目的 探讨β-榄香烯在骨肉瘤中诱导自噬发生的信号通路及其对肿瘤细胞增殖及凋亡的影响.方法 以不同浓度(0、10、20、50、100、150μg/ml)的β-榄香烯处理人骨肉瘤143B细胞24、48 h后,应用CCK-8法检测细胞存活率;用0、20、50μg/mlβ-榄香烯处理143B细胞48 h后,应用流式细胞仪使用AnnexinⅤ-FITC/PI双染法检测细胞凋亡率,并通过荧光显微镜及蛋白印迹法(Western blotting)检测细胞自噬相关蛋白微管相关蛋白1轻链3(LC3B)的分布及表达,Western blotting检测143B细胞中丝氨酸/苏氨酸激酶(AKT)、磷酸化丝氨酸/苏氨酸激酶(p-AKT)、哺乳动物雷帕霉素靶蛋白(mTOR)及磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)蛋白表达水平.结果 β-榄香烯呈浓度依赖性地显著抑制骨肉瘤143B细胞的增殖,其对143B细胞24 h和48 h时的半数抑制浓度(IC50)分别为58.89μg/ml和18.48μg/ml;143B细胞经20、50μg/mlβ-榄香烯处理48 h后,细胞凋亡率分别为(15.43±0.99)％和(19.21±0.82)％,明显高于0μg/mlβ-榄香烯组(6.87±1.02)％;且其细胞Cleaved caspase-3蛋白表达水平亦明显高于0μg/mlβ-榄香烯组,差异均有统计学意义(P<0.05);经20、50μg/mlβ-榄香烯处理骨肉瘤143B细胞48 h后,细胞质内的自噬体数量明显增多,其LC3-Ⅱ/LC3-Ⅰ表达水平较0μg/mlβ-榄香烯组均明显增高,差异均有统计学意义(P<0.05),β-榄香烯可以抑制骨肉瘤细胞p-AKT和p-mTOR的表达,且呈时间及剂量依赖性.结论 β-榄香烯可以诱导人骨肉瘤143B细胞增殖抑制及凋亡,还可以通过抑制AKT/mTOR通路激活细胞自噬.

目的 探讨自体髂骨移植治疗重度距骨软骨缺损的临床疗效分析.方法 选择2012年7月至2017年7月入院符合入选标准(距骨内侧缺损面积>1.5 cm2或病变深度>7 mm)的距骨软骨缺损患者35例,经内踝截骨、取同侧髂骨移植修复缺损部位,患者术前、术后随访均行CT和MRI检查,测量踝关节活动范围(ROM),采用美国矫形足踝协会(AOFAS)及视觉疼痛量表(VAS)对术前术后踝关节的功能及疼痛评定治疗效果,将手术前后相关指标进行统计学分析.结果 术后随访12～36个月,平均(20.6±8.3)个月.91.4％(32/35)的患者术后3个月踝关节肿痛消失,余患者肿痛消失时间较长,最终所有患者踝关节肿痛均消失,末次随访时,测量踝关节活动范围,ROM由术前平均(47.7±6.3)°增加到术后(63.4±7.4)°差异有统计学意义(P<0.01),AOFAS评分较术前显著提高(70.5±7.2,91.3±4.9,P<0.01),VAS评分较术前显著降低(7.2±1.2,1.7±1.1,P<0.01),随访MRI检查关节面修复满意,无明显术后并发症.结论 对于距骨内侧缺损面积>1.5 cm2或病变深度>7 mm的患者,取同侧髂骨移植修复缺损是一种疗效明显的外科手术方法,可广泛应用于临床.

Objectives The aim of this study was to identify patient- and treatment-specific independent risk factors for the recurrence of proximal fibular tumors and complications of their surgical management. Methods Patients who underwent surgical treatment of proximal fibular tumors at our institution from 2004 to 2015 were retrospectively reviewed. All patients had a pathologically confirmed diagnosis and were followed up for at least 12 months for recurrence and complications. All patients were evaluated with respect to seven patient-, disease-, and treatment-specific variables. Results In the univariate analysis, peroneal nerve palsy at presentation and malignancy were associated with an increased risk of recurrence, iatrogenic peroneal nerve injury, and wound healing problems. The multivariate analysis showed that peroneal nerve palsy at presentation was an independent risk factor for recurrence and iatrogenic peroneal nerve injury and that malignancy was an independent risk factor for wound healing problems. Conclusions Peroneal nerve palsy and malignant potential are independent risk factors for complications of surgical treatment of proximal fibular tumors. The recognition of these factors may contribute to proper management and help to prevent recurrence and postoperative complications.

目的 术前栓塞应用于骨科骨盆肿瘤手术对切口愈合的影响.方法 此次实验对象52例患者,按照随机表法分成试验组(n=26)和对照组(n=26),对照组应用明胶海绵条进行栓塞,试验组应用球囊进行栓塞,分析比较两种材质栓塞后的恢复情况和并发症发生情况.结果 试验组患者的住院时间、手术切口愈合时间、术中出血量均优于对照组,组间对比差异较大,差异存有统计学意义(P＜0.05);试验组患者术后切口愈合并发症发生率为11.38％,对照组为42.31％,显示差异有统计学意义(P＜0.05).结论 术前栓塞应用于骨科骨盆肿瘤手术会延迟患者切口愈合时间,但是选用球囊栓塞对术后切口愈合影响较小,且并发症较少,具有一定的安全性.

目的 探讨CT引导下同轴穿刺在骨盆病变诊断中的应用价值.方法 回顾性分析62例于2014年1月至2016年12月间在我科行CT引导下同轴穿刺活检的骨盆病变患者的病例资料,并随访其后续的诊治情况.以手术后病理结果和(或)临床随访(至少为6个月)作为穿刺病理的评价标准,以评价活检在鉴别病变是否为恶性的表现.而且,分析穿刺结果对治疗方案的影响.结果 本研究纳入患者62例,男29例,女33例,平均54(12～84)岁.其中,最终诊断经手术病理确诊者41例,随访确诊者21例.穿刺活检在鉴别病变是否为恶性方面的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为94％,100％,95％,100％,80％.所有患者中出现并发症2例,均为穿刺后局部血肿形成.本组共有35％(22/62)的患者穿刺前后治疗方案进行了调整:18例穿刺前拟行手术切除,穿刺后改行非手术治疗;4例手术方式发生变化,穿刺前拟行广泛切除,穿刺后仅行病灶刮除或清理术.结论 CT引导下同轴穿刺在骨盆病变术前诊断中,尤其在良恶性病变鉴别方面,具有较高的敏感性,特异性及准确率,而且安全性好.可为制订正确的临床决策提供可靠的依据.

目的 分析负压封闭冲洗引流技术在骨科肿瘤术后应用的临床价值.方法 选取本院收治的62例骨科肿瘤行手术治疗患者为研究对象,采用双盲法将所选患者随机分为常规组和研究组,各31例,对常规组患者实施传统创面护理,对研究组患者实施负压封闭冲洗引流技术处理创面,对比2组患者术后平均住院时间、创面坏死情况.结果 研究组患者平均住院时间明显短于常规组,同时研究组患者创面坏死率均显著少于常规组,P ＜0.05,差异显著有统计学意义.结论 通过对骨科肿瘤术后实施负压封闭冲洗引流技术不仅能够有效改善患者术后愈合情况,同时对促进患者早日出院有积极作用.

目的 探讨股骨转移瘤流行病学特征.方法 回顾性分析2010年1月至2015年12月河北医科大学第三医院、济南军区总医院和齐鲁医院诊治的股骨转移瘤患者160例,按股骨转移部位分为三组:股骨近端组、股骨干组和股骨远端组,比较各组患者的性别、年龄、肿瘤原发部位、转移部位、病理性骨折以及治疗方法等方面的差异.结果 共纳入121例股骨转移瘤患者,男性72例,女性49例,中位年龄58岁(22~87岁),其中50~69岁患者居多.原发肿瘤来源前三位依次为肺(49.6%)、肾(14.9%)和未知来源肿瘤(12.4%).发生病理性骨折33例(27.3%),诊断明确后保守治疗35例(28.9%),活检后选择保守21例(17.4%),手术治疗65例(53.7%).股骨近端组77例(63.6%)、股骨干组33例(27.3%)、股骨远端组11例(9.1%).股骨干组发生病理性骨折比例最高(42.4%),股骨近端组次之(23.4%),股骨远端组最低(9.1%),差异有统计学意义(x2=6.242,P<0.05).股骨远端组囊内切除比例最高(71.4%),股骨干组次之(55.0%),股骨近端组最低(23.7%),差异有统计学意义(x2=9.031,P<0.05).股骨近端组关节置换重建比例最高(75.7%),股骨远端组次之(33.3%),股骨干组最低(25.0%),差异有统计学意义(x2=30.223,P<0.001).三组患者性别、年龄、治疗方式及原发肿瘤类型分布无统计学差异(P>0.05).结论 股骨转移瘤导致病理性骨折发生率较高,大多应手术治疗.股骨近端转移瘤以关节置换为主,骨干和远端以骨水泥内固定为主.

目的 探讨术前经皮粗针穿刺活检(CNB)对肢体软组织病变的诊断价值.方法 回顾性分析93例在我院行CNB的软组织病变患者的临床资料.结果 本组93例患者共行CNB 94次,其中3次失败,穿刺成功率为97%(91/94).本组患者最终诊断为恶性病变60例,良性病变33例.91例穿刺成功患者中,真阳性56例,假阳性0例,真阴性32例,假阴性3例.CNB对于明确病变是否为恶性的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为95%、100%、97%、100%、91%.本组共17例患者穿刺前后治疗方案进行了调整,其中12例穿刺前拟行手术切除,穿刺后改行非手术治疗;5例手术方式发生变化,穿刺前拟行广泛切除,穿刺后仅行病灶切除或清理术.结论 CNB在肢体软组织病变诊断中,尤其在良恶性病变鉴别方面,具有较高的敏感性、特异性及准确率.

Background: Malignant tumors in the proximal fibula are rare but life-threatening; however, biopsy is not routine due to the high risk of peroneal nerve injury. Our aim was to determine preoperative clinical indicators of malignancy.Methods: Between 2004 and 2016, 52 consecutive patients with proximal fibular tumors were retrospectively reviewed. Details of the clinicopathological characteristics including age, gender, location of tumors, the presenting symptoms, the duration of symptoms, and pathological diagnosis were collected. Descriptive statistics were calculated, and univariate and multivariate regression were performed.Results: Of these 52 patients, 84.6% had benign tumors and 15.4% malignant tumors. The most common benign tumors were osteochondromas (46.2%), followed by enchondromas (13.5%) and giant cell tumors (13.5%). The most common malignancy was osteosarcomas (11.5%). The most common presenting symptoms were a palpable mass (52. 0%) and pain (46.2%). Pain was the most sensitive (100%) and fourth specific (64%); both high skin temperature and peroneal nerve compression had the highest specificity (98%) and third sensitivity (64%); change in symptoms had the second highest specificity (89%) while 50% sensitivity. Using multivariate regression, palpable pain, high skin temperature, and peroneal nerve compression symptoms were predictors of malignancy.Conclusions: Most tumors in the proximal fibula are benign, and the malignancy is rare. Palpable pain, peroneal nerve compression symptoms, and high skin temperature were specific in predicting malignancy.

目的：探讨低分子肝素（ LMWH）治疗骨转移癌患者下肢深静脉血栓（ DVT）的疗效和安全性。方法对51例骨转移癌合并DVT患者应用低分子肝素钠治疗，对其治疗前后的临床症状、体征、血小板（ Plt）、部分凝血活酶时间（APTT）、D-二聚体（D-Dimer）进行比较。结果骨转移癌合并DVT患者治疗后DVT的总有效率为90．2％；治疗前后D-Dimer差异有统计学意义（P＜0．01）。用药期间9例（17．6％）患者发生出血倾向，但无严重并发症。结论 LMWH治疗骨转移癌合并DVT疗效确切，安全性较高。

BACKGROUND:The risk of lower extremity deep venous thrombosis was high in patients with bone metastases. Major surgery is a major risk factor for thrombosis. There was no standard prophylactic regimen available. <br> OBJECTIVE:To investigate the efficacy and safety of low molecular weight heparins versus rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis in patients with bone metastases. <br> METHODS:From January 2010 to December 2013, a total of 73 patients with bone metastasis in spine, pelvis and lower extremities, who underwent open surgery in the Department of Musculoskeletal Tumor, Third Hospital, Hebei Medical University, China, were retrospectively analyzed. The patients were divided into low molecular weight heparins group (n=41) and rivaroxaban group (n=32) according to the prophylactic drugs after surgery. <br> RESULTS AND CONCLUSION:Nine cases (22%) in the low molecular weight heparins group were found lower extremity deep venous thrombosis, and six cases (19%) in the rivaroxaban group suffered from lower extremity deep venous thrombosis, showing no significant differences (χ2=0.11, P=0.74). The incidences of bleeding events in both groups were respectively 7.32%and 6.25%, showing no significant differences (correctionχ2=0.083, P>0.05). There were no significant differences regarding the levels of platelet, activated partial thromboplastin time and prothrombin time between both groups preoperatively or postoperatively (P>0.05).&nbsp;Therefore, the efficacy and safety of low molecular weight heparins and rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis were similar. Both could effectively reduce the incidence of deep venous thrombosis, with a relative low risk of bleeding.

OBJECTIVE:To analyze the risk factors for deep vein thrombosis (DVT) of the lower extremity in patients with bone metastases. METHODS:Ninety patients with bone metastases were admitted to our hospital From January 2010 to December 2011, and their clinical data were retrospectively analyzed. There were 57 males and 33 females with a mean age of 61 years (range, 27 to 78 years). On admission, all cases were detected by color Doppler ultrasonography for DVT of bilateral lower extremities. Univariate and multivariate analyses were performed to determine the probable risk factors including gender, age, body weight, tumor location, bed confinement and etc. RESULTS:Among the 90 patients, DVT was found in 24 patients on admission and the DVT incidence was 26.7% (24/90). The univariate analysis showed that bed confinement, multiple metastasis, pathological fracture, primary lesion detected, blood group, fibrinogen and hematocrit were significantly related to the incidence of DVT (P < 0.05). The logistic multivariate regression analysis showed that bed confinement, pathological fracture and fibrinogen were independent risk factors for the incidence of DVT. CONCLUSIONS:Bed confinement, pathological fracture and fibrinogen are independent risk factors for the incidence of DVT for patients with bone metastases. Patients with bed confinement >3 days, pathological fracture or fibrinogen >4 g/L should be routinely screened for lower extremity DVT on admission. Once identified, the DVT patients should be treated as early as possible.

Objective To investigate the efifcacy and complications of preoperative arterial embolization in the surgical treatment of high sacral tumors. Methods The data of 37 patients with high sacral tumors who underwent surgical resection in our hospital between January 2006 and December 2011 were retrospectively analyzed. Preoperative arterial embolization were performed in all the patients and surgery were performed within the following 24 hours. The data of surgical time, blood loss, transfusion volume, and the postoperative complications were collected by reviewing the arterial embolization record, image, operation record, progress notes, nursing records and etc. Results Angiography clearly demonstrated the blood supply of the tumor and the dimension of the lesion. The tumor stain was markedly reduced after selective embolization in angiography. The volume of the tumor was decreased, the margin of the tumor became clear, and blood loss during the exposure was reduced. The surgical time was ( 147.97±38.99 ) min, blood loss was ( 1932.35±1293.27 ) ml, transfusion volume was ( 1296.00±938.00 ) ml. No serious embolization-associated complications were observed in all the patients. The incidence of delayed wound healing was 18/37 ( 49%), and the incidence of wound infection was 8/37 ( 22%). Conclusions Preoperative arterial embolization is an effective supplementary means for the surgery of high sacral tumor, which can shorten the surgical time, reduce the blood loss and the transfusion volume. Meanwhile, it could increase the possibility of delayed wound healing and wound infection.

目的 探讨还原型辅酶Q10（CoQ10H2）对氧化应激引起的血管内皮细胞的抗衰老作用。方法 用EGM-2内皮细胞培养基，在5%CO2，37℃条件下培养人脐静脉内皮细胞（HUVECs）。将细胞分为四个实验组：（1）对照组；（2）CoQ10H2组；（3）H2O2组；(4) CoQ10H2+H2O2组。检测凋亡细胞的相关β-半乳糖苷酶阳性细胞，衰老相关分泌表型(SASP)相关基因表达的检测。结果 COQ10H2防止H2O2诱发的细胞衰老，抑制衰老相关基因的表达。结论 COQ10H2通过抑制衰老相关及SASP的基因表达而抑制H2O2处理后内皮细胞衰老进展，从而延缓血管衰老。