[目的]基于高通量测序技术,探究绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)肾阴虚证的潜在机制.[方法]分离培养PMOP肾阴虚证和骨量正常对照组骨髓间充质干细胞(bone mesenchymal stem cells,BMSCs),从BMSCs外泌体中提取RNA,利用芯片测序技术和生物信息学分析mRNA的表达谱和功能.使用定量逆转录聚合酶链式反应(quantitative reverse transcription polymerase chain reaction,RT-qPCR)分析20例PMOP肾阴虚证患者和20例骨量正常对照组受试者差异表达的mRNA.[结果]与骨量正常对照组比较,PMOP肾阴虚证BMSCs外泌体检测出174个差异表达的mRNA,其中92个上调,82个下调;RT-qPCR鉴定出9个关键mRNA(ATM、COL8A1、GABARAPL1、HLA-DQA1、HSPA1L、MAX、PPP2R2D、PTHLH和WWTR1),与基因芯片数据相一致,两组之间差异有统计学意义(P<0.001).功能分析表明,PMOP肾阴虚证患者差异表达的mRNA可能靶向参与丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)、自噬调节、磷脂酰肌醇3激酶-蛋白激酶B(phosphatidylinositol 3 kinase-protein kinase B,PI3K-AKT)和叉头框转录因子O(forkhead box transcription factor O,FoxO)亚族等信号通路.[结论]PMOP肾阴虚证患者BMSCs外泌体中差异表达的基因可能作为新型的生物标志物,为PMOP肾阴虚证的靶向治疗提供有价值的信息.

目的:探讨肩关节镜下双滑轮双排缝合技术治疗骨性Bankart损伤的临床疗效和安全性.方法:2015年6月至2019年6月,采用肩关节镜下双滑轮双排缝合技术治疗骨性Bankart损伤患者16例.男9例,女7例;年龄21～58岁,中位数42岁;优势肩10例,非优势肩6例;中度损伤9例,重度损伤7例.合并肩胛部上盂唇前后位损伤3例、Hill-Sachs损伤4例、肱骨大结节骨折2例、肩袖损伤3例、桡骨远端骨折1例、胫腓骨骨折1例.均无肩关节脱位病史.受伤至手术时间7～43 d,中位数18 d.术中在肩胛骨关节盂骨折面打入双排锚钉,并用锚钉缝线交叉固定骨折块.术后观察骨折复位情况,记录骨折愈合时间及并发症发生情况.采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价肩关节疼痛情况,采用肩关节Rowe评分、美国肩肘外科协会(American shoulder and elbow surgeons,ASES)评分、美国加州大学(the University of California at Los Angeles,UCLA)肩关节评分及Constant-Murely评分评价肩关节功能,并对术前和末次随访时的评分进行比较.结果:本组16例患者均获随访,随访时间12～36个月,中位数23个月;术后1 d的CT检查结果示关节面台阶<2 mm 11例、2～4 mm 4例、>4 mm 1例;骨折均愈合,愈合时间6～16周,中位数10周.末次随访时,恐惧试验均为阴性,肩关节疼痛VAS评分较术前降低[(6.88±1.59)分,(1.94±1.23)分,t=14.738,P=0.000],肩关节功能Rowe评分、ASES评分、UCLA评分、Constant-Murely评分均较术前提高[(57.68±12.61)分,(89.13±5.15)分,t=11.489,P=0.001;(20.50±5.72)分,(32.94±4.70)分,t=6.254,P=0.002;(40.38±9.58)分,(89.44±5.59)分,t=23.182,P=0.000;(67.56±7.90)分,(91.69±3.20)分,t=12.601,P=0.001].术后均无肩关节再脱位、骨块吸收等并发症发生.结论:肩关节镜下双滑轮双排缝合技术治疗骨性Bankart损伤,骨折复位、愈合好,可缓解疼痛,有利于肩关节功能恢复,并发症少.

2012 年1 月 ～2017 年12 月,我科采用异型锁定钢板结合空心加压螺钉治疗12例粉碎性Hoffa骨折患者,疗效满意,报道如下. 1 材料与方法 1.1 病例资料 本组12 例,男9 例,女3例,年龄19～71岁.左侧4例,右侧8例.外侧髁骨折 10 例,内侧髁骨折 2例.伤后至手术时间7～18 d.

目的 探讨白细胞酯酶(1 eukocyte estemse,LE)试纸在成年急性化脓性关节炎(acute septic arthritis)诊断中的应用价值.方法 选择43例急性单关节炎患者,根据细菌学培养结果,分为培养阳性组和培养阴性组,所有患者抽取关节液用试纸条对关节滑液中的白细胞酯酶进行检测,并比较2组间白细胞计数(white blood cell count,WBC)、C-反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、血清降钙素原(procalcitonin,PCT)、关节液白细胞计数(synovial fluid leukocyte count,SF-WBC)、多形核中性粒细胞百分比水平以及不同诊断指标的灵敏度及特异性.结果 43例患者,培养阳性18例,阴性25例.培养阳性组CRP、ESR、PCT、多形核中性粒细胞百分比水平明显高于培养阴性组,差异有统计学意义(P＜0.05),2组间WBC、SF-WBC比较差异无统计学意义(P＞0.05).LE试纸检测的灵敏度和特异度分别为94.4％和84.0％,Youden指数高于其他检测指标.结论 LE试纸应用于成年急性化脓性关节炎的诊断具有较高的灵敏度和特异性,是一种相对准确且经济、简便、快捷的检测方法.

目的 对比分析锁骨钩钢板内固定术与带袢钢板内固定术治疗肩锁关节脱位的临床效果.方法 选取2015年7月-2017年2月金华市中心医院收治的肩锁关节脱位患者84例为研究对象,以随机数字表法分为A组42例,B组42例.A组行带袢钢板内固定术治疗,B组行锁骨钩钢板内固定术治疗.观察2组患者术中出血量、手术时间、术后住院时间、肩关节功能及疼痛程度变化、术前、术后3个月、6个月Constant-Murley评分以及术后并发症发生情况.结果 2组术中出血量、手术时间及术后住院时间比较,差异无统计学意义(均P ＞0.05);肩关节功能及疼痛程度测定显示,术前2组差异无统计学意义(P＞0.05);术后3个月、6个月,A组Constant-Murley评分同B组比较,显著较高,VAS评分同B组比较,明显较低,差异有统计学意义(均P＜0.05);A组术后并发症发生率为7.14％,同B组(23.81％)比较,明显较低,差异有统计学意义(P＜0.05).结论 在肩锁关节脱位治疗中,应用带袢钢板内固定术治疗,患者肩关节功能恢复情况及疼痛改善情况均优于锁骨钩钢板内固定术,且带袢钢板内固定术安全性更高,更值得推广.

Objective To investigate short-term efficacy of acetabular reconstruction with autogenous bone dust graft on the original acetabulum in total hip arthroplasty (THA) for developmental hip dysplasia (DDH) in adult patients.Methods Twenty two patients (24 hips) with osteoarthritis secondary to DDH underwent THA with acetabular reconstruction and autogenous bone dust graft at the true acetabulum from January 2010 to December 2014.There were 7 male (8 hips) and 15 female (16 hips) patients,the Harris scores were (48.3 ± 14.3) points preoperatively,and the mean length difference was (2.9 ± 0.6) cm between two lower limbs of the unilateral DDH patients.The radiological examinations of acetabular prosthesis and bone grafts were performed preoperatively and during the follow-up,while the clinical efficacy was assessed using Harris hip score.Results The mean graft coverage was (23.2 ± 4.6)％,the anteroposterior diameter and width of the socket uncovered during operative evaluation were (14.0 ± 1.7) and(22.1 ± 3.2)mm,respectively.All of the hip rotation center were reconstructed inside the Ranawat triangle,and the mean vertical and horizontal distance between rotation center and inter-teardrop line was (28.1 ± 3.2) and (21.8 ± 1.9)mm,respectively.After operation,20 patients(22 hips) were followed up for 1.5-4 years,averagely(2.4 ± 0.8)years.No nerve damage,loosening or revision of acetabular component was seen in those patients.At last follow-up,the Harris score was (87.3 ± 7.4) points,and the length difference was (0.6 ± 0.3) cm between two lower limbs,showing statistically differences (both P＜ 0.05) when compared with those preoperatively.Radiographs showed that all bone graft was fused to host bone.Within the first year after replacement,the bone graft was partially absorbed in 3 patients,but 2 cases began to grow later.And 2 hips developed grade 1 Brooker heterotopic ossification,none of these has further development.Conclusion For DDH,acetabular reconstruction using autogenous bone dust graft on the original acetabulum in THA is a liable method.The satisfying short-term clinical and radiographic results can be achieved by this method,and its optimal operative indication and long-term efficacy remains to be studied.

Objective To investigate the efficacy of different doses of tranexamic acid ( TA ) use for perioperative blood loss control primary unilateral total hip arthroplasty(THA). Methods 160 patients underwent primary THA due to femoral neck fracture were randomly divided into TA 10 mg/kg group, TA 15 mg/kg group, TA 20 mg/kg group and the control group with 40 cases in each group. In the TA group, 10 mg/kg,15 mg/kg or 20 mg/kg TA with 250ml normal saline was infused intravenously within 15 minutes before skin incision, while an equal volume of nor-mal saline was given instead in the control group. Total blood loss, visible blood loss, hidden blood loss, blood trans-fusion volume, blood transfusion rate, and the rate of deep vein thrombosis of different groups were compared. Re-sults In TA 10 mg/kg group, TA 15 mg/kg group or TA 20 mg/kg group, the total blood loss, visible blood loss, hidden blood loss and blood transfusion volume were all less than those in the control group. The difference had statis-tical significance(P<0. 05). Compared with TA 10 mg/kg group, the total blood loss, hidden blood loss and blood transfusion volume were significantly reduced in TA 15 mg/kg group or TA 20 mg/kg group(P<0. 05). While the incidence of deep venous thrombosis had no statistically significant differences among each group(P>0. 05). Con-clusions Intravenous infusion of TA within 15 minutes before skin incision reduces the perioperative blood loss and blood transfusion volume in primary unilateral THA significantly. Compared with 10 mg/kg, 15 mg/kg or 20 mg/kg TA gains more advantage of less perioperative blood loss.

目的 观察关节镜下清理加术后持续灌洗治疗化脓性膝关节炎的效果,为临床治疗化脓性膝关节炎提供依据.方法 对2010年1月-2012年12月医院18例化脓性膝关节炎患者行关节镜下清理术,术后用生理盐水及庆大霉素灌洗引流1～2周;观察患者治疗期间恢复情况,并进行疗效评定,使用SPSS 19.0软件进行统计分析;膝关节活动度、Neer评分采用t检验;P＜0.05为差异有统计学意义.结果 所有患者术后2～5 d体温恢复正常,4～7d白细胞计数恢复正常,13～19 d血沉和C反应蛋白恢复正常;所有患者切口Ⅰ期愈合,无窦道形成;平均治疗时间为14.9d;随访12个月,未出现复发病例;患者术后8周屈膝达(109.8±15.8)°,高于治疗前的(45.1±10.2)°,差异有统计学意义(P＜0.05);患者治疗后Neer膝关节功能评分为(94.01±4.73)分,高于治疗前的(54.47±3.34)分,差异有统计学意义(P＜0.05);Neer评分优8例、良9例、差1例,优良率为94.44％.结论 关节镜下清理及术后持续灌洗治疗化脓性膝关节炎恢复快、优良率高,是较理想的治疗方法.

Objective To evaluate the therapeutic effect of modified dual plating and less invasive stabilization system(LISS) in the complex fractures of tibial plateau.Methods One hundred and sixty-eight patients with complex fractures of tibial plateau were divided into two groups by the therapeutic methods,89 patients were in modified dual plating group while 79 patients were in LISS group.The advantages and curative effect of two groups were retrospectively analyzed.Results The excellent and good rate in modified dual plating group was slightly higher than that in LISS group [89.9％ (80/89) vs.86.1％ (68/79)],and there was no significant difference (P ＞ 0.05).No patient occurred deep site infection,severe nerve damage,phlebothrombosis in two groups.In modified dual plating group,the operation time and bleeding volume was (89.2 ± 13.6) min and (188.4 ± 45.6) ml,the hospital stay and healing time was (16.5 ± 1.8) d and (13.3 ±2.1) months.In LISS group,the operation time and bleeding volume was (74.3 ± 12.5) min and (236.5 ±65.5) ml,the hospital stay and healing time was (16.7 ± 2.1) d and (11.4 ± 1.5) months.There was no significant difference (P ＞ 0.05).Conclusion The therapeutic effect of modified dual plating and LISS have no significant difference for complex tibial plateau fractures.

目的：研究关节镜下膝关节创伤性多发韧带损伤重建的临床疗效。方法将94例膝关节韧带损伤患者作为观察对象随机分入观察组和对照组，给予关节镜下膝关节创伤性多发韧带损伤重建术治疗，观察期结束后治疗前后患者韧带恢复情况。结果患者韧带损伤腿治疗前KT2000稳定性测量值20磅为（1.37±1.25），30磅为（1.88±0.29），最大提拉力为（2.38±0.81），治疗后20磅为（6.02±1.20），30磅为（6.73±0.30），最大提拉力为（7.42±0.90）。韧带损伤腿治疗前Lysholm评分为（36.61±11.25），Tehner评分为（1.88±0.57），治疗后Lysholm评分为（86.02±21.20），Tehner评分为（4.93±0.30）。治疗前后统计结果具有统计学差异，P<0.05。结论关节镜下实施膝关节创伤性多发韧带损伤重建术对损伤韧带具有良好的治疗效果，值得推广应用。

目的：介绍小切口双纽扣钛板系统治疗肩锁关节脱位的手术方法及中期疗效。方法在2009年8月至2010年11月，对19例RockwoodⅢ-Ⅴ型急性脱位患者施行小切口双纽扣钛板系统重建喙锁韧带手术治疗。结果随访26～40月（平均35.3月），根据 Karlsson评价标准，评估肩部活动度、疼痛程度、肌力及肩锁关节复位X线表现情况进行疗效评定。优16例，良3例，差0例，中期随访优良率为100％。无并发症发生。结论该技术操作简单，切口小，软组织损伤少，关节内干扰少，术后早期功能锻炼，康复时间短，恢复快，中期随访疗效满意。

踝关节骨折是一种常见的损伤.根据Lauge-Haasen分型,旋后外旋型损伤最为常见,约占手术患者的60%以上,其中以Ⅳ度损伤最为严重,属关节内骨折.精确的复位、有效的固定及术后功能锻炼是治疗踝关节骨折的关键[1].我们于2003年4月至2010年4月共手术治疗旋后外旋型Ⅳ度踝关节骨折35例,疗效满意,报道如下.

Objective To evaluate the efficacy of glucosamine hydrochloride,hyaluronic acid and combined use of the two drugs in the treatment of patients with knee osteoarthritis.Methods Totally 162 patients suffering from knee osteoarthritis were random divided into 3 groups,and were treated with glucosamine hydrochloride,hyaluronic acid and combined of above two therapies.Patients reveived medicine 3 times daily with total 480mg/d for glucosamine hydrochloride group,intra-articular injection of hyaluronic acid one time a week with 2ml per time and two treatments combined for combined group.Lequesne index and VAS score were recorded at 1,2,3,4,5 weeks during therapy and 1,2 weeks after therapy.Results Lequesne index were obviously decreased at 5 weeks for 3 groups.It was 3.3±1.6、3.1±1.3、2.8±1.3,respectively.VAS scores were 1.77±0.91、1.66±1.21、1.53±1.13 at 5 weeks for 3 groups.Conclusion Glucosamine hydrochloride、hyaluronic acid were effective in the treatment of knee osteoarthritis.Combined these two therapies was more effective than such treament.

股骨转子间骨折是老年人常见的骨折之一,手术治疗已成为治疗的首选.随着治疗理念的更新及内固定材料的完善,股骨近端骨折的固定方式也逐步从髓外固定改为髓内固定.自AO推出髓内固定物股骨近端髓内钉(PFNA)后,因其内固定切口小,力臂短,抗剪切力强,抗弯,固定效果好逐渐成为股骨转子间骨折特别是不稳定型骨折的主要治疗手段.我们采用PFNA治疗股骨转子间骨折患者各30例并获随访,现将两者的疗效比较报告如下.

Objective To investigate the indication and clinical curative effect of vacuum sealing drainage(VSD) for the complex wound repair of orthopedics.Methods 52 patients with soft tissue defects were treated with VSD.Vacuum aspiration was continued to the granulation,and then the wounds were repaired with suture,skin graft or flap coverage.Results The wound healed well in all the cases.The complication included blocking of drainage in 6 cases,and effusion under-film in 4 cases.Conclusions VSD can be considered one of the effective methods for the treatment of complex soft tissue defect,and can be used as an assist and beneficial supplement to microsurgical flap technology.

目的 检测类风湿性关节炎(RA)患者髋或膝部滑膜组织中血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和色素上皮衍生因子(PEDF)的表达,以研究VEGF、bFGF、PEDF在RA发展中的作用.方法 采用免疫组织化学法对20例RA患者滑膜组织中PEDF、VEGF及bFGF的表达水平进行了检测,并与10例骨关节炎和6例正常滑膜组织进行对照研究.结果 VEGF和bFGF在RA患者的滑膜组织中呈高表达,而在正常人滑膜组织中表达水平则较弱;PEDF在正常人和RA患者的滑膜组织中表达水平均较弱或不表达.结论 RA患者滑膜组织VEGF、bFGF呈过度表达,而PEDF则呈弱表达或不表达.

目的 研究类风湿关节炎(RA)患者滑膜组织中血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)的表达水平,探讨其在RA致病中的作用.方法 应用免疫组织化学法分别测定RA患者滑膜组织VEGF、bFGF蛋白表达水平.以骨关节炎(OA)患者及因外伤、截肢的关节滑膜组织作对照.结果 RA滑膜组织中4/18例VEGF和6/18例bFGF表达明显阳性,14/18例VEGF 和12/18例bFGF 表达强阳性;1/4例OA滑膜组织VEGF表达明显阳性,3/4例表达VEGF阳性,4例bFGF表达为阳性;4例正常滑膜组织VEGF、bFGF均表达为阳性,RA患者滑膜组织VEGF、bFGF表达水平均明显高于对照组(P<0.05).结论 RA患者滑膜组织VEGF、bFGF的过度表达,引起血管增生,是引起RA发病的重要因素.

Objective To evaluate the miniature tissue flap grafting in restoration of minitype wound of the hand. Methods The wounds of 117 fingers from 98 patients, were restored by various skin flaps, among which 23 cases with defects of skin, or bone and tendon in hand restored with miniature tissue flap grafting. Results All the tissue flap survived. On 6～12 month follow-up .the appearance and elasticity of the flap was satisfactory, the function of extend or flex of the finger was good. Conclusion The minitype wound of hand with defects of skin, or bone and tendon can be restored with miniature tissue flap grafting in a single operation.

Objective To set up an animal model of mini tissue flaps and explore the mechanism of retrograde vein drainage.Methods A mini tissue flap based on the saphenous artery(flap size:1.0 cm×1. 0 cm)was created on both hind limbs of 30 Sprague Dawley rats.The left and right hind limbs of each rat were randomly assigned into group 1 and 2.In group 1,the flaps were elevated and the saphenous artery and its accompanying veins were kept in situ.In group 2,the flaps were elevated and only the saphenons artery were kept in situ,while its accompanying veins and other superficial veins were ligated.Survival of the flaps,their appearance and consistency were observed.Reconfiguration of venous drainage of the flaps was evaluated by angiography.Results Flaps of group 1 had normal skin color at postoperative day 1.Only 3 flaps in this group showed mild swelling which subsided at pestoperative day 2.All flaps had normal consistency.All the flaps of group 2 showed mild cyanosis and obvious swelling at postoperative day 1.There was tension of the flaps. Swelling of the flaps decreased and color of the flaps turned normal at postoperative day 2.Tension of the flaps also reduced.For swelling of the flaps,the difference between the two groups were statistically significant in the first and second days postoperatively(P0.01),but insignificant in the 3,7,9 and the 14 days postoperatively. For flap survival,in group 1 all flaps survived with normal skin color,good appearance and elasticity except one flap presented about 0.1 cm marginal skin necrosis.In group 2,there were 2 flaps with about 0.1 em marginal skin necrosis and 3 flaps with complete necrosis.The survived flaps had normal skin color and no swelling,but their appearance and elasticity were slightly worse than that of the flaps in group 1.Conclusion The survival mechanism of mini tissue flaps is different from that of conventional flaps.Restoration of venous drainage relies on collateral anastomosis between the flap and its tissue bed and surrounding margins in the first 3 postoperative days.When arterial flow is patent,mini tissue flaps still have a high survival rate even if the venous flow is obstructed due to a failed vein anastomosis.However a good venous anastomosis is required to ensure good flap appearance and consistency.

目的:探讨采用人工股骨头置换治疗老年股骨粗隆间不稳定性骨折的适应症、方法和疗效。方法:采用人工股骨头置换治疗老年股骨粗隆间不稳定性骨折27例。骨折按Evans分型,ⅢA型11例、ⅢB型10例,Ⅳ型6例。结果:本组27例,随访26例。随访时间17个月至3年零3个月,平均23个月。优13例,良9例,可4例。优良率达84·6%。结论:采用人工股骨头置换术治疗老年严重骨质疏松不稳定骨折和内固定失败者,手术操作简单,降低并发症的发生,提高未来的生活质量,是一种可供选择的有效方法。