目的 比较股内侧肌下入路(SVA)与髌旁内侧入路(MPA)行全膝关节置换术(TKA)治疗膝关节骨性关节炎(KOA)的临床效果.方法 选择KOA患者89例,其中经SVA行TKA 46例(SVA组)、经MPA行TKA 43例(MPA组).比较两组术前及术后1、3、6个月视觉模拟评分(VAS)、膝关节活动度(ROM)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及Berg平衡量表(BBS)评分,手术前后股骨与胫骨机械轴夹角(mFTA),术前及术后6个月起立-行走计时(TUG)测试、被动活动察觉阈值(TDPM)以及患膝术后初次主动直腿抬高(SLR)时间.结果 术后1、3、6个月,两组VAS、ROM、WOMAC评分和BBS评分(除MPA组术后1个月BBS评分外)均较术前显著改善(P均<0.05);除术后6个月BBS评分外,SVA组术后各时间VAS、ROM、WOMAC评分和BBS评分均优于MPA组同期(P均<0.05).两组术后6个月mFTA、TUG测试、TDPM均显著低于术前(P均<0.05),且SVA组术后6个月TUG测试、TDPM优于MPA组(P均<0.05),而两组术后6个月mFTA比较差异无统计学意义(P>0.05).SVA组初次主动SLR时间显著低于MPA组(P<0.05).除SVA组术后出现切口脂肪液化1例外,两组术后均未出现下肢深静脉血栓、切口感染、假体松动或移位等并发症,两组术后并发症的发生率比较差异无统计学意义(P>0.05).结论 与经MPA相比,经SVA行TKA治疗KOA疼痛程度减轻,患膝关节功能和本体感觉功能恢复较好、术后初次主动SLR时间降低,并且不会增加并发症发生.

目的 比较直接前方入路(DAA)与后外侧入路(PLA)半髋关节置换术治疗老年股骨颈骨折的早期临床疗效.方法 将行半髋关节置换术的老年股骨颈骨折患者90例依据不同术式分为DAA组(42例)和PLA组(48例).比较2组术后一般资料,术前及术后1、3、5 d的视觉疼痛模拟评分(VAS),术前及术后1周、1个月、3个月、6个月的Harris髋关节功能评分(HHS).比较分析2组术后1周、1个月、3个月、6个月的髋关节外展肌力矩、单腿站立试验结果、Berg平衡量表评分(BBS)、关节位置感觉(JPS)角度.结果 DAA组手术时间长于PLA组,但切口长度、术中出血量、术后1 d血红蛋白(Hb)下降值均少于PLA组(P<0.01).2组HHS评分、力矩随着时间延续均呈增加趋势,而VAS、JPS角度呈降低趋势,且各时点DAA组HHS、力矩高于PLA组,VAS、JPS角度低于PLA组.DAA组各时点的单腿站立试验结果优于PLA组(P<0.01).DAA组和PLA组并发症发生率(2.4％和4.2％)差异无统计学意义(P>0.05).结论 DAA创伤小、术后髋关节功能和本体感觉恢复快,利于患者的早期康复,应用DAA的早期疗效优于PLA.

目的 比较分析单髁置换术与全膝关节置换术治疗膝关节内侧间室骨性关节炎的疗效.方法 回顾性分析自2018-01-2019-03诊治的50例膝关节内侧间室骨性关节炎(Ahlback 3、4期).25例采用单髁置换术治疗(UKA组),25例采用全膝关节置换术治疗(TKA组).比较2组恢复直腿抬高时间、恢复屈膝＞90°时间,以及术后2周、3个月、12个月疼痛VAS评分、膝关节HSS评分、膝关节活动度.结果 50例均获得随访,随访时间平均18.6(12～24)个月.术后无感染、深静脉血栓形成、假体松动、假体周围骨折、内衬脱位等并发症发生.UKA组恢复直腿抬高时间、恢复屈膝＞90°时间短于TKA组,术后2周时膝关节HSS评分、膝关节活动度、疼痛VAS评分均优于TKA组,差异有统计学意义(P＜0.05);UKA组与TKA组术后3个月、12个月膝关节HSS评分、膝关节活动度、疼痛VAS评分差异无统计学意义(P＞0.05).结论 单髁置换术与全膝关节置换术治疗膝关节内侧间室骨性关节炎均可取得满意疗效,而单髁置换术创伤更小,患者术后康复更快,但适应证也更为严格.

目的 探讨锁骨钩钢板治疗急性TossyⅢ肩锁关节脱位的疗效及术中修复喙锁韧带必要性.方法 运用随机分配原则将43例TossyⅢ型急性肩锁关节脱位患者按手术方式分成2组,均采用锁骨钩钢板治疗,对照组(喙锁韧带不修补)21例,试验组(喙锁韧带修补)22例,平均随访12个月,根据Karlsson评分标准,比较两组在疗效、手术时间及失血量方面差异.结果 对照组手术时间30～45 min、平均40 min,出血量50～60 mL,平均55 mL.试验组手术时间60～80 min、平均70 min,出血量70～100 mL,平均80 mL.两组差异有统计学意义(P<0.05),喙锁韧带不修补对患者造成的创伤更小.所有病例无感染、复位不良、内固定松动、断裂发生,恢复日常生活和工作能力.对照组优良率90.5％(19/21),试验组优良率90.9％(20/22),两组比较,差异无统计学意义(P>0.05).结论 锁骨钩钢板治疗急性TossyⅢ肩锁关节脱位不需修复喙锁韧带即可获得满意临床疗效.

目的 探讨全膝关节置换术(Total Knee Arthroplasty TKA)患者髌骨置换与髌骨不置换术后的临床疗效,从而找出一种更安全有效的方法 ,为临床服务.方法采用前瞻性随机的方法,对本院骨科在2015年1月至2018年1月期间所行的髌骨置换与未置换单侧全膝关节置换(Total Knee Arthroplasty,TKA)者进行研究,按纳入和排除标准共获得77例77膝,其中置换髌骨组38例38膝,男11例,女27例,平均年龄63.4±9.96岁(52～75岁);未置换髌骨组39例39膝,男8例,女31例,平均年龄64.1±7.38岁(50～74岁).髌骨置换和未置换者均采用非限制稳定型胫骨和股骨组件,骨水泥固定,髌骨置换者则采用全聚乙烯三柱髌骨组件骨水泥固定.临床观察指标包括:手术时间、手术失血量、外侧支持带是否松解、患者满意度等;临床评定标准包括:HSS膝关节评分系统,评定髌骨的Feller标准.两组所有数据均采用SPSS 21.0软件行统计分析比较,P<0.05认为差异具有统计学意义.结果 两组患者均获至少1年的完整随访,两组患者至今均无假体松动、假体周围骨折、感染、髌股关节紊乱、髌骨脱位、半脱位等并发症.术前、术后髌骨置换组与髌骨不置换组膝关节HSS评分及Feller髌骨功能评分差异均无统计学意义(P>0.05),但置换髌骨组与未置换组术后的膝关节功能HSS评分、Feller髌骨评分均较术前显著改善(P<0.05).髌骨置换组除在手术时间方面较未置换组显著延长外(P<0.05),在手术相关失血量、外侧支持带松解、患者满意程度方面则与未置换组无差异(P>0.05).结论 1.髌骨置换与否,均能获得TKA术后的疼痛和功能显著改善,从而使患者提高生活质量,恢复日常基本工作和活动;2.TKA疗效的关键取决于假体和器械的合理设计、规范化的手术操作、以及医生经验,而非取决于髌骨是否置换.3.未置换髌骨的TKA术后临床疗效显著,短期随访均无并发症和二次手术发生,较置换髌骨的TKA而言,操作相对简单、创伤小,成本低,是一种安全理想的术式.

目的 分析糖尿病足荧光假单胞杆菌局部感染合并人葡萄球菌人亚种菌血症的临床特点和诊治方法.方法 对1例糖尿病足荧光假单胞菌局部感染行截肢术后合并人葡萄球菌人亚种菌血症患者的临床资料进行回顾性分析.结果 患者合并高血压病和冠心病,既往行右膝上截肢术,因左糖尿病足感染人院,行左大腿膝上截肢术,术后感染加重.本例为条件致病菌的混合感染,血培养显示人葡萄球菌人亚种感染,局部分泌物培养显示荧光假单胞菌感染;两种细菌对多种抗生素耐药,根据药敏试验结果及时调整抗生素,患者生命体征逐渐平稳,康复出院.结论 糖尿病足荧光假单胞菌局部感染合并人葡萄球菌人亚种菌血症临床表现不典型,病情进展快.积极经验性抗感染治疗,控制血糖,及时进行病原学检查,根据药敏结果选择有效抗菌药物,可提高治愈率、降低病死率.

目的:检测VEGF-2578C/A,936C/T和-460T/C基因在骨肉瘤发展过程中的表达水平,从而研究二者可能存在关系.方法:将我院自2014年1月-2017年1月的90例骨肉瘤患者和90例健康对照组成员纳入本研究进行基因多态性的对比分析.结果:对照组的VEGF-2578C/A和-460T/C基因型频率符合哈迪-温伯格定律,但936C/T基因型频率并不符合.骨肉瘤患者-2578C/A的AA基因型(OR=1.90;95％可信区间=1.00-3.78)和CA+AA基因型(OR=1.53;95％可信区间=1.00-2.25)相对于CC基因型而言是显著增加的.结论:-2578C/A的AA基因型与CA+AA基因型有可能提高了骨肉瘤患病率.

Objective To investigate the changes and clinical significance of serum levels in patients between direct anterior approach (DAA) and posterolateral (PLA) in total tip arthroplasty(THA).Methods 60 cases of total hip arthroplasty were collected from October 2015 to March 2017 inWeifang medical university affiliated hospital,26 cases underwent THA throughdirect anteroposterior approach,34 cases underwentTHA through posterior lateral approach.All patients were primary unilateral total hip arthroplasty.The general clinical data and incision length,operation time and intraoperative blood loss were collected from the two groups and fasting venous blood was collected in the morning.The contents of CRP,IL-1,TNF-α,CK in blood serum were detected on the day before operation and 1,3,5 days on the first day and the first day after operation.Results The operative time,intraoperative blood loss,incision length,and acetabular prosthesis aberrations were significantly different between the DAA group and the PLA group (P＜0.05),the rest of the general data showed no significant difference (P＞0.05).The levels of CRP,IL-1 and TNF-α in the serum of the two groups were higher than those before the first day,and reached the peak at 3 days after operation.The difference was statistically significant (P＜0.05).The changes of serum levels of CPR,IL-1,TNF-α,CK in the group DAA and group PLA were similar over time,but the levels of IL-1,TNFα and CK in the DAA group were significantly lower than those in the group PLA.Conclusion The levels of CRP,IL-1,TNF-α and CK in the serum of patientsachieved the highest on the third day after operation,which suggests that 3daysafter operation is the critical period for anti-inflammatory treatment after total hip replacement.The levels of IL-1,TNF-and CK in DAA group were lower,suggesting that DAA has less soft tissue injury than PLA,and the rate of acute aseptic inflammation is lower.Moreover,DAA incision has shorter length,shorter operation time and less bleeding during operation.DAA treatment is superior to PLA.

目的:探索VEGF-2578C/A,936C/T和-460T/C基因多态性在骨肉瘤发展过程中的表达水平,从而研究二者可能存在的先关性.方法:将我院自2014年1月至2017年01月的90例骨肉瘤患者和90例健康对照组成员纳入本研究进行基因多态性的对比分析.结果:对照组的VEGF-2578C/A和-460T/C基因型频率符合哈迪-温伯格平衡参数,但936C/T基因型频率并不在此范围内.骨肉瘤患者-2578C/A的AA基因型(OR=1.90;95％ 可信区间=1.00-3.78)和CA+AA基因型(OR=1.53;95％ 可信区间=1.00-2.25)相对于CC基因型而言是显著增加的.结论:-2578C/A的AA基因型与CA+AA基因型提高了骨肉瘤的患病率.

DEAD-box家族蛋白是一类ATP酶（ATPase）活性依赖的RNA解旋酶,在进化上高度保守,广泛分布在真核生物体内。自20世纪80年代eIF4A（eukaryotic initiation factor 4A）被发现至今,不论是病毒的复制还是哺乳动物体内信号调控,DEADbox家族蛋白几乎涉及与RNA相关的一切生命活动 [1] 。DEAD-box蛋白家族成员除了作为ATPase活性依赖性的RNA解旋酶外,还可以作为共激活转录因子调控细胞生理活动,甚至

全髋关节置换术(total hip arthroplasty,THA)是治疗股骨头无菌性坏死的重要手术方式之一,具有解除髋关节疼痛,改善关节活动、保持双下肢外观的优点,是骨外科重大手术之一.氨甲环酸应用于THA及全膝关节置换术(total knnee arthroplasty,TKA)可减少失血量,目前在国内外已被研究证实并被广泛应用于临床,取得可喜效果.笔者拟通过对80例股骨头无菌性坏死患者行单侧全髋关节置换术术后失血量的研究,探讨关节应用氨甲环酸对减少术后失血量的影响.

Objective To compare the biomechanicals of different plate internal fixations in acetabular fracture.Methods Totally 60 adult fresh semi-pelvis specimens were divided into group A,B,C,D and E randomly.Group A was fixed by locking reconstruction plates,group B was fixed by locking reconstruction plates,group C was fixed by locking reconstruction plates and the posterior columns with lag screws,group D was fixed by lag screws and the posterior columns with locking reconstruction plates and group E was fixed by lag screws.600N,1200N and 1800N loads were imposed on specimens with biomechanical testing machine,and the horizontal displacement,vertical displacement and axial stiffness were observed in the 5 groups.Results The horizontal displacement and vertical displacement in group C,D and E were lower than those in group A and group B,and the differences had statistical significance(P<0.05).The axial stiffness in group C,D and E was significantly higher than that in group A and group B,and the differences had statistical significance(P<0.05).The horizontal displacement and vertical displacement in group A were significantly lower than those in group B,and the differences had statistical significance(P<0.05).The axial stiffness in group A was significantly higher than that in group B,and the difference had statistical significance(P<0.05).There was no significant difference in indexes among group C,D and E(P>0.05).Conclusion The stability of the acetabular transverse fracture is higher than that of the single column fixation method, and the stabilities among different double column fixation methods are close.

目的 探讨膝关节骨性关节炎(OA)模型大鼠骨关节炎进展的不同时期相关生物标志物的表达及意义.方法 将24只Wistar大鼠随机分为对照组(CG组)和3个实验组(TG1组、TG2组和TG3组),每组6只大鼠.实验各组行手术切除右膝内侧半月板及内侧副韧带,分别于术后2、4、6周切取标本进行组织学检查及蛋白聚糖、软骨寡聚基质蛋白(COMP)测定;CG组仅切开关节囊,于术后2周切取标本进行组织学检查及相关生物学标志物测定.结果 随着实验时间延长,各实验组大鼠骨性关节炎Chambers评分增加(F=160.558,q=7.219～29.564,P＜0.05),实验组各亚组蛋白聚糖含量逐渐降低(F=39.561,q=4.599～14,736,P＜0.05),而COMP含量逐渐增加(F=25.521,q=6.488～10.528,P＜0.05),各组之间差异有显著意义.结论 血清中COMP及蛋白聚糖浓度的测定有助于OA的早期诊断、疾病进展监测和预后判断.

The present study aimed to investigate the anti-inflammatory effects and the underlying molecular mechanism of farrerol on IL-1β-stimulated human osteoarthritis chondrocytes. Chondrocytes were pretreated with farrerol 1h before IL-1β stimulation. The effects of farrerol on NO and PGE2 production were tested by Griess reagent and ELISA. The effects of farrerol on COX-2, iNOS, Akt, phosphorylated Akt, and NF-κB activation were measured by western blot analysis. The results showed that farrerol remarkably inhibited IL-1β-induced NO and PGE2 production, as well as COX-2 and iNOS expression. Farrerol also inhibited IL-1β-induced NF-κB activation. Furthermore, farrerol significantly inhibited IL-1β-induced phosphorylation of PI3K and Akt. In conclusion, these results indicated that farrerol inhibited IL-1β-induced inflammatory responses in osteoarthritis chondrocytes by blocking PI3K/Akt/NF-κB signaling pathway.

Objective To investigate the effect of arthroscopic anterior cruciate ligament reconstruction with tibial remnants pres -ervation and tesion.Methods Thirty-six cases of acute arthroscopic anterior cruciate injury were treated with autologous semitendinosus ten -don and gracilis tendon single-boudle anterior cruciate ligament reconstruction under arthroscopy .Anterior cruciate ligament tibial-sided rem-nant were all reserved and pulled to get tensioned by sutures .The femoral-sided remnant was removed and performed intercondylar fossa ex-pansive arthroplasty to avoid the happening of femoral intercondylar notch impingement syndrome .The patients were followed up for more than one year and evaluated according to IKDC and Lysholm rating scale .Results All the patients were followed up for (12.1 ±1.2)months. Thirty-five patients had negative Lachman test ,one patient had one degree of positive .All patients showed negative pivot shift test .34 patients showed normal range of motion;one patient had 5°flexion deficit and one had 5°hyperextension loss.Lysholm score:Preoperative (53.01 ± 5.43)points,the end of second follow-up of (92.09 ±3.27)points,raising(39.08 ±2.16)points(P<0.05).The IKDC subjective score was 94.6 ±3.7.No case occurred cyclops or impingement .Conclusion Arthroscopic renconstruction of ACL with the remnant preserving tech-nique can faciliate revascularization and reinnervation of the reconstructed ligament and benefit to position the tendon graft .ACL stump can close the tunnel to avoid the synoval fluid of the tunnel and the tendon graft erosion potential lacuna and benefit to the tendon -bone healing.

目的 探讨并比较膝关节镜下自体半腱肌和股薄肌腱单束与双束重建PCL后本体感觉的早期恢复情况.方法 选取2008年9月～2010年5月潍坊医学院附属医院骨科PCL断裂后应用自体半腱肌和股薄肌腱单双束重建患膝共18例,其中单束重建组10例,双束组8例,正常膝关节对照组15例,单束重建组和双束重建组于术后6个月时和正常膝关节对照组同时完成膝关节被动位置重现偏差值检查和单足跳测试以评价膝关节本体感觉功能,同时对其Lysholm评分进行观察,将结果进行分析比较.结果 重建PCL两种术式之间患膝的被动位置重现偏差值、单足跳成绩及Lysholm评分,差异均无统计学意义(P>0.05);两种术式重建PCL患膝的被动位置重现偏差值、单足跳成绩及Lysholm评分结果分别与正常对照组比较,差异有统计学意义(P<0.05).结论 两种术式重建PCL后早期患膝的本体感觉恢复情况无差异,但并未恢复到正常水平.

目的 探讨关节镜下不同术式重建前交叉韧带(ACL)后膝关节运动功能恢复情况,为临床术式选择提供依据.方法 144例ACL损伤患者应用自体骨-1/3髌腱-骨(B-PT-B)、单隧道单束腘绳肌腱(ST/G)和单隧道双束腘绳肌腱(ST/G)3种术式关节镜下行ACL重建,定期随访,应用Lysholm评分和Tegner活动水平评分进行膝关节功能评估,比较3种术式临床疗效.结果 ①各组患者膝关节Lysholm评分和Tegner活动水平评分在术后均较术前改善(P＜0.05).②术后任何时间ST/G组Lysholm评分、Tegner评分高于B-PT-B组(P＜0.05),但单隧道单束组、单隧道双束组组间比较差异无显著性(P＞0.05).结论 ①3种术式均能明显改善膝关节运动功能,但在恢复膝关节稳定性及术后客观体征改善方面,近期ST/G组优于B-PT-B组.②单隧道单束和单隧道双束ST/G组术后恢复膝关节运动功能方面差异无显著性.③关节镜下自体ST/G单隧道单束重建ACL能够有效恢复膝关节前后向及旋转稳定性,缩短手术时间,减少创伤,节约成本,是一种相对安全有效的手术方法.

目的进一步提高后交叉韧带损伤的治疗效果。方法对26例后交叉韧带损伤患者行关节镜下半腱肌和股薄肌双束重建术,术后行康复训练。测定术前及术后9个月膝关节被动位置重现偏差值、单足跳距离及Ly-sholm评分。结果与术前相比,术后被动位置重现偏差值明显降低,单足跳距离及Lysholm评分明显升高,P均<0.05。结论关节镜下双束重建及术后康复训练对膝关节本体感觉功能恢复效果肯定。

[Objective]To investigate the effect of rabbit BMSCs with fibrin sealant on accelerating early tendon healing.[Methods]The BMSCs were isolated and amplified.The rabbits were divided into experimental(E) and control(C) groups.The injury model was a sharp complete transection through the midsubstance of the achilles tendon.The experimental group was implanted with composite of BMSCs and fibrin sealant,The control group was operated with only fibrin sealant.Specimens were harvested at 1,3,6,and 12 weeks for analysis,which included evaluation of gross morphology,cell tracing,histological assessment,immunohistochemistry studies,morphometric analysis,and mechanical testing.[Results]The gross morphology of the tendons showed the experimental group had lesser adhesion and better reactiveness than that in the control group.The fibrin had degraded at 3 weeks.Cell tracing showed that the labeled bone marrow derived mesenchymal stem cells remained viable and presented in the intratendinous region for at least 6 weeks,becoming more diffuse at later timepoints.At 3 weeks,collagen fibers appeared more organized and there were better morphometric nuclear parameters in the treatment group.At 6 and 12 weeks,there were no differences between the groups with regard to morphometric nuclear parameters.Biomechanical testing showed improved modulus in the treatment group as compared with the control group at 3 weeks,but not at subsequent timepoint.[Conclusion]Intratendinous cell therapy with bone marrow derived mesenchymal stem cells following primary tendon repair can improve histological and biomechanical parameters in the early stage of tendon-healing.