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中华生物医学工程杂志
中华生物医学工程杂志

钟南山

双月刊

1674-1927

cjbme@vip.tom.com

020-81340157

510182

广东省广州市东风西路195号广州医学院内28栋1楼

中华生物医学工程杂志/Journal Chinese Journal of Biomedical EngineeringCSTPCD
查看更多>>中华医学会、广州医学院主办。本刊办刊宗旨：密切关注并报道生物医学工程学研究的新理论、新方法、新技术，跟踪生物医学工程学在临床中的最新应用成果，服务广大临床医生，促进生物医学工程学的学科发展。生物医学工程的发展一直是临床医学进步的动力，而临床医学所需要解决的问题则是生物医学工程创新的源泉。临床医生、科学家和产业界工程技术人员的紧密合作将为人类创造更美好的健康长寿的新生活。内容和栏目：（1）编者导读；（2）专论；（3）论著；（4）新技术与临床；（5）新技术研发；（6）生物技术；（7）综述；（8）专题讲座。
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    CD3D基因与卵巢癌免疫浸润的相关性及其预后价值

    张韶华王艺璇王赞宏王馨...
    481-487页
    查看更多>>摘要：目的 探讨CD3D基因在卵巢癌（OC）组织中的表达，对卵巢癌肿瘤微环境中免疫浸润的影响及其预后价值。 方法 利用GEPIA数据库分析CD3D基因在包括卵巢癌在内的多种肿瘤中的表达情况；收集2011年1月至2017年12月山西白求恩医院治疗的卵巢癌患者223例及因子宫平滑肌瘤切除全子宫+双侧附件的患者25例，采用免疫组化SP法检测卵巢癌及正常卵巢组织中CD3D基因的蛋白表达，比较CD3D基因表达与卵巢癌患者临床病理特征之间的关系；cBioportal数据库分析CD3D基因的共表达基因；DAVID数据库分析CD3D基因及其共表达基因KEGG功能富集通路；Kaplan Meier plotter数据库分析CD3D基因的预后价值；TIMER2.0数据库分析CD3D基因表达与卵巢癌中主要免疫细胞的免疫浸润关系。 结果 与正常卵巢组织相比，CD3D蛋白在卵巢癌组织中高表达（P<0.05），且在卵巢癌不同FIGO分期、残留病灶是否达R0间的表达差异均有统计学意义（均P<0.05）。Kaplan-Meier-Plotter预后分析提示CD3D基因高表达的患者具有更高的生存率（P<0.05）。表达基因的富集分析提示，该组基因主要富集于Th1与Th2细胞分化通路、T细胞受体信号通路、Th17细胞分化通路、原发性免疫缺陷通路、PD-L1和PD-1免疫检查点通路、自然杀伤细胞介导的细胞毒性通路等。Timer数据库分析发现CD3D基因与肿瘤微环境中B细胞、CD8+ T细胞、CD4+ T细胞和树突状细胞的浸润程度呈正相关（均P<0.05）。 结论 CD3D基因在卵巢癌组织中高表达，其可能通过调整免疫相关通路影响肿瘤微环境中免疫细胞的浸润而改变患者预后。 Objective To investigate the expression of CD3D gene in ovarian cancer tissues, its effect on immune infiltration in ovarian cancer tumor microenvironment and its prognostic value. Methods GEPIA database was used to analysis the expression of CD3D gene in various tumors including ovarian cancer 223 cases of ovarian cancer patients and 25 cases of patients with uterine smooth muscle tumor treated in Shanxi Bethune Hospital from January 2011 to December 2017 were collected. 25 patients with total uterus + bilateral adnexa were resected, and the protein expression of CD3D gene was detected in ovarian cancer and normal ovarian tissues by immunohistochemistry SP method, comparing the relationship between the expression of CD3D gene and clinicopathological features of patients with ovarian cancer the Kaplan Meier plotter database was used to analysis the prognostic value of the CD3D gene the cBioportal database was used to analysis the co-expressed genes of CD3D gene DAVID database to analysis the KEGG functional enrichment pathway of CD3D co-expressed genes TIMER2.0 database to analysis the relationship between CD3D gene expression and immune infiltration of major immune cells in ovarian cancer. Results CD3D protein was highly expressed in ovarian cancer tissues, with statistically significant differences compared with normal ovarian tissues (P<0.05) , and there was a significant difference in expression between different FIGO staging periods of ovarian cancer, between whether the residual lesions reached R0 or not (P<0.05) , and that the high-expression group had a higher survival rate, with a statistically significant difference (P<0.05) Kaplan-Meier-Plotter prognostic analysis also suggested that patients with high CD3D mRNA expression had higher survival rates (P<0.05) . The enrichment analysis of the expressed genes suggested that the genes in this group were mainly enriched in Th1 and Th2 cell differentiation pathway, T cell receptor signaling pathway, Th17 cell differentiation pathway, primary immunodeficiency pathway, PD-L1 and PD-1 immune checkpoint pathway, natural killer cell-mediated cytotoxicity pathway, etc. The analysis of the Timer database found that the CD3D genes were associated with B cells in the tumor microenvironment, CD8+ T cells, CD4+ T cells and the degree of dendritic cell infiltration in the tumor microenvironment were positively correlated (all P<0.05) . Conclusion CD3D gene is highly expressed in ovarian cancer tissues, which may affect the invasion of immune cells in the tumor microenvironment by adjusting immune-related pathways and change the prognosis of patients.

    CD3D基因卵巢癌免疫浸润肿瘤微环境

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    在哺乳动物细胞内基于线性双链DNA"与门"基因线路构建纳米抗体文库

    张凯丽王怡李怡凡赵雁杰...
    488-494页
    查看更多>>摘要：目的 在哺乳动物细胞内基于线性双链DNA"与门"基因线路构建纳米抗体文库。 方法 应用基于线性双链DNA的"与门"逻辑基因线路构建纳米抗体文库，首先通过PCR扩增将互补决定区（CDR）随机序列引入上、下游线性双链DNA，将其共转染至HEK293T细胞，转染48 h后，经RNA提取、cDNA合成、PCR扩增、高通量测序和数据处理步骤，鉴定"与门"形成的纳米抗体文库序列，对本策略进行了分析与评价。 结果 深度测序共测得4 173 356条序列，其中约88.18%的序列为纳米抗体文库序列。文库核酸序列最丰富的序列长度为264 bp，为理论设计长度。后续在264 bp序列中鉴定出22 172种纳米抗体序列，且CDR1~3序列中的核苷酸频率符合NNK模式。 结论 本研究开发了一种基于线性双链DNA"与门"逻辑基因线路在哺乳动物细胞中构建纳米抗体文库的新方法。 Objective A linear-double-stranded DNA (ldsDNA) based AND-gate strategy was developed to construct nanobody library in mammalian cells. Measures We employed the ldsDNA-based AND-gate genetic circuit to introduce nanobody library into cultured mammalian cells. The sequence complexity of the complementary determining regions (CDRs) was introduced into the up- and down-stream ldsDNA by PCR amplification, respectively. After input ldsDNAs being co-transfected into HEK293T cells for 48h, RNA was extracted then cDNA was synthesized. PCR was employed to amplify the library nanobody sequences. High-throughput sequencing (HTS) was employed to analyze the library nanobody sequences. Results We combined the clean merged paired-end reads from three biological repeats and got 4, 173, 356 reads. About 88.18% of the merged reads contain both upstream- and downstream-ldsDNA sequences. The most abundant read length is 264-bp, which corresponds to the intact sequence length. A total of 22, 172 unique nanobody sequences were identified by high-throughput sequencing. Moreover, the library CDR sequences followed the NNK degeneracy. Conclusion We developed a novel ldsDNA-based AND gate genetic circuit to construct nanobody library in mammalian cells.

    纳米抗体互补决定区与门线性双链DNA

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    基于人工智能对广州新型冠状病毒感染住院患者肺部炎症负荷的分层量化分析及临床匹配度研究

    陈熙来吴宏楷甘清鑫曾庆思...
    495-502页
    查看更多>>摘要：目的 基于人工智能（AI）技术对奥密克戎变异株流行期间，广州新型冠状病毒感染（COVID-19）住院患者肺部炎症负荷进行不同分层的量化分析，并探索影像分型与临床分型间的匹配性。 方法 回顾性筛选广州医科大学附属第一医院2022年12月至2023年1月的COVID-19住院患者836例，收集符合纳入标准的348例临床资料及胸部CT影像学数据，同时使用AI胸部CT评估系统量化分析不同亚组的炎症负荷。纳入相同时段内广州医科大学附属第一医院及广州医科大学附属市八医院入院时临床分型为重型和危重型的COVID-19患者368例，基于视觉评价及AI进行临床分型及影像学分型的匹配度分析。 结果 基于双肺、单侧肺及肺叶等多维度对比分析，重症COVID-19患者总病灶，以及磨玻璃病灶、实变病灶的体积（cm3）及占比（%）（炎症负荷）均大于非重症患者（均P<0.001）。重症COVID-19患者的全肺及各肺叶（除右肺中叶外）肺炎评分高于非重症患者（均P<0.05），但全肺体积两组间差异无统计学意义（P>0.05）。危重型及重型2个亚组之间的炎症负荷指标差异无统计学意义（P>0.05）。重症监护室（ICU）患者的双肺病灶体积、磨玻璃影及实变影体积、双肺病灶占比、肺炎分级、全肺评分均大于普通病房患者，全肺体积小于后者（均P<0.05）。入院时临床诊断为重症COVID-19的368例患者，影像学诊断为重症-危重型病毒性肺炎（VP）为178例（48%），影像学轻型-普通型VP为145例（39%），影像学不确定COVID-19所致的呼吸重症为9例（3%），影像学非COVID-19所致的呼吸重症为36例（10%）。 结论 入院临床诊断重症患者有半数以上在影像学并非重症COVID-19，在临床救治中，应重视呼吸系统及其它系统的基础疾病。基于AI的肺部炎症负荷量化分析可为COVID-19患者的精准诊治提供影像学依据。 Objective To quantitatively analyze the stratified pulmonary inflammation burden of hospitalized patients with coronavirus disease 2019 (COVID-19) in Guangzhou during the epidemic of Omicron virus strain based on artificial intelligence (AI) , and explore the correlation between imaging phenotype and clinical phenotype. Methods Retrospective screening of 836 patients hospitalized with COVID-19 from December 2022 to January 2023 at the First Hospital of Guangzhou Medical University. The clinical and chest CT imaging data of 348 cases meeting the inclusion criteria were collected. The CT images were analyzed using an AI chest CT assessment system. 368 COVID-19 patients who were clinically classified as heavy and critical at the time of admission to the First Hospital of Guangzhou Medical University and the Eighth Hospital of Guangzhou Medical University were included within the same period. The matching analysis of clinical phenotype and imaging phenotype was performed based on visual evaluation and AI. Results The inflammation burden including the total lesions, volume (cm3) and percentage (%) of ground glass and solid lesions were greater in critically ill patients with COVID-19 than in non-critically ill patients (all P< 0.001) in three dimensions including bilateral, unilateral and lobar lung. Pneumonia scores in the whole lung and in each lobe (except the middle lobe of the right lung) were higher in critically ill patients with COVID-19 than in non-critically ill patients (allP<0.05) , but whole lung volumes did not differ between the two groups (P>0.05) . There was no difference in inflammation burden between the two subgroups of critical and heavy phenotype (P>0.05) . Bilateral lung lesion volume, ground glass and solid lesions volume, bilateral lung lesions percentage, pneumonia grading, and whole lung score were greater in ICU patients with COVID-19 than in general ward patients, and whole lung volume was less than the latter (allP<0.05) . Of the 368 patients with a clinical diagnosis of severe COVID-19 at admission, the imaging diagnosis was severe-critical viralpneumonia (VP) in 178 (48%) and light-medium VP in 145 (39%) , respiratory severity caused by an uncertain COVID-19 diagnosis in 9 (3%) and a non-COVID-19 diagnosis in 36 (10%) . Conclusion AI-based analysis can quantize the lung inflammation burden in multiple dimensions such as lesion volume and proportion, lung volume, and density changes. It provides objective quantitative indicators for clinical phenotyping and stratification of current inpatients with COVID-19, which may help in the determinization whether clinically severe patients are suffering from severe COVID-19, thus providing an imaging basis for accurate diagnosis and treatment of patients with COVID-19.

    奥密克戎新型冠状病毒感染人工智能体层摄影术,X线计算机

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    SUCLG1基因突变相关的新生儿致死性酸中毒1例并文献复习

    潘翩翩吴玫瑰陈俊操魏谋...
    503-510页
    查看更多>>摘要：目的 探讨SUCLG1基因突变所致新生儿脑肌病型线粒体DNA耗竭综合征9型（MDS）的临床特点，为其早期诊断提供依据。 方法 对广州市妇女儿童医疗中心新生儿科收治的1例新生儿脑肌病型MDS 9型患儿的临床表现、生化结果、辅助检查、尸体病理及基因报告进行回顾性分析，并以"线粒体DNA耗竭综合征""SUCLG1基因""甲基丙二酸尿症""甲基丙二酸""SUCLG1"等为关键词，分别对中国知网、万方、Pubmed、ClinVar自建库至2023年5月收录的文献进行检索，其中仅13篇文章报道20例新生儿期发病的SUCLG1基因突变导致的MDS，本文总结新生儿脑肌病型MDS 9型的临床特点。 结果 本例患儿为足月小样儿，女，生后0.5 h起病，主要表现为呼吸窘迫、难以纠正的代谢性酸中毒、高乳酸血症、低氧血症、尿甲基丙二酸和血氨轻度升高，予以禁食、呼吸循环支持、纠酸等治疗效果欠佳，生后5 d死亡。尸体病理见脑干蛛网膜下腔出血及血肿形成、动脉导管未闭、卵圆孔未闭、左肺动脉狭窄、右心室和左心室室壁增厚。外观及四肢未见畸形。血酰基肉碱提示C0含量极低，C3较正常高值升高3.7倍。尿液GC-MS见少量甲基丙二酸，全外显基因检测出SUCLG1基因c.901G>A（p.Gly301Arg）和c.315-316dup（p.Glu106GlyfsTer63）复合变异，确诊脑肌病型MDS 9型。共检索13篇文献20例新生儿期发病的脑肌病型MDS 9型患者，包括本例共21例，临床特征主要为新生儿期出现不明原因的肌张力减低、喂养困难，伴有甲基丙二酸轻度升高，95%有高乳酸血症，80%有呼吸窘迫，累及呼吸、循环系统者更易出现致死性乳酸酸中毒，全外显子基因测序示SUCLG1基因突变。治疗以支持为主，预后差，死亡率高。 结论 新生儿期不明原因的肌张力减低、喂养困难、乳酸酸中毒、甲基丙二酸轻度升高应警惕新生儿脑肌病型MDS 9型，累及呼吸、循环系统者更易出现新生儿致死性酸中毒，基因测序可帮助诊断。 Objective To investigate the clinical features of neonatal encephalomyopathic mitochondrial DNA depletion syndrome type 9 (MDS) caused by SUCLG1 gene mutation, and to provide a basis for its early diagnosis. Methods The clinical data of a neonatal patient with encephalomyopathic MDS type 9, admitted to the Department of Neonatology at the Guangzhou Women and Children’s Medical Center, was analyzed retrospectively. This included an evaluation of the patient’s clinical manifestations, biochemical results, auxiliary examinations, autopsy pathology, and genetic reports. The key words of "mitochondrial DNA depletion syndrome" "SUCLG1 gene" "methylmalonic aciduria" "methylmalonic acid" "SUCLG1" were used. A literature search was performed in China National Knowledge Infrastructure (CNKI) , Wanfang, Pubmed, and ClinVar from the establishment of the database to May 2023, Only 13 reports have documented 20 cases of neonatal-onset MDS resulting from SUCLG1 gene mutations. This article summarizes the clinical features of neonatal encephalomyopathic MDS type 9. Results The patient was a full-term small for gestational age girl. The main clinical manifestations were respiratory distress, metabolic acidosis, hyperlactacidemia, hypoxemia, urine methylmalonic acid and blood ammonia were slightly elevated. Fasting, respiratory and circulatory support and rectification of acid intoxication were not effective. Autopsy showed brain stem subarachnoid hemorrhage, hematoma formation, patent ductus arteriosus, patent foramen ovale, left pulmonary artery stenosis, right ventricular and left ventricular wall thickening. There were no deformities in appearance or limbs. Acylcarnitines in blood showed that C0 was extremely low and C3 was 3.7 times higher than the normal high value. Urine GC-MS showed A small dose of methylmalonic acid, and the whole exon gene detection of SUCLG1 gene c.901G > A (p.Gly301Arg) and c.315-316dup (p.Glu106GlyfsTer63) compound mutations. Encephalomyopathic mitochondrial DNA depletion syndrome 9 was diagnosed. A total of 21 cases (including this case) of neonatal-onset encephalomyopathic MDS type 9 were retrieved from 13 articles. The main clinical features were unexplained hypotonia and feeding difficulties accompanied by mild elevation of methylmalonic acid, 95% hyperlacticemia, and 80% respiratory distress. Patients with respiratory and circulatory system involvement are more likely to develop fatal lactic acidosis. Whole exome sequencing showed SUCLG1 gene mutation. Treatment is mainly supportive, with poor prognosis and high mortality. Conclusions Unexplained hypotonia, feeding difficulties, lactic acidosis and mild elevation of methylmalonic acid in the neonatal period should be considered for neonatal encephalomyopathy mitochondrial DNA depletion syndrome 9. Patients with respiratory and circulatory involvement are more likely to have neonatal fatal acidosis. Gene sequencing can help with the diagnosis.

    线粒体DNA耗竭综合征SUCLG1基因婴儿,新生酸中毒基因突变琥珀酰CoA连接酶类

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    全身振动对绝经后骨质疏松妇女治疗效果的Meta分析

    于姗黑静友陈媛媛高呈飞...
    511-517页
    查看更多>>摘要：目的 系统评价全身振动（WBV）疗法对绝经后骨质疏松（PMOP）妇女的治疗效果。 方法 检索中国知网、万方、维普、PubMed、EMBASE、The Cochrane Library、Web of science等数据库，限定检索时间从数据库建立到2022年12月。筛选符合纳入标准的文献并进行数据提取，采用STATA软件进行meta分析。 结果 最终纳入10项随机对照研究，共计677名患者。Meta分析结果显示：WBV可以显著提高PMOP妇女的腰椎骨密度（BMD）[加权均数差（WMD）=0.024，95%CI：0.002~0.045，P=0.032]、股骨颈BMD（加权均数差WMD=0.040，95%CI：0.017~0.063，P=0.001）及疼痛评分[标准化均数差（SMD）=-0.786，95%CI：-1.300~-0.272，P=0.002）]，但对患者脂肪质量（WMD=1.028，95%CI：-4.811~2.755，P=0.572）、肌肉质量（WMD=0.632，95%CI：-1.437~2.700，P=0.563）无显著作用。 结论 WBV训练能够提高PMOP妇女BMD并减轻疼痛，但对患者脂肪及肌肉含量无影响。 Objective To comprehensively evaluate the therapeutic effects of whole-body vibration (WBV) training on women with postmenopausal osteoporosis (PMOP) . Methods The CNKI, Wanfang, VIP, PubMed, EMBASE, Cochrane Library, Web of Science databases were searched from database establishment to December 2022. Two independent researchers screened the articles and extracted data according to the inclusion and exclusion criteria. The data were extracted for meta-analysis using STATA software. Results Ten randomized controlled trials with a total of 677 patients were included. The meta-analysis results showed that WBV can significantly increase lumbar spine bone mineral density (BMD) (WMD=0.024, 95%CI: 0.002~0.045, P=0.032) , femoral neck BMD (WMD=0.040, 95%CI: 0.017~0.063, P=0.001) and reduce pain score (SMD=-0.786, 95%CI: -1.300~-0.272, P=0.002) in women with PMOP, but has no significant effect on patient’ fat mass (WMD=1.028, 95%CI: -4.811~2.755, P=0.572) and muscle mass (WMD=0.632, 95%CI: -1.437~2.700, P=0.563) . Conclusions WBV training can improve BMD and relieve pain in women with PMOP, but has no effect on patients’ fat mass and muscle mass.

    绝经后骨质疏松全身振动骨密度Meta分析随机对照试验

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    分化型甲状腺癌术后首次 131I治疗前颈部淋巴结转移的危险因素分析

    惠金子李云波邓颖王俊燕...
    518-523页
    查看更多>>摘要：目的 研究分化型甲状腺癌（DTC）术后首次131I治疗前颈部淋巴结转移（CLNM）的危险因素。 方法 回顾性分析2020年1月至2022年7月于空军军医大学第二附属医院行全甲状腺切除术（TT）及首次131I治疗的332例DTC患者的临床资料，参考首次131I治疗后全身显像（Rx-WBS）+SPECT/CT断层融合显像诊断结果，结合临床表现、其它影像资料和生化指标综合评估，将患者分颈部淋巴结转移阳性组（CLNM+）和阴性组（CLNM-）。采用χ2检验、Mann-Whitney U检验比较两组间临床病理特征的差异；采用二分类Logistic回归分析CLNM的危险因素。 结果 332例DTC患者中，CLNM-组239例，CLNM+组93例，CLNM-组和CLNM+组间性别、原发灶数目、原发灶最大径、被膜侵犯、病理N分期（pN分期）、淋巴结清扫范围、转移淋巴结数目和刺激性甲状腺球蛋白（ps-Tg）差异有统计学意义（P<0.05）；年龄、TSH和中性粒细胞/淋巴细胞（N/L）值差异无统计学意义（均P>0.05）。单因素分析显示性别、原发灶数目、原发灶最大径、被膜侵犯、淋巴结清扫范围、pN分期、转移淋巴结数目、ps-Tg是DTC术后首次131I治疗前CLNM的显著影响因素（OR：2.16、87.04、1.21、2.16、1.92、1.55、1.04、1.02，均P<0.05）；多因素分析显示原发灶数目、被膜侵犯、淋巴结清扫范围、转移淋巴结数目和ps-Tg是CLNM的独立预测因素（均P<0.05）。 结论 CLNM更容易发生在具有多发病灶、被膜侵犯、中央区+颈侧区淋巴结清扫、转移淋巴结数目>6、ps-Tg水平偏高特征的DTC患者中，故需加强此类患者的临床管理。 Objective To analyze the risk factors of cervical lymph node metastasis (CLNM) before initial postoperative radioactive 131I therapy for differentiated thyroid cancer (DTC) . Methods The clinical data of 332 DTC patients who underwent total thyroidectomy (TT) and initial 131I treatment in Second Hospital Affiliated to Air Force Military Medical University from January 2020 to July 2022 were retrospectively analyzed. Based on the diagnosis results of the 131 I whole body imaging (Rx-WBS) +SPECT/CT fusion tomography, combined with the comprehensive evaluation of clinical manifestations, other image data and biochemical indicators, patients were divided into the positive group (CLNM+) and the negative group (CLNM-) . Chi-square (χ2) test or Mann-Whitney U test were used to analyze whether there were differences in various indicators between the two groups. The risk factors of CLNM were analyzed by binary logistic regression. Results Among 332 DTC patients, 239 cases were in the CLNM-group and 93 cases were in the CLNM+group. The difference of gender, number of primary tumor, maximum diameter of primary tumor, capsule invasion, pN stage, scope of lymph nodes dissection, number of metastasis lymph nodes and preablative stimulating thyroglobulin (ps-Tg) between the two groups was statistically significant (all P<0.05) , while the difference of age, TSH and neutrophil/lymphocytes (N/L) values was not statistically significant (allP>0.05) . Univariate analysis showed that gender, number of primary tumor, maximum diameter of primary tumor, capsule invasion, scope of lymph nodes dissection, pN stage, number of metastasis lymph nodes and ps-Tg were risk factors for CLNM (OR: 2.16, 87.04, 1.21, 2.16, 1.92, 1.55, 1.04 and 1.02, all P<0.05) . Multivariate analysis showed that number of primary tumor, capsule invasion, scope of lymph nodes dissection, number of metastasis lymph nodes and ps-Tg were independent predictors of CLNM (allP<0.05) . Conclusion CLNM is more likely to occur in DTC patients with multiple lesions, capsule invasion, more than 6 metastatic lymph nodes, central and lateral cervical lymph node dissection and higher ps-Tg level. For patients with the above characteristics, clinical management should be strengthened.

    分化型甲状腺癌颈部淋巴结转移碘-131治疗治疗剂量131I全身显像危险因素

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    跗骨窦切口联合/不联合3D打印治疗SandersⅡ型/Ⅲ型跟骨骨折疗效比较

    曲文庆孙涛张瑞东宋雨...
    524-530页
    查看更多>>摘要：目的 比较跗骨窦切口联合/不联合3D打印治疗SandersⅡ型/Ⅲ型跟骨骨折的疗效并探讨联合3D打印技术的作用。 方法 回顾性分析2018年1月至2022年7月烟台市烟台山医院骨科采用跗骨窦切口治疗的88例SandersⅡ型/Ⅲ型跟骨骨折患者资料，其中男57例，女31例；年龄19~74岁。SandersⅡ型39足，SandersⅢ型49足。采用跗骨窦切口联合3D打印技术（3D打印组）治疗45例（45足），采用传统跗骨窦切口不联合3D打印（传统组）治疗43例（43足）。比较两组手术时间、切口大小、术中出血量、术中透视次数、骨折复位质量、术后切口并发症、距下关节僵硬情况、术后第3天和末次随访（术后12月）疼痛视觉模拟评分（VAS）、末次随访美国足踝外科协会踝与后足评分（AOFAS）。 结果 3D打印组的手术时间、切口大小、术中出血量、术中透视次数、术后第3天VAS评分分别为（53.2±9.4）min、（48.3±8.2）mm、（47.2±11.0）ml、（9.00±2.6）次、（1.80±0.82）分，均低于传统组的（86.2±11.7）min、（62.2±4.6）mm、（55.0±16.6）ml、（16.6±4.3）次、（2.32±1.20）分（均P<0.05）。3D打印组的骨折复位优良率、术后切口甲级愈合率分别为93.3%（42/45）、91.1%（41/45），高于传统组的65.1%（28/43）、79.1%（34/43），距下关节僵硬率为8.9%（4/45）低于传统组的21.6%（11/43）（均P<0.05）。末次随访时3D打印组和传统组的VAS评分分别为（1.30±0.76）分和（2.87±1.06）分，组间比较差异无统计学意义（P>0.05）；3D打印组的AOFAS评分高于传统组[（90.56±4.84）分比（86.66±6.45）分，P<0.01）]。 结论 与传统跗骨窦切口治疗SandersⅡ型/Ⅲ型跟骨骨折相比，联合3D打印技术有助于改善手术过程和术后疗效。 Objective To compare the therapeutic effects of the Sinus Tarsi Approach combined with 3D printing technology and traditional Sinus Tarsi Approach in the treatment of Sanders type Ⅱ/Ⅲ calcaneal fractures and explore the role of combined 3D printing technology. Methods The data of 88 Sanders type Ⅱ/Ⅲ calcaneal fractures treated with the Sinus Tarsi Approach in orthopedics department of Yantaishan Hospital from January 2018 to July 2022 were retrospectively analyzed, including 57 males and 31 females Age: 19-74 years old. Sanders Ⅱ type 39 feet, Sanders Ⅲ type 49 feet. 45 cases (45 feet) were treated with the Sinus Tarsi Approach combined with 3D printing technology (3D printing group) , and 43 cases (43 feet) were treated with traditional Sinus Tarsi Approach (traditional group) . The operative time, incision size, intraoperative bleeding, intraoperative fluoroscopy frequency, and fracture reduction quality, postoperative incision complications, the visual analogy scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale at the third and last follow-up after surgery. Results The operative time, incision size, intraoperative bleeding, and intraoperative fluoroscopy frequency in the 3D printing group were (53.2±9.4) min, (48.3±8.2) mm, (47.2±11.0) ml, and (9.0±2.6) times, respectively, compared to (86.2±11.7) min, (62.2±4.6) mm, (55.0±16.6) ml, and (16.6±4.3) times in the traditional group, with statistically significant differences (all P<0.05) The excellent and good rate of fracture reduction in the combined 3D printing group and the traditional group were 93.3% (42/45) and 65.1% (28/43) , respectively, with a statistically significant difference between the two groups (P<0.05) The rate of postoperative incision grade A healing in the 3D printing group and the traditional group was 91.1% (41/45) and 79.1% (34/43) , respectively, with a statistically significant difference between the two groups (P<0.05) The rate of subtalar joint stiffness was 8.9% (4/45) and 16.3% (11/43) respectively, with a statistically significant difference between the two groups (P<0.05) The VAS scores of the 3D printing group and the traditional group on the 3rd day after surgery were (1.80±0.82) and (2.32±1.20) , respectively, with a statistically significant difference between the two groups (P<0.05) At the last follow-up, the VAS scores of the 3D printing group and the traditional group were (1.30±0.76) and (2.87±1.06) , respectively, with no significant difference between the two groups (P>0.05) At the last follow-up, the AOFAS scores of the 3D printing group and the traditional group were (90.56±4.84) and (86.66±6.45) , respectively, with a statistically significant difference (P<0.01) . Conclusion Compared with traditional Sinus Tarsi Approach in the treatment of Sanders type Ⅱ/Ⅲ calcaneal fractures, the combination of 3D printing technology can improve the surgical process and postoperative efficacy.

    3D打印技术跟骨骨折跗骨窦入路

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    Taylor空间支架外固定治疗胫骨干开放骨折术后早期与晚期部分负重的对比研究

    赵启军张涛孙逊刘钊...
    531-536页
    查看更多>>摘要：目的 对比分析Taylor空间支架（TSF）外固定治疗胫骨干开放骨折患者术后早期部分负重与晚期部分负重的临床疗效。 方法 回顾性分析2018年1月至2020年6月在天津医院矫形一病区接受TSF治疗胫骨干开放骨折患者63例，依据术后开始部分负重时间的不同分为早期负重组（术后6周）和晚期负重组（术后10周）。终末随访时采用Johner-Wruhs胫骨干骨折疗效评定标准患肢功能。记录并比较两组患者TSF外架带架时间、完全负重时间及并发症发生情况。 结果 两组患者最终均骨折愈合，终末随访时早期负重组患肢功能优良率高于晚期负重组（83.33%比69.7%，Z=-2.072，P=0.038）。早期负重组TSF外架带架时间、完全负重时间均较晚期负重组短（均P<0.05）。 结论 与晚期部分负重相比，TSF外固定治疗胫骨干开放骨折患者术后早期、规律、持续、适度的部分负重能够促进骨折愈合，减少患者带架时间，有利于患肢机能快速恢复，具有临床应用价值及指导意义。 Objective This study aims to compare and analyze the clinical efficacy of early versus late partial weight-bearing in patients undergoing Taylor Spatial Frame (TSF) external fixation for open tibial shaft fracture. Methods 63 patients with open tibial shaft fractures treated with TSF between January 2018 and June 2020 in the Department of Orthopaedics Ward One of Tianjin Hospital were retrospectively studied. Based on the timing of initiating postoperative partial weight-bearing (PWB) , the patients were classified as the early weight-bearing group initiating PWB at 6 weeks postoperative and the late weight-bearing group initiating at 10 weeks postoperative. The limb function was evaluated using Johner and Wruh’s Criteria during the final follow-up. The duration of TSF application, time to full weight-bearing, and occurrence of complications were recorded and compared between the two groups. Results Both groups achieved fracture union. At the final follow-up, the early weight-bearing group exhibited a good-to-excellent rate of 83.33%, while the late weight-bearing group showed a good-to-excellent rate of 69.7%, suggesting a statistically significant difference between the two groups (Z=-2.072, P=0.038) . The early weight-bearing group had a shorter duration of TSF application and time to full weight-bearing compared with the late weight-bearing group, indicating statistically significant differences between the two groups (all P<0.05) . Conclusion Compared with late PWB, early, regular, continuous, and moderate PWB after TSF external fixation in patients with open tibial shaft fracture can promote fracture healing, reduce the duration of external fixation device usage, facilitate rapid functional recovery of the affected limb, thereby exhibiting clinical application value and guiding significance.

    胫骨干开放骨折骨折外固定Taylor空间支架早期部分负重晚期部分负重

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    颈椎前路椎弓根基底部螺钉在骨质疏松椎体中的生物力学研究

    张吉辉赵刘军顾勇杰于亮...
    537-541页
    查看更多>>摘要：目的 评估颈椎前路椎弓根基底部螺钉（ATPRS）在骨质疏松椎体中的生物力学拔出力性能。 方法 选取正常成人骨质疏松颈椎（C3-C7）湿性标本9具（男5具，女4具），每具标本双侧随机置入颈椎前路椎弓根基底部螺钉（ATPRS）、颈椎前路椎弓根螺钉（ATPS）或颈椎前路椎体螺钉（VBS），即平均分成3组（ATPRS比ATPS，ATPRS比VBS，ATPS比VBS），每组3具。所有标本行薄层CT扫描后，将DICOM格式数据导入Mimics软件，进行三维重建，再设计ATPS组的导板并通过3D打印机快速打印成型。ATPS通过导板指导下置钉，ATPRS和VBS行徒手置钉。最后将椎体放置于生物力学实验机上，各组螺钉进行拔出力试验，对比拔出力性能。 结果 ATPRS、ATPS和VBS的平均最大拔出力分别为（287.94±76.78）N、（462.23±174.35）N和（169.20±89.07）N，组间比较，差异均有统计学意义（均P<0.05）。 结论 ATPRS的拔出力要优于VBS，可为ATPRS在临床上的运用提供生物力学方面的支持。 Objective To evaluate the pull-out strength on the osteoporotic vertebral body for anterior transpedicular root screw in cervical spine. Methods 9 wet specimens of normal adult osteoporotic cervical spine (C3-C7) were selected, including 5 males and 4 females. The anterior transpedicular root screw (ATPRS) , anterior transpedicular screw (ATPS) or vertebral body screw (VBS) was randomly placed on both sides of each specimen. All was divided into three groups (ATPRS vs ATPS, ATPRS vs VBS and ATPS vs VBS) with three specimens in each group. After all specimens were scanned by thin-layer CT, DICOM format data was imported into Mimics software for 3D reconstruction, then the guidance drill template of ATPS was designed and quickly printed by 3D printer. ATPS was placed under the guidance drill template, ATPRS and VBS were placed by hand. Finally, the specimens were placed on the biomechanical experimental machine, and the pull-out strength of each group of screw was tested. Results The average maximum pull-out strength of ATPRS was (287.94±76.78) N, ATPS was (462.23±174.35) N, and VBS was (169.20±89.07) N. There was statistical difference between ATPRs and VBS, ATPRS and VBS and ATPS and VBS for pull-out strength (all P<0.05) . Conclusions The pull-out strength of the ATPRS was better than VBS, which can provide the biomechanical support for clinical application.

    拔出力颈椎前路螺钉

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    直线加速器机械和剂量误差对脑胶质瘤容积旋转弧形调强放疗计划验证通过率的影响

    王猛孙维凯王凡王馨...
    542-547页
    查看更多>>摘要：目的 研究加速器机械和剂量误差对胶质瘤容积旋转弧形调强放疗（VMAT）计划剂量验证γ通过率的影响。 方法 选取2022年7月至2023年7月同济大学附属同济医院放射治疗科20例高级别脑胶质瘤病例的VMAT，使用医科达直线加速器和PTW调强验证工具进行验证，统计通过率。利用软件修改这些VMAT计划的某些参数模拟加速器运行过程中可能出现的机械和剂量误差，获得改造后的计划。使用上述设备重新对改造后的VMAT计划进行验证，统计通过率，与原计划的通过率进行比较分析。 结果 机械误差[机架的角度、准直器到位误差和多叶准直器（MLC）不同类型的到位误差]和辐射剂量误差（MU）对胶质瘤VMAT计划的γ通过率均有影响，进一步的研究表明MLC的误差比机架的旋转角度、准直器的相对位置偏离和MU对绝对剂量验证γ通过率有更加明显的影响。 结论 针对胶质瘤患者的VMAT计划，应根据检测仪器的性能采用合适的通过率指标，并尽可能使用绝对剂量验证。 Objective To investigate the effects of accelerator mechanical and dose errors on the dose validation pass rate of the glioma Volumetric Modulated Arc Therapy (VMAT) plan. Methods The VMAT plan of 20 cases of high-grade glioma was selected and verified with Elekta linear accelerator and PTW intensity modulation verification tool, and the passing rate was counted. Use software Matlab to modify some parameters of these VMAT plans to simulate mechanical and dose errors that may occur during accelerator operation, and recalculate the dose. Use the above equipment again to verify the modified VMAT plan, calculate its pass rate, and compare and analyze it with the original plan's pass rate. Result Both mechanical errors (frame rotation angle, collimator positioning error, multi-leaf collimator (MLC) positioning error of different types) and dose errors (MU) have an impact on the validation pass rate of the glioma VMAT plan. Further research has shown that MLC errors have a more significant impact on the absolute dose validation pass rate than frame rotation angle errors, collimator errors and MU errors. Conclusion For the glioma VMAT plan, in order to improve the validation pass rate of the program, it is necessary to separately implement stricter quality control on MLC. Futhermore, appropriate pass rate indicators should be used based on the performance of the testing equipment, absolute dose validation should be used as much as possible.

    机械和剂量误差胶质瘤容积旋转弧形调强放疗通过率

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