腰椎融合术治疗原位复发性腰椎间盘突出症

目的探讨原位复发性腰椎间盘突出症再次手术的原因、手术方法及疗效。方法我院自2000年6月～2005年11月共收治17例原位复发性腰椎间盘突出症患者均采取椎板扩大开窗、椎间颗粒植骨融合、椎弓根钉内固定术,术后随访1～5年（平均19.7月）,进行回顾性分析。结果椎间植骨融合率为94.1%;按Macnab疗效评定标准,优良率为88.2%。结论原位复发性腰椎间盘突出症的主要原因是髓核组织摘除不彻底,神经根粘连,并伴随不同程度的椎管狭窄和腰椎不稳。明确诊断、严格掌握手术指征、认真细致地进行手术操作,可减少或避免手术并发症,取得优良的疗效。     

A quantitative evaluation of sealing ability of 4 obturation techniques by using a glucose leakage test.

OBJECTIVE: The aim of this study was to evaluate the sealing ability of 4 different obturation techniques by using a glucose leakage test. STUDY DESIGN: Eighty extracted single-rooted maxillary incisors were selected for the study. The teeth were decoronated and the root canals prepared using ProFile rotary instruments to an apical dimension of size 40 (0.06 taper). The specimens were then randomly divided into 4 experimental groups (n = 15) and filled with gutta-percha and sealer by using either cold lateral compaction, warm vertical compaction, Thermafil, or the E & Q Plus system. Another 10 teeth each served as the positive and negative controls. A glucose leakage model was used for quantitative evaluation of the coronal-to-apical microleakage at 24 hours, 1, 2, 3, 5, 8, and 12 weeks. RESULTS: No significant difference in the cumulative amount of leakage was found among the 4 groups at 24 hours and 1 week (Kruskal-Wallis test, P > .05). Lateral compaction showed significantly more leakage than the other 3 techniques at longer intervals (Mann-Whitney U test, P < .008). No significant difference was found between vertical compaction, Thermafil, and E & Q Plus at all observation times. CONCLUSIONS: Warm vertical compaction, Thermafil, and the E & Q Plus system showed a better sealing result than cold lateral compaction of gutta-percha at extended observation periods. The glucose leakage method used in this study was able to provide a nondestructive, quantitative, and long-term evaluation of the sealing ability of root canal fillings.     

重组人骨形态发生蛋白4基因腺相关病毒载体对兔骨髓基质干细胞生物学行为的影响

目的应用重组人骨形态发生蛋白4基因腺相关病毒载体(AAV-hBMP4)转染兔骨髓基质干细胞(BMSCs),观察其对BMSCs生物学行为的影响,从而为骨组织工程寻找理想的病毒载体及种子细胞。方法全骨髓法培养兔BMSCs,按感染复数(MOI)值不同设定为四组,分别转染兔BMSCs,观察病毒量对细胞形态的影响。选取影响最小的MOI值,进行后续实验。转染兔BMSCs,MTT法描记细胞生长曲线,观察AAV对细胞增殖活性的影响。以重组增强型绿色荧光蛋白基因的腺相关病毒载体(AAV-EGFP)为参照,行流式细胞仪检测,计算转染效率。AAV-hBMP4与对照病毒AAV-EGFP分别转染细胞,观察细胞形态,行碱性磷酸酶(ALP)染色、Von Kossa染色及ALP含量测定,观察成骨活性。兔肌袋实验观察异位成骨情况。结果MOI值为5×10~4 vg/cell时,AAV对细胞形态影响最小,以此值进行后续实验。AAV转染后,细胞增殖活性良好,转染效率为55％～65％。AAV-hBMP4转染后,细胞形态呈现典型的成骨改变,ALP染色及Von Kossa染色均出现成骨的特征性改变,而AAV-EGFP组无上述改变。细胞上清ALP含量测定显示,实验组ALP含量显著增高,与对照组比较差异有统计学意义(t=218．65,P＜0．01)。兔肌袋实验术后4周组织学检测可见大量钙盐沉积,矿化结节形成。结论AAV-hBMP4转染效率高,对BMSCs的增殖活性影响小,AAV-hBMP4转染的BMSCs可望成为组织工程化骨的理想种子细胞。     

经导管局部溶栓治疗髂-股静脉血栓:58例回顾性分析

目的　探讨经导管局部溶栓治疗髂 股静脉血栓的效果及临床应用中的有关问题。资料与方法　对 5 8例髂 股静脉血栓形成患者 (病程 <4周 4 5例 ,>4周 13例 ) ,采取经导管血栓局部灌注尿激酶 ,尿激酶先团注2 5 0 0 0 0U ,然后以 12 5 0 0 0～ 15 0 0 0 0U/h持续灌注。结果　全组溶栓治疗时间 4～ 5 6h ,平均 36h ,尿激酶用量75 0 0 0 0～ 72 5 0 0 0 0U ,平均 4 70 0 0 0 0U。阻塞段完全开通 (残存狭窄率 <30 % )者 30例 ,部分开通者 2 3例 ,无效 5例 ,有效率达 91.4 %。对残存狭窄率 >30 %的 2 3例 ,14例行经皮球囊血管成形术 (PTA)治疗 ,9例行PTA及内支架治疗。 6例溶栓前放置下腔静脉过滤器。本组无严重并发症及肺栓塞发生。结论　经导管血栓局部灌注尿激酶是治疗髂 股静脉血栓的安全、有效方法。溶栓术后继续肝素全身抗凝治疗可增强溶栓疗效     

内窥镜下手术在眼科的应用

近年来，内窥镜下手术在眼科的应用有了很大进展，并且逐渐展现出其创伤小、并发症少、直视下操作、安全有效的优点。眼内窥镜联合激光可应用于青光眼前房角手术、青光眼睫状体光凝术、周边部视网膜玻璃体手术等等；另外泪道内窥镜在泪器疾病中的应用、鼻内窥镜在鼻眼相关手术中的应用也有很大的发展。眼内窥镜的应用开创了眼科微创手术时代。本文就眼用内窥镜的基本工作原理、应用现状和发展前景进行综述。     

The Application of Topical Anesthesia Combined with Subconjunctival Anesthesia for Glaucoma Surgery

Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5％ Alcaine eye drops combined with subconjunctival anesthesia with 2％ Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes (85.2％) were painless (Grade Ⅰ), 50 eyes (14.0％) were slight painful (Grade Ⅱ), and 3 eyes (0.8％) were more painful (Grade Ⅲ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow vi     

应用腔镜技术治疗肝内外胆管结石的临床研究

目的探讨腔镜技术在治疗肝内外胆管结石中的合理应用. 方法应用腹腔镜结合十二指肠镜和纤维胆道镜治疗96例肝内外胆管结石,其中胆囊结石合并胆总管结石72例,单纯胆总管结石16例,左肝管结石合并胆总管结石8例.主要术式包括腹腔镜胆囊切除联合EST(37例)、腹腔镜胆囊切除术结合胆道镜胆道探查术(54例)、腹腔镜下左肝叶切除联合胆道镜胆管探查术(5例). 结果 96例中,93例术后复查无残留结石.4例出现少量胆漏,平均10天内自愈,无其它严重并发症发生.3例中转开腹手术,其中2例由于存在高位胆管狭窄,1例由于肝门部严重粘连水肿. 结论腔镜治疗肝内外胆管结石可行,合理应用多种腔镜技术治疗肝胆管结石,可以达到安全、有效和微创的目的.     

中药敷脐治疗胸腰椎术后腹胀便秘的效果观察

目的探讨使用大黄厚朴煎剂热敷脐部治疗胸腰椎术后患者腹胀、便秘的疗效。方法选择2005年1月至2006年12月中山大学第二医院骨外科胸腰椎术后出现腹胀便秘的患者80例。分成两组,治疗组用大黄厚朴煎剂热敷脐部;对照组使用开塞露塞肛。观察两组患者肛门排气,排便,腹胀消除及停药复结情况。结果治疗组的总有效率95%,对照组总有效率70%;停药复结情况:治疗组5%,对照组42.5%;腹胀减轻情况:治疗组95%,对照组52.5%。结论大黄厚朴煎剂热敷脐能有效减轻肠胀气,软化大便,对于消除胸腰椎术后患者腹胀便秘明显优于使用开塞露塞肛效果。     

Behcet's disease: global perspective

Behcet's disease (BD) is a vasculitis progressing by attacks and remissions. There are actually four nationwide surveys of BD; Iran (5059 patients), Japan (3316 patients), China (1996 patients), and Germany (590 patients). There are four major case series in the world, Turkey (2147 patients), Korea (1155 patients), Morocco (1034 patients), and UK (419 patients). Other series are based on less than 200 patients.Mucous membrane manifestationsOral aphthosis is seen in 98% of patients (average from the above-mentioned countries). Genital aphthosis occurs less frequently (73%).Skin manifestations are seen in 74% of patients. Behcet's pustulosis (pseudofolliculitis) is seen in 61% of patients in Iran. Erythema nodosum is seen in 22% of patients in Iran. They are more frequent in China and Korea.Ocular manifestations are seen in 51% of patients (anterior uveitis, posterior uveitis retinal vasculitis).Joint manifestations are seen in 39% of patients (arthralgia, monoarthritis, oligo/polyarthritis, ankylosing spondylitis).Neurological manifestations are seen in 7.3% of patients. They are mainly central manifestations due to parenchymal lesions.Gastrointestinal (GI) manifestations are seen in 9% of patients (produced by aphthous ulcers of the intestinal tract).Vascular involvement occurs in 11% of patients. Arterial involvement is rare. In Iran it is seen in 0.6% of patients. Deep vein thrombosis is seen in 6%, large vein thrombosis in 1.2%, and superficial phlebitis in 2.3%.Other lesionsOrchitis and epididymitis were seen in 5.6% of patients in Iran. Cardio-pulmonary manifestations were rare, seen in only 1.4% of patients in Iran.Laboratory findingsErythrocyte sedimentation rate was normal in 43.5% of cases in Iran. Urinary abnormalities were infrequent and transient (9.8% in Iran). Proteinuria was seen in 2%, hematuria in 4.6%, leukocyturia in 5.1%, and cast in 0.3% of cases. Pathergy test was positive in 57.4% and HLA-B51 in 34% of patients.ConclusionBD is a systemic disease with various manifestations. It progresses by attacks and remissions. Lesions usually heal without sequela, except for eyes, brain, and vascular system. The main manifestations are mucocutaneous. The major cause of morbidity is the ocular lesion, which leads to severe loss of vision or blindness.     

再次肝移植治疗移植肝失功能22例报告

目的 总结再次肝移植治疗移植肝失功能的临床经验。方法 回顾分析2004年1月至2006年6月期间中山大学附属第三医院施行22例再次肝移植受者的临床资料，结合文献加以讨论。再次肝移植的原因分别为移植术后胆道并发症（12例）、移植术后肝癌复发（4例）、肝动脉栓塞（2例）、肝动脉狭窄（2例）以及乙肝复发（2例）。再次移植率为3．62％，供肝植入均采用改良背驮式肝移植技术。结果 全组无手术死亡，8例随访至今分别存活21、14、8、3个月各1例，12、1个月各2例；14例存活2周到28个月不等。首次肝移植术后8～30d行再次肝移植病人围手术期病死率最高，为66．7％；1年内死亡10例，主要死亡原因为感染（60％）。结论 再次肝移植是移植肝失功能的惟一有效的治疗方法，正确掌握手术时机及适应证，钻研手术技巧，合理的个体化免疫抑制方案以及围手术期有效的抗感染治疗是提高再次肝移植病人存活率的关键。