目的 探讨抗生素骨水泥联合个体化设计组织瓣治疗创伤性骨髓炎的临床疗效.方法 回顾性分析18例应用抗生素骨水泥联合个体化设计组织瓣治疗的创伤性骨髓炎患者的临床资料.患者均彻底清创清除感染灶,大流量冲洗,抗生素骨水泥链珠填充软组织死腔,抗生素骨水泥柱填充骨缺损,配合全身使用敏感抗生素彻底控制感染,然后个体化设计组织瓣覆盖创面,术后6～8周行骨折内固定并在诱导膜腔内植骨以修复骨缺损.结果 18例患者术后均获14～26个月随访.所有患者皮瓣均Ⅰ期成活,完全骨愈合时间18～41周,术后均无感染复发,无严重并发症发生.末次随访时采用Johner-Wruhs评分标准评定疗效:优9例,良7例,中2例,总体优良率88.9％.结论 抗生素骨水泥联合个体化设计组织瓣治疗创伤性骨髓炎疗效较好,值得临床推广应用.

目的 探讨保留及去除内固定物治疗骨折内固定术后感染的临床疗效.方法 回顾性分析31例骨折内固定术后感染患者,其中采取去除内固定物(A组)的方法治疗18例,采取在"低毒力感染"状态下保留内固定物(B组)的方法治疗13例.比较2组患者术后骨折愈合时间、并发症及住院总费用,采用Saman-tha X线评分标准评价骨愈合质量,采用Paley方法评价邻近关节功能.结果 31例患者均获随访,平均19.5个月(13～41个月).A组平均愈合时间6.8个月,B组13个月.Samantha X线评分:A组平均5.1分,B组4.6分.Paley关节功能评价:A组优5例,良3例,可7例,差3例,优良率为44％;B组优7例,良4例,可2例,优良率为85％.住院总费用:A组108534.47～174591.74元,平均151563.1元;B组18507.94～38140.19元,平均25324.07元.结论 在"低毒力感染"状态下保留内固定物治疗骨折内固定术后感染有利于骨折部位邻近关节功能的锻炼,极大降低医疗费用,临床疗效满意.

目的:探讨消疽汤联合抗生素骨水泥治疗慢性骨髓炎的临床疗效及对血清骨成型蛋白-2(BMP-2)、血沉(ESR)表达的影响.方法:按随机数字表法将中国人民解放军陆军第八十一集团军医院于2017年4月至2019年9月收治的慢性骨髓炎患者98例分为两组.对照组患者(49例)采用抗生素骨水泥治疗,观察组患者(49例)在对照组的基础上联合消疽汤治疗.观察两组患者治疗前、治疗4周后血清肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、BMP-2水平和血常规情况,分析其临床疗效、治疗期间不良反应发生情况和随访1年的复发情况.结果:观察组患者的总有效率明显高于对照组[95.92％(47/49)vs.81.63％(40/49)],差异有统计学意义(χ2=5.018,P=0.025).治疗后,两组患者血清TNF-α、IL-1水平均较治疗前明显降低,BMP-2水平明显升高;与对照组比较,观察组患者血清TNF-α、IL-1水平明显更低,BMP-2水平明显更高,差异均有统计学意义(P<0.05).治疗后,两组患者白细胞计数(WBC)、中性粒细胞百分比(NEU％)和ESR水平均较治疗前明显降低;与对照组比较,观察组患者WBC、NEU％和ESR水平明显更低,差异均有统计学意义(P<0.05).观察组患者的不良反应发生率明显低于对照组[4.08％(2/49)vs.22.45％(11/49)],差异有统计学意义(χ2=7.184,P=0.007);且观察组患者的复发率明显低于对照组[4.08％(2/49)vs.20.41％(10/49)],差异有统计学意义(χ2=6.078,P=0.014).结论:消疽汤联合抗生素骨水泥治疗慢性骨髓炎能够获得较佳的临床疗效,可有效降低患者血清炎症因子水平,提高BMP-2水平,改善血常规指标,降低不良反应发生率和复发率.

目的:探讨zeste基因增强子同源物2(EZH2)和人类RUNT相关转录因子3(RUNX3)在骨巨细胞瘤中的表达,及与骨巨细胞瘤复发的关系.方法:选取2013年10月至2018年1月在本院经病理组织检查确诊为骨巨细胞瘤并接受手术治疗者53例为研究对象,术中收集骨巨细胞瘤患者瘤组织以及瘤旁组织(距瘤组织>3cm),采用免疫组织化学法检测EZH2和RUNX3的表达,分析其与患者临床病理特征的关系;采用Spearman进行相关性分析;术后随访36个月,比较复发组与未复发组EZH2和RUNX3的表达情况.结果:骨巨细胞瘤瘤组织EZH2阳性表达率(69.81％)高于瘤旁组织(15.09％)(P<0.05),RUNX3阳性表达率(32.08％)低于瘤旁组织(86.79％)(P<0.05);瘤组织EZH2、RUNX3表达与肿瘤直径、影像学分级、病理学分级、组织浸润程度均有关(P<0.05);Spearman相关性分析结果显示,骨巨细胞瘤瘤组织中EZH2、RUNX3表达呈负相关(r=-0.544,P<0.05);复发组EZH2阳性表达率(93.33％)高于未复发组(60.53％)(P<0.05),RUNX3阳性表达率(0.00％)低于未复发组(44.74％)(P<0.05).结论:骨巨细胞瘤瘤组织中EZH2为高表达,RUNX3为低表达,且与患者临床病理特征密切相关,EZH2、RUNX3表达呈负相关,EZH2可能抑制RUNX3表达,EZH2、RUNX3可能用于骨巨细胞瘤的病情及预后评估.

目的 探讨应用牵拉成骨技术治疗股骨、胫骨肥大型骨不愈合合并畸形患者的疗效.方法 回顾性分析2016年11月至2019年11月在北京积水潭医院创伤骨科应用牵拉成骨技术治疗的3例股骨、胫骨肥大型骨不愈合合并畸形患者的病历资料.3例均为男性.所有骨折不愈合端均不切开.胫骨不愈合者均需经皮截断腓骨,使用Taylor Spatial Frame(施乐辉公司)固定,将13个参数输入计算机,设定牵开速度1 mm/d,生成电子处方.股骨不愈合者使用Orthofix外固定架固定.术后第2天按照1 mm/d的速度牵拉,在牵开恢复长度的过程中逐渐纠正畸形.随访期间,观察患者畸形纠正情况和骨愈合情况.结果 病例A术后20 d畸形完全纠正,术后15个月获得骨性愈合.病例B术后25 d畸形完全纠正,术后15个月获得骨性愈合.病例C术后29 d成角畸形纠正,术后19个月获得骨性愈合.结论 牵拉成骨技术可纠正肥大型骨不愈合的成角畸形及短缩,可作为肥大型骨不愈合的一种微创治疗方法.

Objective:To report our experience in successful limb salvage in 2 cases of femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours.Methods:From February 2016 to April 2017, 2 patients with femoral fracture of Gustilo type ⅢC were treated at The Great Wall Orthopaedic and Hand Surgery Hospital after warm ischemia beyond 10 hours.Both of them were male, 42 and 27 years of age.After debridement, bone shortening for 8.0 cm and 10.0 cm respectively was followed by replantation. The fractures were fixated end to end with a compression plate, the femoral artery was anastomosed directly and the muscles were sutured end to end.Secondary osteotomy was conducted 4 months after successful replanta-tion, followed by unilateral external fixation for reconstruction.Limb lengthening began one week after sec-ondary osteotomy.The efficacy was assessed by the Paley criteria.Results:Scattered irregular necrosis occurred in the leg muscles but was cured by dermatoplasty through a decompressive incision 40 days after debridement for 4 times.The affected limbs in the 2 cases were successfully saved and lengthened to the same length as the opposite one.The limbs were lengthened for 8.0 and 10.0 cm and for 3.0 and 3.5 months, respectively.The unilateral external fixator was worn for 29 and 24 months, respectively.The plantar sensation recovered to S4 one year after operation.Follow-up at 6 months after removal of external fixation showed excellent bony outcomes and good functional outcomes in both cases According to the Paley criteria.Conclusion:For femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours, thorough debridement, plate fixation, bone shortening and replantation at one stage, followed by secondary limb lengthening using unilateral external fixation, may be practical and effective procedures, as long as in-dications for limb salvage should be comprehensively followed.

目的:探讨保留原锁定接骨板联合Orthofix单边外固定架骨搬移治疗股骨大段骨缺损的临床疗效和安全性.方法:2013年9月至2018年3月收治4例股骨骨折术后骨折不愈合和残留骨缺损患者.男3例,女1例.年龄17～62岁,中位数50岁.均因外伤导致股骨干或股骨远端骨折,前期均采用切开复位锁定接骨板内固定治疗.术后3例患者发生骨折不愈合;1例伤后即存在骨缺损,经多次治疗仍存在大段骨缺损.4例患者均无骨髓炎病史.均一期手术清理不愈合或缺损部位,保留原锁定接骨板,联合Orthofix单边外固定架进行骨搬移.骨搬移速度每天1 mm,分4次完成.待被搬移骨段与股骨远端对合后,二期手术以2枚锁定螺钉通过原锁定接骨板固定被搬移骨段,拆除外固定架.结果:本组患者骨缺损长度6.0～14.0 mm,中位数10.3 mm.一期手术时间116～201 min,中位数170 min.4例患者均获得随访,随访时间16～46个月,中位数25个月.4例均未出现感染,1例出现钉道反应,经局部处理后症状消失;2例患者拆除外固定架6个月后对合端未愈合,其中1例固定被搬移骨段时发生少许偏移,均行对合端清理及自体髂骨植骨术,以1块6孔锁定接骨板辅助固定,4个月后均骨性愈合.最终所有被搬移骨段矿化良好,对合端均愈合.外固定架指数0.360～0.380月·cm-1,中位数0.373月·cm-1.患侧膝关节屈曲活动度,术前30° ～130°,中位数85°;骨搬移完成时30° ～45°,中位数38°;术后16个月60° ～120°,中位数90°.结论:保留原锁定接骨板联合Orthofix单边外固定架骨搬移是治疗股骨大段骨缺损的有效方法,安全性较高,且外固定架放置时间较短.

Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures.Methods A retrospective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016.They were 20 males and 8 females,aged from 24 to 68 years (average,42.3 years).The time from injury to surgery ranged from 7 to 21 days(average,14.5 days).According to the Letournel-Judet classification,there were 2 posterior column fractures,4 transverse fractures,5 posterior column plus posterior wall fractures,6 transverse plus posterior wall fractures,2 T-shaped fractures,3 anterior and posterior transverse fractures and 6 double column fractures.The posterior acetabular approach or combined anterior and posterior approach was used.In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the intraarticular fracture.After the open reduction and internal fixation was accomplished,the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed.The reduction quality,complications and outcomes at the final follow-ups were recorded.Results All the 28 patients were followed up for 10 to 36 months (mean,15.6 months).By the Matta criteria,anatomical reduction was achieved in 26 cases,unsatisfactory reduction in one and poor reduction in one,yielding an anatomic reduction rate of 92.9％.By the improved Mere d'Aubigne & Postel criteria,the clinical outcomes at the final follow-up were excellent in 27 cases and good in one,yielding a good to excellent rate of 100％.Postoperatively,heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function;transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery.No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups.Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface,leading to satisfactory short-term clinical outcomes.

目的 探讨应用螺钉轴位透视法避免髋臼后壁骨折块螺钉固定时钉体进入关节腔的可靠性及意义.方法 回顾性分析2010年1月—2017年5月陆军第81集团军医院骨科采用侧卧或俯卧位行K-L入路切开复位重建钢板螺钉内固定术治疗的髋臼后壁骨折患者102例,术中后壁骨折块解剖复位后均先使用单枚或多枚螺钉(2.4、2.7、3.5mm普通皮质骨螺钉)加压固定,再联合塑形良好的重建钢板固定,其入钉方向均通过术中C臂机投照,按投照方式不同分为两组:传统经验投照组51例采用传统骨盆正位+闭孔斜位+髂骨斜位+其他单一或联合体位,至少3个以上投照方位;螺钉轴位投照组51例采用后壁骨折块固定螺钉轴位法.统计术中C臂机投照次数、手术时间、出血量、置钉准确率、并发症进行两组间比较,末次随访采用改良Merled'Aubigne&Postel标准评定患髋功能.结果 传统经验组术中C臂机投照次数(7.3±3.2)次、手术时间(112.5±30.6)min、出血量(230.7±40.4)mL;而螺钉轴位组投照次数(1.5±0.6)次、手术时间(86.6±12.5)min、出血量(158.4±26.3)mL均显著少于传统经验组,差异均有统计学意义(P<0.05).传统经验组准确率65.3％,而螺钉轴位组准确率94.3％,差异有统计学意义(P<0.05).术后两组均无感染、髋臼周围骨化、坐骨神经牵拉伤.两组患者术后获得12～36个月随访(平均18.5个月),关节功能恢复均满意,均无异位骨化等并发症.结论 螺钉轴位透视法是髋臼后壁骨折术中评价及避免螺钉进入关节腔的一种可靠安全的方法,值得推广.

目的 探讨倒打髓内钉治疗涉及髁部的早期股骨远端复杂骨折可行性、手术策略及其近期临床疗效.方法 选择采用髌下髌腱劈开入路、辅助拉力螺钉、短节段锁定钢板等方法稳定髁部经关节骨折部分,早期应用远端多向锁定倒打带锁髓内钉固定治疗涉及髁部的股骨远端多处多平面复杂骨折患者21例,均为合并经髁部的股骨远端骨折、局部软组织损伤较重,累及单或双髁与干骺端,关节面以劈裂为主,损伤至手术时间5～7天,平均6.3天,进行回顾性总结分析.结果 21例均获得随访,随访时间6～24个月,骨折均顺利愈合,愈合时间10～15周,平均13.1周.术后X线片及CT检查均显示骨折复位固定良好,无皮肤坏死等严重切口并发症,无筋膜腔室综合征、肌肉坏死等深部软组织并发症;按Schatzker-Lambert股骨远端骨折疗效评分系统:优20例,良1例,优良率100％.结论 对于并发软组织损伤严重、涉及髁部股骨中、远段多处多平面复杂骨折进行早期倒打髓内钉固定治疗是一可行的选择,并取得了近期满意疗效.

Objective To investigate the feasibility and clinical effect of Kocher-Langebeck (K-L) approach without cutting the short external rotator muscles of hip for treatment of cetabular posterior column fractures.Methods A retrospective case series study was performed on 28 patients with acetabular fractures admitted from June 2015 to February 2017.There were 23 males and 5 females,averagely aged 43.6 years (range,26-71 years).According to the Letournel classification,there were 9 patients with simple fractures,14 back wall and back pillar fractures and 5 cross fractures.All patients were combined with posterior dislocation.The patients were given tibial tubercle traction after hip joint reduction in the hospital.During the surgery,K-L approach was adopted without cutting the short external rotator muscles of hip.Operation duration and intraoperative bleeding were recorded.Visual analogue score (VAS) was recorded before and after operation.The X-ray at 1 day,6 weeks,3 months and 1 year after operation were reviewed to evaluate fracture healing time.Matta criteria were used to assess the surface flatness of joint.The modified Merle d'Aubigné-Postel scoring system was applied to evaluate the function of hip joint.Intraoperative and postoperative complications were recorded.Results The operation duration was 76-120 min (mean,94 min),and the intraoperative blood loss was 120-320 ml (mean,265 ml).All patients were followed up for average 16 months (range,10-24 months).Preoperative VAS was 5-10 points [(7.5 ± 1.3) points],and 0-3 points [(0.9 ± 0.8) points] 6 months after operation (P ＜ 0.01).All fractures healed and the average healing duration was 10.1 weeks (range,6-12 weeks).According to the Matta criteria,24 patients were graded excellent and 4 good,with excellence rate of 100％.According to the modified Merle d'Aubigné-Postel grading system,clinical results were graded excellent in 23 patients,good in 5,with excellence rate of 100％.Transient sciatic nerve injury occurred in 3 patients after surgery,and the nerve function of these patients fully recovered within 3 months after operation.There were no infection,heterotopic ossification and other complications.The wound healing was good,without liquefaction or cracking.Sciatic nerve injury was found in five patients,three of whom were performed with a transient lesion and recovered within 3 months.Conclusion In the posterior pathway surgery for acetabular posterior column fractures,the K-L approach without cutting the short external rotator muscles of hip can be used to complete the internal fixation with a high rate of fracture healing,sound reduction outcome,satisfactory functional recovery and few complications.

Objective To investigate the feasibility of interlocking intramedullary nail internal fixation for complicated tibial fractures involving tibial plateau,and to summarize the surgical techniques and clinical curative effect.Methods Twenty-one cases of complicated tibial fractures involving tibial plateau treated with proximal tibia multidirectional lock/locking intramedullary nail fixation were retrospectively analyzed from June 2013 to June 2016.The tibial plateau fractures of articular surface were reduced through percutaneous or limited incision assistance and fixed using tensile screw or locking plate internal fixation.After the surgery,the patients were evaluated by using the radiology score of the tibial plateau fracture,and the efficacy was evaluated by the KSS score standard at the end of the follow-up.Results All the 21 patients were followed up with an average follow-up time of 16.3 months (12-24 months).Postoperative X-ray and CT showed that the fracture reduction was fixed well,and the Rasmussen radiological scores of the tibial plateau fractures were 17.7 (17-18),excellent in 20 cases and good 1 case.The fracture healed smoothly,and the healing time averaged 13.1 (10-16) weeks.At the end of the follow-up,KSS score standard was used to evaluate the efficacy of knee joint function,excellent in 19 cases and good 2 cases.Conclusion For planar complex tibial fractures with severe soft tissue injury,involving muhiple segment tibia platform,but with a little collapse,interlocking intramedullary nailing combined with plate and screw internal fixation is a feasible operation method.The injury of this fixation method is small,fracture fixation is reliable.

Objective To investigate effectiveness of the modified Kocher-Langenbeck (K-L) approach for acetabular fractures.Methods A consecutive series of 58 patients with acetabular fracture were treated operatively from January 2013 to December 2016.They were divided into 2 groups according to the approaches used.In the experimental group of 30 patients (25 males and 5 females with an average age of 42.6 ± 13.8 years),the modified K-L approach was used not to dissect the external rotation short muscles and the anterior approach was also used when necessary.In the control group of 28 patients (24 males and 4 females with an average age of 45.2 ± 10.2 years),the traditional K-L approach was used and in combination with the anterior approach when necessary.The 2 groups were comnpared in terms of operation time,intraoperative blood loss,reduction,fracture union time and functional recovery of the affected hip at the last follow-up.Results The experimental group reported significantly shorter operation time (94.2 ± 32.8 min) and significantly less intraoperative bleeding (220.8 ± 96.7 mL) than the control group (135.8 ± 88.0 min and 405.5 ±95.7 mL) (P ＜ 0.05).According to the Matta's criteria for reduction,the experimental group had 24 excellent,4 good and 2 fair cases (an excellent to good rate of 93.3％) while the control group had 20 excellent,3 good and 5 fair cases (an excellent to good rate of 82.1％),showing no significant differences between the 2 groups (P ＞ 0.05).All the 58 patients obtained follow-up for 6 to 24 months (average,16 months).The fracture union time was 10.1 ± 1.9 weeks for the experimental group and 9.9 ±2.1 weeks for the control group,showing no significant differences between the 2 groups (P ＞ 0.05).According to the modified Merle d'Aubigne & Postel scoring for the functional recovery of the affected hip at the last follow-up,the experimental group had 23 excellent,5 good and 2 fair cases (an excellent to good rate of 93.3％) while the control group had 12 excellent,6 good,6 fair and 4 poor cases (an excellent to good rate of 64.2％),showing a significant difference between the 2 groups (P ＜ 0.05).Conclusion Compared with the traditional K-L approach,the modified K-L approach has advantages of small trauma,less hemorrhage and good postoperative recovery so that it can be a good choice among the posterior approaches for acetabular fractures.

Objective To investigate the clinical efficacy of preoperative full reset combined with minimally invasive treatment of extreme distal pilon fractures.Methods A retrospective analysis was made on 34 patients (35 ankles) with tibial fractures extremely close to the distal articular surface treated surgically between January 2011 and January 2015.There were 21 mnales and 13 females,aged 20-71 years (mean,36.2 years).Injury resulted from traffic accidents in 32 patients and high falls in two.Using the AO/OTA fracture classification system,type 43-B3 was noted in three patients,43-C1 in five patients,43-C2 in 18 patients and 43-C3 in eight patients.Calcaneal traction combined with manipulative reduction was used to correct fracture displacement preoperatively.All fractures were stabilized by minimally invasive percutaneous plate osteosynthesis (MIPPO) through single or combined medial,anteromedial and anterolateral approaches while minimizing damage to bone attachment and continuity of soft tissue,after soft tissue swelling subsided.For the patients with articular surface collapsing with severe comminution,a series of procedures were done under direct vision including using the talus articular surface as a mold,stable fixation with fine Kirschner (1-1.5 mm) and thin screws (2.1-2.7 mm series) and impaction bone grafting below subchondral bone.Thereafter,distal tibia anatomical short multi-directional locking plate fixation,distal nail support and early ankle joint functional exercise were done.Burwell-Charnley radiological evaluation system was used for radiological assessment,and TeenyWiss scoring system for ankle clinical symptoms and function.Postoperative complications were recorded.Results Follow-up lasted for 11-38 months (mean,16.6 months).No infection,wound disunion,or plate exposure occurred.Burwell-Charnley radiological evaluation system showed anatomic reduction in 32 patients,unsatisfactory reduction in one,and poor reduction in one.According to the Teeny-Wiss scoring system,the results were excellent in 31 patients,good in two and poor in one,with the excellentgood rate of 97％.Three patients suffered traumatic arthritis after operation and alleviated after oral administration of painkiller.Conclusion With use of full reset combined with manipulative reduction to correct fracture displacement,minimally invasive locking plate,distal row of nails,impaction bone grafting and limited fixation,the patients with extremely distal tibial pilon fractures achieve satisfactory reduction,stable fixation,and early functional exercise.

目的：探讨平台及近平台胫骨近端骨折髓内钉治疗策略及其近期临床疗效。方法采用髌上入路方法对局部软组织条件差，通过体外微创闭合复位及固定手段能够矫正移位，应用多向锁定带锁髓内钉固定治疗以关节面劈裂为主的胫骨平台骨折及胫骨近平台干骺端骨折12例。结果12例患者手术顺利，手术时间80~110分钟，平均92.6分钟；术中未使用止血带，出血量120~220ml。骨折均顺利愈合，愈合时间10~14周，平均12.4周。术后X线片及CT检查均显示骨折复位固定良好，无感染等围术期并发症。术后1年全部病例KSS膝关节功能评分：优11例，良1例，优良率100%。结论通过髌上入路对部分胫骨平台及近平台部骨折进行髓内钉固定治疗，疗效满意。

Objective: To investigate the homemade three-cavity tube in the treatment of deep infection after surgery application effect.Methods: A retrospective clinical data of 57 cases with deep infection analysis of surgical operation of 251 Hospital of PLA, 57 patients were divided into two groups, study group 35 cases, using self-made three-cavity tube drainage treatment, 22 cases in the control group, with incision and drainage treatment. Comparison of two groups of patients with drainage after 2 weeks of deep infection and disconnection time, hospitalization time and other indicators.Results:The total efifciency of comparison: the study group (88.57%) was signiifcantly better than the control group (68.18%) (P<0.05). The comparison of treating WBC, ESR, CRP after 2 weeks: the study group WBC, ESR, CRP values were signiifcantly lower than that of control group (P<0.05). The stitches hospitalization time, compare inpatient expense time, hospitalization time, take out stitches: study group were obviously less than that in the control group, cost of hospitalization time (P<0.05). Conclusion:One stage debridement is inserted into the three cavity irrigation, drainage and drug injection can effectively drainage of deep infection in patients with systemic infection, alleviate, reduce the time of take out stitches, help patients recover.

Objective To study the safety of transplantation of human umbilical-cord mesenchymal stem cells (HUMSCs) in local fracture of New Zealand rabbits and approve experimental evidence for the application of HUMSCs. Methods Fracture models were made and were randomly divided into cell transplantation group and saline group. HUMSCs of BrdU-labeled at a concentration of 1 × 107 cells / ml and saline were injected into the local fractures by the assistane of C-arm X-ray machine. The rabbits were ob-served every day for their general reactions before they were sacrificed. Blood samples were collected for hematological and biochem-ical studies on the 3rd and the 7th day after transplantation. Fracture fragments and spleen organs were inspected pathologically and Immunofluorescence staining was done after air embolism. Results No difference in general reactions after transplantation was ob-served between the two groups. On the 3rd day after transplantation, there was statistically significant differences in the ratios of lymphocytes and monocytes between the two groups ( P < 0. 05) , and there was no difference in serum biochemical parameters (P > 0. 05). On the 7th day after transplantation, there was no significant differences in blood routine and serum biochemical pa-rameters (P > 0. 05). There were no significant differences in fracture fragments and spleen organs on the 3rd day and the 7th day between the two groups (P > 0. 05). Scattered positive cells showing green fluorescence were observed under fluorescence micros-copy on the 7th day after transplantation. Conclusion Conclusion Heterogenous umbilical cord blood mesenchymal cells can sur-vive a lot and transplantation of heterogenous HUMSCs is safe and feasible without side effects.

Objective It is to explore the effect of Human umbilical cord blood mesenchymal stem cells( HUCBMSCs) on fracture healing in rabbits, and to provide a theoretical basis for further experiments and clinical application.Methods HUCBMSCs from umbilical cord blood by density gradient centrifugation were isolated and cultured under sterile conditions and the 3rd generation cells were taken for experiments.New Zealand white rabbits were selected to establish models of transverse fracture of tibia and were randomly divided into HUCBMSCs group (group A) which was injected with 1 ×1010 L-1 HUCBM-SCs suspension from fracture endpoint and the normal saline group (group B) which given normal saline.On the 2nd, 4th and 6th and 8th weeks after cell transplantation, six rabbits in each group were randomly selected to perform on X-ray examina-tion and biomechanical testing and observe fracture healing and callus formation by histological examination.Results The X-ray examination from the 2nd to 8th week and X-ray fracture healing score results showed than: the fracture healing rate of group A was faster than that of group B(P<0.05);Histological observation and the results showed that the speed and quality of fracture healing were better in group A than that in group B(P<0.05);The biomechanical tests showed that the maximum damage on the load at 4th,6th and 8th weeks after cell transplantation of group A were higher than that of group B, the maxi-mum displacement of group A at 4th and 6th weeks were higher than that in group B (P<0.05).Conclusion HUCBMSCs play a catalytic role in fracture healing and an important role in preventing delayed fractures healing or bone nonunion.

近20年来脊柱疾病的外科手术治疗有了长足的发展，并发症也随之日益增多，术后深部感染是其主要并发症之一。目前，脊柱术后深部感染治疗仍然是棘手的问题，我们使用自制“三腔管”在脊柱后路内固定术后深部感染的治疗中取得了良好的疗效，现报道如下。

目的 探讨融合与非融合固定联合应用治疗腰椎管狭窄症的临床疗效.方法 采用融合与非融合固定联合治疗腰椎管狭窄症患者21例,男12例,女9例,平均年龄54(41～81)岁.对椎管狭窄节段行减压椎间融合内固定,对邻近节段椎间盘突出症开窗减压、髓核摘除,棘突间Wallis非融合固定.术后患者获得平均19(6～50)个月的随访,采用视觉模拟评分法(VAS)及腰椎功能障碍指数(ODI)评定手术后疗效.结果 术后无感染、神经根损伤、脑脊液漏等并发症发生.VAS及ODI评定结果显示患者手术前后的VAS及ODI分值改变有统计学意义(P＜0.01).结论 融合与非融合固定治疗腰椎管狭窄症减压效果明显、同时有效减缓了相邻椎间盘退变,是治疗腰椎管狭窄症的有效方法.