目的 研究Carlson后外侧入路、Frosch入路和腓骨头截骨入路治疗累及胫骨平台后外侧骨折的临床疗效及特点,为胫骨平台后外侧骨折的手术入路选择提供参考.方法 回顾性分析2018年1月—2021年12月重庆医科大学附属第一医院骨科手术治疗的累及胫骨平台后外侧骨折患者22例,男性14例,女性8例;年龄22～69岁,平均43.5岁.按手术入路不同分为Carlson后外侧入路组(6例)、Frosch入路组(8例)、腓骨头截骨入路组(8例).Carlson后外侧入路于膝关节的后外侧作切口,在腓肠肌外侧头和比目鱼肌之间进行手术操作,钢板从后方支撑固定.Frosch入路通过一个切口、两个手术窗进行操作,用前外侧钢板螺钉固定.腓骨头截骨入路通过截断腓骨头获得更大手术视野,术后再固定.术后3、6、9、12个月门诊随访摄片,术后12个月根据Rasmussen放射评分评价复位质量、美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节功能评分、膝关节后外侧检查稳定性.结果 Carlson后外侧入路多用于改良Schatzker CT分型为Ⅱ P型骨折(胫骨平台后外侧劈裂塌陷骨折);Frosch入路和腓骨头截骨入路常用于Ⅱ A+P型(胫骨平台后外侧合并前外侧劈裂塌陷骨折).术后随访时间12～18个月,平均14.2个月,骨折平均愈合时间4.3个月.Carlson后外侧入路组平均手术时间(85.0±5.5)min,术中出血量(53.3±6.2)mL,术后12个月HSS评分(88.7±0.6)分,Rasmussen放射评分(17.3±0.4)分.Frosch入路组平均手术时间(133.8±16.3)min,术中出血量(91.3±7.4)mL,术后12个月HSS评分(88.6±1.0)分,Rasmussen放射评分(16.8±0.4)分.腓骨头截骨入路组平均手术时间(184.9±13.9)min,术中出血量(250.0±41.2)mL,术后12个月HSS评分(88.4±1.0)分,Rasmussen放射评分(16.5±0.3)分.各组间手术时间及术中出血量比较差异有统计学意义(P<0.05);HSS评分及Rasmussen放射评分比较差异无统计学意义(P>0.05).胫骨外旋试验均为阴性.结论 Carlson后外侧入路手术时间及术中出血量最少,多用于Schatzker CT分型为Ⅱ P型的骨折.Frosch入路和腓骨头截骨入路主要用于Ⅱ A+P型胫骨平台骨折.三种入路治疗胫骨平台后外侧骨折均能获得良好的临床疗效.

基于CT影像的胸腰椎爆裂骨折治疗临床应用研究,讨论CT影像在临床上的指导意义,以及患者术中、术后的各项指标的变化.本研究对我院诊治的90例腰椎爆裂患者,在手术前均进行三维CT检查和X线检查,并设置术中CT观测组和X线检测组,其中A组术中基于CT三维重建对手术复位进行判断评估并在CT导航引导下使螺钉置入;B组术中依据传统的X线正侧位对手术复位评估,并采用X线透视技术对椎弓根螺钉进行固定治疗.研究表明,进行间接复位治疗,以及后续的调整治疗或者矫正治疗,患者均有较大程度的恢复,根据ASIA评分标准A组中有32.1％的脊髓损伤病患者神经功能明显改善,达到了E级水平,而B组也有一定程度的改善,但仅为22.1％.说明CT影像技术辅助诊断和治疗胸腰椎爆裂骨折的效果明显要优于X线,并且CT导航技术对A3型的3个分型也均有良好的效果.采用CT导航技术验证的准确度约为1.6 mm,其中A组置入螺钉的准确度约为98.8％,B组置入螺钉准确率约为96.5％.说明CT影像技术对复杂性胸腰椎骨折的诊断、分型以及术前、术中模拟等具有重要作用.

Objective To investigate the safety parameters of S2 transverse screw when the sacroiliac screw cannot be transversely placed into the first sacral(S1) vertebra to fix zoneⅢsacral fractures. Methods The 3-D models of 96 pelvis were reconstructed by Mimics software based on CT data, and the virtual S1 transverse sacroiliac screws were placed. When the transverse sacroiliac screw cannot be safely inserted in S1, it would be regarded as a dysplasia. There were 34 S1 vertebrae which belonged to the dysplasia group, and the other paired 34 S1 vertebrae according to gender were classified to the normal group. Placement of the S2 transverse sacroiliac screws were simulated in 68 S2 vertebrae, and then the parameters of screw paths were measured respectively. The soft tissues on pelvic surface were generated by Mimics, and then the body surface projections of S2 transverse screw's entry point B, anterior superior iliac spine's vertex M, iliac crest point N were determined as B1, M1, N1, respectively. At the same time, the lengths of B1M1, B1N1 and M1N1 were measured in section. Results There was significant difference in the lengths of the line B1M1, which were (140.94 ± 16.64) mm and (129.37 ± 14.93) mm in male between the normal group and the dysplasia group (P<0.05), and the lengths of the line B1M1 were (143.95±16.27) mm and (132.07±16.84) mm in female with statistical difference between the normal group and the dysplasia group (P<0.05). The lengths of the line B1N1 in the normal group and the dysplasia group were (69.92±6.73) mm and (72.64±7.46) mm in male with no statistical difference (P>0.05), and were (60.80±7.05) mm and (58.85±7.81) mm in female with no statistical difference (P>0.05). The lengths of the line M1N1 were (157.58 ± 16.83) mm and (150.48 ± 13.21) mm in male of the normal group and dysplasia group, which showed no statistical difference (P>0.05). Similarly, there was no significant difference in the lengths of the line M1N1, which were (156.79±15.84) mm and (151.49 ± 16.59) mm in female between the two groups (P>0.05). Conclusion When the sacroiliac screw cannot be transversely placed in dysplasia S1 vertebra including lumbosacral transitional vertebrae, sacrum not recessed in pelvis andacute alar slope. A 7.0 mm sacroiliac screw can be inserted in S2 vertebra for fixing zoneⅢsacral fractures. Under fluoroscopic monitoring, the body surface entry point of S2 screw can be determined by touching the bony landmarks of the anterior superior iliac spine andiliac crest.

Introduction: The prognostic role of pathologic fracture in osteosarcoma has not been settled down, as previous researches have reached contradictory results. This study is prepared to clarify whether pathologic fracture predicts a poor prognosis of patients with osteosarcoma.Materials and Methods: After completely retrieved databases including China National Knowledge Infrastructure (CNKI), PubMed, Highwire, EMBASE and Science Direct, all eligible articles were included based on inclusion/exclusion criteria. And we performed a meta-analysis to calculate the pooled prognostic role of pathologic fracture in osteosarcoma.Results: Finally, a total of 8 articles met the inclusion/exclusion criteria, involving 1,677 subjects. We found that the pooled hazard ratios (HRs) with 95% confidential interval (CI) of pathologic fracture in osteosarcoma for overall survival (OS) and disease-free survival (DFS) are 2.13 (1.43, 3.15) and 1.58 (1.11, 2.24), respectively.Conclusion: This meta-analysis demonstrated that presentation with a pathologic fracture in osteosarcoma was correlated with a poor prognosis. And pathologic fracture might be a poor predictor of survival in osteosarcoma.

Tetramethylpyrazine (TMP), a major active ingredient of Ligusticum wallichi Franchat extract (a Chinese herb), exhibits neuroprotective properties in ischemia. In this study, we assessed its protective effects on Schwann cells (SCs) by culturing them in the presence of oxygen glucose deprivation (OGD) conditions and measuring cell survival in cold ischemic rat nerves. In the OGD-induced ischemic injury model of SCs, we demonstrated that TMP treatment not only reduced OGD-induced cell viability losses, cell death, and apoptosis of SCs in a dose-dependent manner, and inhibited LDH release, but also suppressed OGD-induced downregulation of Bcl-2 and upregulation of Bax and caspase-3, as well as inhibited the consequent activation of caspase-3. In the cold ischemic nerve model, we found that prolonged cold ischemic exposure for four weeks was markedly associated with the absence of SCs, a decrease in cell viability, and apoptosis in preserved nerve segments incubated in University of Wisconsin solution (UWS) alone. However, TMP attenuated nerve segment damage by preserving SCs and antagonizing the decrease in nerve fiber viability and increase in TUNEL-positive cells in a dose-dependent manner. Collectively, our results indicate that TMP not only provides protective effects in an ischemia-like injury model of cultured rat SCs by regulating Bcl-2, Bax, and caspase-3, but also increases cell survival and suppresses apoptosis in the cold ischemic nerve model after prolonged ischemic exposure for four weeks. Therefore, TMP may be a novel and effective therapeutic strategy for preventing peripheral nervous system ischemic diseases and improving peripheral nerve storage.

Objective To compare the outcome of double Endobutton plate versus clavicular hook plate (CHP) in treatment of Tossy grade Ⅲ acromioclavicular dislocation.Methods A cohort of 82 patients with Tossy grade Ⅲ acromiocavicular dislocation treated between January 2010 and August 2012 were reviewed retrospectively.Based on the treatment choices,the patients were divided into double Endobutton group (36 cases) and CHP group (46 cases).Operative situation,in-hospital parameters,and postoperative visual analogue scale (VAS) of the shoulder,shoulder abduction-rise or anteflexionrise,Constant-Murley shoulder score as well as complications were evaluated.Results There were no statistical differences between the two groups in aspects of operation time,intraoperative blood loss,and length of stay.Mean time to return to work was (13.1 ± 1.4) weeks in double Endobutton group,shorter than (15.5 ±2.6) weeks in CHP group (P ＜0.01).No statistical difference was observed for postoperative complications between the two groups.At postoperative 12 months,VAS was lower in double Endobutton group [(2.1 ± 0.7) points] vs CHP group [(2.9 ± 0.8) points,P ＜ 0.05],but abductionrise and anteflexion-rise were higher in double Endobutton group [(138.6 ± 15.7) °,(140.3 ± 17.6) °] vs CHP group [(91.7 ±8.4)°,(96.7 ± 10.5)°,P＜0.05].Conclusion To treat Tossy grade Ⅲ acromioclavicular dislocation,double Endobutton plate is associated with less shoulder pain,quicker recovery,better shoulder function restoration compared with CHP and there is no need for a second surgery to remove it.

OBJECTIVE:To study the effects of the human keratinocyte growth factor 2 (hKGF-2) on the survival and differentiation of human neural stem cells (hNSCs). METHODS:The hNSCs at 17 passages preserved in liquid nitrogen were resuscitated and cultured for 7 days with normal methods to form neural spheres. The specific Nestin antigen and differentiated cells antigen were identified using immunohistochemistry technology. Some concentrated hNSCs were incubated in 12-well culture plate with 1 mL basic medium [(DMEM/F12 + N2 (1 : 100) + epidermal growth factor (EGF) (20 ng/mL)] and divided into 7 groups, 6 wells each group. hKGF-2 (0, 10, 30, 60, 90, and 120 ng/mL) and bFGF (10 ng/mL) were added in groups A (control), B, C, D, E, F, and G, respectively. The neurospheres and the cell number were recorded for analyzing growth and multiplication of neural spheres. Some concentrated hNSCs were incubated in 6-well culture plate (cover glass coated with polylysine) with 3 mL DMEM/F12 medium and divided into 4 groups, 6 wells each group. N2 (1 : 100), N2 (1 : 100) + hKGF-2 (90 ng/mL), FBS (1 : 20), and FBS (1 : 20) + hKGF-2 (90 ng/mL) were added in groups A1, B1, C1, and D1, respectively. Then, the growth and multiplication of neural spheres were observed during culture; the separated neural spheres was identified and analyzed with indirect immunofluorescence and flow cytometry. RESULTS:Reanimated hNSCs could form neural spheres containing a lot of Nestin antigen; differentiated cells by induction expressed the specific antigens of neurofilament 200 (NF-200) and glial fibrillary acidic protein (GFAP). At 7 days after culture, enlarged neural spheres were observed in each group. The neurospheres and the cell number of hNSCs increased with increased concentration of hKGF-2, showing a gradually increasing tendency; they were significantly higher in groups E, F, and G than that in groups A, B, C, and D (P < 0.05); significant differences were found among groups B, C, and D (P < 0.05), but no significant difference between groups A and B, and among groups E, F, and G (P > 0.05). After induction in vitro, the cell growth showed a progressive increase, significant difference was found among groups (P < 0.05); the percentage of NF-200 positive cells in group B1 was significantly higher than that in the other 3 groups (P < 0.05); the percentage of GFAP positive cells in group B1 was significantly lower than that in the other 3 groups (P < 0.05), but no significant difference among groups A1, C1, and D1 (P > 0.05). At 14 days after culture, cell growth reached the peak, which were mainly astero-cells. CONCLUSION:The hNSCs are pure after incubated to 17 passages in vitro. hKGF-2 can promote the clone and the growth of differentiated cells, and increase the proportion of neuron.

Objective To investigate the regeneration of peripheral nerve allografts after being preserved in University of Wisconsin solution( UW solution) containing tetramethylpyrazine( TMP) for different times at 4 ℃. Methods Fifty-six Wistar rats( male,weighing 200 to 250 g) were divided into 7 groups randomly,A,A',B,B',C,C' and D groups( n = 8) and were inflicted with sciatic nerve defect. The sciatic nerve allografts were collected from another 24 SD rats( 3-month-old,weighing 200 to 250 g) and then preserved in UW solution containing TMP( for A,B and C groups) or not( for A',B' and C' groups) at 4 ℃for different time intervals( 4,6 and 12 weeks),and then employed to repair the sciatic nerve defect of Wistar rats. The rats from group D were treated with fresh sciatic nerve autografts and served as control. In 4,8 and 12weeks postoperatively,the function of affected limb was observed. The weight,morphological and electric neurophysiology of gastrocnemius were measured and observed in 12 weeks postoperatively. Results With respect to the electrophysiological values as well as gastrocnemius weight,the results of groups A and D were better than the other groups,and those of group D were superior to those of group A( P < 0. 05). Pathological observation in 12 weeks after transplantation indicated that the sciatic nerves of groups C and C' were in severe infection and obvious structural disorders with vacuolar degeneration. And the infection was slightest in group D. Microscopic and transmission electron microscopic observation showed that in groups A and D,the nerve fibers were in well-arrangement,and there were more regenerative medullated nerve fibers,with integrated myelin in concentric circles and abundant organelles. The condition in group B was worse than that in group A.There were few regenerative medullated nerve fibers in groups C and C'. Conclusion TMP exerts its protective effect on the regeneration of allograft nerve in 4 weeks.

Objective To investigate the effect of University of Wisconsin(UW) solution on morphology,cell viability and immunogenicity of rat sciatic nerve during cold storage.Methods Rat sciatic nerve segments were preserved in UW solution at 4℃ for 1,4 and 6 weeks,respectively,and fresh rat sciatic nerve segments were set as controls.Morphological changes of sciatic nerve segments were stained by HE and were observed under transmission electron microscope.Cell viability was detected by using LIVE/DEAD Viability/Cytotoxicity kits and confocal microscopy,cell apoptosis was detected by TUNEL staining,and Levels of ICAM-1 and MHCⅡ were detected by Western blotting.Results Epineurium and Schwann cell basal lamina in the UW group at each time point remained intact and were similar to those in the control group.Cell viability was decreased,quantity of TUNEL positive cells was increased and levels of ICAM-1 and MHCⅡ was decreased in the UW group at each time point,as compared with those of the control group(P<0.05).In the UW group,quantity of TUNEL positive cells at both 4 and 6 weeks were larger than that at 1 week(P<0.05),and levels of ICAM-1 and MHCⅡ at both 4 and 6 weeks were lower than those at 1 week(P<0.05),but there was no significantly difference in cell viability,quantity of TUNEL positive cells and levels of ICAM-1 and MHCⅡ between 4 weeks and 6 weeks(P>0.05).Conclusion Cold storage of peripheral nerve with UW solution can effectively maintain structural integrity of epineurium and Schwann cell basal lamina and reduce nerve immunogenicity within one week.

Objective:To investigate the effects of different temperatures on the regeneration of allogeneic nerves of rats preserved in UW solution with Tetramethylpyrazine(TMP).Methods:Totally 60 Wistar rats(male,weighing 200~250 g) were divided into five groups randomly(groups A,B,C,D and E,n=12).The sciatic nerve trunks of 18 SD rats(male,weighing 200~250 g) were incised at about 15 mm and were preserved in UW solution with TMP at different temperatures(group A:4 ℃,group B:-20 ℃,group C:-80 ℃) for fours weeks to repair the sciatic nerve defect of SD rats.Group D was allogeneic nerve graft group and Group E was autologous nerve graft group.General observation was performed at 4,8,12 weeks postoperatively while electrophysiological check,light and electron microscope check were conducted at 12 weeks postoperatively.Results:The results of A、E groups in the electrophysiological test and gastrocnemius weight test were better than those of the other groups,however,statistical differences were observed between group A and E(P0.05).Group A and E displayed similar results in morphology at 12 weeks after the operation.Conclusion:The regeneration of allogeneic nerves preserved in UW solution with TMP at 4 ℃ can be improved.

Objective To observe the effect of tetramethylpyrazine(TMP) on synthesis and secretion of nerve growth factor(NGF) by Schwann cells(SCs) and investigate the potential mechanism of TMP in promoting the repair of peripheral nerve injury.Methods TMP was dissolved in DMSO.SCs were divided into normal control,DMSO control and four test groups.The SCs in normal control group were cultured in normal medium,while those in DMSO control group in normal medium supplemented with DMSO,and those in test groups 1,2,3 and 4 in normal media supplemented with 25,50,100 and 200 μg / ml TMP respectively.Twenty-four hours after culture,the proliferation and apoptosis of SCs were measured by MTT method and flow cytometry,while the expression of NGF at mRNA and protein levels by real-time PCR and ELISA respectively.Results TMP showed no significant effect on proliferation and apoptosis of SCs.No significant differences were observed in the NGF mRNA levels or NGF contents in culture supernatant of SCs in DMSO control group and in test groups 1 and 2(P 0.05).However,the NGF mRNA levels and NGF contents in test groups 3 and 4 showed no significant difference(P 0.05),which were significantly higher than those in normal control group(P 0.05).Conclusion TMP promoted the synthesis and secretion of NGF by SCs in a dose-dependent manner,which might be one of the mechanisms of promoting the repair of nerve injury.

川芎嗪是从川芎中提取的生物碱单体,是川芎的主要活性成分之一,具有抗氧化、拮抗钙超载、抑制细胞凋亡、抗炎、抗血栓改善微循环、减轻缺血/再灌注损伤等药理作用。将川芎嗪添加到胰腺、肾脏、肝脏、肺及周围神经等组织、器官保存液中,有利于减轻组织、器官的缺血和再灌注损伤,从而改善组织、器官的保存效果及移植预后。

Objective:To provide data for the neotype biomateral prothesis design and insertion of the scaphoid.Method: both wrists of health adults(50male 50 female) are scaned by CT,obtain the formatting documents of DICOM,reconstructing the scaphoid with MIMICS,and measure according to the designing requirement.Results:Maximal length of scaphoid(26.16±2.72) mm,Maximal width of scaphoid body(15.15±2.0) mm,Minimal height of scaphoid body(7.52±1.5) mm,Width of tubercle of scaphoid bone(13.36±1.8) mm,Height of tubercle(8.814±1.0) mm,Angle of radial-scaphoid articular surface(151.86±6.36)°,Maximal angle of dorsal-scaphoid(133.85±5.85)°,Maximal macroaxis angle of scaphocapitate(138.00±5.05)°,Maximal transversal Angle of scaphocapitate(170.27±5.09)°,Proportionality of dorsal proximate-distal length(1.15±0.091).Conclusion:The related data of scaphoid are all key indexes to designing and inserting the neotype biomateral prothesis of the scaphoid,according to those data designing the prothesis fiting Chinese people is feasible.

Objective To achieve three-dimensional(3D) contour image of scaphoid for fabricating custom-made artificial scaphoid-prosthesis.Methods The ambi-wrist jionts of healthy adult were scanned with spiral X-ray computed tomography with 0.625mm thick slice,obtain the formatting documents of DICOM,and reconstruct three-dimensional tereo-models of scaphoid with MIMICS10.0.Results The 3D contour image of scaphoid presented was edited and processed easily for the computer aided design(CAD) of custom-made artificial scaphoid.Conclusion The 3D contour image of scaphoid can be obtained by spiral CT scanning,and the digitized data can be applied directly to CAD of custom-made artificial implant and subsequently rapid prototyping fabricating.In addition,the reconstruct ionmethod is simple and can be applied widely to clinical implant fabricating practice of orthopaedics.