[目的]比较股骨颈动力交叉钉系统(femoral neck system,FNS)与4枚空心加压螺钉(cannulate compression screw,CS)两种内固定方式治疗股骨颈骨折的长期临床疗效.[方法]2018年9月—2021年6月,45例股骨颈骨折患者纳入本研究.依据医患沟通结果,22例采用FNS内固定,23例采用CS内固定.比较围手术期、随访和影像资料.[结果]所有患者均顺利完成手术.FNS组在手术时间[(54.6±18.0)min vs(84.3±33.3)min,P=0.001]、术中透视次数显著小于CS组[(17.3±4.2)次vs(24.3±6.3)次,P＜0.001],但 FNS 组切 口长度[(5.4±0.6)cm vs(4.6±0.7)cm,P＜0.001]、术中失血量[(132.4±50.9)ml vs(47.0±15.7)ml,P＜0.001]显著大于CS组.所有患者均获随访15～46个月,平均(29.5±15.2)个月.FNS组恢复完全负重活动显著早于CS组[(5.5±1.2)个月vs(7.7±4.2)个月,P=0.029].随时间推移,两组Harris评分、髋伸-屈ROM和髋内旋-外旋ROM均显著增加(P＜0.05).至末次随访时,FNS组晚期不良事件,包括内固定物切出、股骨颈短缩、骨不连、股骨头坏死的发生率显著低于CS组[7/22(31.8％)vs15/23(65.2％),P=0.027].FNS组的全髋置换翻修率低于CS组,但差异无统计学意义[4/22(18.2％)vs 8/23(34.8％),P=0.563].影像方面,与术前相比,末次随访时两组Garden指数均显著改善(P＜0.05).至末次随访时,FNS组不良影像改变发生率显著低于CS组(P＜0.05).随时间推移,两组髋退变Tonnis分级均有加重趋势,但差异无统计学意义(P＞0.05).[结论]FNS固定青中年人股骨颈骨折在骨折愈合和晚期不良事件发生率明显优于CS.

目的 探讨白藜芦醇调控miR-25对高糖诱导的成骨细胞增殖和凋亡的影响和机制.方法 采用25 mmol/L的葡萄糖处理MC3T3-E1,在此基础上用不同浓度的白藜芦醇(0、20、40、80μmol/L)干预体外培养的MC3T3-E1细胞,四甲基偶氮唑蓝(MTT)法检测细胞活力,确定用药浓度.流式细胞术检测细胞凋亡,Western印迹检测活化的含半胱氨酸的天冬氨酸蛋白水解酶(Cleaved-caspase)-3蛋白的表达水平,实时荧光定量PCR(RT-qPCR)检测miR-25的表达水平.将miR-25模拟物转染MC3T3-E1细胞,经高糖刺激后,采用上述方法检测细胞增殖和凋亡的变化.将miR-25抑制物转染MC3T3-E1细胞,经高糖刺激和白藜芦醇干预后,采用上述方法检测细胞增殖和凋亡的变化.Western印迹检测核因子(NF)-κB信号通路蛋白相关蛋白表达水平.结果 高糖诱导后MC3T3-E1细胞存活率显著降低,白藜芦醇干预可显著减轻高糖刺激对MC3T3-E1细胞存活的抑制作用,并呈一定的剂量依赖性(P<0.05).高糖诱导后MC3T3-E1细胞凋亡率显著升高,Cleaved-caspase-3蛋白表达显著升高,miR-25表达显著降低,白藜芦醇(40μmol/L)干预可显著减轻高糖刺激对MC3T3-E1细胞凋亡及miR-25表达的影响(P<0.05).高表达miR-25可显著减轻高糖刺激对MC3T3-E1细胞增殖和凋亡的影响(P<0.05).低表达miR-25可逆转白藜芦醇对高糖诱导的MC3T3-E1细胞增殖和凋亡的影响(P<0.05).白藜芦醇干预可显著减轻高糖刺激对MC3T3-E1细胞NF-κB信号通路的影响,低表达miR-25可逆转白藜芦醇对高糖诱导的MC3T3-E1细胞NF-κB信号通路的影响(P<0.05).结论 白藜芦醇通过上调miR-25抑制NF-κB信号通路促进成骨细胞存活,减轻高糖诱导的成骨细胞凋亡,进而发挥保护作用.

[目的]评估髋臼双柱合并后壁骨折单一髂腹股沟入路复位内固定,且后壁骨块未予固定的临床结果.[方法]2016年5月—2021年1月对髋臼双柱合并后壁骨折的30例患者行手术治疗,男17例,女13例;平均年龄(41.4±15.5)岁.前柱采用钢板固定,后柱采用后柱拉力螺钉固定,后壁不予固定.评价临床与影像结果.[结果]本组30例患者均顺利手术,术中无严重并发症.所有患者均获得临床骨折愈合,末次随访时所有患者VAS评分,髋伸屈ROM,髋内外旋ROM,Harris评分,Merle-d'Aubigne-Postel评分均较术后3个月时显著改善(P＜0.05).影像方面,术后影像显示所有患者均达到或保持髋关节同心圆复位状态,骨折复位满意,前后柱螺钉位置良好,无突入关节腔等情况.与术后3个月相比,末次随访时Matta骨折复位评级及Tonnis髋退变评级均无显著变化(P＞0.05).[结论]单一髂腹股沟入路复位内固定,且后壁骨块未予处理治疗髋臼双柱合并后壁骨折取得良好的临床效果.

Objective:To investigate the effect of vector sum concept in fine-tuning posterior column screw channel via ilioinguinal approach for the treatment of bi-column acetabular fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 42 patients with acetabular double column fracture admitted to Weifang People′s Hospital from July 2015 to May 2021, including 22 males and 20 females, aged 23-77 years [(49.3±16.3)years]. The ilioinguinal approach was used in all patients with the anterior column fixed with a plate and posterior column fixed with a lag screw. The vector sum concept was used intraoperatively to fine-tune the posterior column screw channel in 19 patients (channel fine-tuning group): namely, a 2.5 mm Kirschner wire was inserted into the bony channel of the posterior column screw under fluoroscopy of iliac oblique and obturator oblique positions; when the Kirschner wire was not located in the middle of the ischial ramus under single fluoroscopy, the vector only needed to be adjusted in one direction, with zero in the other direction; when the Kirschner wire was not located in the middle of the ischial ramus under fluoroscopy of both the iliac oblique and obturator obturator oblique positions, the sum of the deviation vectors in the two directions was calculated before fine-tuning. The vector sum concept was not used to fine-tune the posterior column channel screw in 23 patients (channel non-fine-tuning group). The time of posterior column screw placement, intraoperative blood loss, frequency of guide wire adjustment and fracture healing time were recorded and compared between the two groups. At 6 months after operation, the quality of fracture reduction and hip function were assessed by Matta score and Merle D′Aubigne-Postel score, respectively. The complications were observed.Results:All patients were followed up for 7-71 months [(35.7±8.5)months]. In channel fine-tuning group, the time of posterior column screw placement was (5.1±1.5)minutes, with intraoperative blood loss of (798.8±83.9)ml, frequency of guide wire adjustment of (1.8±0.5)times and fracture healing time of (12.4±3.2)weeks; while these parameters [(39.8±12.0)minutes, (1 119.3±172.0)ml, (5.6±1.6)times and (15.6±4.2)weeks] were significantly shorter or less in channel non-fine-tuning group ( P<0.05 or 0.01). There were no significant difference in the quality of fracture reduction and hip function between the two groups at 6 months postoperatively (all P>0.05). After operation, symptoms of lateral femoral cutaneous nerve was found in seven patients, superficial incision infection in two who was healed after debridement and dressing change, deep venous thrombosis of lower limbs in three. There was no significant difference in the incidence of postoperative complications between the two groups [channel fine-tuning group: 26%(5/19), channel non-fine-tuning group: 30%(7/23)] ( P>0.05). Conclusion:For bi-column acetabular fractures via ilioinguinal approach, application of vector and concept to fine-tune the posterior column screw channel is beneficial for rapid screw placement into the osseous channel, significant reduction of intraoperative blood loss and early fracture healing.

[目的]介绍单一腹直肌外侧切口治疗双柱髋臼骨折的手术技术和初步临床效果.[方法] 2016年9月-2019年7月,采用腹直肌外侧切口治疗双柱髋臼骨折32例,其中男14例,女18例;年龄21～72岁,平均(36.42±4.73)岁.腹直肌外侧切口显露髋臼,以髂外动静脉为分割显露第一、二窗,以髂腰肌外侧为第三窗.术中一窗配合二窗显露前柱、四方体及后柱并复位固定;应用第三窗显露髂缘并复位固定;采用Matta评价髋臼功能评级及改良Merle D'Aubigne和Postle评价术后髋关节功能.[结果]所有患者均顺利完成手术,无明显并发症.随访9～24个月,平均(14.73±2.34)个月;应用Matta评价骨折复位情况:优21例,良7例,可4例,优良率87.50％.末次随访应用Merle D'Aubigne和Postle进行髋关节功能评价:优19例,良8例,可4例,差1例,优良率84.38％.[结论]腹直肌外侧入路治疗双柱髋臼骨折,具有切口小,四方体及前柱显露充分,直视下后柱螺钉及髂坐钢板的固定,并发症少等优点,值得推广.