目的 探讨穴位埋线联合椎间盘突出部位注射医用臭氧及甲强龙治疗根性坐骨神经痛的临床效果.方法 选择108例椎间盘突出导致根性坐骨神经痛患者,按照治疗方式不同分为观察组和对照组各54例.对照组选取突出部位,依次注射医用臭氧5 mL(30μg/mL)、甲强龙20 mg,每周1次,持续3个月.观察组严格按照中医辨证分型标准分成四种类型,在以上药物注射治疗基础上均以大肠俞、环跳、委中、阳陵泉为主穴进行穴位埋线,再根据不同证型增加两个辅穴行穴位埋线(寒湿证增加昆仑、秩边,湿热证增加飞扬、丰隆,肝肾不足证增加脾俞、肾俞,气滞血瘀证增加膈俞、次髎),每周1次,持续3个月.比较两组治疗前后疼痛分级指数(PRI)评分、视觉模拟评分法(VAS)评分、行为疼痛6点评分(BRS-6)、Oswestry功能障碍指数(ODI)评分,观察两组治疗效果及不良反应发生情况.结果 治疗前两组各类观察项目评分比较差异均无统计学意义(P均>0.05).治疗3个月,观察组PRI感觉评分、PRI情感评分、PRI总分、VAS评分、BRS-6评分、ODI评分均低于对照组,观察组总有效率高于对照组,差异具有统计学意义(P均<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05).结论 中医穴位埋线联合医用臭氧及甲强龙注射治疗椎间盘突出致根性坐骨神经痛,可以明显缓解患者肢体疼痛,改善其肢体功能受限,且无不良反应发生率升高情况.

[目的]探讨下肢主干血管损伤后超时限修复及其功能重建,并观察临床疗效.[方法]回顾性研究收治的30例下肢主干血管超时限修复患者,男21例,女9例,年龄13～55岁,平均(34.17±9.40)岁.其中股动脉13例,包括开放性3例,闭合性10例;腘动脉17例,包括开放性6例,闭合性11例.[结果]30例患者中,直接吻合者22例,行对侧大隐静脉移植者7例,1例肢体短缩后吻合.损伤至血流再通时间10～72 h,平均(41.07±19.32)h;27例患者术后肢体血运良好,2例截肢,1例因大出血,给予结扎血管,肢体虽然存活,但末端血运差.30例患者最终截肢2例,截肢率6.67％.28例保肢功能者随访24～60个月,平均(41.25±10.45)个月.1 1例患者出现继发性足下垂畸形,再次手术,行Ilizarov踝支架矫正畸形.末次随访时,28例患者足底感觉、足背伸肌力、足背伸-跖屈ROM、膝伸-屈ROM和VAS评分均较术后1个月时显著改善,差异均有统计学意义(P＜0.05).28例患者开始行走时间20～240 d,平均(75.25±55.35)d,完全负重时间30～400 d,平均(148.57±90.02)d.[结论]对超时限主干血管损伤,经积极手术,术后综合治疗,仍可获得较满意临床效果.

目的:探讨和比较通过3D打印技术制作的标杆型导板在颈椎后路手术寰枢椎椎弓根置钉中的优势和安全性.方法:回顾性分析我院我科自2016.09至2018.09因颈椎病入院并行颈后路手术且行寰枢椎椎弓根置钉的共计58例.按照是否使用3D打印技术制作的标杆性导板而将其分为实验组及对照组.实验组(28例)在导板辅助下进行置钉,而对照组(30例)则采用常规的徒手置钉.比较两组患者的置钉手术时间,透视次数,出血量,置钉的准确性,两组患者的术后及术后半年的疼痛评分(VAS)及日本骨科协会颈椎功能评分(JOA)评分.结果:所有患者均随访半年以上.两组患者在出血量指标的比较中未发现统计学差异(P＞0.05).实验组的透视次数及手术时间均显著少于对照组,其准确度在显著优于对照组(P＜0.05).两组患者在疼痛评分及功能评分的比较中均未发现显著性差异(P＞0.05).结论:与传统常规手术技术相比,使用3D打印技术标杆性导板能有效的降低透视次数和手术时间,提高置钉的准确性,且不增加风险,具有很好的安全性.在临床中可进一步的进行推广.

Objective To evaluate our replantation and functional reconstruction of amputated lower extremities.Methods From February 2013 to October 2017,13 patients with an amputated lower extremity were treated at Orthopaedic Department,The 960th Hospital of the PLA Joint Logistics Support Force.They were 10 males and 3 females,aged from 15 to 63 years (average,39 years).In all the patients,large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage.After desired extension was achieved,the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction.Postoperatively,functions of the knee and ankle joints,sensory recovery of the foot sole,length and appearance of the extremity were observed.Results All the 13 patients were followed up for 12 to 24 months (average,16 months).All the limb replants survived well.Of them,12 were satisfied with their weight-bearing walking and therapeutic outcomes.Conclusions For an amputated lower extremity,the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

网络信息技术在加强医院图书信息管理中发挥着很重要的作用.基于此,本文将图书馆资料信息当作研究的重点,对加强医院图书资料信息管理和开发应用策略进行了阐述.

BACKGROUND:Skeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of irreducible facet dislocation is usually accompanied with potential catastrophic consequences including neurological deficit and severe disability. Therefore, a consistent and evidence-based treatment plan is imperative.CASE PRESENTATION:The literature regarding the management of traumatic unilateral locked cervical facet dislocations was reviewed. Two patient cases (a 30-year-old Asian man and a 25-year-old Asian woman) who suffered irreducible cervical facet dislocations were presented. These two patients received surgical treatments including posterior reduction by poking facet joints, adjacent spinous process fixation by wire rope banding, anterior plate fixation, and intervertebral fusion after the failure of skull traction and closed reduction. At the postoperative 24-month follow-up, intervertebral fusion was achieved and our patients' neurological status improved based on the American Spinal Injury Association scale, compared with their preoperative status.CONCLUSIONS:Unilateral facet joint dislocations of subaxial cervical spine are difficult to reduce when complicated with posterior facet fractures or ligamentous injury. Magnetic resonance imaging can be beneficial for identifying ventral and dorsal compressive lesions, as well as ligamentous or capsule rupture. The combination of posterior reduction and anterior fixation with fusion has advantages in terms of clinical safety, ease of operation, and less iatrogenic damage.

[目的]探讨坏死型伸指肌腱经皮瓣覆盖后的疗效及临床价值.[方法] 2010年10月～2016年10月,采用前臂骨间背侧动脉逆行岛状皮瓣修复90例伸指肌腱外露坏死患者.因感染或就诊不及时皮瓣修复二期进行,术中全部保留或大部分保留坏死的伸指肌腱,并予以皮瓣覆盖.[结果] 90例患者接受手术,术后皮瓣均顺利成活,术中未发生新的重要血管、神经损伤.创面I期愈合37例,但是由于肌腱或深部组织感染严重,部分皮瓣周围持续渗出,伤口持续渗出者给予清洁换药,保持引流通畅(或部分患者给予清创),均获得愈合,术后二期愈合46例.创面愈合时间14～56 d,平均(20.16±4.73)d.术后83例获随访,随访时间3～36个月,平均(22.64±5.16)个月.术后1、2个月时各有2例患者发生伤口破溃,渗液溢出,经换药(或简单清创)伤口再次愈合,末次随访时,除6例患者出现关节僵硬、活动度差,其余患者均感满意.皮瓣外形较好,无明显臃肿,根据手指关节总活动度(total ac-tive motion,TAM)评定标准:优良率92.8％.患指伸指肌力:优良率97％.未伤指组的掌指关节、近指关节和远指关节活动主评分均高于伤指组,但两组间掌指关节、近指关节和远指关节活动主评分的差异,均无统计学意义(P＞0.05).[结论]伸指肌腱即便坏死仍有保留价值,应用骨间背皮瓣修复后仍可以获得良好功能.

Oxidative stress represents a major cause of cellular damage and death in the process of osteoporosis. Antimycin A (AMA) has been shown to stimulate mitochondrial superoxide anions and reactive oxygen species (ROS). α-Lipoic acid (α-LA) is a naturally occurring essential coenzyme in mitochondrial multienzyme complexes and acts as a key player in mitochondrial energy production. However, whether α-LA affects the cytotoxicity of AMA in osteoblastic cells is unknown. In this study, we investigated the protective effects of α-LA against AMA-induced cytotoxicity using the MC3T3-E1 osteoblast-like cell line. Our results indicated that α-LA treatment attenuated AMA-induced cytotoxicity and LDH release in a dose-dependent manner. Notably, a significant recovery effect of α-LA on mineralization inhibited by AMA was found. Our results also demonstrated that treatment with 50 μM AMA leads to a reduction of mitochondrial membrane potential (MMP) and the complex IV dysfunction, which was inhibited by pretreatment with α-LA in a dose-dependent manner. In addition, treatment with α-LA significantly reduced the generation of ROS and mitochondrial superoxide production induced by AMA. In addition, our result suggests that PI3K/Akt and CREB pathways are related to the protective effect of α-LA. Importantly, Hoechst 33258 staining results indicated that pretreatment with α-LA prevented AMA-induced apoptosis. Mechanistically, we found that α-LA prevents MC3T3-E1 cells from apoptosis through attenuating cytochrome C release and reducing the level of cleaved caspase-3.

Background: miR-124-3p has been reported to be involved in the pathogenesis of many diseases by modulating a variety of signaling pathways. In this study, we aimed to understand the impact of miR-124-3p expression level on the fracture healing in the patients of metaphyseal fracture of distal tibia, who received minimal invasive percutaneous plate osteosynthesis. Methods: We firstly collected 195 patients of metaphyseal fracture of distal tibia, and the genotype of rs531564 was determined: GG (n=124) and GC+CC (n=71). We collected information of the participants including age, gender, total in-hospital time, smoking and alcohol consumption. Subsequently, we searched the miRNA database online to identify the possible binding sequence of miR-124-3p located within the 3’-UTR of the target gene. We did correlation analysis and luciferase to understand the regulatory relationship between miR-124-3p and BMP6. Meanwhile, we also conducted real time PCR and western blotting analysis to study the mRNA and protein expression level of BMP6 in different genotype groups. We then treated the cells with scramble control, miR-124-3p mimics, BMP6 siRNA and miR-124-3p inhibitors to investigate the influence of miR-124-3p on the expression of BMP6, viability and apoptosis of cells. Results: Total in-hospital time was significantly longer in GC+CC group than GG group. MiR-124-3p was up-regulated in GG group than GC and CC groups. BMP6 was virtual target of miR-124-3p. There existed negative regulatory relationship betweenmiR-124-3p and BMP6. The mRNA and protein expression level of BMP6 decreased in GG group. MiR-124-3p decreased the expression of BMP6. MiR-124-3p negatively interfered with the viability of cells and BMP6 positively interfered with the viability of cells. MiR-124-3p reduced apoptosis and BMP6 promoted apoptosis. Conclusion: These data proved the expression of miR-124-3p was associated with the healing of metaphyseal fracture of distal tibia, and could be recognized as a biomarker to predict the healing of metaphyseal fracture of distal tibia.

To investigate the expression of hypoxia inducible factor (HIF-1α) and vascular endothelial growth factor (VEGF) in the synovium of collagen-induced arthritis (CIA) joint, and whether the PI3K pathway regulates angiogenesis in rheumatoid arthritis or not. A randomized controlled according to the principle of the rats were divided into normal control group (10 rats) and the experimental group (40 rats). The experimental group rats were established as type II collagen plus adjuvant Freund's complete adjuvant-induced arthritis model. HIF-1α and VEGF proteins' expression in serum of CIA rats group and normal control group were detected by ELISA. Microvessel density (MVD) in synovial tissue of CIA rats group and normal control group were detected by immunohistochemistry (IHC) staining. The protein expression of PTEN, PI3K, and AKT in synovial tissue were detected by Western Blot. Compared with normal control group, toes and ankle swelling and arthritis index (AI) of CIA rat increased, and the expression of VEGF and HIF-1α proteins in peripheral serum increased, IHC showed that MVD was significantly higher than that of the control group, and the difference was statistically significant (p<0.05). Western Blot results showed that PI3K and AKT proteins expression in CIA synovial tissue of rats increased, while the expression of PTEN protein decreased. Correlation analysis showed that VEGF and HIF-1 levels in the peripheral serum of CIA rats were positively correlated with arthritis index (AI); the contents of HIF-1α and VEGF in the peripheral serum of CIA rats were positively correlated with MVD in synovium tissue. The CIA rat model regulated the expression of HIF-1α and VEGF proteins in peripheral serum by PI3K signaling pathway, and then regulated neovascularization in RA.

This study aims to investigate the effect of early and delayed injury minimally invasive percutaneous plate osteosynthesis on the treatment of distal tibial metaphyseal comminuted fracture. This study involved 90 patients with distal tibial metaphyseal comminuted fractures for treatment of minimally invasive percutaneous plate osteosynthesis between February 2012 and October 2014 in our hospital. According to treatment time, 90 patients were divided into early group and delayed group. Early group performed minimally invasive percutaneous plate osteosynthesis (MIPPO) surgery in early injury, delayed group performed MIPPO surgery in delayed injury. There were no differences for operation time, intra-operative bleeding, follow-up time and fracture healing time between early and delayed groups (P>0.05). Hospitalization time in early group (14.3 +/- 2.4 d) was significantly shorter than delayed group (19.7 +/- 3.3 d) (t=8.878, P<0.05). There were no claudication, fixation failure, nonunion and other complications in two group patients. In last follow-up, there were no significant differences for Lowa ankle score of function, pain, gait, activity between two groups (P>0.05). There were no significant differences for Lowa ankle rating score between early and delayed group (t=0.636, P>0.05). Soft tissue complications incidence after surgery of two groups were 4.44% and 8.89% respectively, the differences were not statistically significant (X-2=0.714, P>0.05). In conclusion, effect of early and delayed injury minimally invasive percutaneous plate osteosynthesis for treatment of distal tibial metaphyseal comminuted fracture and postoperative complications incidence of soft tissue were comparable. Hospitalization time was shorter for early injury treated with minimally invasive percutaneous plate osteosynthesis.

To investigate the repair method of the pediatric acute open injured Achilles tendon,we retrospectively reviewed 24 cases of pediatric acute open injured achilles tendon.All patients were treated by one stage debridement.According to the heterogenous type of achilles tendon and skin injury,appropriate surgical methods were selected to repair achilles tendon.Skin soft tissue defect was repaired with appropriate flaps.Th patients were followed up in the 24 cases from 13 to 42 months (average 29 months).At the final follow-up,no secondary achilles tendon rupture occurred.Distal portion necrosis of the flap occurred in one case and infections in two.At last the wounds healed by dressing change.All flap recovered their partial sense after six months.Therefore,efficient and suitable measures of pediatric acute open achilles tendon injury should be taken according to the conditions of achilles tendon and skin soft tissue injury.Thorough debridement and restoring of the length and tension of achilles tendon are very important.

OBJECTIVE:To evaluate the effectiveness of posteromedial double plates in the treatment of complex olecranal fracture.METHODS:Between September 2011 and July 2015, 13 patients with complex olecranal fractures were treated with posterior olecranon locking compression plate and medial mini-plate. There were 8 males and 5 females with an average age of 41.6 years (range, 22-68 years). Injury was caused by traffic accident in 4 cases, falling from height in 6 cases, and crush by object in 3 cases. According to the Mayo classification, fracture was rated as Mayo type ⅡB in 5 cases and as Mayo type ⅢB in 8 cases. Of 13 cases, 7 had Regan-Morrey type Ⅲ coronoid fractures, including 5 anterior dislocations of the elbow joint and 2 posterior dislocations. The time between injury and admission ranged from 1.5 to 10.0 hours (mean, 5.7 hours). At last follow-up, the elbow function was assessed according to the Broberg-Morrey evaluation criteria. X-ray films was performed to observe fracture healing.RESULTS:All incisions healed at first stage and no neural complications occurred. The patients were followed up 9-38 months (mean, 22.1 months). All patients achieved bone union at 3.0-5.5 months (mean, 3.7 months) according to X-ray results. Subluxation of radial head and mild heterotopic ossification occurred in 1 patient respectively, who had no uncomfortable symptoms of movement disorder, elbow instability and pain, and no special management was performed. At last follow-up, the flexion and extension range of motion (ROM) of the elbow was 95-130° (mean, 116.4°); the rotation ROM of the forearm was 150-175° (mean, 170.8°); and the elbow function was excellent in 4 cases, good in 7 cases, and fair in 2 cases, and the excellent and good rate was 84.6%. No internal fixation failure, elbow stiffness, or traumatic arthritis occurred.CONCLUSIONS:For complex olecranal fractures, an early and stable anatomic reconstruction of trochlear notch in the olecranon with posterior olecranon locking compression plate and medial mini-plate can obtain good effectiveness in joint functions.

Reconstruction of a defect of the weightbearing forefoot region remains a challenging problem owing to the limited alternatives available. The digital artery flap can be used for coverage of defects in the weightbearing forefoot. The present study reports our results using a digital artery flap for reconstruction of soft tissue defects of the weightbearing forefoot in 8 patients. The mean patient age was 35 ± 11.3 years. The etiology of the soft tissue defects included 4 (50%) traumatic events, 2 (25%) dysfunctional scars, and 2 (25%) neuropathic ulcerations. The mean postoperative follow-up duration was 22 ± 11.1 months (range 12 months to 4 years). All 8 flaps survived successfully. The complications included 1 case of delayed healing of a neuropathic ulceration. The digital artery flap is a good alternative for soft tissue defects of the weightbearing forefoot. The surgical techniques for harvesting the flaps are easy to manage.

儿童手部闭合性掌骨多发骨折是由于直接暴力所致的严重损伤, 该损伤常并发手部骨筋膜室综合征,骨筋膜室综合征 (osteofascial compartment syndrome,OCS) 指常发生在四肢,由骨、骨间膜、肌间隔和深筋膜形成的骨筋膜室内的肌肉和神经因急性缺血而产生的一系列早期征候群.由于儿童患者具有症状隐蔽性、不典型性,得不到及时治疗者肌肉神经将出现不可逆损伤,甚至截肢,应引起骨科临床工作者的高度重视.笔者所在医院2009年-2013年收集11例骨筋膜室综合征患者,采用早期背侧双"S"切开并VSD负压封闭创面,二期骨折固定封闭切口的治疗方法,现报告如下.

Objective To discuss the classification and management of upper part wall of acetabulum fractures. Methods From January 2000 to June 2013,10 cases of upper part wall of acetabulum fractures were retrospectively analyzed. On the basis of the X-ray and three-dimensional computed tomography,they were diagnosed and classified,treated differently according to the classification. Results Among the 10 cases 2 were received conservative treatment,8 were treated with operation. All the cases were followed up for 6 to 12 months, with an average time of 8 months;8 cases of the series were rated as fine (80%). Conclusion The upper part wall of acetabulum fractures could obtain good outcome on basis of the diagnosis and classification of it.

Objective To investigate the mechanism and treatment of supracondylar femoral closed fracture associated with sciatic nerve injury. Methods 15 cases of supracondylar femoral closed fracture associated with sciatic nerve injury patients underwent surgical treatment. The fracture was taken reposition and fixation, sciatic nerve exploration, nerve decompression or fascicular suture. Results The occurrence of excellent nerve recovery was 6 cases, fair recovery was 4 cases, poor recovery was 3 cases, bad recovery was 2 cases. Conclusions Patients with supracondylar femoral closed fracture associated with sciatic nerve injury should underwent the surgery as soon as possible, with the operation of fracture reposition and fixation, sciatic nerve exploration, nerve decompression or fascicular suture, in order to obtain a better outcome. It has a positive effect in operation and prognosis on the electromyography with intraoperative visual observation of the extent of sciatic nerve injury.

前臂及手部毁损性骨折往往伴有肌肉、神经、血管以及软组织的损伤或缺损,治疗难度大。严重损伤后患者预后较差,甚至会出现休克,危及生命。我科于2010年8月至2014年8月对36例前臂和手部毁损性骨折采用外固定支架+克氏针+脉冲冲洗器+负压封闭引流( vacuum sealing drainage, VSD)技术联合治疗,经10~24个月随访,患者的感觉及运动功能均有不同程度恢复。现报告如下。

PURPOSE:The aim of this meta-analysis was to assess the safety of denosumab in postmenopausal women with osteoporosis or low bone mineral density (BMD).METHODS:Safety of denosumab was compared with placebo or bisphosphonates. A systematic literature search without language restriction was conducted up to January, 2014. The RevMan 5.1 software was used for statistical analysis.RESULTS:A total of 11 English literatures were eventually identified. The pooled data in the overall analysis revealed that there was no significant difference when compared denosumab with placebo or bisphosphonates in any adverse events (AAE) (RR=0.99, 95% CI=0.98-1.01, p=0.29), serious adverse event (SAE) (RR=1.05, 95% CI=0.98-1.13, p=0.18), neoplasm/cancer (RR=1.14, 95% CI=0.95-1.37, p=0.16) and deaths (RR=0.77, 95% CI=0.57-1.04, p=0.09). However, significant differences were found when compared denosumab with placebo or bisphosphonates in SAE related to infection (RR=1.23, 95% CI=1.00-1.52, p=0.05) and non-vertebral fracture (RR=0.86, 95% CI=0.74-1.00, p=0.05). Subgroup analysis was performed by the type of drugs which was used in the control group. The results of subgroup analysis did not demonstrate the differences between denosumab and bisphosphonates in SAE related to infection (RR=1.13, 95% CI=0.63-2.03) and non-vertebral fracture (RR=1.31, 95% CI=0.87-1.98).CONCLUSIONS:Compared to placebo, denosumab treatment significantly decreased the risk of non-vertebral fracture but increased the risk of SAE related to infection in the postmenopausal women with osteoporosis or low BMD. However, no difference between the safety of denosumab and bisphosphonates was found.

Introduction Reconstruction of weight-bearing heel defects remains a challenge because of the unique characteristics of the plantar skin. Though numerous surgical reconstructive options have been reported, the instep flap represents an ideal option and seems to be more acceptable to patients than others. However, when the heel defect expands to the instep area, the ipsilateral instep is not available for flap elevation. A free instep flap harvested from the contralateral foot can be a good solution, but this method has been scarcely reported. Case presentation A 41-year-old Asian man presented to our institution with a soft-tissue lesion in the weight-bearing heel and instep area. His heel was reconstructed with a free instep flap from the other foot, end-to-side anastomosis of its medial plantar artery to the recipient posterior tibial artery and end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve. Conclusion The flap survived successfully, and no ulceration occurred in the flap. At the last follow-up appointment at 30 months post-surgery, a very good functional and aesthetic outcome was verified, indicating that the suggested approach may prove to be the treatment of choice in selected cases of weight-bearing heel reconstruction.