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 探讨腹腔镜技术在急腹症诊治中的作用。方法 回顾性分析笔者所在医院2008年10月至2011年12月期间收治的128例急腹症患者应用腹腔镜技术进行诊治的临床资料。结果 127例均明确诊断，１例十二指肠迟发性破裂腹腔镜探查漏诊，患者2d后因腹痛剧烈而行剖腹探查术，发现为十二指肠破裂， 确诊率为99.2％。103例（80.5％）于腹腔镜下完成手术，11例（8.6％）中转开腹手术，14例经腹腔镜检查明确诊断后行保守治疗。所有手术患者术后无严重并发症发生，全部患者均痊愈出院。平均手术时间为72min （32 ～166min）；平均出血量为125ml （20～230ml）； 平均住院时间为5d （3～12d）。结论 急腹症应用腹腔镜技术是一种十分安全有效的方法，具有诊断治疗一体化、创伤小、恢复快，住院时间短等优点。
目的 探讨利用特殊手术器械和相应的手术操作技巧对提高甲状腺外科手术的安全性及质量的作用。方法 借助MPBS系列器械和超声刀的推剥、分离、切割、止血等技术完成甲状腺手术。结果 完成甲状腺部分切除、次全切除或侧叶切除术共468例，手术时间（40±20）min，术中出血量（30±25）ml，住院时间（4±1）d；切口细小，瘢痕平整；术后出现短暂声嘶3例，饮水呛咳2例，局部皮下积液2例。随诊1～3年，平均1.8年，3例复发，1例甲状腺功能低下。无甲状旁腺功能低下和永久性神经损伤病例。结论 利用MPBS器材和超声刀技术在甲状腺疾病外科治疗中的应用安全可靠，具有手术安全、简捷、出血少、时间短、切口小、副损伤少、恢复快的临床效果，值得进一步推广和探讨。
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 总结术后早期炎性肠梗阻和慢性假性肠梗阻的临床特点及处理方法。 方法 回顾性分析我科2004年3月至2009年3月期间的15例术后早期炎性肠梗阻及9例慢性假性肠梗阻的临床特点及治疗结果。 结果 15例术后早期炎性肠梗阻中保守治疗13例，平均11 d症状缓解出院； 再次手术2例，分别于术后11 d和8 d治愈出院。9例慢性假性肠梗阻中保守治疗6例，平均20 d症状缓解出院； 手术治疗3例，术后继续保守治疗，平均30 d症状缓解出院。 结论 术后早期炎性肠梗阻及慢性假性肠梗阻虽然各有其临床表现特点，但治疗上有共性，多数病例采用保守疗法便可治愈。