人工生物材料和医疗器具的安全性与可靠性

本文重点论述人工生物材料的可靠性、安全性及其保证措施。     

载瘤动脉闭塞术治疗颅内巨大动脉瘤的探讨

目的总结和探讨脑血管造影和载瘤动脉闭塞在治疗颅内巨大动脉瘤上的作用及特点。方法60例颅内巨大动脉瘤患者,根据其脑血管造影的特点采取血管内介入方法[可脱式球囊和(或)弹簧圈]闭塞载瘤动脉近端53例、闭塞载瘤动脉两端后孤立动脉瘤7例;其中23例闭塞前先行颅内-外血管搭桥术。结果出院时Rankin评分分级:单纯血管内介入治疗组37例中轻残3例,合并颅内-外血管搭桥术组23例中死亡1例、重残2例。1-6年的影像学随访动脉瘤无复发。结论血管内介入结合颅内-外血管搭桥术闭塞载瘤动脉是治疗颅内巨大动脉瘤的方法之一。     

外伤性延迟性脾破裂的诊断和治疗（附21例报告）

目的探讨外伤性延迟性脾破裂的发病规律、临床特点、诊断和治疗方法。方法结合国内外资料及本组病例进行回顾性分析。结果明确诊断16例，误诊为肝破裂2例，宫外孕破裂2例，脾肿瘤1例。21例均手术治疗，行脾切除14例，其中保留副脾2例；脾切除加自体脾组织网膜内移植术3例；脾缝合修补术3例；脾部分切除术1例。死亡1例，原因有就诊晚、失血性休克。结论本病由于腹腔内出血与受伤时间间隔长，容易误诊。诊断除依靠病史、临床表现外，应及时进行腹腔穿刺、B超及CT检查。治疗以脾切除为主，可根据病情、脾破裂的程度以及是否有合并伤等情况采取保脾手术。     

肩关节周围炎的循证针灸治疗

目的:从循证医学的角度,向临床医生介绍肩关节周围炎的循证针灸治疗方案的确立方法.方法:以一位具体的肩关节周围炎患者为例,介绍如何提出临床问题,怎样检索相关文献,如何对所检索的文献进行评价,如何结合本病例的具体情况和医生的个人经验,运用所检索的证据拟定治疗方案.结果:采用按照循证医学方法确立的肩关节周围炎的针灸治疗方案治疗15次后,患者生活质量明显好转.结论:通过临床提出问题、寻找证据、分析证据、循证决策、循证实践过程,不但患者可达到满意疗效,主管医生也提高了理论水平和临床能力.     

医用钛合金在三种不同生理电解液中的耐腐蚀行为研究

利用电化学方法研究医用钛合金在0.9%NaCl生理盐水，模拟人工唾液，模拟人工体液中的腐蚀情况，分析腐蚀电位和腐蚀电流密度，扫面电镜观察腐蚀表面形貌，CA-A型接触角测试仪测试钛合金表面被腐蚀后接触角的变化。实验表明：钛合金在三种生理电解液中的腐蚀情况依次是：模拟人工唾液〉模拟人工体液〉0.9%NaCl生理盐水。扫面电镜观察表明，医用钛合金在0.9% NaCl生理盐水腐蚀后，表面出现了许多腐蚀孔，经模拟人体体液腐蚀后，表面变得粗糙不平整，腐蚀孔数目变化不大，钛合金经人工唾液腐蚀后，腐蚀孔数目增多，部分腐蚀孔孔径明显增大。经三种生理电解液腐蚀后，钛合金表面接触角都减小。结论：医用钛合金在人工唾液中的腐蚀最严重，在临床应用中应给予相应的防范措施。     

多节段髓内星形细胞瘤的临床研究

目的 探讨不同年龄段、恶性程度不同的多节段髓内星形细胞瘤患者的诊治特点.方法 21例多节段(3个椎体节段以上)髓内星形细胞瘤患者均行后正中入路显微镜下肿瘤切除术,以UOA分值差(术后UOA和术前UOA差值)评估手术效果.以Logistic回归和多元线性同归分析统计学数据.结果 肿瘤性质直接影响肿瘤的切除程度(X2=10.41,P=0.03),高度恶性肿瘤只能大部切除或减压.年龄(X2=12.53,P=0.01)、肿瘤性质(X2=16.44,P=0.002)和部位(X2=27.12,P=0.04)影响近期手术效果(UOA分值差);青少年患者、低度恶性肿瘤手术效果较好,单纯累及胸段的患者手术效果差.结论 低度恶性或青少年多节段髓内星形细胞瘤患者应尽早手术,术后疗效满意.     

经前后路联合手术治疗L5S1椎体结核

目的 探讨一期经前路病灶清除后路植骨内固定治疗L5S1椎体结核的临床疗效.方法 对40例L5S1椎体结核患者,采用一期经前路病灶清除椎体间植骨加后路椎弓根螺钉内固定植骨融合治疗.结果 所有患者随访6～24个月,35例植骨融合良好,5例融合欠佳;有1例出现尿路感染.结论 一期经前路病灶清除椎体间植骨加后路椎弓根螺钉内固定椎板植骨治疗L5S1椎体结核能在彻底清除病灶的前提下保证脊柱的稳定性,提高植骨块的融合率和缩短患者卧床时间.     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

乳腺良恶性病变的磁共振T2*W首过灌注成像与血管生成相关性研究

Objective： To study the diagnostic value of T2^＊-weighted first-pass perfusion imaging in breast tumors. Methods： We analyzed the magnetic resonance imaging （MRI） information along with the pathological and immunohistochemistry results. Magnetic resonance imaging was performed in 28 patients with breast tumor. The time to signal intensity curves were generated according to the T2^＊-weighted first-pass perfusion imaging. The curve＇s maximal signal intensity drop rate and maximal signal intensity decrease time were analyzed and compared with the pathological diagnoses after surgery. Results： Malignant breast lesions showed higher maximal signal intensity drop rate （44.69% ± 17.07 vs. 17.22% ±7.49, P 〈 0.001） than benign lesions, but there was no significant difference of maximal signal decrease time between those two lesions （23.94 s ± 4.92 vs. 20.02 s ± 6.83, P 〉 0.05）. Conclusion： The T2^＊-weighted first-pass perfusion imaging has enough sensitivity and specificity in breast tumor diagnosis.     

加强行业管理规范人体器官移植技术

人体器官移植技术历经近半个世纪的发展历程．在上个世纪70年代我国逐步开展对肝脏、心脏和肾脏等器官移植技术的研究工作。近5年来，随着国际医学研究交流频繁，国内一些大型医疗机构加大了对器官移植技术上的投入．使人体器官移植技术发展迅猛。但同时也伴随着一些医疗费用过高、买卖供体等问题的出现。因此，如何规范人体器官移植技术．是当前的一个重要研究课题。