目的 探讨全身麻醉下手法牵引复位联合颈前路减压植骨融合内固定术治疗颈椎骨折脱位的疗效.方法 回顾性分析自2015-01-2016-01诊治的62例颈椎骨折脱位,在全身麻醉下行手法牵引复位,复位时需要注意牵引的方向和牵引的力度,颈椎骨折脱位复位满意后尽量选择行一期颈椎前路椎间盘切除减压植骨融合内固定术.结果 本组手术时间平均92(78～120)min,术中出血量平均80(50～300)ml.术后切口均一期愈合,均未发现切口感染.10例需要气管切开并转入ICU监护.术后8例出现不同程度腹胀,5例出现低蛋白血症,5例吞咽困难,均对症处理.62例均获得随访,随访时间平均18(12～24)个月.随访期间影像学检查显示椎间融合率达到100％,无假关节形成.末次随访时ASIA评分:A级5例,B级18例,C级10例,D级20例,E级9例.结论 全身麻醉下手法牵引复位可提高颈椎骨折脱位复位成功率,复位后再行颈前路减压植骨融合内固定术,可缩短手术时间、简化手术方式,并且不会加重脊髓损伤.

BACKGROUND: To evaluate effectiveness and safety of extended laminoplasty for the treatment of ossification of posterior longitudinal ligament (OPLL) involving the C2 segment. METHODS: A total of 132 cases who accepted laminoplasty for treating the OPLL from 2010 to 2015 were included and divided into Group A (n = 26, with C2 OPLL and C2-C7 laminoplasty), Group B (n = 29, with C2 OPLL and C3-C7 laminoplasty), and Group C (n = 77, without C2 OPLL and had C3-C7 laminoplasty). Clinical and radiologic outcomes were compared among the 3 groups. RESULTS: At the final visit, significant improvements in japanese Orthopedic Association score, Neck Disability Index, Health-Related Quality-of-Life Short Form 36 Physical Component Summary, and Visual Analog Scale score in neck were observed in all 3 groups. However, all the C2-C7 Cobb angle, C2-C3 Cobb angle, sagittal vertical axis, and number of cases with cervical or segmental kyphosis in the 3 groups were not significantly changed. Although total blood loss, operation time, maximum Visual Analog Scale score in neck, incidence of axial pain, change of C2-C7, or sagittal vertical axis in Group A were all significantly larger than that in Group B or Group C, differences in neurologic recovery rate, Neck Disability Index, Health-Related Quality-of-Life Short Form 36 Physical Component Summary, change of the C2-C3 Cobb angle, and incidence of cervical or segmental malalignment among the 3 groups were not significant at the final visit. CONCLUSIONS: If decompression indication for cases with OPLL involving the C2 segment was appropriate, extended laminoplasty up to the C2 segment could provide satisfactory neurologic recovery and would not accelerate cervical or segmental malalignment progression.

Osteosarcoma is the most common malignancy of bone that occurs in young adults and children, with a five-year survival rate of 60-70%. Metastasis of osteosarcoma maintains an even poorer prognosis. GREM1 plays an important role in regulating organogenesis, body patterning, and tissue differentiation. However, there are limited studies on GREM1 in osteosarcomas. This study was carried out to characterize the expression and function of GREM1 in osteosarcoma cells, thus extending our understanding of osteosarcoma metastasis. GREM1 expression was detected in hBMSC, hFOB1.19, Saos-2, MG63 and U2OS cell lines using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analysis. Gain- and loss-of-function approaches were used to assess the biological function of GREM1 in U2OS cells. The effects of GREM1 on U2OS cell proliferation were examined using the CCK-8 and colony formation assay. Migration and invasion ability were confirmed by the wound healing and Transwell assay, respectively. Flow cytometry was used to analyse the effect of GREM1 on the cell cycle and apoptosis. The expression of GREM1 targets was evaluated by qRT-PCR and western blotting. The expression of GREM1 was significantly downregulated in osteosarcoma. GREM1 overexpression inhibited the proliferation, migration and invasion of U2OS cells. GREM1 overexpression suppressed tumour cell-induced endothelial cell migration and invasion ability. The effect of GREM1 may be transduced through regulation of the BMP target transcription factor inhibitor of MMP-2 and -9 as well as Id1. GREM1 overexpression and knockdown regulates the tumorigenesis of osteosarcoma in vivo. In conclusion, GREM1 is downregulated in osteosarcoma cells, and overexpression of GREM1 inhibits the proliferation, migration, invasion and angiogenesis abilities of osteosarcoma cells in vitro and in vivo.

军事训练伤是基层部队的常见病和多发病,其发生率及严重程度、致残情况、防治效果等对部队安全稳定和战斗力生成均有重要影响.本文通过分析军事训练伤的发展现状和门诊治疗过程中存在的问题,提出在军队医院设立军事训练伤联合门诊的构想,并按照三个步骤分期实施,以强化军队医院为军服务宗旨、提高训练伤诊疗质量、创新优化各级医疗卫生机构卫勤保障机制.

目的 探讨颈椎后路单开门椎管扩大成形术与颈椎后路椎板切除减压椎弓根钉内固定术治疗颈椎后纵韧带骨化症并发C5神经根麻痹的影响因素,并总结预防和治疗经验.方法 回顾性分析自2011-06-2014-06诊治的83例颈椎后纵韧带骨化症,43例行颈后路单开门椎管扩大微型钛板成形术(A组),40例行颈后路椎板切除减压椎弓根钉内固定术(B组).比较2组术前及末次随访时JOA评分,以及C5神经根麻痹发生率.结果 术后1～3 d内共出现8例(9.6％)C5神经根麻痹,其中A组出现2例(4.7％),B组出现6例(15.0％);A组术后C5神经根麻痹发生率低于B组,差异有统计学意义(P＜0.05).8例C5神经根麻痹患者采用甘露醇脱水及地塞米松治疗,进行积极功能锻炼,症状得到缓解;2例遗留肩部疼痛及关节活动受限,在全身麻醉下行肩关节松解术.2组末次随访时JOA评分较术前明显提高,差异有统计学意义(P＜0.05).结论 颈椎后路单开门椎管扩大成形术和椎板切除减压椎弓根钉内固定术治疗颈椎后纵韧带骨化症均能获得有效的神经功能恢复,但颈椎后路椎板切除减压椎弓根钉内固定术后并发C5神经根麻痹的概率更高,因此需在围手术期进行合理预防和治疗以降低术后C5神经根麻痹的发生率及其严重程度.

部分临床医学研究生存在与患者沟通的障碍,不少问题根植于"语商"的不足.通过分析研究生存在的语言特征及问题,指出目前医学教育中人文沟通课程的现状和缺陷,提出集中教育和小组教育、翻转课堂和专家授课、全程监督和定期考核、深入社区和医院实践四个结合的应对措施,以提高研究生的"语商",减少医患沟通矛盾.

医学研究生的知识产权保护意识以及成果转化的能力还存在一定的短板.这与目前医学教育的课程缺陷有关,但研究生群体的创新潜力值得挖掘.通过专利和成果转化理论授课、指导学生撰写专利和基金、开展专利和成果转化总结、建立成果转化评估体系等举措,使研究生的产权意识得到了升华,提高了其申请专利、积极产出的能力.知识产权相关知识的教学经验值得推广.

Primary medical officer is an integral part of the military logistics,which plays an important role in the preservation of effective strength, reduction of casualties, and improvement of combat effectiveness. It is an important way to maintain the sustainability of the medical officer by strengthening the comprehensive quality of them. By analyzing the shortcomings of Chinese army's medical training primary medical officer and based on the advancement of US Army's training expe-rience,we make conclusions as follows: strengthening medical undergraduate medical education, more continuing education,and getting more deeply involved in the development of civil military in-tegration.

针对当前陆军基层部队心理卫生工作开展情况进行了梳理,分析总结了当前心理工作特点及存在的问题,提出强化思想重视、制度落实,建立反馈机制;加强人才培养、继续教育,建立学习机制;优化分级诊治、危机干预,建立主动机制;深化军民融合、军地联动,建立高效机制等建议措施,全面提高陆军基层部队心理卫生工作水平.

我军规模结构和力量编成改革以来,基层部队卫生队改编为建制连队,即卫生连,在管理模式、自身职能、军事训练等方面发生了重大变化.改建后的卫生连应尽快适应新的管理模式,平衡军事训练与卫勤保障的关系,并探索适合卫生连自身定位和发展的途径.本文通过分析军改对卫生连在卫勤保障方面的一系列影响,提出形成独特作风、锤炼看家本领、完善精良装备、强化研究能力和明确与后方医院联动等对策建议.

Objective To develop an autopsy table for the cervical surgery of the small animal to enhance the efficiency by regulating the angles during the operation to expose cervical vertebra adequately.Methods The autopsy table was composed of a table body,a head rack and a foot rack.The head rack was connected with the body by a loose-leaf shaft,which had a screw under a semi-cylindrical cushion put into a sliding slot of the cushion to regulate and fix its position.The table body had four straps at its comers to imobilize the extremities of the experimental animal,and some screws were used to adjust and position the straps to four oblique sliding slots.Results The autopsy table adapted itself to sizes of small animals,which gained advantages in exposure of operating field,short operating time,decreased intraoperative blood loss,head imobilization as well as reduced workload.Conclusion The autopsy table enhances surgery efficiency and safety and has easy operation and low cost,and thus is worthy promoting in the cervical experiment of small animals.

BACKGROUND:The treatment of multilevel lumbar degenerative disease (LDD) is complicated and challenging, and the optimal surgical strategy remains controversial.OBJECTIVE:To compare the differences in clinical and radiologic outcomes and in complications after 1-level interbody fusion versus multilevel interbody fusion for the treatment of multilevel LDD.METHODS:A total of 100 patients with multilevel LDD were randomized in a 1:1 ratio into the 1-level interbody fusion group or the multilevel interbody fusion group. Clinical and radiologic results and major complications in the 2 groups were analyzed. Clinical outcomes were assessed using the Visual Analog Scale for radicular and back pain, the Oswestry Disability Index, and the short-form 36 physical score. Clinical status was assessed by the Whitecloud classification. Radiologic evaluation included assessment of lumbar lordosis, pelvic incidence, and sacral slope.RESULTS:There were no significant differences in clinical and radiologic results between the 2 groups. Procedure duration and intraoperative blood loss were significantly greater in the multilevel interbody fusion group than in the 1-level interbody fusion group; the multilevel interbody fusion group also had greater incidences of temporary nerve root palsy, wound infection, and adjacent segment disease.CONCLUSION:A hybrid technique including 1-level interbody fusion and multilevel posterolateral fusion is recommended for patients with multilevel LDD.

目的 评价短节段与长节段内固定治疗退变性脊柱侧弯(DS)的临床疗效.方法 检索建库至2016-01万方、维普、CBM、Pubmed、Medline等外数据库,中文以“退变性脊柱侧弯”、“退行性脊柱侧弯”、“内固定”、“长”、“短”,英文以“degenerative scoliosis”、“interior fixation”、“long”、“short”等关键词查找采用短节段或长节段内固定治疗DS的队列研究或随机对照(RCT)文献.提取手术时间、术中出血量,手术前后Cobb角、ODI指数、腰椎前凸角,以及并发症发生率等指标,利用RevMan 5.3及SPSS 19.0统计学软件进行数据分析.结果 纳入12篇文献,中文10篇,英文2篇,共计569例.短节段固定308例,长节段固定261例.短节段组在手术时间、术中出血量、并发症发生率方面优于长节段组,而长节段组手术前后ODI指数改善优于短节段组,差异有统计学意义(P＜0.05).在腰椎冠状位Cobb角和腰椎前凸角的矫正方面上,2组差异无统计学意义(P＞0.05).结论长、短节段内固定治疗DS均能够获得较好的Cobb角和腰椎前凸角矫正效果.长节段固定在ODI指数改善方面占优势,短节段固定在手术时间、术中出血量、并发症发生率方面占优势.

目的 探讨颈椎创伤性瘫痪患者围手术期腹胀的临床相关因素,为其早期预防和治疗提供必要依据.方法 回顾性分析2009-06-2011-06在本院脊柱外科收治的92例颈髓损伤致瘫痪患者的临床资料.记录入选对象出现的一般情况、神经损害程度(采用美国脊髓损伤协会的ASIA分级)、围手术期腹胀发生情况(结合主观感受、腹部平片、进食情况、腹部叩诊等指标)、术后首次排气时间、排便、镇痛泵使用情况等内容,对结果进行相关危险因素分析.结果 92例患者中有65％(60/92)出现不同程度的腹胀症状,其中,高龄、神经功能损害程度高、术后首次排气时间长、术后使用镇痛泵时间超过24h等为围手术期出现腹胀的危险因素.结论 颈椎创伤性瘫痪患者围手术期出现腹胀的发生率高,对于具有高危因素的重点患者需要进行及时的针对性救治,可改善预后,提高患者生存质量.

To analysis the intendance of occupational disease types such as radiation damage, neck and lumbar diseases, gastrointestinal disease in orthopedic surgeon group, finding existing cogni-tive misunderstanding prblems for orthopedic surgeon in occupational disease such as insufficient cog-nition and prevention, unawareness of control measures and little attention. As a result, proposed measures for holiday system security, to take health management lessons, and to strengthen the abi-lity of self-protection for the orthopedic occupational health educational strategies.

目的 调查两栖步兵部队军事训练伤情况,并提出防治措施.方法 利用问卷与面谈调查某两栖部队385名官兵,分析训练伤发病情况及其影响因素.结果 约有47.5％的官兵发生训练伤.其中,五千米武装越野(36％)、400米障碍跑(30％)、战术训练(24％)等项目受伤比例高;山地(42.6％)、平地(41.5％)等环境容易受伤;训练强度过大、疲劳、自身技术动作错误等为主要诱因;20～25岁年龄段发生伤病的居多(48.4％);3年以下军龄的多发(50.2％);腰(42.6％)、膝(42.1％)、踝(36.1％)等部位好发;冬春季及夏季早期为训练伤高发期;运动系统损伤和环境损伤共同存在.结论 两栖步兵兼有陆地及濒海训练的要求,需要加强对基层官兵训练伤的重视,完善基础研究,探索防治措施.

研究生教育须将业务学习与社会实践教育结合起来,调研发现,部分研究生存在交流能力差、医德医风欠优、社会活动能力低、就业能力不足等问题.鉴于此,我教学医院积极进行了教学的改革和探索.多年来组建了形式多样的“社会课堂”,如博士团下乡、义诊、定点服务、门诊讲堂等,提高了研究生医患交流能力、强化了爱患爱伤观念、增强了社会活动能力、提高了就业质量,获得了研究生和社会好评.

骨科亚学科的分化导致专业型增强。调查发现，脊柱外科研究生对脊柱激素损伤的基本概念、救治流程、预后判断和并发症防治掌握不足。教学组将损伤控制理念引入研究生的脊柱脊髓外伤教学中，帮助其把握该理念在临床应用中的适应证、熟知实际操作流程，对完成研究生期间的临床实践有明显的促进作用。

Objective To analyzed the digestive system management clinical application in pa-tients with cervical spine injury with paraplegia in perioperative period,retrospectively. Methods Analysis of Shanghai changzheng hospital spinal surgery in 2011-2013,84 patients with digestive system management mode of treatment of cervical vertebra trauma patients with paraplegia with clini-cal data,including age, gender,injury factors,cervical vertebra injured segments,operation situation, abdominal management methods and prognosis,statistical via abdomen symptom relief after processing. Digestive management of patients with paraplegia with cervical vertebra trauma,our methods are the nutrition support, fluid management,physical stimuli,effective purge and so on. Results Through perioperative effective digestive system managemen,67 patients’s abdominal symptoms eased in the varying degree,no one had colostomy. That method proved to improve the quality of life. Conclusion Reasonable and timely digestive system management can effectively reduce the cervical vertebra trauma patients with paraplegia with abdominal symptoms, improving quality of life of postoperative patients.

分析了骨科术后随访的重要性,采用摸底调查发现骨科研究生在术后随访中存在的不能持之以恒、形式单调、效率低下等问题,以案例教学、设计随访表、灵活使用随访方式、有效利用资料等方法进行针对性的教学,在教学中注意过程督导、医患沟通能力培养、医德教育等方面,取得了良好效果.