目的 研究以胶原蛋白海绵为支架复合骨髓间充质干细胞(BMSCs)和成骨细胞(OB)体外构建的组织工程骨修复兔尺骨骨缺损的能力.方法 新西兰大白兔27只,制备双侧尺骨中段1.5 cm节段性骨缺损模型,按植入的修复物随机分成3组,每组9只.A组为胶原蛋白海绵复合OB,B组为胶原蛋白海绵复合BMSCs细胞,C组为胶原蛋白海绵复合OB和BMSCs细胞,D组为胶原蛋白海绵,作为自身对照.每组植入物植入前在体外培养1周,术后4、8、12周每组分别取3只动物,进行X线检查、大体标本观察和HE染色组织学观察,比较4组骨缺损的修复情况.结果 C组的成骨效果在任何时间检测点均优于其他组(均P<0.05),表现出更好的骨质量、更高的X线得分和更大数量的骨体积.A组和B组X线得分、新生骨体积差异无统计学意义(均P>0.05),但均高于同时间点的D组.12周时新生骨组织几乎接近正常骨组织,髓腔再通;A组和B组12周时骨缺损区仍处于改建塑形期,D组只有少量骨痂形成,骨不愈合.结论 OB和BMSCs两种细胞混合复合胶原蛋白海绵修复兔尺骨节段性缺损的效果最佳,为骨组织工程种子细胞的选择提供了参考,有望成为组织工程修复骨缺损的治疗方法 .

目的:探讨经伤椎固定治疗胸腰椎骨折患者的效果.方法:回顾性分析2014年12月～2018年1月收治的500例胸腰椎骨折患者的临床资料,按固定方法不同将500例患者分为经伤椎组和跨伤椎组,各250例.经伤椎组采用经伤椎固定治疗,跨伤椎组采用跨伤椎固定治疗,比较两组手术时间、术中出血量,术前、术后3d及术后1年伤椎椎体前缘高度比及Cobb角,术后并发症发生情况.结果:两组手术时间、术中出血量,术后3d伤椎椎体前缘高度比及Cobb角比较,差异无统计学意义(P＞0.05);经伤椎组术后1年伤椎椎体前缘高度比(82.69± 10.53)％高于跨伤椎组的(75.42± 8.65)％,Cobb角(10.06± 2.13)°小于跨伤椎组的(15.58±2.36)°,术后并发症发生率1.60％低于跨伤椎组的6.00％,差异有统计学意义(P＜0.05).结论:经伤椎固定与跨伤椎固定均能维持胸腰椎骨折患者术后伤椎矫正度,但经伤椎固定能降低术后远期矫正度丢失,内固定失败率低,是一种更为理想的固定方法.

Objective To compare the clinical effect and safety between total knee arthroplasty and arthroscopic synovectomy in the treatment of knee joint pigmented villonodular synovitis.Methods From January 2010 to June 2015,112 patients with knee joint pigmented villonodular synovitis in our hospital were divided into group A and group B according to surgical approach,each group 56 cases.The group A underwent total knee arthroplasty,and the group B underwent arthroscopic synovectomy.The knee joint activity,knee function,postoperative complication rate and recurrence rate after 1 year were analyzed statistically before and after operation.Results There were no significant differences in knee joint activity and knee function scores between the two groups before operation (P ＞ 0.05),at 3 months after operation,the group A were significantly better than those of group B,the difference was statistically significant (P ＜ 0.05);The incidence of postoperative complications in group A was 3.57％,and there was no recurrence in 1 year,the incidence of postoperative complications in group B was 5.36％ and the recurrence rate was 3.57％,There was no significant difference between the two groups (P ＞ 0.05).Conclusion Treatment of knee joint pigmented villonodular synovitis using total knee arthroplasty gets more significant clinical effect,and the incidence and recurrence rate of postoperative complications are low,which is of great clinical value and worthy of popularization.

BACKGROUND:There are many kinds of ways to obtain osteoblasts at present, but how to get high-purity osteoblasts in a easy and fast way has become a hot research. <br> OBJECTIVE:To explore a method to get massive and high purified osteoblasts effectively by comparing three common primary osteoblast culture methods, and to observe the biological characteristics of the osteoblasts from the skul of neonatal rabbit. <br> METHODCalvarias were dissected from newborn New Zealand white rabbits within 24 hours, and osteoblasts were isolated with bone tissue method, col agenase digestion method and modified tryptase and col agenase sequential digestion method respectively, then the cells were subcultured in vitro. Osteoblast proliferation and osteogenic activity were identified by inverted microscope for morphology observation. The rate of living osteobalsts was counted with trypan blue staining. The growth curve of the cells was drawn with MTT method. Alizarin red staining was applied to detect alkaline phosphatase and osteocalcin protein in the cellculture supernatants. Col agen I and col agen III immunohistochemical staining was also performed. RT-PCR was used to determine the expression of osteocalcin and col agen I mRNA expression. <br> RESULTS AND CONCLUSION:The cultured cells showed highly homogeneous appearance with active proliferation, and they had the typical features of osteoblasts. Alizarin red staining and col agen I immunohistochemical staining were both positive, while col agen III immunohistochemical staining was negative.&nbsp;Alkaline phosphatase and osteocalcin protein expression in the cellculture supernatants can be detected. The expression of osteocalcin and col agen I mRNA was positive in the RT-PCR test. Compared with col agenase digestion method, the modified tryptase and col agenase I sequential digestion method cost less time, presented higher production of osteoblasts and higher cellsurvival rate (P<0.05). Bone tissue method was the easiest method and did the least damage to osteoblasts, but it presented lowest production of osteoblasts and cost the maximum time among the three methods. So it cannot be used in large-scale osteoblast culture. A large quantity of high purity osteoblasts were obtained by modified trypsase and col agenase I sequential digestion method, which can be used as a reliable and efficient way to obtain the original generation osteoblasts in vitro.

目的:探讨胫骨平台骨折切开复位内固定术后手术部位感染的相关危险因素.方法:回顾性分析了2005年7月至2010年11月间在我院行胫骨平台骨折切开复位内固定手术且随访时间大于一年的216例患者的相关资料,进行单因素及多因素Logistic回归,最终筛选出导致SSI的独立危险因素.结果:216例患者中,男性163例,女性53例,平均45.5岁,其中发生感染的患者21例(8.3％).引入多因素Logistic回归方程,得出术部位感染的独立危险因素为开放性骨折和手术时间.结论:开放性骨折(OR=4.77,P=0.004)和手术时间(OR=2.94,P=0.003)与胫骨平台骨折切开复位内固定术后SSI相关.因此,增加术者操作的熟练度、进行分期手术及提高手术效率均有助于减少伤口暴露时间,降低SSI的发生率.

Aim:To detect the mitochondrial DNA(mtDNA) and apoptosis in esophageal squamous cell carcinoma(ESCC) TE-13 cells.Methods:TE-13 cells were allocated into 2 groups:EB treatment group and control group.RT-PCR was used to detect the expression of mtDNA,and apoptosis in the cells was detected by flow cytometry at days 4,8 and 12.Results:The result of mtDNA expression in EB treatment group gradually decreased from(0.467±0.031),(0.197±0.015) to 0 at days 4,8 and 12,control group was(0.660±0.046),(0.673±0.031)and(0.653±0.021),and there were significant differences between the two groups(Fgroup=1 133.878,Ftime=109.058,Finteraction=104.597;P0.001).The results of flow cytometry revealed that cell apoptosis rates in EB treatment group were significantly higher than those of control group at days 4,8 and 12(Fgroup=2 773.035,Ftime=407.652,Finteraction=406.641;P0.001).Conclusion:The inhibition of mtDNA duplication may prompt the apoptosis of TE-13 cells.

AIM:To observe the impact of a tuberous sclerosis complex 2(TSC2)-specific antisense oligonucleotide (ASODN) on cell proliferation and apoptosis in human esophageal cancer cell line EC9706. METHODS:A TSC2 ASODN at different concentrations (5,10 and 15μmol/L) was transfected into EC9706 cells using cationic liposomes.A sense oligonucleotide(15μmol/L) and nonsense oligonucleotide(15μmol/L) were used as negative controls,and non-transfected EC9706 cells were used as a normal control.At 24,48 and 72 h after transfection,MTT and TUNEL assays were used to examine the proliferation and apoptosis of EC9706 cells,respectively,and immunocytochemistry and RT-PCR were used to determine the expression of TSC2. RESULTS:Compared to the three control groups,transfection of the TSC2 ASODN increased proliferation,decreased apoptosis (13.11±0.13,9.31±0.29,4.38±0.43 vs 16.46±0.43,16.63±0.34,16.23±0.45,all P < 0.05),and reduced the expression of TSC2 mRNA and protein (FmRNA = 260.23,572.22,1004.35,Fprotein = 50.60,330.69,1221.28,all P < 0.05) in EC9706 cells in a time- and concentration-dependent manner.Transfection with a dose of 15μmol/L for 72 h exhibited the most strong effect(P < 0.05). CONCLUSION:The TSC2 ASODN could enhance proliferation and inhibit apoptosis in human esophageal cancer cell line EC9706.

目的对比来氟米特和甲氨蝶呤治疗国内类风湿性关节炎患者的临床疗效和安全性。方法在中国科技全文数据库、中文科技期刊数据库等数据库检索1989年1月至2008年12月有关来氟米特治疗类风湿性关节炎的随机化对照试验文献,用REVMAN5.0对入选的文献进行Meta分析。结果来氟米特与甲氨蝶呤治疗RA疗效相比差异有统计学意义(P=0.03),RR=1.06,95%CI为(1.01,1.12)。两药在不良反应上差异也有统计学意义(P<0.00001),RR=0.54,95%CI为(0.45,0.66)。结论来氟米特治疗类风湿性关节炎疗效优于甲氨蝶呤,且不良反应低于甲氨蝶呤,是一个比较安全有效的改变病程药。

胸腰椎骨折临床常见,随着脊柱牛物力学的研究,后路椎弓根钉固定治疗胸腰椎骨折脱位、越来越被骨科医生所接受.本院骨科2000年10月至2008年9月手术治疗38例胸腰椎骨折脱位、患者疗效满意,现分析如下.

<正>临床上因挤压、碾挫、撕脱等原因造成的足踝部皮肤、软组织缺损并不少见,足踝部骨折后局部软组织肿胀,切开复位时若掌握不好时机,加上术中对局部的皮肤软组织

腰椎管狭窄是骨科临床较常见的一种疾病.它是由于腰椎管结构改变腰椎管因骨性或纤维性增生移位导致一个或多个平面骨腔狭窄,从而使硬膜囊受压,出现马尾神经及相应的神经根症状.

目的探讨经皮穿刺腰椎间盘臭氧注射治疗腰椎间盘突出症的临床疗效。方法42例腰椎间盘突出症患者在透视下用21G针头穿刺病变椎间盘内及椎间孔周围,注射医用臭氧气体5mL,浓度为50μg/mL。结果患者随访6～12个月,显效19例,有效16例,无效7例,总有效率83.33%。绝大多数患者在术后2个月内取得较好的疗效,至少随访6个月,未见严重并发症的发生。结论经皮穿刺腰椎间盘臭氧注射治疗腰椎间盘突出症是一种安全有效、并发症少的微创疗法。

指甲位于末节手指的末端部分,手指末节很容易受到损伤,带指甲的末端缺损后不仅影响手指功能,而且外形亦遭破坏,患者的心理也会受到很大的影响.因而,指尖受伤离断,患者往往都强烈要求再植.1983-2006年间,对168例196指指尖离断者进行了修复,手术方法包括吻合血管的指尖离断再植,改良清创缝合术,原位缝合术.现将随访结果总结分析如下.

目的总结应用带蒂皮瓣在急诊手外伤皮肤缺损修复手部创面的临床效果。方法应用带蒂皮瓣修复手部皮肤缺损106例。其中前臂逆行岛状皮瓣20例,指动脉岛状皮瓣12例,上臂内侧带蒂皮瓣11例,髂腹股沟皮瓣19例,胸部带蒂皮瓣23例,腹部带蒂皮瓣21例。结果106例皮瓣全部成活,术后腹部皮瓣和骼腹股沟皮瓣因脂肪较厚,稍显得臃肿,全部做了去脂修整。随访6-18个月,手部功能、外形恢复良好。结论应用带蒂皮瓣急诊修复手指外伤创面,具有操作简单、容易掌握、外形质地良好、皮瓣成活好等优点,可根据手的皮肤缺损实际情况选择应用。