髂骨前区外侧面的血液供应

髂前上棘至髂嵴结节间的髂翼部较厚,是临床骨移植常用的供骨区。Taylor及苗华等研究髂嵴前部的血液供应状况,作了旋髂浅、深动脉的调查。为了给经髂骨外侧取骨提供有关资料,我们着重对臀上动脉深支的上支和旋股外侧动脉交通支,对髂骨前区外侧面的血液供应进行了观察。     

缝匠肌髂骨瓣移植的解剖学研究

为临床应用缝匠肌髂骨瓣移植治疗股骨头缺血性坏死提供解剖学上的依据.在6具(12侧)灌注红色乳胶的成人尸体标本上,对供应缝匠肌髂骨瓣血管的人肌位置、入肌外径及其在髂骨瓣的分布进行观测.结果显示股深动脉分支、旋股外侧动脉横支及降支分别在距髂前上棘(10.8±1.2)cm、(¨.2±2.1)cm、(1 6.3±2.5)cm进入缝匠肌,入肌外径分别为(3.0±0.2)mm、(2.9±0.1)mm、(2.8±0.1)mm,在髂骨分布范围分别为2.0 cm×3.5 cm、2.0 cm×3.0 cm、2.0 cm×2.8 cm.缝匠肌髂骨瓣血供丰富,提示选择分离缝匠肌蒂的最佳长度为(10.8±1.2)cm.     

股骨颈骨折不同植骨方法效果分析

目的：报道采用不同植骨方法治疗股骨颈骨折的效果。方法：对98例股骨颈骨折行开放复位内固定后采用游离髂骨移植、带旋髂深动脉蒂髂骨块移植、带臀上动脉深上支蒂髂骨块移植、带缝匠肌肌蒂髂骨块移植及带股方肌肌蒂骨块移植等方法。结果：术后6,12和24月分别进行X光照片检查,游离髂骨移植15例,术后1年骨折愈合率为26．9％;带旋髂深动脉骨移植32例,术后1年骨折愈合率为71．9％;带臀上动脉深支骨移植25例,术后1年骨折愈合率为68％,带缝匠肌肌蒂骨移植14例,术后1年骨折愈合率为64．3％。带股方肌肌蒂骨移植12例,术的1年骨折愈合率为58．3％。骨折愈合率基底型骨折达96．6％（29／30）,头下型骨折为37．5％（12／32）。上述病例术后6月骨折愈合率均较低于1年,但2年骨折愈合率与术后1年无区别。结论：五种植骨方法中,带肌蒂或血管蒂骨移植均可达到较好效果,而以带肌蒂骨块移植更易于操作而值得推广。在骨折在类型方面,基底型骨折治疗效果最好,经颈型骨折次之,头下型骨折更次。因此,对头下型骨折应慎重选择带血管蒂或带肌蒂骨移植。     

髂嵴前部血供的解剖学研究及其临床意义

目的 :为合理应用带血管蒂髂嵴前部骨瓣转位或移植术提供解剖学依据。方法 :在 32侧经动脉内灌注红色乳胶的成人标本上 ,解剖观测供应髂嵴前部血管的起源、走行、分支、分布、外径和吻合情况。结果 :髂嵴前部存在着丰富的血供 ,主要由旋髂浅动脉 ,旋髂深动脉 ,旋股外侧动脉升支 ,臀上动脉深上支构成 ,其分支在髂嵴前缘相互吻合成网 ,每支血管各有特点 ,有很强的互补性。结论 :临床可根据不同需要选择带合适血管蒂的髂嵴前部骨瓣行移位或移植术 ,并利用其互补性选择最佳术式。     

游离髂骨骨皮辨移植

1978年Taylor报告二例游离旋髂浅血管髂骨骨皮瓣。1979年Taylor对髂骨血供进一步研究,从50例旋髂深血管解剖研究发现旋髂深血管髂骨骨皮瓣更优于旋髂浅血管     

髂骨移植的显微外科解剖学研究

作者比较系统的观察了50具尸体(100侧)的髂骨及100侧干性髂骨,并做了血管的局部墨汁灌注和X线血管造影。对髂骨及其血管的位置、形态、口径、长度,以及考虑到手术显露中所需要的局部关系等,做了比较详细的研究。作者认为髂骨质疏松,可塑性大,血液供应丰富,充填确实,承重较好,且有适当的截取长度,故力理想的移植供区。按游离显微血管髂骨移植的要求:臀上动脉、旋髂深动脉、第三腰动脉作为髂骨移植的血管蒂的条件是很优越的;旋股外侧动脉、旋髂淺动脉适于作骨肌皮瓣复合组织的移植蒂;旋股外侧动脉适于作股骨头、颈骨内移植血管;第四腰动脉、髂腰动脉不适用于骨移植的血管蒂。     

左前臂旋髂深血管浮标式复合组织移植一例

患者女性.11岁,住院号7336.左尺骨开放性骨折清创、钢板螺钉内固定后半年,于1985年11月4日入院.检查:左前臂中下1/3尺侧有异常活动.前臂旋转受限.X线摄片见左尺骨中下1/3接骨板固定,尺骨缺损长度约4cm. 入院后一周,在持续硬脊膜外麻醉及臂丛阻滞麻醉下行左前臂带旋髂深血管浮标式复合组织瓣移植术.在股动脉搏动消失点至髂嵴中点连线作切口线,并设计棱形皮肤约1.5×2cm.在股三角处显露股动静脉,于髂前上棘处紧贴骨面切断腹股沟韧带,在其附近找出沿髂嵴内唇上走行的旋髂深血管的主干和终支.然后游离髂骨块,在骨内侧面将髂肌与旋髂深血管分离出来.将髂肌纤维牵开即可触及髂骨内板,确保旋髂深血管进入髂骨的各小分支完好无损.按需要量从内壁切取4×2×1cm骨块.骨块上各层组织和浮标皮肤成完整梯形.逆向解剖血管蒂,蒂长约8cm.用盐水纱布包裹复合组织髂骨块.置髂窝备用.     

腹横肌修复膈缺损的初步研究

目的为带蒂腹横肌瓣转位修复膈缺损提供解剖学基础.方法在40侧新生儿尸体标本上,解剖观测腹横肌的形态、血供及神经支配.结果1)腹横肌肌性部厚度平均为(0.98±0.22)mm,与腱膜部移行处的长度平均为(10.35±1.78)cm,平脐高度的宽度平均为(4.88±1.05)cm,腱膜部平均宽度(2.62±0.51)cm.2)腹横肌血供为多源性,由肋间后动脉、肋下动脉、腰动脉、旋髂深动脉升支供血,位置恒定.结论设计带蒂腹横肌瓣转位修复膈缺损具有可行性.     

用旋髂深血管游离复合髂骨瓣重建下颌骨缺损(摘要)

自1980年,我们对旋髂深血管游离复合髂骨瓣进行了研究,并用此瓣重建了4例下颌骨缺损,均获成功。解剖研究在20例成人尸体上,对旋髂深血管的走行进行了观察和比较;并在7例新鲜尸体上,进行了旋髂深动脉的墨水灌注,以观察其供区。旋髂深动脉在腹股韧带中点的后上方起自髂外动脉,起     

带旋髂深动脉的髂骨瓣移植治疗青壮年股骨颈骨折

目的: 用带血管蒂的髂骨瓣移植入股骨头颈内,重建股骨头颈的血液循环,防止股骨头缺血坏死,促进骨折愈合.方法: 游离旋髂深动脉至其分枝进髂骨处,切取带髂骨膜的骨瓣,以血管蒂为轴沿髂腰肌下隧道植入股骨头颈骨槽内.结果:术后经1～4年随访, 优良率达92.6%.结论:旋髂深动脉解剖位置恒定,变异少,血供充足,血管蒂长,并有相应静脉回流,形成一完整的循环系统,移植后的骨块有直接成骨能力,能加速骨折愈合,防止股骨头缺血坏死.本术式疗效好、方法简单、易掌握、无并发症等优点.     

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…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

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.