两种不同术式对老年股骨颈骨折治疗对比

目的：探讨全髋关节置换术与股骨头置换术治疗对比。方法：回顾性的分析对2007年1月-2008年12月年我院接收的70例60岁以上的老年股骨颈骨折的进行股骨头置换和全髋关节置换两组不同手术方式的临床资料。结果：两组股骨颈骨折治疗的手术时间、住院时间及术后并发症及治疗效果无明显统计学差异,两组术后半年到一年半的Harris评分较术前评分有显著的统计学意义。结论：人工股骨头置换术和髋关节置换是治疗老年股骨颈骨折的有效方法,可根据患者的自身情况、疾病特点等选择不同术式。     

Osteogenic growth peptide enhances the rate of fracture healing in rabbits

The discovery of growth factors, such as osteogenic growth peptide (OGP), that stimulate bone formation led to experiments to discover whether they can accelerate fracture healing. To determine whether OGP enhances the rate of healing in rabbits, fractures were made in the tibiae of New Zealand White rabbits and immobilized with either a plastic plate (unstable mechanical conditions), or a dynamic compression plate (stable mechanical conditions). OGP was administered to experimental animals by intravenous injection from day 4 until the day before sacrifice; control animals were not injected. After treatment with OGP, callus development under unstable mechanical conditions was accelerated. At 7 days, the cartilage in the centre of the callus was covered by bone and endochondral ossification had started; these events occur at 10 days in control fractures. Subsequently, endochondral ossification is completed earlier which allows the invasion of the fracture gap by cells, so that cortical union is complete by 21 to 28 days. In control fractures, bone is only beginning to form in the gaps at 28 days. There was no increase in the size of the callus in any of the experimental fractures compared to the untreated controls. Treatment with OGP has no observable effect on the rate of healing of fractures under stable mechanical conditions. These observations suggest that under unstable mechanical conditions only, the rate of callus formation and subsequent cortical healing is enhanced by treatment with OGP, but that the size of the callus is determined by mechanical and other factors.     

跟骨骨折手术治疗并发症原因分析及预防

目的:探讨手术内固定治疗跟骨骨折发生并发症的原因及预防.方法:2007年5月～2010年9月应用切开复位跟骨钛板和闭合橇拔复位斯氏针内固定术治疗的64例跟骨骨折患者中,对出现并发症的患者进行回顾性分析,探讨其发生并发症的可能原因.结果:其中2例切口感染浅表坏死,1例腓肠神经损伤,腓骨长短肌腱断裂1例,腓骨肌腱炎4例,创伤性关节炎5例,复位丢失3例.结论:应根据骨折类型选择恰当的治疗方案,正确把握手术时机、规范操作,可有效减少并发症,获得满意的疗效.     

股骨近端防旋髓内钉与联合加压交锁髓内钉治疗老年股骨转子间骨折的疗效比较研究

目的:研究对比股骨近端防旋髓内钉(PENA-Ⅱ)与联合加压交锁髓内钉(Inter Tan)治疗老年股骨转子间骨折的疗效。方法:选择2014年6月至2016年6月我院收治的老年股骨转子间骨折患者92例,按照随机数字表法分为PENA-Ⅱ组与Inter Tan组,每组各46例。两组患者分别接受PENA-Ⅱ治疗和Inter Tan治疗,术后进行为期12个月的随访。比较两组临床疗效、手术相关指标(手术时间、术中出血量、骨折愈合时间)、手术前后骨密度水平变化情况以及并发症发生情况。结果:PENA-Ⅱ组优良率为89.13%,略高于Inter Tan组的86.96%,但两组比较差异无统计学意义(P0.05)。PENA-Ⅱ组患者手术时间、术中出血量分别为(65.2±15.3)min、(57.2±29.3)m L,明显低于Inter Tan组患者的(84.3±13.8)min、(104.7±36.5)m L(P0.05),两组患者骨折愈合时间比较差异无统计学意义(P0.05)。术前、术后12周以及术后24周PENA-Ⅱ组患者的腰椎骨密度水平与Inter Tan组比较差异无统计学意义(P0.05)。两组切口感染、肺部感染、下肢深静脉血拴、近端股骨外侧皮质劈裂以及髋内翻发生率对比差异无统计学意义(P0.05)。结论:PENA-Ⅱ与Inter Tan治疗老年股骨转子间骨折的临床疗效相当,且两种手术方法对骨密度水平的影响及术后并发症发生率相似。但PENA-Ⅱ治疗具有手术时间短以及术中出血量少等优势,值得临床推广应用。     

Comparative analysis of vascular endothelial cell activation by TNF-α and LPS in humans and baboons

As an Old World nonhuman primate, baboons have been extensively used for research on dyslipidemia and atherogenesis. With increasing knowledge about the endothelium's role in the initiation and progression of atherosclerosis, the value of the baboon model can be increased by developing it for research on the role of dysfunctional endothelium in atherogenesis. Toward that goal, we have established and validated methods of isolating and culturing baboon femoral artery endothelial cells (BFAECs) and compared baboon endothelial cellular characteristics with those of humans. Our results indicated that baboon and human endothelial cells share similar growth and culture behaviors. As was the case for human endothelial cells, BFAECs responded to tumor necrosis factor (TNF)-α stimulation with increased expression of adhesion molecules (maximum increase for intracellular adhesion molecule (ICAM): 1.76±0.26-fold; vascular cell adhesion molecule (VCAM): 1.65±0.25-fold; E-selectin: 2.86±0.57-fold). However, BFAECs were hyporesponsive to lipopolysaccharide (LPS) (range, 0.25–20 μg/mL) in adhesion molecule expression, whereas 1 μg/mL LPS induced 2.14- to 3.71-fold increases in human endothelial cells. The differential responses to LPS were not related to TLR-2 and toll-like receptor (TLR)-4 expression on the cell surface. And baboon microvascular endothelial cells had similar features as BFAECs. We observed constitutive expression of interleukin (IL)-6, IL-8, granulocyte macrophage colony-stimulating factor (GM-CSF), and monocyte chemoattractant protein (MCP)-1 in both human and baboon endothelial cells, and these cytokines were further induced by TNF-α and LPS. We also demonstrated that the responses to TNF-α or LPS varied among baboons maintained under the same dietary and environmental conditions, suggesting that response may be controlled by genetic factors.     

锁定钢板与半肩关节置换治疗老年肱骨近端骨折疗效比较

目的:比较锁定钢板(Locking plate,LP)与半肩关节置换(semi-shoulder arthroplasty,SSA)治疗老年肱骨近端NeerⅢ、Ⅳ型骨折临床疗效。方法:对我院骨科2009年5月至2013年5月收治的61例老年肱骨近端NeerⅢ、Ⅳ型骨折的患者资料进行回顾性分析,男性18例,女性43例,年龄60~84岁,平均69.3岁。其中采用LP治疗者40例,采用SSA治疗者21例,观察两组患者的手术时间、失血量、Neer评分情况,记录手术并发症情况,并进行统计学比较。结果:所有患者均获得随访,平均随访时间14.5个月(12~20个月)。LP组手术时间(105.6±20.4 min vs 80.6±18.2 min,t=2.650,P=0.01)多于SSA组,两组在手术出血量(188.5±25.2 ml vs 200.5±31.6 m L,t=1.666,P=0.1)、Neer评分优良率(92.5%vs 90.5%,X2=0.075,P=0.784)和并发症发生率(4.8%vs12.5%,X2=1.351,P=0.245)无明显差异。结论:在老年肱骨近端NeerⅢ、Ⅳ型骨折的治疗上,SSA手术时间短,但手术并发症发生率以及疗效优良率与LP相似,临床应根据病情及需要灵活选择手术方式。     

Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress

Early stages of avascular necrosis of the femoral head (AVNFH) can be conservatively treated with hyperbaric oxygen therapy (HBOT). This study investigated how HBOT modulates inflammatory markers and reactive oxygen species (ROS) in patients with AVNFH. Twenty-three male patients were treated with two cycles of HBOT, 30 sessions each with a 30 days break between cycles. Each session consisted of 90?minutes of 100% inspired oxygen at 2.5 absolute atmospheres of pressure. Plasma levels of tumor necrosis factor alfa (TNF-α), interleukin 6 (IL-6), interleukin 1 beta (IL-1β) and ROS production were measured before treatment (T0), after 15 and 30 HBOT sessions (T1 and T2), after the 30-day break (T3), and after 60 sessions (T4). Results showed a significant reduction in TNF-α and IL-6 plasma levels over time. This decrease in inflammatory markers mirrored observed reductions in bone marrow edema and reductions in patient self-reported pain.     

3D打印技术辅助前侧微创入路手术治疗不稳定型骨盆骨折的临床疗效分析

目的:探讨3D打印技术辅助前侧微创入路手术治疗不稳定型骨盆骨折的临床疗效及安全性。方法:选择2014年8月到2017年2月在我院诊治的骨盆骨折患者78例作为研究对象,按照随机信封抽签原则分为观察组与对照组,每组各39例。对照组采用常规X线与CT进行手术设计,观察组采用3D打印技术进行手术设计,两组都给予前侧微创入路手术治疗,比较两组的手术时间、切口长度、骨折愈合时间、术中出血量、术中和术后并发症的发生情况及术后3个月的骨盆功能优良率。结果:所有患者都完成手术,无术中严重并发症发生,两组手术时间及切口长度对比差异无统计学意义(P0.05)。对照组的骨折愈合时间、术中出血量显著高于观察组(P0.05)。观察组术后并发症的发生率(5.1%)显著低于对照组(25.6%)(P0.05),术后3个月的骨盆功能优良率(97.4%)显著高于对照组(74.4%)(P0.05)。结论:与常规X线与CT前侧微创入路手术治疗比较,3D打印技术辅助前侧微创入路手术治疗不稳定型骨盆骨折可为患者提供安全、有效、个性化的治疗,减少术后并发症的发生,改善患者的骨盆功能。     

经皮椎体成形术对骨质疏松性胸腰椎骨折患者生物力学的影响研究

目的:探讨经皮椎体成形术对骨质疏松性胸腰椎骨折患者生物力学的影响。方法:选取9具冻存新鲜尸体的胸腰段脊柱开展研究,并应用随机数字表法分为观察组、对照1组和对照2组,每组各3具。观察组、对照1组均制作成骨质疏松性胸腰椎骨折模型,观察组经椎弓根注入含有对比剂的低粘度骨水泥,对照1组置入椎弓根螺钉内固定,分别于术前和术后测量两组椎体的主要生物力学指标(最大抗压强度、刚度、高度),对照2组则作为参照,仅测量一次,对三组生物力学指标检测结果进行统计分析。结果:观察组椎体术前的最大抗压强度、刚度、高度与对照1组比较差异无统计学意义(P0.05),但两组术前最大抗压强度、刚度较对照2组降低,而高度较对照2组升高(P0.05)。观察组和对照2组术后的最大抗压强度、刚度均较对照1组升高,高度较对照1组降低(P0.05),而观察组术后的最大抗压强度、刚度、高度与对照2组比较差异无统计学意义(P0.05)。结论:应用经皮椎体成形术对骨质疏松性腰椎骨折患者实施治疗,能够有效恢复患者椎体生物力学,效果确切。     

经皮椎体成形术对老年骨质疏松性胸腰椎压缩骨折患者血清MMP-3、TIMP-1、IL-6及疗效的影响

目的:探讨经皮椎体成形术对老年骨质疏松性胸腰椎压缩骨折患者血清基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶抑制因子-1(TIMP-1)、白细胞介素-6(IL-6)及疗效的影响。方法:选择60例2016年10月到2017年3月我院接诊的老年骨质疏松性胸腰椎压缩骨折患者,依照随机数表法分为实验组和对照组,每组30例,在都给予常规药物治疗的基础上,对照组给予复位枕垫和康复训练治疗,实验组采用经皮椎体成形术治疗。结果:治疗前,两组血清MMP-3、TIMP-1、IL-6水平无差异(P0.05);治疗后,两组血清MMP-3、IL-6水平均降低,实验组下降幅度更大,两组血清TIMP-1水平均升高,实验组上升幅度更大(P0.05);治疗前,两组患者VAS评分无差异(P0.05),治疗1周及治疗后,实验组患者VAS评分均低于对照组(P0.05);治疗前,两组患者Cobb角无差异(P0.05),治疗后,两组患者Cobb均明显下降,实验组较对照组下降更大(P0.05);治疗前,两组患者伤椎高度比无差异(P0.05),治疗后,两组伤椎高度比明显下降,实验组低于对照组(P0.05);治疗后,实验组有效率96.67%大于对照组的76.67%,差异显著(P0.05)。结论:经皮椎体成形术能有效降低患者血清MMP-3、IL-6水平,恢复TIMP-1水平,能显著提高治疗老年骨质疏松性胸腰椎压缩骨折的疗效