科创中国

目的 观察伤椎置钉并椎体内植骨内固定术在胸腰椎骨折治疗中的应用效果.方法 至少一侧椎弓根完整的胸腰椎骨折26例,予伤椎撬拨复位置钉、椎体内植骨、椎弓根内固定,据胸腰段正侧位片比较术前、术后即刻、术后6个月的椎体高度及Cobb's角,并评估脊髓神经功能和融合情况.结果 术后随访7~28个月.患者术后即刻伤椎椎体前缘高度占正常高度百分比及Cobb's角优于术前(P均<0.05);伤椎外形恢复满意;按ASIA脊髓神经功能分级,伴神经损伤者15例中,A级1例无恢复,余均改善1~3级(P均<0.05),内固定无失效,植骨皆融合.结论 伤椎置钉并椎体内植骨内固定术治疗胸腰椎骨折可重建椎体结构,增强脊柱稳定,近期疗效较好.

Many researches on drilling force and temperature have been done with the aim to reduce the labour intensiveness of surgery, avoid unnecessary damage and improve drilling quality. However, there has not been a systematic study of mid- and high-speed drilling under dry and physiological conditions(injection of saline). Furthermore, there is no consensus on optimal drilling parameters. To study these parameters under dry and physiological drilling conditions, pig humerus bones are drilled with medical twist drills operated using a wide range of drilling speeds and feed rates. Drilling force and temperature are measured using a YDZ-II01 W dynamometer and a NEC TVS-500 EX thermal infrared imager, respectively, to evaluate internal bone damage. To evaluate drilling quality, bone debris and hole morphology are observed by SEM(scanning electron microscopy). Changes in drilling force and temperature give similar results during drilling such that the value of each parameter peaks just before the drill penetrates through the osteon of the compact bone into the trabeculae of the spongy bone. Drilling temperatures under physiological conditions are much lower than those observed under dry conditions, while a larger drilling force occurs under physiological conditions than dry conditions. Drilling speed and feed rate have a significant influence on drilling force, temperature, bone debris and hole morphology. The investigation of the effect of drilling force and temperature on internal bone damage reveals that a drilling speed of 4500 r/min and a feed rate of 50 mm/min are recommended for bone drilling under physiological conditions. Drilling quality peaks under these optimal parameter conditions. This paper proposes the optimal drilling parameters under mid- and high-speed surgical drilling, considering internal bone damage and drilling quality, which can be looked as a reference for surgeons performing orthopedic operations.

目的:观察质子泵抑制剂( PPI)奥美拉唑对两种不同剂型的麦考酚酸(MPA)药代动力学的影响.方法:两组患者在肾移植术后分别给予不同剂型的MPA[吗替麦考酚酯片(MMF)和麦考酚钠肠溶片(EC-MPS)]抗排斥治疗,均联用环孢素A和激素,均在术后立即给予奥美拉唑预防治疗,持续至术后第7天停用,分别观察术后第3、7、10天MPA的血浆浓度、达峰时间、峰值,其中血浆MPA浓度采用高效液相色谱(HPLC)法测定,分别采集服药前及服药后0.5h、1h、1.5h、2h、3h、4h、6h、8h及12h全血标本,采用WinNonlin 5.2程序,按非房室模型进行药代动力学参数的计算每次MPA浓度的MPA-AUC012h值.比较奥美拉唑对MMF和EC-MPS的达峰时间、峰值浓度和MPA-AUC0.12h值的影响.结果:MMF组在肾移植术后第3、7、10天达峰时间分别为(1.50-±0.71)h、(2.50±1.04)h、(1.25±0.60)h,其中第7天较第3天达峰时间延后,第10天较第7天达峰时间明显提前(P<0.05),峰值浓度分别为(7.69±2.25)μg/ml、(8.95±5.60) μg/ml、(9.87±3.82)μg/ml(P >0.05),MPA-AUC0-12h分别为(38.98±14.63) mg·h/L、(34.59±12.04)mg·h/L、(32.47±10.81) mg·h/L(P >0.05);EC-MPS组在肾移植术后第3、7、10天达峰时间分别为(2.50±0.53)h、(2.56±0.62)、(2.63±0.74)h(P >0.05),峰值浓度分别为(11.56±9.59)μg/ml、( 12.64±8.49) μg/ml、(10.11±9.19)μg/ml (P >0.05),MPA-AUC0.12h分别为(22.76±15.52)mg·h/L、(25.31±10.37)mg·h/L、(16.68±14.77) mg·h/L(P >0.05).MPA-AUC012h两组间比较第3、7、10天P值分别为0.065、0.382、0.05;达峰时间两组间比较第3、7、10天P值分别0.01、0.721、0.002;峰值浓度两组间比较P值分别为0.878、0.328、0.505.结论:奥美拉唑能明显延长MMF达峰时间,可能降低MMF的峰值浓度;但对EC-MPS的药代动力学无影响.在肾移植术后应用MMF作为免疫抑制剂的患者术后应早期的检测MPA的浓度,及时调整MMF的剂量.

各种引起终末期肾病常见的原发性和继发性肾小球疾病均可在肾移植术后复发.常见的复发性原发性肾小球疾病包括IgA肾病、局灶节段性肾小球硬化、特发性膜性肾病和膜增生性肾小球肾炎;常见的复发性继发性肾小球疾病则包括狼疮性肾炎、过敏性紫癜性肾炎、肾淀粉样变性、轻链沉积病、原纤维性/免疫管状肾小球肾炎、混合性冷球蛋白血症性肾病、糖尿病肾病及血管炎肾损害等.由于各移植中心开展移植肾活检的策略不同,因而各移植中心报道的不同病因引起复发性肾小球疾病的发生率也不一致.复发性肾小球疾病患者的病情轻重不一,但无论临床症状还是病理改变一般均轻于自体肾疾病;致使疾病易复发的危险因素各有不同,但一般年轻、自体肾脏疾病重、进展迅速、活体供肾……易致疾病复发;一些疾病经移植前强化治疗可以减少复发;移植后早期确诊疾病复发,且采取积极的治疗措施,能使一些复发性疾病受者临床获益.总之,尽管多种原发性和继发性肾小球疾病在肾移植后均能复发,导致移植肾再次受损,但肾移植仍不失为终末期肾病最有效的疗法之一.