Objective: To explore the learning curve of SkyWalker robot-assisted total knee arthroplasty（TKA）. Methods: The operative data of SkyWalker robot-assisted TKA from January 2022 to April 2022 were collected. During the operation, fixed personnel recorded the total operation time, tripod installation time, reference frame installation time, bone registration time, and the number of registered red dots, osteotomy time, soft tissue and bone preparation time after osteotomy, installation and test time and prosthesis implantation time in real time. Results: Operative data from 50 cases of 7 surgeons were collected in this study including 28 cases of SkyWalker-assisted TKA and 22 cases of manual TKA. The total operation time of robot-assisted TKA and manual TKA was（123.3±22.0）min and（103.6±22.9）min, and the difference was statistically significant（P=0.003）. Surgeon 1 completed the TKA of 13 cases with the help of SkyWalker robot, with the accumulation of experience his spending time on the operation decreased significantly, and his peak number of CUSUM curve was seven. The time of robotic osteotomy decreased significantly and its peak number of CUSUM curve was also seven, and the other operation steps like bone registration did not change significantly. The proportion of accurate preoperative planning of prosthesis size among the 7 surgeons increased significantly from the initial 38% to 85%. Conclusions: In SkyWalker robot-assisted TKA, after the operator is familiar with the SkyWalker robot, the operation time is significantly reduced mainly on the osteotomy, and the critical value of the learning curve is in the 7th case.

目的 探讨采用初次全膝关节置换术治疗壤塘地区膝关节大骨节病(KBD)患者的近期临床效果.方法 回顾性分析2017-01至2019-09四川省壤塘县人民医院骨科收治膝关节大骨节病患者88例,男32例,女56例,年龄34～67岁,平均(53.57±10.40)岁.Ⅰ期35例,Ⅱ期53例.全部膝关节大骨节病患者行人工全膝关节置换术,分别在术前,术后1、3、6、12、36个月,采用疼痛视觉模拟评分(VAS)评估膝关节疼痛严重程度、美国膝关节协会评分(KSS评分)、美国特种外科医院膝关节评分(HSS评分)系统评估膝关节功能,简明健康状况量表(SF-36)评分评估生活质量,测量膝关节活动度(ROM),治疗前和末次随访时拍摄双下肢负重全长X光片测量髋-膝-踝角及胫股角评估下肢力线情况.结果 随访36～54个月,平均随访(39.85±6.89)个月.VAS疼痛评分、HSS临床评分、KSS功能评分、SF-36评分、生理职能、躯体疼痛、活力、社会功能、情感职能、精神健康评分得到明显改善(P<0.05).下肢力线髋膝踝角(HKA)、ROM得到改善(P<0.05).结论 高原地区膝关节大骨节病Ⅰ期、Ⅱ期患者行首次接受人工关节置换术后能矫正下肢力线,缓解膝关节疼痛,改善关节功能,值得临床推广.

Objective: To compare the short-term clinical outcomes between functional alignment（FA） and restricted kinematic alignment（rKA） used in robot-assisted total knee arthroplasty（RTKA）. Methods: Patients who underwent RTKA for knee osteoarthritis in our hospital from October 2021 to April 2022 were retrospectively analyzed and divided into FA group and rKA group according to the operator and intraoperative knee alignment guidance method. The general data, surgical data, pre and post-operative hip-knee-ankle angle（HKA）, lateral distal femoral angle（LDFA）, proximal medial tibial angle（MPTA）, external rotation angle of the femoral prosthesis, Knee Society score（KSS） of the knee at 3 months postoperatively, and complications were statistically analyzed in both groups. Results: A total of 37 patients（39 knees） were included in this study, there were 19 patients（20 knees） in the FA group and 18 patients（19 knees） in the rKA group. There was no significant difference in average age, body mass index（BMI）, pre and postoperative HKA, LDFA and MPTA between the two groups（P＞0.05）. The external rotation angle of femoral prosthesis was 2.05°±0.41°in the FA group and-1.11°±0.39° in the rKA group, and the difference between the two groups was statistically significant（P＜0.05）.The postoperative Knee Society score-the knee score（KSS-K） and Knee Society score-the function score（KSS-F） were 88.50±1.67 and 88.60±1.14 respectively in the FA group, and 89.47±1.62 and 89.95±1.26 respectively in the rKA group, and no statistical significance was found between the two groups（P＞0.05）. There was no anterior knee pain, patellar maltracking, or other serious complications occurred in either of the groups. Conclusions: The femoral prosthesis of robot-assisted rKA-aligned TKA patients have more internal rotation than that of FA-aligned TKA patients. There is no evidence showed that femoral prosthesis internal rotation has an effect on the occurrence of anterior knee pain and patellar maltracking and knee function. There is no significant difference in short-term outcomes between robot-assisted FA aligned and rKA aligned TKAs.

Objective To investigate the therapeutic effect of 3D printed anatomical tibial prosthesis in the repair of bone defects after debridement of tibial osteomyelitis. Methods Five patients with bone defects after debridement of lower tibial osteomyelitis were treated between January 2015 and December 2020 in the Eighth Medical Center of Chinese PLA General Hospital. Their bone defects were repaired via 3D printed anatomical titanium alloy tibial prosthesis. The duration of surgery and volume of intraoperative bleeding were recorded. The patients were followed up regularly for 12 months. Visual analog scale (VAS) score, Hospital for Special Surgery (HSS) knee score, American Orthopedic Foot and Ankle Score (AOFAS) Ankle Hindfoot Scale and 6-minute walk distance (6MWD), Timed "Up and Go" (TUG) test and 36-Item Short Form Health Survey were used to assess the clinical efficacy. The wound healing and complications were observed, while leukocyte count, C-reactive protein level and erythrocyte sedimentation rate (ESR) were detected and calculated. Results The mean duration of operation was 156.75±32.40 min, while the mean amount of intraoperative bleeding was 490.00±84.06 mL. After 12 months of follow-up, the VAS pain score, HSS score and AOFAS score were significantly improved (P < 0.05). The time for TUG and 6MWD were significantly extended and lengthened after operation (P < 0.05). The scores of postoperative qualities of life were elevated (P < 0.05). During the 12-month follow-up, the leukocyte count, ESR and C-reactive protein level were all within the normal ranges. The wounds healed well without sinus formation. Conclusion 3D printed anatomical titanium alloy tibial prosthesis has the advantages of effectively restoring good function of the lower limbs, mitigating preoperative pain and reducing postoperative complications.

Objective:To explore the applicability and effect of the self-directed learning teaching model in the teaching of joint surgery.Methods:A total of 60 interns in The Eighth Medical Center of PLA General Hospital from September 2018 to September 2020 were randomly divided into the traditional group (using traditional teaching methods) and self-directed learning group (using the self-directed learning approach), with 30 students in each group. The general condition, teaching performance (including theoretical and practical achievements), scores of abilities (including abilities of literature review, lecturing, organization, communication and teamwork), and subjective evaluation scores (learning interests and satisfaction) were analyzed. SPSS 23.0 statistical software was used to conduct independent-sample t-test and chi-square test. Results:The self-directed learning group had higher scores than the control group in the theoretical score [(87.63±7.01) vs. (79.56± 7.08)] and practical score [(86.40±6.45) vs. (82.70±7.65)], literature review score [(16.33±2.45) vs. (14.50±2.27)], the ability of lecturing [(15.56±2.97) vs. (13.90±2.56)], organization [(17.61±2.34) vs. (14.96±2.55)], communication [(17.06±1.91) vs. (14.53±1.96)], and teamwork [(16.23±1.71) vs. (14.76±2.32)], as well as the indicators of learning interest and levels of satisfaction (teaching form and teaching effect), with significant differences between the two groups ( P<0.05). Conclusion:The self-directed learning teaching model can inspire students' initiative, improve teaching quality, and contribute to new ideas for teaching reform.

目的 探讨应用Masquelet技术分期治疗足踝结核的临床疗效.方法 回顾性分析解放军总医院第八医学中心骨科2017年1月至2020年1月收治并确诊的6例足踝结核的临床资料.所有研究对象均采用Masquelet膜诱导技术分期治疗:一期彻底清除病灶,抗生素骨水泥占位,创面应用负压封闭引流技术(VSD)负压吸引;二期感染控制后,取出占位器,在诱导膜内自体骨或自体骨混合异体骨结构性植骨融合内固定.围手术期早期、全程、足量、规律联合应用抗结核药物治疗.对比患者术前和末次随访血沉(ESR)、C反应蛋白(CRP)、美国足踝矫形协会(AOFAS)和视觉模拟量表(VAS)评分,记录复发、完全负重时间及关节融合时间.结果 所有患者随访10～43个月,平均(33.3±11.8)个月.术前ESR、CRP分别为(54.0±14.0)mm/h、(54.1±18.9)mg/L,术后末次随访分别下降至(8.1±2.6)mm/h(t=8.478,P<0.001)和(3.1±1.1)mg/L(t=6.329,P=0.001),均有统计学差异.AOFAS评分从术前(36.0±8.9)分提高到术后(72.0±8.3)分(t=-7.821,P=0.001),VAS疼痛评分由(5.0±1.4)降至(0.5±0.5)分(t=7.268,P=0.001),均有统计学差异.所有患者无复发,均获得骨性融合,融合时间8～24个月,平均(15.0±2.6)个月,完全负重时间9～20个月,平均(13.8±4.8)个月.结论 采用Masquelet技术治疗足踝结核是一种安全有效的方法,能恢复肢体功能,提高手术成功率.

[目的]比较三种肌腱移植物重建前交叉韧带(ACL)的组织学早期愈合过程.[方法]新西兰兔60只,随机分为三组,分别用自体肌腱(自体组)、深低温冷冻同种异体肌腱(深冻组)、冷冻干燥同种异体肌腱(冻干组)重建ACL,每组20只.于术后3、8、12、24周时取材,行组织学观察.[结果]移植物关节内段:术后3周各组移植物内细胞结构消失;术后8周移植物浅层有成纤维细胞增殖,但深层为无细胞纤维;术后12周各组移植物浅层细胞数增多,由浅入深逐渐长入移植物;术后24周各组移植物浅层与深层细胞密度均匀一致,深层无细胞区域消失.移植物腱骨界面:术后3周腱骨界面成纤维细胞增殖;术后8周各组腱骨界面软骨细胞出现,出现散在斜形sharpey纤维;术后12周各组软骨细胞增多,各组斜形sharpey纤维数量增多,自体组出现垂直形sharpey纤维,有连续性“潮线”结构;术后24周垂直形sharpey纤维比例增多,连续性“潮线”结构范围扩大.随时间推移,三组移植物关节内段和腱骨界面内的细胞数均显著增加(P＜0.05).细胞数排序为自体组＞深冻组＞冻干组,术后8周和12周时,三组间差异有统计学意义(P＜0.05),而术后24周时,三组间差异已无统计学意义(P＞0.05).[结论]冻干异体肌腱和深冻异体肌腱早期组织学愈合过程较自体肌腱延迟,但24周后三种肌腱移植物的愈合程度趋同.

目的 探讨比较不同手术时机修补急性膝关节后内侧角(PMC)损伤的临床疗效.方法 回顾性分析2015年12月—2018年12月解放军总医院第八医学中心PMC损伤患者10例,男性7例,女性3例;年龄19～46岁,平均30.1岁.按手术时机不同分为早期手术组和延期手术组,各5例.早期手术组于患者平均受伤(3.4±1.6)d行手术治疗,延期手术组于患者平均受伤(29.0±5.7)d行手术治疗,两组患者术前一般资料比较差异无统计学意义(P>0.05).比较两组患者术后国际膝关节文献委员会膝关节评估表(IKDC评分)、Lyshlom评分、膝关节活动度、术后并发症情况.结果 早期手术组IKDC评分(81.8±6.6)分,Lyshlom评分(85.2±8.9)分,与延期手术组(72.8±6.1)分、(73.4±4.7)分比较,差异有统计学意义(P<0.05).术后4、8、12周早期手术组膝关节活动度(81.0±11.3)°、(115.0±15.8)°、(122.2±10.3)°,延期手术组(53.6±13.6)°、(83.4±19.3)°、(106.8±6.6)°,差异有统计学意义(P<0.05).两组患者均未出现并发症.结论 早期修补急性PMC损伤有利于膝关节功能的恢复.

目的 探讨应用3D全仿真解剖型半骨盆肿瘤假体重建骨盆肿瘤切除术后骨缺损的可行性、安全性和有效性.方法 对2016年3月至2018年6月收治的3例骨盆软骨肉瘤患者(年龄49～61岁),根据Enneking分类,肿瘤累及Ⅰ+Ⅱ+Ⅲ区,行肿瘤切除后应用3D全仿真解剖型骨盆假体进行半骨盆重建.采用耻骨结节-髂后上棘和外侧辅助入路,记录术中出血量、输血量、手术时间以及肿瘤复发、转移等并发症情况.采用视觉模拟量表(VAS)评分和Harris评分标准对疼痛和髋关节功能进行评估.结果 3例患者术后均获得随访,随访时间18～41个月,中位随访时间27.6个月.术中平均失血量(2266.67±1078.57)ml,输血量(2660.00±1278.59)ml.Harris疼痛评分由术前(28.00±4.35)分提高为术后(57.00±6.24)分;VAS评分为由术前(8.33±0.57)分降低为术后(3.00±2.00)分.无髋关节脱位、假体松动、伤口愈合延迟、假体周围感染、局部复发等并发症发生.结论 应用3D全仿真解剖型半骨盆假体重建骨盆软骨肉瘤切除术后骨缺损是一种安全有效的方法.

[目的]分析本院住院结核病患者中骨关节结核的特征及外科干预情况,为骨关节结核诊疗提供参考.[方法]描述性分析本院2007年1月～2019年12月收治的结核病患者,分析年度病例数、患者性别构成、发病年龄、病变累及解剖部位,以及是否进行外科干预等相关资料.[结果]本院13年共收治住院结核病患者42 215例,其中骨关节结核3 924例,占所有结核的9.30％,居第3位.骨关节结核基本特征是男女比例约1.23∶1,平均年龄(45.90± 18.57)岁(1～90岁),发病年龄呈双峰分布,分别为16～30岁和46～60岁.按侵犯部位:脊柱结核占76.86％,包括腰椎占40.32％,四肢骨关节占23.14％,膝、髋关节分别占6.29％、5.40％.按是否多病灶:多发脊柱结核为7.39％,而多发四肢结核为0.33％.所有骨关节结核患者采用保守单纯抗结核治疗1 167例,外科手术干预2757例,手术率占70.26％.[结论]骨关节结核是常见的肺外结核,男性多于女性,高发年龄段在16～30岁和46～60岁.骨关节结核累及部位变化很大,但脊柱、髋和膝是骨关节结核最常见部位;四肢大关节结核多为单关节发病,但四肢单纯骨结核少见.

目的 比较Herbert钉内固定与肩关节镜下缝线桥技术治疗肱骨大结节骨折的临床疗效.方法 回顾性分析解放军总医院第八医学中心骨科2008年1月—2018年1月收治的42例肱骨大结节骨折患者,依据手术方法分为Herbert组(21例)和关节镜组(21例).Herbert组采用Herbert钉内固定,男性8例,女性13例;年龄27～78岁,平均51.3岁;致伤原因:道路交通伤3例,摔伤18例.关节镜组采用关节镜下缝线桥技术,男性5例,女性16例;年龄24～79岁,平均46.3岁;致伤原因:道路交通伤2例,摔伤19例.两组患者术前一般资料比较差异无统计学意义(P>0.05),比较两组的手术时间、术中出血量、切口长度、住院时间、骨折愈合时间、并发症发生率、VAS、美国肩肘外科医师评分(ASES)、肩关节评分系统(Constant)评分和末次随访肩关节活动度.结果 42例患者随访时间8～18个月,平均13.9个月.Herbert组与关节镜组出血量[(125.7±36.1)mLvs.(22.2±9.1)mL]、手术时间[(75.1±19.9)minvs.(64.7±14.3)min]、切口长度[(5.1±0.7)cm vs.(3.0±0.9)cm]、住院时间[(8.4±2.3)d vs.(4.3±1.5)d]、骨折愈合时间[(37.7±8.6)d vs.(31.0±6.3)d]、VAS评分[(1.9±0.9)分vs.(1.3±0.9)分]比较,差异均有统计学意义(P<0.05),Herbert组ASES评分(71.6±12.5)分、Constant评分(68.4±13.6)分低于关节镜组(80.5±10.2)分、(79.7±12.5)分(P<0.05),Herbert组并发症发生率14.2％高于关节镜组4.7％,末次随访时关节镜组肩关节前屈上举活动度(117.0±21.3)°、外展(76.4±11.0)°、外旋(34.1±7.8)°、内旋(68.7±8.4)°、后伸(31.1±7.8)°,均明显优于Herbert组(100.9±18.1)°、(69.9±6.8)°、(27.0±9.0)°、(59.2±13.4)°、(27.6±8.5)°(P<0.05).结论 肩关节镜下缝线桥技术治疗肱骨大结节骨折治疗效果好,与Herbert钉治疗相比,具有安全性好、出血量小、手术时间短、切口小、 住院时间短、术后并发症发生率少等优点.

[Objective] To study the characteristics of acetabular bone loss in advanced hiptuberculosis.[Methods]From November 2010 to December 2016,73 patients who were definitively diagnosed as advanced hip tuberculosis,including 39 males and 34 females (1:1.15) aged (47.95±16.61) years in average (ranged from19 years to 85years),underwent pelvic volume scan by the 320-row CT.The DICOM format data was processed by Mimics to get the three-dimensional reconstructive pelvic model.The three-dimensional structure of the acetabulum before pathological changes was got by mirror image technique,in which the unaffected acetabulum was set to a standard hemisphere,then the center of the acetabulum was determined by sphere fitting.The damaged acetabulum was further divided to anterior,posterior,superior and inferior areas according to mark points.The unaffected acetabular volume,bone loss in total and the different areas of the affected acetabulum were respectively measured.Then percentages of bone loss in total and the different areas of the affected compared to the unaffected acetabulum was converted.Based on those,acetabular bone loss was divided into 3 levels:mild (＜ 50％),moderate (50％～100％) and severe (＞100％).Furthermore,according to the ratio between a single area bone loss and the total bone loss,the pathology was divided into 2 types:diffuse type with the ratio＜50％ and segmental type with the ratio ≥50％.[Results] The ratio of the acetabular bone loss was (0.62±0.48) on average,ranged from 0.06 to 1.68,in the 73 patients.Of them,36 (50％) were grades as mild,25 (36％) as moderate and 12 (14％) as severe acetabular bone loss,in term of the type,56 (77％) had diffuse bone loss and the remaining 17 (23％) were segmental bone loss.The bone loss in superior area was larger than the anterior area or the posterior area (P＜0.05),and the bone loss in anterior area or posterior area was larger than the inferior area (P＜0.05),however,there was no difference between the anterior areaand posterior area (P＞0.05).[Conclusion] Reconstructing the 320-row CT scan data of the advanced hip tuberculosis with Mimics is an effective tool to determine the shape,position,quantity and type of the acetabular bone loss.These 3-dimensional characteristics of acetabular bone loss are helpful to making treatment plane for advanced hip tuberculosis.

[目的]探讨PCR-反向膜杂交技术鉴定疑似关节结核临床标本中分枝杆菌菌种的应用价值.[方法]应用PCR-反向膜杂交法和培养菌种鉴定法对35例疑似关节结核和35例非关节结核临床标本行分枝杆菌菌种鉴定,应用PCR-直接测序法验证PCR-反向膜杂交法阳性鉴定结果准确性.[结果]培养菌种鉴定法在疑似关节结核组培养鉴定出8例结核分枝杆菌,1例牛结核分枝杆菌,非关节结核组培养结果均为阴性;灵敏度25.7％,特异度100％.PCR-反向膜杂交法在疑似关节结核组鉴定出18例结核分枝杆菌复合群,1例戈登分枝杆菌,1例浅黄分枝杆菌,与PCR-直接测序结果一致;非关节结核组中1例结核分枝杆菌复合群阳性,PCR-直接测序未扩增出核苷酸序列;灵敏度57.1％,特异度97.1％.两种菌种鉴定法检测阳性率差异有统计学意义(x2=11.28,P=0.01).[结论]PCR-反向膜杂交技术可快速将疑似关节结核中分枝杆菌鉴定至种,指导诊断.

目的:评价髓芯减压联合负压吸引术治疗早期股骨头坏死的疗效.方法:术前术后记录患者的Harris评分、VAS评分及检测其股骨头血管功能定量参数,以评价术前术后髋关节功能及股骨头微循环的变化情况.结果:术后经影像学检查未见股骨头发生塌陷或坏死区明显扩大.除术后1个月(P＞0.05)外,术后其余的VAS评分均低于术前(P＜0.05);术后的Harris评分均高于术前(P＜0.05).在ARCO Ⅰ期组坏死区Kep值于术后3、6个月均低于术前(P＜0.05);坏死区iAUC值于术后3个月低于术前(P＜0.05).在ARCOⅡ期组坏死区Ve值于术后1个月低于术前(P＜0.05).结论:这种新的手术方法在短期内可有效地改善髋关节功能,减轻疼痛症状,并具有延缓坏死股骨头塌陷的作用.可在一定程度上改善ARCOⅠ期股骨头坏死的微循环瘀滞问题,但对ARCOⅡ期股骨头坏死的改善情况不明显.

目的 研究结核分枝杆菌(M.tb)潜伏感染相关蛋白Rv2659c对结核潜伏感染与活动性骨关节结核T细胞免疫应答的特性.方法 使用CFP10-ESTA6蛋白(CE)通过酶联免疫斑点实验(ELISPOT)从健康志愿者中筛选出来感染健康组(42例)和结核潜伏感染组(33例).从住院志愿者中筛选出非结核骨关节病组(35例)及活动性骨关节结核病组(30例).使用Rv2659c蛋白刺激各组人群外周血单个核细胞(peripheral blood mononuclear cell,PBMC),应用EHSPOT技术检测分泌IFN-γ的效应T细胞斑点数(斑点形成细胞,spot forming cells,SFC),比较其在不同人群中的差异;以潜伏感染组为阳性组,以活动性骨关节结核病组为阴性组,绘制Rv2659c潜伏抗原的ROC曲线,在特异度80％及90％两个点取SFC的cut-off值,评价Rv2659c对结核潜伏感染与活动性骨关节结核的鉴别诊断效能.结果 潜伏感染组的SFC值(2.5/28)显著高于活动性骨关节结核病组(0/2)、非结核骨关节病组(2.5/6.25)及未感染健康组(0/2.5),均P＜0.05.Rv2659c重组蛋白的曲线下面积(AUC)为65.2％,95％可信区间(CI)0.51 ～0.794.特异度80％时,cut-off值为3;特异度90％时,cut-off值为5.Rv2659c蛋白诱导产生细胞免疫应答的阳性率在潜伏感染组最高(54.5％),显著高于活动性骨关节结核病组(20％)、非结核骨关节病组(11.4％)以及未感染健康组(16.7％)3组,均p ＜0.05.结论 Rv2659c诱导活动性骨关节结核患者效应T细胞产生的免疫应答显著低于结核潜伏感染人群;Rv2659c对于鉴别结核潜伏感染人群与活动性骨关节结核病具有一定诊断价值.

目的 分析髋、膝关节结核外科治疗后复发的影响因素.方法 采用回顾性研究的方法,收集解放军第三○九医院全军骨科中心关节外科2008年1月至2015年12月收治的89例经外科治疗后复发的髋、膝关节结核患者,其中男61例、女28例,中位年龄45岁.对研究对象初次手术前诊断是否明确、是否行抗结核药物治疗、初次手术方法等信息进行分析.结果 89例复发患者中45例(50.6％)术前诊断错误而未进行抗结核药物治疗,32例(36.0％)抗结核药物治疗不规范.复发患者中,行切开引流或有限病灶清理术者50例(56.2％),行关节镜下病灶清除术者29例(32.5％),微创引流术8例(9.0％),关节融合术2例(2.3％).结论 术前诊断不明确、未进行正规有效抗结核药物化疗是髋、膝关节结核外科治疗后复发的主要原因.

[目的]评估活动性关节结核不同病理材料聚合酶链式反应(polymerase chain reaction,PCR)检测结果,探索提高PCR检测阳性率的方法.[方法]2013年1月～2014年12月,对43例晚期活动性关节结核患者手术中获取脓液、干酪样组织及肉芽组织分别进行结核分枝杆菌(MTB)荧光定量PCR检测.男23例,女20例;年龄15～74岁,平均45.6岁.其中膝关节结核20例,髋关节结核15例,肩关节结核3例,踝关节结核3例,距下关节结核1例,骶髂关节结核1例.对3种不同病理材料PCR检测阳性率进行比较分析.[结果]肉芽组织74.42％ (32/43)阳性率明显高于干酪样组织58.14％ (25/43)和脓液37.21％ (16/43),x2值12.181,3种病理材料MTB-PCR检测阳性率差异有统计学意义(P =0.002);3种病理材料联合行PCR检测阳性率88.37％ (38/43).[结论]活动性关节结核不同病理材料PCR检测阳性率有差异,多种病理材料联合检测可提高检测阳性率.

目的:研究股骨髁内、外侧面表面特征,探索内侧副韧带、内侧髌股韧带、外侧副韧带、腘肌腱重建时股骨定位参照点.方法:选取2013年7月～2014年7月国内正常成人志愿者男58膝、女58膝,进行320 CT容积扫描股骨远端三维重建,分别在股骨内上髁、外上髁表面画前后标记线及上下标记线,测量内、外上髁最高点相对远端软骨缘平面高度,距离前后、上下标记线的长度.同时对13例新鲜冷冻成年膝关节标本标记行320CT扫描重建,测量骨性最高点与韧带附着点中心的距离与方位.结果:股骨外上髁最高点与远端软骨缘相对高度为男5.79±1.38 mm、女6.11±1.84 mm,股骨内上髁最高点与远端相对高度为男6.91±1.62 mm、女6.82±1.43 mm.股骨外上髁最高点到后髁的相对距离占前后比为男(33.8±3.0)％、女(32.8±4.6)％,到远端的距离占上下比为男(59.5±4.1)％、女(60.8±3.7)％.股骨内上髁最高点到后髁的相对距离占前后比为男(44.7±8.1)％、女(48.5±6.1)％,到远端的距离占上下比为男(63.9±7.8)％、女(64.8±7.8)％.外侧副韧带位于股骨外上髁最高点远后方(50.5±5.4)°、2.96±0.36 mm,腘肌腱位于远后方(38.07±2.57)°、10.52±0.86 mm.内侧副韧带位于股骨内上髁最高点远后方(37.6±2.9)°、4.93±0.71 mm,内侧髌股韧带位于近后方(37.21±1.16)°、12.79±1.68 mm.结论:股骨内、外侧髁侧面上均有位置、高度相对恒定的骨性最高点,可作为四条韧带重建时股骨定位参照点,本实验的数据可以为临床提供参考.

Objective To compare the antitumor effects of Ewing’s sarcoma protein ( EWS ) 306, EWS 289 and EWS 401 of human leukocyte antigen ( HLA )-antigen ( A ) / 0201-restricted epitope peptides against dendritic cells ( DCs ) of Ewing’s sarcoma.Methods The peptide 9 of EWS / FLI-1 protein, which was easily combined with HLA-A / 0201 of human cell antigen was screened by Operating software of BIMAS and SYFPEITHI. And then the corresponding epitope peptide was generated. The standard 4 h-51Cr release experiment was used to test the lethal effects of cytotoxic T lymphocytes ( CTLs ) against tumor cells. Enzyme linked immunospot assay ( ELISPOT ) was applied to detect the interferon-γ ( IFN-γ ) releasing of effector cells induced by DC vaccines of epitope peptides. Accordingly, the antitumor effects in vitro were compared in an animal experiment, and all these animals received immunotherapy. Results A strong binding force with HLA-A / 0201 was noticed in the screened EWS 306, EWS 289 and EWS 401, and the generated epitope peptides were QLWQFLLEL ( EWS 306 ), ILGPTSSRL ( EWS 289 ) and SMYKYPSDI ( EWS 401 ) respectively. A high lethality was noticed in EWS 306, EWS 289 and EWS 401 groups. When the effector /target cell ratio was 50 : 1, the lethalities in EWS 306, EWS 289 and EWS 401 groups were ( 20.2±1.8 ) %, ( 12.6±0.3 ) % and ( 11.9±0.2 ) % respectively. And while in the control group, the lethality was ( 6.7±0.1 ) %. When the effector / target cell ratio was 100:1, the lethalities in EWS 306, EWS 289, EWS 401 and the control groups were ( 51.2±3.7 ) %, ( 24.6±2.1 ) %, ( 17.8±0.9 ) % and ( 7.2±0.2 ) % respectively. There were statistically signiifcant differences when the lethality between the EWS 306 group and the others was compared (P<0.05 ). The number of secreted IFN-γ in EWS 306 group was 118.3±3.6, which was obviously higher than 35.1±1.0 in EWS 401 group, 34.2±0.9 in EWS 289 group and 5.0±0.1 in the control group ( P<0.05 ). The tumor volume was ( 978.9±28.2 ) mm3 in EWS 306 group, which was obviously smaller than ( 1992.9±16.1 ) mm3 in the negative control group and ( 2001.9±12.3 ) mm3 in the blank control group. At the 35 day after inoculation, the survival rate in EWS 306 group was 80%, which was higher than 0% in the blank control group and 10% in the negative control group (P<0.05 ). At 40 day after inoculation, the survival rate in the blank control group was reduced to 0%, and 80% in EWS 306 group was obviously higher than that of the other control groups (P<0.05 ).Conclusions Stronger antitumor effects against DCs are noticed in EWS 306 when compared with that of EWS 289 and EWS 401. EWS 306 can effectively activate the lethal effects of CTLs against tumor cells and provide a new direction for the immunotherapy for Ewing's sarcoma.

Objective To discuss the significance of the detection of interferon-γin the diagnosis of active joint tuberculosis. Methods 5 kinds of specific proteins of mycobacterium tuberculosis were used as stimulating protein, the chemiluminescence enzyme immunoassay was used to test the content of interferon-γ. The interferon-γof 35 cases of patients with active joint tuberculosis and 35 cases of healthy people were detected. The difference of the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ra-tio and negative likelihood ratio of 5 kinds of proteins to the diagnostic of active joint tuberculosis were compared. Results CFP10/ESAT6 fusion protein, Rv2041c protein, Rv0057/1352 fusion proteins, Rv1419 protein and Rv1656 protein were used as stimulating protein, the sensitivities of active joint tuberculosis by the whole blood interferon-γassay were 77.1%, 68.6%, 71.4%, 74.3%and 65.7%. The specifici-ties were 65.7%, 54.3%, 57.1%, 60.0%and 62.9%. The positive predictive values were 62.9%, 60%, 62.5%, 65%and 63.9%. The negative predictive values were 74.2%, 63.3%, 66.7%, 70%and 64.7%. The positive likelihood ratios were 2.25, 1.5, 1.67, 1.86 and 1.77. The nega-tive likelihood ratios were 0.348, 0.579, 0.5, 0.429 and 0.545. Conclusion The detection of interferon-γhas certain significance to joint tu-berculosis. But it is not as an index of diagnosing joint tuberculosis.