目的 分析早期闭合复位经皮穿针固定治疗闭合性Lisfrance关节骨折脱位的临床效果.方法 回顾性选取选取2002年1月至2016年6月期间我科室收治的31例Lisfrance骨折脱位患者的临床资料,均经X线或CT断层扫描确诊,行早期(受伤后24h内)闭合复位经皮穿针固定治疗,术后定期复查X线片或CT.采用Maryland足部评分系统评定手术效果,并记录并发症发生情况.结果 与术前相比,31例患者术后1年Maryland足部评分中疼痛、活动度、步态行走距离、外观、踝、稳定度、支撑、跛行、鞋、上下楼梯、地形评分及总分均显著提高,差异有统计学意义(P＜0.01).31例患者中,Lisfrance关节骨折脱位足部手术疗效评价为优者19例、良12例,优良率为100％.随访期出现感染、关节炎者各1例,并发症发生率为6.45％.结论 早期闭合复位经皮穿针固定治疗闭合性Lisfrance关节骨折脱位的临床复位效果满意,并发症少,对改善患者预后有重要意义.

Objective To investigate the effects of sufentanil on activation of spinal astrocytes in mice after unilateral sciatic nerve injury.Methods Eighty healthy male BALB/c mice,aged 6-8 weeks,weighing 18-22 g,were randomly divided into 4 groups (n=20 each): sufentanil high dose group (group H),middle dose group (group M),low dose group (group L) and model group (group MO).After model of sciatic nerve injury was established by unilateral sciatic nerve transection,group H,M and L,sufentanil 10 μg/kg,5 μg/kg,2.5 μg/kg was injected intraperitoneally once a day continuously for 3 days,while the equal volume of saline was injected in group MO.Five mice in each group were selected,and the sciatic nerve functional index were measured at 4,8,12 weeks.The 5 mice were sacrificed from each group and the damage on the same side L4-L6 segments of the spinal cord were removed at 2,4,8,12 weeks.The pathological changes were examined under light microscope at 8 week point.The expression of GFAP was determinatied at each time points by immuno-histochemistry.Results Compared with group L and MO,sciatic nerve functional index significantly was increased in groups H and M (P<0.05),and no significantly change was found in group L.Spinal cord neurons had a better morphology in groups H and M than in group L and MO.Compared with group MO,The expression of GFAP were significantly up-regulated in groups H,M and L (P<0.05).Compared with group L,the expression of GFAP were significantly up-regulated in groups H and M (P<0.05).Conclusion Sufentanil promotes spinal astrocyte activation after peripheral nerve injury in mice and improves repair after peripheral nerve injury.

目的通过对复杂Pilon骨折的手术时机和手术方法的研究,选择Pilon骨折的最佳治疗方案。方法对28例复杂Pilon骨折患者的手术治疗方案进行临床回顾性研究,按照骨折类型及皮肤软组织条件予以切开复位内固定术或有限内固定结合外固定术治疗,观察手术的治疗效果及治疗时机的选择结果。结果本组患者随访时间为12～24个月,平均随访时间16个月。本组所有患者术后均达到骨性愈合,对本组病例的临床疗效评价采用Mazur评分标准,结果显示优18例,良8例,中2例,优良率达到92.8%。结论对于复杂Pilon骨折治疗方案的选择,需要根据骨折类型、伤后局部软组织条件来选择适宜的手术治疗时机和恰当手术治疗方法方能获得较佳的临床治疗效果。

目的:探讨应用锁定加压钢板微创治疗胫腓骨中下段粉碎性骨折的临床疗效。方法:2010年1月～2012年2月,38例胫腓骨中下段粉碎性骨折微创锁定加压钢板内固定治疗。结果:术后随访6～30个月,平均随访时间15.4个月,骨折平均愈合时间18.7周,疗效根据Baird-Jackson评分标准。评价:优18例,良5例,中2例,差0例,优良率92.00%。结论:微创锁定加压钢板内固定是治疗胫腓骨中下段粉碎性骨折的一种较好方法,具有手术创伤小,并发症少,骨折愈合快,功能恢复满意等优点。

<正>同侧股骨颈合并股骨干骨折(IFNSF)常由机动车交通事故、高处坠落伤等高能量创伤所致,且多伴有多系统严重损伤。以往此类型骨折并不常见,但近年来随着交通运输业的迅速发展,其发病率有不断增加的趋势。虽然这类骨折治疗上有不同的内固定方法可供选择,但尚无一种治疗方法得到普遍认可。

<正>股骨粗隆间骨折(ITF)是老年高龄患者常见的骨折之一,占髋关节骨折的60%～70%;对于高龄老年患者来说,粗隆间骨折在1年内的死亡率约为15%～20%〔1〕。股骨粗隆间由于血供丰富,骨折愈合较快,目前主张早期手术治疗。防旋股骨

正>本文对坐骨神经损伤BALB/c小鼠应用苦参碱,通过对坐骨神经相应脊髓节段S100蛋白表达的测定和神经电生理指标的观察,探讨苦参碱对周围神经损伤后的恢复作用。1材料与方法1.1实验动物和分组健康成年雄性BALB/c小鼠160只（体重25±2g,由吉林大学基础医学院实验动物中心提供）,单

Objective To investigate the BALB / c mice after sciatic nerve injury in the sciatic nerve after application of matrine corresponding spinal segment in the expression of gap-43.Methods Healthy adult BALB / c mice 320,consistent with unilateral sciatic nerve cut,the randomized dose,at different times for L4-6 spinal segment,using Real time-PCR detection of the corresponding spinal segment of sciatic nerve gap-43 expression changes,while the LFB myelin staining of sciatic nerve recovery.Results Realtime-PCR results indicate that high-dose and medium-dose group 12h,24h 3d 5d 1w,2w,4w,gap-43 expression was significantly higher than low-dose group and blank control group,8w no significant difference between the groups.LFB staining showed that the recovery of the sciatic nerve high-dose group was significantly better than low-dose group and control group.Conclusion application of sciatic nerve injury in the spinal cord of matrine on the corresponding segments of sciatic nerve cells in the activation of gap-43 play a catalytic role in reducing the infiltration of inflammatory cells to achieve the purpose of promoting nerve regeneration.

目的 探讨红光对周围神经损伤后再生的作用。方法健康雄性成年Wista大鼠40只，随机分为实验组和对照组，每组20只，在手术显微镜下剪断每组实验动物右后肢的坐骨神经，采用9-0无损伤线将神经外膜吻合，术后实验组采用红光照射腰骶段及神经损伤部位，光功率密度为60 J/cm2，1次/日，每次照射15 min，共20d;对照组不进行照射。结果术后4、8、12、16周，实验组坐骨神经传导速度、动作电位波幅、有髓纤维平均直径和有髓纤维数目均明显优于对照组(P＜0.05)。 结论 红光照射治疗可促进损伤后周围神经再生，改善肢体功能。

The purpose of this study is to explore the expression of growth-associated protein(GAP-43) in spinal cord segments connected with injured sciatic nerve by the treatment with brazilein in mice. Unilateral sciatic nerve interruption and anastomosis were performed. Physiological saline(blank group), high dose, middle dose and low dose of brazilein were administrated intragastrically to healthy adult BALB/c mice in separate groups. L4-6 spinal segments connected with the sciatic nerve were harvested. Real-time PCR(Polymerase chain reaction) and Western blot analysis were performed to detect the expression of GAP-43 in spinal segments. Histological staining on myelin and the electrophysiology were performed to examine the sciatic nerve recovery. GAP-43 was activated in spinal cord L4-6 connected with injured sciatic nerve. In the survival time of 12 h, 24 h, 3 d, 5 d, 7 d and 14 d, GAP-43 expression in the motor neurons of spinal cord of the high dose group and that in the middle dose group were significantly higher than those on the low dose and blank groups. Myelin in the high dose group and that in the middle dose group were more mature and the potential amplitude and MNCV(motor nerve conduction velocity) in the high and middle dose groups were obviously higher than those in the low dose group and blank group. Brazilein facilitates the expression of GAP-43 in neurons in spinal cord L4-6 segments connected with injured sciatic nerve, which promotes nerve regeneration.

目的:探讨锁骨骨折应用解剖型锁定钢板内固定治疗的手术方法及疗效。方法:26例锁骨骨折采用解剖型锁定钢板内固定治疗,术后功能练习。结果:术后随访9~18个月、平均12个月,术后骨折愈合时间2~3个月,平均2.6个月。术后未出现延迟愈合、骨不连、肩关节功能障碍及锁骨下神经血管损伤等并发症。结论:锁骨骨折应用解剖型锁定钢板内固定治疗具有内固定稳固,损伤小,对骨组织及断端血运破坏小等优点,具有较好的治疗效果。

目的:探讨PFNA与捆扎带联合治疗股骨近端粉碎骨折的疗效。方法:对16例股骨粗隆下粉碎骨折患者应作PFNA与捆扎带髓内外固定。结果:16例随访7~18个月,骨折愈合时间6~14个月。X线片显示16例患者均接近解剖复位,参照Harris髋关节功能评分法,16例解剖复位患者中优13例,良2例,可1例。结论:该方法能有效恢复股骨粗隆下粉碎骨折的稳定性及完整性,手术相对简单,骨折愈合好,疗效满意。