of corolla,relative length of style,and shape of capsule.This species was incompatible reproductively with the other members of the complex,but partly compatible with A.stenanthina,a species in another section.Therefore,we recognized only one species with two subspecies in the complex,A.potaninii subsp.potaninii and subsp,wawreana,moved A.lobophylla out of the complex,and reduced all the other names as new synonyms.     

Modelling the effects of different fracture geometries and healing stages on ultrasound signal loss across a long bone fracture

The effect on the signal amplitude of ultrasonic waves propagating along cortical bone plates was modelled using a 2D Finite Difference code. Different healing stages, represented by modified fracture geometries were introduced to the plate model. A simple transverse and oblique fracture filled with water was introduced to simulate the inflammatory stage. Subsequently, a symmetric external callus surrounding a transverse fracture was modelled to represent an advanced stage of healing. In comparison to the baseline (intact plate) data, a large net loss in signal amplitude was produced for the simple transverse and oblique cases. Changing the geometry to an external callus with different mechanical properties caused the net loss in signal amplitude to reduce significantly. This relative change in signal amplitude as the geometry and mechanical properties of the fracture site change could potentially be used to monitor the healing process.     

Experimental and clinical study of immunomodulators Immunomax and Gepon in complex treatment of acute purulent surgical infection]

The efficacy of the immunomodulators immunomax and gepon in the treatment of acute purulent surgical infection of soft tissues was studied under experimental and clinical conditions. Gepon was used in the form of 0.04% ointment in the phase of the wound infection regeneration vs. the routine use of 10% methyluracil ointment. Immunomax was administered in a dose of 40 units under the experimental conditions and 200 units in the clinical trial 3 times every 2nd day intramuscularly. The experimental investigation was performed on 20 male guinea pigs in a model of a suppurating wound. The animals were divided into 2 groups (main and control) of 10 animals each. Flat wounds were prepared according to the A. V. Nikolaev's method. The clinical trial enrolled 126 patients with acute surgical infection of the soft tissues. The patients were treated in the Hospital of General Surgery of the Faculty of Pediatrics of the Russian State Medical University during the period from 2003 to 2004. The patients were divided into 2 groups (main and control). The structure of the main and control groups was comparable by the sex and age of the patients, nosological forms and severity of the disease. The patients of the main group (65 subjects) were given the immunomodulators in complex with the routine surgical treatment and drug therapy. The patients of the control group (61 subjects) were given the same surgical treatment and drug therapy but without the use of the immunomodulators. General and local manifestations of the purulent infection were considered as the criteria of the treatment efficacy. The qualitative and quantitative composition of the wound bacterial infection was determined and histological examination of the wound bioptates was performed. Planimetry of the wound surface was carried out and the acceleration index of the wound clearing and healing was evaluated. In the total, high therapeutic efficacy of immunomax and gepon, practically no contraindications and adverse reactions to their use, the ease and simplicity of their handling can be stated.