[目的]探讨槲皮素对软骨肉瘤细胞线粒体功能的影响及作用机制.[方法]软骨肉瘤细胞培养传代后随机分为加药组、激动剂组和空白对照组,加药组加入槲皮素,激动剂组加入槲皮素及740Y-P,空白对照组仅保留肿瘤细胞.干预48h后检测细胞活性,线粒体膜电位(Δψm),细胞内活性氧(ROS)水平,Akt、p-Akt、Bax、Bcl-2蛋白的表达水平.[结果]加药组细胞活力低于激动剂组(P＜0.05).加药组线粒体ΔψI低于激动剂组及空白对照组(P＜0.05);加药组ROS含量高于激动剂组及空白对照组(P如.05).加药组p-Akt表达水平低于激动剂组及空白对照组(P＜0.05).Bax表达水平加药组高于激动剂组及空白对照组(P＜0.05);Bcl-2表达水平加药组低于激动剂组及空白对照组(P＜0.05).[结论]槲皮素能够通过调节PI3K/Akt通路,降低软骨肉瘤细胞线粒体的生理功能,启动线粒体诱导的细胞凋亡程序.

[点评] 落枕的原因主要有两个方面:一是肌肉扭伤,如夜间睡眠姿势不对,枕头过高、过低或过硬,均可引起颈部一侧肌肉紧张,时间长了易导致局部气血运行不畅、疼痛不适、活动明显受限;二是感受风寒,如睡眠时受寒,使颈背部气血凝滞、经络痹阻,导致局部僵硬疼痛、活动不利.

腰椎管狭窄症主要由腰椎关节强硬引起.腰椎狭窄症的临床表现分为两类:一类为局域性症状,如下腰痛,僵硬等,一类为神经根症状,如神经性跛行.适当保护性治疗可以改善这些症状,但是一些顽固病例仍需手术治疗.单纯腰椎管减压术适用于以神经根症状为初发表现并且脊椎生物力学稳定的患者.术前评估时如出现背部手术失败综合征,退行性不稳定,严重畸形,有症状的椎骨脱离,难治性退行性椎间盘疾病,以及邻近节段病的患者可行腰椎融合术.术中评估出现广泛椎体压缩合并椎间隙大或者骨储存量不足的患者可行腰椎融合术.

Objective:To discuss the effect of percutaneous kyphoplasty ( PKP) used in the treatment of osteoporotic multiple vertebral compression fractures in elderly patients .Method s:From 2010 December to 2013 August, retrospective analysis of 32 patients with OVCF who were treated by PKP (102 vertebraes )clinical datas were carried out , male 5 cases,female 27 cases, age range 62-83 years, aver-age 72.6 years old, including 74 fresh fracture vertebras, 28 old fracture vertebras.6 cases of 2 vertebras,21 cases of 3vertebras , 5 cases of 4 vertebras above .All the patients underwent lumbar and thoracic spine anteroposterior and lateral X -ray, CT and MRI scanning be-fore surgery.The group take bilateral puncture 83 vertebras, take unilateral puncture 19 vertebras.ALL patients were carried out with a visual analog pain scores ( VAS) , vertebral kyphosis angle (Cobb angle ) , vertebral sagittal index ( SI)measurements before and after sur -gery.We use SPSS13.0 statistical software to analysis .Results:The group surgery was smoothly, without the occurrence of spinal cord and nerve injury and other complications of surgery , patients feel the waist and back pain significant relief or relieved after surgery , and get ambulation under the protection of orthosis .From 24 to 48h after surgery, compared with the preoperative VAS score , SI index and Cobb angle showed significant difference (P<0.01).The patients were followed up for 4-36 months, average 24 months.5 cases of patients symptom recurrenced during follow -up, Review X-ray showed the Cobb angle had slightly lost , SI index of vertebras with PKP did not change, MRI showed a new fracture , 3 patients of them symptoms relieved after conservative treatment , 2 patients of them take up surgery again, symptoms disappeared after surgery .Conclusion:Percutaneous kyphoplasty can relieve the pain exactly , restore vertebral shape and height in a certain extent .So, percutaneous kyphoplastyis a effective and safe method for the treatment of osteoporotic vertebral compres -sion fractures in elderly patients .

Objective To evaluate the clinical value of desmopressin in reducing blood loss following total hip arthroplasty (THA) .Methods From September 2007 to June 2009, 62 patients (28 males and 34 females) underwent THA.They were randomly divided into 2 even groups.Group A (desmopressin group) received intravenous administration of desmopressin(0.3 μg/kg diluted in 100 mL normal saline) at 30 minutes preoperatively and in 2 consecutive days postoperatively.Instead Group B (control group) received intravenous administration of normal saline of the same volume and in the same manner.The amounts of calculated total blood loss, intraoperative blood loss, postoperative wound blood loss and blood transfusion were recorded.The hemoglobin concentration (Hb) , hematocrit (Hot), platelet (Plt),fibrinogen (Fib), prothrombin time (PT), activated partial thromboplastin time (APTT) were also examined one day before and one day after operation for comparison.The patients were examined for occurrence of deep vein thrombosis(DVT) by Color Doppler Flow Imaging.Results The intraoperative blood loss was 375 ±43 mL in Group A and 392 ± 55 mL in Group B, without significant difference between the 2 groups ( P ＞0.05 ).The postoperative drainage volume was 276 ± 49 mL in Group A and 294 ± 52 mL in Group B with no significant difference either ( P ＞ 0.05).The total blood loss was 920 ±80 mL in Group A and 1150 ±99 mL in Group B, with a significant difference between the 2 groups ( P ＜ 0.05) .There were also significant differences between the 2 groups in average amount of blood transfusion, patients needing blood transfusion and postoperative Hb, Hct, Plt levels and APTT( P ＜ 0.05).No DVP event was found 14 days postoperation in either group.Conclusion During and following THA, a short-term use of desmopressin can significantly decrease blood loss and transfusion required.

Objective:To discuss the clinical effect of total hip arthroplasty and wedged vertebral osteotomy on the treatment of kyphosis and hip stiffness of ankylosing spondylitis.Method:25 patients who subjected to kyphosis caused by ankylosing spondylitis with hip malformation from June 2002 to June 2007 were analyzed.All patients accepted surgical treatment,there were 24 males and 1 females.28 hips of 25cases underwent total hip arthroplasty firstly for hip stiffness,including 22 cases of,unilateral side 3 bilateral sides,and cemented prosthesis was used in 13 cases,biological prosthesis in 15.Then wedged vertebral osteotomies were done one month later for the kyphotic deformity.The osteotomies were performed at level of T10-L5,and the vertebrae were fixed by pedicle screw and rods system.The clinical effect of kyphosis rectification and hip function between pre-or post-operation were evaluated by measuring Cobb′s angle and Harris hip score respectively.Result:Mean time of unilateral THA was 1.5h,bilateral THA was 3.5h;the average blood loss was 200ml in unilateral THA,450ml in bilateral THA.1 patient was complicated with stress ulcer which was cured by the treatment.The mean operation time of spine was 3h and the mean blood loss was 400ml.The mean follow-up period was 32 months(range,10 to 60 months).The average Cobb′s angle was 76.84°±13.29° before operation and 10.20°±3.85° after operation,rectification angle was 66.64°±13.26°(P0.01).The mean Harris hip score improved from 15.84 ±7.50 preoperatively to 73.36 ±7.35 postoperatively(P 0.01).X-rays at last follow-up showed bony fusion in all osteotomied sites without loss of the corrected angles.Conclusion:Total hip arthroplasty combined with wedged vertebral osteotomy is a safe and efficient treatment for kyphosis caused by ankylosing spondylitis with hip malformation.

Objective To study the operation method to prevent complication in total knee arthroplasty(TKA) with severe valgus deformity.Methods 21 patients with severe valgus deformities were undergone TKA.The operations were done through lateral Z shape incisions.Prosthesis rotation positioning and soft tissue balancing were done,and the lower leg alignments were restored.When soft tissue was tight both in flexion and extension,releasing was done with 90° flexion in upper lateral collateral ligament of lateral condyle,articular capsule angulus posteriolateralis and popliteal tendon,and with extension in upper iliotibial tract in grid form.When soft tissue was fine in flexion and tight in extension,releasing was done in iliotibial track,lateral collateral ligment and posterior capsule;When soft tissue was tight in flexion and fine in extension,releasing was done in popliteal tendon,lateral collateral ligament and angulus posteriolateralis of the articular capsule.Results 21 cases were followed up for 9～28 months,averaged 26.7 months.Among them,2 cases had late onset peroneal nerve palsy,and recovered after 3 month.Operative incision got primary healing.Preoperative KSS score was(43.3±4.1) points,and was restored to(83.8±5.2) points in 12 months,and(87.4±4.5) points in 24 months.Conclusions It is more difficult to perform TKA with valgus than varus.Lateral approach and the operation is beneficial for prevention of complication.

[Objective]To observe the growth status and osteogenic potential of gene transferred mesenchymal stem cells with Ad-BMP-2 planted on allogenetic acellular and decalcified bone matrix served as tissue engineering scaffold.[Method]Rabbit mesanchymal stem cells transferred with Ad-BMP-2 were seeded on allogenetic acellular and decalcified bone matrix,the growth status of gene transferred MSCs on the scaffold was observed by scanning electron microscopy and the ostengenic potential was observed by testing contents of ALP and BGP and secretion of Collagen I in the culture supermatant.[Result]The MSCs transfected with Ad-BMP-2 grew well on the tissue engineering scaffold,the osteogenic ability of the gene transfected MSCs showed great significant difference compared with that of the control group.[Conclusion]The MSCs transfected with Ad-BMP-2 can grow well on the acellular and decalcified bone matrix and the osteogenic potential can be great improved by gene transfection.

自从Sjaastad等(1983)介绍了颈源性头痛(cervicogenic headache CEH)以来,随着现代医疗技术的发展,颈源性头痛越来越被临床所接受,但是直到1990年,术语"颈源性头痛"才被国际头痛研究会所承认.尽管颈源性头痛发病机制尚未完全明确,一般认为与颈椎的增生性改变有关,尤其是钩椎关节病变造成上中段神经根刺激引起颅神经疼痛发作,也有学者认为与枕大、枕小神经有关,并且由C2～3节段的病变所引起.

[Objective]To investigate the endogenous erythropoietin expression of neural stem cells(NSCs) of rats after hypoxia.[Method]We used a rat NSCs culture model.EPO expression after 4 hours of hypoxia was studied.It was examined again following 12 hours of hypoxic lethal insult which was applied various times after hypoxic preconditioning.EPO expression was studied by western blotting.[Result]Following the preconditioning,expression of EPO increased immediately and reached a peak 4 hours later.It lasted till 8 hours later.While applied the lethal hypoxia,EPO expression of cells in preconditioning 24 hours group were was significantly increased than that in preconditioning 4 hours group.[Conclusion]The hypoxic preconditioning can lead an increased endogenous EPO expression and decrease the threshold of EPO expression against subsequent lethal stimulation during a certain period.

[Objective]To investigate the pathogenesis,pathology,diagnosis and therapy of hyponatremia after acute spinal cord injury.[Method]Fifteen in-patients with hyponatremia after acute spinal cord injury from 2004 to 2006 were retrospectively analyzed.[Result]Serum sodium was lower than 130 mmol/L in all cases.Urine sodiumcanned was from 40 to 68 mmol/L and urine osmotic pressure was from 420 to 980 mmol/L.After limitation of water intake and appropriate salt intake,12 patients recovered at 2 to 3 weeks.Because of fever and avoiding limitation of water intake,the other 3 patients recovered slowly.[Conclusion]The more serious the acute spinal cord injury,the higher the frequency of hyponatremia;syndrome of inappropriate antidiuretic hormone secretion(SIADH) is its primary cause: appropriate measures should be taken to correct the hyponatremia according to the findings of serum sodium and urine osmotic pressure.

目的:探讨老年脊髓型颈椎病患者的脊髓功能受损特征及干预方式.方法:哈尔滨医科大学第二临床医学院脊柱外科1999-01/2003-12获得随访的脊髓型颈椎病患者84例,根据患者年龄分为老年组和对照组,进行回顾性研究.对两组患者的围手术期表现、临床表现及影像学表现等方面进行对比.结果:与对照组相比,老年组患者多有其他系统伴发疾病.两组患者术前、术后的日本矫形外科学会(JOA)评分,老年组为(6.2±3.2)分和(10.7±2.9)分;对照组为(9.0±3.3)分和(13.1±3.5)分.两组患者的轮替运动速度(AMR)老年组为(11.7±3.6)分和(16.8±4.2)分;对照组为(13.9±4.2)分和(19.5±5.1)分.术后结果均有明显改善(P＜0.01),但老年组不如对照组.影像学资料显示,老年组中存在椎间不稳的患者(15/22)明显多于对照组(11/62).结论:老年脊髓型颈椎病患者围手术期多合并有其他系统疾病.椎间不稳可能是老年脊髓型颈椎病的重要发病机制之一.合理的干预方式选择及正确的围手术期处理是取得满意疗效的关键.

无放射影像学异常颈脊髓损伤 (spinal cord injury without radiographic abnormality,SCIWORA) 在临床上并非罕见,但直到1982年Pang等[1]才将其列为脊髓损伤的一种特殊类型.由于对此类损伤的特点及预后缺乏深入了解,因此在治疗方法及手术适应证选择方面仍存在一些问题,影响了疗效.自1998年1月至2002年6月,笔者收治此类患者22例,手术治疗18例,经随访,取得满意疗效.报告如下.

BACKGROUND: Idiopathic scoliosis(IS) is a kind of three-dimensional deformity. At present, little is known about the outward appearance and the inherent law of the deformity.OBJECTIVE: To investigate the inherent law between Cobb' s angle of IS and multivariable rotation deformity of top vertebrae.DESIGN: A non-randomized controlled retrospective study was conducted.SETTING and PARTICIPANTS: The study was completed in the Department of Orthopaedics, the Second Affiliated hospital of Harbin Universify. The subjects were patients with IS, 21 males and 16 females, aged 9-32years old.METHODS: Cobb' s angles were measured by anteroposterior X-ray examination of spines. Rotation angles of top vertebral(Aaro method) and angles between axis lines of bilateral top vertebral pedicles and axis lines of top vertebral bodies were measured by CT scan.MAIN OUTCOME MEASURES: Cobb' s angles measured by anteroposterior X-ray examination; rotation angles of top vertebrae and angles between axis lines of bilateral vertebral pedicles and axis lines of vertebral bodies measnred by CT scan.RESULTS: Within 38°-124°, when Cobb' s angles increased 1°, the rotation angles of top vertebrae would increase 0.39°. Angles between axis lines of bilateral top vertebral pedicles and axis lines of top vertebral bodies were (4.72 +6.02)° and (14.22 +6.52)° respectively.CONCLUSION: There are obvious inner link and linear relationship between Cobb' s angles of IS and rotation of top vertebrae. There is significant difference in axis angles between lateral top vertebral pedicles and top vertebral bodies.

Objective:To inquire into the clinical therapeutic effect and reliability of rotational manipulation for cervical spondylosis in vertebral artery type. Methods: One hundred and eighty patients of cervical spondy-losis in vertebral artery type were treated with rotational manipulation. Results: All the patients were follwed up for 4 months.89 cases have got excellent results,73 cases good and 18 fair. Conclusion:Rotational manipulation is an effective method for cervical spondylosis in vertebral artery type. The correct diagnosis and selection of indication are the key for good results.

目的探讨旋转手法治疗老年人椎动脉型颈椎病的临床疗效及安全性.方法对60例老年人椎动脉型颈椎病患者采用颈椎定位旋转手法进行治疗.结果经随访,治愈26例,显效21例,有效13例,总愈显率为78.3%.结论旋转手法同样适合老年人椎动脉型颈椎病的治疗,正确的操作方法及适应证的选择是确保安全及取得良好临床疗效的关键.

目的:探讨强直性脊柱炎后凸畸形全脊椎楔形截骨矫正术后并发应激性溃疡的相关因素及预防措施.方法:回顾性分析5例强直性脊柱炎后凸畸形矫正术后并发应激性溃疡患者的临床资料.结果:本组5例患者,经去除应激因素、胃肠减压、全身支持等综合治疗后,均得到了临床治愈.无死亡病例发生.结论:强直性脊柱炎后凸畸形矫正术后并发应激性溃疡是一种严重并发症.对长期服用非甾体类消炎药物患者,围手术期应预防性使用胃粘膜保护剂及抑制胃酸分泌药物,防止应激性溃疡的发生.

目的:探讨硬膜外腔注药治疗腰椎间盘突出症临床疗效与影像学区域定位的相关性.方法:选取单节段腰椎间盘突出症56例,根据CT、MRI对突出间盘进行影像学区域定位分类,将硬膜外腔注药治疗后的效果与影像学区域定位进行对比分析.结果:经平均1年5个月随访,本组56例患者治疗后,优35例,良15例,差6例,总优良率为89.3%;其中位于a域的优良率为95%,优良率亦明显高于位于c域者.结论:硬膜外腔注药是治疗腰椎间盘突出症的有效方法,根据影像学区域定位正确选择病例是取得满意疗效的关键.

Objective To analyse the loss of correction after spine osteotomy in ankylosing spondylitis kyphosis and suggest a method to prevent it.Methods We had follow-up surveyed 95 ankylosing spondylitis patients after correction ostecpomy for 5 years and 6 months.We compared the preoperative with postoperative reontegenogram and analyzed the relationship between the loss of correction and the stage of the disease,corrective degree after operation,internal or external fixation,and other elements.Results We found that in 34 cases the losses of correction were less than 5°,and in 19 cases the losses of correction were 6°～10°,in 24 cases the losses of correction were 11°～15°and in 16 cases the losses of correction were 16°～20°.There were 2 cases whose losses of corrcetion were more than 21°.The average loss of correction was 12.2°.Conclusion In order to prevent the loss of correction,the orthomorphia should be performed after the development of ankylosing spondylosis becomes stable,and try to correct the body axial angle to a normal degree;make the internal or external fixation reliable and pay more attention to the perioperative nursing care.

目的探讨儿童新鲜无放射影像异常颈脊髓损伤(SCIWORA)的临床特点及治疗.方法对14例儿童SCIWORA(非手术治疗13例、颈后路寰枢椎融合术1例)进行回顾性分析.结果本组患儿死亡1例,13例获平均3年随访,无明显改善者3例,其余患儿肢体功能均有不同程度的恢复.根据ASIA分级标准,治疗前为A级3例、B级5例、C级5例、D级1例;治疗后恢复至B级1例、C级2例、D级5例、E级2例.结论颈椎一过性脱位造成的脊髓损伤是儿童SCIWORA的主要原因,神经功能恢复情况与脊髓原发性损伤程度密切相关,治疗以非手术方法为主,对存在颈椎明显不稳者可采用手术治疗.