弹性髓内针在儿童下肢长骨骨折中的应用

目的 观察弹性髓内针治疗儿童下肢长骨骨折的疗效.方法 回顾性分析2005年9月至2009年3月采用弹性髓内针治疗且获随访的82例儿童下肢长骨骨折(股骨骨折48例,胫骨骨折34例)的疗效.结果 全部病例均获随访,随访时间6～30个月,平均14个月.术后愈合优77例(93.90%),良5例(6.10%).82例全部Ⅰ期愈合,无骨感染和骨不连发生,无术后断针、再移位及拔针后再骨折现象.结论 弹性髓内针固定是一种安全、简便、快速的儿童长骨干骨折的治疗方法,与传统的技术相比,它具有损伤小、不损伤骺板、骨折愈合快、住院周期短、患儿易耐受等优点,是目前治疗儿童下肢长骨骨折的理想方法.     

闭合复位弹性髓内针固定治疗儿童四肢长骨粉碎性骨折

目的总结分析闭合复位弹性髓内针固定治疗儿童长管状骨干粉碎性骨折的临床疗效。方法回顾性分析我院2008年6月-2011年9月采用闭合复位弹性髓内针固定治疗的51例儿童四肢长骨干粉碎性骨折,其中肱骨骨折2例,尺桡骨骨折11例,股骨骨折21例,胫骨骨折17例。结果随访全部病例,随访时间7个月～2年,平均19个月。全部病例获得骨性愈合,邻近关节活动和患肢功能完全恢复。无骨感染,骨不连发生及再发骨折。结论闭合复位弹性髓内针固定治疗儿童长管状骨干粉碎性骨折是一种微创、有效的治疗方法,早期需配合皮牵引或石膏托外固定。     

弹性髓内针与钢板固定治疗儿童股骨干骨折疗效比较

目的探讨对儿童股骨干骨折进行钢板或弹性髓内针固定手术治疗的效果,并总结其经验。方法117例儿童股骨干骨折,其中65例行铜板固定,52例行弹性髓内钉固定。结果65例钢板固定组,术后发生感染3例;骨折愈合时间平均4个月,骨不连2例,钢板断裂1例,再骨折2例;肢体过长15例。52例弹性髓内钉固定组,术后发生感染l例。骨折愈合时间平均3．5个月,无骨不连、髓内钉断裂及再骨折病例。术后出现肢体不同程度过长10例。结论弹性髓内钉固定具有操作简便,损伤少,不累及骨骺,复位良好,恢复快,便于早期康复及并发症少的优点,是一种微创、安全、简便的骨折治疗方法。     

弹性髓内钉在小儿下肢管状骨折中的临床及护理研究

目的探讨撬拨法及弹性髓内钉治疗小儿下肢管状骨折的疗效及护理方法。方法对82例儿童下肢管状骨折采用弹性髓内钉治疗(TIEN组),并给予积极的护理配合,与同期非弹性髓内钉治疗者(钢板组及非手术组)相比较。结果随访全部病例,随访时间6~30个月,平均14个月。TIEN组与钢板组及非手术组相比,在住院时间、完全负重时间、并发症等方面有明显的差异。全部病例,无骨感染和骨不连发生,无术后断针、再移位及再骨折现象。结论弹性髓内钉固定是一种安全、简便、快速的儿童长骨干骨折的治疗方法,与传统的技术相比,它具有损伤小、不损伤骺板、骨折愈合快、住院周期短、患儿易耐受等优点,是目前治疗儿童下肢长骨骨折的理想方法。     

髓内针固定术后旋转不稳定性骨折不愈合的治疗

目的 探讨保留原有髓内针附加钢板固定加植骨治疗带锁髓内针术后旋转不稳定性骨折不愈合的临床疗效.方法 23例带锁髓内针术后旋转不稳定性骨折不愈合患者,男20例,女3例,年龄21～63岁,平均33.7岁.骨折部位:股骨干16例,胫骨干4例,肱骨干3例.初次手术为闭合复位带锁髓内针固定15例,切开复位带锁髓内针固定8例.骨折不愈合的时间为带锁髓内针固定术后9～38个月,平均17个月.X线示肥大性骨折不愈合14例,萎缩性骨折不愈合9例.均采用保留髓内针附加钢板固定加松质骨植骨术治疗.术中检查均证实骨折端存在旋转不稳定.结果 随访时间7～35个月,平均14.5个月.23例患者骨折均获得愈合,愈合时间为8～20周,平均14周.无感染、内固定松动或断裂等手术相关并发症.结论 保留原有髓内针附加钢板固定加植骨术可有效消除髓内针术后旋转不稳定,是治疗髓内针术后骨折不愈合简单、安全、有效的方法.     

弹性髓内钉治疗儿童胫骨不稳定性骨折的疗效分析

目的探讨弹性髓内钉内固定治疗儿童胫骨不稳定性骨折的疗效和手术成功要素。方法对32例胫骨不稳定性骨折的患儿采用弹性髓内钉内固定治疗,观察骨折愈合、功能恢复及不良反应。结果所有患儿均获随访3～21个月,骨折全部愈合,髋、膝、踝节功能完全恢复正常,术后无感染、骨不连、骨骺损伤,无明显畸形愈合。结论弹性髓内钉内固定治疗儿童胫骨不稳定性骨折效果满意。     

带锁髓内针内固定骨折延迟愈合原因分析与处理

目的：报告12例胫骨和股骨骨折带锁髓内针内固定的疗效。方法：对12例胫骨和股骨骨折带锁髓内针内固定、骨不愈合或延迟愈合行上端锁针取出术后治疗。结果：12例患者3个月后均有大量骨痂形成,全部愈合。结论：带锁髓内针内固定早期疗效可靠,后期可影响骨折进一步愈合。     

弹性髓内钉固定治疗儿童长骨干骨折

目的：评价弹性髓内钉内固定治疗儿童长骨干骨折的疗效。方法：自2005年1月至今采用弹性髓内钉治疗儿童长骨干骨折14例。股骨骨折6例,胫腓骨骨折4例,肱骨骨折2例,尺桡骨骨折2例。术后所有病例均得到随访,随访时间4～12个月（平均6.5个月）。结果：所有病例骨折均获得I期愈合,愈合时间平均10周。邻近关节活动和患肢功能完全恢复正常。本组病例术后无感染、骨不连、畸形愈合和骨骺损伤。6例术后半年门诊行髓内针取出。结论：弹性髓内钉内固定治疗儿童闭合复位困难的长骨干骨折有效,适用于6～15岁儿童的长骨干骨折,具有手术切口小、软组织损伤小、手术时间短、康复快、并发症少等特点。     

弹性髓内针治疗儿童前臂骨干骨折

目的探讨弹性髓内针治疗儿童前臂骨干骨折的疗效。方法12例儿童前臂骨干骨折采取C臂X线透视下闭合复位，弹性髓内针固定治疗。结果随访4—12个月，全部骨性愈合，术后仅1例患儿发生前臂旋后功能受限10°，其余患儿前臂功能恢复均良好。结论弹性髓内针治疗儿童前臂骨干骨折安全、有效、微创、愈合快、功能恢复良好。     

弹性髓内针逆行髓内固定治疗大龄儿童肱骨近端骨折

目的:探讨弹性髓内针逆行髓内固定技术治疗大龄儿童肱骨近端骨折的临床效果?方法:2006年6月~2011年12月收治的36例大龄儿童肱骨近端骨折患儿采用弹性髓内针逆行固定治疗,其中采用经内外髁入路弹性髓内针逆行固定组14例,经外髁入路弹性髓内针逆行固定组22例?术后均采用肩关节外展支具固定6~8周?骨折愈合后去除肩关节外展支架后即行康复训练?弹性髓内针在术后3~4个月X线片显示骨折线模糊,骨折端有连续性骨小梁形成后拔除?所有患者均获6~24个月(平均13个月)随访?所有骨折均于术后8周左右愈合?未发现骨不连?肱骨头坏死?骨折再移位?结果:肩关节评价采用Constant绝对值评分方法,Constant评分为(92.2 ± 7.1)分,其中优28例,良6例,可2例,无差病例?优良率94.4%?36例末次随访时患侧肩关节活动范围:外展平均160.5° ± 12.4°,前屈上举平均155.2° ± 14.5°,外旋平均56.5° ± 12.5°,内旋平均62.3° ± 15.5°?3例出现针尾激惹,1例术后出现尺神经麻痹症状?结论:采用弹性髓内针逆行髓内固定技术治疗大龄儿童肱骨近端骨折具有创伤小?术中出血少,手术时间短,手术疤痕小,良好的肩关节功能等优点,是临床治疗大龄儿童肱骨近端骨折的理想方法?     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…