Objective To investigate the influence of spinal cord decompression on posterior surgical treatment of thoracolumbar fracture, and to provide the practical basis for the indications of posterior spinal cord decompression Methods The cl inical data were retrospectively analyzed from 170 cases of thoracolumbar fracture treated with posterior surgical treatment between January 2005 and January 2009. There were 119 males and 51 females with an average age of42.7 years (range, 17-68 years). The fracture locations included T11 in 22 cases, T12 in 30 cases, L1 in 57 cases, and L2 in 61 cases. According to Denis classification system, there were 65 cases of compression fractures, 44 cases of burst fractures, 25 cases of flexion-distraction injuries, and 36 cases of fracture-dislocations. The time from injury to operation was 3-8 days (mean, 4.4 days). All the cases were divided into 4 groups according to space-occupying rates of spinal cord: group A, ≤20% (n=32); group B, 21%-40% (n=68); group C, 41%-60% (n=37); and group D, ≥ 61% (n=33). Through statistical analysis, the correlation between space-occupying rates and spinal cord function (Frankel grade) was evaluated, and the necessities of spinal cord decompression was studied in the patients who had neurological symptoms with space-occupying rates under 40%. Results There was no positive correlation between the degree of spinal cord injury and the space-occupying rates of bone fragments broken into the spinal canal. All patients were followed up 13-41 months (mean, 23.5 months). During the follow-up period, no secondary neurological damage occurred in the patients who were not given posterior spinal cord decompression with space-occupying rates under 40% (28 cases). And also in the cohort of patients with neurological symptoms whose space-occupying rates were under 40%, the posterior spinal cord decompression (65 cases) could improve the spinal cord function significantly when compared with no decompression cohort (7 cases), (P lt; 0.05). Conclusion The relative indications of posterior spinal cord decompression for thoracolumbar fracture are as follows: the cases having neurological symptoms with space-occupying rates under 40% and the ones having the neurological symptoms or not with space-occupying rates above 40%.
To investigate the immunoreaction, histological reaction and turnover by comparing the xenotransplantation of fresh human amniotic membrane (HAM) with that of preserved HAM, and to analyze the cl inical appl ication value of different kinds of HAM preparations. Methods Subcutaneous implant models were establ ished in 150 BALB/C mice, which were randomized into 5 groups of 30 mice each, based on different implants: fresh amniotic membrane (FAM), double fresh amniotic membrane (DFAM), glycerin preserved amniotic membrane (GPAM), chorion (positive control) or merely operation (negative control). The tissue samples from grafted area were observed with SABC and HE staining, and the inflammatory cells were calculated with l ight microscopy. 1, 2, 4, 8 and 12 weeks after surgery. Results The mice in all of groups were normal in eating and moving, and the wound surface healed well. In all of AM groups, the expression of MHC Ⅱ and the calculation of inflammatory cells were much less than those in chorion groups, showing significant differences (P lt; 0.01). At 1, 8 and 12 weeks after surgery, there were no significant differences in the expression of MHC Ⅱ and the calculation of inflammatory cells in all of AM groups, compared with other groups (P gt; 0.05). From 2 weeks to 4 weeks after surgery, there were no significant differences in the expression of MHC Ⅱ and the calculation of inflammatory cells between FAM and DFAM groups (P gt; 0.05), but they were both more than those in GPAM groups, showing significant differences (P lt; 0.05). At the 4th week after surgery, in all of AM groups, the expression of MHC Ⅱ and the calculation of inflammatory cells were less than those at the 2nd week, showing significant difference (P lt; 0.01).The amniotic epithel ium was still al ive in fresh AM groups until 4 weeks after transplantation. Early after surgery, fibroblasts infiltrated AM from the substantia basilaris layer while made fibrous capsule around the epithel ium. After 12 weeks, the amnion absorbed. Conclusion As a kind of heterologous biomaterial, whether fresh or preserved, HAM can be seemedof ideal immunocompatibil ity and histocompatibil ity. Fresh HAM with al ive epithel ium may be more successful in area ofrepair and reconstruction.
Objective To evaluate the relationship between the single nucleotide polymorphisms (SNPs) of the adiponectin gene +45 in exon 2 and type 2 diabetes mellitus (T2DM) in Chinese population via meta-analysis. Methods Databases including PubMed, Ovid, CBM, VIP, CNKI, and WanFang Data were searched from inception to June 2012, and the references of articles were also retrieved to collect case-control studies about the correlation of SNPs of the adiponectin gene +45 in exon 2 and T2DM in Chinese population. According to the self-designed inclusion and exclusion criteria, two reviewers screened articles, extracted data, and assessed the quality of the included studies independently. Then meta-analysis was performed STATA 11.0, with stability evaluated by both stratified analysis and sensitivity analysis. Moreover, Begg’s funnel plot and Egger’s method were used to assess the published bias of articles. Results 21 articles involving 22 studies were included (3272 T2DM cases and 2597 controls). There were significant differences between the two groups in dominant, recessive and addictive genetic models, and the pooled ORs (95% CI) were 1.36 (1.04, 1.78), 2.07 (1.55, 2.75), and 2.44 (1.59, 3.75), respectively. Conclusion The genetic single nucleotide polymorphisms of the adiponectin +45 in exon 2 is associated with type 2 diabetes in Chinese population. G allele of APM1 is a risk factor for type 2 diabetes, no matter in dominant, recessive or addictive genetic models.
目的 探讨腹腔镜下行直肠癌根治术（L-Dixon，L-Miles）的应用价值。方法 对我院2009年10月至2011年1月期间收治的68例行腹腔镜直肠癌根治术患者的临床资料进行回顾性分析。结果 68例患者中行L-Dixon术55例，L-Miles术12例，中转开腹行Dixon术1例，手术过程顺利。术后第4天1例并发吻合口漏、盆腔脓肿，行开腹引流、横结肠造瘘术，6个月后关闭瘘口，恢复正常。本组患者随访时间2～12个月，平均随访时间8个月，均恢复良好，无肿瘤复发及转移。结论 腹腔镜下行直肠癌根治术具有手术野清晰、创伤小、恢复快等优点，可取得与开腹手术相当或更好的根治效果，使患者受益。
目的 观察和评估活性多孔纳米复合人工颗粒骨纳米羟基磷灰石聚酰胺66（n-HA/PA66）骨修复下肢承重骨大块良性肿瘤性骨缺损的临床疗效。 方法 选取2007年12月－2011年5月，良性骨肿瘤行股骨和胫骨手术术后骨缺损较大，需植骨填充且植骨量＞20 g的患者67例。其中骨巨细胞瘤26例，纤维结构不良18例，骨囊肿10例，其他良性骨肿瘤13例。肿瘤刮除后瘤腔大小为3.0 cm×2.0 cm×1.5 cm～7.0 cm×3.0 cm×3.0 cm。全部患者行病灶刮除、瘤腔灭活、大量打压式植入n-HA/PA66人工骨，根据患者情况加用同种异体松质骨、含DBM人工骨，并根据皮质受累范围及厚度选择适当内固定。定期随访观察伤口愈合情况、患者肝肾功能、免疫指标、关节活动度及植骨处愈合情况。 结果 67例患者全部获得随访，随访时间7～45个月，平均31.3个月。所有患者伤口均I/甲愈合，术后无肝、肾功能损害，无免疫相关疾病发生。患者植骨愈合时间为术后3～9个月，平均4.6个月，愈合率95.2%。术后骨巨细胞瘤患者局部复发3例，均经再次手术，随访未再复发。 结论 n-HA/PA66颗粒骨可作为下肢承重骨大块良性肿瘤性骨缺损的植骨填充材料。