[目的]探讨非植骨融合单纯经皮短节段椎弓根螺钉固定治疗伴有后方韧带复合体损伤的屈曲-牵张型(AO分类B型)不稳定胸腰段脊柱骨折的临床疗效.[方法]回顾性分析2015年1月～2018年10月本院采用非植骨融合单纯经皮短节段椎弓根螺钉固定治疗的39例伴后方韧带复合体损伤的屈曲-牵张型不稳定胸腰椎骨折患者,总结围手术期、随访和影像资料.[结果]所有患者手术顺利完成,术中未发生脊髓神经根、血管损伤;手术时间(85.52±6.10) min,术中出血量(60.34±23.12) ml,支具保护下地行走时间(2.61±0.35)d,住院天数(9.47±1.61)d.所有患者随访(14.22±1.16)个月,随时间推移,39例患者的VAS和ODI评分均显著减少(P＜0.05).影像方面,与术前相比,术后39例患者椎体前缘高度显著增加(P＜0.05),而矢状面Cobb角显著减少(P＜0.05).术后椎体前缘高度和矢状面Cobb角无显著改变(P＞0.05).至末次随访时,未出现内固定断裂或松动.[结论]非植骨融合单纯经皮微创后路短节段椎弓根螺钉固定治疗无神经功能损害的伴有后方韧带复合体损伤的屈曲-牵张型不稳定胸腰段脊柱骨折安全有效.

少数病例报告描述了与急性髌骨脱位有关的股骨髁骨软骨骨折[1-3].其发生率并不十分确切.如果骨软骨块几乎全部是软骨性的,而骨性很小,则可能无法通过普通X线影像诊断.这种损伤的发病机理尚不清楚.髌骨与股骨滑车之间的高速低能量剪切力会导致软骨或骨软骨骨折[4],这与引起髌骨脱位的机制相似,这类骨折可以发生在股骨髁的多个部位.通常情况,轻度屈膝状态下的髌骨脱位,骨折部位好发于股骨前外侧髁的非承重部分和髌骨下内缘[5-6].创伤性骨软骨碎块通常仅作为关节内游离体,在手术清创时切除[7-9].骨折部位通过形成纤维软骨样组织愈合,最终导致膝关节疼痛、早期退行性关节炎.

Objective To access the clinical utility of miniature free Flap to repair multi-digit soft tissue defect. Methods From June 2015 to June 2017, 9 cases of soft tissue defect in 26 digits were treated with multiple miniature free flap reconstructions, including 2 digits defect in 3 cases using bilateral fibular flap of the toe, 3 digits defect in 4 cases using bilateral fibular flap of the toe plus uniliateral medial pedal flap and 4 digits in 2 cases using bilateral fibular flap of the toe plus biliateral medial pedal flap. The doner site were directly closed in all cases. Results All flaps survived postoperatively without vascular crisis. Donor and recipient sites healed by first intention. With a mean follow-up of 18 months (ranged 3～24 months), all free flaps appeared to be in good texture, elasticity and aesthetics. According to CMAHS upper extremity scoring system, postoperative hand function were rated excellent in 21 cases, good in 4 cases and poor in 1 case. Static 2 point discrimination was 7.5 mm (ranged 6 mm～9 mm). Conclusion We can achieve a satisfactory long -term aesthetic and functional outcome of multiple digital soft tissue reconstruction using miniature free flap.

目的:评价个体化手术治疗退变性腰椎侧凸合并腰椎管狭窄症的临床疗效.方法:回顾性分析自2013年5月—2017年5月陆军军医大学大坪医院采用个体化手术,治疗48例重度退变性腰椎侧凸合并腰椎管狭窄症的临床疗效,即:根据每例患者的症状、体征、影像学表现,判定责任节段,精准减压;根据侧凸的类型应用截骨矫正、钉棒矫正、融合器矫正等方法适度矫正;合理应用长节段融合.观察术后疼痛缓解和功能改善情况.结果:所有患者均顺利完成手术,平均随访29.5月,术后患者临床症状明显缓解或消失,术后患者的Cobb角显著减小(P<0.01)、腰椎前凸角显著恢复(P<0.01),VAS评分显著降低(P<0.01),ODI评分显著改善(P<0.01);未出现严重并发症.结论:个体化手术是治疗重度退变性腰椎侧凸合并腰椎管狭窄症的有效方法之一.

目的:探讨防旋型股骨近端髓内钉(PFNA)内固定术对股骨粗隆间骨折患者生物力学性能的影响.方法:选取重庆市急救医疗中心2015年6月～2017年6月收治的股骨粗隆间骨折患者132例,根据患者的手术方式分成A组(n=66)与B组(n=66).A组行PFNA内固定术,B组行人工髋关节置换术.比较两组围手术期指标,包括手术时间、术中出血量、卧床时间、术后引流量、住院时间、骨折愈合时间;采用Harris评分评价两组术前、术后6个月、术后12个月的关节功能恢复情况;分别在术后6个月、术后12个月比较两组生物力学特性,包括扭转1.5°时的扭转刚度与扭矩以及荷载800 N时的压缩刚度与压缩位移;并记录两组并发症发生率.结果:A组术中出血量小于B组,手术时间、卧床时间、住院时间及骨折愈合时间短于B组,差异有统计学意义(P<0.05).两组术后6个月、术后12个月的Harris评分高于术前,且A组术后6个月的Harris评分高于B组,差异有统计学意义(P<0.05).两组术后12个月扭转1.5°时扭转刚度、扭转1.5°时扭矩、荷载800 N时压缩刚度均高于术后6个月,荷载800 N时压缩位移小于术后6个月,且A组术后6个月扭转1.5°时扭转刚度、扭转15°时扭矩、荷载800 N时压缩刚度均高于B组,荷载800 N时压缩位移小于B组,差异有统计学意义(P<0.05).A组和B组的并发症发生率分别为6.06％和9.09％,差异无统计学意义(P>0.05).结论:与人工髋关节置换术相比,股骨粗隆间骨折患者行PFNA内固定术能取得更显著效果,可进一步促进术后机体功能恢复,改善术后6个月的生物力学性能,未增加并发症风险,临床推广价值更高.

目的:了解骨质疏松性椎体压缩性骨折(OVCF)早期进行经皮椎体成形术(PVP),或经皮椎体后凸成形术(PKP)围手术期指标和疗效的差异.方法:回顾性分析86例骨质疏松性椎体压缩骨折患者,其中PVP组52例、PKP组34例.比较两组围手术期指标(手术时间、骨水泥注入总量、术后伤椎增加高度、术后VAS评分)和随访指标(椎体前缘高度、后凸Cobb角、椎体压缩率)的统计学差异.结果:PVP组(27.7±6.0)手术时间短于PKP组(37.3±8.1);PVP组(4.6±1.4)骨水泥注入总量小于PKP组(6.0±2.7),PVP组(2.6±1.5)术后伤椎增加高度小于PKP组(9.0±2.0),PVP组(2.4±0.4)术后VAS评分小于PKP组(1.9±0.2),差异均有统计学意义(P<0.05).两组患者术后比较,PVP组(19.85±2.16)椎体前缘高度低于PKP组(24.18±3.07),PVP组(12.43±2.08)后凸Cobb角大于PKP组(8.01±3.45),PVP组(24.89±5.52)椎体压缩率大于PKP组(20.23±3.49)差异均有统计学意义(P<0.05).术前术后比较,两组患者椎体前缘高度均显著增加、后凸Cobb角和椎体压缩率均显著降低(P<0.05).结论:PKP相比PKP能进一步改善OVCF病椎的裂隙修复,尽可能恢复椎体高度,术后疼痛程度轻;但手术时间较长,骨水泥注入量相对较多,且不适用于重度压缩骨折.

目的 探讨冠状动脉造影与支架置入术对腺苷二磷酸(ADP)诱导的血小板聚集率的影响.方法 前瞻性纳入2012年5月1日至2013年4月30日中国医学科学院阜外医院冠心病患者343例,术前至少7d连续服用阿司匹林100 mg,每日1次;氯吡格雷75 mg,每日1次.根据支架置入情况分为单纯冠状动脉造影组(造影组,173例)和支架置入组(170例).患者在接受冠状动脉介入操作之前及之后24 h内,分别采集空腹血样本,用光学比浊法测定血小板聚集率,比较两组患者术前、术后血小板聚集率的变化,支架置入组有66例患者自愿参加血小板聚集率复测亚组分析.结果 两组患者术前、术后血小板聚集率比较,差异无统计学意义(P＞0.05);造影组患者术前、术后血小板聚集率比较,差异无统计学意义(P=0.062),而支架置入组患者术后血小板聚集率显著高于术前[(55.59±10.47)％比(52.47±11.97)％,P＜0.001],差异有统计学意义;支架置入组患者术后血小板聚集率增加大于造影组[(3.12±8.31)％比(1.06±7.40)％,P=0.010],差异有统计学意义.随着患者支架置入数量的增加,术后血小板聚集率呈递增趋势,但差异无统计学意义(P＞0.05).支架置入组血小板聚集率复测亚组患者(66例)术后30 d血小板聚集率显著低于术后24 h[(54.71±11.64)％比(56.68±10.21)％,P=0.019],且与术前基线值比较,差异无统计学意义[(54.71±11.64)％比(54.26±12.23)％,P=0.901].结论 冠状动脉支架置入操作可导致术后血小板活性升高,该作用可在术后30 d内消失,而单纯冠状动脉造影则无此影响.

Objective To observe and compare the effects of electrocoagulation hemostasis, forceps hemo-stasis and compression hemostasis on the operative incision healing in calcaneal fracture patients.Methods From Dec.2012 to Dec.2015,60 patients with calcaneal fracture were treated.Among them 48 were male and 12 were fe-male ranged from 18 to 59 years(average,36.6 years).All cases (66 calcaneal fractures) were treated by open re-duction and internal fixation through L-type calcaneal lateral incision.Intra-operative hemostasis methods included the electrocoagulation hemostasis, forceps hemostasis and compression hemostasis. Indexes such as age, fracture classification,time from injury to operation,operation time,drying time and healing time of the incision,incidence of incision-related complications and Maryland foot function score among the 3 groups were recorded and statistically analyzed.Results The forceps hemostasis group was significantly better than the electrocoagulation hemostasis group and the compression hemostasis group in the drying time and healing time of the incision and the incidence of&nbsp;incision-related complications( P<0.05) ,while there was no significant difference between the electrocoagulation he-mostasis group and the compression hemostasis group(P>0.05) in the above 3 indexes.No significant difference was observed in Maryland foot function score among the three groups(P>0.05).Conclusion Forceps hemostasis could significantly reduce the incidence of incision-related complications during the calcaneal fracture operation.

BACKGROUND:Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention (PCI): a 300 mg loading dose (LD) in clopidogrel naїve patients and a 75 mg maintenance dose (MD) once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown. We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype.METHODS:Chinese patients undergoing PCI (n = 840) were assigned to 2×2 groups in the trial according to different clopidogrel pretreatment strategies (470 patients in LD, 370 patients in MD) and CYP2C19 genotypes (494 carriers of any CYP2C19 *2 or *3 loss-of-function allele, 346 non-carriers). The primary outcome was platelet aggregation (PA) as measured by the 10 µmol/L adenosine diphosphate induced light transmission aggregation.RESULTS:Compared with MD group, LD strategy showed a significantly higher PA-((59.22 ± 11.67)% vs. (52.83 ± 12.17)%, P < 0.01), similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers ((59.41 ± 10.91)% vs. (52.10 ± 12.90)%, P < 0.01). LD patients in either the CYP2C19 loss-of-function allele carrier or non-carrier group showed a significantly higher PA compared with MD group ((61.50 ± 10.61)% vs. (56.84 ± 10.74)%, P < 0.01; (56.06 ± 12.34)% vs. (46.88 ± 11.78)%, P < 0.01, respectively). A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype (P = 0.001).CONCLUSION:The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI, especially in the CYP2C19 2 or 3 loss-of-function allele non-carriers. (ClinicalTrials.gov number NCT01710436)

目的：评价以CYP2C19基因型或血小板功能表现型两种不同的分组方式，对冠状动脉支架置入术后持续服用氯吡格雷的患者临床预后及安全性的预测价值。

Objective To investigate the clinical effect of the bone graft fusion of the posterior lumbar interbody fusion (PLIF) combined with posterolateral fusion(PLF) in treating lumbar spondylolisthesis .Methods 63 cases of lumbar spondylolisthesis were performed the posterior unilateral or bilateral vertebral plate resection ,nerve root canal decompression ,clearing the slippage space , reduction ,fixation short-segment vertebral pedicle nail-stick system for reduction and fixation ,bone graft fusion with the interverte-bral space Cage and posterior-lateral bone graft fusion ,vertebral pedicle isthmus cracking was performed the clearance and bone graft fusion(PLIF combined with PLF ) .The JOA scores ,lumbar lordosis ,segment lordosis ,intervertebral space height ,slippage rate and complications were recorded before operation ,in postoperative 1 week ,6 ,12 months .Results All cases had no serious complications .The JOA scores were increased to some different degrees from the beginning of postoperative 1 week ,with the reha-bilitation time extension ,the JOA scores were gradually increased ,the improvement rate of the postoperative JOA score averaged 85 .00% .The lumbar lordosis ,segment lordosis ,intervertebral space height and slippage rate after operation were significantly im-proved compared with before operation ,the fusion failure rate was 4 .76% .Conclusion The bone graft fusion of PLIF combined with PLF is one of ideal methods to treat lumbar spondylolisthesis .

目的：与药效动力学相关的维生素K环氧化物还原酶复合体亚单位1基因（VKORC1）、与药代动力学相关的细胞色素P4502C9基因（cytochrome P4502C9，CYP2C9）的基因多态性是导致华法林用药剂量差异的两个主要基因。细胞色素P4504F2基因（Cytochrome P4504F2，CYP4F2）对华法林剂量影响较小。本研究的目的是确定上述基因在中国汉族人群中个的分布情况。

Objectives: This study aims to compare the protein composition of high-density lipoprotein (HDL) particles in coronary heart disease (CHD) patients and controls by proteomic methods.Background: HDL has been reported to exert pro-atherogenic properties in CHD patients. Accumulating evidence indicates that HDL composition, rather than the HDL-C level, determines its functions. The changes in HDL composition involved in the conversion of anti-atherogenic to pro-atherogenic properties in CHD patients are currently unknown.Methods and Results: iTRAQ combined with nanoLC-MS/MS was performed to obtain a differential expression profile of the HDL pooled samples of the male age-matched CHD patients and controls (n = 10/group). Of the 196 proteins identified in the examined HDL, 12 were differentially expressed between the CHD patients and the controls, including five up-regulated proteins and seven down-regulated proteins. Using GO analysis, we determined that the up-regulated proteins were mostly involved in inflammatory reactions, displaying a potential pro-atherogenic profile. In contrast, the down-regulated proteins were mostly involved in lipid metabolism processes, displaying anti-atherogenic properties. To confirm the proteomic results, serum amyloid A (SAA) and apoC-I were selected and quantified by ELISA, in the same population as the proteomic analysis, as well as another independent population (n = 120/group). Consistent with the proteomic results, the amount of SAA was significantly increased, and apoC-I was significantly decreased in the HDL particles of CHD patients compared with those of controls (P < 0.05).Conclusions: Our study shows that the HDL proteome changes to a pro-atherogenic profile in CHD patients, which might compromise the protective effects of HDL. Proteomic analysis of HDL composition may provide more relevant information regarding their functional properties than steady-state HDL-C levels.

Objective: To explore the impact for plasma levels of ferritin(FT) and transferrin(TRF) to the risk levels of coronary artery disease(CAD).Methods: Our research included 2 groups, CAD group, n=321 patients and Control group, n=290 healthy subjects. The fasting venous blood was taken from everybody, plasma FT level was detected by electro-chemiluminescence assay and TRF was examined by immune turbidimetric method. The results were compared between 2 groups. Results: Compared with Control group, CAD group had significantly increased plasma FT(236.7 ±174.8) ng/ml vs(207.8 ± 136.9) ng/ml, P=0.032 and decreased TRF(230.5 ±38.1) mg/dl vs(261.6 ± 42.3) mg/dl, P0.001. Multivariate logistic regression analysis presented that plasma FT was not related to CAD, P=0.646 and FRT was related to the risk of CHD(OR: 0.98, 95% CI 0.97-0.99), P0.001. The area under ROC curve for CAD diagnosis showed that FT had no diagnostic value(P=0.145, 95%CI 0.417-0.756), while TRF had medium diagnostic value(P0.001, 95%CI 0.673-0.756), the best cut-off point was TRF≤ 243.5 mg/dl, with the sensitivity of 82.4% and specificity of 47.6%. Conclusion: Our work implies that for CAD related FT and TRF study, plasma level of TRF is more valuable.

Objective To evaluate the impact on QTc interval and relevant adverse drug reaction of amiodarone injection for inpatients.Methods 1 111 inpatients from 4 upper first class hospitals in Beijing were enrolled from May 2011 to July 2012,the QTc intervals were measured to evaluate whether there would be change before and after amiodarone injection within 24 hours,and suspected proarrhythmia adverse effects due to study drug were monitored during the entire period of administration.Results The average heart rate was slowed(87.4±21.2bpm vs 99.6±27.9bpm,P 0.001) and QT interval was prolonged(388.5±55.9ms vs 366.0±55.9ms,P 0.001) significantly after amiodarone administration as compared with the baseline,but QTc interval was not changed with statistical significance(456.8±51.0ms vs 457.8±50.2ms,P =0.554).One patient with atrial tachycardia experienced TdP after 54 hours amiodarone injection concomitant with oral amiodarone showed a prolonged QTc interval up to 756ms previously,TdP didn't occur again after amiodarone discontinuation and appropriate treatment.Conclusion Amiodarone injection within 24 hours does not impact on QTc interval with statistical significance in inpatients.Electrocardiograph should be monitored in a continuous amiodarone injection to avoid the relevant adverse drug reaction,especially when using oral amiodarone concomitantly.

目的观察一期植骨联合负压封闭引流治疗大面积皮肤缺损伴感染性骨不连的临床疗效.方法28例感染性骨折不愈合或骨缺损患者,彻底清除患处失活的软组织和骨组织,直至骨折端点状出血.一期植入自体松质骨颗粒,外固定架固定.创面用负压封闭引流装置(VSD)覆盖,术后敏感抗生素静滴,创面每7~10d更换VSD,直至创面新鲜肉芽覆盖,二期植皮.结果平均随访20(12~38)个月.术后平均36(25~48)d移植骨质表面覆盖肉芽组织,VSD时间平均30(23~46)d,术后28例均待肉芽生长良好后行植皮术,2例行2次植皮后存活,其余均一次植皮成功,植皮术后创面平均16(14~24)d愈合.术后骨折愈合时间平均6.5(3~12)个月,平均8.5(5~16)个月去除外固定.结论一期植骨联合VSD技术是一种有效治疗大面积皮肤缺损伴感染性骨不连的方法.

前路减压植骨内固定手术治疗胸腰椎爆裂骨折51例,术后伤椎椎体高度、Cobb角及椎管容积明显改善,脊髓不完全性损伤患者神经功能按Franke分级有1～3级不同程度的恢复。

Objective To summarize and analyze the adverse reactions(ADR)induced by amiodarone injection from Jan.2011 to Mar.2012 at our hospital,and to guide the rational drug use.Methods A retrospective study was conducted on the use and medical records of amiodarone injection(n=396)from Jan.2011 to Mar.2012 at our hospital,the adverse reactions of abnormal hepatic function,hypotension and bradycardia needing intervention,Torsade de Pointes which were caused by amiodarone injection were counted and analyzed.Results The incidence of the abnormal hepatic function induced by amiodarone injection was 14.6%,the more total quantity of intravenous amiodarone in 24 hours,the more hepatotoxicity the patients got.There were 8 patients with hypotension and 4 with severe bradycardia needing intervention,and there were 2 patients with Torsade de Pointes.Conclusion The incidence of adverse reactions of amiodarone injection is low and it's safe under intensive monitoring.