螺旋臼联合植骨修复全髋置换翻修术中的Ⅰ、Ⅱ型髋臼骨缺损

目的 介绍螺旋臼联合植骨技术在髋关节翻修手术中骨缺损的修复应用.方法 回顾分析1997年以来,21例在翻修术中存在髋臼骨缺损患者,按AAOS分:型8例,Ⅱ型13例;Ⅰ型采用螺旋臼联合颗粒-植骨,Ⅱ型采用螺旋臼联合结构性压碎屑性植骨;术后进行临床评估及X线评估.结果 术后平均随访8～6月,平均22.8个月,未出现假体失败而需要再次翻修病例,植骨组织未见明显骨吸收.Hartis评分系统评估患者髋关节功能,翻修术前平均28分,术后均84分.结论 采用螺旋臼联合植骨修复翻修术中Ⅰ、Ⅱ型髋白骨缺损,与骨床接触更紧密,减少植骨界面间微动现象,同时可阻断乙烯臼与髋臼骨质接触,减少骨溶解.该方法可有效修复Ⅰ、Ⅱ型髋臼骨缺损.     

大直径多固定孔臼杯在人工髋关节翻修术髋臼骨缺损结合植骨中的应用

目的探讨人工髋关节翻修术髋臼周围骨量储备或缺损的处理经验及选取生物型大直径多固定孔臼杯应用。方法选取辽宁本溪第一人民医院2008年5月-2012年4月期间髋关节翻修术中存在不同程度髋臼骨缺损共32例（34髋）,骨缺损类型为Paprosky Ⅱ、Ⅲ型。我们采用大直径多孔臼杯结合植骨修复骨缺损,恢复髋臼旋转中心。结果平均随访3.2（2.5～3.67）年,Harris评分18髋〉90分,13髋为80～89分,2髋为70～79分,1髋〈70分,优良率达88.6%。结论大直径多孔臼杯结合植骨处理髋关节翻修术中严重髋臼骨缺损,中期效果良好。     

同种异体骨打压植骨联合Jumbo臼杯在Paprosky Ⅱ型髋臼缺损髋关节翻修中的应用

目的：探讨同种异体骨打压磨挫植骨联合Jumbo臼杯治疗PaproskyⅡ型髋臼缺损在髋关节翻修中的临床效果。方法：收集我院2015年1月—2018年12月行髋关节翻修术且术中采用同种异体骨打压磨挫植骨联合Jumbo臼杯治疗PaproskyⅡ型髋臼缺损34例患者的病历资料，记录患者的手术时间、手术出血量、围手术期输血量。比较术前术后影像学资料(髋臼旋转中心高度、髋臼外展角、偏心距)、髋关节功能评分(Harris评分)、疼痛视觉模拟VAS评分，围手术期并发症发生情况。结果：随访时间为19～36(24.5±6.3)个月。手术时间为90～312(126.2±31.7)min,手术出血量100～420(216±93)ml,围手术期输血量0～4(2.1±0.5)U。患者术后6个月随访时的Harris评分、VAS评分、髋臼旋转中心高度、髋臼外展角、偏心距较术前均有明显改善，差异具有统计学意义(P<0.05);至少1年后的末次随访上述各指标与术后6个月相比无明显变化(P>0.05)。4例患者出现严重并发症，腘静脉血栓1例、切口感染3例。结论：髋关节翻修术中采用同种异体骨打压植骨联合Jumb...     

颗粒性打压植骨在股骨缺损的髋关节翻修中的应用

目的：探讨颗粒性打压植骨技术在股骨缺损的髋关节翻修中的应用效果。方法：对15例20髋合并股骨缺损患者行全髋翻修术,术中对股骨缺损采用颗粒性打压植骨技术结合钛网和结构性植骨,使用骨水泥解剖型假体进行股骨翻修,术后对其中14例(19髋)进行髋关节X线检查及髋关节功能Harris评分。结果：X线检查显示17髋股骨缺损植骨处愈合,无明显骨吸收以及假体下沉,术前Harris评分平均为34.18分,术后提高到86.6分,Harris评分优良率89.5%。结论：颗粒性打压植骨是治疗严重股骨缺损的一项有效方法。     

打压植骨结合结构性植骨重建成人髋臼发育不良性骨缺损

目的：探讨全髋置换术中应用打压植骨结合结构性植骨在重建成人髋臼发育不良（developmental dysplasia of hip,DDH）性骨缺损中的疗效。方法：回顾性分析2007年1月-2012年6月,在我科治疗的成人DDH 11例患者,发育不良按Crowe分型为Ⅱ型5例,Ⅲ型6例;骨缺损按美国骨科医师学会分类术前均为Ⅲ型混合型缺损。3例用同种异体股骨头,8例用自体股骨头进行结构性植骨,均用2、3枚螺钉固定。1例用骨水泥型带加强环的臼杯,10例用非骨水泥型带螺旋臼杯压配固定。均取股骨侧髓腔或自体髂骨碎粒打压植骨。术中不同程度松解髋周组织。结果：所有患者顺利完成手术,无1例感染。经6~48个月的随访,未发现关节疼痛、臼杯松动。Harris评分由术前的平均39.7分（18~52分）提高到术后末次随访时的平均85.7分（52~96分）。结论：结构性植骨及合适的臼杯能提供髋臼骨缺损的结构性即时支撑,打压植骨颗粒能提供充足的骨量支持从而促进臼杯与骨床的融合。     

植骨在髋臼骨缺损人工全髋关节置换中的应用

目的探讨存在髋臼缺损的人工全髋关节置换（THR）中植骨的应用效果。 方法对58例75髋存在髋臼骨缺损患者行全髋关节置换手术,术中对根据骨缺损的情况分别进行颗粒性、结构性和混合性植骨,术后对其中46例（59髋）进行髋关节X线检查及髋关节功能Harris 评分。结果平均随访时间为45.6个月。X线检查显示54髋植骨处愈合, 无明显骨吸收,占91.5%;5髋出现植骨边缘透亮带,占8.5%。 术前Harris 评分28～42分,平均34.18;术后髋关节功能,优：23例28髋, 良：20例26髋, 尚可： 3例5髋,优良率91.5%。结论自体骨重建存在骨缺损的髋臼, 增加了髋臼覆盖,提高了人工全髋置换术后髋臼假体稳定自性,近期临床效果好。     

金属网杯结合植骨技术在髋臼骨缺损中的应用

随着人工髋关节置换术(total hip arthroplasty, THA)的广泛开展,患者生存期的延长,目前全髋关节的翻修病例也在不断增加.我院翻修患者的手术,已经占全髋关节置换的15%.有效修复髋臼处骨缺损的部位,重建髋臼处的解剖结构,将直接影响到翻修假体的稳定性和远期效果,是髋关节翻修术成功的关键因素.我科自2008年1月至2010年8月,采用颗粒打压植骨及结构植骨技术,根据髋臼缺损金属加强网和加强杯特点,依据Paprosky髋臼骨缺损的不同分型,结合使用金属网和金属杯进行髋臼缺损重建22例,随访效果满意,报告如下.     

全髋关节翻修术中髋臼缺损的重建

目的 :在全髋关节翻修术中 ,通过打压植骨、髋臼钢板或金属钛网对髋臼骨缺损进行重建 ,以恢复髋臼的完整性 ,提高髋臼假体的稳定性。　方法 :全髋关节翻修术 38例 ,其中 12例采用自体或异体骨植骨、髋臼重建钢板或金属钛网固定 ,对重建后的髋臼进行支撑和加强。　结果 :12例患者术后随访 3～ 38(平均 13.1)个月 ,X线片表明髋臼侧植骨处仅 1例出现轻度骨吸收 ,其余骨愈合良好 ,未出现骨吸收和内固定移位。　结论 :对于髋关节翻修中 ,对髋臼骨缺损者采用打压植骨、髋臼钢板或金属钛网支撑加强 ,重建髋臼的骨性结构是一种有效的方法 ,可提高髋臼假体的稳定性     

初次髋关节置换术中髋臼重建的策略

目的:探讨初次全髋关节置换术(THA)中髋臼重建方法的选择.方法:回顾性分析2001年至2006年间32例初次THA的患者(CroweⅢ、Ⅳ型先天性髋关节脱位15例,髋关节感染后融合6例,陈旧性髋臼骨折11例),其中内移髋关节旋转中心6例,结构性植骨11例,颗粒松质骨打压植骨15例;有4例应用钛网,4例重建钢板,3例加强杯固定.术后进行临床评估及X线评估.结果:术后平均随访41(8～72)个月,Harris评分平均为84分;3例臼杯松动需要进行翻修手术.结论:将髋臼重建在真臼位置,并进行软组织松解及下肢长度的平衡处理,通过不同的重建方法可以获得良好的髋关节功能.     

自行设计骨水泥加压器在全髋关节置换术中的临床运用及疗效分析

目的:分析自行设计的骨水泥加压器在人工全髋关节置换术的临床运用及疗效。方法:2010年8月至2012年12月收治55例患者,其中25例采用我科自行设计髋臼侧骨水泥加压器加压,30例采用常规髋臼加压技术行人工全髋关节置换术,术前后行髋关节X线检查,并对比分析假体周围骨水泥分布情况。结果:术后在X线片上按Delee-Charnley髋臼分区法,设计组无一例Ⅰ区透光区。常规组有1例Ⅰ区透光区,1例Ⅲ透光区。结论:骨水泥加压器在人工全髋关节置换术中骨水泥加压灌注技术优势明显,与假体的松动及生成率相关。     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.