目的 探讨急性低血压时,通过前庭感受器兴奋前庭内侧核(MVN)对延髓头端腹外侧(RVLM)区c-Fos蛋白表达的影响及MVN区部分谷氨酸(Glu)受体机制.方法 选用前庭器官正常的大鼠,制备压力感受器受损(SAD)大鼠模型(n=36),随机分为6组,对照组、MVN阻断〔利多卡因(LIDO)+硝普钠(SNP)、Glu受体阻断剂(MK-801)+SNP和CNQX+SNP〕组、MVN激动剂〔Glu受体激动剂N-甲基-D-天冬氨酸(NMDA)和α-氨基-3-羟基-5-甲基-4-异恶唑丙酸(AMPA)〕组,每组6只.经微量注射泵在MVN区注入LIDO和离子型Glu受体阻断剂(MK-801、CNQX)及激动剂(NMDA、AMPA)后,结合免疫组织化学方法观察静脉注射SNP诱发急性低血压(对照组、LIDO+SNP组、MK-801+SNP组、CNQX+SNP组)及无SNP诱发低血压(NMDA组、AMPA组)时RVLM内c-Fos蛋白表达情况.结果 对照组MVN区注入人工脑脊液后,静脉注射SNP使RVLM区c-Fos蛋白表达明显增多;LIDO+SNP组、MK-801+SNP组、CNQX+SNP组SNP作用明显减弱(P<0.05);NMDA组、AMPA组RVLM区c-Fos蛋白表达显著增加(P<0.05).结论 SNP诱发的急性低血压,通过兴奋外周前庭感受器兴奋MVN后,经MVN区离子型Glu受体兴奋RVLM.

[目的]探讨延胡索乙素(l-THP)对福尔马林致痛大鼠的镇痛作用及其机制.[方法]取清洁级雄性SD大鼠,随机分为生理盐水对照组、福尔马林模型组、布洛芬阳性对照组及l-THP高、中、低剂量组.观察l-THP对福尔马林致痛大鼠舔爪时间、L4-L5脊髓后角c-Fos蛋白及5-HT2A受体表达的影响.[结果]大鼠足底注射给予福尔马林后出现双相痛的表现.与福尔马林模型组比较,布洛芬阳性对照组及l-THP高、中、低剂量组福尔马林诱导的第Ⅱ相痛时间均明显缩短(P＜0.05).大鼠足底注射给予福尔马林30、60、90 min时L4-L5腰段脊髓灰质后角均有c-Fos蛋白和5-HT2A受体表达,且均在60 min时表达最明显.大鼠足底注射给予福尔马林60 min后,福尔马林模型组大鼠L4-L5腰段脊髓灰质后角内c-Fos表达水平明显高于生理盐水对照组(P＜0.05),布洛芬阳性对照组及l-THP高、中、低剂量组c-Fos表达水平均明显低于福尔马林模型组(P＜0.05);福尔马林模型组大鼠L4-L5腰段脊髓灰质后角内5-HT2A受体表达水平较生理盐水对照组明显升高(P＜0.05),布洛芬阳性对照组及l-THP高、中、低剂量组5-HT2A受体表达水平均明显低于福尔马林模型组(P＜0.05).[结论]L4-L5脊髓后角c-Fos蛋白和5-HT2A受体参与了由福尔马林诱导的机体疼痛感觉过程;l-THP对福尔马林引起的疼痛效应具有抑制作用,且中、高剂量l-THP的抑制作用较布洛芬的效果更为显著,其作用机制可能是由5-HT2A受体所介导的.

术后感染在胫腓骨切开复位内固定手术中很常见,由于胫腓骨切开复位内固定术并发术后感染处理很困难,容易引起切口不愈合、延迟愈合,甚至切口感染.骨科医生应该做到早发现及时处理.

Objective To observe the level changes of glutamate(Glu) and aspartic acid (ASP) in the Rostral Ventrolateral Medulla(RVLM) in sodium nitroprusside (SNP)-induced acute hypotension.Methods Forty adult male Wistar rats were divided into four groups:sham-operated group(Sham),bilateral labyrinthectomy group(BL),sinoaortic denervation group(SAD) and SAD+BL group.To investigate the level changes of Glu and ASP in RVLM in Sham,BL,SAD,SAD+BL groups following SNP infusion.Results (1)Infusion SNP decreased the mean blood pressure in Sham,BL,SAD and BL+SAD groups,and the blood pressure return to the baseline when infusion finished.(2) There was no significant difference in the level of Glu and ASP release in the RVLM in 4 groups before SNP infusion.(3) The level of Glu and ASP release peaked 10 min after SNP infusion in all 4 groups,and the level of Glu and ASP in BL,SAD and BL+ SAD groups were obviously decreased compared with Sham group.

目的 探讨早期全麻下颅骨牵引联合颈前路手术治疗下颈椎骨折脱位伴关节突交锁的临床疗效.方法 回顾性分析2014年8月至2017年10月我科诊治的34例下颈椎骨折脱位合并关节突交锁患者的临床资料及手术方法及随访情况.结果 34例患者中单侧小关节脱位11例,双侧小关节脱位23例.脱位节段:C3-42例,C4-511例,C5-619例,C6-72例.术后无患者出现脊髓功能恶化,1例患者术后5天因呼吸肌麻痹呼吸衰竭死亡,余33例患者术后随访6-48个月,平均24.5个月.末次随访患者脊髓功能(ASIA评分),20例无变化,B级转为C级4例,C级转为D级7例,D级转为E级2例.末次影像学随访显示颈椎复位满意,颈脊髓无明显压迫.结论 早期全麻下颅骨牵引联合前路手术治疗下颈椎骨折脱位、关节突交锁疗效相对安全有效,应根据损伤的具体类型改变牵引方向及复位时机.

目的:对腰间盘突出症患者进行单纯髓核摘除术后进行腰背肌功能锻炼的疗效进行评估.方法:回顾性分析2013年6月-2016年3月诊断为腰间盘突出症后在我院行单纯髓核摘除术,随访满1年的患者中选取出院后认真完成腰背肌功能锻炼患者15名,未按要求进行腰背肌功能锻炼的患者15名,比较两组术前、术后的VAS评分、ODI评分及腰背部肌力.结果:VAS评分及腰部肌力比较发现,两组在术后3个月时两组间无明显差异,但在术后6个月及12个月时两组间存在明显差异.ODI评分比较也与上述结果相符.结论:腰间盘突出症患者术后坚持进行功能锻炼,可有效缓解腰部疼痛症状,提高日常生活能力及腰部肌力,使患者尽快回归日常生活,在提高手术效果方面有重要意义.

目的：探讨计算机导航辅助下经 wiltse入路行后路椎弓根置钉治疗老年胸腰椎骨折的效果。方法选取该院2010年6月至2013年2月单节段胸腰椎压缩性或爆裂性骨折但无神经症状，不需行椎管减压患者81例，随机分为传统后正中入路组（ A组：n＝21）、导航辅助下经传统后正中入路组（ B组：n＝37）和导航辅助下经wiltse入路组（ C组：n＝23），比较3组的手术优缺点。结果术后椎弓根钉置入优良率 C 组明显高于A、B组，并且C组术中出血量、术后引流量、疼痛视觉模拟评分（ VAS）上最优。结论导航辅助下经 wiltse入路组在治疗上，具有准确率高、术中创伤性小及术后腰背部疼痛缓解明显的优点。

[背景]观察导航仪引导下经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF)的治疗效果.[病例报告]采用导航仪引导下PVP和PKP治疗OVCF 73例共107个椎体.给其中陈旧性骨折(PVP组)24例29个椎体行PVP治疗,给新鲜骨折(PKP组)49例66个椎体行PKP治疗.给再发骨折9例10次共12个椎体均行PKP治疗.PVP组骨水泥注入量为2～3 mL,PKP组为3～4 m L.随访10～37个月,平均为15个月,观察疼痛视觉类比评分(VSA)变化、伤椎高度丢失及再发骨折频度.PVP组与PKP组手术前后1dVAS间差异均有统计学意义(P＜0.05).两组术后1d伤椎平均高度与术前比较均恢复(P＜0.05),PKP组恢复更加显著(P＜0.05).随访10个月时与术后1d的VSA比较两组均无明显差异(P＞0.05),两组伤椎高度均有丢失,而PKP组丢失略大(P＜0.05).PVP组中术后再发骨折2例,PKP组中7例.[讨论]导航仪引导下PVP和PKP治疗OVCF均有较好的治疗效果,可降低并发症的发生.

目的:通过观察笔者所在医院收治的难复性下颈椎骨折脱位伴关节突交锁患者临床治疗过程资料,探讨分析使用前后联合入路手术治疗该疾病产生的临床疗效。方法:详细分析2012年3月-2012年5月期间笔者所在医院骨科收治的17例难复性下颈椎骨折脱位伴关节突交锁患者的具体病情,施行前后联合入路治疗。采用ASIA分级标准对患者术前术后的脊髓功能进行分级,对比两者差异。结果:术前A级7例,B级6例,C级4例,D级0例,术后为A级1例,B级1例,C级0例,D级15例,患者术后脊髓功能相对于术前,ASIA级别更低。结论:治疗难复性下颈椎骨折脱位伴关节突交锁需根据患者损伤类型,制定个体化的脊髓功能恢复方案,采取前后联合入路手术有利于减低脊髓的压迫,从而有利于脊髓的恢复。

BACKGROUND: Traumatic cervical spine injury cannot be ignored, because it wil injury the spinal cord and thus leads to paralysis if not treat timely and effectively. OBJECTIVE: To search the Chinese Clinical Trial Register, North American Clinical Trial Register and Thomson Reuters Web of Science database and to perform literature metrological analysis on the registered projects and published literatures of the relative clinical trials about the traumatic cervical spine injury. METHODS: The Chinese Clinical Trial Register was searched with the key words of “cervical vertebrae” for the clinical trial program on the traumatic cervical spine injury; the North American Clinical Trial Register was searched with the key words of “cervical vertebra”, “trauma” or “cervical spine”, “Trauma” for the related clinical trials, and a total of 22 registered projects were obtained; the Thomson Reuters Web of Science database was searched with the key words of “neck vertebra, cervical vertebra, vertebrae cervicales, cervical spine, C-Spine, Trauma” for the literatures on the traumatic cervical spine injury published from 2003 to 2012. RESUTLS AND CONCLUSION: There are only five clinical trial registration projects related to the traumatic cervical spine injury in the Chinese Clinical Trial Register, 22 clinical trial registration projects related to the traumatic cervical spine injury in the North American Clinical Trial Register. The clinical trial registration projects in the Chinese Clinical Trial Register are significantly less than those in the North American Clinical Trial Register. The clinical trial registration projects related to the traumatic cervical spine injury searched from the North American Clinical Trial Register are distributed in three states and 17 countries, and mainly distributed in America. The clinical trial registration projects related to the traumatic cervical spine injury are mainly the intervention studies, and most of the intervention methods are internal fixation. No diagnostic test in the clinical trial registration. The number of literatures on traumatic cervical spine injury published from 2003 to 2012 in the Thomson Reuters Web of Science database have been reached to 1 597, and the amount of literatures published by the United States is accounted for the largest proportion of the total number (46.84%), the Chinese is accounted for 1.94%. The highly cited papers are mainly published on the Journal of Trauma-Injury Infection and Critical Care. The clinical trial registration unit that registered clinical trials on traumatic cervical spine injury in the Chinese Clinical Trial Register did not publish literatures on the Thomson Reuters Web of Science database. The clinical trial registration unit that registered four clinical trials on traumatic cervical spine injury in the North American Clinical Trial Register was the Ottawa Hospital Research Institute, and the unit published the most literatures (30 literatures) was the University of British Columbia, and mainly between 2009 to 2012. The literature on the traumatic cervical spine injury published by the two units above is registered also, the registration number is NCT00290875.

目的探讨治疗多节段脊髓型脊椎病前后不同手术入路的方法,寻求较好的治疗方式。方法选取2009年8月至2012年8月于我院神经外科多节段脊髓型脊椎病患者100例。将患者分为两组,每组50人。患者无发育性椎管狭窄,无后纵韧带骨化,采用前路手术方式,为实验组。患者无颈椎后凸畸形,采用后路手术方式,为对照组。比较两组的JOA评分改善率。结果实验组与对照组手术前JOA评分无统计学差异。实验组与治疗组治疗后JOA评分均较治疗前提高,差异具有统计学意义(P<0.05)。实验组JOA评分升高较对照组高,且差异具有统计学意义(P<0.05)。结论多节段脊髓型脊椎病的手术治疗中,前入路手术方式可以有效减少颈椎病变对于脊髓的压迫,有效改善症状,值得临床推广应用。

Objective To evaluate the clinical and imaging efficacy of posterior pedicle screw fixation and transpedicular hydroxyapatite bone graft in the treatment of thoracolumbar burst fracture.Methods 36 patients of thoracolumbar burst fractures in Affiliated Hospital of Yanbian University from March 2008 to March 2010 were selected and divided into group A and group B according to the operation methods,20 cases in group A were treated with posterior pedicle screw reduction and fixation,16 cases in group B were treated with transpedicular hydroxyapatite bone graft combined with posterior pedicle screw reduction and fixation.Internal fixation was taken out 12 months after the operation.Fractured vertebral wedged angle,local kyphosis angle,anterior vertebral compression ratio,Denis pain and functional status score were compared between the two groups.Results No surgery related complications and the fracture internal fixation was found.The differences of fractured vertebral wedged angle,local kyphosis angle,anterior vertebral compression ratio in the two groups before and 3 months after the operation were not statistically significant(P > 0.05).The differences of fractured vertebral wedged angle,local kyphosis angle,anterior vertebral compression ratio in group A [(11.2 ±1.7)°,(11.2 ±2.0)°,(0.79 ±0.15)] and group B [(9.5 ±2.2)°,(9.7 ±2.1)°,(0.87±0.16)] were statistically significant(P < 0.05);the differences of fractured vertebral wedged angle,local kyphosis angle,anterior vertebral compression ratio in group A [(12.2 ±2.6)°,(12.3±2.6)°,(0.78±0.13)] and group B [(10.1±2.7)°,(10.3±2.7)°,(0.85±0.18)] were statistically significant(P < 0.05).The differences of Denis pain and functional status scores in the two groups were not statistically significant(P > 0.05).Conclusion Transpedicular hydroxyapatite bone grafting can effectively assist the maintenance of postoperative correction and spinal sagittal alignment to prevent fixation failure.The long-term effect need further investigation.

Objective To design and make sliding load external fixator (SLEF) according to unilateral angulated external fixator and dynamic hip screw, and evaluate its biomechanical properties. Methods Five pairs of fresher adult femur specimens were prepared,after t he model of A1.1 (AO classification) fracture was established. The specimens in the experimental group were fixed with sliding load external fixation (SLEF) while the specimens in the control group were fixed with traditional one arm external fixation. The specimens were loaded on electronic almighty experimental plane. The consequence was recorded by YD-15type dynamic electric resistance deformeter. The load was 0-800N. Results In a walking cycle ,the emergence of a peak in the control group, and three test contingency peaks and two minimum in the experimental group , and this facilitated the healing of fractures. Conclusion The sliding load external fixator (SLEF) has double functions of sliding and load. It can avoid coxa vara and other complications, and promote union of fracture.

Objective To design and make the sliding load external fixator (SLEF) and evaluate its biomechanical properties.Methods Five pairs of fresher adult femur specimens were prepared,and the model of A1.1(AO classification) fracture was established.For the experimental group the specimens were fixed with the sliding load external fixation (SLEF),while for the contorl group the specimens were fixed with traditional one arm external fixation.It was conducted on the electronic almighty experimental plane.Experimental tests were divided into the opened angle,the stress distribution in the edge of fracture,the fracture-contact area.Results ①Opened angle:under every load,the opened angle of the experimental group was significantly smaller than control group.②The stress distribution in the edge of fracture:the outer side four points were pulled stress,but the experimental group including tension side were all pressure stress.③Fracture-contact area:the experimental group was 47.1% bigger than the control group under the same load. Conclusion The performance of the biological mechanics about sliding load external fixator (SLEF) is superior to the ordinary fixed devices.

Objective To report the design and preliminary result of clinical application of sliding load external fixator for intertrochanteric fracture of the femur.Methods On the foundation of unilateral angulated external fixator and dynamic hip screw,the sliding load external fixator were designed and made.From May 2003 to December 2005,22 high risk patients with intertrochanteric fracture of the femur were treated with the new sliding load external fixator.Results Twenty patients were followed up with the mean follow-up time at 12 months(from 2 to 30 months).The bone healing was achieved in all patients.The time of bone healing ranged from 10 to 13 weeks(averaging 12 weeks).Only 4 patients had the superficial pin site infection and it was cured with pin site care.No deep infection and non-union or malunion was found.The hip joint function recovered well.Conclusion The sliding load external fixator is easy and convenient to perform,has duplicate functions of load and sliding,can shift between static and dynamic fixation according to the clinic requirements,make the fixation more reasonable,can prevent coxa vara and the sliding out of pin or trans-head of femur.It is an ideal method for treatment of the intertrochanteric fracture of the femur in high-risk and senile patients.

手术治疗股骨粗隆间骨折以来对老年人非稳定骨折的固定原则一直存在着分歧:在获得了尽可能的解剖复位后,固定愈坚强愈好还是尽可能早期动力化固定,以提供骨折端的接触.

1999年5月～2004年8月用折断式加压螺纹钉从锁骨内侧打入治疗锁骨中1/3骨折,取得了满意疗效,现总结如下:

患者,女性,13岁.平时双下肢酸痛,但能忍受.2003年6月13日上体育课,跟别的同学玩耍时不甚摔倒右大腿着地,当即右大腿剧痛,不能站立,送往当地医院拍片检查发现,右股骨上1/3骨折,后转到本院骨科住院治疗.入院查体:病儿消瘦,发育欠佳,痛苦面容,被动体位.

患者,男,38岁.约7年前开始左小腿不适,后渐渐增大,没有明显的疼痛,近3年肿物增大明显且有明显的左小腿及足背麻木和足背伸功能障碍以致行走困难.