合谷穴与尺神经深支的位置关系

目的:探讨合谷穴与尺神经深支的位置关系.方法:在100只成人手标本上解剖观测合谷穴局部.结果:拇指呈伸位,合谷穴直刺进针时,针体经手背合谷穴皮肤至拇收肌掌面的组织厚度是(2.38±0.34)cm,该厚度均超过合谷穴手背至手掌面皮肤组织厚度的一半.皮肤进针点与尺神经深支终末段穿拇收肌处的距离是(3.53±0.24)cm.尺神经深支终末段穿拇收肌横头与拇收肌斜头之间入拇收肌后间隙,并在此间隙内发出各分支,其中拇收肌横头支行向外下方,拇收肌斜头支行向前外上,第一骨间背侧肌支水平向外下后方,拇短屈肌支水平向外.结论:合谷穴针刺时,拇指应呈伸位,直刺进针,深度以不超过患者皮肤进针点至手掌面皮肤组织厚度的一半为宜.尺神经深支终末段的分支走行方向,可能与临床上针刺合谷穴时向不同方向进针有不同的疗效和针感具有一定的关系.     

风门穴与肺俞穴针刺安全深度及角度的应用解剖研究

采用钢针标定法和层次解剖法,在46具成年人尸体上,研究风门穴与肺俞穴的解剖结构和针刺深度及角度。结果显示:向下直刺的解剖结构依次是皮肤、浅筋膜、斜方肌、菱形肌、上后锯肌、竖脊肌、肋提肌、肋间内膜、胸内筋膜、肋胸膜,向下直刺的平均危险深度,风门穴为49.51 mm,肺俞穴为44.88 mm;向外下斜刺,当针体与矢状面夹角在20~25°时,危险深度最小;向内下斜刺,当针体与矢状面夹角大于20°时,比较安全。     

改良的逆行外踝后外侧筋膜皮瓣治疗足部皮肤软组织缺损

目的探索逆行外踝后外侧筋膜皮瓣的临床应用价值。方法自2003年3月-2005年6月笔者采用改良逆行外踝后外侧筋膜皮瓣的治疗方法。治疗足背皮肤软组织缺损病人23例，随访6个月。根据受伤类型，压砸伤15例。皮肤撕脱伤8例。皮瓣设计的轴心线腓肠神经及腓肠内侧神经的走行路线。即胭窝中点与跟腱和外踝中点的连线；皮瓣的旋转点在外踝上5cm，基底部蒂宽大于3cm。皮瓣切取近端可达胭窝部位，近端皮瓣宽可达10cm；皮瓣蒂部携带1—1．5cm的皮桥。皮瓣切取时先在胭窝部位寻找并切断小隐静脉，并于胭窝部位寻找腓肠肌内侧头与外侧头肌间间隙。于肌间隙中寻找并保护腓肠内侧皮神经及其营养动脉，切断神经及动脉，有肌膜与深筋膜之问游离皮瓣，在接近腓肠内侧皮神经及其营养动脉时切取部分肌膜加以对其保护。结论术后所有皮瓣均无肿胀，无感染，完全成活。改良逆行外踝后外侧筋膜皮瓣。以腓肠浅动脉及腓肠内侧皮神经营养动脉为营养动脉，使皮瓣的切取范围从以往的小腿中下2／3扩展到胭窝部位，使皮瓣翻转后的覆盖范围远迭足背跖趾关节附近。在临床上有很好的应用价值。     

针刺天鼎、天柱穴为主治疗肩周炎62例

本组62例中,男27例,女35例;年龄34～76岁,其中右肩42例,左肩20例;病程2周至2年零3个月。 1.治疗方法 (1)针剌治疗:取穴:天鼎、天柱穴。操作法:肩周炎患者在这两穴多可摸到条索状结节,并有明显压痛,在压痛点上直刺进针,天鼎穴进针深度为0.5寸,天柱穴进针深度为0.8寸左右,以“捻转补泻”的泻法运针,使局部产生酸胀感,或向肩部放散,留针15～20分钟,每隔5分钟行针1次,     

腓肠神经营养血管皮瓣的解剖特点与逆行应用

目的:研究腓肠神经营养血管皮瓣的解剖特点,为临床设计腓肠神经营养血管逆行皮瓣提供解剖依据.方法:通过对20侧新鲜小腿进行血管铸型后解剖,观察测量腓肠神经营养血管的来源、走行、分布及与小隐静脉和腓肠神经的位置关系.结果:腓肠神经位置恒定,为多源性血供,且呈节段性分布.腓肠神经在行走全程中,上段有腘窝中间动脉伴行,其直径为(0.06±0.01)cm,并有腓肠肌的肌皮穿支与之吻合;下段有腓肠中间浅动脉伴行供血,其直径为(0.04±0.01)cm,并有腓动脉穿支与之吻合.腓肠神经营养血管形成了纵行皮神经滋养血管网,在营养神经的同时,还发出小分支供养相应区域的皮肤.在外踝尖上方3~7 cm 范围内,腓动脉穿支数量为2~4支(平均为3支),直径为0.02~0.10 cm,一般0.06 cm 以上的穿支总能找到1条,该穿支血管是腓肠神经营养血管逆行筋膜蒂皮瓣的解剖学基础.结论:腓肠神经营养血管有多源性、吻合丰富、血供较好的特点,可以设计腓动脉穿支为旋转点的腓肠神经营养血管逆行筋膜蒂皮瓣,在不牺牲下肢主干血管的情况下,主要应用于小腿中下1/3段、踝周及足部等处皮肤软组织损伤的修复与治疗.     

基于VOXEL-MAN操作平台少海穴的三维可视化研究

目的 以少海穴为研究对象,探讨穴位的三维重建的方法 .方法 基于VOXEL-MAN操作平台,运用色度特征空间的交互式分割方法 对肌肉等组织进行分割;对神经血管以数学建模的方式进行重建;在此基础上以运行脚本的方式获取少海穴的三维进针动画. 结果 通过少海穴的三维进针动画,可以系统地观察针体和少海穴周围各组织的空间位置关系. 结论 穴位的三维重建采用的切片数据集,应带有丰富的神经血管信息.     

针罐操作中毫针针刺深度影响因素研究

目的:研究针刺拔罐操作中针刺深度的影响因素。方法:选取26名女性成年志愿者为受试对象。观察在(30.66±1.33)kPa负压的拔罐针刺操作中,不同穴位(肾俞穴和殷门穴)、不同初始进针深度(20 mm和25 mm)、不同行针手法(提插和捻转手法)对毫针向皮肤表面运动的位移变化。结果:提插手法受试者的毫针位移大于捻转手法(P<0.05),初始进针深度为20 mm者毫针位移大于25 mm者(P<0.01),肾俞穴的毫针位移大于殷门穴(P<0.05)。结论:针罐操作时应考虑运针手法、穴位部位及初始进针深度对针刺深度的影响。     

硬膜外阻滞穿刺角度和置管长度的探讨(附2000例临床总结)

目的 :探讨硬膜外阻滞穿刺一针成功率 ,提高硬膜外阻滞临床效果。方法 :在硬膜外穿刺成功后 ,测量穿刺针针体和侧中线皮肤的夹角度 ,进针深度 ,硬膜外腔留置导管的长度。结果 :穿刺针针体和皮肤的夹角主要与棘突倾斜度有关 ,进针深度和患者性别、身高、体重有关 ,硬膜外腔留置导管不宜超过 4cm。结论 :参照穿刺点不同角度、深度 ,可显著提高穿刺成功率 ,缩短穿刺时间 ,减少患者痛苦及并发症 ,硬外腔留置导管最好 2～ 3cm。     

腓动脉踝上穿支腓肠神经营养血管皮瓣修复足部皮肤缺损

目的:探讨应用带外踝上穿支腓肠神经营养血管皮瓣修复足部缺损,简化手术操作,改善皮瓣血供。方法:2006年6月～2010年3月,对11例足部皮肤缺损的病人应用带外踝上腓动脉穿支腓肠神经营养血管皮瓣修复。缺损面积范围:5cm×3cm9cm×9cm.其中男8例,女3例,最小年龄18岁,最人年龄62岁,平均年龄31岁,缺损原因:车祸5例,慢性感染性溃疡3例,肿瘤1例,缺损部位:足跟部4例,内踝部2例,足背部3例;手术彻底清创后或切除肿物后,以胭窝中点与外踝尖跟腱中点连线为轴,以外踝上腓动脉穿支处为旋转点设计皮瓣。皮瓣蒂部设计3cm～4cm宽的筋膜蒂及2cm～3cm宽的皮桥。手术先切开蒂部后缘至深筋膜下,确认外踝上穿支,切开上缘及内外侧缘,在深筋膜下向蒂部分离皮瓣,通过明道将皮瓣转移至受区。供瓣区创面直接缝合或植皮修复。结果:11例足部皮肤缺损病例修复后,皮瓣全部成活。但有8例术后足外侧感觉麻木。结论:带外踝上穿支腓肠神经营养血管皮瓣结合了穿支皮瓣及皮神经营养血管皮瓣的优点,具有操作简便,蒂部较长,血供丰富。是修复足部皮肤缺损,特别是前足皮肤缺损可供选择的一种方法。     

"筋会"阳陵泉在软组织损伤中的临床应用

阳陵泉穴是足少阳胆经之合穴,最早见于<灵枢·九针十二原>.阳陵泉位于小腿外侧腓骨小头前下方凹陷处,逐层分别为皮肤、皮下组织、小腿深筋膜、腓骨长肌、腓骨短肌,皮肤有腓肠外侧皮神经分布.腓总神经在腘窝上角由坐骨神经分离以后,沿着腘窝外侧壁到腓骨小头的后下方穿腓骨长肌,分为腓浅、深神经,腓浅神经支配腓骨长、短肌.     

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.     

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…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.