目的 探讨多b值弥散加权成像(diffusion weighted imaging,DWI)序列ADC值用于鉴别脊柱骨质疏松性压缩骨折与椎体转移瘤病理性压缩骨折的价值.方法 回顾性分析2009 年1 月～2019 年 12 月本院收治的脊柱骨质疏松性压缩骨折 68例(A组)及椎体转移瘤病理性压缩骨折患者74 例(B组),分别测量其多b值DWI下的ADC值,并进行组间比较;采用曲线下面积(area under curve,AUC)分析多b值DWI鉴别两者的价值.结果 脊柱骨质疏松性压缩骨折形态多为楔形及凹陷形、椎体后缘成角,椎体内可见残留正常骨髓信号,多b值DWI以等或低信号为主;椎体转移瘤病理性压缩骨折形态多为倒楔形及扁平形、可见椎体附件受累及椎旁软组织肿块,多b值DWI以高信号为主.两组患者的ADC值均随着b值增加而下降,但A组的ADC值显著高于B组(P<0.05);b值分别取 0、100、200、400、600、800 s/mm2 时,鉴别二者的AUC值分别为 0.671、0.706、0.897、0.918、0.743、0.712;当多b值DWI取400 s/mm2 时的诊断效能最佳(P<0.05),其准确度、特异度、敏感度、阳性预测值、阴性预测值、约登指数分别为90.12％、86.34％、91.37％、73.85％、72.17％及77.71％.结论 MRI形态学对于鉴别脊柱骨质疏松性压缩骨折与椎体转移瘤病理性压缩骨折有一定的帮助,而多b值DWI取400 s/mm2 时,具有最佳的诊断效能.

目的 探究微小RNA-142-3p(miR-142-3p)靶向蛋白激酶R样内质网激酶(PERK)/免疫球蛋白结合蛋白(Bip)信号通路对骨关节炎模型大鼠的干预作用.方法 选取60只SPF级雄性大鼠,随机挑选15只作为空白组,其余45只建立骨关节炎模型,最终39只建模成功,随机分为模型组、下调组、上调组,每组13只;建模成功后,空白组和模型组于膝部注射生理盐水,上调组和下调组分别于右膝关节腔内注射miR-142-3p mimic和miR-142-3p inhibitor.HE染色观察各组大鼠膝关节软骨组织病理学变化;观察并比较各组大鼠膝关节活动度、压痛阈值、热痛阈值;酶联免疫吸附试验(ELISA)检测血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平;实时荧光定量PCR检测转化生长因子-β(TGF-β)、Ⅰ型胶原α1(COL1α1)、金属蛋白酶组织抑制因子1(TIMP1)mRNA水平;Western blot检测PERK/Bip信号通路蛋白表达量.结果 与模型组相比,下调组miR-142-3p表达量降低,上调组miR-142-3p表达量升高,差异有统计学意义(P<0.05),提示miR-142-3p转染成功.通过组织病理学观察发现,空白组和上调组大鼠膝关节软骨组织完整,模型组和下调组大鼠膝关节软骨退变,正常软骨结构丧失.与空白组比较,其他各组大鼠膝关节活动度较小,压痛阈值、热痛阈值较低,IL-1β、TNF-α、TGF-β、COL1α1、TIMP1 mRNA水平较高,PERK、Bip、Caspase-9蛋白表达较高,差异均有统计学意义(P<0.05);与模型组比较,下调组大鼠膝关节活动度较小,压痛阈值、热痛阈值较低,IL-1β、TNF-α、TGF-β、COL1α1、TIMP1 mRNA水平较高,PERK、Bip、Caspase-9蛋白表达较高,差异均有统计学意义(P<0.05);与模型组和下调组比较,上调组大鼠膝关节活动度较大,压痛阈值、热痛阈值较高,IL-1β、TNF-α、TGF-β、COL1α1、TIMP1 mRNA水平较低,PERK、Bip、Caspase-9蛋白表达较低,差异均有统计学意义(P<0.05).结论 上调骨关节炎大鼠miR-142-3p的表达可有效改善大鼠膝关节活动度、压痛阈值及热痛阈值,减轻炎症反应,调节滑膜纤维化标志物水平.可能的分子机制是miR-142-3p通过抑制PERK/Bip信号通路上PERK、Bip、Caspase-9蛋白的表达减轻炎症反应.

背景 布鲁氏杆菌性脊柱炎作为布鲁氏杆菌引起的一种传染性变态反应性疾病,其治疗方式主要为手术治疗和保守药物治疗.布鲁氏杆菌性脊柱炎患者手术切口为非清洁切口,术后易发生伤口不愈合.目的 本研究通过分析布鲁氏菌性脊柱炎患者术后伤口不愈合的危险因素,为预防该类患者术后伤口不愈合提供参考.方法 该研究纳入2013年1月-2018年1月于邯郸市中心医院行手术治疗的布鲁氏菌性脊柱炎患者94例.记录患者的基本资料及围术期相关指标.应用多因素logistic回归分析布鲁氏杆菌性脊柱炎患者术后伤口不愈合的危险因素.结果 94例患者中男54例,女40例,年龄(47.36±7.32)岁.13例(13.83％)出现术后伤口不愈合.年龄(OR:1.135,95％CI:1.032～1.248,P=0.009)、合并糖尿病(OR:9.020,95％CI:1.294～62.885,P=0.026)、手术病灶清除程度(OR:20.911,95％CI:1.908～229.141,P=0.013)和血白蛋白水平(OR:0.776,95％CI:0.664～0.907,P=0.001)是布鲁氏杆菌性脊柱炎患者术后伤口不愈合的危险因素.结论 高龄、合并糖尿病、手术病灶清除不彻底及血白蛋白水平降低是布鲁氏杆菌性脊柱炎患者术后伤口不愈合的危险因素.合理选择手术适应证是降低术后伤口不愈合发生率的关键.

目的 研究滑膜组织miR-203基因启动子区异常甲基化状态与肥胖膝关节骨性关节炎(KOA)关节液促炎因子水平相关性.方法 KOA患者滑膜组织及关节液取白2018年1月～2019年1月于河北省邯郸市中心医院行膝关节人工关节置换的36例患者,体重指数(BMI)≥28.0 kg/m2的患者纳入肥胖组(23例),18.0 kg/m2≤BMI≤23.9 kg/m2的患者纳入正常对照组(13例).甲基化特异性PCR(MSP)检测滑膜组织miR-203的基因启动子区甲基化状态.通过定量聚合酶链反应(qPCR)检测miR-203在滑膜组织的表达水平;应用qPCR检测miR-203在肥胖组和正常对照组中的表达水平;采用Pearson相关分析探讨miR-203与BMI,关节液中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)的相关性.结果 肥胖组滑膜组织中miR-203基因启动子区呈异常低甲基化状态,正常对照组则呈部分低甲基化状态.与正常对照组比较,肥胖组滑膜组织中miR-203的表达水平升高,差异有统计学意义(P＜0.05).肥胖组关节液中IL-1β、IL-6、TNFα的相对表达均高于正常对照组,差异均有统计学意义(均P＜ 0.05).miR-203基因启动子区甲基化水平与人群BMI和关节液中IL-1β、IL-6、TNF-α均呈负相关(均P＜ 0.05);miR-203表达水平和与人群BMI和关节液中IL-1β、IL-6、TNF-α均呈正相关(均P＜0.05).结论 KOA患者滑膜组织miR-203基因启动子区低甲基化与肥胖KOA患者BMI及关节液促炎因子水平密切相关,miR-203可作为肥胖KOA炎症的重要调控因素及KOA治疗的潜在靶标.

Objective:To investigate the effects of ursolic acid (UA)on xenografts growth in osteosarcoma of nude mice. Methods:Nude mice models bearing human osteosarcoma were made by injecting inoculation human osteosarco-ma cancer MG - 63 cell line and were treated with different concentrations of UA [5,10,20mg/(kg·d)]and cispl-atin (2mg/ kg)for 5 days,once a day. The histopathological changes of tumor tissue was observed by HE staining. The tumor cells apoptosis was detected by TUNEL. The expression of caspase - 3,Bax,bcl - 2 protein were detected by IHC and were semi - quantitative analyzed. Results:Compared with model group,the necrosis presentation,tumor cell shrinkage and other pathological morphological changes appeared. The number of apoptotic cells in tumor tissue of UA treated groups were significantly increased. The tumor weight were decreased and the inhibition rate were increased. The expression of Bax and caspase - 3 were significantly increased and the bcl - 2 protein was significantly de-creased,and the ratio of Bax/ bcl - 2 were significantly increased. All of the effects of UA above were dose - depend-ent with a certain. Conclusion:UA had inhibitive effects on xenografts growth in osteosarcoma cancer of nude mice perhaps through depressing apoptosis,which perhaps related to its effects of regulating the expression of apoptosis - re-lated proteins (caspase - 3,Bax,bcl - 2)and increasing the ratio of Bax/ bcl - 2.

Objective To investigate the effects and mechanism of ursolic acid( UA) on immune function of osteosarcoma cancer rats. Methods The osteosarcoma cancer rat models were conducted by injecting osteosarcoma cancer cell line UMR106 and were treated with UA 100,50,25 mg/(kg·d) and Cisplatin 2. 5 mg/(kg·d) by intraperitoneal injection for 5 d. The rats' general states and tumor growth conditions were observed,the histopathological changes of tumor tissue were observed by HE staining; he tumor weight was detected and inhibition rate was calculated, the spleen lymphocyte transformation rate was detected by MTT, the content of IL-2 and TNF-αin serum were detected, the percentage of CD4+, CD8+in blood were detected and the ratio of CD4+/CD8+ was calculated. Results The diet situation of the rats in UA treated groups were improved, tumor were reduced and hardness were less, tumor cell showed shrinkage, tissue necrosis, etc; the tumor inhibition rate were increased; the spleen lymphocyte transformation rate were significantly increased;the content of IL-2 and TNF-αin serum were significantly decreased;the CD4+percentage in blood were significantly increased, the CD8+percentage was significantly decreased, the ratio of CD4+/CD8+ in UA treated groups were significantly increased. The effect of the above mentioned effects of UA has a certain dose dependence. Conclusion UA can effectively improve the immune function of osteosarcoma cancer rat;which perhaps related to its effects of increasing the spleen lymphocyte transformation rate, reducing the content of IL-2 and TNF-α, increasing CD4+ percentages,de-creasing CD8+ percentages and raising the ratio of CD4+/CD8+.

Objective To investigate the effects of Ursolic Acid(UA) on the proliferation and apoptosis of human osteosarcoma MG-63 cells.Methods The human osteosarcoma MG-63 cells in logarithmic growth phase was treated with UA (10, 20, 40μg/mL) and Cisplatin (40μg/mL).The cellular growth inhibition rate was calculated by MTT, cell cycle and apoptosis rate were analyzed by flow cytometry, the expression of Bax mRNA and bcl-2 mRNA were detected by RT-PCR, the expression of caspase-3 protein was detected by western blotting.Results The cellular growth inhibition rate of human osteosarcoma MG-63 cell in UA treated groups were significantly increased;the G0/G1 phase of the cell cycle was prolonged and the G2/M phase was shortened, the apoptosis rate was significantly increased;the expression of Bax mRNA was significantly increased, while the expression of bcl-2 mRNA was significantly decreased, and the ratio of Bax/bcl-2 was significantly increased;the expression of caspase-3 protein was significantly increased;all of the effects above were dose-dependent with a certain.Conclusions UA can effectively inhibit human osteosarcoma MG-63 proliferation and promote it apoptosis, which perhaps related to its effects of arresting cell cycle and regulating the expression of apoptosis-related genes and proteins.

目的：探讨溃疡性结肠炎（ UC）患者的骨密度变化情况。方法选取我院2012年1月－2014年12月收治的UC患者100例作为观察组，健康体检者60例作为对照组。超声检测2组L1～L4骨密度（ BMD）。结果观察组患者骨密度降低56例（56％），骨量减少37例（37％），骨质疏松7例（7％）。观察组患者的骨密度及T值均低于对照组，差异均有统计学意义（P＜0．05）。结论 UC患者可引起BMD降低而发生骨质疏松。

目的：探讨不同固定方法对颈椎单开门椎管扩大成形术后颈椎曲度和颈椎活动度的影响。方法回顾性分析行颈后路单开门术治疗的61例脊髓型颈椎病患者资料，根据门轴固定方法分为丝线组25例、锚钉组16例和钛板组20例，评估3组患者手术疗效和术后颈椎曲度及颈椎活动度的变化。结果3组术后1年VAS评分及JOA评分均较术前明显改善（P均＜0．05）；锚钉组和钛板组术后1年VAS评分均低于丝线组（P＜0．05），但锚钉组和钛板组比较差异无统计学意义（P＞0．05）；3组间JOA评分及神经功能改善率比较差异均无统计学意义（P均＞0．05）。锚钉组和钛板组术后1年CCI、ROM均高于丝线组（P均＜0．05），二者丢失量均低于丝线组（P均＜0．05），但锚钉组和钛板组比较差异无统计学意义（P＞0．05）。结论丝线悬吊、带线锚钉和微型钛板固定临床疗效均显著，但后两者在保持颈椎曲度和颈椎活动度方面疗效更佳。

目的：探讨利伐沙班用于老年腰椎管狭窄症术后预防性抗凝的安全性和有效性。方法将71例年龄超过50岁行腰椎后路椎板减压椎弓根钉内固定术治疗的腰椎管狭窄症患者分为2组，A组41例术后口服利伐沙班， B组30例不予利伐沙班口服，评估2组手术时间、术中出血量、切口引流量、出血事件和静脉血栓事件发生情况。结果2组手术时间、术中出血量、术后引流量及出血事件发生情况比较差异均无统计学意义（P均＞0．05），但A组静脉血栓发生率明显低于B组（P＜0．05）。结论利伐沙班在显著降低老年腰椎管狭窄症患者术后静脉血栓发生率的同时，并未增加出血风险，是目前腰椎术后较理想的一种抗凝药物。

目的：分析闭合性复位股骨近端防旋髓内钉（ PFNA）固定治疗老年股骨转子间骨折围手术期的隐性失血原因和防治措施。方法对82例采用PFNA固定方案治疗的老年股骨转子间骨折病例进行回顾性研究，根据身高、体质量及手术前后红细胞比容，应用Gross方程计算失血总量和隐性失血量。结果围手术期失血总量（489．32±6.41）mL，显性（术中）失血量（78．24±8．98）mL，隐性失血量（412．63±5．27）mL，隐性失血占失血总量的（84．33±1．24）％。结论围手术期隐性失血量远远超过术中出血量。在评估出血量时要充分考虑隐性失血，并注意监测血常规。

腰椎管狭窄症的手术治疗，国内长期采用后路椎板减压椎弓根钉棒固定（坚强固定）植骨融合术，其疗效确切，但可导致邻近节段退变加快[1]，近年来改进的椎弓根螺钉加弹性棒固定（弹性固定）技术已取得良好疗效。笔者对51例腰椎管狭窄症病例进行了回顾性研究，介绍如下。