保留髌下脂肪垫的高位前侧入路在膝关节镜手术中的应用

目的:探讨保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中应用的临床疗效。方法:回顾性分析2014年10月至2015年10月我院膝关节镜手术60例。其中32例采取膝关节镜高位前侧入路保留髌下脂肪垫;28例采取常规入路,术中刨削部分髌下脂肪垫。记录患者手术时间、关节腔引流量,并于术后6个月进行膝前疼痛VAS评分及膝关节功能Lysholm评分。结果:膝关节镜常规入路切除髌下脂肪垫组与膝关节镜高位前侧入路保留髌下脂肪垫组临床治疗优良率分别为92.9%和93.8%,组间比较差异无统计学意义(P>0.05);但两组间手术时间、关节腔引流量、术后6个月VAS评分、Lysholm评分比较,差异有统计学意义(P<0.05)。结论:膝关节镜手术中,保留髌下脂肪垫对比切除髌下脂肪垫术后疗效优势明显。膝关节镜高位前侧入路在保留髌下脂肪垫的同时保证手术视野的充分暴露,利于手术操作,缩短手术时间,减轻患者术后膝前疼痛,有利于快速康复。     

保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中的效果

目的:分析保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中的效果。方法:将2016年1-11月78例膝关节镜手术治疗患者作为研究对象,并根据随机数字表法分为对照组和试验组,各39例。对照组采用常规入路进行膝关节镜手术治疗,试验组采用保留髌下脂肪垫的膝关节镜高位前侧入路进行膝关节镜手术治疗。比较两组膝关节镜手术治疗优良率,手术平均操作时间、关节腔平均引流量、术中平均出血量,干预前后患者膝前疼痛VAS评分、膝关节功能Lysholm评分、生活质量QOL评分,感染、出血等手术并发症发生率。结果:试验组膝关节镜手术治疗优良率高于对照组(P<0.05);试验组手术平均操作时间、关节腔平均引流量、术中平均出血量均低于对照组(P<0.05);干预前两组膝前疼痛VAS评分、膝关节功能Lysholm评分、生活质量QOL评分相近(P>0.05);干预后试验组膝前疼痛VAS评分、膝关节功能Lysholm评分、生活质量QOL评分均优于对照组(P<0.05);试验组感染、出血等手术并发症发生率低于对照组(P<0.05)。结论:保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中的效果肯定,可缩短操作时间,减少创伤出血。该手术能有效减轻患者膝前疼痛,减少手术并发症的发生,对改善膝关节功能和患者生活质量意义重大。     

保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中的效果

目的:分析保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中的效果。方法:将2016年1-11月78例膝关节镜手术治疗患者作为研究对象,并根据随机数字表法分为对照组和试验组,各39例。对照组采用常规入路进行膝关节镜手术治疗,试验组采用保留髌下脂肪垫的膝关节镜高位前侧入路进行膝关节镜手术治疗。比较两组膝关节镜手术治疗优良率,手术平均操作时间、关节腔平均引流量、术中平均出血量,干预前后患者膝前疼痛VAS评分、膝关节功能Lysholm评分、生活质量QOL评分,感染、出血等手术并发症发生率。结果:试验组膝关节镜手术治疗优良率高于对照组(P0.05);试验组手术平均操作时间、关节腔平均引流量、术中平均出血量均低于对照组(P0.05);干预前两组膝前疼痛VAS评分、膝关节功能Lysholm评分、生活质量QOL评分相近(P0.05);干预后试验组膝前疼痛VAS评分、膝关节功能Lysholm评分、生活质量QOL评分均优于对照组(P0.05);试验组感染、出血等手术并发症发生率低于对照组(P0.05)。结论:保留髌下脂肪垫的膝关节镜高位前侧入路在膝关节镜手术中的效果肯定,可缩短操作时间,减少创伤出血。该手术能有效减轻患者膝前疼痛,减少手术并发症的发生,对改善膝关节功能和患者生活质量意义重大。     

银质针透热疗法结合超声波治疗髌下脂肪垫劳损的临床研究

目的 观察银质针结合超声波治疗髌下脂肪垫劳损的疗效,探讨该病的治疗方法.方法 将74例髌下脂肪垫损害患者,随机分为治疗组和对照组各37例,治疗组采用银质针透热结合超短波治疗,对照组只采用超短波治疗,治疗前后采用活动痛(VAS)、症状改善率作为观测指标,比较两组疗效并进行统计学处理.结果 治疗组与对照组的总有效率比较差异有统计学意义(P<0.05),两组治疗前后VAS评分比较差异有统计学意义(P<0.01),治疗组效果更好.结论 银质针透热结合超短波对髌下脂肪垫劳损有很好的疗效.     

经皮松解髌外侧支持带结合关节镜下清理治疗髌股骨关节炎

目的:探讨经皮松解髌外侧支持带结合关节镜下关节清理术治疗髌股骨关节炎的疗效。方法:对2008年4月~2010年10月该院采用经皮松解髌外侧支持带结合关节镜下关节清理术治疗髌股骨关节炎并获得随访的患者进行门诊随访。采用Lysholm膝关节评分标准和对患者下蹲时膝前痛采用疼痛视觉模拟评分(VAS)法进行评价。结果:术前与术后6个月,术前与术后1年Lysholm评分和VAS评分比较存在显著性差异(P<0.01),术后6个月与术后1年Lysholm评分和VAS评分也存在显著性差异(P<0.01)。结论:经皮松解髌外侧支持带结合关节镜下关节清理术治疗髌股骨关节炎具有操作简单、创伤小、松解充分、疗效可靠等优点。     

肌骨超声引导下针刀辅助治疗退行性半月板病变64例临床观察

目的观察肌骨超声引导下针刀辅助治疗退行性半月板病变的临床疗效。方法将128例退行性半月板病变患者采用随机数字表法分为对照组和治疗组,各64例。对照组给予常规治疗,治疗组在对照组治疗方法的基础上采用肌骨超声引导下的针刀治疗。2组均每周治疗1次,连续治疗5周。治疗结束后比较2组治疗前后的膝关节功能量表(Lysholm)评分、视觉模拟评分法(VAS)评分、压痛指数及治疗期间的不良反应发生情况。结果治疗后2组Lysholm评分均明显升高,VAS评分及压痛指数均明显降低,与同组治疗前比较差异有统计学意义(P0.05),且治疗组改善更明显,与对照组治疗后比较差异均有统计学意义(P0.05);2组治疗期间均未出现血常规、尿常规、心电图异常及过敏反应等不良反应。结论肌骨超声引导下针刀辅助治疗退行性半月板病变疗效确切,可有效促进患者膝关节功能的恢复,缓解疼痛,值得临床推广应用。     

针刀为主综合治疗髌骨外侧高压症的临床观察

目的评价针刀治疗髌骨外侧高压综合征的临床疗效。方法将髌骨外侧高压症患者40例,随机分为治疗组和对照组各20例。治疗组应用针刀为主行髌周组织减压松解,配合手法调整力线和挤压综合治疗,疗程3周;对照组予关节腔内注射玻璃酸钠,疗程5周。两组均予美洛昔康片口服。观察两组治疗前和治疗后1月疼痛视觉模拟评分法（Visual Analogue Score,VAS）评分及膝关节Lysholm评分变化。结果治疗组总有效率为100％,高于对照组的80％（P〈0．05）。治疗后两组VAS评分均下降,Lysholm评分均上升,与本组治疗前比较,差异均有统计学意义（P〈0．05）;两组治疗后组间比较,治疗组VAS评分下降和Lysholm评分上升多于对照组,差异有统计学意义（P〈0．05）。结论针刀治疗髌骨外侧高压症,明显改善临床症状,临床应用安全有效,值得进一步临床推广使用。     

针刀松解枕下肌群治疗颈性眩晕42例临床观察

目的 观察针刀松解枕下肌群治疗颈性眩晕的临床疗效。方法 将84例颈性眩晕患者采用随机数字表法分为对照组和治疗组,各42例。对照组给予常规针刺治疗,治疗组给予针刀松解枕下肌群治疗。2组均以5 d为1个疗程,2个疗程后比较2组的临床疗效及治疗前后的眩晕障碍量表(DHI)、视觉模拟评分法(VAS)评分。结果 对照组总有效率为61.9%(26/42),治疗组为85.7%(36/42),2组比较差异有统计学意义(P0.01);治疗后2组DHI、VAS评分均明显降低,与同组治疗前比较差异有统计学意义(P0.01),且治疗组降低更明显,与对照组治疗后比较差异有统计学意义(P0.05)。结论 针刀松解枕下肌群治疗颈性眩晕临床疗效显著,可明显改善患者的眩晕症状,值得临床推广应用。     

弹拨拔伸法对膝骨关节炎临床疗效观察

目的:探讨弹拨拔伸法对膝骨关节炎治疗效果的影响。方法:100例膝骨关节炎患者分为对照组(n=50)和治疗组(n=50),对照组采用双氯芬酸钠缓释片及舒筋外洗颗粒治疗,治疗组采用弹拨拔伸法。治疗前后采用Lysholm膝关节评分量表和视觉模拟评分法(VAS)进行评定。结果:两组患者VAS和Lysholm膝关节量表评分均改善,治疗组较对照组改善更明显(P<0.01)。结论:运用弹拨拔伸法能进一步改善膝骨关节炎患者膝关节功能,缓解疼痛。     

针刀镜配合分筋恢刺法治疗急性痛风性膝关节炎的效果观察

目的:分析研究针刀镜配合分筋恢刺法治疗急性痛风性膝关节炎的临床效果。方法:选取2017年8月-2018年6月于本院风湿免疫科确诊并收入院治疗的156例急性痛风性关节炎患者作为研究对象,全部患者按随机抽样法分为试验组和对照组,每组78例,对照组采用常规口服药物治疗,试验组给予针刀镜配合分筋恢刺法治疗。对比两组治疗总有效率、治疗前后膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分法(VAS)及关节Lysholm评分。结果:试验组治疗总有效率显著高于对照组,差异有统计学意义(P0.05)。治疗前,两组患者ROM、VAS评分及关节Lysholm评分比较,差异均无统计学意义(P0.05);治疗后,两组VAS评分均明显低于治疗前,ROM、Lysholm评分均明显高于治疗前,差异均有统计学意义(P0.05);且治疗后,试验组VAS评分明显低于对照组,ROM、Lysholm评分均明显高于对照组,差异均有统计学意义(P0.05)。结论:针刀镜配合分筋恢刺法治疗急性痛风性膝关节炎,能够显著提高关节活动功能,降低关节疼痛,疗效显著,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.     

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     

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.     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.