Objective To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis. Methods Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement wasperformed via extraperitoneal approach, then tricortical il iac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main cl inical symptom was persistent pain in lumbosacral area. The involved segments included L4, 5 (3 cases), L5, S1 (8 cases), and L4-S1 (5 cases). The lumbosacral angle was 18-32° (mean, 22°). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation. Results The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative compl ication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31° (mean, 21°) at last follow-up. Conclusion The extraperitoneal approach can provide direct and safe access to the lesion. The structural il iac bone allograft and posterior instrumentation could reconstruct effectively the stabil ity of the lumbosacral junction.
Objective To investigate the therapeutic effectof the modified anterior approach in treatment of the patients with cervicothoracic junction spinal lesions. Methods From September 2000 to January 2005, 23 patients (15 males, 8 females) with spinal lesions in the cervicothoracic junction underwent a standard cervical approach, which was combined with apartial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Among thepatients, 3 had fracture, 7 had dislocation, 6 had tuberculosis, and 7 had tumor. The pathologic change regions was as follows: 2 in the C6-T1 segment, 2in the C6-T2 segment, 3 in the C7-T1 segment, 3 in the T3 segment, 8 in the T1 segment, and 5 in the T2egment. The classification of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 4 at grade D, and 6 at grade E. All the patients underwent a radical excision of the affected spinal bone, were given a proper tricortical iliac crest and anterior instrumentation to reconstruct the anterior spinal column, followed by immobilization in a brace for 3-6 months. Results The mean followup period was 30 months (range, 1042 months). Bony fusion was obtained in all the patients.One patient died of pulmonary cancer metastasis 10 months after operation. The nerve function of the spinal cord recovered at different degrees (1 at grade A, None at grade B, 2 at grade C, 10 at grade D, 10 at grade E). Conclusion Ourmodified anterior approach can provide a direct and safe access to the lesions in the region.
目的 总结成都市某男男性行为人群（MSM）中人类免疫缺陷病毒（HIV）感染者合并其他传染病的情况，为科学防治艾滋病提供依据。 方法 2010年1月－12月，采用网络、现场、活动场所收发调查问卷，用Excel统计结果数据。 结果 共调查104例艾滋病患者，合并肝炎感染者11例（10.58%），其中乙肝病毒感染者8例（7.69%），丙肝病毒感染者3例（2.88%）；合并性传播疾病感染61例（58.65%），其中梅毒感染26例（25%），尖锐湿疣感染者17例（16.35%），生殖器疱疹感染者10例（9.62%），淋病感染者2例（1.92%），沙眼衣原体感染者4例（3.85%），生殖道支原体感染者2例（1.92%）；合并真菌感染者87例（62.14%），其中耶氏肺孢子菌感染者6例（5.77%），马尔尼菲青霉菌感染者2例（占1.92%），隐球菌感染者5例（4.81%），组织胞浆菌1例（0.96%）；合并结核感染者23例（22.12%）及非结核分枝杆菌3例（2.88%）；病毒感染14例（13.46%），全部为水痘-带状疱疹病毒感染；寄生虫感染（弓形虫）1例（0.96%）。 结论 在MSM人群中HIV患者性传播疾病感染比例高；真菌感染率高；结核感染率高；HCV感染和弓形虫感染率低。
Objective To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome. Methods Between May 2006 and September 2011, 4 patients with subcoracoid impingement syndrome were treated, including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability. There were 3 males and 1 female with an average age of 36 years (range, 20-56 years). The disease duration was 6-22 months (mean, 11.2 months). The patients had a history of chronic pain and click of the anterior should, which was aggravated in adduction, internal rotation, and flexion. The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign. The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased. The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy. The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface. Shoulder was fixed with the external braces for 6 weeks. Results Healing of incision by first intention was observed in all cases without any complication. All the 4 patients were followed up from 8 months to 5 years. At last follow-up, pain and click disappeared. The mean visual analogue scale (VAS), University of California at Los Angeles (UCLA), Constant, and simple shoulder test (SST) scores were significantly improved from 7.75, 10.25, 65.50, and 9.75 at preoperation to 0.25, 34.25, 91.25, and 0.25 at last follow-up respectively. The axial CT in adduction position and MRI showed that long coracoid process was removed; the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation; and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation. Conclusion Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid impingement, which has less complications and faster recovery.
【Abstract】 Objective Prostaglandin E2 (PGE2) production increases in human tendon fibroblasts after the tendon injuries and repetitive mechanical loading in vitro. To analyze the relations between PGE2 and tendinopathy by observing the changes of collagen content and proportion after the Achilles tendon of rabbits is repeatedly exposed to PGE2. Methods Twenty-four Japanese rabbits (aged 3-4 months, weighing 2.0-2.5 kg, and male or female) were equally randomized into 2 groups according to injection dose of PGE2: low dose group (50 ng) and high dose group (500 ng). Corresponding PGE2 (0.2 mL) was injected into the middle segment of the Achilles tendon of hindlimb, the same dose saline into the same site of the other side as controls once a week for 4 weeks or 8 weeks. The Achilles tendons were harvested at 4 and 8 weeks after injection. HE staining was used to observe the cell structure and matrix, and picric acid-sirius red staining to observe the distribution and types of collagen fibers, and transmission electron microscopy was used to measure the density of the unit area and diameter of collagen fibers. Results HE staining showed that collagen structural damage was observed in low dose and high dose groups. Picric acid-sirius red staining showed that the content of type I collagen significantly decreased while the content of type III collagen significantly increased in experimental side of 2 groups at 4 and 8 weeks after injection when compared with control sides (P lt; 0.05). The content of type I collagen was significantly lower and the content of type III collagen and ratio of type III to type I were significantly higher in high dose group than in low dose group (P lt; 0.05). Transmission electron microscopy showed that the collagen fibers density of unit area was significantly lower and the diameter was significantly smaller in high dose and low dose groups than in the controls (P lt; 0.05), and in high dose group than in low dose group (P lt; 0.05). Conclusion Repeat exposure of the Achilles tendon of rabbit to PGE2 can cause the decrease of type I collagen, the increase of type III collagen, the reverse ratio of type I to type III, reduced unit density of collagen fibers, and thinner collagen fibers diameter, which is related with tendinopathy.
目的 研究组织工程骨结合带锁髓内钉修复成年山羊大段负重骨缺损的可行性，探索更可行的技术路径。 方法 将24只成年山羊，通过骨髓穿刺法获取山羊骨髓间充质干细胞（BMSC），将体外扩增及成骨定向诱导的第2代BMSC与同种异体脱钙骨基质（DBM）通过双相接种法构建组织工程骨。24只成年山羊，以带锁髓内钉构建股骨中段3 cm骨缺损模型。随机分为3组，每组8只。实验组以组织工程骨修复骨缺损，对照组单独使用DBM和空白组旷置。术后1、12、24周行X线片观察及评分，12、24周每组各处死4只动物行组织学观察和生物力学检测。 结果 标本大体观察示实验组和对照组术后12周骨缺损部位被骨痂连接，髓腔贯通，24周全部愈合；实验组24周恢复正常解剖形态，对照组外形仍然粗糙、不规则；空白组术后12周及24周缺损部位均为纤维组织充填。术后1周各组X线评分无明显差异（P＞0.05），实验组术后12周及24周X线评分均优于对照组和空白组，对照组优于空白组，各组24周X线评分均高于12周时，差异均有统计学意义（P＜0.05）。实验组术后12、24周的最大抗扭强度分别达正常侧的47.07% ± 5.05%和83.73% ± 2.33%，显著高于对照组和空白组（P＜0.05）；空白组2个时间点最大抗扭强度均不超过正常的15%，与骨不连时的纤维连接相符。组织学检查示术后12周实验组和对照组骨缺损区DBM支架材料基本被吸收，有典型的同心圆排列的哈弗系统形成，周围偶见淋巴细胞；术后24周，实验组和对照组股骨缺损均被修复，但实验组较对照组的新骨更多、骨塑形更好；空白组术后24周骨缺损区中央仍为纤维组织填充。 结论 组织工程骨结合带锁髓内钉能够更有效修复成年山羊负重骨大段骨缺损，满足负重骨的生物力学要求。
Objective To analyze the distribution of stress in the upper and lower plates of the prosthesis-bone interface, and the effect of interface pressure on osseointegration. Methods CT scanning was performed on goats at 1 week after artificial cervical disc replacement to establish the finite element model of C3, 4. The stress distribution of the upper and lower plates of the interface was observed. At 6 and 12 months after replacement, Micro-CT scan and three dimensional reconstruction were performed to measure the bone volume fraction (BVF), trabecular number (Tb. N), trabecular thickness (Tb. Th), trabecular separation (Tb. Sp), bone mineral density (BMD), bone surface/bone volume (BS/BV), and trabecular pattern factor (Tb. Pf). The C3 lower plate and C4 upper plate of 4 normal goat were chosen to made the cylinder of the diameter of 2 mm. The gene expressions of receptor activator for nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), transforming growth factor β (TGF-β), and macrophage colony-stimulating factor (M-CSF) were detected by real time fluorescent quantitative PCR at immediate after cutting and at 24 and 48 hours after culture. The samples of appropriate culture time were selected to made mechanical loading, and the gene expressions of RANKL, OPG, M-CSF, and TGF-β were detected by real time fluorescent quantitative PCR; no mechanical loading samples were used as normal controls. Results Under 25 N axial loading, the stress of the upper plate of C3, 4 was concentrated to post median region, and the stress of the lower plate to middle-front region and two orbits. According to stress, the plate was divided into 5 regions. The Micro-CT scan showed that BMD, Tb.Th, BVF, and Tb.N significantly increased, and BS/BV, Tb.Sp, and Tb.Pf significantly decreased at 12 months after replacement when compared with ones at 6 months (P<0.05). At 24 and 48 hours after culture, the gene expressions of RANKL, OPG, and TGF-β were signifi-cantly higher than those at immediate (P<0.05), but no significant difference was found between at 24 and 48 hours after culture (P>0.05). The mechanical loading test results at 24 hours after culture showed that the RANKL and OPG gene expressions and OPG/RANKL ratio in C3 lower plate and C4 upper plate were significantly up-regulated when compared with controls (P<0.05), but no significant difference was shown in TGF-β and M-CSF gene expressions (P>0.05). Conclusion Domestic artificial cervical disc endplate has different pressure distribution, the stress of lower plate is higher than that of upper plate. Pressure has important effect on local osseointegration; the higher pressure area is, the osseointegration is better. Under the maximum pressure in interface, the osteoblast proliferation will increase, which is advantageous to the local osseointegration.
ObjectiveBased on the cell-extracellular matrix adhesion theory in selective cell retention (SCR) technology, demineralized bone matrix (DBM) modified by simplified polypeptide surface was designed to promote both bone regeneration and angiogenesis.MethodsFunctional peptide of α4 chains of laminin protein (LNα4), cyclic RGDfK (cRGD), and collagen-binding domain (CBD) peptides were selected. CBD-LNα4-cRGD peptide was synthesized in solid phase and modified on DBM to construct DBM/CBD-LNα4-cRGD scaffold (DBM/LN). Firstly, scanning electron microscope and laser scanning confocal microscope were used to examine the characteristics and stability of the modified scaffold. Then, the adhesion, proliferation, and tube formation properties of CBD-LNα4-cRGD peptide on endothelial progenitor cells (EPCs) were detected, respectively. Western blot method was used to verify the molecular mechanism affecting EPCs. Finally, 24 10-week-old male C57 mice were used to establish a 2-mm-length defect of femoral bone model. DBM/LN and DBM scaffolds after SCR treatment were used to repair bone defects in DBM/LN group (n=12) and DBM group (n=12), respectively. At 8 weeks after operation, the angiogenesis and bone regeneration ability of DBM/LN scaffolds were evaluated by X-ray film, Micro-CT, angiography, histology, and immunofluorescence staining [CD31, endomucin (Emcn), Ki67].ResultsMaterial related tests showed that the surface of DBM/LN scaffold was rougher than DBM scaffold, but the pore diameter did not change significantly (t=0.218, P=0.835). After SCR treatment, DBM/LN scaffold was still stable and effective. Compared with DBM scaffold, DBM/LN scaffold could adhere to more EPCs after the surface modification of CBD-LNα4-cRGD (P<0.05), and the proliferation rate and tube formation ability increased. Western blot analysis showed that the relative expressions of VEGF, phosphorylated FAK (p-FAK), and phosphorylated ERK1/2 (p-ERK1/2) proteins were higher in DBM/LN than in DBM (P<0.05). In the femoral bone defect model of mice, it was found that mice implanted with DBM/LN scaffold had stronger angiogenesis and bone regeneration capacity (P<0.05), and the number of CD31hiEmcnhi cells increased significantly (P<0.05).ConclusionDBM/LN scaffold can promote the adhesion of EPCs. Importantly, it can significantly promote the generation of H-type vessels and realize the effective coupling between angiogenesis and bone regeneration in bone defect repair.
Objective To analyze the short-term effectiveness of repairing musculus extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) tendon using suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis. Methods Between March 2009 and May 2011, 10 patients (10 elbows) with recalcitrant lateral epicondylitis received repair of the ECRB and EDC tendon to the lateral epicondyle using a single suture anchor after debridement of extensor tendon insertion. There were 6 males and 4 females with an average age of 45.4 years (range, 36-57 years). The dominant elbow was involved in 8 patients and nondominant elbow in 2 patients; there were 4 manual workers and 6 ordinary workers. The disease duration ranged from 8 to 24 months (mean, 12.3 months). All patients had epicondylus lateralis humeri pain, local swelling and tenderness, and positive Mill sign. The average elbow range of motion (ROM) was 11.3°(range, 0-30°) in extension and was 132.5°(range, 120-145°) in flexion. Preoperative MRI showed external humeral epicondylitis in all patients. ResultsPrimary wound healing was obtained in all patients without complications of infection, leakage of joint fluid, and stiffness of elbow. Ten patients were followed up 4 to 23 months with an average of 12 months (more than 12 months in 7 cases). The time to return to work was (3.75 ± 0.95) months for manual workers and was (2.91 ± 0.20) months for ordinary workers, showing no significant difference (t=1.715, P=0.180). Compared with preoperation, the mean visual analogue scale (VAS) score significantly decreased (P lt; 0.05), and Mayo score and the grip strength of dominant and nondominant significantly increased (P lt; 0.05), but no significant difference was found when compared with non-surgical side at last follow-up (P gt; 0.05). At last follow-up, the average ROM was —1.5° (range, 0-—10°) in extension and was 150.5°(range, 140-160°) in flexion. ConclusionTo suture anchor for repairing the ECRB and EDC after debridement is a satisfactory procedure to treat recalcitrant lateral epicondylitis. It can effectively prevent loss of the forearm extensor strength, relieve the pain, recover the grip strength, and obtain good results.