目的 分析血清Flt3配体(Flt3L)和生长停滞特异性蛋白6(Gas6)对骨折患者感染的诊断效果.方法 以2019年1月-2021年6月河南省驻马店市中心医院收治的进行骨折内固定手术治疗的188例患者为研究对象,依据患者是否发生术后感染分为感染组45例和非感染组143例,分析感染患者感染病原菌分布,单因素及多因素Logistic回归分析骨折患者术后感染影响因素,受试者工作特征(ROC)曲线分析Flt3L和Gas6对骨折患者术后感染的诊断效果.结果 45例术后感染患者共检出69株病原菌,其中革兰阳性菌23株(33.33％),主要为金黄色葡萄球菌,革兰阴性菌43株(62.32％),主要为铜绿假单胞菌,真菌3株(4.35％).多因素Logistic分析结果显示,创口遗留死腔、合并糖尿病、手术时间≥3h是骨折患者术后感染的影响因素.ROC曲线分析结果显示,血清Flt3L、Gas6表达水平对骨折患者术后感染均有较佳的诊断效果,两者联合应用,特异度为0.902,敏感度为0.800.结论 创口遗留死腔、合并糖尿病、手术时间≥3h为骨折患者术后感染的影响因素,Flt3L、Gas6表达水平对骨折患者术后感染有较佳的诊断价值.

目的 观察原发性骨肉瘤组织中circ-PRMT5和miR-138-5p表达变化,探讨其与骨肉瘤临床病理特征的关系.方法 行根治性切除术治疗的原发性骨肉瘤患者60例,取手术切除肿瘤组织为肿瘤组,癌旁正常组织为对照组.采用实时荧光定量PCR法检测2组circ-PRMT5和miR-138-5p表达.以骨肉瘤组织circ-PRMT5、miR-138-5p相对表达量中位数6.745、0.665为临界值,将60例患者分为circ-PRMT5高表达组30例(circ-PRMT5相对表达量＞6.745)和低表达组30例(circ-PRMT5相对表达量≤6.745),miR-138-5p高表达组30例(miR-138-5p相对表达量＞0.665)和低表达组30例(miR-138-5p相对表达量≤0.665),比较circ-PRMT5和miR-138-5p高、低表达组不同年龄、性别、肿瘤位置、TNM分期、肿瘤直径及肿瘤转移比率.Pearson相关法分析骨肉瘤组织中circ-PRMT5与miR-138-5p表达的关系.结果 肿瘤组circ-PRMT5相对表达量(6.77±0.17)高于对照组(1.04±0.06)(P＜0.05),miR-138-5p相对表达量(0.72±0.05)低于对照组(5.75±0.24)(P＜0.05).circ-PRMT5高表达组TNM分期Ⅲ～Ⅳ期及肿瘤转移比率(73.33％、90.00％)高于低表达组(43.33％、40.00％)(P＜0.05),TNM分期Ⅰ～Ⅱ期及无肿瘤转移比率(26.67％、10.00％)低于低表达组(56.67％、60.00％) (P＜0.05);miR-138-5p高表达组TNM分期Ⅲ～Ⅳ期及肿瘤转移比率(36.67％、50.00％)低于低表达组(80.00％、80.00％)(P＜0.05),TNM分期Ⅰ～Ⅱ期及无肿瘤转移比率(63.33％、50.00％)高于低表达组(20.00％、20.00％) (P＜0.05);circ-PRMT5、miR-138-5p高表达组与低表达组年龄、性别、肿瘤位置、肿瘤直径比较差异均无统计学意义(P＞0.05).骨肉瘤组织中circ-PRMT5与miR-138-5p表达呈负相关(r=-0.777,P＜0.001).结论 骨肉瘤组织中circ-PRMT5呈高表达,miR-138-5p呈低表达,提示TNM分期晚,肿瘤转移发生率高.

Objective:To investigate the effects of posterior internal fixation combined with transpedicular bone grafting in elderly patients with osteoporotic thoracolumbar fractures.Methods:Clinical data of 92 elderly patients with osteoporotic thoracolumbar fractures were retrospectively analyzed.According to the operation method, patients were divided into the control group(n=38)and the observation group(n=54). The control group received the conventional posterior approach and short-segment transpedicular fixation, and the observation group underwent transpedicular fusion in addition to the treatment the control group received.Surgery quality metrics, clinical effects and postoperative recovery were compared between the two groups.Results:The operation time and bleeding volume were higher in the observation group than in the control group( P<0.05). The bone fusion rate was higher and the failure rate of internal fixation was lower in the observation group than in the control group(96.3% vs.78.9%, 3.7% vs.15.8%, χ2=6.929 and 4.103, all P<0.05). The Japanese Orthopaedic Association score(JOA score)increased in both groups after operation( Ftime=47.628, P<0.05). The increase of the JOA score( Finteraction=4.477, P<0.05)and the overall JOA score( Fgroup=5.638, P<0.05)were greater in the observation group than in the control group.The Oswestry Disability Index(ODI)index in both groups decreased with time( Ftime=72.581, P<0.05). The decrease of the ODI index( Finteraction=7.421, P<0.05)and the overall ODI( Fgroup=9.276, P<0.05)were higher in the observation group than in the control group.The visual analogue scale(VAS)score in both groups decreased with time( Ftime=93.157, P<0.05). The decreases of the VAS score( Finteraction=9.473, P<0.05)and the overall VAS( Fgroup=13.272, P<0.05)score were greater in the observation group than in the control group.The Frankel nerve function grade was better in the observation group than in the control group 12 months after operation( z=2.123, P<0.05). Conclusions:Posterior internal fixation combined with transpedicular bone grafting can help improve nerve function, reduce postoperative pain, and has a high bone fusion rate and a low failure rate of internal fixation.

Objective To investigate the expression of apolipoprotein A5 (APOA5) protein in cholangiocarcinoma and its effect on the biological characteristics of cholangiocarcinoma cells.Methods Cholangiocarcinoma tissues and adjacent tissues were collected and the expression level of APOA5 protein was analyzed by immunohistochemistry.The control cell line and APOA5 knockdown stable cell line were established in cholangiocarcinoma cell line QBC939 by lentiviral.The proliferation of the cells was measured by cell counting kit-8 (CCK-8).The migration ability of the bile duct cancer cells was analyzed by Transwell technique.The tumor formation of the two groups in the body was analyzed by Xenograft experiment in nude mice.Results Compared with the expression level of APOA5 protein (129.43 ± 20.43) in the paracancerous tissue,the expression of APOA5 protein (494.28 ± 31.87) in the bile duct carcinoma significantly increased (t =4.912,P =0.000).Compared with the control group,the proliferation of APOA5 short hairpin RNA (shRNA) cells decreased significantly (F =3.901,P =0.000).Compared with the control group [(421.25 ±31.44)],the cell migration ability of APOA5 shRNA group (138.33 ± 23.76) significantly decreased (t =5.109,P =0.000).Compared with the control group,the growth rate of tumor in APOA5 shRNA group slowed down significantly,the difference was statistically significant (F =2.918,P =0.014).Conclusion The expression level of APOA5 protein in cholangiocarcinoma is significantly increased and is closely related to the proliferation,migration and tumor formation of cholangiocarcinoma cells.

目的 探讨T淋巴瘤侵袭转移诱导因子1(Tiam1)和Ras相关的C3肉毒素底物1(Rac1)蛋白在骨肉瘤和良性骨肿瘤组织中的表达.方法 采用免疫组化SP法检测53 例骨肉瘤和20 例良性骨肿瘤Tiam1和Rac1蛋白表达.结果 53 例骨肉瘤Tiam1和Rac1蛋白阳性表达率分别为60.7%和52.8%;20 例良性骨肿瘤中Tiam1和Rac1蛋白阳性表达率分别为10.0%和15.0%,骨肉瘤组织和良性骨肿瘤组织Tiam1和Rac1蛋白表达比较差异有统计学意义(χ2=15.203及8.505,P均＜0.05),二者在骨肉瘤组织中的蛋白表达呈正相关(γp=0.476,P＜0 05).结论 在骨肉瘤中Tiam1和Rac1蛋白的过表达可能共同参与骨肉瘤的发生.

<正>腰椎滑脱由退行性变、峡部裂、创伤、发育不良及病理等原因造成,是引起下腰痛及腰腿痛的主要原因之一,严重影响人们的日常生活和工作。脊柱滑脱症的治疗原则是确保融合,尽可能恢复解剖序列,解除产生疼痛症状的原因。自上世纪

目的:探讨巨噬细胞抑制细胞因子-1(macrophage inhibitory cytokine-1,MIC-1)及尿激酶型纤溶酶原激活剂(urokinaseplasminogen activator,uPA)蛋白表达与骨肉瘤发生、发展的关系。方法:应用免疫组织化学SP法检测53例骨肉瘤和20例良性骨肿瘤组织中MIC-1及uPA蛋白表达。结果:53例骨肉瘤组织中MIC-1及uPA蛋白阳性表达率分别为58.5%和62.3%;20例良性骨肿瘤中MIC-1及uPA蛋白阳性表达率分别为10.0%和0,骨肉瘤组织和良性骨肿瘤组织MIC-1及uPA蛋白表达差异均有统计学意义(χ2=13.784及22.726,P均<0.05)。MIC-1、uPA蛋白表达与骨肉瘤组织Enneking分级、有无远端转移均密切相关。且二者蛋白表达呈正相关关系(γ=0.292,P<0.05)。结论:MIC-1和uPA在骨肉瘤发生、发展过程中起重要作用,MIC-1及uPA的联合检测有望成为骨肉瘤早期诊断和判断预后的分子指标之一。

<正>肱骨髁间骨折是严重肘部损伤造成的临床较难处理的骨折,以青壮年多见,骨折损伤的程度以及治疗措施的选择往往决定着预后。近年来的治疗方法已趋向于及早切开复位内固定,术后积极进行功能锻炼。由于肱骨远端解剖结构复杂,且伤后骨折多移位或粉碎,使手术难度增加。2006年12月—2009年11月,驻马店市中心医院采用双钢板法治疗肱骨髁间骨折共17例,疗效满意,报告如下。

目的:探讨后路单阶段腰椎椎弓根截骨治疗强直性脊柱炎后凸畸形手术方法及临床疗效。方法:9例强直性脊柱炎后凸畸形患者采用后路单阶段(L3)椎弓根截骨矫形同时使用椎弓根钉棒系统内固定。结果:9例患者均获随访,时间20~46个月,术后后凸畸形均明显改善,术前Cobb S角36°~69°(平均50°),颌眉角30°~70°(平均55°)。术后Cobb S角16°~28°(平均24°),颌眉角12°~22°(平均16°)。矫正患者后凸畸形,改善了视线水平,提高患者生活质量。结论:后路单阶段腰椎椎弓根截骨并椎弓根钉棒系统治疗强直性脊柱炎后凸畸形方法相对简便,临床效果可靠,是治疗强直性脊柱炎后凸畸形较理想的方法。

目的:探讨髋关节置换术股骨转子下截骨在髋关节发育不良CroweⅣ型患者手术治疗中的临床应用及改良研究。方法:采用髋关节后外侧入路,对髋关节发育不良CroweⅣ型17例(17髋)患者实施股骨转子下2.5 cm处短缩旋转截骨,断端采用锁定钢板外侧固定,再植入Zweymuller-S L喷涂生物股骨柄,复位。结果:患者术后Harris评分63~92分,平均81分,其中优2例、良10例、中4例、差1例,优良率70.5%;股骨侧截骨处均骨性愈合,无假体松动,无神经麻痹,患侧髋无疼痛,活动度良好,Trendelenburg征阴性,无需辅助行走。结论:股骨转子下截骨法可纠正髋关节发育不良CroweⅣ型患者的下肢长度及前倾角,提高截骨端骨愈合率。

目的 总结手术治疗股骨远端骨折的疗效,探讨手术方式的选择.方法 对2000年1月至2007年1月手术治疗且得到随访的股骨远端骨折共78例进行分析,用Merchant膝关节功能评定标准判定疗效.结果 本组78例患者随访6～40个月(平均19个月),其中2例发生骨折不愈合,2例患肢膝关节僵直.骨折临床愈合后4个月,采用Merchant膝关节功能评定标准判定疗效:优29例,良33例,可12例,差4例,优良率为79.49%.结论 股骨远端骨折的手术治疗应根据骨折类型选用合适的内固定方式,术中解剖复位,牢固固定,术后指导患者早期进行功能锻炼,是提高疗效的重要因素.

目的探讨拉力螺钉及张力带钢丝治疗移位的髌骨骨折的临床疗效。方法常规膝前弧形切口入路,复位空心拉力螺钉及张力带钢丝内固定治疗髌骨骨折18例,男11例,女7例,年龄25～62岁,平均36.5岁。术后第1天开始膝关节被动锻炼。18例平均随访26个月。结果18例骨折全部愈合,平均愈合时间(1.6±2.5)个月,没有发生内固定失败及术后感染。结论切开复位空心拉力螺钉及张力带钢丝内固定适合于髌骨横形、纵形骨折,复位良好,固定可靠,能促进早期功能锻炼,康复快,并发症少,但不适合严重的髌骨粉碎性骨折。

Objective To explore the clinical effect of AO clavicular hook plate for treatment of acromioclavicular joint dislocation(Tossy Ⅲ) and distal clavicular fracture(Neer Ⅱ).Methods Twenty-seven patients with acromioclavicular joint dislocation(Tossy Ⅲ) and distal clavicular fracture(Neer Ⅱ) were treated with AO clavicular hook plate,the ruptured acromioclavicular ligament was directly repaired in operation.All patients were followed up for 5 to 48 months,mean twenty-eight months.Results According to Karlsson evaluation criterion in 27 cases,22 cases were excellent,3 cases were good and 2 cases were poor,the excellent and good rate was 92.6%.Conclusion AO clavicular hook plate is a good tool for treatment of acromioclavicular joint dislocation and distal clavicular fracture.

目的 探讨复杂胫骨Pilon骨折的手术方法及疗效.方法 1998年1月至2005年12月手术治疗胫骨Pilon骨折Ⅱ型8例、Ⅲ型23例.结果 采用Mazur等制定的踝关节症状与功能评分系统评分,并进行了14～60个月(平均29.3个月)的随访,本组中优17例,良10例,中3例,差1例,优良率达84.38%.结论 正确选择手术时机,先复位固定腓骨,胫骨关节面尽可能解剖复位,骨缺损充分移植骨填充及钢板支撑固定,能降低胫骨Pilon骨折术后的并发症,并获得满意的疗效。

目的采用改良逆行外踝上筋膜皮瓣修复前足软组织缺损。方法对5例前足软组织缺损的病例,采用改良逆行外踝上筋膜皮瓣进行修复,最大面积9 cm×6 cm,最小5 cm×4 cm。结果5例皮瓣完全成活,随访2个月~2年,皮瓣质地优良,外观及功能满意。结论改良逆行外踝上筋膜皮瓣血运可靠,质地佳,血管蒂长,可逆行修复前足,尤其是足端的软组织缺损。

目的探讨腰椎间隙感染病人的诊治方法及预防措施。方法对我院1998年5月~2003年12月治疗的8例腰椎间隙感染病人的临床资料进行回顾性分析。结果8例均采用联合应用抗生素治疗,1例形成脓肿并行扩创及闭式冲洗引流,均获痊愈,随访1例有慢性腰痛,1例腰部僵硬,余6例无特殊不适。结论腰椎间隙感染病人痛苦重,首要病因为细菌性感染,联合应用有效抗生素可使其早日痊愈,采用积极的预防措施可减少此病并发症的发生。

目的介绍陈旧性下尺桡关节脱位的治疗方法及效果。方法对11例陈旧性下尺桡关节脱位,采用旋前方肌骨膜瓣移位术及尺骨节段截除术使下尺桡关节复位。结果术后随访1~24个月,前臂旋转功能、腕关节活动度恢复满意,X线片示下尺桡关节对位关系正常。结论对不同下尺桡关节陈旧性脱位治疗采用不同术式,分别治疗,才能获得良好效果。

手掌逆行皮肤撕脱伤临床上比较常见,多由于碾轴机械挤压患者保护性回抽造成.我们自2000～2003年收治手掌逆行撕脱伤共17例,通过综合治疗,收到满意治疗效果,现报告如下.

目的:观察胫骨带锁髓内钉内固定治疗胫腓骨骨干骨折的临床效果.方法:本组36例(38侧)胫腓骨骨干骨折采用带有远、近端瞄准器的胫骨带锁髓内钉内固定治疗.结果:随访32例(33侧),平均愈合时间28周,1例踝关节伸屈轻度受限外,余膝、踝关节伸屈正常,2例膝部疼痛,可忍受,12例已于术后1年取出髓内钉.结论:胫骨带锁髓内钉内固定治疗胫腓骨骨干骨折既能满足早期肢体锻炼的要术,避免关节僵硬及肌肉萎缩,又解决了生活上穿衣的不便,是治疗胫腓骨骨干骨折先进的有效方法.

(足母)趾损伤在临床上比较常见,我们2002～2003年应用逆行足底风侧岛状皮瓣修复(足母)趾损伤3例,取得满意疗效,现报告如下.