镶嵌式外固定架治疗长骨骨不连17例体会

目的：探讨长骨骨不连的一种治疗方法。方法：2007年1月至2009年8月,采用镶嵌式外固定架治疗17例长骨骨不连。本组17例,男11例,女6例,年龄16-64岁,平均31岁。2例为血源性骨髓炎病理性骨折后,股骨、胫骨各1例;6例为创伤性骨髓炎后骨折不愈,肱骨1例,股骨1例,胫骨4例;9例为手术后无感染性骨不连,肱骨2例,股骨2例,胫骨5例;7例有不同程度畸形,6例有1.5-8cm骨短缩,其中2例同时行骨痂延长术。结果：全部病人均获随访,随访时间9-20个月,以1975年天津全国骨科会议制定的骨折愈合标准为依据,本组17例病人均获得临床愈合,骨不连处平均愈合时间为4～9月（平均6.2月）,1例延长8cm,另1例延长6cm。结论：利用镶嵌式外固定架治疗长骨骨不连一种简单有效的方法。     

外固定架联合抗感染活性骨治疗下肢创伤性骨髓炎

目的:验证外固定架联合抗感染活性骨(ARBX)治疗下肢创伤性骨髓炎的疗效。方法:25例下肢创伤性骨髓炎患者给予原内固定取出、病灶清除、断端修整、抗感染活性骨植骨、外固定架固定,通过长期随访,分析评价其疗效。结果:随访2-10年,平均6年,感染彻底控制无复发23例,感染治愈率92%;骨不连、骨缺损获得骨性愈合24例,1例残留骨不连,愈合时间6-24月,骨性愈合率96%。结论:外固定架联合抗感染活性骨是治疗下肢创伤性骨髓炎的安全有效手术方法。     

IV型镶嵌式外固定器治疗下肢长骨骨缺损

目的:探讨应用IV型镶嵌式外固定器治疗下肢长骨骨缺损的临床疗效.方法:1996年4月～2008年4月应用IV型镶嵌式外固定器治疗下肢长骨骨缺损48例患者,其中股骨8例,胫骨40例.骨缺损长度为5～15cm,平均8cm.随访时间9-27个月,平均18个月.结果:48例患者肢体长度均得到恢复;骨缺损达到骨性愈合,平均愈合时间8.2个月;6例骨折成角,均<10°;12例共25处针孔感染;所有病例无神经血管损伤表现,髋、膝、踝关节活动均未受影响.结论:IV型镶嵌式外固定器是治疗长骨复杂骨缺损、成功重建肢体长度的有效方法.     

Ⅳ型镶嵌式外固定器治疗下肢长骨骨缺损

目的：探讨应用IV型镶嵌式外固定器治疗下肢长骨骨缺损的临床疗效。方法：1996年4月～2008年4月应用IV型镶嵌式外固定器治疗下肢长骨骨缺损48例患者,其中股骨8例,胫骨40例。骨缺损长度为5～15cm,平均8cm。随访时间9-27个月,平均18个月。结果：48例患者肢体长度均得到恢复;骨缺损达到骨性愈合,平均愈合时间8.2个月;6例骨折成角,均〈10°;12例共25处针孔感染;所有病例无神经血管损伤表现,髋、膝、踝关节活动均未受影响。结论：IV型镶嵌式外固定器是治疗长骨复杂骨缺损、成功重建肢体长度的有效方法。     

扩髓更换髓内钉治疗髓内钉固定后股骨干肥大性骨不连

目的:评价扩髓更换髓内钉治疗髓内钉固定后股骨干肥大性骨不连的临床疗效及手术适应症。方法:自1998年4月至2009年6月采用扩髓更换髓内钉治疗11例髓内钉固定后股骨干肥大性骨不连,其中男9例,女2例,年龄23-61岁。平均36.2岁,骨折部位在股骨上1/3者2例;中1/3者6例;下1/3者3例,原始骨折Winquist-Hansen分型:I型2例,II型3例,III型4例,IV型2例。结果:11例患者均获随访,时间:11～56个月,平均27.4个月,2例患肢短缩1 cm。另4例未获得骨性愈合,3例再次采用附加钢板合并自体髂骨植骨,1例远端锁钉动力化,再次干预后获得骨性愈合,愈合时间6～16个月,平均8.3个月。结论:扩髓更换髓内钉是治疗髓内钉固定后股骨肥大性骨不连的传统方法,基于力学稳定和临床观察,更适用于股骨中段骨不连。     

重组合异种骨治疗股骨非感染性骨不连的长期疗效观察

目的:探讨重组合异种骨治疗股骨非感染性骨不连的长期临床疗效。方法:对2000年1月至2006年9月间我院应用重组合异种骨(RBX)治疗的37例股骨非感染性骨不连患者进行回顾性分析,其中男26例,女11例;年龄4～70岁,平均31.6岁。骨折部位:股骨近端4例,中段30例,远端3例。骨不连类型:肥大型9例,营养不良型6例,萎缩型22例。固定方式:加压钢板24例,髓内钉11例,外固定架2例。结果:37例患者获得51-131个月的随访,平均90.2个月,骨不连一次手术愈合率:94.6%,4例股骨近端骨不连患者采用Harris评分系统评定疗效,优3例,良1例,差0例,优良率100%。3例股骨远端骨不连患者采用美国膝关节协会评分系统(KSS)评定疗效,优1例,例良1例,差1例,优良率66.7%。30例股骨干骨不连患者采用Harris评分系统和KSS评定疗效,优21例,良8例,差1例,优良率96.7。总优良率94.6%。长期观察均无免疫排斥反应表现。结论:RBX用于治疗股骨非感染性骨不连具有材料充足、骨折愈合率高、组织兼容性好长期应用无免疫排斥反应等优点,是一种良好的自体骨替代材料。     

15例腓肠肌岛状穿支肌皮瓣修复胫骨近端骨髓炎伴骨外露的临床观察

目的:观察腓肠肌岛状穿支肌皮瓣治疗胫骨近端骨髓炎伴骨外露的临床效果。方法:回顾性分析2013年1月至2015年6月在我科收治的15例胫骨近端骨髓炎伴骨外露患者,采用彻底清创、腓肠肌岛状穿支肌皮瓣进行修复治疗,皮肤缺损面积为5cm×4 cm~8 cm×6 cm,切取皮瓣面积为6 cm×5cm~9 cm×7 cm。术后对皮瓣成活率、并发症、膝踝关节功能、皮瓣外观满意度进行随访观察。结果:本组15例中14例肌皮瓣一期愈合,1例二期愈合,术后随访6~18个月无感染复发病例,膝踝关节功能良好。根据改良ASAMI评分系统评价疗效:优10例,良4例,中1例,差0例。结论:腓肠肌岛状穿支肌皮瓣修复胫骨近端骨髓炎伴骨外露具有良好疗效。     

抗感染活性骨治疗感染性胫骨骨不连的临床研究

目的:观察抗感染活性骨(ARBX)治疗感染性胫骨骨不连的临床效果。方法:回顾性分析我院自2008年1月-2015年1月收治并系统随访应用抗感染骨治疗的36例创伤后感染性骨不连病例,给予原内固定取出或外架拆除,病灶清除,去除硬化骨及死骨,髓腔再通,抗感染活性骨植骨,外架或钢板重新固定,统计患者病程时间,伤口愈合时间,患者院前手术次数,滴注引流时间及抗生素应用疗程,骨性愈合时间,内、外固定物拆除时间以及功能恢复情况,并总结治疗疗效。结果:平均随访2.4年(1年2月-4年10月),骨不连彻底治愈30例,4例患者感染控制,半皮质愈合,2例感染复发,骨不连未愈合。结论:1抗感染活性骨是治疗感染性骨不连的一种有效的植骨材料,具有控制感染,促进骨折愈合的作用;2彻底清除坏死,失活组织是控制感染,促进感染性骨不连愈合的关键;3清理断端,断端骨髓腔再通可促进成骨,促进骨折愈合。     

LCP结合自体髂骨联合RBX植骨治疗非感染萎缩型肱骨干骨不连的体会

目的:探讨锁定加压钢板(Locked compression plate,LCP)结合自体髂骨联合重组合异种骨(recombinant bone xenograft,RBX)植骨治疗非感染萎缩型肱骨干骨不连的疗效及相关体会。方法:于2009年2月-2015年9月期间,应用LCP结合自体髂骨联合RBX植骨治疗了15例非感染萎缩型肱骨干骨不连。结果:本组获随访9-29个月,骨不连均获得愈合。肩关节功能优良率86.7%,肘关节功能优良率100%。结论:依据本组研究及相关文献报道,LCP结合自体髂骨植骨联合RBX植骨可提高骨不连愈合率。     

应力叩击仪促进胫骨骨折外固定架术后骨折愈合的临床观察

目的:探讨应力叩击仪促进胫骨骨折外固定架术后骨折愈合的临床价值。方法:选取132例胫骨骨折患者为研究对象,随机抽样法分成研究组和对照组两组,各66例。对照组采用术后常规干预方案,研究组予以术后应力叩击仪叩击治疗方案。比对两组患者的骨不愈合率、骨延迟愈合率、骨折愈合时间、完全负重时间、骨折6个月时Lane-Sandhu X线评分及Johner-wruh评估情况。结果:1研究组骨不愈合率及骨延迟愈合率分别为4.5%和7.6%,均显著低于对照组的19.7%和22.7%(P0.05);2研究组骨折愈合时间及完全负重时间分别为(82.6±9.2)d和(101.5±10.5)d,均显著短于对照组的(105.9±10.3)d和(122.4±10.3)d,(P0.05);对照组骨折6个月时Lane-Sandhu X线评分为(2.2±0.5)分,显著低于研究组的(3.0±0.5)分,(P0.05);3研究组骨折6个月时Johner-wruh优良率为90.1%,显著高于对照组的75.8%(P0.05)。结论:应力叩击仪应用于胫骨骨折患者外固定架手术后的康复治疗中,可有效缩短骨折愈合时间、提高骨折愈合率,对加快骨痂生长速度、促进病情转归有利。     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.     

肝癌中HBV和HCV基因和抗原的分布及意义

采用原位分子杂交方法检测HCV RNA及HBV X基因;采用免疫组织化学方法研究HCV核心抗原,非结构区C33c抗原及HBxAg在肝细胞肝癌中的定位及分布.结果表明(1)HCV RNA、HBV X基因在肝细胞肝癌组织检出率分别为40%(55/136)和82%(112/136).HCV RNA定位于癌细胞的胞浆内,阳性细胞呈散在、灶状及弥漫分布三种形式;HBV X基因在肝癌细胞中的分布呈胞浆型、核型及核浆型,阳性细胞也呈上述三种分布形式;(2)HCV C33c抗原、核心抗原在肝细胞肝癌中的阳性率为81%(133/164)及86%(141/164).C33c抗原定位于癌细胞及肝细胞的胞浆内;核心抗原既定位于癌细胞核中,又可定位于胞浆中.C33c抗原阳性细胞以灶状分布为主;而核心抗原阳性细     

Selection with two alleles and complete dominance

For a plant selection model with frequency-independent viabilities, fertilities and selfing rates, it is shown that apart from global fixation, for certain parameter combinations a protected polymorphism and facultative fixation (either allele may become fixed according to initial frequencies) may both occur. Facultative fixation requires different selling rates for the dominant and recessive type. Protection of the polymorphism requires resource allocation for male and female function. In this connection the problem of purely genetically caused population extinction is discussed.
For general frequency dependence and regular segregation, the chances for establishment of a completely recessive gene are compared to those of a completely dominant gene. It is proven that the process of establishment of the recessive gene, despite a fitness advantage, may be considerably endangered by drift effects if random mating prevails. The recessive gene may reach the same effectivity in establishment as a dominant gene, only if the recessive homozygote mates exclusively with its own type during the period of establishment.