单侧椎体后凸成形术治疗多发性骨髓瘤相关多节段椎体压缩性 骨折的临床观察

目的：评价经单侧穿刺球囊扩张椎体后凸成形术（BKP) 治疗多发性骨髓瘤（MM)相关的多节段椎体压缩性骨折的可行性与 临床疗效。方法：2009 年8月～2011 年10 月收集单纯采用经皮单侧穿刺BKP治疗MM所致的多节段椎体压缩性骨折患者共11 例30 个椎体。手术前后分别通过视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、SF-36 各项指标评分、X线检查,以评价手术 前后椎体疼痛的缓解、功能改善、患者满意度、椎体的高度及后凸Cobb 角的恢复,以及骨水泥的渗漏情况。结果：11 例患者共30 个椎体均手术顺利。术中经单侧椎弓根注入骨水泥平均3.26 mL/椎。平均手术时间19 min/ 椎。每个椎体的平均透视19次。平 均随访12.5 个月,4 例随访中死亡。术后各时期的VAS和ODI评分均较术前明显降低(P<0.05)。术后SF-36 大部分指标评分明显 改善。术后椎体前缘、中线高度及Cobb 角矫正较术前明显恢复(P<0.05)。骨水泥渗漏率3.1%,但无明显的临床症状。结论：经单 侧穿刺BKP 治疗MM相关的椎体压缩性骨折手术时间短,较为安全,缓解疼痛迅速,明显改善后凸畸形,提高了患者生活独立能 力和精神状态。     

椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的临床分析

目的分析老年骨质疏松脊柱压缩骨折行椎体后凸成形术的治疗方法及临床效果,为临床提供依据。方法回顾性分析我院2014年10月~2015年10月收治的老年骨质疏松脊柱压缩骨折患者40例的临床资料,全部患者均为椎体后壁完整疼痛性骨质疏松脊柱压缩骨折,均接受椎体后凸成形术治疗,经双侧椎弓根、椎弓根旁置入可扩张球囊,将骨折塌陷椎体进行复位,采取骨水泥填充球囊扩张产生的椎体内空腔,术后观察患者症状改善和骨折复位情况。结果 40例患者手术均顺利完成,术后48h内患者疼痛显著缓解,骨折椎体前缘以及中部高度丢失,从手术前的(12.5±2.2)mm、(9.1±1.3)mm减少到手术后的(4.6±1.4)mm、(3.3±1.0)mm;后凸畸形Cobb角从手术前的(22.2±5.1)°矫正到手术后的(9.1±4.6)°,其中1例患者术后出现少量骨水泥渗漏,1例患者手术过程中一侧穿刺管中出现脑脊液,即停止该侧手术。结论老年骨质疏松脊柱压缩骨折行椎体后凸成形术治疗效果显著,可以快速缓解患者的疼痛,使患者脊柱序列得到恢复,值得临床推广使用。     

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。     

Pilon 骨折的分型与治疗进展

本文回顾了Pilon骨折的诊断、分型及治疗发展,Pilon骨折特点是高能量损伤累及踝关节负重关节面的胫骨远端骨折,常伴有腓骨骨折和下胫腓关节分离。20世纪中期Pilon骨折被认为无法通过内固定进行治疗,公认的方法是通过骨牵引使关节早期模造获得关节功能的恢复。20世纪后期随着AO理论的深入研究,学术界广泛认同所有关节内骨折的理想治疗方法是解剖复位、坚强固定和早期活动。此后,随着内固定技术的发展及骨科BO理论的出现,目前普遍认为Pilon骨折的治疗应遵循的原则是:1.寻求骨折稳固和软组织完整之间的一种平衡;2.不以牺牲局部软组织血供来强求达到坚强固定。     

Bifidobacterium longum supplementation improves age-related delays in fracture repair

Age-related delays in bone repair remains an important clinical issue that can prolong pain and suffering. It is now well established that inflammation increases with aging and that this exacerbated inflammatory response can influence skeletal regeneration. Recently, simple dietary supplementation with beneficial probiotic bacteria has been shown to influence fracture repair in young mice. However, the contribution of the gut microbiota to age-related impairments in fracture healing remains unknown. Here, we sought to determine whether supplementation with a single beneficial probiotic species, Bifidobacterium longum (B. longum), would promote fracture repair in aged (18-month-old) female mice. We found that B. longum supplementation accelerated bony callus formation which improved mechanical properties of the fractured limb. We attribute these pro-regenerative effects of B. longum to preservation of intestinal barrier, dampened systemic inflammation, and maintenance of the microbiota community structure. Moreover, B. longum attenuated many of the fracture-induced systemic pathologies. Our study provides evidence that targeting the gut microbiota using simple dietary approaches can improve fracture healing outcomes and minimize systemic pathologies in the context of aging.     

螺旋CT扫描及三维重建技术在股骨颈骨折分型及治疗中的应用

目的:探讨螺旋CT扫描及三维重建技术在股骨颈骨折分型及治疗中的应用价值。方法:选择2010年5月~2013年5月期间我院收治的股骨颈骨折患者237例为研究对象,根据患者扫描检查方式的不同将其分为对照组(112例)和观察组(125例),对照组患者行髋关节X线正位扫描,观察组行髋关节正位64排螺旋CT扫描,两组均根据扫描结果进行分型并制定相应的治疗方案,比较两组患者骨折内固定手术后2年的股骨头坏死率及骨折不愈合率。结果:两组行骨折内固定手术比例比较,差异无统计学意义(P0.05);术后2年,对照组股骨头坏死5例(22.73%),骨不连6例(27.27%);观察组股骨头坏死1例(3.70%),骨不连1例(3.70%),观察组患者股骨头坏死率及骨折不愈合率均显著低于对照组,差异均有统计学意义(P0.05)。结论:螺旋CT扫描及三维重建成像能够全面、准确显示股骨颈骨折的损伤情况,有助于骨折的正确分型和治疗方法的选择,改善预后。     

不同类型的下颌骨骨折的手术治疗

目的：评估不同类型的下颌骨骨折的手术入路及固定方法。方法：对于52例不同类型下颌骨骨折患者采用不同的口外或口内切口及相应的固定方法。结果：52例患者伤口全部一期愈合,51例咬合关系恢复到伤前咬合关系,1例出现咬合关系不良,X线检查骨折线队位良好。结论：对于不同部位的下颌骨骨折应采用相应的手术切口及固定方法,以获得最好的疗效。     

Oligomeric state of membrane transport proteins analyzed with blue native electrophoresis and analytical ultracentrifugation

Blue native electrophoresis is used widely for the analysis of non-dissociated protein complexes with respect to composition, oligomeric state and molecular mass. However, the effects of detergent or dye binding on the mass and stability of the integral membrane proteins have not been studied. By comparison with analytical ultracentrifugation, we have evaluated whether the oligomeric state of membrane transport proteins is reflected reliably with blue native electrophoresis. For the analysis we have used two well-characterized transporters, that is, the major facilitator superfamily protein LacS and the phosphotransferase system EII(Mtl). For another member of the major facilitator superfamily, the xyloside transporter XylP from Lactobacillus pentosus, the complete analysis of the quaternary structure determined by analytical ultracentrifugation and freeze-fracture electron microscopy is presented.Our experiments show that during blue native electrophoresis the detergent bound to the proteins is replaced by the amphipathic Coomassie brilliant blue (CBB) dye. The mass of the bound CBB dye was quantified. Provided this additional mass of bound CBB dye is accounted for and care is taken in the choice and concentration of the detergent used, the mass of LacS, XylP and EII(Mtl) and four other membrane (transport) proteins could be deduced within 10 % error. Our data underscore the fact that the oligomeric state of many membrane transport proteins is dimeric.     

Tight Junctions of the Blood–Brain Barrier

1. The blood–brain barrier is essential for the maintainance and regulation of the neural microenvironment. The blood–brain barrier endothelial cells comprise an extremely low rate of transcytotic vesicles and a restrictive paracellular diffusion barrier. The latter is realized by the tight junctions between the endothelial cells of the brain microvasculature, which are subject of this review. Morphologically, blood–brain barrier-tight junctions are more similar to epithelial tight junctions than to endothelial tight junctions in peripheral blood vessels.2. Although blood–brain barrier-tight junctions share many characteristics with epithelial tight junctions, there are also essential differences. However, in contrast to tight junctions in epithelial systems, structural and functional characteristics of tight junctions in endothelial cells are highly sensitive to ambient factors.3. Many ubiquitous molecular constituents of tight junctions have been identified and characterized including claudins, occludin, ZO-1, ZO-2, ZO-3, cingulin, and 7H6. Signaling pathways involved in tight junction regulation comprise, among others, G-proteins, serine, threonine, and tyrosine kinases, extra- and intracellular calcium levels, cAMP levels, proteases, and TNF. Common to most of these pathways is the modulation of cytoskeletal elements which may define blood–brain barrier characteristics. Additionally, cross-talk between components of the tight junction– and the cadherin–catenin system suggests a close functional interdependence of the two cell–cell contact systems.4. Recent studies were able to elucidate crucial aspects of the molecular basis of tight junction regulation. An integration of new results into previous morphological work is the central intention of this review.