目的 评价肩关节镜下改良“Chinese-way技术”在较大-巨大肩袖撕裂修补术中的应用价值.方法 回顾性分析2017-06 ～ 2019-07行改良“Chinese-way技术”肩袖修补的19例较大-巨大肩袖撕裂患者的临床资料.术中对肩袖Footprint新鲜化并止点内移,将肱二头肌长头腱从结节间沟松解后,实施肱二头肌长头腱肌腱向后外不切断改良转位移植,然后对肩袖裂口行Suture-Bridge修补术.于术后6周及2、3、6、12、18、24个月随访记录患者疼痛视觉模拟量表(VAS)评分、加州大学洛杉矶分校(UCLA)评分、Constant-Murley评分及肩关节活动度以评估治疗效果.结果 所有患者获得随访,术前VAS评分为5[4,8]分,Constant-Murley评分为(42.65±6.61)分,UCLA评分为(11.21 ±3.10)分.术后VAS评分为1[[0,2]分,Constant-Murley评分为(78.15 ±7.25)分,UCLA评分为(31.52±3.64)分,术后与术前比较差异有统计学意义(P＜0.01).术前前屈上举平均为62.7.,体侧外旋平均为12.2.,内旋后伸基本达到L4水平,前屈抗阻肌力平均为健侧的11.4％;术后前屈上举平均为154.6.,体侧外旋平均为32.3.,内旋后伸基本达到T12水平,前屈抗阻肌力平均为健侧的64.0％.结论 利用肩关节镜下改良“Chinese-way技术”修补较大-巨大肩袖撕裂,在2年随访中可获得较为满意的临床治疗效果,且具有技术门槛低、简便易行的优点,但仍需要进一步进行前瞻性、大样本和多中心研究对该技术的长期疗效进行验证.

背景:前期临床研究中发现,人类白细胞抗原B27阳性与强直性脊柱炎早发髋关节强直具有强相关性.目的:分析强直性脊柱炎早发髋关节强直与人类白细胞抗原B27基因亚型的易感性,探讨人类白细胞抗原B27基因亚型在强直性脊柱炎早发髋关节强直发病中的作用.方法:收集具有完整病历资料的强直性脊柱炎早发髋关节强直患者300例,强直性脊柱炎非早发髋关节强直患者300例.研究经过广西壮族自治区人民医院伦理委员会审议通过,所有受试者及监护人均签署知情同意.采用病例-对照研究方案,其中强直性脊柱炎早发髋关节强直组,在其开始发病5年内,均有放射学检查(髋关节MRI、CT,骨盆X射线正侧位片)证实髋关节发生强直.收集2组患者一般情况和临床表现,采集患者2 mL静脉血,通过PCR-SSP高分辨技术进行29种人类白细胞抗原B27基因亚型检测,计算人类白细胞抗原B27各基因亚型的构成比,分析相对危险度.结果与结论:①2组患者人类白细胞抗原B27检测的总阳性率为93.67％(562例):强直性脊柱炎早发髋关节强直组99.33％,强直性脊柱炎非早发髋关节强直组88.59％;②共找到29种人类白细胞抗原B27亚型中的6种,分别是B*2702、B*2703、B*2704、B*2705、B*2706及B*2713;2组均以B*2704及B*2705亚型为主,组间比较,B*2704亚型在强直性脊柱炎非早发髋关节强直组所占比例最高(P<0.01),强直性脊柱炎早发髋关节强直组B*2705亚型所占比例最高(P<0.01);③B*2705亚型与强直性脊柱炎早发髋关节强直发病危险度相关(OR=1.896,95％可信区为1.221-3.218);④结果表明,强直性脊柱炎患者以B*2704和B*2705为主要亚型,其中B*2705亚型是导致强直性脊柱炎患者早发髋关节强直的易感基因.B*2705亚型可作为强直性脊柱炎早发髋关节强直早期诊断的重要参考指标.

OBJECTIVE: This study aimed to evaluate the biomechanical characteristics of the anterior upper thoracic plate fixation system (AUTP). METHODS: Twelve specimens were divided into 2 groups: the AUTP group and the anterior cervical locking plate (ACLP) group. Bone mineral density was assessed in all specimens. The specimens were loaded with pure bending moments of +/- 4 Nm to move toward extension/flexion, right/left lateral tilt, and right/left axial rotation. Each specimen was tested in 3 load cycles under 3 conditions (native, destabilized, and torsion). The tightening moments were assessed in every screw using a torsion meter. RESULTS: The tightening moment of the AUTP screws was more pronounced than the ACLP (P < 0.05). Significant decreases after stabilization with the AUTP compared with the native situation were observed in the AUTP group (P < 0.05). In terms of the direction of lateral tilt and torsion, the neutral zone increased significantly after stabilization with the AUTP compared with the native situation (P < 0.05). CONCLUSIONS: The AUTP was shown to provide more rigidity to the destabilized spine than the ACLP.

[目的]探讨强直性脊柱炎(AS)早发髋关节强直的相关因素,为选择恰当的治疗方案提供依据.[方法]搜集AS患者1000例,记录患者的一般情况,AS早发髋关节强直阳性家族史,临床表现,实验室检查数据,放射学检查结果.采用Logistic回归的方法筛选出AS早发髋关节强直的相关因素,建立Logistic回归模型,显示其相关的危险性.[结果]在AS患者中共有早发髋关节强直182例,占全部病例的18.20％,占髋关节疼痛者的55.49％.单因素分析结果显示,HLA-B27、血沉、病程、起病时骶髂关节炎、持续肌腱端炎、髋关节疼痛、阳性家族史与早发髋关节强直具有相关性.多因素分析显示与早发髋关节强直相关的临床因素包括,HLA-B27、阳性家族史、持续肌腱端炎、髋关节疼痛.[结论] AS早发髋关节强直的相关危险因素有:HLA-B27阳性、持续肌腱端炎、髋关节疼痛、家族史有早发髋关节强直.当出现以上危险因素,应早期积极进行针对性干预治疗,减轻或延缓髋关节强直的进展,避免髋关节残疾的发生.

Objective To compare the clinical outcomes of percutaneous fixation and closed reduction external fixation in the treatment of proximal humerus epiphyseal separation in children. Methods The clinical data of 48 children with fractures of proximal humerus epiphyseal separation were retrospectively analyzed,among whom group A was treated with percutaneous fixation(n = 24), and group B was treated with closed reduction and external fixation(n = 24). The clinical effects and complications were compared between the two groups. Results All the patients were followed up. According to the Flynn score evaluation,the Flynn scores of shoulder and elbow joint function in group A(85. 35 ± 11. 85) were significantly higher than those in group B(74. 16 ± 10. 12) (P < 0. 05). According to the preoperative and postoperative shoulder joint abduction angle evaluations,group A was (171. 4 ± 5. 4) degrees,and group B was (152. 8 ± 6. 1) degrees,with a significant difference in the excellent and good rate between the two groups(P < 0. 05). Conclusion The percutaneous fixation can improve the proximal humerus epiphyseal separation of the shoulder and elbow outreach angle better and has a better long-term prognosis and clinical application than the closed reduction external fixation.

Objective To investigate the effects of Rapamycin (RAPA) and Adriamycin (ADM) on proliferation of osteosarcoma MG-63 cells and their mechanisms.Methods Human osteosarcoma MG-63 cells in logarithmic growth phase was treated with ADM solution of different concentrations (0.125, 0.25, 0.5, 1.0, 2.0 mg/L) and RAPA solution of different concentrations (20, 50, 100 nmol/L) alone or in combination.Then the cell inhibition rate was determined by MTT after 48 hours, and Coefficient of drug interaction (CDI) was calculated to evaluate the nature of the interaction between the two drugs.The cell inhibition rate was the highest when MG-63 cells were treated with 100 nmol/L RAPA combined with 0.5 mg/L ADM.At this moment, CDI was less than 0.7 and the two drugs showed a significant synergistic effect.According to the optimal combination concentration, we randomly divided MG-63 cells in logarithmic growth phase into five groups: ADM group (treated with 0.5 mg/L ADM), RAPA group (treated with 100 nmol/L RAPA), the combination group (treated with 0.5 mg/L ADM and 100 nmol/L RAPA), DMSO solvent group (treated with the same concentration of DMSO) and the blank control group (without any treatment).The cell proliferation ability was detected by MTT for 5 days.The expression levels of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and matrix metalloproteinase 2 (MMP-2) mRNA were analyzed by real-time PCR at 48 h.Results There was no significant difference in cell proliferation ability among these groups on day 1 and 2 (all P>0.05).The cell proliferation ability of the combination group was lower than those of the blank control group, DMSO solvent group, ADM group and RAPA group on day 3-5 (all P<0.05).The relative expression of HIF-1α, VEGF and MMP-2 mRNA in the combination group was significantly lower than that in the blank control group, DMSO solvent group, ADM group and RAPA group (all P<0.05).Conclusion RAPA combined with ADM may synergistically inhibit the proliferation of human osteosarcoma MG-63 cells by decreasing the expression of HIF-1α, VEGF, MMP-2 mRNA.

目的 探讨前外侧小切口(OCM)治疗成人髋臼发育不良的临床效果.方法 回顾分析2009-06～ 2014-06在广西壮族自治区人民医院骨科采用前外侧小切口手术入路,进行了单侧全髋关节置换治疗的22例髋臼发育不良伴骨性关节炎成人患者的资料.对术口长度、术中出血量、手术时间、术后的引流量、手术前后血红蛋白值,以及术前、术后、术后6个月,末次髋关节Harris评分及术后X线片影像等进行统计分析及评估.结果 术口长度为(7.521.0)cm、术中出血量为(260±92.8)ml、手术时间为(70.5±15.6)min、术后的引流量为(195 ±45)ml、手术前血红蛋白量为(121±16.8)g/L、手术后血红蛋白量为(95±12.6)g/L,术后髋关节功能Harris评分为良好.结论 前外侧入路小切口人工全髋关节置换术治疗成人髋臼发育不良近期效果好,患者恢复快.

[目的]比较前外侧小切口(OCM)入路与前外侧入路人工全髋关节置换治疗成人髋臼发育不良的近中期临床疗效.[方法]回顾分析2001年6月～2011年6月在广西壮族自治区人民医院骨科进行单侧全髋关节置换的61例成人髋臼发育不良伴骨性关节炎患者的临床资料.手术采用OCM和前外侧两种入路.对两组术口长度、术中出血量、手术时间、术后引流量、手术前后血红蛋白值、术后起床时间、术后住院时间、以及术前、术后、术后12个月及末次随访髋关节Harris评分及术后X线片影像进行评估比较.[结果]术后伤口均一期愈合,随访4～14年,平均(5.8±2.5)年.两组术中出血量、手术时间、术后引流量、手术前后血红蛋白值差异均无统计学意义(P＞0.05);两组术口长度、术后起床时间、术后住院时间差异有统计学意义,OCM入路明显优于前外侧入路(P＜0.05);两组术前、术后3、12个月及末次随访髋关髋关节功能Harris评分比较差异无统计学意义(P＞0.05).[结论]两种入路人工全髋关节置换治疗成人髋臼发育不良中期疗效相当;OCM入路创伤小、患者术后恢复更快.

Total knee arthroplasty is one of the most common surgical procedures in the department of orthopedics. It is also the best way to treat end-stage disease of the knees and it corrects joint deformity and improves joint function. Periprosthetic joint infection (PJI) is one of the most devastating complications after total knee arthroplasty. It has also been the main cause for failure of total knee arthroplasty. PJI not only results in substantial patient morbidity, but also is a challenge to the orthopaedic community and it brings a great economic burden to the patients and the society. Prevention is the most important measure to reduce PJI. Malnutrition, diabetes, obesity, smoking, preoperative intra-articular knee injections and rheumatoid arthritis are some of the risk factors of PJI. There are a number of strategies for the prevention of infection during the perioperative period. Preoperative prevention measures include preoperative optimization of malnutrition, glycaemic control, smoking quit, discontinuation of the immunosuppressant, skin preparation, decolonization etc. Intraoperative prevention measures include particle-free operating environment, administration of prophylactic antibiotics and irrigation; postoperative prevention measures include blood management, wound dressing and wound drainage. Although there are many uncontrollable factors that could increase the risk of PJI, providing positive intervention for those controllable risk factors is significant in reducing PJI. We focus on consulting references at home and abroad about the prevention of knee prosthesis infection in the past three years and summarize the influence of various factors on PJI. The concept of prevention of PJI should run through the whole perioperative period. We believe that positive preventive measures must be able to reduce the rate of PJI to a minimum. Therefore, we review the prevention of PJI during the perioperative period aiming to explore how to reduce the risk of PJI and provide some references to related research and clinical treatment domestically and overseas.

OBJECTIVES:The purpose of the present study was to simultaneously examine the transcript levels of a large number of interleukins (ILs; IL-9, IL-10, IL-12, IL-13, IL-16, IL-17, IL-18, IL-26, and IL-27) and investigate their correlation with the clinicopathological profiles of patients with tuberculous intervertebral discs.METHODS:Clinical data were collected from 150 patients participating in the study from January 2013 to December 2013. mRNA expression levels in 70 tuberculous, 70 herniated, and 10 control intervertebral disc specimens were determined by real-time polymerase chain reaction.RESULTS:IL-10, IL-16, IL-17, IL-18, and IL-27 displayed stronger expression in tuberculous spinal disc tissue than in normal intervertebral disc tissue (P<0.05). Our results illustrated multiple correlations among IL-10, IL-16, IL-17, IL-18, and IL-27 mRNA expression in tuberculous samples. Smoking habits were found to have a positive correlation with IL-17 transcript levels and a negative correlation with IL-10 transcript levels (P<0.05). Pain intensity, symptom duration, C-reactive protein levels, and the erythrocyte sedimentation rate exhibited multiple correlations with the transcript levels of several ILs (P<0.05).CONCLUSIONS:The experimental data imply a double-sided effect on the activity of ILs in tuberculous spinal intervertebral discs, suggesting that they may be involved in intervertebral discs destruction. Our findings also suggest that smoking may affect the intervertebral discs destruction process of spinal tuberculosis. However, further studies are necessary to elucidate the exact role of ILs in the intervertebral discs destruction process of spinal tuberculosis.

目的:探讨脊柱结核椎间盘中白细胞介素17(IL-17)、白细胞介素17受体(IL-17R)的表达及与C反应蛋白(CRP)和血沉(ESR)的关系.方法:采用RT-PCR检测样本中的IL-17、IL-17R mRNA的表达,同时分析IL-17、IL-17R的表达及与CRP和ESR的关系.结果:结核组中IL-17、IL-17R的表达均高于对照组(P＜0.05);且两者呈正相关(r=0.478 2,P=0.009).IL-17、IL-17R的表达随着CRP和ESR的升高而增高(P＜0.05).结论:IL-17、IL-17R可能在脊柱结核椎间盘的破坏中起到作用,CRP和ESR可影响IL-17、IL-17R的表达水平.

Conservative therapy for intraspinal tumor is mentioned very often in the literature. However, there is no clear reference on surgical method choices for intraspinal tumors. Therefore, we conducted a systematic review to investigate the difference of preoperative and postoperative symptoms between the hemilaminectomy (HEM) and laminectomy (LAM) on intraspinal tumor. A computer based online search of the computerized data bases MEDLINE and PUBMED and EMBASE and ISI Web of Science for articles published from 1970 to January 2011 was performed. Studies that compared hemilaminectomy with laminectomy were included. Data were evaluated by RevMan 5.0 for the systematic review. Six eligible trials including 409 intraspinal cases were considered. The systematic review indicates that hemilaminectomy was more efficient in the improvement of early symptoms than laminectomy. The combined odds ratios (OR) were 2.82, with 95% confidence intervals (CIs) (1.75–4.54). The systematic review indicates that hemilaminectomy was more efficient than laminectomy in the improvement of advanced symptoms. The combined OR was 2.42, with 95% CI (1.56–3.74). In the case of appropriate surgical indications, the choice of hemilaminectomy was better for improving symptoms as cerebrospinal fluid leakage, infection, poor circulation and other possible complications for patients with intraspinal tumor.

Study Design A retrospective study of intradural extramedullary schwannoma. Objective The purpose of this study was to compare treatment results in the differential surgery of intradural extramedullary schwannoma. Background A reference guide to the surgical procedures available to treat intradural extramedullary schwannoma has not yet been established. Methods The study retrospectively reviewed 110 patients: Group A: laminectomy+microscopic excision; Group B: hemilaminectomy+microscopic excision; Group C: laminectomy+microscopic excision+pedicle screw fixation. Researchers selected patients for this retrospective review by applying the following criteria: 1) back pain spread out from the tumor level, sensory and motor loss; 2) treatment by surgery; 3) clinical diagnosis made by physical examination, magnetic resonance imaging (MRI), and pathology; 4) a minimum clinical and radiologic follow-up of 12 months. The clinical outcomes were assessed by comparing the Visual Analogue Pain Scores (VAS) and the Japanese Orthopedic Association Scores (JOA score). The study also performed a cost-effectiveness analysis. Results Cervical vertebrae: The estimated blood loss in Group B was significantly less than in Group C (P<0.05) (Table 1). Thoracic vertebrae: The duration of hospital stay and estimated blood loss in Group A was significantly less than in Group C (P<0.05) (Table 2, 3). Lumbar vertebrae: The resection rate in Group C was significantly higher than in Group A and Group B (P<0.05) (Table 4). Treatment in Group B was the least expensive, and therefore, the most cost-effective. Conclusion In the case of appropriate surgical indications, the study suggests that hemilaminectomy+microscopic excision is advantageous in the removal of cervical schwannoma, and that laminectomy+microscopic excision is advantageous in the removal of thoracic schwannoma; lumbar intradural extramedullary schwannoma can be managed by laminectomy+microscopic excision+pedicle screw fixation.

Objectives: The purpose of the present study was to simultaneously examine the transcript levels of a large number of MMPs (-3, -8, -9, -13 and -14) and ADAMTS-4 and to investigate their correlation with the clinicopathological profile of patients suffering from tuberculous intervertebral discs.Design and methods: Clinical data were collected from 130 patients participating in the study from March 2011 to April 2012. mRNA expression levels were determined by means of the real-time polymerase chain reaction in 60 tuberculous (TB), 60 herniated, and 10 control intervertebral disc (ID) specimens.Results: MMP-8, -9, -13, and -14 that showed a stronger expression in spinal TB disc tissue compared to normal ID tissue (P<0.05). Our results showed multiple positive correlations among MMP-8, -9, and -13 mRNA in TB samples. Smoking habits were found to significantly up-regulate the transcript levels of MMP-3 and -13 (P<0.05). Pain intensity, duration of symptoms, CRP, and ESR significantly affected the transcript levels of several MMPs (P<0.05).Conclusions: The MMPs may drive extracellular matrix destruction in spinal tuberculosis intervertebral discs. The experimental data imply a synergistic effect on the activity of these MMPs in spinal tuberculosis intervertebral discs. Furthermore, the experimental data suggest that smoking plays an unfavourable role in the prognosis of spinal tuberculosis intervertebral discs. Moreover, pain intensity, duration of symptoms, CRP, and ESR may affect the process of extracellular matrix destruction by increasing the expression of MMPs in spinal tuberculosis intervertebral disc samples. (C) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

BACKGROUND: Osteoporotic fracture is an osteoporotic complication caused by reduced estrogen and can be effectively corrected by estrogen supplementation. OBJECTIVE: To investigate the effects of polygonatum polysaccharide (PSP) on cytokines in osteoporotic fracture rats. METHODS: Sprague-Dawley rats, aged 6 weeks old, were established into osteoporosis models by ovariectomy. After 90 days, the tibia was cut off to create models of osteoporotic fracture. At 1 week after osteoporotic fracture, rats were intragastrically administered 400, 200, 100 mg/kg PSP and intramuscularly administered estradiol. RESULTS AND CONCLUSION: Compared with common fracture rats, serum level of interleukin 1, 6 was increased in osteoporotic fracture rats. After intervention with 400 mg/kg PSP or estradiol, serum level of interleukin 1, 6 in osteoporotic fracture rats was significantly decreased (P < 0.05), but 200 and 100 mg/kg PSP did not affect serum level of interleukin 1, 6 (P > 0.05). Results showed that only high concentration of PSP can treat osteoporotic fracture.

We assessed the effect of treatment with the interleukin-1 receptor antagonist protein (IRAP) on morphological and functional recovery in a rat model of SCI. All sections were processed for immunohistochemistry, hematoxylin–eosin, and Nissl staining. Rats were assessed for hind limb motor function using the Basso, Beattie, and Bresnahan (BBB) hind limb locomotor rating scale and the inclined plane test. At 1, 48, and 72 h after operation, there was a significant increase in neurofilament proteins and brain-derived neurotrophic factor expression in the IRAP group I when compared with the saline group I and the sham-operated group I (P < 0.05). The mean inclined plane scores and BBB scores for the IRAP group II were higher than the saline group II at 1, 2, 3, and 4 weeks post-injury (P < 0.05). In conclusion, treatment with IRAP enhanced neuronal survival after SCI.

目的:观察中药膳食对肥胖型大鼠模型脂质代谢的影响。方法:60只SD大鼠纳入实验,随机分为正常对照组,低剂量中药膳食组,中剂量中药膳食组,高剂量中药膳食组,肥胖模型对照组。予各组行相应的灌胃给药治疗,实验3个月后,测量Lee’s指数、脂肪总重量、血清三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、肿瘤坏死因子-α(TNF-α)。结果:高剂量和中剂量中药膳食组的Lee’s指数、脂肪总重量、TG、TC、LDL、TNF-α比肥胖模型对照组低(P<0.05),HDL值增大(P<0.05)。但低剂量中药膳食组与肥胖模型对照组相比较,差异无统计学意义(P>0.05)。结论:中药膳食可以影响肥胖型大鼠脂质代谢,对肥胖症可能起到有效的治疗作用。