目的:研究不同手术方式对腰椎间盘突出症治疗的作用对比.方法:将我院自2010年7月~2014年7月收治手术治疗腰椎间盘突出症的患者80例作为研究对象,回顾性分析患者临床资料,其中,采用小切口椎板开窗髓核摘除术19例(A组),采用后路切开半椎板切除减压、髓核摘除术39例(B组),采用后路切开全椎板减压、髓核摘除术22例(C组),对比3种不同手术方式患者治疗的优良率、手术时间、术中出血量、术后并发症.结果:经过12~36个月的随访,3组患者优良率均较高,差异无统计学意义(P>0.05).A组手术时间明显短于B组和C组,术中出血量、术后并发症明显少于B组和C组,差异有统计学意义(P<0.05).B组和C组在手术时间、术中出血量、术后并发症三方面差异无统计学意义(P>0.05).结论:传统腰椎后路椎间盘摘除术治疗腰椎间盘突出疗效确切,其中以小切口椎板开窗髓核摘除术操作最为简单,安全性最高,临床可结合患者具体情况选择相应的术式.

目的:探究股骨粗隆间骨折患者采用髓内与髓外内固定的治疗效果.方法:选取本院2012年4月~2016年3月收治的112例股骨粗隆间骨折患者,并采用抽签的方式将其分为2组,观察组56例患者采用髓外固定治疗,对照组56例患者采用髓内固定治疗.并对2组患者治疗后的手术相关指标与不良反应发生率进行对比.结果:观察组与对照组患者在术中出血量、手术时间、住院时间、骨折愈合时间以及术后Harris评分方面的对比,差异性不显著(P>0.05),不具备统计学方面的意义;观察组患者治疗后出现1例不良反应,发生率为1.79%;对照组患者治疗后出现9例不良反应,发生率为16.07%,观察组患者治疗后不良反应发生率明显比对照组低,差异性显著(P<0.05),具备统计学方面的意义.结论:髓内与髓外内固定对股骨粗隆间骨折均有一定的治疗效果,但与髓内固定治疗相比,髓外固定可使患者的不良反应发生率显著降低.

目的 探讨解剖钢板和加压螺栓微创治疗跟骨关节内骨折疗效.方法 挑选2015年1月至2016年6月我院104例跟骨关节内骨折患者,随机分成观察组与对照组,每组52例.观察组执行小切口微创解剖钢板联合加压螺栓固定治疗,对照组执行传统解剖钢板联合螺钉治疗.对比两组术后跟骨结构、功能恢复情况与并发症出现情况.结果 对比两组术后跟骨结构、功能恢复情况与并发症出现情况,差异具有统计学意义(P<0.05).对比手术前两组踝-足评分系统(AOFAS)评分,差异无统计学意义(P>0.05).对比手术后两组踝-足评分系统(AOFAS)评分,观察组比对照组高,差异具有统计学意义(P<0.05).观察组并发症出现率3.8%,对照组并发症出现率21.2%,观察组比对照组低(P<0.05).结论 小切口微创解剖钢板联合加压螺栓疗效明显,手术后患者跟骨结构、功能都得到有效恢复,安全系数高,值得大力推广运用.

目的 探讨双侧支持钢板治疗复杂股骨髁骨折的疗效.方法 选取铁法煤业集团总医院2010年9月-2014年9月收治的骨折AO分型C型股骨髁骨折病人,将69例应用双侧支持钢板治疗者作为观察组,69例应用传统拉力螺钉内固定治疗者作为对照组,对比两组病人治疗优良率、骨折愈合时间、并发症等.结果 观察组与对照组相比优良率高、骨折愈合时间短,且未出现严重并发症,差异具有统计学意义(P＜0.05).结论 应用双侧股骨远端解剖锁定支持钢板治疗复杂股骨髁骨折疗效肯定,并发症少,骨折愈合情况良好,值得在临床推广应用.

目的：讨论经伤椎置钉短节段椎弓根螺钉固定系统治疗胸腰椎骨折的临床效果。方法采用经伤椎椎弓根螺钉3椎体6钉内固定技术治疗60例胸腰椎骨折患者进行回顾性分析。结果本组治疗显示院内固定手术失败率0%，术后伤椎高度矫正率96±15.2%，术后Cobb角变化值17.5±5.65%，远期伤椎高度丢失率1.7±0.57%，远期Cobb角丢失值1.17±0.52%。结论经伤椎椎弓根螺钉3椎体6钉内固定技术治疗胸腰椎骨折效果良好。

目的探讨应用改良Ilizarov架骨搬移同时行足部骨牵引治疗胫骨缺损伴足下垂的临床效果。方法自2004年10月至2008年10月,我们应用改良Ilizarov架骨搬移同时行足部骨牵引治疗胫骨缺损伴足下垂3例,其中男2例,女1例,平均年龄31岁,2例为开放骨折骨缺损,1例为胫骨慢性骨髓炎,均有软组织创面及患肢足下垂。结果在3例病人中,无1例出现血管神经损伤,创面及骨愈合率100%。结论对胫骨缺损,骨髓炎伴有足下垂的病例应用改良Ilizarov架骨搬移同时行足部骨牵引治疗胫骨缺损伴足下垂是一种较好的疗法,可同时施行治疗,缩短治疗时间。

目的探讨采用经Wiltse肌间隙入路复位内固定术治疗胸腰段椎体骨折的临床分析。方法本文将回顾分析2010年9月至2011年9月,我院采用改良的经竖脊肌肌间隙入路椎弓根内同定术治疗胸腰椎骨折42例临床资料。为了验证此技术与传统技术的优势,我们将病例随机分为Wiltse肌间隙入路组42例,男28例,女14例,年龄区间为22～53岁,平均42.8岁;传统后正中入路21例,男11例,女10例,年龄21～56岁,平均43.5岁。比较2组患者围手术期参数及影像学指标。结果 2组患者经过围手术期的疗效观察表明,采用经Wiltse肌间隙人路手术具有手术时间短、出血量少、术后引流量小、患者术后卧床时间短,以及在术后经疼痛视觉模拟评分(visualan alogue scale,VAS)评估其比传统技术具有明显优势,差异有统计学意义(p<0.05)。术后随访中Wiltse肌间隙人路手术组患者均获得愈合。结论临床采用Wiltse肌间隙人路技术进行内固定治疗胸腰段椎体骨折,其具有术者操作简单、出血少、创伤小及术后患者恢复快等优势。

目的讨论股骨近端锁定钢板治疗股骨粗隆下骨折的临床疗效。方法采用股骨近端锁定加压钢板治疗股骨粗隆下骨折38例。患者在术后均获得随访,其时间为7～18个月(平均随访时间12.5个月)。结果对患者采用Harris评分标准进行判断疗效,采用股骨近端锁定加压钢板组总优良率89%,无内固定断裂、骨不连等并发症,功能恢复较好,手术时间短、出血较少,在治疗股骨粗隆下骨折上,相对于DHS及重建钉具有一定的优势。结论选择股骨近端锁定加压钢板治疗股骨粗隆下骨折具有损伤小、固定可靠、骨折愈合率高、手术时间短、术中出血少等优点,具有良好的临床应用价值。

骨盆骨折的临床发生率越来越高,而对骨盆骨折的治疗方法很多,由早期的保守治疗为主,逐渐转为以手术治疗为主.2004年1月-2008年1月我们收治骨盆骨折患者71例,其中采用外固定架治疗16例,取得了良好的效果.现报告如下.

AIM:There are some reports about the treatment of spinal cord injury with neural stem cells(NSCs) transplantation,but the ideas about the transplantation time and patterns and detection indexes are still different.In this study,the effects of cryopreserved NSC transplantation on the axonal regeneration after the spinal cord injury in rats were observed.METHODS:The experiment was carried out in the experimental animal center of China Medical University from June 2005 to June 2006.①Thirty-six adult Wistar rats,either male or female and 250-300 g,were provided by the experimental animal department of China Medical University.Neural stem cells were isolated from 10 neonate rats and cultured.All treatments for animals were accorded with the animal ethical criteria.②NSCs at logarithmic phase were cryopreserved at-70 ℃ for 2 weeks and labeled with 5-bromodeoxyuridine(Brdu) after rewarming.After the models of spinal cord injury were established,the NSCs were transplanted into the injured site immediately.Thirty-six rats were randomly divided into NSC transplantation group,DMEM solution group,and control group.③NSC survival and migration were detected by immunohistochemistry,and the reconstruction of spinal cord were detected by horseradish peroxidase(HRP) staining.RESULTS:Of the 36 spinal injured model rats,4 died of overdose of anesthesia,and 5 died of infection,but all were supplemented.Brdu-labeled positive NSCs were detected in the injured spinal cord after transplantation on the 7th day,and increased on the 14th day,then gradually decreased since the 28th day till disappeared.The number of HRP positive cells in transplantation group was significantly higher than DMEM solution.CONCLUSION:Cryopreserved NSCs can survive in the injured site after transplantation and promote the reconstruction of axoplasm pathway of injured spinal cord.

目的探讨经后路椎弓根钉内固定,椎板减压治疗胸腰椎骨折的手术指征及治疗效果。方法经后路切开,椎弓根钉复位固定,椎板减压,植骨融合治疗胸腰椎骨折67例,其中,两节段以上4例。结果经12～48个月随访,平均24.5个月,术后骨折均复位满意,有神经损伤者大部分有所改善,骨折椎体高度无明显丢失,无继发性脊柱后凸畸形加重。结论对胸腰椎骨折出现机械性、神经性或混合性不稳定者,需及时治疗,经后路椎弓根钉复位,固定,椎板减压,植骨融合可有效重建脊柱稳定性,改善神经功能。

胫骨髁间嵴撕脱性骨折常合并半月板、前交叉韧带等损伤,且伤后常遗留髁间窝撞击或膝关节不稳.传统的治疗方法是开放手术复位固定骨折,手术创伤较大,本院自2006年4月至2007年3月采用关节镜监视下复位治疗胫骨髁间嵴撕脱性骨折,取得了良好疗效.报告如下.

Objective To predict the prevalent trend of coal worker's pneumoconiosis(CWP)in Daming mine of Tiefa corporation.Methods The “questionnaire for coal worker's pneumoconiosis” and the “questionnaire for coal workers without pneumoconiosis” were used to collect the information of coal worker's health status.Life table was used to calculate the cumulate incident rate and average incident rate per year;based on the hypothesis that the life expectancy of coal workers was as same as those of local people,we estimate the number of CWP in workers at different age who were exposed to dust in different period in the future.Results The average incidence rate of coal worker's pneumoconiosis were 0.40%k,0.44%,0.06%,and 0.01% respectively according to the dust exposure period as follows:before 1959,1960-1964,1965—1969,and 1970—1979.The incidence decreased year by year.The number of CWP workers who exposed to dust before 1959,1960—1964,1965—1969,and 1970—1979 were 17,7,2,and 2,respectively.The CWP incidence rate will begin to decrease in the future.Conclusion The results of prediction show that the old workers who were first exposed to dust before 1964 will be the main proportion of patients with CWP diagnosed in the future.In general,the number of the CWP patients will mainly in the following 15 years,and it will decrease year by year.

[Objective]To predict the incidence tendency of coalminers' pneumoconiosis in the following 10 years and provide evidence for the prevention and control work.[Methods] Statistic analysis was made on the diagnosed coalminers' pneumoconiosis patients in Tiefa Coalmine Corporation since 2005;grey system GM(1,1) was used to predict the changing tendency of coalminers' pneumoconiosis in the following 10 years.[Results]The GM(1,1) model of the dynamic prediction of the long-term incidence tendency of coalminers' pneumoconiosis in Dalong coalmine was X^(k)=1183.47×e-0.028 49×(k-1)+1218.471,the total relative deviation was 0.02,total relative deviation rate was 0.0%;C=0.15,P=1.00;the expected numbers of CMP patients during the periods of 2005—2006,2007—2008,2009—2010 and 2011—2012 were 27.23,26.47,25.72,25.00 and 24.30 respectively. [Conclusion]This model is accurate and reliable that can be applied for the prediction of the incidence tendency of coalminers' pneumoconiosis;the number of coalminers' pneumoconiosis patients will decrease in the following 10 years.

目的探讨关节镜诊断治疗膝关节滑膜软骨瘤病的方法及临床应用价值。方法自2005年12月～2007年3月,本院共收治10例膝关节滑膜软骨瘤病患者,男7例,女3例,患者在关节镜下得到确诊,并应用常规器械取出关节内游离体、彻底切除病变的滑膜,其中9例患者通过8-10个月的随访,了解患膝活动度、疼痛,肿胀情况。结果9例随访患者,术前HSS膝关节功能评分为(58±4)分,术后症状明显减轻,无复发,最后随访时HSS膝关节功能评分为(86±7)分。结论通过关节镜诊治膝关节滑膜软骨瘤病,创伤小,膝关节功能恢复快,无复发,是一种安全有效值得推广的方法。

目的探讨胫骨平台骨折切开复位内固定的临床疗效。方法对1993年3月～2007年4月开放手术治疗胫骨平台骨折45例进行回顾性分析,按照Schatzker分型:Ⅱ型13例,Ⅲ型6例,Ⅳ型11例,Ⅴ型9例,Ⅵ型6例。结果45例中42例得到随诊,经6～30月的随诊,根据马元璋的评价标准:优13例,良20例,可5例,差4例。结论切开复位内固定治疗胫骨平台骨折需选择合适的手术时机,坚强的内固定,积极早期处理合并伤,早期的膝关节功能锻炼。

AIM: To investigate the effect and significance of mesenchymal stem cells (MSCs) transplantation on the polysialylated neural cell adhesion molecule (PSA-NCAM) after spinal cord injury (SCI) of rats. METHODS: The experiment was performed at the Experimental Animal Center, China Medical University from June 2004 to June 2005. Four rats were randomly selected to isolate and cultivate MSCs. After MSCs grew till the 4th generation and 60% confluence, medium was removed. 5-bromodeoxyuridine was applied to label medium. Thirty-six rats were randomly divided into three groups: SCI cured with MSCs transplantation (group A), SCI received phosphate buffered solution (PBS) (group B), blank control group (group C), with 12 in each group. SCI models were established, and MSCs was transplanted immediately after injury. Survival of cells was observed with immunohistochemical method at days 7, 14 and 28. Positive cell expression of 5-bromodeoxyuridine and PSA-NCAM was measured with hematine-eosin (HE) staining and strep-avidin-biotin-peroxidase complex (SABC) immunohistochemical method. RESULTS: Of the 40 rats, 36 were established SCI models and 6 died of infection, but they were made up for. ①Positive cells of 5-bromodeoxyuridine in the group A appeared at day 7, which showed yellow. There were many positive cells in nearby injured area, but gradually reduced when moved toward capitular head and caudal end. The farthest movement was 1.5 cm from injured area. There was no positive cells in the group B and group C. ②Expression of PSA-NCAM appeared at proximal end at day 7 in the group A. A few positive cells appeared in the group B. No positive cell appeared in the group C. Brown granula located at kytoplasm and cell membrane of neuron. At day 14 after transplantation, positive cells became more in the group A. Compared with the group B, there were significant differences (16.0±2.6,6.0±2.3,P < 0.05). At day 28, positive nerve cells became less gradually in the group A. CONCLUSION:MSCs can obviously improve the expression of PSA-NCAM after transplantation. It may be an important mechanism of repairing the SCI and participating synapsis reconstitution.

目的:Netrin-1蛋白可能具有轴突引导作用,观察其在大鼠急性脊髓损伤后不同时点的表达及损伤脊髓组织形态学的变化.方法:实验于2002-10/2003-10在中国医科大学实验动物中心完成,选取Wistar大鼠40只,随机分为损伤组20只,假手术组15只,正常对照组5只.制作大鼠脊髓半横断损伤模型,并于术后1,3,5,7,14 d分别选择损伤组大鼠4只,假手术组3只,正常对照组1只,麻醉下取出T10节段脊髓经过处理制成切片,行苏木精-伊红染色观察损伤脊髓组织形态改变.经苏木精-伊红染色和常规卵白素-生物素-过氧化物酶复合物染色,电镜检测Netrin-1阳性反应物的表达.各组每只分别选取9张组化切片,分别从灰质前角至后角取8个高倍镜视野,测定其阳性反应物的平均灰度值,通过对平均灰度值的分析,测定Netrin-1的表达量.结果:在整个实验过程中,40只大鼠无死亡.实验切片360张,所取视野的平均灰度值均达到统计学分析要求.①3组苏木精-伊红染色组织形态学改变:假手术组与正常对照组脊髓均为正常结构.损伤组脊髓损伤后第1天灰质内出现片状出血、中央区碎裂,轴突断裂及脱髓鞘改变;第3天神经元肿胀,逐渐形成空洞,胶质细胞减少;第5,7天残存神经元减少,胶质细胞增生;第14天神经元胞浆内尼氏体染色呈虎斑状,提示生理功能逐渐恢复②3组Netrin-1表达:损伤组大鼠脊髓损伤后第1天于胶质细胞上可检测到Netrin-1的表达,第3天在神经元胞质内出现,表达逐渐升高,第5天表达量较假手术组增加26.3%,组间有差异x2=0.023,P＜0.05.第7天达到高峰并趋于稳定,第14天开始逐渐下降.正常对照组仅少量表达,假手术组与正常组之间差异比较P＞0.05.结论:在脊髓损伤后轴突导向分子Netrin-1呈一过性表达,其表达变化与苏木精-伊红染色损伤组脊髓修复程度均具有时序性.

目的:探讨脊髓源性神经干细胞向神经元诱导分化过程中生长相关蛋白43的表达,分析其对脊髓损伤修复的主导作用.方法:实验于2003-03/09在中国医科大学实验动物中心完成.取15只孕14 d的胎鼠,自胎鼠的脊髓区提取神经干细胞,经培养及神经巢蛋白免疫细胞化学鉴定,观察在神经干细胞定向诱导分化为神经元过程中,生长相关蛋白43于不同时间点的形态学表达.培养液为添加B27(2%)、碱性成纤维细胞生长因子(20 mg/L)、表皮细胞生长因子(20mg/L)的无血清培养基DMEM/F12.置于37℃、体积分数为0 05的COz培养箱中悬浮培养,观察其生长情况,每3天换液1次,共培养5次.分别于分化1,2,4,8 d取出载玻片,对生长相关蛋白的表达进行免疫组化检测.总细胞和阳性细胞在显微镜下计数.结果:15只胎鼠的脊髓源性神经干细胞全部进入结果分析.①神经干细胞的培养情况:培养24 h后,可见神经球;第2天时,神经球数目增多,呈桑椹状,折光性强,死细胞无光泽,仅有轮廓.②神经干细胞的鉴定结果:免疫细胞化学染色可见神经球内圆形细胞呈神经巢蛋白抗原强阳性,核未着色.神经干细胞定向分化后,细胞逐渐贴壁,到第4,8天时,细胞逐渐变大,突起变长,偶见多个突起.神经元特异性烯醇化酶阳性的神经元,胞浆及核膜出现棕色阳性反应,细胞核大而圆,无着色.细胞连续计数共712个,其中神经元特异性烯醇化酶阳性细胞296个,比例为41.57%.③神经干细胞分化过程中生长相关蛋白表达的测定:神经干细胞分化第1天,胞质内出现生长相关蛋白,第4天表达增强,于核周及突起中明显,逐渐向胞膜转移,并且长的突起与其他细胞的突起之间形成连接,至分化第8天时这种突起生长停止,神经干细胞分化为成熟的神经元细胞,生长相关蛋白反应减弱并消失.细胞连续计数共736个,其中生长相关蛋白阳性细胞246个,比例为33.42%.结论:在神经干细胞分化为神经元的过程中,生长相关蛋白基因呈一过性表达,参与引导突起的生长并发挥促进作用.

Objective: To explore the possibility of transdifferentiation of bone marrow mesenchymal stem cells (MSC) of adult rat to neural precursor cells in vitro. Methods: After the primary culture and subculture differentiation of MSC was induced into neural precursor cells by cytokine and oxidane . Gross observation, immunocytochemistry analysis, flow cytometry analysis, and electrophysiological examination were performed. Results: The MSC could be transdifferentiated to neural precursor cell with the expression of Nestin. The inducible rate of MSC was 49.8%. The induced cells showed different electrophysiological features from the MSC,but similar to the neural stem cells. Conclusion: Neural precursor cells derived from bone marrow have the possibility in the therapy of central nervous system damage.