ObjectiveTo investigate whether lidocaine can reverse Kupffer cell dysfunction in diabetic mice, as well as the mechanism of lidocaine in affecting liver abscess formation by improving the phagocytic function of Kupffer cells. MethodsC57BLKS/J db/db mice were divided into diabetes control group and diabetes+lidocaine group, and C57BLKS/J db/m mice were divided into non-diabetes control group and non-diabetes+lidocaine group, with 5 mice in each group. All mice were fed with the suspension of Klebsiella pneumoniae. Kupffer cells were collected from each group and were cultured in vitro; an electron microscope was used to measure the change in ultrastructure, and Kupffer cells were measured in terms of the levels of inflammatory mediators, the expression level of intercellular adhesion molecule-1 (ICAM-1), the chemotactic function of neutrophils, and phagocytic function; liver abscess formation was also observed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. ResultsCompared with the non-diabetic mice, the diabetic mice had significant reductions in mitochondria and rough endoplasmic reticulum, endoplasmic reticulum dilation, mitochondrial swelling, and an increase in lipid droplets in Kupffer cells. Compared with the non-diabetes control group, the diabetes control group had significant increases in the levels of nitric oxide (NO) (4.95±0.06 μmol/L vs 1.34±0.13 μmol/L, P＜0.05), interleukin-6 (IL-6) (740.04±8.58 pg/mL vs 515.77±4.62 pg/mL, P＜0.05), tumor necrosis factor-α (TNFα) (774.23±798 pg/mL vs 461.51±176 pg/mL, P＜0.05), interferon gamma (IFNγ) (842.33±14.79 pg/mL vs 542.47±6.75 pg/mL, P＜0.05), and ICAM-1 (2.40±0.02 vs 1.33±0.01, P＜0.05) in Kupffer cells, a significant increase in neutrophil chemotaxis (100.80±10.18 vs 13.80±3.70, P＜005), and a significant reduction in phagocytic capacity (9.86±1.82 vs 60.00±354, P＜0.05), with no effect on liver abscess formation (40% vs 0, P＞0.05). Compared with the diabetes control group, the diabetes+lidocaine group had significant reductions in the levels of NO (3.35±0.28 μmol/L vs 4.95±0.06 μmol/L, P＜0.05), IL-6 (688.42±36.34 pg/mL vs 740.04±8.58 pg/mL, P＜0.05), TNFα (631.15±4.30 pg/mL vs 774.23±7.98 pg/mL, P＜0.05), IFNγ (704.56±3.64 pg/mL vs 842.33±1479 pg/mL, P＜005), and ICAM-1 (1.50±0.02 vs 2.40±0.02, P＜0.05) in Kupffer cells, a significant reduction in neutrophil chemotaxis (33.40±5.60 vs 100.80±10.18, P＜0.05), and a significant increase in phagocytic capacity (49.20±2.59 vs 986±1.82, P＜0.05), with no effect on liver abscess formation (0 vs 40%, P＞0.05). ConclusionLidocaine can inhibit Kupffer cell inflammatory response and improve the phagocytic function of Kupffer cells in diabetic mice, thereby exerting a protective effect on Kupffer cells, but it had no effect on liver abscess formation.

目的 探讨距腓前韧带损伤在踝关节前外侧撞击时对关节软骨磨损的影响,及踝关节镜撞击物清理+自体骨软骨移植+距腓前韧带修复术治疗效果分析.方法 自2016年8月～2018年12月,共收治前外侧踝关节撞击综合征患者42例,对所有患者进行踝关节镜探查并观察软骨磨损情况.术中清除撞击组织及增生骨赘,修复(移植)磨损软骨及距腓前韧带.采用AOFAS评分进行疗效评估.结果 术后获得随访26例,(随访时间6～26个月,平均17.1个月),AOFAS评分由术前(56.69±6.3)分提高到末次随访时(88.80±3.94)分.手术前后差异具有统计学意义(P<0.05).在42例前外侧踝关节撞击患者中.无韧带损伤5例,单纯距腓前韧带损伤26例,踝关节外侧三角韧带不同程度损伤11例.22例存在软骨损伤,其中单纯距腓前韧带损伤占14例,外踝三角韧带不同程度损伤8例,无韧带损伤0例.撞击部位软骨损伤5例,距骨顶内侧软骨损伤12例,距骨顶内侧对应面软骨损伤3例.距骨顶内侧与其对应面均软骨损伤2例.撞击部位与软骨损伤部位符合不显著,不存在统计学意义(P>0.05).结论 当距腓前韧带损伤后,在踝关节运动时,距骨发生内翻、前移,产生踝关节半脱位.距骨顶内侧与踝顶发生撞击,进而导致距骨顶内侧软骨磨损.踝关节镜并韧带修复可有效治疗踝关节前外侧撞击,缓解疼痛,增强踝关节稳定性,良好保护踝关节软骨.

[目的]探讨经后路治疗严重脊柱后凸畸形的矫形策略及并发症.[方法] 2007年3月～ 2015年6月,采用经后路顶椎切除、前柱支撑植骨、矫形固定手术(顶椎切除+重建术)治疗严重脊柱后凸畸形28例,男18例,女10例;年龄8 ～56岁,平均24.6岁.病程21～38个月,平均25个月.颈胸椎7例,胸椎10例,胸腰椎4例,腰椎5例,腰骶椎2例.先天性15例,结核10例,翻修3例.术前Cobb角80°～135°,平均103°;术前Frankel分级:B级4例,C级11例,D级13例.术后及末次随访时测量后凸Cobb角.[结果]所有手术顺利完成.手术平均时间250 min.术中出血量850 ml～3000ml,平均1 430 ml.2个椎体切除8例,3个椎体切除11例,4个椎体切除6例,5个椎体切除3例.2例硬脊膜锐性撕裂,予以修复,已痊愈.术中唤醒试验发现:4例出现脊髓功能损伤加重情况,予静滴甲基强的松龙0.4 g～0.5 g处理后,术后2～4周脊髓功能逐渐恢复至术前.手术早期并发症:腹壁疼痛11例,术后早期痉挛性抽搐2例,伤口感染1例,脑积液漏1例,呼吸功能不全1例,无尿潴留、腹胀、十二指肠上动脉综合征.25例患者获术后随访,随访时间2 ～72个月,平均16个月.均无断钉、断棒等现象.患者症状及外形均明显改善.后凸Cobb角由术前(103.14±12.27)°(80°～ 135°)矫正至术后2周(31.28±8.13)°(12°～ 43°),矫正率69.67％,末次随访(34.84 ±9.04)°(13°～53°),矫正率为66.22％,矫正丢失率为11.38％.术后2周与末次随访的后凸Cobb角与术前相比,差异具有统计学意义(P＜0.05).术后2周Frankel分级B级1例,C级11例,D级13例,E级3例.末次随访D级2例,E级23例.与术前相比frankle分级均有改善,差异具有统计学意义(P＜0.05).所有病例均达到骨性融合.融合时间6～8个月,平均7个月.[结论]采用经后路顶椎切除、前柱支撑植骨、矫形固定手术(顶椎切除+重建术)治疗严重脊柱后凸畸形可取得较好效果.