Aim: The aim of this study is to examine the role of the microrchidia (MORC) family, a group of chromatin remodeling proteins, as the therapeutic and prognostic markers for colorectal cancer (CRC). Background: MORC protein family genes are a highly conserved nucleoprotein superfamily whose members share a common domain but have distinct biological functions. Previous studies have analyzed the roles of MORCs as epigenetic regulators and chromatin remodulators; however, the involvement of MORCs in the development and pathogenesis of CRC was less examined. Objective: The current work examined the role of the MORCs as the therapeutic and prognostic markers for CRC. Methods: The expressions and prognostic significance of MORC family genes in CRC were explored. The role of these genes in tumor immunity was comprehensively analyzed in terms of their functions in immune cell infiltration, tumor microenvironment (TME), and their interaction with immune regulatory genes such as immunosuppressive genes, immune checkpoints and immunostimulatory genes. The relations between MORC family genes, tumor mutation burden (TMB), DNA, mismatch repair (MMR), RNA methylation, microsatellite instability (MSI), and drug sensitivity were investigated using the R statistical software. The expressions of MORC4 in 150 CRC tissues and 60 paracancer tissues were detected by immunohistochemical method. CRC cell proliferation, migration, and invasion were measured by cell counting kit-8 (CCK-8), scratch assay, and transwell cell invasion assay. Results: The expressions of MORC2 and MORC4 were significantly upregulated, whereas those of MORC1 and MORC3 were noticeably downregulated in CRC in comparison to their expressions in normal colorectal mucosal tissues. Patients with high-expressed MORC2 showed a more unfavorable prognosis than those with a low MORC2 level. Functional annotation analysis identified 100 MORC family genes with the most significant negative or positive correlations to diabetic cardiomyopathy, amyotrophic lateral sclerosis, oxidative phosphorylation, Huntington’s disease, thermogenesis, Parkinson’s disease, olfactory transduction, Alzheimer’s disease, prion disease. MORC3 expression was positively correlated with Stromal score, Immune score and ESTIMATE score, while MORC2 expression was negatively related to the three scores in CRC, these correlations were not statistically significant. Additionally, the MORC family genes were significantly positively correlated with tumor-infiltrating immune cells such as T helper cells and exhibited close relations to some immunosuppressive genes such as CXCR4 and PVR, immunostimulatory genes such as TGFBR1, KDR, and CD160 as well as some immune checkpoint genes. It was found that the expressions of some members of MORC family genes were positively correlated with DNA methylation, MSI, TMB, MMRs, and drug sensitivity in CRC and that the mRNA and protein levels of MORC4 were remarkably upregulated in CRC tissues than in adjacent normal tissues (P<0.05). In the MORC4 knockdown group, DLD-1 cell proliferation was more inhibited than in the negative control (NC) and siRNA groups (P<0.05). Furthermore, the migratory capacity of DLD-1 cells and the number of cells crossing the basement membrane in the MORC4 knockdown group were reduced compared to the NC and siRNA groups (all P<0.05). Conclusion: The expressions of MORC family genes were significantly different in CRC samples, which was related to the immune cell infiltration and prognosis of CRC. Thus, the MORC family genes were considered as markers for indicating the clinical immunotherapy and prognostic outcome of CRC.

目的:探讨甘草甜素调控miR-4651表达对多发性骨髓瘤RPMI8226细胞增殖、凋亡的影响机制.方法:将多发性骨髓瘤RPMI8226细胞随机分为对照组、甘草甜素低、中、高浓度组、miR-4651组、miR-NC组、甘草甜素+anti-miR-4651组、甘草甜素+anti-miR-NC组;用四甲基偶氮唑盐比色法(MTT)检测细胞增殖抑制率,流式细胞仪检测细胞凋亡,实时荧光定量聚合酶链式反应(RT-qPCR)检测miR-4651表达水平.结果:与对照组比较,甘草甜素低、中、高浓度组骨髓瘤RPMI8226细胞增殖抑制率、细胞凋亡率和miR-4651表达水平均逐渐升高(P＜0.05),呈剂量依赖性.上调miR-4651表达后,骨髓瘤RPMI8226细胞增殖抑制率和细胞凋亡率均升高(P＜0.05),而抑制miR-4651的表达则逆转了甘草甜素对骨髓瘤RPMI8226细胞增殖和凋亡的作用.结论:甘草甜素通过上调miR-4651表达可抑制多发性骨髓瘤RPMI8226细胞增殖,促进细胞凋亡.

目的 探讨ADP核糖基化因子的GTP酶激活蛋白1(ASAP1)、肌动蛋白束蛋白1(FSCN1)在胃癌中的表达、预后相关性.方法 运用UALCAN、Kaplan-Meier数据库分析ASAP1、FSCN1在胃癌组织与正常胃黏膜组织中的表达与患者预后的关系,并采用qRT-PCR、免疫组化验证ASAP1、FSCN1在胃癌与癌旁的表达差异.结果 与正常胃黏膜组织相比,ASAP1、FSCN1在胃癌组织中表达升高(P＜0.01),且ASAP1、FSCN1高表达组患者的总生存率下降(P＜0.05).qRT-PCR显示胃癌中ASAP1、FSCN1 mRNA的表达水平高于癌旁正常黏膜组织(P＜0.05).免疫组化结果显示,胃癌ASAP1、FSCN1阳性表达率高于癌旁正常胃黏膜组织,差异均有统计学意义(P＜0.05).ASAP1 mRNA和FSCN1 mRNA的表达成正相关(r=0.558,P=0.000).ASAP1、FSCN1的表达与胃癌浸润深度、淋巴结转移及远处转移相关(P＜0.05).Kaplan-Meier生存分析发现,ASAP1、FSCN1阴性表达总体生存率高于阳性表达(P＜0.05).结论 ASAP1、FSCN1在胃癌组织中均高表达,2者可能协同促进胃癌的发生和发展,且在胃癌的浸润、转移中发挥了重要作用.

目的 探讨染色质重塑蛋白家族CW型锌指结构蛋白4(MORC4)在结直肠癌(CRC)中的表达及其对CRC细胞生物学行为的影响.方法 收集2018年1月至2019年2月台州市第一人民医院经手术切除的CRC组织及癌旁组织,选择CRC细胞系(HCT-15、SW480、SW620、DLD-1、HCT116)和人结肠上皮细胞株(NCM460).采用qRT-PCR方法检测80例CRC组织及其相应的癌旁组织中MORC4 mRNA的表达.采用免疫组化法检测150例CRC组织及60例癌旁组织中MORC4蛋白表达情况,分析MORC4蛋白高表达与患者临床病理特征的关系.绘制Kaplan-Meier生存曲线分析MORC4蛋白表达与CRC患者预后关系.选择MORC4 mRNA表达水平较高的DLD-1细胞为研究对象,构建MORC4敲低细胞DLD-1(敲低组)及空白对照组、阴性对照组,采用细胞增殖/凋亡检测(CCK-8)法、划痕实验及Transwell细胞侵袭实验检测CRC细胞的增殖、迁移及侵袭情况.结果 相比癌旁组织,CRC组织中MORC4 mRNA表达水平及MORC蛋白表达率均显著升高(均P＜0.05).不同性别、年龄、肿瘤位置(左右侧)、肿瘤直径、T分期的患者CRC组织MORC4蛋白高表达率比较,差异均无统计学意义(均P＞0.05);不同分化程度、淋巴结转移情况、远处转移情况、肿瘤-淋巴结-转移分期及血清癌胚抗原水平的患者CRC组织MORC4高表达率比较,差异均有统计学意义(均P＜0.05).与MORC4低表达患者相比,MORC4高表达患者预后更差(P＜0.01).相比空白对照组和阴性对照组,敲低组细胞24、48、72 h增殖能力均显著降低,迁移能力显著降低,穿基底膜细胞数量明显减少(均P＜0.05).结论 CRC患者MORC4表达上调与不良预后相关,MORC4可能是CRC的一个预后标志物,敲低MORC4可抑制CRC细胞增殖、迁移和侵袭.

Background:Gastric cancer (GC) represents a universal malignant tumor of the digestive system. Stromal and immune cells belong to two main nontumor components exerting a vital function in the tumor microenvironment.Methods:Based on TCGA database, this study downloaded clinical information and gene profiles of GC. The ESTIMATE algorithm was adopted for evaluating the score of immune-infiltrating cells. This work employed Sangerbox to explore the differentially denoted genes (DEGs) related to stromal, immunity, and prognosis. Besides, the STRING database was involved in order to detect the association among the proteins. The MCODE module of Cytoscape software was used to screen key genes. Oncomine and GEPIA databases were used, aiming to study the differences in key genes in healthy gastric mucosa and GC. At last, we adopted TISDIB and TIMER databases for analyzing the association of guanine nucleotide binding protein subunit-4 (GNB4) between gastric cancer and tumor immune cells. qRT-PCR was applied for exploring differential GNB4 expression between GC and normal gastric mucosa and investigating the relation of GNB4 with tumor-infiltrating lymphocytes (TILs).Results:Patients undergoing a great stromal score exhibited worse prognostic outcome, and cases having a low immune score had better prognosis. Overall, altogether 656 genes were upregulated with 5 genes being downregulated, which were matrix immune-related differential genes. Furthermore, 18 genes were screened as hub genes on the basis of the univariate Cox risk model of TCGA database (82 differential genes predicted poor GC survival). Oncomine and GEPIA databases revealed that GNB4 expression in gastric cancer was obviously higher in comparison with that in normal gastric mucosa. The GSEA, TISDIB, and TIMER databases revealed that GNB4 is involved in various tumor signal pathways and immune and metabolic processes. qRT-PCR demonstrated that GNB4 expression in gastric cancer was notably higher in comparison with that in normal gastric mucosa, showing significant association with matrix TILs.Conclusion:The selected key gene GNB4 is a potential biomarker to guide the immunotherapy of gastric cancer.

目的 构建提高临床自体输血率的有效管理模式.方法 从该院患者、医务人员和医院制度建设三个方面进行研究,查找自体输血推广的难点和障碍,提出相应改进措施,形成自体输血管理的有效模式.结果 2017年该院自体输血率为14.73％,项目启动后,自体输血率为35.45％(2018年)及40.55％(2019年),明显高于2017年(P＜0.05).其中,2019年神经外科与脊柱外科自体输血率分别达到67.4％、61.2％.结论 通过构建有效的自体输血管理模式,可推进临床自体输血应用,提高输血安全性,节约宝贵的血液资源,缓解临床用血紧张;提升医患认同感,推动医院临床用血合理水平与输血病历质量稳步提升.

Objective:To investigate the levels and significance of bone alkaline phosphatase(BALP) and cross-linked N-telopeptides of type I collagen (NTX) in patients with diabetic foot osteomyelitis(DFO).Methods:From October 2017 to June 2020, 139 patients with diabetic foot (DF) who were diagnosed and treated were selected as research objects. According to whether DF patients complicated with osteomyelitis, they were divided into non osteomyelitis group (n=59) and osteomyelitis group (n=80). The clinical data of the two groups were compared. The levels of serum BALP and NTX were detected by enzymelinked immunosorbent assay (ELISA), receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of serum BALP and NTX for DFO, and Multivariate Logistic regression analysis was used to analyze the influencing factors of DFO.Results:The glycosylated hemoglobin, WBC count, serum BALP and NTX levels in osteomyelitis group were significantly higher than those in non osteomyelitis group(P<0.05). There were no significant differences in age, male/female ratio, course of diabetes, proportions of diabetic nephropathy, proportions of ulcer history, proportions of coronary heart disease and proportions of hypertension (P>0.05); the area under the curve (AUC) of serum BALP and NTX in the diagnosis of DFO was 0.836 and 0.863, the cut-off value was 99.98 mmol/L and 9.45 nmol BCE/μM Cr, respectively, the corresponding sensitivity was 78.8%, 75.0% and the specificity was 84.3% and 88.1%, respectively. The AUC of combined diagnosis was 0.908, and the sensitivity and specificity were 91.3% and 83.1% respectively; WBC count, BALP and NTX were risk factors of DFO (P<0.05).Conclusions:The levels of serum BALP and NTX in patients with DFO are significantly increased, and both of them may play an important role in the pathogenesis of DFO. BALP combined with NTX can improve the diagnostic value of DFO, which is helpful for clinical screening of DFO patients.

目的 分析 Ⅱ 型胶原 C 端肤(C-terminal cross-linking telopeptide of type Ⅱ collagen,CTX-Ⅱ)、组织基质金属蛋白酶抑制剂1(Tissue inhibitor of matrix metalloproteinase 1,TIMP-1)在化脓性关节炎患者血清中表达情况,探讨二者与化脓性关节炎预后相关性.方法 回顾性分析自2017-01-2019-12诊治的65例化脓性关节炎(化脓性关节炎组)、64例单纯关节炎(骨关节炎组)与65例健康体检者(对照组),并将治愈、显效、有效的患者定义为预后良好组,治疗无效患者定义为预后不良组.比较各组间血清CTX-Ⅱ、TIMP-1、人C-反应蛋白(C-reactive protein,CRP)及全血中红细胞沉降率(Erythrocyte sedimentation rate,ESR)水平,分析化脓性关节炎患者血清CTX-Ⅱ、TIMP-1水平与ESR、CRP水平的相关性,分析血清CTX-Ⅱ、TIMP-1对化脓性关节炎患者预后不良预测价值.结果 194例均顺利完成检查.化脓性关节炎组与骨关节炎组血清CTX-Ⅱ、TIMP-1、CRP及ESR水平较对照组高,化脓性关节炎组血清CTX-Ⅱ、TIMP-1、CRP及ESR水平较对照组高,预后良好组化脓性关节炎患者治疗后血清CTX-Ⅱ、CRP及ESR水平较预后不良组低,TIMP-1水平较预后不良组高,差异有统计学意义(P＜0.05).化脓性关节炎组血清CTX-Ⅱ与CRP、ESR水平呈正相关,TIMP-1与CRP、ESR水平呈正相关(P＜0.05).血清CTX-Ⅱ、TIMP-1联合预测化脓性关节炎患者预后不良曲线下面积为0.924,敏感度为91.30％,特异度为80.95％.结论 CTX-Ⅱ、TIMP-1在化脓性关节炎患者血清明显高表达,与患者疾病严重程度有关,可能作为预测化脓性关节炎患者预后不良潜在的标志物.

目的 探讨原发性肝癌(PLC)组织中骨形态发生蛋白(BMP)-4表达情况及其与PLC临床病理特点及预后的关系.方法 选择2012年1月至2017年12月该院收治的70例PLC患者的肝癌组织及癌旁组织标本进行研究.采用免疫组织化学法测定肝癌组织和癌旁组织中BMP-4表达.结果 肝癌组织BMP-4阳性率高于癌旁组织(P<0.05).肿瘤中低分化、TNM分期Ⅲ ～ Ⅳ期、有淋巴结转移患者BMP-4阳性率高于高分化、TNM分期Ⅰ ～ Ⅱ期、无淋巴结转移者(P<0.05),BMP-4阳性率与患者年龄、性别、甲胎蛋白(AFP)、HBsAg、肿瘤大小、门静脉癌栓无关(P>0.05).PLC组织中BMP-4低表达患者的生存时间高于BMP-4高表达患者(P<0.05).结论 PLC组织BMP-4高表达,与PLC病情及预后相关.

目的 探讨3D打印结合微创钢板内固定技术治疗胫骨远端骨折的临床疗效.方法 选取2017年1月—2017年10月于武汉科技大学附属普仁医院骨科确诊的闭合性胫骨远端骨折患者24例,按照随机数字表法将其分为3D微创组和常规微创组;患者均行胫腓骨下段CT扫描.3D微创组数据以医学数字成像及通信格式输出,数据经Mimics软件处理后输入3D打印机,制作出与骨折部位比例1:1的骨折模型,术前模拟复位,制定个性化手术方案;常规微创组按常规MIPPO技术行骨折内固定术.比较两组患者手术时间、术中出血量、术中透视次数;采用Burwell-Charnley标准评价骨折复位情况;采用AOFAS踝关节评分系统评价患者术后12个月踝关节功能恢复情况.结果 两组Burwell-Charnley影像学评价比较,差异无统计学意义(P>0.05);3D微创组手术时间、术中出血量和术中透视次数少于常规微创组(P<0.05);两组术后踝关节AOFAS评分比较,差异无统计学意义(P>0.05).结论 应用3D打印结合微创钢板内固定技术治疗胫骨远端骨折较传统微创手术具有明显优势,可以为胫骨远端骨折治疗提供新的思路.

目的：探讨桡骨远端“T”型锁定钢板联合骨螺钉在外侧 Hoffa骨折中的临床应用效果。方法我院自2011年9月至2015年1月对13例外侧 Hoffa骨折采用桡骨远端“T”型锁定钢板联合骨螺钉固定，其中男10例，女3例；年龄26～64岁，平均38岁。根据 AO／OTA分型属于33-B3型。根据 Letenneur分型[3]，Ⅰ型6例，Ⅱ型2例，Ⅲ型5例。治疗后观察骨折愈合、膝关节功能及术后相关并发症发生情况。结果本组均经过1年随访，13例骨折均达临床愈合，愈合时间为12～16周，平均（13．5±1．4）周。按 Letenneur等的 Hoffa骨折术后功能恢复评估标准对膝关节功能评分，优9例，良4例，绝大多数患者膝关节功能恢复正常，无术后相关并发症发生。结论桡骨远端“T”型锁定钢板联合骨螺钉固定外侧 Hoffa骨折的临床效果满意。

目的:探讨3D打印技术在肱骨髁间骨折患者手术中的应用效果.方法:对2015年1月至2015年10月期间武汉市普仁医院收治的13名肱骨髁间骨折患者的临床资料进行回顾性研究.随机将这13例患者分为甲组和乙组.甲组中有7例患者,乙组中有6例患者.对两组患者均进行手术治疗.术中,对甲组患者使用传统的锁定接骨板进行内固定,对乙组患者使用3D打印定制的接骨板进行内固定,然后比较两组患者手术的用时、并发症的发生率、肘关节功能的优良率、肘关节屈曲/伸直的幅度、肘关节旋前/旋后的幅度以及其骨折愈合的时间.结果:乙组患者手术的用时和骨折愈合的时间均短于甲组患者,差异有统计学意义(P<0.05).两组患者并发症的发生率、肘关节功能的优良率、肘关节屈曲/伸直的幅度以及肘关节旋前/旋后的幅度相比差异无统计学意义(P>0.05).结论:将3D打印技术应用到肱骨髁间骨折患者的手术中,能有效地缩短其手术的用时和骨折愈合的时间.

BACKGROUND: Traditional open surgery will do great damage to the patients with thoracolumbar fractures, and easily induces local degeneration. In contrast, the novel method is minimally invasive, which contributes to the functional recovery of the spine.OBJECTIVE: To discuss the essential procedures and precautions in the treatment of thoracolumbar fractures with percutaneous pedicle screw fixation.METHODS: Twenty-seven cases of single-level thoracolumbar fractures without spinal neurological deficits treated with percutaneous pedicle screw fixation were selected. The operation time and intraoperative blood loss were observed. The Visual Analogue Scale scores during axial turning at baseline and 3 days postoperatively, and the Visual Analogue Scale scores of the operation region at 1 and 3 days postoperatively were detected, respectively.RESULTS AND CONCLUSION: (1) Twenty-seven patients with 108 vertebrae underwent percutaneous pedicle screw fixation under the guidance of the needle, the puncture was smooth, 98 vertebrae was punctured successfully once, and 10 vertebrae were punctured successfully twice. (2) The Visual Analogue Scale scores during axial turning at 3 days postoperatively were significantly lower than those at baseline, and the scores of the operation region at 3 days postoperatively were significantly lower than those at 1 day postoperatively (P < 0.001). (3) The mean operation time was (109±18) minutes, and the mean intraoperative blood loss was (60±16) mL. (4) There were no nerve root injury and other complications. (5) Our results indicate that percutaneou pedicle screw fixation is a minimally invasive and safe method to treat the patients suffering single-level thoracolumbar fractures without spinal neurological deficits.

Objective To discuss the diagnostic evaluation,treatment and prognosis of multiple trauma complicated with spinal cord injury.Methods 100 cases with acute spinal trauma and spinal cord injury who admitted in our hospital from January 2013 to November 2014 were selected.ISS score and ASIA score were used to the diagnostic evaluation of patients preoperatively.According to the results of the ISS score,the patients were divided into:17-24 points incomplete paraplegia combined with multiple trauma group,25-34 points paraplegia merge more serious multiple trauma group,≥ 35 points paraplegia with severe multiple trauma group.Before and after surgery,the circumstances,the injury site,blood transfusion after admission,surgical site,the days of hospitalization were assessed in the three groups.Results ISS scores increased with the increase of surgical site and the number of injuries.Postoperative ASIA score and ISS-AIS score in three groups were increased compared with preoperation,incomplete paralysis combined with multiple trauma group had statistically significant differences in the number of the injured area,blood transfusion,hospitalization time,the number of surgical site compared with the other groups (P＜0.05).The surgical site,length of stay,the more serious the injury site between paraplegia merge multiple trauma group and paraplegia with severe multiple trauma group,the differences were statistically significant (P＜0.05);paraplegia merge more serious multiple trauma group and paraplegia with severe multiple trauma group had no statistically significant difference in blood transfusion in surgery (P ＞0.05).Conclusion Damage control principle in acute spinal trauma and spinal cord injury has important significance,using the method of preoperative diagnostic evaluation to help you choose and determine the prognosis of the treatment method,while the preoperative evaluation and surgical timing also has important guidance.

目的 通过观察氯化镉诱导的骨肉瘤细胞凋亡与细胞特异性周期阻滞及caspase活化的影响,阐明氯化镉诱导的细胞凋亡效应及其分子机制.方法 应用AnnexinV/PI和API等标记,流式细胞仪对人骨肿瘤细胞凋亡及周期特异性的检测,运用RT-PCR的方法检查Caspase-3、Caspase-9活化情况.结果 处于静止期的外周血对氯化镉凋亡诱导不敏感,而G1期氯化镉诱导骨肉瘤细胞出现了明显的细胞凋亡.氯化镉诱导的细胞凋亡主要是在细胞周期的G1期发生.观察组采用氯化镉凋亡诱导,对照组未做处理,结果显示观察组的Caspe-3、Caspase-9 mRNA的表达值显著高于对照组.结论 氯化镉诱导的细胞凋亡与骨肉瘤细胞的细胞周期相关,存在G1期细胞周期阻滞的周期特异性,且此过程中发生了caspase活化,参与细胞凋亡.

目的 探讨溶血磷脂酰胆碱(lysoph-osphatidylcholine,LOA)对骨肉瘤细胞粘附和体外迁移能力的影响.方法 培养骨肉瘤细胞Mg-63,待其生长至对数生长期,传至第3代收集肿瘤细胞,各细胞分为两份.通过LOA预处理细胞后,一份以MTT微量酶比色反应法定量粘附细胞数,一份以划痕损伤实验检测迁移能力.统计分析比较LOA对骨肉瘤细胞迁移和粘附能力的相关性.结果 MTT法检测结果显示,不同作用时间(0、6、12、24、48 h)不同剂量LOA(0.000、0.001、0.010、0.060、0.100 mg/ml)干预后骨肉瘤细胞体外粘附能力明显加强,与对照组(0.000 mg/ml各组)相比,差异有统计学意义;Transwell结果显示,不同作用时间(0、6、12、24、48 h)不同剂量LOA(0.000、0.001、0.010、0.060、0.100 mg/ml)干预后骨肉瘤细胞体外迁移能力随着时间及剂量的增加而明显加强,与对照组(0.000 mg/ml各组)相比,差异有统计学意义.结论 LOA具有促细胞骨架变化进而调节细胞粘附和迁移能力的作用,表明LOA在恶性肿瘤发生进展中可能与肿瘤的侵袭和转移密切相关.

Objective To evaluate the clinical effects of the medial locking plate and the anterior T type plate in the treatment of Pilon fractures of type C3. Methods Eleven patients with Pilon fractures of type C3 were chosen from April 2011 to November 2011. All of them were treated by open reduction and internal fixation with the medial locking plate and the anterior T type plate. The outcomes of fracture healing and complications were observed. The ankle functions were evaluated according to the Mazur ankle performance index. Results During the average follow?up period of (24±2) months, fractures in all patients healed. Frac?ture healing time was (13.5±1.4) weeks for those patients. According to the Mazur ankle performance index at last visit, the treatment in 8 patients showed excellent outcomes and three showed well. The flexibility of moving forward and backward for the treated ankle was 39.2° ± 1.8° and 21.5° ± 1.8° respectively, which had no statistically significant difference comparing to the other side (40.9°±2.2°, and 22.9°±1.7°, P>0.05). There was no evidence of the post?operation complications. Conclusion After receiving the treatment of medial locking plate and the anterior T type plate for Pilon fracture of type C3, patients had a fully recovery on both fracture and function without suffering any related complications. The treatment reaches a successful clinical outcome, which is worth using widely.

目的：探讨64排螺旋CT低剂量扫描在肺孤立小结节的良恶性病变的鉴别与诊断价值。方法对收治的肺孤立性小结节病变56例患者进行64排螺旋CT低剂量扫描复查，并与穿刺活检或手术病理确诊结果进行对比研究。结果64排螺旋CT低剂量扫描对肺孤立性小结节病变的良、恶性鉴别诊断的敏感性为93．10％，特异性为88．46％，准确性为90．91％。恶性病变患者的CT影像学表现与良性病变比较存在明显差异，其中恶性病变患者的边缘大部分呈现不规则或分叶，而良性病变患者的边缘则呈现清楚的状态，且差异具有统计学意义。另外，良性病变患者的内部结构表现为钙化的例数明显多于恶性病变患者，且差异具有统计学意义。炎性结节组和恶性结节组患者在动态增强扫描期间，在各时间点的CT值均明显高于良性结节组，且差异具有统计学意义。对比炎性结节组和恶性结节组的不同时间点动态增强CT值可以发现炎性结节组在30s、90s、180s的动态增强CT值均升高，但是两组无差异（ P ＞0．05）；而在300s和480s，炎性结节组的动态增强CT值明显下降，而恶性结节组则下降不明显，而且炎性结节组在300 s和480 s的动态增强CT值明显低于恶性结节组，且差异具有统计学意义）。结论64排螺旋CT低剂量扫描可以为鉴别和诊断良、恶性肺孤立性小结节病变提供有利证据。

OBJECTIVE To explore the efficacy of plate external fixation combined with rinse suction drainage in treatment of tibial fracture patients complicated with infections so as to provide scientific basis for treatment of the tibial fracture patients complicated with infections .METHODS The clinical data were collected from 26 tibial frac-ture patients with confirmed infections who were treated in hospitals from Sep 2013 to Dec 2014 ,and the enrolled patients were randomly divided into the observation group and the control group ,with 13 cases in each .The ob-servation group was treated with locking compression plate external fixation combined with rinse suction drainage , while the control group was given topical drug therapy .The therapeutic effects were observed and compared be-tween the two groups of patients ,and the statistical analysis of data was performed with the use of SPSS 12 .0 software .RESULTS The cure rate of the observation group was 76 .92% ,the control group 46 .15% ;the total ef-fective rate of the observation group was 100 .00% ,the control group 76 .92% ,and there was significant differ-ence between the two groups (P<0 .05) .The incidence of complications of the observation group was 0 ,signifi-cantly lower than 8 .69% of the control group (P<0 .05) .CONCLUSION The locking compression plate external fixation combined with rinse suction drainage can achieve ideal effect on treatment of the tibial fracture patients complicated with infections and effectively control the infections .

随着脊柱外科技术的发展,脊柱后路截骨矫形术在临床逐渐广泛开展,可用于矫正强直性脊柱炎、先天性椎体发育异常、陈旧性骨折、脊柱结核及椎体肿瘤等相关疾病所致的局部严重后凸畸形,亦可用来完成重度脊柱侧凸畸形的治疗.目前临床常用的后路截骨技术大致可分为闭合截骨术(SPO),经椎弓根截骨术(PSO),全椎体切除术(VCR).以上3种术式各有侧重点,手术效果亦存在差别.现就脊柱后路截骨技术治疗局部严重后凸畸形的相关研究进行综述.