人工股骨头置换与全髋关节置换术治疗老年人移位型股骨颈骨折的3年随访疗效比较

目的 探讨人工股骨头置换术和全髋关节置换术治疗老年移位型股骨颈骨折患者的临床疗效.方法 回顾性分析我院2010年1月至2012年1月收治的82例65岁以上老年移位型股骨颈骨折病例,其中47例采用人工股骨头置换术,35例采用人工全髋关节置换术,总结分析两组患者手术持续时间、术中出血量、术后引流量、早期并发症,并对所有患者进行追踪随访,采用Harris评分评价中短期治疗效果.结果 人工股骨头置换术组手术时间(38.9+9.1)min,明显短于全髋关节置换术组的(62.7± 10.1)min;人工股骨头置换术组术中出血量为(381.4±79.5)ml,明显少于全髋关节置换术组的(478.5±118.6)ml;人工股骨头置换术组术后引流量(124.3±26.1)ml,明显少于全髓关节置换术组(138.2±18.1),差异均有统计学意义(P＜0.05).人工股骨头置换术组患者术后早期并发症发生率为12.8％,全髋关节置换术组为11.4％,差异无统计学意义(P＞ 0.05).本组患者术后随访3年,术后1年两组患者Harris评分及优良率(77.1％ vs.76.6％)差异无统计学意义(P=0.542);术后3年全髋关节置换术组Harris评分及优良率(51.4％ vs.38.3％)明显高于人工股骨头置换术组,两组比较差异有统计学意义(P=0.001).结论 两种术式各具优缺点,近期效果基本相同,全髋关节置换术中期效果优于人工股骨头置换术.     

全髋与半髋关节置换治疗不稳定型老年股骨颈骨折疗效比较

目的比较全髋置换与半髋置换治疗老年不稳定型股骨颈骨折的疗效。方法回顾性分析新疆医科大学第一附属医院关节外科2007年1月至2011年8月收治的168例不稳定型股骨颈骨折患者,其中采用全髋人工关节置换89例,行双极人工股骨头置换79例。结果双极人工股骨头置换组患者手术时间、术中出血量、输血量均少于全髋人工关节置换组[(66.4±10.0)min vs(85.3±14.6)min]、[(361.8±78.8)mL vs(550.9±149.7)mL]、[(292.7±103.5)mL vs(400.4±99.8)mL](P<0.05);术后1年髋关节功能Harris评分全髋人工关节置换组要优于双极人工股骨头置换组(z=-8.96,P<0.05)。结论全髋人工关节置换术的临床治疗效果优于双极人工股骨头置换术,但要求患者对手术的耐受力要高,临床上应结合患者的身体状况以及预期活动能力来选择最合适的手术方案。     

人工全髋置换术及人工股骨头置换术治疗老年股骨颈骨折疗效比较

目的探究人工全髋置换术与人工股骨头置换术治疗老年股骨颈骨折的临床疗效。方法选择2013年1月至2014年1月黄梅县人民医院收治的100例老年股骨颈骨折患者为研究对象,采用随机数字法将患者分为人工股骨头置换术组(50例)和人工全髋置换术组(50例),其中人工股骨头置换术组给予人工股骨头置换术治疗,人工全髋置换术给予人工全髋置换术治疗。治疗后比较两组患者的手术情况、疗效、髋关节功能恢复情况以及并发症发生情况。结果人工股骨头置换术组患者的手术时间、术中出血量、术后引流量均明显短于或少于人工全髋置换术组[(78±12)min比(114±13)min、(248±18)mL比(441±13)mL、(97±10)mL比(141±19)mL](P<0.01),而住院时间、住院费用与人工股骨头置换术组比较差异无统计学意义(P>0.05);人工全髋置换术组患者术后1年的Harris评分、疗效、髋关节功能恢复优良率均明显高于人工股骨头置换术组(P<0.05);两组早期并发症的发生率比较差异无统计学意义[14.0%(7/50)比10.0%(5/50),P>0.05];人工全髋置换术组晚期并发症发生率低于人工股骨头置换术组[16.0%(8/50)比4.0%(2/50),P<0.05]。结论人工股骨头置换术、全髋关节置换术均可作为老年股骨颈骨折患者治疗的有效手段,前者具有手术时间短、创伤小等优点,后者在髋关节功能恢复及并发症方面较前者更具优势,远期疗效明显优于前者。     

早中期股骨头坏死样本的骨微结构分析

背景 股骨头坏死患者常处于青壮年,如果不及时治疗,会快速进展,发生股骨头的塌陷,严重影响工作生活,最终需要接受全髋关节置换.目的 观察早期股骨头坏死标本不同区域微观结构,研究其内部结构变化规律,为早期股骨头坏死的治疗提供指导.方法 收集2019年3月-?2020年1月因股骨头坏死于解放军总医院第一医学中心行全髋关节置换术患者的10个股骨头标本,其中女性5例,男性5例,年龄41～66岁,平均52岁.术前起病时间3～24个月,平均9.5个月.根据改良的国际骨循环研究学会(ARCO)分期标准,放射学分期均为Ⅱ期.将骨坏死标本沿冠状位切成厚约2?mm切片,采用micro-CT、高精度X线检查、病理学等方法研究股骨头坏死不同区域内部结构变化规律.结果 通过micro-CT及病理切片染色发现早中期股骨头坏死标本软骨下骨正常的屏障作用减退或消失,部分区域有新生血管侵入,坏死区骨小梁结构完整性消失,骨小梁表面新生骨较少,且存在大量空骨陷窝.硬化区骨小梁数量和厚度均明显增加,新生类骨质较多,硬化区成骨相对于坏死区和正常区更为活跃.骨计量参数统计分析显示硬化区骨矿密度(bone?mineral?density,BMD)?(mg/cc)(202.83±38.95?vs?79.00±24.50和102.12±17.44)、骨体积分数(bone?volume?fraction,BV/TV)?(50.35％±7.40％?vs?29.14％?±?8.80％和33.68％±5.70％)相对于坏死区和正常区明显增加(P均<0.05).同时坏死修复反应区血管面积也较坏死区和正常区明显增加(P<0.05).结论 早中期股骨头坏死已发生软骨下骨屏障作用减退.坏死区保留死骨,改变成骨方式,对于早中期骨坏死的治疗及塌陷的预防具有积极意义.     

全髋关节置换术与人工股骨头置换术治疗老年股骨颈骨折的临床对照观察

目的观察全髋关节置换术与人工股骨头置换术治疗老年股骨颈骨折的临床疗效,并关注治疗后患者的睡眠质量及生活质量的差别,以期为临床工作提供理论支持。方法收集我院168例老年股骨颈需进行假体置换术的患者,将其分为观察组（84例）与对照组（84例）。对照组行人工股骨头置换术,观察组行全髋关节置换术,观察两组患者手术时间、随访疗效评价、睡眠质量及生活质量的差别。结果观察组治疗后的优良率明显高于对照组（92.86%vs82.14%）（χ2=4.408 2,P=0.035 8）,观察组患者睡眠质量明显低于对照组[（6.46±2.46）分vs（10.32±3.46）分]（t=8.14,P=0.013 2）,观察组患者生活质量明显高于对照组（均P〈0.05）,但观察组患者手术时间明显长于对照组[（108.43±13.25）min vs（70.25±23.13）min]（t=13.46,P〈0.01）。结论对老年股骨颈骨折的患者应积极进行全髋关节置换术,临床疗效满意,术后的睡眠及生活质量理想,临床中可以积极应用。     

老年股骨颈骨折应用全髋关节和双极人工股骨头置换术治疗的临床比较

目的比较老年股骨颈骨折患者接受全髋关节和双极人工股骨头置换术治疗的不同效果。方法选择2016年10月至2017年10月本院老年股骨颈骨折患者70例,其中35例患者接受全髋关节置换术,视作观察组,另外35例患者接受双极人工股骨头置换术,视作对照组,比较两组效果。结果观察组术后一个月髋关节功能、生活质量分别为(84.16±7.14)分、(89.46±6.98)分,对照组为(75.88±6.47)分、(76.30±5.72)分,P0.05。结论全髋关节置换术治疗老年股骨颈骨折患者能够更明显改善患者髋关节功能以及生活质量,值得推广。     

老年人股骨头置换术麻醉体会

目的探讨老年股骨头置换术麻醉处理方法及应用效果。方法 34例老年股骨头置换术患者均给予腰麻联合硬膜外麻醉处理,记录其麻醉效果及不良反应发生情况,给予统计学分析后得出结论。结果 34例老年患者麻醉起效时间(1.22±0.78)min、麻醉阻滞完善时间(7.18±1.76)min、硬膜外用药量(3.49±2.41)m L。术中7例患者发生麻醉相关不良反应,发生率14.71%,与未发生不良反应患者所占比例(85.29%)对比结果具有统计学意义(P<0.05)。结论对老年股骨头置换术患者给予腰麻联合硬膜外麻醉处理可获得满意麻醉效果及安全性,有利于保障患者手术疗效及预后,提高其生活质量及生命安全。     

分析手术室细节护理对老年患者股骨头置换术的应用效果

目的:分析手术室细节护理对老年患者股骨头置换术的应用效果。方法:选取2015年09月-2017年8月期间于我院接受股骨头置换术治疗的102例老年患者(≥60岁)作为研究对象,根据随机数字表格分配的方法将病例分为研究组52例、对照组50例,对照组给予手术室常规护理,研究组在此基础上行细节护理,观察对比两组患者心理状态、护理质量及护理满意度。结果:研究组患者心理状态、对应护理人员护理服务质量及护理满意度评分均明显较对照组更优(P0.05)。结论:对行股骨头置换术治疗的老年患者实施手术室细节护理可显著改善其心理状态,保证护理质量,进一步促进了手术顺利进行。     

单侧腰麻在老年患者人工股骨头置换术的临床应用

目的探讨CSEA单侧腰麻应用于老年患者人工股骨头置换术的可行性.方法随机选择60例拟行人工股骨头置换术的老年患者,随机分为轻比重和重比重两组,根据患者个体差异,分别向蛛网膜下腔注射0.375%重比重布比卡因1.2～1.6ml(重组)与0.375%轻比重布比卡因1.2～1.6ml(轻组).结果麻醉满意程度:重组优良率30例(100%),轻组优良率27例(97%)(P＞0.05),两组病人均取得一个确切的术侧阻滞的麻醉效果.两组病人布比卡因用量:重组(5.3±1.2)mg,轻组(5.5±1.6)mg(P＞0.05).低血压、恶心、呕吐、寒战和术后头痛的发生率均较低,两组间无显著性差异(P＞0.05).结论CSEA轻比重与重比重单侧腰麻法均适合于老年患者人工股骨头置换术.     

围术期护理干预对股骨头缺血性坏死治疗效果的影响分析

目的:探讨围术期护理干预对股骨头缺血性坏死治疗效果的影响。方法:选取行人工髋关节置换术的58例股骨头缺血性坏死患者,按数字表法,随机将选取的患者分为两组,各29例,对照组患者仅给予常规护理措施,观察组在对照组基础上给予有效的围术期护理干预措施。结果:观察组治疗后Harris评分明显高于对照组(91.5±6.3 vs 84.2±6.4),差异有统计学意义(P0.05);观察组并发症发生率明显低于对照组(3.45%vs17.24),差异有统计学意义(P0.05)。结论:股骨头缺血性坏死患者行人工髋关节置换术可有效改善患者肢体功能,降低术后并发症,值得临床推广应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.