颅内微创血肿穿刺术与小骨窗血肿清除术治疗高血压性脑出血的疗效比较

目的 对比观察颅内微创血肿穿刺术与小骨窗血肿清除术治疗高血压性脑出血的临床疗效.方法 选取2008年6月至2010年6月收治的116例高血压性脑出血患者.按照随机数字表法分为两组,每组58例.A组采用颅内微创血肿穿刺术治疗,B组采用小骨窗血肿清除术治疗,比较两组的临床疗效及神经功能恢复情况.结果 A组治疗的总有效率为87.9%(51/58),明显高于B组的72.4%(42/58),两组比较差异有统计学意义(P

Abstract：

Objective To compare and observe the clinical effects of microscopic evacuation of intraeranial hematoma and small bone flap approach mierosurgical operation in treatment of hypertensive cerebral hemorrhage.Methods From June 2008 to June 2010,116 cases of patients with hypertensive cerebral hemorrhage were classified into two groups with 58 cases in each by random digits table.Group A was treated with microscopic evacuation of intracranial hematoma and group B was treated with small bone flap approach microsurgical operation.The clinical efficacy and neurological impairment Scores were observed and compared between the two groups.Results The total effective rate in group A[87.9%(51/58)]was significantly higher than that in group B[72.4%(42,58)](P<0.05).After treatment 14 d and 28 d,the neurological impairment scores in group A were (22.1±6.2).(12.6±3.3)scores and in group B were (23.5±6.7),(18.6±5.1)scores.Compared with pre-treatment[group A:(41.9±8.1)scores;group B (41.7±7.9)scores],after treatment l4 d and 28 d,the neurological impairment scores in two groups were significantly decreased(P<0.05).Moreover,After treatment28 d,the neurological impairment scores in group A were significantly lower than those in group B(P<0.05).Conclusion Both microscopic evacuation of intracranial hematoma and small bone flap approach microsurgical operation are effective methods in hypertensive cerebral hemorrhage,but microscopic evacuation of intracranial hematoma can enhance the effect and improve the neurological function.     

舒芬太尼联合罗哌卡因在高龄患者下肢手术术后镇痛的研究

目的 探讨舒芬太尼联合罗哌卡因在高龄患者下肢手术术后患者自控硬膜外镇痛(PCEA)使用的安全性和合适浓度.方法 择期行下肢手术的高龄患者80例,按随机数字表法分为A、B、C、D四组,每组20例,术后PCEA泵内舒芬太尼浓度分别为0.1、0.2、0.3、0.4 μg/ml,并联合0.125%罗哌卡因.记录术后4、10、24、48 h静息状态时视觉模拟评分(R-VAS)、活动状态时视觉模拟评分(C-VAS)、改良Bromage运动神经阻滞评分、Ramsay镇静评分.观察PCEA泵使用情况及其不良反应.结果 术后各时间点A、B组C-VAS、镇痛药用量、有效按压次数明显高于C、D组(P＜0.01或＜0.05);按压有效率明显低于C、D组(P＜0.05);而C、D组间比较差异均无统计学意义(P＞0.05).D组术后10、24 hRamsay镇静评分[(4.5±0.5)、(4.6±0.6)分]明显高于A组[(2.7±0.8)、(2.7±0.8)分]、B组[(2.9±0.9)、(2.7±0.9)分]、C组[(3.0±0.7)、(2.9±0.5)分](P＜0.05).四组患者均未发生低血压和呼吸抑制.结论 四种舒芬太尼剂量联合罗哌卡因用于高龄患者下肢手术术后PCEA均安全有效,其中以0.3μg/ml舒芬太尼浓度联合罗哌卡因镇痛效果更好,且不良反应少.

Abstract：

Objective To investigate the safty and proper concentration of using the sufentanil combined with ropivacaine in patient-controlled epidural analgesia (PCEA) under lower limb surgery in elderly. Methods Eighty patients scheduled for lower limb surgery were divided into 4 groups by random digits table with 20 cases in each. The concentration of the sufentanil were 0.1,0.2,0.3 and 0.4 μ g/ml in group A, B, C, D respectively. The concentration of the ropivacaine were 0.125% in each group for the PCEA.R-VAS, C-VAS , Bromage score, Ramsay score, press times ,dosage and side effects were monitored and recorded at 4,10,24 and 48 h after operation. Results Compared with those in group C, D, C-VAS,dosage of the analgesia,press times of PCEA were higher in group A,B (P＜0.01 or ＜ 0.05),the efficacy of press was lower in group A, B(P＜0.05), but there was no significant difference between group C and group D(P＞0.05 ).The Ramsay score 10,24 h after operation in group D[(4.5 ± 0.5 ), (4.6 ± 0.6) scores] was higher than that in group A,B,C [(2.7 ±0.8), (2.7 ±0.8) scores vs.(2.9 ± 0.9), (2.7 ± 0.9) scores vs. (3.0 ±0.7), (2.9 ±0.5) scores] (P ＜0.05). There were no case with hypotension and respiratory depression.Conclusion PCEA of four methods are safe and effective in elderly which 0.3 μ g/ml sufentanil combined with 0.125% ropivacaine have good analgesic effect and less side effect.     

椎弓根螺钉内固定并椎间Cage植骨治疗腰椎滑脱症

目的 观察后路椎弓根螺钉内固定联合椎间Cage植骨融合治疗腰椎滑脱症的手术疗效,并与椎间单纯颗粒植骨融合术进行对比分析.方法 2006年8月至2009年1月对46例腰椎滑脱症患者采用椎弓根钉棒系统复位内固定治疗,其中椎间Cage植骨组(A组)24例,椎间单纯自体骨粒打压植骨组(B组)22例.术前、术后随访期间拍摄X线片测量腰椎滑脱复位率、相对椎间隙高度以及腰骶角的变化,观察融合节段的融合率,并且按照日本矫形外科学会(JOA)的下腰痛评分标准进行临床疗效评价.结果 通过手术复位所有患者的腰腿疼痛症状得到缓解,且在随访18个月时显示A组滑脱复位率为94.7%、相对椎间隙高度为(74.93±7.85)%、腰骶角为36.6°±3.6°,B组分别为89.9%、(68.72±12.40)%、39.3°±5.6°,两组比较差异有统计学意义(P<0.05).A组植骨融合率为95.83%(23/24),B组植骨融合率为90.91%(20/22),两组比较差异有统计学意义(P<0.05).结论 采用椎弓根螺钉内固定联合椎间Cage植骨融合治疗腰椎滑脱症可有效防止腰椎滑脱复位丢失,中远期疗效明显,是治疗腰椎滑脱症较理想的方法.

Abstract：

Objective To observe the therapeutical effect by using pedicle screw and interbody fusion cage,and compare with posterior interbody simple autogenous bone graft. Methods From August 2006 to January 2009,46 cases of lumbar spondylolisthesis patients were treated by using pedical screw internal fixation system, including 24 cases of cage-graft (group A), 22 cases of interbody simple autogenous bone graft (group B), efficacy evaluation using JOA evaluation standard, and measured lumbar olisthe reset rate, relative intervertebral space height and lumbosacral angle of recovery and observed fusion rate through the preoperative and postoperative follow-up X-ray films. Results All the patients' waist pain symptoms relieved after operative reduction. At 18 months of follow-up , group A of lumbar olisthe reset rate was 94.7%, relative intervertebral space height was (74.93 ± 7.85)% ,lumhosacral angle was 36.6° ± 3.6° ,meanwhile group B was 89.9%, (68.72 ± 12.40)%,39.3°± 5.6°. There were significant differences between two groups (P<0.05). Bone graft fusion rate in group A was 95.83% (23/24), in group B was 90.91%(20/22), there was significant difference between two groups (P < 0.05). Conclusion Pedicle screw system and interbody cage-graft in treatnent of lumber spondylolisthesis can effectively prevent the loss of reduction,mid and long-term effects are satisfactory,it is a stable and reliable method.     

2型糖尿病患者非酒精性脂肪性肝病分级与尿白蛋白排泄率的关系

目的 观察2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者的肝脏超声分级与尿白蛋白排泄率(UAER)的关系.方法 选取197例T2DM患者,按脂肪肝的严重程度分为三组:A组66例为不伴NAFLD的患者,B组63例为伴轻度NAFLD的患者,C组68例为伴中或重度NAFLD的患者.同时对三组患者的一般临床资料、UAER及其他常规生化指标进行组间比较,并进行血脂、HOMA-IR与UAER的相关性分析.结果 与A组患者相比,B组、C组患者的UAER显著升高[(86.49±65.19)mg/24 h比(115.16±101.99)mg/24 h比(159.45±149.08)mg/24 h,P＜0.05].与A组患者相比,B组、C组患者高密度脂蛋白胆固醇下降明显[(1.21±0.37)mmol/L比(1.05±0.38)mmol/L比(0.99±0.21)mmol/L,P＜0.05].多元回归分析显示三酰甘油与UAER之间的相关性最显著(P＜0.05).结论 T2DM合并NAFLD患者随着脂肪肝严重程度的增加,血脂紊乱进行性加重,UAER也随之增加.提示伴有中、重度NAFLD的T2DM患者已出现了较为显著的微血管病变.

Abstract：

Objective To observe the relationship of liver ultrasound class and urinary albumin excretion ratio (UAER) in type 2 diabetes mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD). Methods One hundred and ninety-seven T2DM patients were divided into 3 groups according to the degree of hepar adiposum: group A (66 subjects without NAFLD), group B (63 subjects with mild NAFLD) and group C (68 subjects with moderate or severe NAFLD). Their clinical indexes,UAER and biochemical parameters were measured and compared, the relative analysis of blood fat, HOMA-IR and UAER was done. Results Compared with those in group A, the levels of UAER were significantly increased [(86.49 ± 65.19) mg/24 h vs. (115.16 ± 101.99) mg/24 h vs. (159.45 ± 149.08) mg/24 h,P ＜ 0.05], and the levels of high density lipoprotein cholesterol decreased in group B and group C[(1.21 ± 0.37) mmol/L vs.(1.05 ± 0.38) mmol/L vs. (0.99 ± 0.21) mmol/L,P ＜ 0.05]. Multiple stepwise regression analysis showed that triglyeride was the most important risk factor affecting UAER(P ＜ 0.05). Conclusions There is a close relationship between NAFLD and UAER in T2DM. In the subjects with moderate or severe NAFLD, the UAER increases which indicates that these patients already have capillary vessel injury apparently.     

两种新型非生物型人工肝治疗慢性乙型重型肝炎疗效观察

Objective To explore the clinical effects of two new treatment methods of non-biologic artificial liver [slower plasma exchange (PE) combined with continuous veno-venous hemofiltration (CWH), and coupled plasma exchange filtration adsorption (CPEFA)] in treatment of chronic severe hepatitis B patients. Methods 130 patients with chronic severe hepatitis B were divided into three groups. 44 patients were treated with a parallel circuit of being combined slower PE and CWH based on the conservation medical therapy (group A). 43 patients were treated with CPEFA based on the conservation medical therapy (group B). 43 patients received PE with conservative medical therapy (group C). The clinical symptoms, signs, liver function, blood sodium concentration, effective rates and survival rates in three groups were surveyed before and after treatment. Results The symptom and signs of the majority in the above different groups improved. In group A and B, hyponatremia of patients were improved, the effective rates (within 6 months after the treatment) were 70.45% and 72.09% respectiverly. There was no statistical difference between the two groups (χ2=0.10,P>0.05), the survival rates(6 months) were 45.45% and 46.51% respectively and there was no statistical difference (χ2 = 0.08, P > 0.05). In group C, patients' hyponatremia did not change, the effective rate (51.16%)was obviously lower than those in group A and B (χ2 = 7.55,9.31, P < 0.01) and the total survival rate(6 months) was 30.23% also lower than those in group A, B (χ2 = 4.80,6.10, P < 0.05). Conclusions Being combined slower PE and CWH with a parallel circuit and CPEFA are two new, safe and effective methods of non-biologic artificial liver treatment.     

高频喷射通气对单肺通气患者氧化应激反应的影响

目的 研究高频喷射通气(HFJV)对单肺通气患者氧化应激反应的影响.方法 择期行食管癌根治术患者45例,按随机数字表法分为双肺通气组(A组)、单肺通气组(B组)、单肺通气时非通气侧给予HFJV(驱动压力1 kg/cm2,频率100次/min)组(C组),每组15例.分别于开胸前(T0),单肺通气后(A组于开胸后)30 min(T1)、90 min(T2)、150 min(T3),手术结束时(T4)测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、一氧化氮(NO)浓度.结果 T2～T4时B、C组SOD活性[B组:(47±10)、(37±9)、(41±7)kU/L;C组:(58±12)、(51±11)、(49±9)kU/L]低于A组[(78±8)、(75±7)、(79±6)kU/L](P＜0.05),T1～T4时B、C组MDA、NO浓度高于A组(P＜0.05);T3时C组SOD活性明显高于B组(P＜0.05),T1～T4时C组MDA浓度及T2～T4时NO浓度低于B组(P＜0.05).结论 HFJV能在一定程度上抑制单肺通气患者的氧化应激反应.

Abstract：

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.     

DSA下动脉取栓与传统的动脉取栓手术效果的比较研究

目的 比较DSA下动脉取栓手术与传统的动脉取栓手术的临床效果,评价DSA下动脉取栓的临床应用价值.方法 回顾分析2005年1月至2009年12月68例传统动脉取栓手术(A组)和72例DSA下动脉取栓手术(B组)的临床资料,比较两组手术情况(手术时间、出血量、术前术后踝肱指数变化、截肢率等).结果 B组手术时间[(76 ±17)min],明显少于A组手术时间[(95±22)min,t=5.74,P＜0.01];B组术中出血量[(83±35)ml]显著少于A组出血量[(102±58)ml,t=2.362,P＜0.05];B组手术前后踝肱比差值(0.32±0.08)与A组手术前后踝肱比差值(0.25±0.12)有明显改善(t=2.33,P＜0.05);A组有8例病人截肢,B组有2例病人发生截肢(u=2.06,P＜0.05);A组有2例病人死亡,B组有1例病人死亡(P＞0.05).结论 DSA下动脉取栓术中可以精确的判断动脉栓塞的位置,并能够进一步确诊动脉硬化闭塞、动脉内血栓形成、动脉瘤等复杂的病变,提高了取栓的成功率,减少手术创伤,降低截肢率,是治疗急性动脉栓塞安全、有效的方法.

Abstract：

Objective Compared with the effect of thromboembolectomy assisted with intraoperative digital subtraction angiography (DSA) and traditional method,evaluate the value of intraoperative DSA on surgical procedures for acute lower limb arterial embolism. Methods Sixeight cases of traditional thromboembolectomy to take on the operation (group A) and 72 cases under the DSA operation (group B)were analyzed during January 2005 to December 2009, Comparing two sets of operation (time, the amount of bleeding and the ankle brachial index changes before and after the surgery , amputations rate). Results The operation time of group B [(76 ±17) min] was less than that of group A [(95 ± 22) min, t =5. 736, P ＜ 0. 01] ; the amount of bleeding of group B [(83 ± 35 ) ml] was significantly less than group A [(102 ± 58 ) ml, t = 2. 362, P ＜ 0. 05]; The difference of ABI in group B after the operation than before (0. 32 ±0. 08) than that in group A(0. 25 ±0. 12) had remarkably improved ( t =2. 33, P ＜0. 05) ;there were 8 patient amputations in group A and 2 in group B ( u = 2. 06 , P＜ 0. 05 ); there were 2 patients died in group A and one in group B ( P ＞ 0.05 ). Conclusion Thromboembolectomy assisted with DSA can be accurate assessment of the arteries embolism position, elevate the success rate in the operation ,reduce the rate of amputation saws.     

不同通气模式在慢性阻塞性肺疾病合并呼吸衰竭方面的效果比较

目的 探讨比较不同通气模式在慢性阻塞性肺疾病(COPD)合并呼吸衰竭中的效果.方法 选取50例COPD合并呼吸衰竭患者,按随机数字表法分为A组和B组,每组25例,均采用有创通气,出现肺部感染控制窗后分别采用同步间歇指令通气(SIMV)+压力支持通气(PSV)和PSV+呼气末正压(PEEP)模式进行治疗,比较两组患者的机械通气时间、住院时间、再插管、并发症及治疗前后的血清白细胞介素(IL)-8、超敏C反应蛋白(hs-CRP)、IL-4、干扰素(IFN)-γ水平.结果 B组的机械通气时间、住院时间短于A组[(11.8±2.3)、(16.8±3.2)d比(20.3±2.0)、(28.8±4.1)d],再插管率、并发症发生率均低于A组[8%(2/25)、8%(2/25)比24%(6/25)、24%(6/25)],而治疗后B组出现肺部感染控制窗后24、48 h的血清IL-8、hs-CRP、IL-4、IFN-γ水平均低于A组,差异有统计学意义(P＜0.05).结论 COPD合并呼吸衰竭行机械通气患者在出现肺部感染控制窗后及早行鼻面罩给氧效果更好,应引起重视.

Abstract：

Objective To study and compare the effect of different ventilation modes in chronic obstructive pulmonary diseases (COPD) combined with respiratory failure. Methods Fifty patients with COPD combined with respiratory failure were divided into group A and group B with 25 cases each by random digits table,and they were treated with invasive positive pressure ventilation. Then the two groups were respectively treated with synchronized intermittent mandutory ventilation (SIMV) + pressure suppert ventilation (PSV) and PSV + positive end-expiratory pressure (PEEP) after appearing the pulmonaryinfection-control- window. And the time of mechanical ventilation, length of hospital stay, reintubation rate, complication rate and serum interleukin (IL)-8,high Sensitiveity c-reactive protein (hs-CRP), IL-4 and interferon (IFN)- γ of the two groups before and after the treatment was analyzed and compared. Results The time of mechanical ventilation and length of hospital stay in group B was shorter than that in group A [(11.8 ± 2.3), (16.8 ± 3.2) d vs. (20.3 ± 2.0), (28.8 ± 4.1) d], and the reintubation rate and complication rate was lower than that in group A [8%(2/25), 8%(2/25) vs. 24%(6/25), 24%(6/25)]. The levels of serum IL-8, hs-CRP, IL-4 and IFN- 7 were lower in group B than those in group A (P ＜ 0.05). Conclusion The effect of nasal mask inhaled oxygen early given to COPD combined with respiratory failure is better, and it should be paid attention to.     

颈前带状肌纵切口与颈白线切口在甲状腺手术中应用的效果评价

目的 评价颈前带状肌纵切口与颈白线切口在甲状腺手术中应用的优、缺点.方法 回顾性分析91例行甲状腺手术患者的临床资料,按照随机数字表法分为两组,观察组46例采用颈前带状肌纵切口,对照组45例采用颈白线切口,两组麻醉均采用颈丛神经阻滞.比较两组患者的手术效果.结果 两组患者的总手术时间、术中出血量和术后并发症比较差异均无统计学意义(P>0.05);观察组在甲状腺上极、下极及外侧的暴露效果评分[(3.88±0.32)、(3.68±O.46)、(3.55±0.47)分]明显高于对照组[分别为(2.15±0.22)、(2.18±0.42)、(2.18±O.39)分](P<0.01),但在甲状腺峡部的暴露效果评分[(2.31±0.39)分]明显低于对照组[(3.48±0.52)分](P<001).观察组SF-36评分总分[(77.1±7.3)分]明显高于对照组[(66.4±6.8)分](P<005).结论 颈前带状肌纵切口与颈白线切口在甲状腺手术中应用效果均满意,但两种切口暴露效果不同,手术时需根据患者具体情况选择适合的手术人路.

Abstract：

Objective To evaluate the advantages and disadvantages of cervical strap muscles longitudinal incision and linea alba cervicalis incision in thyroid surgery.Methods The clinical data of 91 patients with thyroid surgery wefe retrospectively analyzed.They were divided into two groups by random digits table,46 patients with cervical stsap muscles longitudinal incision as the observation group,45patients with linea alba cervicalis incision as the control group,the surgery effect of two groups was compared. Results The operative time,blood loss and postoperative complications between the two groups,the differences were not statistically significant(P>0.05).Compared with control group,the exposure evaluation scores in the upper pole[(3.88±0.32)points vs.(2.15±0.22)points],under pole[(3.68±0.46) points vs.(2.18±0.42) points]and lateral side[(3.55±0.47)points vs.(2.18±0.39)points]of thyroid in observation group were significantly better (P<0.01),but the exposure effect scores in thyroid gorge were signilicantly lower [(2.31±0.39) points vs.(3.48±0.52) points](P<0.01),SF-36 score was better [(77.1±7.3) points vs.(66.4±6.8)points](P<0.05).Conclusion The effects of cervical strap muscles longitudinal incision and linea alba cervicalis incision in thyroid surgery are satisfactory,but the exposure effect of two incision are different,thus it is required to choose the applications according to the conditions ofpatients.     

脑卒中偏瘫后遗症期老年患者抑郁的治疗研究

目的 评价道家认知疗法对脑卒中偏瘫后遗症期老年患者抑郁及生活质量的影响.方法 77例脑卒中偏瘫后遗症期伴发抑郁的老年患者,按随机数字表法分为常规治疗组(38例)和综合治疗组(39例),常规治疗组采用抗抑郁剂联合一般支持性心理治疗,综合治疗组在此基础上进行道家认知治疗,两组均治疗8周,随访6个月.于治疗前,治疗后2、4、8周末及随访期末,采用汉密尔顿抑郁分级量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)分别对患者的抑郁症状及生活质量进行评定,并进行统计学分析.结果 常规治疗组治疗后HAMD评分逐渐下降,治疗后8周[(22.35±4.69)分]与治疗前[(29.62±5.95)分]比较差异有统计学意义(t=6.425,P＜0.01);随访期末HAMD评分[(24.48±4.12)分]又升高,与治疗后8周比较差异有统计学意义(t=2.014,P＜0.05),但较治疗前HAMD评分仍显著降低(t=4.836,P＜0.01).常规治疗组SS-QOL评分在治疗后逐渐升高,治疗后8周[(105.39±25.84)分]与治疗前[(86.63±23.84)分]比较差异有统计学意义(t=4.933,P＜0.01);随访期末SS-QOL评分[(96.09±21.37)分]较治疗后8周又有所下降(t=2.543,P＜0.05),但较治疗前仍显著升高(t=2.790,P＜0.05).综合治疗组治疗后HAMD评分持续下降,治疗后8周[(20.08±4.60)分]及随访期末[(15.21±3.42)分]与治疗前[(30.14±4.92)分]比较差异均有统计学意义(t=8.341、15.443,P＜0.01),并且随访期末HAMD评分显著低于治疗后8周(t=4.724,P＜0.01).综合治疗组治疗后SS-QOL评分呈逐渐升高趋势,治疗后8周[(117.56±26.22)分]及随访期末[(126.57±21.82)分]较治疗前[(86.54±23.90)分]显著升高(t=6.716、8.916,P＜0.01);随访期末SS-QOL评分也较治疗后8周显著升高(t=2.378,P＜0.05).综合治疗组治疗后8周及随访期末HAMD评分显著低于常规治疗组同时间点评分(t=2.118,P＜0.05;t=8.405,P＜0.01),SS-QOL评分显著高于常规治疗组同时间点评分(t=3.123,P＜0.05;t=6.580,P＜0.01).结论 抗抑郁剂联合一般支持性心理治疗或在此基础上进行的道家认知治疗均可不同程度地改善脑卒中偏瘫后遗症期老年患者的抑郁症状,提高其生活质量.道家认知疗法起效虽慢,但远期疗效好.

Abstract：

Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.     

多节段脊髓型颈椎病的前路或后路与后前路联合手术的临床疗效及并发症分析

目的 观察多节段脊髓型颈椎病行单纯前路或后路与后前路联合手术后的脊髓功能改善及预后状况,探讨后前路联合手术的临床疗效及并发症情况.方法 将2001年1月至2008年1月收治的298例多节段脊髓型颈椎病患者按手术方式分为三组:颈前路手术减压植骨钛网植入钛板内固定术121例(单纯前路手术组),后路单开门椎管扩大成形术112例(单纯后路手术组),后前路联合手术65例(后前路联合手术组).行脊髓功能日本骨科学会(JOA)评分、体感诱发电位检查,对比三组患者的术后疗效.结果 全部病例均获得1～7年随访,平均(4.7±1.4)年.单纯前路手术组改善率78.1%,优良率72.7%(88/121),单纯后路手术组改善率70.6%,优良率66.1%(74/112),两组比较差异有统计学意义(P<0.05).后前路联合手术组改善率86.7%,优良率83.1%(54/65),与单纯前路手术组、单纯后路手术组比较差异均有统计学意义(P<0.05).结论 在治疗多节段脊髓型颈椎病的手术中,后前路联合手术在疗效上明显优于单纯前路手术或单纯后路手术.脊柱稳定性单纯前路手术、单纯后路手术、后前路联合手术逐一降低.     

射频消融髓核成形术后颈椎间盘内压力的变化

目的 观察射频消融髓核成形术对颈椎间盘内压力的影响,以提供射频消融髓核成形术治疗颈椎间盘突出症的理论依据.方法 应用射频消融髓核成形术治疗颈椎间盘突出症患者42例(神经根型颈椎病33例,椎动脉型颈椎病9例),于射频消融前后分别测量颈椎间盘内压力,并于术后1周采用日本骨科学会(JOA)评分评估其疗效,探讨颈椎间盘内压力的变化与临床疗效之间的关系.结果 射频消融髓核成形术后,33例神经根型颈椎病患者颈椎间盘内压力较术前降低(1.84±0.96)kPa(P=0.000),术后1周JOA评分较术前升高(3.27±1.35)分(P=0.000);9例椎动脉型颈椎病患者颈椎间盘内压力较术前降低(1.72±0.92)kPa(P=0.000),术后1周JOA评分较术前升高(2.78±0.67)分(P=0.000).相关分析表明椎间盘内压力的降低程度与JOA评分的升高程度呈显著正相关(p<0.05).结论 射频消融髓核成形术可以降低颈椎间盘内压力,从而达到缓解临床症状的目的 .     

颈椎椎管成形术结合微型钛板治疗多节段颈椎病

目的评价颈椎椎管成形术结合微型钛板治疗多节段颈椎病的疗效。方法采用颈椎后路单开门结合微型钛板内固定治疗多节段颈椎病患者21例,对术前和术后JOA评分、椎管矢状径、颈椎生理曲度等指标进行统计学分析。结果21例患者均获随访,时间9～48个月,未见严重并发症。术后6个月CT提示铰链侧骨质愈合;末次随访根据JOA评分法进行疗效评价：优9例,良7例,可3例,差2例,末次随访JOA改善率达62．5％;颈椎管矢状径术前为（9．2±1．1）mm,术后1个月为（13．5±1．4）mm,术后1个月与术前比较差异有统计学意义（t=3．02,P〈0．01）,术后各期无明显变化（P〉0．05）;颈椎曲度术前为（12．6±14．7）。,末次随访为（17．1±12．4）。末次随访与术前比较差异有统计学意义（t=8．26,P〈0．01）,术后6个月内颈椎曲度改变不明显（P〉0．05）。结论颈椎椎管成形术结合微型钛板治疗多节段颈椎病,能够有效的扩大并维持椎管矢状径,改善颈椎生理曲度,改善脊髓神经功能。     

椎管储备间隙减少的过伸性颈髓损伤的颈前路治疗

目的 探讨椎管储备间隙减少的颈髓过伸性损伤的受伤特征和前路手术治疗效果.方法 回顾性分析大连医科大学附属二院骨外科于2004年3月～2009年3月收治的52例患者的临床资料,所有病例均经MRI提示为原有椎管储备间隙减少,其中所有病例均有颈间盘突出,27例患者存在椎管狭窄,根据对25例对于致压物主要在间盘水平的病例,将病变间隙突出间盘切除,自体髂骨植骨块植骨或带有自体骨颗粒的钛网或椎间融合器植骨融合钢板内固定术 对于27例存在明显椎管狭窄者,单纯间盘切除不能彻底减压,行椎体次全切除钛笼植骨融合钢板内固定术.术后对临床结果进行JOA评分 观察并记录患者的神经功能恢复、临床症状的改善及颈椎融合情况,比较手术前、术后随访时JOA评分,评价临床治疗效果.结果 49例患者获得随访,3例外地患者失访,时间6～24个月,平均随访时间是10个月.按JOA评分术前患者JOA评分为（8.55±1.52）分,半年随访时JOA评分为（12.87±1.68）分,采用配对t检验对术前、术后随访时JOA评分进行统计学分析,有显著性差异（P＜0.001,α=0.05）,其中将手术改善率为（56.37±5.58）%.术后随访平均5个月X线片示椎体间骨性融合.结论 对于椎管储备间隙减少基础上造成的颈椎过伸性损伤的患者,颈前路减压植骨加带锁钢板内固定手术是一种较好的选择.     

颈椎管和腰椎管狭窄同时存在的诊断及手术治疗

目的 探讨颈椎管和腰椎管狭窄同时存在的临床特点及诊治方法.方法 颈椎管和腰椎管狭窄同时存在的患者27例,单独颈椎手术9例,单独腰椎手术7例,颈椎及腰椎都接受手术治疗11例.结果 22例患者获得随访,随访时间为5个月至8年6个月,平均49个月.以主要症状为主的患者随访16例,日本骨科学会(JOA)评分由术前平均(8.6±0.2)分,提高到术后2周平均(11.7±0.3)分,术后3个月平均(13.1±0.2)分,术后6个月平均(13.5±0.2)分,术后12个月平均(13.9±0.3)分.术后12个月随访时患者改善率79.2%,优良率93.8%(15/16).结论 多节段椎管狭窄的治疗应该坚持个体化原则,分清主要及次要病灶,如果没有明显主要病灶可先行颈段手术.     

颈椎后路单开门椎管成形术对脊髓型颈椎病患者疗效及预后

目的通过不同手术方法探究颈椎后路单开门椎管成形术对脊髓型颈椎病患者的临床治疗效果及远期预后情况。方法将患者随机分两组,锚钉悬吊固定组(AS组):采用颈椎后路单开门椎管成形术中的锚钉悬吊固定法;Arch钢板固定组(TP组):采用颈椎后路单开门椎管成形术中的Arch钢板固定法。每组各45例。通过两种方法分析AS组与TP组的神经功能、轴性症状、开门角度和门轴侧融合率的疗效及远期预后差异性。结果手术前AS组与TP组JOA评分无差异性,AS组与TP组手术后1年与手术前相比较JOA评分均明显升高;AS组与TP组相比较神经功能改善率无差异性;术后1年,TP组11例发生轴性症状,发生率为24.44%,AS组26例发生轴性症状,发生率为57.78%,经比较有明显差异。通过CT测量开门角度,术后1个月和1年,TP组与AS组相比较开门角度明显增大,两组术后1年与术后1个月相比较降低,但TP组仍大于AS组。结论在颈椎后路单开门椎管成形术中Arch钢板固定法优于锚钉悬吊固定法,对脊髓型颈椎病患者的治疗效果显著,且一年内远期预后整体效果好,Arch钢板固定法好于锚钉悬吊固定法。     

数字化三维塑形钛网修补颅骨缺损患者的临床优势分析

目的探讨数字化三维塑形钛网与传统手工塑形钛网修补颅骨缺损的临床价值。方法回顾性分析78例颅骨缺损患者的临床资料,按所用钛网不同分为数字化三维塑形钛网组（41例）和传统手工塑形钛网组（37例）,比较两组住院时间、手术操作时间、住院费用、塑形满意度以及并发症情况。结果数字化三维塑形钛网组住院费用和塑形满意度明显高于传统手工塑形钛网组[（12978．1±4765．7）元比（9436．6±3798．7）元、（9．87±0．13）分比（9．41±0．09）分],并发症发生率明显低于传统手工塑形钛网组[4．9％（2／41）比29．7％（11／37）],两组比较差异均有统计学意义（P〈O．05）;两组住院时间、手术操作时间比较差异无统计学意义（P〉0．05）。结论数字化三维塑形钛网修补颅骨缺损时操作便捷,在很大程度上降低了手术的风险以及并发症发生率,并能达到高标准的塑形效果,值得临床推广。     

经皮单侧与双侧椎弓根入路椎体后凸成形术的疗效对比研究

目的 比较经皮单侧与双侧椎弓根入路球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效.方法 对64例(68椎)骨质疏松性椎体压缩性骨折患者,根据手术方法不同,分为单侧入路组(33例)与双侧入路组(31例).比较两组手术前后视觉模拟评分法(VAS)评分、Cobb角、手术时间方面的差异.结果 术前、术后24h、术后3个月,单侧入路组VAS评分分别为(8.42±1.33)、(2.21±1.67)、(2.09±1.58)分,Cobb角分别为(31.24±9.12)°、(14.21±9.21)°、(14.43±9.36)°;双侧入路组VAS评分分别为(8.36±1.52)、(2.13±1.80)、(2.00±1.71)分,Cobb角分别为(30.84±8.77)°、(13.94±8.87)°、(14.07±9.87)°,两组患者术后24h及术后3个月VAS评分、Cobb角均较术前明显改善(P＜0.0l);且两组同一时段VAS评分、Cobb角比较差异无统计学意义(P＞0.05).单侧入路组和双侧入路组手术时间分别为(45.00±8.76)、(72.00±9.32)min,差异有统计学意义(P＜0.01).结论 经皮单侧椎弓根入路椎体后凸成形术与经皮双侧椎弓根入路椎体后凸成形术相比,具有创伤小、手术时间短、患者与术者接受的X线辐射小等优点,且可以达到和经皮双侧椎弓根入路椎体后凸成形术相似的疗效.     

改良经椎间孔椎体间融合术治疗腰椎退变性疾病

目的 探讨改良经椎间孔椎体间融合术治疗腰椎退变性疾病的临床疗效.方法 2007年6月至2009年5月对62例腰椎退变性疾病患者行改良经单侧椎间孔椎体间植骨融合,相应节段椎弓根钉内固定术.其中腰椎间盘突出合并腰椎不稳28例,腰椎间盘突出合并椎管狭窄27例,退变性滑脱7例.累及单节段48例,累及双节段14例.通过观察融合情况,记录术前、术后3个月和末次随访时的视觉模拟评分(VAS)和日本矫形外科学会(JOA)评分判定治疗效果.结果 62例患者均获得随访,随访时间15～30(22.77±3.82)个月.无神经损伤、脑脊液漏、感染及椎弓根钉断裂等并发症.术后1年椎体间融合率为96.8%.依据JOA评分,优34例,良24例,可4例,差0例,优良率为93.5%(58/62).术后VAS和JOA评分与术前比较差异有统计学意义(P＜0.05),术后3个月VAS和JOA评分与末次随访时比较差异无统计学意义(P＞0.05).结论 改良经椎间孔椎体间融合术在充分减压同时能减少进入椎管带来的并发症,临床疗效好,是治疗腰椎退变性疾病的有效术式.     

Zero-P椎间融合器的早期临床疗效

目的：研究Zero-P椎间融合器在颈椎前路减压椎体间融合（ACDF）术后的早期临床疗效。方法：选取颈椎疾病患者31例,均行ACDF术,共置入Zero-P椎间融合器31枚,融合节段均为单节段。术后定期摄X线片检查,采用日本骨科学会（JOA）评分,神经功能改善率（RIS）评价患者术前、术后颈脊髓神经功能。结果：31例患者均获12个月以上随访,平均14.70个月,手术时间（72±10）min,术中出血量（60±12）mL;1例患者术后24 h内出现咽部疼痛,经对症治疗,术后7 d内症状消失;术后3个月X线片提示颈椎椎间隙骨性融合,术前JOA评分（8.65±1.85）分,术后末次随访时为（16.09±0.91）分,差异有统计学意义（P〈0.05）;术后6个月神经功能改善率为（89.60±9.45）%,与术后12个月的（90.30±8.94）%比较,差异无统计学意义（P〉0.05）;术后椎间高度、生理弧度恢复满意。结论：Zero-P椎间融合器应用于颈前路减压植骨融合治疗颈椎疾病的早期随访疗效满意。