股骨侧远端生物固定假体在高龄患者全髋关节翻修中的应用

背景：对高龄患者行人工全髋关节翻修时如何正确选择股骨侧假体固定方式,可否应用组配式股骨假体处理此类难题? 目的：验证股骨侧生物固定型假体在老年人全髋翻修后的效果。 方法：采用远端固定生物型股骨假体对11例75岁以上股骨侧假体松动患者进行翻修。11例股骨骨缺损根据Paprosky分型,Ⅰ型2髋,Ⅱ型2髋,ⅢA型7髋。 结果与结论：11例患者均随访16个月以上,患者Harris评分从翻修前的37分(22~49分)改善至随访结束时的89分(78~92分),优良率>90%,无患者发生再次松动。翻修后X射线片显示假体周围骨质密度和厚度明显增加。提示远端固定生物型假体可在股骨远端髓腔内获得可靠的轴向及抗旋转初始稳定性,尤其适用于伴有近端骨缺损的高龄患者的翻修治疗。     

人工全髋翻修及非骨水泥假体的应用：5年同一机构41例41髋资料回顾

背景：随着人工全髋关节置换后随访时间的延长,需行翻修者逐渐增多。而人工关节出现机械性松动前常已发现假体周围骨溶解,它将随着时间的推移而逐渐加重,不断加重的骨溶解会引起人工关节松动,最终导致关节翻修。 目的：观察非骨水泥假体在人工全髋关节置换后翻修术中的应用效果。 方法：对2004/2009沈阳市骨科医院收治的人工关节置换后患者41例(41髋)进行了翻修,再置换关节为北京普鲁士钢研外科植入物有限公司提供的旋入式全髋关节及美国史塞克有限公司生产的非骨水泥压配式全髋关节。41个髋臼中无髋臼骨缺损8髋,GustilloⅠ~Ⅱ型髋臼松动17髋,Ⅲ型髋臼松动8髋,对上述患者直接用纯钛螺旋臼成型或髋臼底加用颗粒植骨;Ⅳ型髋臼松动骨缺损8髋,采用颗粒植骨,钛网重建髋臼,骨水泥髋臼假体成型。取出假体柄后试情况置入非骨水泥普通假体柄或加长柄,根据试骨缺损情况进行假体周围植骨,必要时捆绑带固定。 结果与结论：髋臼侧进行了钛网重建植骨的8例患者翻修后3 d可以下地非负重拄拐行走,其余患者均可以于翻修后3 d下地负重行功能练习。翻修后随访6~66个月,无假体移位下沉等不稳迹象,无需要再重新翻修的病例,Harris评分由翻修前的平均32.6分增加到翻修后的平均88.1分。随访X射线片显示部分患者骨质改建,密度增加,未发现假体周围有新出现亮带的患者。结果提示,采用非骨水泥假体对髋关节进行翻修后,近期可取得较好的修复效果,远期效果有待随访。     

人工关节置换后疼痛行再次全髋关节翻修41例

高州市人民医院脊柱关节外科2000-08/2006-08共收治人工髋关节及人工股骨头置换后髋关节疼痛而进行人工全髋关节翻修患者44例，获得随访41例。翻修施术者为第一作者，副主任医师，从事人工关节专业工作9年，完成人工关节置换620余例。①人工股骨头置换后疼痛患者26例，男17例，女9例；年龄67~79岁，平均72.3岁。因假体柄松动12例，髋臼磨损8例，人工股骨头脱位3例，关节周围骨化2例，假体柄断裂1例。②人工全髋关节置换后疼痛患者15例，男9例，女6例；年龄66~80岁，平均73.4岁。因假体柄松动6例，髋臼假体松动2例，髋臼假体磨损2例，人工股骨头脱位2例，切口感染1例，迟发性感染1例，假体柄断裂1例。③随访41例翻修后材料反应：4例患者出现骨水泥反应综合征，表现为急性低血压、低血氧、心律失常，均无人工关节的排斥反应。随访期内X射线片复查关节假体未见金属腐蚀现象，髋臼聚乙烯假体无降解。④随访41例翻修后宿主反应：人工全髋关节翻修后第2天复查血常规，患者白细胞计数普遍升高，术后第7天复查白细胞计数，除个别伤口感染者外绝大多数患者恢复正常。3例患者出现下肢静脉血栓。疼痛缓解率达90.2%。41例随访1~7年结果提示假体松动、髋臼磨损、人工股骨头脱位、关节周围骨化等并发症是造成人工髋关节置换后髋关节疼痛的主要原因，全髋关节翻修能明显改善疼痛状况。     

采用锥形沟槽式股骨组配柄假体行股骨侧翻修*

【摘要】 目的 总结采用锥形沟槽式股骨组配柄假体行全髋股骨侧翻修术的体会。方法 本组共19例（21髋）,其中男6例,女13例,单髋17例,双髋2例,年龄47～86岁（平均67岁）。术前诊断均为股骨柄假体合并臼杯假体的无菌性松动。股骨侧骨缺损按Paprosky标准,诊断为Ⅱ型缺损者4髋,Ⅲa型缺损者14髋,Ⅲb缺损者3髋。全部患者的股骨侧翻修手术均采用利马锥形沟槽式股骨组配柄假体。结果 所有假体均获初始稳定,无一例发生感染、脱位等并发症。患肢不等长由术前的3cm改善为术后的0.5cm。平均随访7年(5年～10年),Harris评分由术前的平均46.2?5.2改善至翻修手术半年后的平均90.3?.3分,而末次随访仍维持在平均92.2?.5分。X线片显示翻修柄获广泛骨长入达骨性稳定者20髋（95%）,纤维性稳定者1髋（5%）。所有患者的近段骨缺损植骨区均显示广泛性骨修复。翻修柄在正、侧位X线片上的髓内充填率分别达80%和70%以上者18髋（86%）,<80%和70%者3髋（14%）,全组假体平均下沉2.4mm(0～10mm)。至今无1例因假体松动或其他原因需行再翻修手术治疗。结论 采用锥形沟槽式股骨组配柄假体行翻修手术,必须注重：1）手动扩髓等方法预防骨折;2）合理的髓内充填和近段组件调整以预防假体下沉和脱位;以及3）锥形连接处近段的骨重建等技术关键,才能取得更为满意的疗效。     

人工膝关节表面置换治疗膝关节病86例98膝

背景：人工全膝关节表面置换是治疗膝关节病的有效治疗方法，但疗效与诸多因素相关。 目的：观察分析人工全膝关节表面置换治疗严重膝关节骨关节病的效果。 方法：1999-07/2008-06收治严重膝关节骨关节病86例(98膝)行全膝关节表面置换，不置换髌骨。采用膝关节表面后稳定型假体84例95膝，其中Plus公司假体92膝，美国施赛克公司后稳定性假体3膝；京航公司生产保留后交叉韧带假体1例双膝，国产爱康假体1例单膝。置换后定时随访，应用美国John.N.Insall评分系统进行膝关节功能评估。 结果与结论：所有病例获1~9年随访，平均5.2年。至最后一次随访，5例7膝膝关节屈曲< 90°，2例伸膝> -10°，1例双膝为类风湿性关节炎，1例双膝使用的为早期国产膝关节假体。1例置换后1年反复出现关节积液，保守治疗治愈，但活动度丢失。根据John•N•Insall评分标准，膝关节置换后在疼痛、关节功能及活动度等方面均有明显的改善，优良率为90.7%。提示全膝关节表面置换是治疗膝关节病的有效方法；严格选择置换适应证，规范置换操作及系统地康复训练，可获得满意疗效。     

三种人工髋关节置换治疗股骨头坏死67例：2年随访验证

背景：传统的全髋关节置换后可能需行多次翻修,近年来保留股骨颈甚至股骨头的人工髋关节置换的重建效果得到了普遍认可。 目的：采取保留股骨颈全髋置换、无柄关节以及表面置换方案治疗股骨头坏死,比较分析其治疗效果以及重建后并发症的发生情况。 方法：纳入2005-01/2007-07收治的股骨头坏死患者67例,根据病情分组治疗,保留股骨颈全髋置换组22例,无柄关节组20例,表面置换组25例,所有患者均获得2年以上随访。置换前、置换后1年及2年对患者进行评估,包括Harris髋关节评分、髋关节X射线片、髋关节与假体相关不良事件以及翻修情况。 结果与结论：经过2年以上的随访,表面置换组无翻修,Harris评分高于无柄关节组及保留股骨颈全髋置换组(P < 0.05);无柄关节组翻修1例;保留股骨颈全髋置换组翻修2例。提示与保留股骨颈全髋置换及无柄关节置换相比,表面置换对于恢复患者髋关节功能有着明显的优势,并发症少,翻修率低,对于年轻患者是一个较好的选择。     

人工双动股骨头置换后近期脱位全髋关节翻修：同一机构13年143例置换者中的5例翻修*

背景：前期文献对人工双动股骨头置换后翻修原因的分析主要集中在假体松动下沉、髋臼磨损、假体柄断裂等方面,有关置换后近期脱位翻修的报道较少。 目的：分析人工双动股骨头置换后近期脱位的原因,探讨行人工全髋关节置换翻修的必要性。 方法：回顾性分析1995-05/2008-10行人工双动股骨头置换后全髋关节翻修5例患者的临床资料,男3例,女2例,年龄75~87岁,平均81岁。翻修原因均为置换后近期脱位,所有病例均一期翻修,有骨质缺损者同时植骨。翻修后早期观察血常规及血沉变化;翻修后6个月,1,2年评估髋关节Harris评分;以X射线平片观察骨盆前后位髋臼假体位置。　 结果与结论：所有患者翻修后获得至少1年(1~4年)随访,无一例需要再翻修,末次随访Harris评分平均88分。全部病例翻修后无伤口感染和神经血管损伤。扩髓时骨皮质不全骨折1例,X射线片显示人工关节假体位置正常,无松动感染征象。提示手术技巧不当及病例选择不当为人工双动股骨头置换后近期脱位的主要原因。由于双动头的双动特点,一旦脱位难以闭合复位,只能行翻修术。若手术指征正确,手术技巧娴熟,全髋翻修手术可以获得良好的临床效果。 关键词：全髋关节翻修;双动股骨头假体;置换;脱位;随访     

应用钢板和人工骨行全髋关节股骨侧假体翻修11例★

背景：对于股骨假体paprosky分型Ⅲ型、Ⅳ型翻修时，大多数学者趋向于采用非骨水泥涂层的长柄翻修假体。但是，关于骨缺损的植骨材料选择、植骨方式、钢板是否可以采用等问题，在骨科界目前尚未有较成熟的意见。 目的：观察同时采用钢板和人工骨进行全髋关节股骨侧假体翻修的疗效。 方法：11例股骨侧假体翻修患者(paprosky分型Ⅲ型8例，Ⅳ型3例)均采用现代无骨水泥技术，记忆合金环抱钢板4例，加压钢板或有限接触钛板2例，锁定钛板5例，所有病例均使用异体或异种颗粒骨进行嵌压植骨、异体骨板结合钢丝或线缆握紧系统器械进行结构重建。翻修前后髋关节功能按Harris评分标准进行评价，观察患者手术切口愈合及髋关节活动情况。 结果与结论：11例患者均获得随访，平均13.6个月，Harris评分优良9例(82%)，可1例(9%)，差1例(9%)。提示患者股骨侧假体翻修中，同时应用钢板和人工骨进行髋关节股骨侧翻修，能让股骨侧paprosky分型Ⅲ型和Ⅳ型缺损合并假体周围骨折固定快且牢固，生物型假体即刻达到稳定，手术时间和创伤减少，并允许患者早期进行功能锻炼。     

金属钛网支撑颗粒骨植骨处理人工全髋关节翻修中的髋臼骨缺损

目的：观察应用钛网及颗粒骨植骨处理人工全髋关节翻修中髋臼骨缺损的效果。 方法：自2003-01/2008-07吉林大学第一医院医院骨关节二科对31例行髋臼翻修的患者采用颗粒状松质骨打压植骨联合金属钛网固定重建髋臼骨缺损,男13例,女18例;年龄56~77岁,平均65岁;前次手术距翻修手术2.5~11.0年,平均8.3年。髋臼缺损按AAOS分类：Ⅱ型14例,Ⅲ型17例,翻修前髋关节Harris评分平均37分。31例患者均使用骨水泥固定假体,术后进行临床评估及X射线评估。 结果：31例患者均获得随访,随访时间3个月~5年。患者术后24 h即开始下肢被动功能锻练,3周下床不完全负重活动20例,11例于术后5周下床活动,3个月正常活动。术后半年Harris评分较术前平均提高45分,其中优20例,良9例,可2例,优良率94%。术后早期3个月内未见感染、假体周围骨折、脱位、神经血管及盆腔脏器损伤、栓塞等并发症;3例患者伤口延迟愈合,间断性渗液至术后3周;无髋臼假体需再次翻修病例。2例患者在X射线平片上出现透亮带,考虑存在移植骨被吸收可能。 结论：打压植骨联合金属钛网固定在处理髋关节翻修术中髋臼缺损时,操作简单方便,疗效可靠。     

关节镜在全膝关节置换后早期急性感染治疗中的应用

选择2003-09/2006-12解放军第二军医大学第二附属医院骨科接诊的全膝关节置换后3周内出现膝关节急性感染、膝关节正侧位X射线片未见明显骨质破坏和假体松动10例患者（11膝）进行关节镜下清创。术后持续大剂量生理盐水灌注冲洗1周，静脉给予万古霉素6周。所有患者均获随访，随访时间平均为29.9个月。8例患者关节镜清创后局部及全身症状消失、血沉以及C-反应蛋白处于正常范围，末次随访平均关节活动度为115°，平均HSS评分为82.1。2例患者接受二期翻修手术，1例患者二次翻修手术失败后接受膝关节融合手术。结果提示关节镜清创配合术后大剂量灌注冲洗和静脉抗生素是治疗全膝关节置换后早期急性感染的有效方法之一。     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Cultural Identity and Experiences of Prejudice and Discrimination of Afghan and Iranian Immigrant Youth

In culturally diverse and immigrant receiving societies, immigrant youth can be subject to prejudice and discrimination. Such experiences can impact on immigrant youth’s cultural identity and influence their psychosocial outcomes. This paper presents findings of a study that examined cultural identity and experiences of prejudice and discrimination among Afghan (N = 9) and Iranian (N = 17) immigrant youth in Canada. The study had a prospective, comparative, longitudinal qualitative design. Data was gathered through focus groups, interviews, journals and field logs. Four main themes emerged on participants’ experiences of prejudice and discrimination: (a) societal factors influencing prejudice; (b) personal experiences of discrimination; (c) fear of disclosure and silenced cultural identity; and (d) resiliency and strength of cultural identity. Drawing from Rosenberg’s (Conceiving the self, Basic Books, New York, 1979) self-concept framework and Romero and Roberts (J. Adolesc., 21:641–656, 1998) distinction between prejudice and discrimination, results indicated that youth’s extant and presenting cultural identity were affected. Inclusive policies and practices are needed to promote youth integration in multicultural and immigrant receiving settings.

发作性睡病与异态睡眠的诊治

本文目的是探讨发作性睡病与异态睡眠的诊断与治疗.发作性睡病被漏诊和误诊的几率较高,危害较大,共患异态睡眠比例高.文章从发作性睡病临床特征、REM睡眠的作用、发作性睡病与异态睡眠(睡眠瘫痪、睡眠幻觉、快眼动睡眠期行为障碍)共病特征及治疗这四个方面进行了讨论.     

小胶质细胞和少突胶质细胞前体的培养和鉴定

目的 探讨新生大鼠脑组织小胶质细胞(MG)和少突胶质细胞(OL)前体的分离和体外培养方法 . 方法 取新生2 d SD大鼠脑组织,体外原代培养混合胶质细胞7 d后,分别采用"改良振荡伴差速贴壁"法和"营养缺失伴振荡"法纯化培养MG和OL前体,并分别应用免疫荧光染色异凝集素-B4(IB4)和OL前体标记物(O4)进行鉴定.结果 混合胶质细胞培养7 d后呈明显三层增长,其中MG位于上层,星型胶质细胞位于底层,两者之间为2型少突星型(O2A)祖细胞.纯化培养后OL前体胞体呈小圆形,有双极或三极突起,MG则以阿米巴形、圆形居多,或边缘呈毛刺状.免疫荧光染色IB4显示绿色荧光,MG纯度达到90%以上.免疫荧光染色O4显示棕黄色荧光,OL前体纯度达到95%以上. 结论 采用"改良振荡伴差速贴壁"法以及"营养缺失伴振荡"法分别成功获取大量纯度高、活力好的MG和OL前体.     

Design and pharmacological activity of glycinamide and N-methoxy amide derivatives of analogs and constitutional isomers of valproic acid

A series of glycinamide conjugates and N-methoxy amide derivatives of valproic acid (VPA) analogs and constitutional isomers were synthesized and evaluated for anticonvulsant activity. Of all compounds synthesized and tested, only N-methoxy-valnoctamide (N-methoxy-VCD) possessed better activity than VPA in the following anticonvulsant tests: maximal electroshock, subcutaneous metrazol, and 6-Hz (32-mA) seizure tests. In mice, the ED₅₀ values of N-methoxy-VCD were 142 mg/kg (maximal electroshock test), 70 mg/kg (subcutaneous metrazol test), and 35 mg/kg (6-Hz test), and its neurotoxicity TD₅₀ was 118 mg/kg. In rats, the ED₅₀ of N-methoxy-VCD in the subcutaneous metrazol test was 36 mg/kg and its protective index (PI = TD₅₀/ED₅₀) was > 5.5. In the rat pilocarpine-induced status epilepticus model, N-methoxy-VCD demonstrated full protection at 200 mg/kg, without any neurotoxicity. N-Methoxy-VCD was tested for its ability to induce teratogenicity in a mouse strain susceptible to VPA-induced teratogenicity and was found to be nonteratogenic, although it caused some resorptions. Nevertheless, a safety margin was still maintained between the ED₅₀ values of N-methoxy-VCD in the mouse subcutaneous metrazol test and the doses that caused the resorptions. On the basis of these results, N-methoxy-VCD is a good candidate for further evaluation as a new anticonvulsant and central nervous system drug.     

Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents

OBJECTIVE: Using predetermined criteria for study quality and methods, a literature review and meta-analysis of seven reports about pediatric bipolar disorder (BPD) was conducted to determine if there is a consistent picture of the phenomenology and clinical characteristics of BPD in children and adolescents. METHODS: Searches were conducted in MedLine and PsycINFO using the terms mania, BPD, children and adolescents, and was limited to published articles in peer-reviewed journals. Seven reports were selected that met the following criteria: a systematic method for the elicitation and reporting of symptoms and clinical characteristics of subjects; subjects were interviewed by a trained researcher or clinician; ages 5-18 years; use of a diagnostic system, either DSM or RDC for categorization; a consensus method for the establishment of the diagnosis of BPD. RESULTS: Most DSM-IV symptoms of mania were common in the children and adolescents with BPD with the most common symptoms being increased energy, distractibility, and pressured speech. On average, four of five bipolar cases also showed threshold levels of irritable mood and grandiosity, and more than 70% of all cases showed elated/euphoric mood, decreased need for sleep, or racing thoughts. Roughly 69% of cases also showed poor judgment, whereas only half of bipolar cases demonstrated flight of ideas, and slightly more than one-third showed hypersexuality or psychotic features. CONCLUSIONS: The clinical picture that emerges is that of children or adolescents with periods of increased energy (mania or hypomania), accompanied by distractibility, pressured speech, irritability, grandiosity, racing thoughts, decreased need for sleep and euphoria/elation.     

Effects of Agonists and Antagonists of Cholecystokinin on Contractile and Myoelectric Activity of Isolated Muscle of Colon and Ileum in the Dog and Guinea Pig

This study evaluates the effects of agonists and antagonists of cholecystokinin (CCK) on contractile and myoelectrical activity in isolated longitudinal muscle strips from colon or ileum of guinea pigs or beagle dogs. Caerulein and CCK-8 caused a dose-dependent increase of contractile and myoelectrical spike activity in both species with maximal effects seen between 10⁻⁸ and 3 × 10⁻⁸ M. The dose responses were identical for both CCK agonists and species. The dose-related effects of CCK compounds on colonic muscle were slightly shifted to the right when compared to ileum in both species. All antagonists, the proglumide-derivatives CR1409, CR1392, and CR1505, as well as the nonpeptide substances asperlicin and L-364,718, caused a parallel rightward shift of CCK's dose-dependent motor activity response, indicating the competitive nature of inhibition. The antagonists displayed a rank order of potency in antagonizing CCK's action on intestinal motility similar to their ability to antagonize CCK's action on pancreas and gallbladder. L-364,718 was the most potent antagonist, followed by CR1409, CR1505, CR1392, asperlicin, and proglumide. The antagonists did not affect contractile or myoelectrical responses to acetylcholine, histamine, motilin, or substance P. Thus compounds that have been described as CCK antagonists for pancreas and gallbladder also act as specific and competitive antagonists of CCK's action on contractile and myoelectrical activity of Heal and colonie muscle.     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.