病灶清除、植骨融合内固定术治疗腰骶段脊柱结核54例

目的：探讨一期后路病灶清除、植骨融合内固定术治疗腰骶段脊柱结核的临床疗效。方法：选取我院腰骶段脊柱结核患者54例,所有患者均采用一期后路病灶清除、植骨融合内固定术手术治疗,术前术后给予规范的抗结核治疗,观察患者术前,术后及随访时腰骶角、椎间隙高度等情况。结果：所有患者手术时间为160~290min,平均220.5±45.6min,出血150~1000ml,平均517.4±69.8ml,随访时间为6~36个月,平均25.6±5.2个月。切口均一期愈合,无慢性窦道形成,随访期间1例患者术后6月复发,经手术治疗后痊愈。5例患者术后出现神经根性刺激症状,对症治疗后好转。术后,末次随访中腰骶角较术前均有有明显的提高（P〈0.05）,椎间隙高度改变在术前,术后及末次随访结果具有显著性差异（P〈0.05）。结论：一期后路病灶清除、植骨融合内固定术可有效治疗腰骶段脊柱结核,恢复腰骶角正常生理曲度,增加椎间隙高度,明显改善患者腰痛等症状。

C_(2、3)前路植骨融合内固定术治疗Hangman骨折并发椎间盘损伤38例

探讨目的：Hangman骨折椎间盘并发损伤发的外科治疗方法及机制。方法：38例Hangman骨折伴颈2、3椎间盘损伤，行颈椎前路C2、3椎间隙植骨融合，Zephir颈前路钛板固定术，8例植入Syn Cage。结果：35例颈痛症状消失，3例残留轻度颈痛症状，未出现神经症状加重、植骨块移位、吸收和切口感染等并发症，术后3～6个月C2、3获得骨性融合。随访2～6年，平均3年7个月，均不影响工作。结论：椎间盘损伤并发Hangman骨折是一种特殊骨折类型，C2、3前路植骨融合内固定术符合其病理生理特点。

打压支撑植骨术治疗围塌陷期股骨头坏死66例

目的:观察打压支撑植骨术治疗围塌陷期股骨头坏死(ONFH)的临床疗效,分析影响治疗结果的原因。方法:选择连续性ONFH患者66例96髋,其中激素性坏死27例43髋,酒精性31例41髋,创伤性患者5例7髋,特发性3例5髋。按ARCO分型,ⅡA 7髋,ⅡB 21髋,ⅡC 8髋,ⅢA 32髋,ⅢB 23髋,ⅢC 5髋。两组患者均接受打压支撑植骨术治疗,术后服用中药。随访5～25个月,平均19.01个月。结果:Harris评分,术前56.67±13.97,末次随访时84.63±7.277,其中优28髋(29.2%),良52髋(54.2%),可11髋(11.2%),差5髋(5.2%),优良率83.3%,有效率94.8%。ARCOⅡ期髋治疗结果优于Ⅲ期,坏死范围越大、坏死部位越靠近股骨头外侧,预后越差,差异有统计学意义。而采用自体腓骨与同种异体腓骨治疗,差异无统计学意义。结论:采用打压支撑植骨术加中药治疗围塌陷期ONFH能明显改善患者髋关节功能,并能有效减少术后股骨头塌陷及并发症的产生。股骨头坏死的分期、范围、部位对治疗结果有预测意义。

内固定加微创植骨融合术治疗青壮年胸腰椎骨折临床分析

目的:探讨后路伤椎短节段内固定联合椎间植骨融合治疗青壮年胸腰椎骨折临床疗效及应用价值。方法:选择我院治疗的青壮年胸腰椎骨折患者94例,随机均分为治疗组和对照组,每组各47例,对照组给予后路伤椎短节段内固定治疗,治疗组后路伤椎短节段内固定联合椎间植骨融合治疗,观察两组治疗效果。结果:两组手术时间、术中出血量经统计学分析比较无显著差异(P>0.05)。治疗组治疗后椎体前缘高度及Cobb角改善情况优于对照组,经统计学分析比较差异显著(P<0.05)。治疗组治疗后Oswestry评分改善情况优于对照组,经统计学分析比较差异显著(P<0.05)。结论:采用后入路疗效可靠,功能恢复良好,可以合理矫正后凸的畸形并坚强骨性融合。

有限切开加植骨内固定治疗肱骨近端骨折46例疗效分析

目的:探讨有限切开加植骨治疗肱骨近端移位骨折的临床疗效。方法:通过有限切开使用锁定钢板结合植骨对46例肱骨近端移位骨折进行治疗,采用Neer分类和评定标准分析疗效。结果:46例患者获随访平均14个月,骨性愈合44例,出现螺钉退出肩关节半脱位致肱骨头坏死2例,按Neer评分标准分,优21例,良18例,可5例,差2例。总优良率为84.8%。结论:有限切开加植骨治疗肱骨近端移位骨折符合AO内固定原则,固定牢靠,可早期行功能锻炼,术后功能恢复满意。

后路减压联合棘突间植骨融合预防胸腰椎骨折术后矫正丢失的临床研究

目的:探讨后路减压联合棘突间植骨融合预防胸腰椎骨折术后矫正丢失的效果。方法:胸腰椎骨折患者64例根据手术方法的不同分为治疗组与对照组各32例,治疗组采用后路减压联合棘突间植骨手术,对照组采用单独的后路减压手术。结果:所有患者都植骨融合,融合率为100.0%。治疗组优良率为87.5%,对照组优良率为79.2%,两组优良率对比有显著性差异(P<0.05)。两组患者术后神经功能明显改善(P<0.05)。两组术后第3天伤椎的矢状面指数(SI)、伤椎椎体前缘压缩百分比(ABC)和椎间隙高度丢失百分比(ISH)对比无显著性差异(P>0.05);但术后3周两组相比,治疗组SI、ABC和ISH明显少于对照组(P<0.05)。结论:胸腰椎骨折术后矫正丢失是临床上比较常见的现象,后路减压联合棘突间植骨融合的应用能在预防术后矫正丢失的基础上,提高治疗优良率和恢复神经功能。

通痹益肾汤联合髓内减压植骨术治疗股骨头坏死39例

目的:探讨髓内减压植骨术结合中医疗法综合治疗股骨头坏死的临床疗效。方法:两组均采用髓内减压植骨术治疗,治疗组术后加用中药(生地黄、熟地黄、白芍药、桃仁、牡丹皮、红花、当归等),同时采用留火灸治疗,对比分析两组疗效。结果:两组harris评分治疗后较治疗前均有明显提高,差异具有统计学意义(P<0.05),且观察改善较对照组明显,差异具有统计学意义(P<0.05),两组治疗后在股骨头坏死表面积比、低密度脂蛋白、胆固醇、甘油三酯、全血黏度高切、全血黏度低切、全血黏度、红细胞比容指标上较治疗前明显有降低,差异具有统计学意义(P<0.05),且治疗组在以上指标的改善幅度明显大于对照组,差异具有统计学意义。结论:髓内减压植骨术结合中医疗法综合治疗股骨头坏死临床疗效显著,利于在临床中推广应用。

椎弓根固定加椎体间植骨治疗椎间盘突出症疗效观察

目的:探讨椎弓根固定加椎体间植骨治疗腰椎间盘突出症的临床效果。方法:随机选取70例腰椎间盘突出症患者为研究对象,分成2组,对照组予以常规的髓核摘除术,观察组在对照组的基础上加用椎弓根固定加椎体间植骨治疗。观察2组治疗后的效果情况。结果:对照组的优良率为51.4%,总有效率为71.4%;观察的优良率为88.5%,总有效率为97.1%。两组比较有明显的差异性;另外两组在术后椎间隙的高度恢复上、术后腰背部疼痛和生活质量评分上也有明显差异性,均具有统计学意义。但是两组在术后的出血量和术后感染上无明显差异性。结论:椎弓根固定加椎体间植骨治疗腰椎间盘突出症临床效果明显,可增加椎间隙高度,提高患者生活质量。

Investigation of bioactivity and biodegradability of Mg-bioceramic implants:An in vitro study for biomedical applications

In this study,Mg-based composites,by the addition of ZnO,Ca_(2)ZnSi_(2)O_(7),Ca_(2)MgSi_(2)O_(7),and CaSiO_(3)as bioactive agents,were fabricated using friction stir processing.The microstructure and in vitro assessment of bioactivity,biodegradation rate,and corrosion behavior of the resultant composites were investigated in simulated body fluid(SBF).The results showed that during the immersion of composites in SBF for 28 d,due to the release of Ca^(2+)and PO_(4)^(3-)ions,hydroxyapatite(HA)crystals with cauliflower shaped morphology were deposited on the surface of composites,confirming good bioactivity of composites.In addition,due to the uniform distribution of bioceramic powders throughout Mg matrix,grain refinement of the Mg matrix,and uniform redistribution of secondary phase particles,the polarization resistance increased,and the biodegradation rate of composites significantly reduced compared to monolithic Mg matrix.The polarization corrosion resistance of Mg-ZnO increased from 0.216 to 2.499 kΩ/cm^(2)compared to monolithic Mg alloy.Additionally,Mg-ZnO composite with the weight loss of 0.0217 g after 28 d immersion showed lower weight loss compared to other samples with increasing immersion time.Moreover,Mg-ZnO composite with the biodegradation rate of 37.71 mm/a exhibited lower biodegradation rate compared to other samples with increasing immersion time.

前后路联合手术治疗腰椎结核11例

目的:探讨前路结核病灶的清除,后路内固定加后外侧及椎体间植骨融合术治疗腰椎结核的特点及疗效。方法:采用前路结核病灶清楚、后路椎弓跟系统内固定、椎间植骨融合术治疗腰椎结核患者11例。结果:术后随访6～12个月,所有患者手术切口均Ⅰ期愈合,局部无窦道形成,临床症状消失。2例后凸畸形患者,后凸角度平均矫正20.2°,随访期间无丢失,畸形矫正满意,2例马尾神经受累病人症状消失,所有患者后外侧植骨4～6个月均融合。结论:术前、术后正规系统的抗痨治疗,术中病灶的彻底清除及有效可靠的后路内固定、椎间植骨融合,是保证脊柱结核手术治疗成功的关键。

前路内固定治疗胸腰椎结核伴后凸畸形162例

目的:探讨前路植骨内固定治疗胸腰段脊柱结核伴后凸畸形与截瘫的疗效。方法:采用前路病灶清除,植骨内固定治疗胸腰椎结核伴后凸畸形162例,观察术后植骨融合、畸形矫正、截瘫恢复及结核病灶愈合情况。结果:平均随访2年2个月,156例患者获访,平均融合时间为3.6个月。骨性融合率100%。在胸段、胸腰段及腰段后凸畸形分别平均纠正29°、15°及9°,随访时无矫正度丢失;伴截瘫者11例,Frankel神经功能平均恢复2级;脊柱结核均治愈。结论:一期前路病灶清除植骨内固定,融合时间短,畸形矫正效果好,减压彻底,有利于截瘫恢复。

Inactivated Bone Replantation with Preservation of the Epiphysis in Children with Osteosarcoma:Clinical Report of Two Cases

Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.

Microstructure, mechanical and bio-corrosion properties of as-extruded Mg-Sn-Ca alloys

The as-extruded Mg？Sn？Ca alloys were prepared and investigated for orthopedic applications via using optical microscopy, scanning electron microscopy, X-ray diffraction, as well as tensile, immersion and electrochemical tests. The results showed that, with the addition of 1% Sn and the Ca content of 0.2%？0.5%, the microstructure of the as-extruded Mg？Sn？Ca alloys became homogenous, which led to increased mechanical properties and improved corrosion resistance. Further increase of Ca content up to 1.5% improved the strength, but deteriorated the ductility and corrosion resistance. For the alloy containing 0.5% Ca, when the Sn content increased from 1% to 3%, the ultimate tensile strength increased with a decreased corrosion resistance, and the lowest yield strength and ductility appeared with the Sn content of 2%. These behaviors were determined by Sn/Ca mass ratio. The analyses showed that as-extruded Mg？1Sn？0.5Ca alloy was promising as a biodegradable orthopedic implant.

Treatment of Non-union Femoral Neck Fractures with Vascularized Fibula Grafting

Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck. The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results : One hundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibula graft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19 years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3 and 81. 6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impact on the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral head and preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the affected femoral head and neck, could promote the femoral head restoration and reconstruction. In addition, the periosteum of fibula plays a role in fracture healing.

Effects of Guiyuanfang and autologous transplantation of bone marrow stem cells on rats with liver fibrosis

AIM: To investigate the therapeutic effects of Guiyuanfang and bone marrow stem cells (BMSCs) on rats with liver fibrosis.METHODS: Liver fibrosis model was induced by carbon tetrachloride, ethanol, high lipid and assessed biochemically and histologically. Liver function and hydroxyproline contents of liver tissue were determined.Serum hyaluronic acid (HA) level and procollagen Ⅲ level were performed by radioimmunoassay. The VG staining was used to evaluate the collagen deposit in the liver.Immunohistochemical SABC methods were used to detect transplanted BMSCs and expression of urokinase plasminogen activator (uPA).RESULTS: Serum transaminase level and liver fibrosis in rats were markedly reduced by Guiyuanfang and BMSCs. HA level and procollagen Ⅲ level were also reduced obviously,compared to model rats (HA: 47.18±10.97 ng/mL,48.96±14.79 ng/mL; PCⅢ: 22.48±5.46 ng/mL, 26.90±3.35ng/mL; P＜0.05).Hydroxyproline contents of liver tissue in both BMSCs group and Guiyuanfang group were far lower than that of model group (1 227.2±43.1 μg/g liver tissue, 1390.8±156.3 μg/g liver tissue; P＜0.01). After treatment fibrosis scores were also reduced. Both Guiyuanfang and BMSCs could increase the expression of uPA. The transplanted BMSCs could engraft, survive, and proliferate in the liver.CONCLUSION: Guiyuanfang protects against liver fibrosis.Transplanted BMSCs may engraft, survive, and proliferate in the fibrosis livers indefinitely. Guiyuanfang may synergize with BMSCs to improve recovery from liver fibrosis.

Utility of co-transplanting mesenchymal stem cells in islet transplantation

Islet transplantation is characterized by the transplantation of isolated islets from donor pancreata into a diabetic recipient. Although it is a viable choice in the treatment of insulin dependent diabetes mellitus, most patients (approximately 90%) require insulin five years after transplantation. Recently, the co-transplantation of mesenchymal stem cells (MSCs) and islets in animal studies has revealed the effectiveness of MSCs co-transplantation for improving islet function. Themechanisms underlying the beneficial impact of MSCs include immunomodulation and the promotion of angiogenesis. In this review, we discuss MSCs and how they support improved graft survival and function.

Inhibitory Effects of Some Plant Extracts on 5 Bacterial Strains

[Objective] This study was conducted to develop potential natural plant products for controlling walnut blight pathogen and other bacteria. [Method] Inhibitory effects of extracts obtained from 15 plants with 3 solvents on bacteria were investi- gated by disk diffusion method. [Results] Except the extracts from Magnolia grandi- flora and Typha orientalis, extracts of 13 plant leaves presented inhibitory effects on 5 bacteria strains to certain degrees. Among them, the effect of water extract of Aesculu schinensis on Bacillus sp. XHE8 was the strongest, with inhibition zone di- ameter reaching （31.3＋3.9） mm and the ratio to control above 5.0. Four of the 5 tested strains were sensitive to the extracts of Sambucus chinensis, and 3 of them were inhibited by Ophiopegon japonicas extracts and Reineckia camea extracts, with ratios of treatment to control large than 1.5 in all. Leaf extract of A. chinensis had significant anti-bacteria ability, and could be used as a potential plant source for bactericide. [Conclusion] The results laid a foundation for exploring active com- pounds and elucidating the mechanism in it.

Structural bone allografts with intramedullary vascularized fibular autografts for the treatment of massive bone defects in extremities

Objective:To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods: From January 2001 to December 2005, large bone defects in 19 patients (11 men and 8 women, aged 6 to 35 years) were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm (mean 17.6 cm), length of vascularized free fibular was 15 to 29 cm (mean 19.2 cm), length of massive bone allografts was 11 to 24 cm (mean 17.1 cm). Location of massive bone defects was in humerus(n=1), in femur(n=9) and in tibia(n=9), respectively. Results: After 9 to 69 months (mean 38.2 months) follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion: The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.