Volume 87  ·   Issue 37  ·  2007

Recently, computer assisted orthopedic surgery (CAOS) has become a hot spot in orthopedic academic research at home and abroad. Many hospitals in China have applied CAOS surgical system to carry out a considerable number of orthopedic surgeries. CAOS can plan the surgical path before operation, trace and navigate the surgical site, surgical instruments and orthopedic implants in real time during operation, and evaluate the treatment effect after operation. These advanced treatment methods, which are different from traditional orthopedic surgery, have been recognized and mastered by more and more orthopedic surgeons. However, with the gradual increase of clinical application of CAOS, the problems exposed in the application process also increase correspondingly.

Objective to compare the accuracy and operation characteristics of three-dimensional C-arm navigation system and CT navigation system in lumbar pedicle puncture. Methods According to the operation requirements of each navigation system, the pedicle puncture of L3, L4 and L5 was carried out on the same lumbar spine specimen under the guidance of three-dimensional C-arm and CT navigation at the same time. During the puncture process, the real-time detection was carried out by C-arm X-ray fluoroscopy machine to judge the accuracy of navigation. The operation characteristics and advantages and disadvantages of the two navigation systems in each link were summarized. Results Both navigation systems have very high accuracy in guiding pedicle puncture, but the operation process has its own characteristics. Conclusion Both navigation systems have their unique advantages. The navigation operation of three-dimensional C-arm is convenient and rapid, especially suitable for percutaneous puncture. CT navigation equipment requires relatively little, and the image is clear, which is more suitable for osteoporotic vertebral body.

Objective to treat complex calcaneal fractures with internal fixation assisted by computer navigation system.Methods 110 cases of complex calcaneal fractures (130 sides) were treated by computer navigation system.According to the results of calcaneal X-ray and 64-slice spiral CT scan.Among them, 57 cases of Sander's type Ⅱ, 45 cases of type Ⅲ and 28 cases of type Ⅳ were classified preoperatively.Results All patients were followed up for 6~24 months.The average follow-up was 16.3 months.Postoperative X-ray showed that the height, width, length of calcaneal bone, B (o) lhor's angle and Gissane's angle were recovered, and no incision was infected.Postoperative function was evaluated according to Maryland foot scoring system.Among the 130 sides in this group, 63 sides (48.46%) were excellent (90~100 scores), 57 sides (43.85%) were good (75~89 scores), and 10 sides (7.69%) were acceptable (50~74), with an excellent and good rate of 92.31%.

Objective to explore the method and curative effect of total knee arthroplasty under computer navigation. Methods Total knee arthroplasty was performed in 46 cases (54 knees) by computer navigation. Osteotomy, soft tissue balance adjustment and prosthesis rotation and positioning were performed according to the lower limb force line, joint space and ligament balance displayed by digital three-dimensional bone model during operation. The operation time, bleeding volume, 48 h drainage volume and complications were observed after operation. Full-length X-ray films of lower limbs were taken to measure the KNA angle (hip, knee and ankle angle), the variable of joint space angle under stress and the separation variable of joint space under tension before and after operation. The rotation angle of tibia and femur prosthesis was measured by CT after operation, and the tangent position of patella X-ray film was taken to understand the alignment of patellofemoral joint. The short-term curative effect was observed at 3 months after operation. Results 54 total knee arthroplasty were successfully completed under computer navigation, without complications such as nerve and vascular injury, fracture, fat embolism, etc. The operation time was (80 ± 15) min/knee, and the bleeding drainage volume was (550 ± 60) ml/knee at 48 h. The HISS score was (92 ± 4) at 2 weeks after operation, Two weeks after operation, there was a high difference between the range of knee movement, the KNA angle shown before and after operation, the variable of joint space angle under medial stress, the variable of joint space angle under lateral stress and the separation variable of joint space under tension before and after operation (P<0.01). The rotation angle of tibia and femur prosthesis was measured by CT after operation (4.2 ± 0.4) °. The tangential position of patella X-ray film after operation showed that the patella joint aligned well, without dislocation and instability. The range of joint movement flexion was (120 ± 9) ° after 3 months after operation, and there was no abnormal knee relaxation. Conclusion Intraoperative computer navigation can observe the change of lower limb force line, rotation alignment of knee prosthesis and soft tissue ligament balance in real time and dynamically, and provide geometric and morphological data, and reconstruct the knee joint biomechanically and anatomically, which improves the repeatability of total knee prosthesis and ensures the safety of the system.

Objective to investigate the incidence and pathological characteristics of incidental prostate carcinoma and their relationship with clinical diagnosis and treatment of prostate carcinoma. Methods A retrospective study was conducted on all prostate specimens with undiagnosed prostate carcinoma before operation from January 1999 to August 2005 in the Institute of Urology of Peking University. The incidence rate of incidental prostate carcinoma was summarized, and its pathological characteristics and clinical significance were evaluated. Results A total of 53 cases of incidental prostate carcinoma were detected in 1483 prostate specimens from January 1999 to August 2005 in the Institute of Urology of Peking University. The incidence rate was 3.6%. The pathological grade was Gleason score 2 (1+1) to 9 (4+5); The volume ranged from 0.18 mm3 to 1440.00 mm3. Among them, 47 cases (88.7%) had nonsignificant carcinoma with volume less than 0.5 cm3; There were 6 cases (11.3%) of clinically significant prostate cancer with volume greater than 0.5 cm3. The clinically significant prostate cancer was only found in TURP specimens. 20% of the incidental carcinomas in TURP specimens were clinically significant prostate carcinomas. The clinically significant incidental prostate carcinomas were mainly distributed in the transitional and central areas of the prostate, and their pathological grades were Gleason scores of 3+4 (2 cases), 4+2 (1 case) and 4+5 (3 cases). The tumors were diffuse, and the clinical features before operation were palpation and/or imaging examination (-), elevated blood PSA and puncture (-). Conclusion The incidence rate of incidental prostate carcinomas at present is 3.6%, which is slightly lower than that in 1980s. The clinically significant prostate carcinomas accounted for 11.3% of the incidental prostate carcinomas. The reason why these clinically significant prostate carcinomas were not clinically diagnosed before operation is related to the pathological features of the tumors.

Objective to summarize the clinical and pathological characteristics of intralobar pulmonary sequestration and to understand the expression of tumor-associated protein p53 and carcinoembryonic antigen (CEA) in chronic inflammation. Methods The clinical characteristics, surgical treatment mode and pathological characteristics of 7 cases of intralobar pulmonary sequestration were collected and analyzed, and the expression of p53 and CEA in tissues of pulmonary sequestration was detected by immunohistochemical staining. Results The main symptom of 7 cases of intralobar pulmonary sequestration was pulmonary infection. All patients were diagnosed before operation and underwent surgical treatment, mainly lobectomy. Abnormal systemic blood vessels all originated from thoracic aorta. The diseased lung tissues showed cystic dilatation to varying degrees, and some epithelial hyperplasia. All 6 cases of cyst epithelium showed positive expression of p53 protein, localized in the top layer of mucosal epithelium. CEA was diffusely expressed in the epithelium of 6 cases, while the expression of p53 and CEA in mucosal epithelium of lobar bronchus was negative. Conclusion Intralobar pulmonary sequestration can be diagnosed by enhanced CT and three-dimensional reconstruction technique, and lobectomy is mostly used to treat it. The abnormal accumulation of p53 protein and the expression of CEA may occur in the top layer of hyperplastic epithelium, which may be related to local chronic inflammatory stimulation.

Objective to evaluate the value of stress myocardial perfusion imaging in the diagnosis of female coronary artery disease (CHD). Methods 259 female patients underwent both stress myocardial perfusion imaging and coronary angiography in Beijing Fuwai Cardiovascular Hospital (interval<60 d), with an average age of (60±8) years, of which 227 patients underwent exercise test myocardial perfusion imaging and 32 patients underwent drug stress myocardial perfusion imaging. Results Among 227 patients undergoing exercise test myocardial perfusion imaging, 79 patients showed obvious coronary artery stenosis, including 33 single vessel lesions, 23 double vessel lesions and 23 three vessel lesions, involving 67 anterior descending left coronary artery, 41 circumflex left coronary artery, 40 right coronary artery and 8 main left coronary artery. The sensitivity and specificity of exercise test myocardial perfusion imaging were 63%, 97%, The accuracy was 85%. The sensitivity of diagnosing patients with single, double and three-vessel coronary artery disease was 61%, 52% and 78%, respectively. According to whether the exercise test reached the termination index, 227 patients were divided into two groups, namely, the exercise test reached the termination index group (n =137) and the exercise test failed to reach the termination index group (n =90). In the exercise test reached the termination index group, the sensitivity of exercise test myocardial perfusion imaging in diagnosing female coronary artery disease was 86%, while in the exercise test failed to reach the termination index group, the sensitivity of diagnosing female coronary artery disease was 38%. Among 32 patients undergoing drug-stressed myocardial perfusion imaging, 13 cases showed obvious coronary artery stenosis. The sensitivity, specificity and accuracy of drug-stressed myocardial perfusion imaging in diagnosing female coronary artery disease were 85%, 84% and 84%. Conclusion Stress myocardial perfusion imaging can effectively diagnose female coronary artery disease, and drug-stressed myocardial perfusion imaging is more suitable for elderly women with impaired exercise endurance.

Objective to analyze the effects of different degrees of preoperative pulmonary hypertension on early hemodynamic indexes, ultrasound cardiac function examination, perioperative complications and mortality in patients with heart transplantation. Methods from June 2004 to December 2006, 67 consecutive patients who underwent orthotopic heart transplantation in Fuwai Cardiovascular Hospital were retrospectively summarized. According to the preoperative pulmonary vascular resistance, the patients were divided into 3 groups: 15 cases without pulmonary hypertension and pulmonary vascular resistance equal to or lower than 2.5 Wood units in group Ⅰ; In group Ⅱ, 42 cases had mild to moderate pulmonary hypertension and pulmonary vascular resistance greater than 2.5 Wood units and less than 5.0 Wood units; In group Ⅲ, 10 cases of severe pulmonary hypertension and pulmonary vascular resistance were equal to or greater than 5.0 Wood units. The indexes of CVP, MPAP, CO, SvO2 and PAWP before anesthesia, immediately after operation, 12, 24 and 48 h were continuously monitored and recorded; Left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (EF) and mitral and tricuspid valve regurgitation were measured by ultrasound at the 1st, 3rd, 7th day, 1st month and 3rd month after cardiopulmonary bypass. Results All patients in this study completed heart transplantation, and there was no operation death in the three groups (within 30 days after operation). The preoperative EF value of patients in group Ⅲ was compared with that in group Ⅰ, P<0.05; There was no significant difference in the time of blocking cardiopulmonary bypass, the time of hot ischemia and cold ischemia of donor heart in the three groups; The time of cardiopulmonary bypass in group Ⅲ was significantly longer than that in group Ⅰ and group Ⅱ, P<0.05. Compared with group Ⅰ, the time of cardiopulmonary bypass in group Ⅲ was significantly lower than that in group Ⅰ and group Ⅱ, P<0.05. The time of cardiopulmonary bypass in group Ⅲ before anesthesia was significantly lower than that in group Ⅰ, and the PCWP was significantly higher than that in group Ⅰ, P<0.05. The time of cardiopulmonary bypass in group Ⅲ was significantly lower than that before anesthesia, especially 48 hours after operation, P<0.05, but the pulmonary artery pressure still increased. Postoperative acute renal failure was observed in 3 cases (1 case in group Ⅱ, 2 cases in group Ⅲ) and acute right heart failure in 6 cases (1 case in group Ⅰ, 2 cases in group Ⅱ, 3 cases in group Ⅲ). Except for 2 patients in group Ⅲ who showed moderate tricuspid regurgitation in early postoperative period, no obvious abnormalities such as heart enlargement and systolic function were found in ultrasonography. Conclusion Pulmonary artery pressure was significantly reduced in patients with preoperative severe pulmonary hypertension in early stage after heart transplantation, but complications such as acute right heart failure were likely to occur after operation. The protection of donor heart, the maintenance of right ventricular function during perioperative period, especially during and early postoperative period, and the monitoring of anti-infection and rejection reaction are the keys to ensure the successful operation.

To investigate the characteristics and related factors of recurrent cerebrovascular disease after cardiac catheterization (CC) in patients with previous cerebral stroke. Methods 892 patients with previous cerebral stroke who underwent CC were retrospectively analyzed. The general status, number, distribution and treatment of cardiovascular disease, recurrent cerebral stroke and related factors of patients were analyzed. Results 101 patients had cerebral stroke during and within 24 hours after operation, accounting for 11.32%, 33 patients had transient ischemic attack (TIA), 64 patients had acute cerebral infarction (CI) and 4 patients complicated with cerebral hemorrhage (CH). Logistic regression analysis showed that the risk factors of recurrent acute cerebral vascular accident after CC in patients with cerebral vascular surgery included: male, alcohol consumption, hyperlipidemia, peripheral vascular disease, number of cardiovascular diseases and treatment methods. Conclusion The risk factors of recurrent acute cerebral stroke after CC in patients with cerebral vascular surgery included: male, alcohol consumption, hyperlipidemia, peripheral vascular disease, number of cardiovascular diseases and treatment methods.

Objective to investigate the expression and role of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in chronic heart transplantation rejection. Methods the recipients were pretreated with donor splenocytes (SPC) and cyclophosphamide (CP), and then ectopic heart transplantation was performed. The expression of VCAM-1 and VCAM-1 in the transplanted heart was detected by immunohistochemistry. Results After SPC and CP pretreatment, the expression levels of ICAM-1 and VCAM-1 in the transplanted heart were significantly reduced, while the expression levels of ICAM-1 and VCAM-1 in the acute rejection and cyclosporine A (CsA) treatment groups were significantly enhanced (both P<0.05).

Objective to observe the effects of sirolimus on collagen synthesis and mRNA expression of type Ⅰ and type Ⅲ collagen in rat smooth muscle cells cultured in vitro.Methods Rat thoracic aorta smooth muscle cells were cultured by tissue patch method in vitro.The cells were identified by immunohistochemical cytoplasmic α-actin staining.The experimental cells were divided into 5 groups according to different concentrations of sirolimus, and the final concentrations of sirolimus were 100, 10, 1, 0.1 and 0 ng/ml respectively (control group). After inoculation, the cells in each group were synchronized, and the drug intervention was carried out according to the experimental design.After 24 hours of treatment, 3H labeled L-proline was added and co-cultured for 12 h. The cells were collected, added with scintillation solution, and the incorporation amount of L-3H proline (cpm value) was measured in a liquid scintillation counter. The mRNA expression of type Ⅰ and type Ⅲ collagen was detected by RT-PCR. GAPDH was used as an internal reference, and the product was electrophoretized with gelatin and imaged under ultraviolet light. The corrected optical density value was used for statistical analysis. Results Sirolimus could significantly inhibit collagen synthesis in smooth muscle cells, The difference of L-3H proline incorporation values was statistically significant between the concentration groups by analysis of variance (F =18.936, P<0.001). The difference was statistically significant between the group with one-sided t-test above 1 ng/ml and the control group (all P<0.001). The results of electrophoresis image analysis of RT-PCR products showed that the expression of type Ⅰ collagen mRNA was statistically significant between the concentration groups (F =13.244, P<0.001), but the expression of type Ⅲ collagen mRNA was not statistically significant between the concentration groups (F =2.409, P =0.070). Conclusion Sirolimus can inhibit collagen synthesis and type Ⅰ collagen mRNA expression in smooth muscle cells in a dose-dependent manner, but has no significant effect on the expression of type Ⅲ collagen mRNA.

Objective to determine the concentration of endogenous agmatine before and after spinal cord injury in rats.Methods Forty-two SD rats were randomly divided into sham operation group and 1, 4, 8, 24, 48 and 72 h after injury groups.The experimental model of spinal cord injury in rats was established by modified Allen's blow method.After OPA-MCE pre-column derivatization in spinal cord tissues at each period, high performance liquid chromatography and fluorescence detection were performed, and the concentration of samples was calculated by external standard method.Results The content of endogenous agmatine in spinal cord tissues before injury was (0.64±0.11) μ g/g; The concentration of agmatine decreased slightly at 1 h after spinal cord injury, increased at 4 h after injury, reached a peak at 8-24 h, then gradually decreased, and approached the normal level at 3 D. Conclusion the concentration of agmatine in the central nervous system of mammals should range from 0.2 to 1.1 μ g/g. Although the concentration of endogenous agmatine increased significantly after spinal cord injury, it has not reached the effective concentration of blocking N-methyl-D aspartate receptor and inhibiting nitric oxide synthase activity in vitro experiments, so it is difficult to exert its neuroprotective effect.

Objective to study the effect of antisense integrin β 6 gene on the growth and proliferation of colon cancer cells. Methods the expression vector of antisense β 6 gene was constructed, and then transfected into colon cancer cells to stably express it. The expression of β 6 mRNA in the cells was detected by RT-PCR; The expression of β 6 protein on the cell surface was detected by flow cytometry; The changes of binding capacity of cells to fibronectin in each group were detected and analyzed; Detecting and analyzing the changes of cell proliferation ability in each group; The transfected cells and normal cells were implanted subcutaneously in nude mice to observe the tumor-forming ability of the cells. The results of the experimental group and the control group were compared. Results Compared with the control group, the amount of β 6mRNA and the expression of β 6 protein on the cell surface (30%) of colon cancer cells transfected with antisense β 6 gene were significantly reduced (P<0.01); Its binding power to fibronectin is reduced; Its ability of growth and proliferation was significantly weaker than that of the control group; Conclusion Antisense β 6 gene can significantly inhibit the expression of β 6 gene at the level of transcription and translation, thus inhibiting the growth and proliferation of colon cancer cells, which confirms that integrin β 6 plays an important role in regulating the growth and proliferation of colon cancer cells.

Objective to investigate the effect of hypoxia-inducible factor (HIF) -1 α silencing by RNA interference technique on the chemosensitivity of esophageal squamous cell carcinoma EC9706 cells under hypoxia and its mechanism. Methods The hypoxia microenvironment of tumor was simulated in vitro by chemical hypoxia method [the final concentration of cobalt chloride (CoCl2) added to culture medium was 75 μ mol/L]. The inhibition rate of EC9706 cells in normoxic culture and hypoxic culture groups under the action of cisplatin/paclitaxel and the inhibition rate of EC9706 cells in hypoxic culture after RNA interference under the action of cisplatin/paclitaxel was detected by MTS colorimetry. The expression of HIF-1 α protein induced by hypoxia after HIF-1 α gene silencing was detected by Western blot method. The cell cycle of EC9706 cells under hypoxia before and after RNA interference was detected by flow cytometry. Results The siRNA interference technique aimed at HIF-1 α gene, The inhibition rate of HIF-1 α protein in normoxic culture group was significantly higher than that in hypoxic culture group at the same drug concentration (P<0.05). The inhibition rate of RNA interference group was significantly higher than that in untransfected group and control siRNA transfection group at the same drug concentration and hypoxic condition (P<0.05). Compared with untransfected group/unrelated control siRNA transfection group, the S phase and G1 phase cells were significantly increased (P<0.05). Conclusion HIF-1 α-induced cell cycle arrest in EC9706 under hypoxic condition may be one of the mechanisms of cell resistance under hypoxic condition. RNA interference can reverse chemoresistance in esophageal cancer cell EC9706 in hypoxic environment.

Objective to investigate the role of different ventilation modes and spontaneous breathing in preventing alveolar re-collapse after alveolar recruitment. Methods Eighteen healthy breed dogs were selected to establish a model of acute respiratory distress syndrome (ARDS) induced by oleic acid. Volume-controlled ventilation (VCV), positive end-expiratory pressure (PEEP) 16 cm H2O, tidal volume (VT) 10 ml/kg, and ventilation frequency 30 times/min were used as the basal state after stabilization. Alveolar recruitment (RM) was performed by pressure-controlled ventilation (PCV, PEEP 35 cm H2O, PCV 15 cm H2O, for 60 s). They were divided into three groups: VCV group (VCV ventilation, VT 15 ml/kg), PCV group (PCV ventilation, regulating pressure control level to keep VT at 15 ml/kg) and SB group (PCV ventilation, preserving a certain degree of spontaneous breathing, regulating pressure control level to keep VT at 15 ml/kg). Results the low inflection points of VCV group, PCV group and SB group were (16.1±1.9) cm H2O, (17.4±1.5) cm H2O and (17.1±1.6) cm H2O, respectively. After alveolar recovery, PaO2 in VCV group maintained at the same level as basal state, while PaO2 in PCV group and SB group was significantly higher than basal state. Compared with VCV group, PaO2 in SB group increased significantly at 30 min (P<0.05), and intrapulmonary shunt decreased significantly at 5, 30 and 60 min (P values were 0.077, 0.058 and 0.076, respectively). (3) Compared with basal state, the plateau pressure and mean airway pressure in SB group were significantly lower than that in VCV group (P<0.05), and the mean airway pressure was significantly lower than that in other two groups from 120 min to the end of the experiment (P<0.05).

Syphilis is a sexually transmitted disease caused by Treponema pallidum infection, which can affect many systems in the whole body. When the nervous system is involved, it is called neurosyphilis. The clinical manifestations of neurosyphilis are complex, and it is easy to be misdiagnosed and misdiagnosed. This study retrospectively analyzed the clinical and auxiliary examination data of 18 patients with neurosyphilis admitted to our hospital from 2000 to 2006, and found that 11 cases of neurosyphilis were missed in the first diagnosis, accounting for 61.1%, including 9 cases outside the hospital and 2 cases in the hospital.

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver, with occult onset, high degree of malignancy and poor prognosis, and there are significant sex differences. The incidence of male and female is about 3~5:1. Naugler et al. study on diethylnitrosamine (DEN) -induced HCC mouse model found that DEN can significantly increase the serum IL-6 concentration in male mice, while there is no obvious sex difference in the formation of liver cancer in mice with IL-6 removal; DEN increased the production of IL-6 in hepatic Kupffer cells through toll-like receptor (TLR) adaptor protein-MyD88, while estrogen inhibited the secretion of IL-6 in Kupffer cells and reduced the circulating IL-6 amount in male rats. Knockdown of MyD88 could greatly prevent the formation of HCC in male rats.

Sponsored by Chinese Medical Journal and undertaken by the Department of Orthopedics of Beijing Military Region General Hospital, the academic seminar on computer navigation technology in orthopedics was held in Beijing Military Region General Hospital on March 31, 2007.

With the development of computer-assisted surgery technology, computer navigation is more and more applied to various fields of orthopedics. The goal of computer-assisted surgery is to improve the accuracy of surgery, reduce the amount of radiation during surgery, achieve minimally invasive purpose and simplify surgery. However, because different navigation systems have different operating procedures, different imaging support and different operating habits of doctors, it is very important to find a navigation system suitable for orthopedics doctors' needs.