骶骨肋骨1例

病例男，４７岁。因腰酸、腰痛、偶尔见肉眼血尿行腹部平片及静脉尿路造影时见：右侧骶髂关节下方见一长条骨影，沿骶骨右侧走行，近端同骶骨右侧耳状面下缘形成关节，远端游离于小骨盆腔内，致骨盆畸形，右侧骶髂关节较对侧为高（图１）。切线位摄片示长骨呈弓形，一端与骶骨形成关节，一端游离在臀部软组织内，弓部可见一裂隙状影。讨论骶骨肋骨是起始于骶骨的肋图１右骶髂关节下方有一长条骨，沿盆壁下行，上与骶骨耳状面成关，下端游离于小骨盆腔。骨，它从骶椎向下或向外走行，具有皮质和松质结构。它是十分罕见的先天发育畸形，国外文…     

手法整复骶髂关节半脱位65例临床体会

骶髂关节位于腰臀部，由髂骨及骶骨的耳状关节面组合而成，周围有多条坚韧的韧带加强，结构上较稳定，是一个微动关节。但当外力作用使其发生强力牵拉、扭转及冲撞，超过了正常生理范围时，便可引起骶髂关节周围软组织牵拉、扭转损伤，甚至造成骶髂关节半脱位。本病多为急性发病，常出现腰骶部剧烈疼痛，行走坐立活动受限。自1985年以来，笔者采用手法整复治疗骶髂关节半脱位，收到理想的效果。     

骶髂关节损伤与血管的应用解剖学测量

背景:骶髂关节部位骨折脱位可导致血管的严重损伤。目的:观察骶髂关节周围血管解剖学特征,明确各血管与周边组织的关系。设计、时间及地点:单一样本观察,于2007-10/2008-01在南通大学解剖教研室完成。材料:20具防腐成年尸体骨盆标本(南通大学解剖教研室提供),男16具,女4具,年龄在30～60岁。方法:40侧骨盆标本,依次选用不同的平面,采用前后双侧入路,观察血管的走行特点。主要观察指标:测量血管直径及到骨盆后壁的垂直距离。结果:①左侧髂总动脉距骨壁平均距离为(5.31±0.25)mm,右侧髂总动脉距骨壁平均距离为(5.47±0.23)mm。②髂外动脉自髂总动脉发出后于骶骨翼的前方向外下方走行,行程中于距起点(32.30±0.43)mm处斜跨骶髂关节的前方,其跨越骶髂关节处距骶髂关节的距离为(17.28±0.43)mm,于骶岬处距骶髂关节的距离分别为(2.20±0.21)cm和(2.95±0.25)cm。③髂内动脉左右侧口径无显著差别(P>0.05)。④左侧髂内动脉距骨壁距离大于右侧。⑤髂腰动脉至骨壁距离为(6.97±0.17)mm,小于10mm,距骨壁较近。结论:骶髂关节动脉解剖学特点决定了在骶髂关节骨折脱位中损伤的概率。根据测量结果可以得出:①骶髂关节脱位及骨折时,损伤髂总动脉的概率较小。②髂外动脉距骶髂关节的垂直距离较远,髂内动脉距骨壁距离较远,当发生骶髂关节部骨折时,骨折片直接刺伤血管的可能性较小。③髂内动脉距骶髂关节水平距离较小,故当发生骶髂关节脱位半骨盆移位时,有可能受到牵拉损伤。④骶外侧动脉距骨壁较近,所以骶骨I区骨折时易受损伤。⑤髂腰动脉至骨壁距离较近,故当发生骶髂关节脱位时半骨盆移位可能受到牵拉损伤。     

曲面重组技术在强直性脊柱炎骶髂关节病变中的应用价值

目的 探讨多层螺旋CT(MSCT)曲面重组(CPR)技术在强直性脊柱炎(AS)骶髂关节病变中的应用价值.方法 33例临床确诊为AS的患者,采用5mm层厚、5mm层间距行双侧骶髂关节MSCT容积扫描,获得的原始横断面图像,再采用2.5mm层厚、1.2mm层间距重叠重建轴面源像,并将源像传输至AW4.0工作站,用reformat软件进行多平面重组(MPR)获得骶骨矢状面图像,分别在骶骨上缘1/4、1/2、3/4处沿骶骨走行划曲线进行CPR成像获得双侧骶髂关节冠状面图像.结果 33例AS患者骶髂关节CPR图像,有较高的密度分辨率、空间分辨率,清楚、直观地在冠状面上显示了完整的骶髂关节及其病变,其中0级2例,Ⅰ级5例,Ⅱ级11例,Ⅲ级10例,Ⅳ级5例.结论 骶髂关节CPR冠状面图像清晰,符合诊断要求,与横断面图像结合,更有助于全面观察AS骶髂关节病变的程度和范围.     

骶髂关节韧带应用解剖学意义

背景：骨盆后部结构中,骶髂后韧带复合体、骶结节韧带和骶棘韧带的完整,对骨盆稳定性有重要作用.目的：观察骶髂关节周围韧带解剖结构,了解各韧带对关节稳定性的作用.方法：对20具防腐成年尸体骨盆标本,共40侧依次采用前后方入路,对骶棘韧带,骶结节韧带,耻骨联合及骶髂关节诸韧带结构进行解剖学观察.结果与结论：骶髂关节周围韧带可分为3组：骶髂前韧带、骶髂骨间韧带和骶髂后韧带.耻骨上下韧带及耻骨前后韧带.骶棘韧带和骶结节韧带.此3组韧带主要有两个功能：连接脊柱和骨盆环;维持骨盆环的稳定.     

骶骨肿瘤侵犯骶髂关节的CT及MRI表现

目的 分析良、恶性骶骨肿瘤侵犯骶髂关节的CT及MRI表现。方法 观察51例骶骨肿瘤对骶髂关节侵犯的CT和MRI表现。其中骨巨细胞瘤19例,神经鞘瘤6例,神经纤维瘤1例,脊索瘤7例,恶性纤维组织细胞瘤、小细胞肉瘤和梭形细胞肉瘤各1例,软骨肉瘤6例,尤因肉瘤2例,黏液乳头状室管膜瘤1例,转移癌6例。结果 骶髂关节受侵29例(29/51,56.86％),其中双侧骶髂关节受侵11例,单侧受侵18例。骶髂关节受侵发生率在良性肿瘤患者中为53.85%(14/26),在恶性患者中为60.00％(15/25)。CT表现为关节双侧骨质破坏、关节面消失,软组织肿块占据骶髂关节;MRI表现为骶髂关节双侧骨质信号消失,被肿瘤信号取代。结论 骶骨恶性肿瘤常侵犯骶髂关节。骶骨良性肿瘤中,骨巨细胞瘤最易侵犯骶髂关节。     

CT导引骶髂关节穿刺活检和注射技术在强直性脊柱炎早期诊断与治疗中的作用

背景：影像学方法是强直性脊柱炎(ankylosing spondylitis，AS)主要的检查手段，CT导引技术可为AS的早期诊断和临床治疗提供补救手段，目的：评估CT导引经皮骶髂关节穿刺活检及关节内注射技术在AS的早期诊断与治疗中的作用。设计：非随机对照的研究。地点、对象和干预：本实验在在汕头大学医学院第一附属医院放射科完成。实验选取盆部标本3具(标本组)、汕头大学医学院风湿病研究室患者18例(AS组)和拟诊早期AS的未分化脊柱关节病(undifferentiated spondyloarthropathies，uSpA)患者10例(uspA组)。在CT导引下，经臀部皮肤作骶髂关节穿刺，28例患者并作滑膜部活检和注射治疗。主要观察指标：穿刺的部位和成功率、标本阳性率、治疗有效率。结果：盆部标本穿刺到位率67％(4／6)，28例患者穿刺到位率96％(54／56)。穿刺层面距骶髂关节下缘(1．69&;#177;0．63)cm。活检标本获取率88％(46／54)，病理检查阳性率92％(22／24)。AS组和uSpA组患者的骶髂关节见炎症改变。关节内注射治疗近期有效率79％(22／28)。全组病例无并发症和副作用发生。结论：CT是骶髂关节穿刺有效、安全的导引手段；穿刺平面以骶髂关节中、下1／3交界处为宜。对uSpA患者作骶髂关节活检有利于AS的早期诊断。骶髂关节内注射是AS和uSpA全身药物治疗的有效补充。     

骶骨螺钉固定骶髂关节钉道参数的变异性

背景:正确地选择进针点、进针方向和骶髂螺钉长度,以及对S1椎弓根形状和骶髂关节毗邻结构解剖的了解成为骶髂关节螺钉置入成败的关键。目的:通过对成人骨盆后环的CT测量,为临床用骶髂螺钉固定骶髂关节提供形态学依据,并探讨钉道参数的变异性相关因素。设计、时间及地点:测量实验,于2008-01/10在河北工程大学CT中心完成。对象:选择100名健康成人,男女各50人,年龄23～56岁,平均32岁,无骶髂关节疾患。方法:用CT对100名健康成人骨盆进行扫描成像,测量S1椎弓根宽、高;S1到髂骨翼的投影点中心(即进针点)至相应椎体对侧前皮质距离,至相应椎弓根中心的距离;进针点与坐骨切迹和髂后上、下棘的距离;S1的轴线(即进针方向)与矢状面和冠状面所成的角度,并记录受检者的性别、身高、体质量。分别对不同性别、左右侧别的钉道长度、进针方向进行显著性检验;以协方差分析方法分析性别、身高、体质量等因素的主效应和交互效应;并以泊松相关分析研究各因素的相关性。主要观察指标:骶髂关节螺钉参数的数值。结果:100名受试者均进入结果分析。①S1椎弓根宽平均(25.8±2.5)mm,高平均(21.2±2.7)mm;进针点至对侧前皮质的距离为(84.5±4.56)mm;进针方向与冠状面的夹角为(25.9±6.5)°,与矢状面夹角为(22.2±5.6)°;进针点与髂后上棘的距离平均(38.5±4.3)mm,与髂后下棘的距离(39.2±6.7)mm;与坐骨大切迹的距离(43.9±7.6)mm。②以协方差分析方法分析性别、体质量、身高各因素对钉道长度、椎弓根宽度的主效应和交互效应,在消除体质量及身高因素的影响后,性别对钉道长度及椎弓根宽度的影响无显著性意义(P>0.05)。左、右侧别相比,钉道长度、进针角度及椎弓根宽度差异无显著性意义(P>0.05)。泊松相关分析显示身高、体质量与椎弓根宽度及钉道长度呈显著正相关,而进针角度与后两者无显著相关性。结论:经骶髂关节骶骨钉的钉道参数具有较大变异性,不同个体有显著不同;体质量和身高是两个影响变异性重要的相关因素。     

骶骨功能不全性骨折的^99mTc-MDP SPECT/CT影像特征

目的:分析和总结骶骨功能不全性骨折(Insufficiency fracture,IF)的99mTc-MDP全身骨显像及骨盆SPECT/CT断层融合显像的影像学特征,探讨SPECT/CT的诊断增益价值。方法:回顾性分析21例经影像检查或临床观察、随访明确诊断为骶骨IF的临床及影像资料,分析两种影像检查在骶骨IF上的影像特征,对比二者的诊断准确性。结果:全身骨显像诊断15例(71.4%)骶骨IF骨折中,4例(26.7%)表现为单侧骶骨翼与骶髂关节平行走行的显像剂分布异常浓聚灶,其中有2例累及S2~S3骶骨体部;11例(73.3%)表现为双侧骶骨翼浓聚区形成的2条与骶髂关节平行的纵行带,其中8例(53.3%)同时累及S1~S4骶骨体部浓聚区形成的与骶髂关节垂直的水平带连接组成,表现为7例(46.7%)呈典型"蝶"形、"H"形,1例呈"弓"形。骨盆SPECT/CT断层融合显像上诊断骶骨IF 20例(95.2%),12例(60%)骶骨IF表现为双侧显像剂分布异常浓聚,9例(45%)在CT上可见双侧骶骨翼骨折,其中8例(40%)同时累及S1~S4骶骨体部,表现为双侧骶骨翼处走行与骶髂关节平行的低密度不规则"锯齿"状骨折透亮线影和/或硬化带、不均匀骨痂形成,骶骨翼边缘伴或不伴骨皮质不连续、轻微错位,骶骨体部横行骨折线走行与骶髂关节垂直;8例(40%)为单侧骶骨翼骨折,6例(30%)CT上显示为骶骨翼上走行与骶髂关节平行的模糊不规则低密度骨折线和硬化带,向前累及骶骨翼边缘伴骨皮质断裂、轻微错位,4例(20%)累及S2~S3骶骨体部骨折线走行垂直于骶髂关节。全身骨显像与骨盆SPECT/CT断层融合显像诊断骶骨IF的准确率分别为71.43%(15/21)和95.2%(20/21),骨盆SPECT/CT断层融合显像诊断骶骨IF准确率高于全身骨显像,差异具有统计学意义(P<0.05)。结论:全身骨显像上骶骨典型的"H"形、"蝶"形或"弓"形的显像剂异常浓聚可较容易诊断骶骨IF,但在不典型骶骨IF时,骨盆SPECT/CT断层融合显像能提高骶骨IF的诊断准确率,具有明显的增益价值。     

髋臼区域松质骨骨小梁束的大体分布及力学

背景:虽然目前已采用多种力学研究方法对骨盆的力学特性进行了大量的研究,但是该区域的确切应力分布仍不甚明了。目的:观察髋臼区域骨小梁的大体分布状况并与现有生物力学研究结果对比。方法:采用4具干燥骨盆标本,取其两侧髋骨分别按照髋臼边缘构成的平面及闭孔平面进行切割,观察其切面的骨小梁分布模式以了解了解髋臼区域骨小梁的大体分布状况。结果与结论:髋骨骨小梁可分为:①骶耻束:从耳状面及髂后上棘髂后下棘发出沿弓状线到达耻骨联合,部分骨小梁终止于髋臼后上方。②髂臼束从从耳状面坐骨大切迹发出到达髋臼后上部,位于骶耻束浅层。③髂坐束:从髂结节发出到达坐骨结节,部分骨小梁终止于髋臼前上方。其中骶耻束与髂坐束相交于臼顶,在坐骨大切迹、髂耻隆起及骶耻束与髂坐束相交部位骨质致密。总体上人类髋骨骨小梁主要由髂臼束、骶耻束与髂坐束构成。在坐骨大切迹、髂耻隆起及骶耻束与髂坐束相交部位骨质致密。这与现有研究中髋臼区域的应力分布负荷基本吻合。     

耳后切口在腮腺肿瘤手术中的应用

目的 评价耳后切口在腮腺肿瘤手术中应用的临床价值.方法 33例腮腺肿瘤患者,采用由耳后腮腺切口入路,术中保留面神经和耳大神经,胸锁乳突肌瓣填塞缺损区.结果 所有患者均达临床I期愈合,无涎瘘发生.6例患者术后出现暂时性面瘫,均在1个月内恢复.所有患者耳垂麻木均于术后3个月内恢复.结论 腮腺耳后切口较传统切口并发症少,不损容,效果好,具有临床应用价值.     

简易负压引流在严重耳廓不完全离断伤中的应用

目的探讨简易负压引流在严重耳廓不完全离断伤治疗中的效果。方法将41例(41耳)患者随机分为负压组及对照组,对2组的愈合时间,术后第1、7天的疼痛数值进行比较。结果负压组愈合时间显著短于对照组(P0.05),术后第1天疼痛数值显著低于对照组(P0.01)。结论简易负压引流治疗严重耳廓不完全离断伤具有操作简单、病程明显缩短、患者痛苦小的优点。     

耳大神经移植治疗腮腺内面神经鞘瘤2例临床分析并文献复习

目的 探讨耳大神经移植在腮腺内面神经鞘瘸治疗中的意义.方法 分析面神经鞘瘤切除并取耳大神经移植的2例患者的临床资料.结果 术后面神经功能恢复较快,并发症少.结论 耳大神经移植结合显微外科技术以及血供丰富的软组织移植床对面神经缺损修复至关重要,且切取耳大神经后无严重后遗症.应用耳大神经移植修复面神经较为理想,值得临床推广应用.     

Great Auricular Neuralgia

An unusual neuralgia of the great auricular nerve resulting from a skin incision to insert a cardiac pacemaker is described. The anatomy and presumed pathophysiology are discussed.     

耳穴敷贴法施护糖尿病周围神经病变的疗效观察

目的观察耳穴敷贴法施护糖尿病周围神经病变(DPN)的临床疗效。方法将80例DPN的患者,随机分为实验组和对照组,每组40例。在严格控制血糖并执行DPN的治疗基础上,实验组采用王不留行籽耳穴敷贴施护的方法。对照组按临床护理路径进行护理。并比较两组临床疗效。结果实验组总有效率85.0%,对照组总有效率57.5%,两组比较有显著性差异(P<0.05);两组治疗后神经电生理变化的比较有显著性差异(P<0.05)。结论耳穴敷贴法施护DPN有较好的疗效。     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.