Model essay on the opening report of master of medicine-"Treatment of nonunion of long bone fracture of limbs"
Key words: steel wire encircling limb long bone fracture Jinan paper opening report
First, the basis, purpose and significance of the topic:
Fracture nonunion is a common clinical disease in orthopedics, in which there are many long bones in limbs, such as tibia, femur and humerus. In view of the second operation of nonunion of long bone fracture of limbs, bone grafting combined with LCP internal fixation is often used in our hospital. Autologous iliac bone as bone graft material has the advantages of simple material, good histocompatibility, no graft rejection and strong bone induction. These advantages make ilium the best donor for bone transplantation, and it has formed a knowledge in clinic. Bone grafting is an important method to treat nonunion of fracture, and its mechanism is the role of scaffold and mineral supply caused by creeping substitution. The smooth progress of creeping substitution requires precise reduction, adequate bone grafting and firm fixation. In order to achieve full bone grafting and promote fracture healing as soon as possible, we adopted intramedullary 360? Bone grafting, external wire ligation and LCP rigid internal fixation were used, and the postoperative follow-up was 3~ 12 months. The clinical effect of the operation was analyzed according to the healing and functional recovery. The purpose of this topic is to explore the improved surgical method and curative effect of treating nonunion of long bone fracture of limbs, and to provide reference for clinical treatment.
Based on the clinical data of the tutor for many years, this topic systematically sorts out the literature about surgical treatment of fracture nonunion at home and abroad, combines the follow-up investigation and retrospective analysis of patients with long bone fracture nonunion in the orthopedic ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, and analyzes the treatment effect according to the special biomechanical characteristics of orthopedics and the clinical experience of the tutor in treating fracture nonunion for many years, and makes a preliminary discussion and discussion on the details in the operation. At the same time, I hope that through the research and summary of the tutor's clinical practice, I can provide some help and guidance for future clinical work.
Second, the current research trends and levels at home and abroad.
The treatment of nonunion of fracture can be divided into surgical treatment and non-surgical treatment, among which the most important surgical treatment is the improvement of bone grafting and internal fixation of broken end. Autologous bone transplantation is effective in the treatment of fracture nonunion, and has formed a * * * understanding. Bone grafting is an important method to treat nonunion, and the combination of intramedullary and extramedullary bone grafting is often used in clinic. Enter along the muscle space, carefully peel off the subperiosteal fracture, take out the internal fixation device, remove the scar between the broken ends of the bone, bite off the hardened bone, open the medullary cavity, trim the broken ends, reset by hand, and take the bone according to the bone defect. Intramedullary bone grafting used a bone rod slightly thicker than the medullary cavity and clung to the medullary cavity bone; Bone grafting of extramedullary upper cover should be fixed with screws; Bone fragments can fully fill the residual gap, so as to truly achieve the purpose and requirements of bone grafting. Creeping substitution with autogenous skin-cancellous bone graft shortens the process of fracture healing. Fresh autogenous bone has biological activity, no immune rejection, no risk of infectious diseases, and bone conduction and bone induction.
The replacement of internal fixation should adhere to the following principles. If the original steel plate is fixed internally, the interlocking intramedullary nail or longer steel plate can be replaced and placed on the tension side; If the original interlocking intramedullary nail is used for internal fixation, a larger intramedullary nail or steel plate can be used for internal fixation; The original short steel plate can be replaced with a longer steel plate. All cases need bone grafting. After replacing the internal fixator, those who use plaster external fixation after operation should do muscle contraction as soon as possible. After the callus grows, remove the plaster and start the joint flexion and extension movement. However, doctors should treat specific problems in clinic and deal with them according to the growth of callus. When leaving the hospital, they must give the patient detailed doctor's advice and cooperate with the doctor until the fracture is completely healed. LCP plate internal fixation is suitable for nonunion of long bone fracture of limbs. Broken bone and transplanted bone can be fixed by lag screw, and the broken bone end can be locked by axial compression. The key to the operation is to remove all scar connective tissue at the fracture end, bite off all hardened bone at the bone end, expose normal bone and drill through the medullary cavity. The implanted bone block must be firmly embedded in the defect area, and the gap should be filled with cancellous bone. We should actively and correctly guide postoperative functional exercise, and strictly follow up regularly. Avoid premature and incorrect loading. To sum up, for the treatment of fracture nonunion, autogenous bone transplantation is effective, safe and reliable, with mature technology and wide application, which is worth popularizing.
Third, the main content of the study.
1. Clinical data
1. 1 case source
All the cases in this study were collected in the orthopedic ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine.
(2) Collection time
May 2009 ~ 2065438+0065438+February.
(3) case selection
1. Diagnostic criteria [2]
(1) medical history: definite history of trauma, no healing after 6 months, and no further healing trend after 3 months.
(2) Symptoms: angulation, rotation, lateral displacement, shortening deformity or segmental bone defect, pain or inability to bear weight, local pain under pressure, etc.
(3) Signs: local sinus formation, pus discharge, pseudojoint or local soft tissue scar and defect.
(4) Auxiliary examination: X-ray findings: the bone end was hardened and the pulp cavity was closed; The bone end is atrophic and loose, with a large gap in the middle; Or the end of the bone is hardened and becomes Chu Jiu pseudojoint with each other, then any one of these three forms can be defined as fracture nonunion.
2. Inclusion of case criteria:
(1) accords with the diagnostic criteria of this disease;
(2) The average healing time of fracture is more than half a year, forming pseudojoint;
(3) The average healing time of the fracture is more than half a year, and the X-ray photos of many times show the fracture line.
Clearly visible, there is no or little callus inside and outside;
(4) X-ray showed that the fracture line was widened, the bone surface at the fracture end was compact and hardened, the bone marrow cavity was closed, osteoporosis was found, there was no trabecular formation between callus, or there was obvious bone defect;
(5) Clinical manifestations include bone infection, defect, deformity, limb unequal length, local sinus formation, pus discharge, etc.
3. Criteria for excluding cases:
(1) does not meet the above diagnostic criteria.
(2) The patient suffers from serious medical diseases and cannot tolerate the operation.
(3) Patients with mental illness
(4) Incomplete information affects judgment.
2. Observation method of curative effect
The evaluation of nonunion should include the double evaluation of bone healing and functional recovery:
(1) Evaluation criteria of bone healing: The evaluation results depend on four indicators: bone healing, infection, deformity and limb length. Among them, the criteria of bone healing are that the X-ray shows that the fracture line is blurred, there are continuous bone spurs passing through the fracture line, the fracture has no abnormal activity after removing or trying to loosen the external fixator, the lower limbs can walk painlessly, and the upper limbs have a sense of stability at the fracture site. Evaluation criteria:
Excellent: fracture healing, no infection, broken end deformity.
Good: Fracture healing and two of the other three criteria.
It can be: fracture healing and one of the other three criteria.
Poor: the fracture did not heal or re-fracture, or healed but did not meet any of the other three criteria.
(2) Functional evaluation criteria
Functional evaluation is divided into upper limbs and lower limbs. The upper limb mainly considers its flexibility, and the lower limb mainly plays the role of carrying weight.
Evaluation indexes of lower limbs: ① obvious claudication; ② Ankle joint or any joint of knee joint is stiff (when knee joint is completely straight or ankle joint is completely straight, the range of motion is normal or the contralateral side is lost 15? Above): ③ The soft tissue condition is poor; ④ Pain that restricts activities or affects sleep: ⑤ Loss of working ability or inability to take care of oneself in life.
Excellent: working ability, no other four indicators.
Good: Strong working ability, with one or two of the above four indicators.
Ability: Ability to work, with the above three or four indicators.
Poor: loss of work ability or inability to take care of themselves, regardless of whether there are other indicators.
Reference for upper limb function evaluation? What are the evaluation criteria of Steuart and Hdlly for upper limb function? [3]
There are three observation indexes: pain, range of motion of joints and ability of daily activities.
L: evaluation criteria of upper limb function
Partial pain, pain, any limited joint activity, daily activities.
excellent
20~40 is it hard or tired? Slightly limited
Persistence difference > 40? Seriously limited
5. Project progress and arrangement:
2009-0520 10- 12 case collection and follow-up.
2010-102010-12 data collection and data analysis
2011-01201-03 Write the paper and finalize it.
Fourth, the characteristics and expected effect of this topic
The application of autogenous bone transplantation in the treatment of fracture nonunion has achieved remarkable results, and it has been recognized that the experience in the treatment process needs to be constantly summarized, and retrospective work and systematic arrangement are needed. Therefore, it is particularly important to analyze the clinical data of fracture nonunion.
By collecting and sorting out the clinical data of orthopedic patients in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2009-20 10/0, the related problems of autogenous bone transplantation in the treatment of fracture nonunion were studied and summarized. Statistical analysis score was used to compare preoperative, postoperative and related aspects, so as to objectively, truly and accurately evaluate the clinical effect of autogenous bone transplantation in the treatment of fracture nonunion and further guide clinical work.
Feasibility analysis of verb (abbreviation of verb)
Orthopaedics of Affiliated Hospital of Shandong University of Traditional Chinese Medicine is the key discipline and department evaluated by Shandong Administration of Traditional Chinese Medicine, which is well-known in the province and has a wide range of patients. Professor Wang Mingxi has been engaged in clinical work for more than 30 years and has rich clinical experience. A lot of research and clinical work have been done on the treatment of fracture nonunion, and good results have been achieved. This topic collects and sorts out the clinical data of orthopedics in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine in recent years, and studies and summarizes these first-hand data under the guidance of the tutor.
Non-union of long bone fracture of limbs is difficult to cure because of many complications, and the process of functional recovery after operation is long. It is very necessary and feasible to sum up experience in the treatment process. This topic mainly studies the application of 360 steel wire hoop in Shandong Provincial Hospital of Traditional Chinese Medicine in recent years. The curative effect of bone grafting combined with LCP internal fixation in the treatment of nonunion of long bone fractures of limbs is analyzed, so the topic selection is feasible. The research of the subject has also been strongly supported by schools, affiliated hospitals and other departments. I believe this project can be successfully completed.
Main references
Xu, Ge Baofeng, Xu Yinkan, et al. Practical Orthopedics [M]. Beijing People's Military Medical Publishing House, 2007.
[2] Wang Yiqian, et al. Bone and joint injuries [M]. People's Health Publishing House, 2007
Xia Hetao. Brief introduction of combined external fixator [EB/OL]. Beijing Institute of External Fixation Technology, 2005.
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Zhou Laixi, Lin Bendan, ZhiGang Zhong, et al. Biomechanical comparison and clinical study of three internal fixation devices for tibial fracture [J]. Journal of Bone and Joint Injury, 2000; 15 ( 5 ): 428 ~430
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Model essay on the opening report of medical papers: cell signal transduction and research and development of targeted anti-tumor drugs
First, the purpose and significance of the topic
Quantitative structure-activity relationship (QSAR) is a new subject developed in 1960s, which is derived from structure-activity relationship (SAR). QSAR is to calculate the chemoinformatics of a series of compounds with known structures and biological activities (such as a series of compounds with similar structures and the same pharmacological effects), select an appropriate mathematical model, establish a quantitative relationship between the activities and structures of compounds, explain the changes in biological activities of compounds caused by changes in molecular structures, and infer their possible mechanisms of action. Then an effective QSAR model is established. If new compounds appear and their structural data are known, their biological activities can be predicted, and the structures of existing compounds can be optimized to improve their biological activities. This method is widely used in the rational design of bioactive molecules such as drugs, pesticides and chemical poisons. After more than 40 years of development, quantitative structure-activity relationship has become a very active research field in the world.
Although great progress has been made in tumor chemotherapy, and new anti-tumor drugs appear constantly, there are still many problems in tumor chemotherapy, mainly solid tumors account for 90% of malignant tumors, but most solid tumors such as lung cancer, liver cancer, colon cancer and pancreatic cancer still lack effective drugs; The existing anti-tumor drugs have too many side effects and lack selectivity; Tumor cells are resistant to anti-tumor drugs [1].
QSAR mainly focuses on the early research and development of drugs, which opens up a new way for the screening and design of new drug molecules [2]. With the known receptor structure, the quantitative structure-activity relationship of anti-tumor drugs is studied, and non-cytotoxic drugs that can target specific tumors and specific targets are found by generating ligands complementary to the receptor structure, so as to make them more selective and targeted. With the establishment of the new QSAR model, the time for synthesizing new drugs is greatly shortened, the development cost is reduced, and the effectiveness of drugs for specific tumor population can be predicted to some extent. It has played a positive role in promoting tumor treatment.
Second, the research status at home and abroad
Chemotherapeutic drugs for cancer have developed rapidly, and a large number of research documents on anticancer drugs are published every year. Countries also attach great importance to the research and development of anticancer drugs, and have invested heavily. For this purpose, the United States established the National Cancer Institute (NCI) and became the authoritative organization for anti-tumor in the world.
The research and development direction in China is mainly anti-tumor drugs containing Chinese herbal medicines and their effective components, which can be summarized as follows: (1) structural modification of existing drugs to improve their pharmacological properties, such as increasing water solubility and reducing toxic and side effects; (2) Under the guidance of new mechanisms or targets, searching for new active substances as lead compounds; (3) looking for new goals. In the post-genetic biology, scientists have to face thousands of potential drug targets and discuss their interactions with small compounds. (4) Strengthen the study of quantitative structure-active structure-relationship.
In recent years, with the rapid development of molecular biology and computer technology, the technical route of new drug development has changed greatly. More and more international research institutions use computer-aided molecular design in the development of new anti-tumor drugs, which greatly speeds up the design of new drugs, saves manpower and material resources in the creation of new drugs, and enables pharmacologists to develop new drugs under the guidance of theory. Computer-aided molecular design is mainly divided into two situations: one is to find new drugs by generating ligands complementary to the receptor structure when the receptor structure is known; The other is to establish a quantitative structure-activity relationship for a group of compounds with similar activities when the receptor structure is unknown, and then modify the structure based on this model to predict the formation of new compounds.
QSAR, as an important calculation method and common means in the design and research of anti-tumor drugs, plays an important role in the development and research of new drugs. In the past half century, QSAR research has greatly promoted the development of organic synthetic chemistry, medicinal chemistry and drug design, and has become a powerful tool to study the physical and chemical properties and biological activities of substances in order to seek molecular explanations. The following briefly introduces some commonly used methods for quantitative activity-structure activity relationship research as follows.
1, 2D-QSAR There are many traditional 2D QSAR methods, such as Hansch method, group contribution method and molecular connectivity index method [3].
Among them, the most famous and widely used method is Hansch method. It assumes that the changes of some biological activities of the same series of compounds are related to the changes of some measurable physical and chemical properties (hydrophobicity, electrical properties and spatial properties, etc.). ), and these factors are isolated from each other, and a quantitative structure-activity relationship model can be obtained by using statistical methods such as multivariate free energy correlation and multivariate linear regression.
Group contribution method is a method established by Free-Wilson based on the substructure information and biological toxicity of organic compounds. The model holds that the toxic effect between organic compounds and receptors is the sum of the toxic contributions of different substituents at specific positions of organic compounds. Free-Wilson method is only suitable for organic compounds with the same parent structure, and is often used for preliminary toxicity assessment of organic compounds.
Molecular connectivity index (MCI) was proposed by Kier and Hall. It describes the structural properties of molecules according to the arrangement or connection of skeleton atoms in molecules. MCI is a topological parameter, including zero-order term (0Xv), easy-order term (1Xv), second-order term (2Xv) and so on. Can be determined according to the structural formula of the molecule and the point price of the atom (? ), which has a good correlation with the data of organic toxicity. MCI can strongly reflect the three-dimensional structure of molecules, but its ability to reflect the electronic structure of molecules is weak, so it lacks clear physical meaning. However, due to its convenience, simplicity and independence from experiments, it has been widely used and developed in recent years [4 ~ 8].
2. Three-dimensional quantitative structure-activity relationship method (3D-QSAR) With the further development of structure-activity relationship theory and statistical methods, in 1980s, three-dimensional structural information was introduced into quantitative structure-activity relationship research, namely 3D-QSAR. Compared with 2D-QSAR method, 3D-QSAR method is more explicit in physics and chemistry, which can indirectly reflect the characteristics of non-bond interaction between drug molecules and targets. Therefore, the 3D-QSAR method has been rapidly developed and widely used in recent ten years, and there are many research methods [9], such as molecular shape analysis (MSA), distance geometry (DG), comparative molecular field analysis (Comfa), comparative molecular similarity factor analysis (Comsia) and phesudo receptor. CoMFA is the most widely used method.
3. With the development of science and technology and the progress of production technology, some advanced methods for building QSAR models have emerged, all of which have good prediction ability. Among them, heuristic method (HM), support vector machine (SVM) and gene expression programming (GEP) are common. Support vector machine (SVM) is a new general learning method proposed by Vapnik[ 10] and others according to statistical theory. Based on the VC dimension theory of statistical theory and the principle of minimum structural risk, it can solve practical problems such as small sample, nonlinearity and high dimension [1 1- 12]. Gene expression programming (GEP) is based on the idea of biological inheritance, which maintains biological characteristics and has good reproducibility. Can it be carried out? Genetic variation? Control, and finally reliable experimental results can be obtained.
Third, the main research content
1. Consult Chinese and foreign literatures and select data sources.
2. Calculation of physical and chemical parameters and structural parameters.
3. Analysis of specific structural parameters.
4. Research on 4.SVM GEP method.
5. Establishment of quantitative structure relationship.
6. Verification of quantitative structure relationship.
7. Draw conclusions and summarize.
Fourth, the paper work plan
Mid-March? Early April: Topic selection.
Early April? At the end of April: consult the materials, get familiar with the experimental principles and methods, and prepare the opening report.
May 10: open the topic.
The first day of May? At the end of May: Conduct graduation design experiments, record data and write papers.
Early June? Mid-June 30th: graduation thesis defense.
Verb (abbreviation of verb) reference
Ren Huayi. Clinical medicine of china Medical Journal (Shandong), 2005,7 (2): 28-33.
[2] Xu Juan, Wang Lin. QSAR and QMR study computer-aided drug design. Foreign medicine? Journal of Pharmacy, 2003,30 (3):135-138.
[3] Guo Zongru. Introduction to medicinal chemistry. Beijing: China Medical Science and Technology Press, 1994.4038+008.
[4] Bakur Rao, Shyam R, Asole Karl. QSAR model for predicting the influence of ionic strength on the adsorption of chlorobenzene and phenol at sediment-water interface. Shuiyan, 200l, 35 (14): 3391-3401.
, Du Xihua, Tang. QSAR studies the acute toxicity of substituted aromatic hydrocarbons to photobacterium phosphoreum, Daphnia magna and shad. Applied Chemistry, 2002,19 (11):1037-18.
Qin, a man. Study on the correlation between the quantitative structure of substituted phenols and the properties of active p. Organic Chemistry, 2003,23 (7): 654-658.
Block xihua. Topological structure of biological activity of substituted aromatic compounds. Journal of Nanchang University (Science Edition), 2005,29 (2):155-160.
[8] Alexander Sabli ·c·QSAR's model for estimating the characteristics of persistent organic pollutants is used to evaluate its environmental fate and risk. Chemical circle, 200 1, 43(3): 363 -375.
Hou Tingjun, Joe, Zhang Wei. Computer-aided drug molecular design. Beijing: Chemical Industry Press, 2004.
[ 10] Vapnik VN。 The essence of statistical learning theory.
New York: springer Press, 1995.
Yan Hui, Zhang, Li. Identification of sedimentary microfacies by SVM. Geophysical and Geochemical Computing Technology, 2000, (2): 158-164.
[12] sheets. Statistical learning theory and support vector machine. Acta automatica sinica, 2000, (1): 32 -42.
[13] Vapnik V, Golowich S, smola a. Support vector method for function approximation, regression estimation and signal processing. In: mozer M, Jordan M, Petzted. Neural information processing system, MIT press, 1997-09.
Ma Yunqian, Zhang. Application of support vector machine function fitting in fractal interpolation. Journal of Tsinghua University (Natural Science Edition), 2000, (3): 76- 78.
[15] Muller K-R, Smola A J, rats ch g. using support vector machine to predict time series. Proceedings of ICANN 97, Springer Lecture Notes on Computer Science, 1997: 999- 1005.