自固化磷酸钙人工骨修复骨缺损的临床观察

目的评价自固化磷酸钙人工骨修复骨缺损的临床效果。方法对8例骨缺损患者应用自固化磷酸钙人工骨进行手术植入治疗，其中5例单纯用自固化磷酸钙人工骨植入，3例取自体髂骨与自固化磷酸钙人工骨混合后植入，进行连续6～12个月的临床观察。结果所有患者无不良的局部和全身反应。X线片显示，术后3个月自固化磷酸钙人工骨植入区与缺损周围的骨组织之间界限模糊，有新生骨形成：6个月自固化磷酸钙人工骨植入区明显有新骨长入，自固化磷酸钙人工骨与骨组织融为一体、骨缺损已基本修复。3～6个月自同化磷酸钙人工骨的密度逐渐减低。结论自固化磷酸钙人工骨具有良好的生物相容性和骨传导作用，其内连接结构既可以保持一定的刚度和强度，又便于骨组织长入；其理想的生物降解效应更有利于骨组织的改建和塑性。     

同种异体兔骨髓间充质干细胞复合纳米晶胶原基骨修复胫骨缺损的实验研究

目的探讨同种异体兔骨髓间充质干细胞（marrow mensenchymal stem cells，MSCs）与纳米晶胶原基骨（nano—hydroxyapatite／collagen，NHAC）修复材料构建的组织工程骨修复兔胫骨缺损的可行性。方法24只新西兰大白兔胫骨中段形成10mm长的骨缺损，右侧骨缺损处植入组织工程骨作为实验组，左侧骨缺损处植入单纯NHAC作为对照组。术后3、6、9、12wk分批处死动物，行一般情况、缺损区大体观察、X线、组织学染色分析等指标检测，行统计学分析，比较各组修复骨缺损的效果。结果24只新西兰大白兔均进入结果分析。①术后一般情况：各组兔术后恢复及进食均正常，伤口无炎症反应，愈合良好。②大体观察：实验组术后6wk骨缺损部分修复，9、12wk骨缺损完全修复，3、6、9、12wk骨缺损修复情况明显好于对照组。③X线：实验组缺损区术后3wk可见有骨痂生长，9wk骨缺损基本修复，对照组术后12wk缺损区基本修复，各观察时间点实验组骨缺损修复情况明显好于对照组。④组织学染色：实验组缺损区新生类骨样组织、编织骨和板状骨出现的时间较对照组早，并且不经软骨介导即可直接成骨，而对照组以“爬行替代”方式修复骨缺损。结论同种异体兔MSCs复合NHAC修复骨缺损的能力较单纯NHAC强且迅速，能够对大段骨缺损进行快速有效的修复。     

同种异体复合自体骨移植治疗骨感染后大段缺损

目的评价大段同种异体骨复合自体骨移植修复骨感染后大段骨缺损的临床效果。方法2000年4月~2006年5月对15例长骨感染后大段骨缺损患者采用锁钉固定并同种异体骨复合自体骨移植。结果经14个月至5年随访,术后1例感染复发,经再次手术后治愈;其余骨折愈合良好,感染无复发。结论同种异体骨为一种良好骨植入材料,由于其来源较广,应用方便,复合自体骨可应用于骨感染后造成的大段骨缺损。     

外伤性胫骨平台骨折手术治疗分析

目的：总结手术治疗胫骨平台骨折的临床疗效。方法：对86例胫骨平台骨折切开复位内固定，骨缺损同时予以植骨。结果：86例随访2—36个月，平均18个月，优良率83．4％。结论：对胫骨平台骨折采用切开复位内固定，骨缺损同时予以植骨是有效方法。     

塑形钛钢板内固定治疗跟骨骨折

目的：探讨塑形钛钢板在跟骨骨折中的应用价值。方法：治疗19例（21足）跟骨骨折，均采用塑形钛钢板内固定，其中2足应用自体髂骨植骨。结果：平均随访11．5个月，按照Maryland足部评分系统标准，优良率为90．5％。结论：塑形钛钢板治疗跟骨骨折，固定牢靠，术后可早期功能锻炼，减少骨折后的并发症，是一种良好的跟骨内固定方法。     

异型TCP钢板内固定治疗胫骨平台骨折28例

对28例胫骨平台骨折根据骨折部位及类型采用膝前内或外侧纵切口，复位骨折后先用2枚克氏针交叉临时固定，若有骨缺损，植入髂松质骨块垫平关节面。内髁骨折选用T形、外髁骨折选用匙形TCP钢板(也称高尔夫钢板)塑形后置于胫骨内、外侧支撑固定；钢板上端交叉拧入两枚φ6．5mm松质骨拉力螺钉，螺纹应通过骨折线并穿透对侧骨皮质。术后行下肢关节功能锻炼器(CPM)锻炼，负重不少于术后3个月。全组病例随访6～24个月。平均14个月，结果骨折均愈合，参照马元璋对膝关节功能评分来评定，疗效优9例，良15例，中3例，差1例，优良率为85．71％。认为具有“支撑”作用的TCP异型钢板固定，不仅可以支撑骨皮质，还可以固定钢板近端的螺钉，阻止钢板下骨的移动，固定效果较为肯定。     

同种异体骨和自体骨髓移植治疗骨不连

目的：探讨用同种异体骨和自体骨髓移植治疗骨折不愈合的疗效。方法：自1997年6月至2003年6月，采用同种异体骨和自体骨髓移植治疗骨不连患者26例。采用抽取自身红骨髓混合同种异体骨植入骨折处，并选用合适的固定材料固定。结果：26例全部获得随访，时间为6个月-26个月，平均16个月。最终获骨折愈合。X线显示：骨折线消失，有连续骨痂形成。结论：自体骨髓移植在骨不连部位有良好的成骨作用，配合同种异体骨植入治疗和预防骨不连效果确切，疗效满意，有临床应用价值。     

碱性成纤维细胞生长因子和异体下颌骨复合移植的实验研究

目的：探讨碱性成纤维细胞生长因子(b-FGF)对异体下颌骨移植后再血管化及骨改建的影响，评价b-FGF和异体骨复合移植修复下颌骨缺损的临床价值。方法：在20例双侧下颌骨缺损的兔模型中，左侧植入b-FGF和异体骨修复作为实验组，右侧单纯异体骨修复作为对照组。植入后1个月、3个月分别行墨汁明胶血管灌注透明法及组织学观察再血管化及骨改建的情况。结果：b-FGF 异体骨组血管化较异体骨组完全，骨形成也较异体骨组早且充分。结论；b-FGF可促进异体下颌骨移植后再血管化，在骨改建过程中有骨诱导作用，b-FGF和异体骨复合移植是一种有临床应用前景的骨缺损修复方法。     

珊瑚—bBMP复合人工骨治疗骨缺损的临床应用研究

目的：评价珊瑚-牛骨形态发生蛋白（bBMP)复合人工骨临床治疗骨缺损的疗效。方法：应用珊瑚-bBMP复合人工骨治疗21例不同情况骨缺损患。术后随访观察3-15个月，根据患恢复情况做出评价。结果：随访病例骨缺损均于4-6月得到满意修复，肢体功能恢复良好。结论：珊瑚-bBMP复合人工骨修复骨缺损疗效确切，是一种较为理想的骨缺损修复材料。     

生物陶瓷复合自体骨髓液治疗骨缺损

目的 探讨生物陶瓷复合自体骨髓液治疗骨缺损的临床疗效.方法 对48例骨缺损患者采用复合自体骨髓液的贝奥路生物陶瓷（β-磷酸三钙）手术植入治疗,术后随访8～32个月,平均24个月,定期行X线检查.结果 所有患者均无不良反应发生,切口一期愈合,X线片显示：术后1个月生物陶瓷替代骨和宿主骨接触界面变模糊,有新骨形成 2个月骨壁增厚,新骨生成明显,生物陶瓷雪片样崩解 4～6个月时骨缺损基本修复,骨皮质明显增厚,骨密度和健侧相近,髓腔形态改建 18～24个月生物陶瓷完全降解.骨愈合率为100%,平均骨性愈合时间4.5个月.结论 复合自体骨髓液的生物陶瓷能有效地修复骨缺损,是一种充满前景的骨移植替代材料.     

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…