骨科实习教学中的问题及对策

实习教学是培养医学生的重要环节,是理论教学与临床实践的桥梁。根据骨科专业性强、内容繁多,带教老师多肩负繁重临床工作等特点,我们通过加强师资队伍建设,落实带教责任制,明确学习目标,培养学习兴趣,注重基本功训练,规范实施问诊查体,养成独立的临床诊断与治疗思维,重视病历书写,培养临床思维,加强医患交流,掌握常见多发病的诊疗常规,注重动手能力培养,强化骨科影像教学等内容,提高实习生综合素质,达到提高骨科临床教学质量的目的。     

骨科3D打印技术安全性和有效性非对照研究综述

目的 评价骨科3D打印技术临床应用的安全性和有效性。方法 通过非对照研究的系统性综述,分析 3D打印技术在骨科临床应用的安全性和有效性。结果 无对照研究分析显示：螺钉穿破皮质发生率为3.83%（按螺钉数计算）,并发症发生率为2.13%,手术感染发生率为0.28%,假体问题发生率为0.79%,平均手术时间为139.23分钟,部分安全性和有效性指标的评价结果与有对照研究的结果相似。结论 虽然3D打印技术在骨科的临床应用有一定价值,但其推广还需经济学评价。     

3D打印技术骨科临床应用效应系统性综述

目的 评价3D打印技术骨科临床应用的效应。方法 通过系统性综述和Meta分析,比较3D打印技术与传统常规技术在骨科临床应用的效应。 结果 对25篇纳入的文献进行Meta分析显示,3D打印技术可减少骨科手术时间（26分钟左右）,降低术中出血量（77毫升左右）,提高植钉准确率或成功率（为传统常规技术的2.10倍）,但未减少并发症发生率。结论 3D打印技术骨科临床应用的短期效应总体较好,但在我国骨科临床应用应谨慎发展。     

骨科住院患者死亡原因的研究分析

目的:对骨科住院患者死亡原因进行研究分析。方法:本研究采用回顾性病史分析方法,对我院2002年11月至2011年3月期间的骨科住院患者死亡病例进行统计分析。结果:在此期间共发生死亡病例27例。死亡的原因分别是:呼吸系统衰竭、急性心肌梗死、急性脑血管病、多器官衰竭以及出血性休克。结论:年龄在70-80岁之间的股骨颈骨折病人的死亡率最高,属于高危人群;手术的治疗干预并没有提高患者的死亡率;患者的死亡时间并没有在特定的时间段出现高值。肺栓塞是导致骨科病人死亡的高危因素。通过采取有效的预防措施,可以降低骨科住院患者的死亡率。     

骨科3D打印技术临床研究的状况分析

目的 研究骨科3D打印技术临床研究状况。方法 通过文献检索,对纳入的107篇文献进行系统性综述,描述骨科3D打印技术临床研究的基本状况。结果 骨科3D打印技术临床研究对象以男性为主,主要集中在成人群体,并且研究时间主要在2007年~2012年。3D打印技术经常应用于骨科手术的复位内固定、畸形矫正、椎弓根钉置入、肿瘤切除、翻修重建、膝关节置换。结论 骨科3D打印技术仍处在初步临床发展阶段。     

Circulating interleukin-6 is not altered while γ-tocopherol is increased in subjects scheduled for knee surgery with low vitamin D

The purpose of this study was to identify if circulating interleukin (IL)-6 and γ-tocopherol (γT) fluctuate with vitamin D status in subjects with an underlying knee joint injury or disease. We hypothesized that low vitamin D associates with an increase in plasma γT while serum IL-6 remains unchanged in subjects with an underlying knee joint trauma or disease. Fifty-four subjects scheduled to undergo primary, unilateral anterior cruciate ligament reconstructive surgery (ACL; n = 27) or total knee arthroplasty (TKA; n = 27) were studied. Circulating γT, α-tocopherol (αT), lipids (cholesterol and triglycerides), IL-6, and 25-hydroxyvitamin D (25(OH)D) were measured in fasting blood samples obtained prior to surgery. Subjects were classified as vitamin D deficient, insufficient, or sufficient if they had a serum 25(OH)D concentration <50, 50–75, or >75 nM, respectively. The majority (57%) of the subjects possessed a serum 25(OH)D less than 50 nM. Circulating cholesterol, triglycerides, and IL-6 were not significantly (all p > 0.05) different between vitamin D status groups. However, lipid corrected αT was significantly (p < 0.05) decreased and both lipid- and non-lipid-corrected plasma γT concentrations were significantly (both p < 0.05) increased with low serum 25(OH)D (i.e., <50 nM). A significant (p < 0.05) multi-variate analysis revealed that an increase in plasma γT per lipids was significantly (p < 0.05) predicted by a decrease in serum 25(OH)D but not by a decrease in plasma αT per lipids. We conclude that low vitamin D associates with an increase in plasma γT but not IL-6 in subjects with an underlying joint injury or disease.     

Evaluation of F8-TNF-α in Models of Early and Progressive Metastatic Osteosarcoma

The targeted delivery of tumor necrosis factor-α (TNF-α) with antibodies specific to splice isoforms of fibronectin [e.g., F8-TNF, specific to the extra-domain A (EDA) domain of fibronectin] has already shown efficacy against experimental sarcomas but has not yet been investigated in orthotopic sarcomas. Here, we investigated F8-TNF in a syngeneic K7 M2–derived orthotopic model of osteosarcoma as a treatment against pulmonary metastases, the most frequent cause of osteosarcoma-related death. Immunofluorescence on human osteosarcoma tissue confirmed the presence of EDA in primary tumors (PTs) as well as metastases. In mice, the efficacy of F8-TNF against PTs and early pulmonary metastases was evaluated. Intratibial PT growth was not affected by F8-TNF, yet early micrometastases were reduced possibly due to an F8-TNF–dependent attraction of pulmonary CD4⁺, CD8⁺, and natural killer cells. Furthermore, immunofluorescence revealed stronger expression of EDA in early pulmonary metastases compared with PT tissue. To study progressing pulmonary metastases, a hind limb amputation model was established, and the efficacy of F8-TNF, alone or combined with doxorubicin, was investigated. Despite the presence of EDA in metastases, no inhibition of progressive metastatic growth was detected. No significant differences in numbers of CD4⁺ or CD8⁺ cells or F4/80⁺ and Ly6G⁺ myeloid-derived cells were observed, although a strong association between metastatic growth and presence of pulmonary Ly6G⁺ myeloid-derived cells was detected. In summary, these findings demonstrate the potential of F8-TNF in activating the immune system and reducing early metastatic growth yet suggest a lack of efficacy of F8-TNF alone or combined with doxorubicin against progressing osteosarcoma metastases.