ObjectiveTo screen for the differentially expressed genes in steroid-induced osteonecrosis of the femoral head (ONFH) by gene microarray. MethodsThe femoral head tissue of ONFH was harvested from 3 patients with steroid-induced ONFH, aged 25, 31, and 38 years, respectively. Normal tissue was harvested from a 26-year-old male remains contributor. HE staining of the specimens was performed for observing the histology manifestation; the total RNA was extracted for measuring the purity; cDNA probe was synthesized by reverse transcription, and then were hybridized as the cDNA microarray for scanning of fluorescent signals and differentially expressed genes in the tissues. ResultsHE staining of normal tissue showed complete unit composed of lamellar bone, continuous and complete lamellar bone with a concentric arrangement around blood vessels, and normal bone cells in the trabecular bone lacuna. In ONFH tissue, adipose tissue increased in the medullary cavity, with increased fat cells filling in the medullary cavity and extruding capillary, and with decreased bone cells in the bone trabecula, which had deeply-stained nuclear chromatin, pyknotic or cracking nucleus, and even bone cells disappeared in the part of the bone lacuna, and trabecular bone became thin, sparse, interrupt, reduced area in visual field/unit. Total RNA extraction electrophoretogram displayed clear bands of 28S and 18S, and the brightness ratio of the 28S:18S was 2:1, indicating good total RNA quality. And 44 genes were differentially expressed, and there were 28 up-regulated genes and 16 down-regulated genes, including cell/organism defense genes, cell structure/motility genes, cell division genes, cell signaling/cell communication genes, cell metabolism genes, gene/protein expression genes, and unclassified genes. ConclusionThe analysis of the gene expression profile of steroid-induced ONFH can provide evidence for the pathogenesis of ONFH.
目的 探討腹腔鏡技術在急腹癥診治中的作用。方法 回顧性分析筆者所在醫院2008年10月至2011年12月期間收治的128例急腹癥患者應用腹腔鏡技術進行診治的臨床資料。結果 127例均明確診斷，１例十二指腸遲發性破裂腹腔鏡探查漏診，患者2d后因腹痛劇烈而行剖腹探查術，發現為十二指腸破裂， 確診率為99.2％。103例（80.5％）于腹腔鏡下完成手術，11例（8.6％）中轉開腹手術，14例經腹腔鏡檢查明確診斷后行保守治療。所有手術患者術后無嚴重并發癥發生，全部患者均痊愈出院。平均手術時間為72min （32 ～166min）；平均出血量為125ml （20～230ml）； 平均住院時間為5d （3～12d）。結論 急腹癥應用腹腔鏡技術是一種十分安全有效的方法，具有診斷治療一體化、創傷小、恢復快，住院時間短等優點。
目的 探討利用特殊手術器械和相應的手術操作技巧對提高甲狀腺外科手術的安全性及質量的作用。方法 借助MPBS系列器械和超聲刀的推剝、分離、切割、止血等技術完成甲狀腺手術。結果 完成甲狀腺部分切除、次全切除或側葉切除術共468例，手術時間（40±20）min，術中出血量（30±25）ml，住院時間（4±1）d；切口細小，瘢痕平整；術后出現短暫聲嘶3例，飲水嗆咳2例，局部皮下積液2例。隨診1～3年，平均1.8年，3例復發，1例甲狀腺功能低下。無甲狀旁腺功能低下和永久性神經損傷病例。結論 利用MPBS器材和超聲刀技術在甲狀腺疾病外科治療中的應用安全可靠，具有手術安全、簡捷、出血少、時間短、切口小、副損傷少、恢復快的臨床效果，值得進一步推廣和探討。
ObjectiveTo discuss the clinical result of extrinsic radioulnar tether combined with anchoring nail fixation for treating chronic dorsal instability of the distal radioulnar joint (DRUJ). MethodsBetween July 2011 and December 2012, 6 patients with chronic dorsal instability of the DRUJ were treated with extrinsic radioulnar tether combined with anchoring nail fixation. There were 1 male and 5 females with the average age of 27.3 years (range, 22-35 years). All of 6 patients had a wrist trauma history. The average disease duration was 4.8 years (range, 6 months to 15 years). Radiographs were taken postoperatively to observe the anchoring nail loosening. The stress test and forearm rotation test were used to evaluate the function of DRUJ. The complications, the grip power, range of motion, and visual analogue scale (VAS) scores were recorded at last follow-up. And the joint function was evaluated by disability of arm, shoulder, and hand (DASH) score. ResultsPrimary healing of incision was obtained in all cases, without any complications such as infection and ulnar neck fracture. All 6 patients were followed up 6-24 months (mean, 13.7 months). Stability was achieved in all patients. Radiographs showed that the joint space was widened and dislocation of the ulnar head was improved at 3 and 6 months after operation. The results of the stress test and forearm rotation test were negative. At last follow-up, the grip power, DASH score, VAS score, and range of motion of the wrist were significantly improved when compared with preoperative ones (P<0.05). ConclusionExtrinsic radioulnar tether combined with anchoring nail fixation is an easy method of surgical revision to treat chronic dorsal instability of DRUJ, which can maintain the stability and protect the blood supply of triangular fibrocartilage complex.
ObjectiveTo investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness.MethodsBetween June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured.ResultsAll flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases.ConclusionModified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.
目的 總結術后早期炎性腸梗阻和慢性假性腸梗阻的臨床特點及處理方法。 方法 回顧性分析我科2004年3月至2009年3月期間的15例術后早期炎性腸梗阻及9例慢性假性腸梗阻的臨床特點及治療結果。 結果 15例術后早期炎性腸梗阻中保守治療13例，平均11 d癥狀緩解出院； 再次手術2例，分別于術后11 d和8 d治愈出院。9例慢性假性腸梗阻中保守治療6例，平均20 d癥狀緩解出院； 手術治療3例，術后繼續保守治療，平均30 d癥狀緩解出院。 結論 術后早期炎性腸梗阻及慢性假性腸梗阻雖然各有其臨床表現特點，但治療上有共性，多數病例采用保守療法便可治愈。