目的:探讨经伤椎椎弓根螺钉固定治疗脊柱骨折的疗效及对患者疼痛、Cobb角的影响.方法:选择2013年2月至2018年2月我院接诊的脊柱骨折患者80例作为研究对象,以随机数表法分为观察组(n=41)和对照组(n=39).对照组采用跨伤椎固定治疗,观察组采用经伤椎椎弓根螺钉固定治疗.比较两组患者临床手术指标、日本骨科协会评估治疗(JOA)评分、视觉模拟评分(VAS)、椎体压缩率、Cobb角水平及伤椎椎体高度.结果:观察组患者手术时间、术中出血量及住院时间均显著低于对照组(P＜0.05);治疗后,两组患者JOA评分、VAS评分均明显改善(P＜0.05),且观察组患者VAS评分显著低于对照组(P＜0.05);治疗后,两组患者椎体压缩率、Cobb角水平均明显改善(P＜0.05),且观察组患者椎体压缩率、Cobb角水平显著低于对照组(P＜0.05);两组患者治疗前椎体前、后缘高度无明显差异;治疗后,两组患者椎体前、后缘高度均明显改善(P＜0.05),且观察组患者椎体前、后缘高度显著高于对照组(P＜0.05).结论:脊柱骨折患者采用经伤椎椎弓根螺钉固定治疗栓效果显著,可改善患者疼痛、Cobb角水平,值得临床推广.

目的 探讨颅骨牵引复位配合颈前路减压融合术治疗下颈椎骨折脱位合并关节突绞锁的临床效果.方法 选取解放军总医院第八医学中心2015年1月～2018年1月收治的下颈椎骨折脱位合并关节突绞锁患者96例,根据随机数字表法将所有患者分为对照组和研究组,每组各48例.研究组给予颅骨牵引复位配合颈前路减压融合术治疗,对照组给予前路撑开撬拨复位固定,比较两组患者临床疗效、患者恢复情况、脊髓神经功能、围术期指标,记录两组术后并发症发生情况.结果 研究组总有效率明显高于对照组(P＜0.05).两组术后1年感觉功能、运动功能评分均升高,且研究组高于对照组(P＜0.05).研究组手术时间短于对照组,术中出血量少于对照组(P＜0.05).研究组术后美国脊髓损伤协会(ASIA)分级评分高于对照组(P＜0.05).研究组并发症发生率显著低于对照组(P＜0.05).结论 下颈椎骨折脱位合并关节突绞锁患者经颅骨牵引复位配合颈前路减压融合术治疗效果显著,可有效改善脊髓神经功能,降低并发症的发生.

Epigallocatechin‑3‑gallate (EGCG) is a polyphenolic compound extracted and isolated from green tea, which has a variety of important biological activities in vitro and in vivo, including anti‑tumor, anti‑oxidation, anti‑inflammation and lowering blood pressure. The aim of the present study was to investigate the protective effect of EGCG against secondary osteoporosis in a mouse model via the Wnt/β‑catenin signaling pathway. Reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and western blotting were used to analyze runt‑related transcription factor 2 and osterix mRNA expression, and the protein expression of cyclin D1, Wnt and β‑catenin, and suppressed peroxisome proliferator‑activated receptor γ protein expression. The protective effect of EGCG against secondary osteoporosis was examined and its potential mechanism was analyzed. Treatment with EGCG significantly decreased serum calcium, urinary calcium, body weight and body fat, and increased leptin levels in mice with secondary osteoporosis. In addition, EGCG treatment significantly inhibited the structure score of articular cartilage and cancellous bone in proximal tibia metaphysis in mice with secondary osteoporosis. Treatment also significantly decreased alkaline phosphatase activity, runt‑related transcription factor 2 and osterix mRNA expression. EGCG also significantly induced the protein expression of cyclin D1, Wnt and β‑catenin, and suppressed peroxisome proliferator‑activated receptor γ protein expression in mice with secondary osteoporosis. Taken together, these results suggest that EGCG may be a possible new drug in clinical settings.

Modern pharmacological studies revealed that Celastrol exhibits anti‑inflammation, anti‑bacteria, anti‑virus, anti‑fertility, insect‑resistance functions and has been used for the treatment of rheumatism, rheumatoid arthritis, blood diseases, skin diseases and agricultural insecticide. The present study aimed to investigate the effects of Celastrol on glucocorticoid‑induced osteoporosis (GIOP) and the underlying molecular mechanisms. The findings of the current study revealed that Celastrol reduced body weight, urine calcium/creatinine, tartrate‑resistant acid phosphatase 5b, C‑terminal telopeptide of type I collagen, and induced osteocalcin in GIOP rats. In addition, alkaline phosphatase, triiodothyronine receptor auxiliary protein and cathepsin K mRNA expression levels were effectively suppressed, and osteocalcin, bone morphogenetic protein 2, type I collagen and runt‑related transcription factor 2 mRNA expression levels were effectively induced in osteoporosis rats treated with Celastrol. Celastrol inhibited prostaglandin E2 and caspase‑3 protein expression levels, and induced phosphoinositol 3‑kinase (PI3K), phosphorylated‑protein kinase B (AKT) and glycogen synthase kinase‑3 phosphorylation, Wnt and β‑catenin protein expression in GIOP rats. The present study demonstrated that Celastrol may inhibit GIOP in rats via the PI3K/AKT and Wnt signaling pathways.

Objective To observe the clinical effect of Expert A2FN treating the adult femoral shaft fractures and evaluate its clini-cal value. Methods From May 2010 to May 2014, there were 23 adults of femoral shaft fractures treated by Expert A2FN internal fixa-tion in our hospital, 15 men and 8 women, aged 19-58 years, mean 37. 27 ± 10. 34 years old. Patients were followed up 3-28 months, an average of 15 months. Results Totally 23 patients had been followed up, fracture healing normally, no incision and bone infection, no broken nails and nail back phenomenon, no limb vascular thrombosis, muscle atrophy and joint dysfunction, etc. Conclusion Expert A2FN is an ideal treatment for adult femoral shaft fractures. It has small surgical trauma, less bleeding, short period and high fracture healing rate significantly.

Objective To evaluate the clinical results of one-stage artiifcial humeral head replacement in the treatment of comminuted proximal humeral fractures in the elderly. Methods From December 2010 to October 2014, 19 patients with comminuted proximal humeral fractures were adopted and treated, whose mean age was 71.3 years old ( range:63-85 years ). There were 8 cases of Neer 3-part fractures and 11 cases of Neer 4-part fractures, accompanied by dislocation of the humeral head in 7 cases, brachial plexus injuries in 3 cases, ipsilateral distal radius fractures in 2 cases and ipsilateral femoral neck fracture in 1 case. Hypertension was noticed in 15 cases, type II diabetes in 13 cases and old and lacunar cerebral infarction in 6 cases. All the patients underwent humeral head replacement using the same prostheses of Bigliani/Flatow type produced by Zimmer company at 3-7 days after injuries. Early functional exercise was carried out after the surgery according to the Neer rehabilitation principles. The average follow-up time was 16.3 months. Pain severity and range of motion ( ROM ) of the joint were recorded, as well as the complications of dearticulation, prosthetic loosening and periprosthetic joint infections. The postoperative functions were evaluated according to the Constant-Murley scoring system. Results Fifteen patients had no pain and 4 patients had mild pain. No dearticulation, prosthetic loosening or periprosthetic joint infections were found. The mean postoperative functional score was 70.1, and the rate of subjective satisfaction was 78.9%. Conclusions Artiifcial humeral head replacement is a good choice in the treatment of comminuted proximal humeral fractures in the elderly, which can quickly relieve pain and restore joint function. There are many key factors that cannot be ignored, namely surgical indications, timing and techniques, functional exercise, etc.

目的 设计一种新型经椎弓根螺钉动力内固定系统,并测试其对失稳腰椎的稳定性效果及对相邻节段的作用.方法 1采用6具人新鲜尸体腰椎标本,测试各个节段的活动度,为新型动力内固定系统的设计提供参数支持.2以钛合金棒、钛缆和钛合金碟片弹簧为主要结构,根据正常腰椎各节段的活动度,参照文献报道的相关测试结果,设定动态连接棒屈曲范围0～10°,旋转范围0～5°,并对其进行了相关力学测试.3制作腰椎失稳模型,测试新型动力内固定系统固定后失稳腰椎固定节段及相邻节段的运动范围(ROM)和中性区(NZ),并与坚强固定对比,同时测定其上邻节段软骨终板下压力,探讨其稳定性及对相邻节段的作用.结果 与完整脊柱相比,新型动力内固定系统固定后屈伸和侧屈方向的ROM和NZ较完整脊柱减小(P＜0.05),但旋转方向的ROM和NZ与完整脊柱无显著性差异(P＞0.05).与坚强固定组相比,新型动力内固定组三个主方向的ROM和NZ均显著增加,差异有显著性意义(P＜0.01).疲劳试验后的结果表明,固定节段在三个主方向上的ROM和NZ均较疲劳前显著增加(P＜0.05),但与失稳脊柱相比,差异仍具有显著性意义,与完整脊柱相比,动力内固定屈伸方向的ROM和NZ仍较小,两组相比差异显著(P ＜0.05),侧屈与旋转方向的ROM和NZ与完整脊柱无显著性差异(P＞0.05).结论 新型动力内固定系统可控性强、可靠性好、能够提供足够的活动度.新型动力内固定系统能对失稳腰椎提供各方向上的稳定性,尤其对前屈后伸的稳定效果最好,疲劳试验后也能提供足够的稳定性.相邻节段的ROM和上邻节段终板下压力与固定方式无显著相关.

Objective: To evaluate the preparation and application effect of K-shaped titanium mesh in anterior cervical fusion. Methods:Degenerative cervical spondylosis cases were analyzed statistically, including simple cervical discherniation, discherniation associated with ossification of posterior longitudinal ligament, double segment lesions, three segmental lesions cases. All patients were in X-ray and MRI to exclude fracture or dislocation before the surgery. Surgical subtotal vertebral nerve decompression was put into use, and k-shaped titanium mesh airfoil support plus titanium screw to fixation. Results:The 23 cases patients in this group were followed up with the rate of 74.2%from 6 to 33 months, and with average of 15 months. Bone fusion time averaged to 6 months, with the fusion rate of 100%.Postoperative X-ray examination showed no built-in objects loose, prolapse or settlement. Conclusion: K-shaped titanium implants with titanium screw fixation to obtain subtotal vertebral cervical spine immediately after the strong stability, could avoid the shift, extrusion and sedimentation of the inside plant, with high security surgery. And the K-shaped titanium mesh was prone to preparation.

Objective To summarize the successful treatment of non-invasive lower extremity fascial space infection.Methods From June 2005 to June 2012,we treated 13 cases of patients with non-invasive leg fascial space infection.We cleared the abscess and placed VSD drainages in the wound cavities.After surgery,based on the results of bacteriological culture and drug sensitivity testing,we gave them the anti-infective therapies and nutrition support therapies,and we observed the treatment effects and recurrences.Results All 13 patients were followed up for 10 to 24 months,and the patients′wounds healed without recurrence after surgery.Conclusion In the surgical treatment of non-invasive lower extremity fascial space infections,completely clear the abscess was a basis,deep(continuous,long time,unobstructed) drainage was a key,using of sensitive drugs created a condition,and the nutritional support was a guaranty for all the successful treatments.

Objective To observe the clinical effect and analysis of indicators by only anterior,only posterior or combined anterior and posterior approach for the treatment of thoracic and lumbar tuberculosis.Methods From June 2001 to June 2011,107 patients with thoracic and lumbar tuberculosis were treated in our department with a debridement and reconstruction of spinal stability,respectively by only anterior,only posterior or combined anterior and posterior approach.We observed its clinical therapeutic effect and analyzed those indicators relating operations by following up 3-36 months.Results In the operation cure rate,recurrence rate,and improved neurological function,there was no statistical difference between three kinds of operation.In the correction of deformity,there was only anterior <only posterior or combined anterior and posterior approach,and no statistically significant difference was found between the latter two.In the postoperative orthopedic angle loss.There was combined anterior and posterior approach <only posterior < only anterior.While in operation time,intraoperative blood loss,postoperative complications and total medical costs.There was only posterior < only anterior < combined anterior and posterior approach.Conclusion Three different operation approach for the treatment of thoracic and lumbar tuberculosis can achieve good clinical results,but there is the more complex surgical operation,the more postoperative complications,and the higher medical costs by only anterior or combined anterior and posterior approach.From the short-term clinical findings,the operation type by only posterior approach is the more advantages and more selective,but the long-term effects need further observation.

OBJECTIVETo evaluate the effectiveness of open reduction and internal fixation and repair of palmar ligment in treating trans-scaphoid perilunate dislocation.METHODSFrom June 1995 to June 2001,14 patients with trans-scaphoid perilunate dislocation were treated with open reduction and internal fixation and repair of palmar ligment. Among them,there were 13 males and 1 female,the ranging in age from 21 to 38 years,averaged 25.4 years. All patients were posterior dislocation and all operations were performed within 2 weeks after injury.RESULTSAll patients were followed up from 24 to 60 months with an average of 28.3 months. Thirteen scaphoid fractures were primary healed and functions of wrist joint were good. Bone disunion was found in 1 case and part functions of wrist joint were limited. No found necrosis of lunate and scaphoid. According to clinical scoring system of Cooney, 9 case got excellent results, 3 good, 1 fair and 1 poor.CONCLUSIONOpen reduction and internal fixation and repair of palmar ligament is effective in treating trans-scaphoid perilunate dislocation,which can early provide steady fixation for scaphoid,and profit to recover blood supply of lunatum and subterminal scaphoid.

Objective To observe and analyze the vacuum sealing drainage technology in the debridement surgery of lumbar spinal tuberculosis and study the clinical effect of treatment.Methods From may 2007 to may 2010,33 lumber tuberculosis patients underwent debridement by extraperitoneal or transpedicle,and were continuing attracted for 7 to 10 days using vacuum sealing drainage.Then the treatment effect and recurrence were observed.Results All of 33 cases using vacuum sealing drainage postoperative had a healing wound.During the following up for 3 to 28 months,no recurrence of tuberculosis lesions was found.Conclusion The vacuum sealing drainage technology is an important supplementary means in the surgical treatment of lumber tuberculosis.Its role of emptying the promotion of inflammatory effusion,wound healing and preventing recurrence can not be ignored.

Objective To study the application of vacuum sealing drainage(VSD) in treatment of spinal sinus tract tuberculosis accompanying infection.Methods Foci of spinal sinus tract tuberculosis accompanying infection in 20 patients admitted to our department in March 2006-April 2009 were removed and washed with placement of VSD.The VSD was pulled out and the patients were given anti-infection and anti-tuberculosis treatment after operation.The wound was closed after 10 days.Results The wound was healed quite well.The patients were followed up for 12-36 months(mean 24 months) during which no formation of sinus tract was observed in all patients.After closure of the sinus tract,the tuberculosis foci were removed with different procedures,internal fixation of the fractures was performed according to their different sites,and the spinal tuberculosis was then healed.Conclusion VSD is a simple,pain-free and efficacious procedure for spinal sinus tract tuberculosis accompanying infection with a rather good therapeutic effect,thus providing the preparation of operation for the treatment of sinus tract formation and relapsed spinal sinus tract tuberculosis due to the rupture of abscess.

【Objective】 To evaluate the value of clavicular amputation in the excision of neurilemmoma of brachial plexus.【Methods】 A retrospective analysis of 21 cases of brachial plexus schwannoma from 1999 to 2009 we treated in surgery,of which nine cases using the traditional means of exposure,the others using the clavicular amputation during the surgical exposure.【Results】 There were 16 cases of the patients were followed up,the rate was 76%,the follow-up time was 3 months to 7 years.During this period,all patients were no recurrence.In traditional means of brachial plexus revealed,two of nine cases(22%) with varying degrees of postoperative pain and numbness of the upper limb,the one with the healing of the incision,his neurological symptoms gradually reduced,and was a complete remission in 3 weeks;another one with a long-term drug treatment and physical rehabilitation,his neurological symptoms recovered slowly,and remaining limb C6 and C7 innervated skin numbness symptoms for all time.However,with the expanded exposure of clavicular amputation 13 cases of the patients had no any neurological dysfunctions.【Conclusion】 Surgical resection is an indispensable means in the treatment of neurilemmoma of brachial plexus,clavicular amputation can expand the surgical view and fully expose the tumor,which is an important condition to ensure a complete resection of tumor and to prevent an intraoperative injury of brachial plexus.

Objective Of analysis of thoracic and lumbar tuberculosis by one-stage anterior debridement and a fusion fixation failure.Methods From January 2006 to January 2011,11 cases of thoracic and lumbar tuberculosis by anterior debridement and a fusion with fixation failure to our hospital and retreated patients,including 7 cases of secondary surgery in our hospital renovation and posterior pedicle screw system fixation reconstruction of spinal stability.Results After the second thoracic and lumbar spine surgery renovation and reconstruction of the 7 patients with full clinical recovery,follow-up of 6 months to 2 years,no recurrence of tuberculosis,sinus formation and fixation failed again and so on.Conclusion Thoracic and lumbar tuberculosis by anterior debridement and a fusion with internal fixation have a failure rate(3.7%,our hospital statistics).There is a clear correlation between success or failure of internal fixation and Surgeon′s techniques.Such a difficult surgery should be highly trained senior doctors to complete.The failure of internal fixation should be promptly renovated,and pedicle screw fixation has obvious advantages in the second reconstruction of spinal stability.

Objective To evaluate the clinical effect of the vacuum sealing drainage technology in the debridement surgery of sacroiliac joint tuberculosis with large lumbosacral abscesses.Methods From october 2005 to october 2010,17 sacroiliac joint tuberculosis patients with large lumbosacral abscess underwent debridement using vacuum sealing drainage and after that they were continuing attracted for 7 to 10 days.Patients situation were observed in the hospital after treatment.Results 17 patients were followed up for 6 to 38 months.All the patients healed.There was no postoperative recurrence of tuberculosis.Conclusion In surgical removal of lesions on sacroiliac joint tuberculosis with large lumbosacral abscess,the continued application of vacuum sealing drainage(VSD) can create a clean cavity,and ensure wound healing and prevent recurrence.It expands technological space and has a great value in the clinical treatment of bone and joint tuberculosis.

Objective To analyze and compare Kirschner wire and Cable-pin in the treatment of patellar fracture in clinical effect and application value. Methods From December 2006 to December 2009,107 cases of patellar fracture patients admitted to our hospital were treated with Kirschner wire (68 cases) and Cable-pin surgical treatment (39 cases).The fracture type, operation time, blood loss, hospital stay, medical costs, postoperative complications and long-term recovery of knee function in the two groups were recorded and analyzed by software SPSS11.0.Results 107 patients were followed up for 3~21 months with an average time of 14.2 months.The operation time and bleeding volume of Cable-pin treatment group were less than those of Kirschner wire treatment group (P<0.05), but the medical cost was much higher than the latter (P<0.01). Postoperative complications, hospital stay, fracture healing time and long-term knee function recovery between the two groups had no significant difference. Conclusion Surgical treatment of patellar fracture with Kirschner wire is a more extensive, flexible and effective method.Cable-pin is simple, effective and reliable, but only applies to transverse patellar fracture, and also is expensive,and so it has some limitations in clinical application.

Objective To establish a three-dimensional finite element model and make mechanical analysis of "V"-type atlantoaxial reduction and internal fixation. Methods According to "V"-type atlantoaxial and internal fixation,based on screw-type Ⅱ design parameters,and using Pro/E 2001 and MSC.Patran 2005 software,we set up a finite element model and calculated the region containing the node scope of the force as the sites binding and 100N mechanics adding. Results The model looked realistic,geometric similarity.The deformation stress field mainly concentrated in the reset device V-tip arm bending and stability.The strength of its maximum stress was 4.78MPa,and the scope had 2794 nodes.V-type wing of the acute angle point of convergence of the premises to bear the stress intensity followed.It was 0.31MPa,and the scope had 1953 nodes.V-type wing by the end of edge was the smallest for the 1.22×10-3MPa,and there was the scope of 1730 nodes. Ⅱ-shaped fixed nail stress concentrated at the central parts of tooth and the art on both sides of teeth,with maximum stress intensity of 1.68×10-2MPa,and there was the scope of 1146 nodes. Conclusion The reduction and fixation devices to load at the time of recovery deformation forces and mechanical characteristics adapted to Ni-Ti shape memory alloy material functions and super-elasticity completely,which meets the clinical needs.

目的 分析比较Kirschner wire和Cable-pin在髌骨骨折治疗中的临床效果和应用价值.方法 回顾2006年12月～2009年12月间笔者医院收治的107例髌骨骨折病人,分别用Kirschner wire和Cable-pin手术治疗68例和39例,记录两组病人的骨折类型、手术历时、术中出血量、住院日、医疗费用、术后并发症及远期膝关节功能恢复情况,应用SPSS11.0软件对观察指标进行统计学分析.结果 107例病人全部获得随访,随访时间为3～21个月,平均14.2个月.Cable-pin治疗组患者的手术历时和术中出血量均明显少于Kirschner wire治疗组(P<0.05),但医疗费用远高于后者(P<0.01).两组病人术后并发症、住院日、骨折愈合时间和远期膝关节功能恢复情况无统计学差异.结论 应用Kirschner wire手术治疗髌骨骨折更为广泛,方法灵活且疗效肯定,是一种性价比较高的治疗方法;Cable-pin操作简单、疗效可靠,但仅适用于横断性髌骨骨折,且医疗费用昂贵,在临床应用中有一定局限性.