手术治疗胫骨平台骨折34例疗效观察

目的总结手术治疗胫骨平台骨折的疗效。方法回顾性分析胫骨平台骨折手术患者34例,骨折类型按Schatzker分型,其中Ⅰ型7例,Ⅱ型9例,Ⅲ型5例,Ⅳ型7例,Ⅴ型6例,Ⅰ型骨折采用切开复位松质骨拉力螺钉固定,其他类型采用切开复位、钢板螺钉内固定,缺损塌陷处自体或同种异体骨植骨。结果 34例患者均获得随访,随访时间为7-38个月,平均18个月,功能评价采用Hohl膝关节功能分级系统,临床结果优良率达85.3%。结论手术内固定是治疗胫骨平台骨折的重要方法 ,术中解剖复位应根据不同分型给予牢固内固定,早期正确功能锻炼能够提高手术效果。     

RüediⅡ、Ⅲ型Pilon骨折的手术治疗

目的:研究应用切开复位内固定或(和)外支架固定治疗RüediⅡ、Ⅲ型Pilon骨折。方法:对23例胫骨远端平台骨折(Pilon骨折),Rüedi分型:Ⅱ型9例,Ⅲ型14例。均作切开复位,16例行内固定,7例行螺钉、克氏针内固定合并外支架固定。结果:本组23例随访6￣38个月,骨折均愈合。疗效:优13例,良5例,可3例,差2例。结论:根据软组织条件行切开复位内固定或(和)外支架固定是治疗RüediⅡ、Ⅲ型Pilon骨折合理有效的方法。     

胫骨平台骨折43例临床分析

目的探讨胫骨平台骨折治疗措施及合并症的处理方法。方法本组43例,按照Hohl氏分类,Ⅰ型9例,Ⅱ型21例,Ⅲ型13例。对所有Ⅰ型患者均行非手术治疗,对骨折移位明显的Ⅱ型、Ⅲ型共32例患者切开复位内固定。结果经6个月-8年随访,优良率达82％。结论作者认为对胫骨平台骨折手术治疗要应用坚强的内固定,以便早期行膝关节功能锻炼,对合并症也要及时合理进行同步治疗,对骨折塌陷部位要植骨。     

膝关节镜引导微创复位内固定治疗胫骨平台骨折的临床研究

目的:探讨膝关节镜引导微创复位内固定在治疗胫骨平台骨折中的效果和临床价值。方法:选取2011年1月至2013年12月间本院收治的64例胫骨平台骨折患者,分为实验组和对照组,每组32例,实验组采用膝关节镜引导微创复位内固定治疗,对照组采用传统的切开复位内固定治疗。比较两组患者的恢复优良率,手术出血量,切口长度,骨折愈合时间。结果:实验组的功能恢复情况优良率较对照组患者的高,在出血量、手术切口长度及骨折愈合时间方面,也较对照组患者少、短。差异均具有统计学意义(P<0.05)。结论:胫骨平台骨折在膝关节镜引导下微创复位内固定治疗具有很高的临床应用价值,是安全和有效的,值得临床推广应用。     

胫骨髁间隆突骨折手术治疗的临床分析

目的：寻求简单、有效的方法治疗胫骨髁间隆突骨折，恢复前交叉韧带的长度与张力，保持膝关节的稳定性。方法：对15例因外伤造成的胫骨髁间隆突骨折，采用“切开复位加钢丝内固定术”。术后石膏固定6周，开始膝关节功能锻炼。结果：15例患均得随访半年－5年，按王氏方法评定疗效：优12例，良3例，优良率达100％。结论：切开复位加钢丝内固定术治疗胫骨髁间隆突骨折方法简单、有效，临床使用疗效满意。     

复杂型胫骨平台骨折76例内固定手术疗效分析

目的:探讨复杂型胫骨平台骨折内固定手术治疗的临床疗效。方法:回顾性分析76例复杂型胫骨平台骨折患者,经切开复位并采用L型或T型加压钢板及高尔夫解剖钢板进行内固定手术的疗效。结果:76例骨折均愈合良好,经6月至6年随访,按Merchant评分标准评价,患者膝关节功能优24例、良32例、可12例、差8例,总优良率达73.68%,伤口一期愈合率89.47%,术后经积极膝关节功能锻炼后,膝关节伸屈功能90%以上得到恢复。结论:采用L型或T型加压钢板及高尔夫解剖钢板治疗SchatzkerⅣ型、Ⅴ型、Ⅵ型复杂型胫骨平台骨折,可以减少骨折的塌陷并达到关节面的解剖复位,其内固定牢固,经术后早期不负重膝关节适度功能锻炼,可取得较满意的疗效。     

关节镜辅助下手术治疗胫骨平台骨折

目的:探讨关节镜辅助下的胫骨平台骨折手术的方法和效果。方法:应用关节镜辅助治疗胫骨平台骨折18例,按Schatzker分型,I型5例,Ⅱ型7例,Ⅲ型4例,Ⅳ型2例。术后随访3～16个月。结果:未出现关节内感染、骨折不愈合、内固定松动及骨筋膜室综合征等术后并发症。随访后X线片显示18例患者关节面残留台阶均小于2mm,无骨性关节炎表现,未出现胫骨平台的再塌陷。按照Lysholm膝关节评分标准,18例患者平均90.3分(71～95分),膝关节活动度平均110°(95～125°)。结论:关节镜辅助下手术符合现代微创手术的治疗原则,具有创伤小,直视下手术,诊断更明确,安全性高,可协助处理关节内结构的损伤,使感染概率减小,恢复快等优点,因此在合适的患者群中值得优先选择。     

胫骨平台双髁骨折治疗体会

目的:探讨胫骨平台双髁骨折的手术治疗经验。方法:12例胫骨平台骨折类型按schatzker分型均为Ⅴ型骨折,给予手术切开复位,双钢板内固定。结果:12例中11例随访12~24个月,按日本作者提出的适用于一般膝关节损伤患者的功能评定方法平均88分。结论:胫骨平台双髁骨折采用双钢板内固定是一种可靠的方法。     

关节镜辅助下微创内固定系统治疗胫骨平台骨折的临床疗效

目的 探讨关节镜辅助下微创内固定系统(LISS)治疗胫骨平台骨折的临床疗效。 方法 回顾性分析浙江省人民医院2013年7月—2015年1月期间50例经6个月以上随访的胫骨平台骨折患者的临床资料,均在关节镜辅助下采用微创内固定系统对骨折进行治疗。首先在关节镜下探查半月板、韧带等软组织损伤情况并进行修复,之后在关节镜辅助下复位骨折并采用微创内固定系统对骨折进行固定,术后进行循序功能锻炼。定期复查并记录患者术后并发症发生的情况、关节活动度改变情况、骨折愈合情况并采用Rasmussen评分系统对患者膝关节功能进行评价。 结果 上述所有患者术后6个月内出现骨折畸形愈合3例,手术切口坏死或感染2例;术后6个月患者膝关节屈膝达75°115°,平均(93.4±7.8)°;伸膝为0°15°,平均(3.9±1.8)°;骨折临床愈合时间为2.5~7.0个月,平均(3.8±1.1)个月;采用Rasmussen评分系统对患者膝关节功能进行评价,显示治疗优良率为88%。 结论 关节镜辅助下微创内固定系统治疗胫骨平台骨折能够在关节镜监视下对骨折进行复位,有利于关节面及下肢力线的恢复,促进关节功能的恢复,具有创伤性小、并发症少、视野良好等优点,值得临床推广。      

踝关节外固定支架治疗胫骨远端爆裂骨折

目的:探讨踝关节外固定支架治疗胫骨远端爆裂骨折(Pilon 骨折)的临床疗效.方法:随访2003～2009年治疗的胫骨远端爆裂骨折28例.骨折类型按Ruedi和Allgower分型:Ⅰ型11例,Ⅱ型9例,Ⅲ型8例;24例合并腓骨骨折.胫骨均采用可活动踝关节外固定支架结合小切口切开复位克氏针和/或螺钉有限内固定固定,腓骨用1/3管状钢板内固定.结果:平均随访22个月,根据Mazur踝关节症状与功能系统评价标准:优21例,良6例,可1例,优良率96.43%.结论:可活动踝关节外固定支架结合小切口切开复位克氏针和/或螺钉有限内固定固定,操作简便,对骨折局部血循环干扰少,可早期活动踝关节,是治疗胫骨远端爆裂骨折一种较好的选择.     

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…