老年糖尿病患者人工股骨头置换术的围手术期护理

老年糖尿病患者行人工股骨头置换术的机率日益增高，其手术的危险性大，并发症多。近一年来，我科收治老年糖尿病患者行人工股骨头置换术共19例，治疗效果满意。现将护理经验报告如下。     

脊髓损伤移植治疗的研究进展

脊髓损伤后的修复是一个极具挑战性的课题，组织或细胞移植可能是极具治疗前景的方法之一。脊髓损伤后移植治疗的目的在于;提供适合轴突再生的基质；桥接损伤后形成的缝隙；替代补充死亡的神经细胞；作为基因治疗的载体等几个方面。移植采用的组织和细胞多种多样，目前部分研究已经在动物实验中取得了令人满意的效果。     

CT引导下经皮螺钉固定治疗骶髂关节骨折脱位

目的 探讨应用CT引导经皮螺钉固定治疗骶髂关节骨折脱位的适应证、手术方法及临床效果。方法 牵引复位后，局部麻醉下CT引导经皮螺钉固定骶髂关节骨折脱位12例，其中男8例，女4例；年龄25—48岁，平均36．2岁。按照AO骨盆环损伤分型方法：B型8例，其中B1型5例，B2型3例；C型4例，其中C1型2例，C2型2例。患者取俯卧位，进行骶髂关节处局部麻醉。采用髂骨翼后侧进针点，根据局部解剖标志确定进针方向，经皮钻入3根克氏针，CT扫描选择置入位置正确的克氏针，拧入空心拉力螺钉。结果 手术平均时间52min。12例患者均获随访，时间9—37个月，平均17．6个月，无神经损伤并发症，基本恢复原有工作和生活。结论 CT引导下经皮螺钉固定技术是一项安全有效和微创的手术操作，适用于骶髂关节骨折脱位治疗。     

课堂教学中多媒体技术应用的思考

本文探讨了多媒体教学的优点及其应用过程中需要把握的一些问题，提出正确认识多媒体教学技术的优点，并处理好多媒体技术与其它教学因素间的关系。实现医学课堂教学的最优化。     

后路显微内镜下下腰段脊神经根鞘膜切开减压术的临床应用(附39例临床报道)

目的探讨后路显微内镜下下腰段脊神经根鞘膜切开减压术的方法及临床效果. 方法选择39例下腰椎间盘突出症术前有严重肢端麻木和剧烈的根性疼痛,术中见神经根明显充血水肿,增粗粘连者.在行髓核切除的同时,采用自制内镜下脊神经根鞘膜切开减压微型手术刀,沿神经根背侧纵行切开3～5 mm. 结果内镜(MED-Ⅱ)下脊神经根鞘膜切开松解39例,17例手术24 h内肢端发麻和根性疼痛症状完全消失,余在术后2周内症状完全消失.该组症状完全消失时间1～14 d,平均6.5 d. 结论微创脊神经根鞘膜切开减压术能迅速缓解腰椎间盘突出症所致患肢肢端麻木和根性疼痛,加快神经功能恢复.内镜下(MED-Ⅱ)腰段脊神经根鞘膜切开减压术是临床上安全有效的方法.     

成人腰椎峡部裂型滑脱症的微创治疗

Objective To investigate the clinical experiences and technical skills of adult isthmic spondylolisthesis. Methods Twenty-one patients with adult isthmic spondylolisthesis underwent minimally invasive surgery. There were 12 men and 9 women, with the mean age of 51.7 years. Isthmic spondylolisthe-sis occurred at the L4.5 in 7 patients, and at the L5S1 in 14 patients. According to Meyerding classification, 13 cases were of Grade Ⅰ, 7 of Grade Ⅱ, 1 of Grade Ⅲ. Under general anesthesia, guiding by fluoroscopy, the surgeries performed minimally invasive microendoscopic(METRx) techniques for posterior decompression, interbody cage fusion and novel Sextant-R percutaneous pedicle screw techniques for deformity reduction and fixation. Results Seventeen cases were followed up 1 year postoperatively. The average low back pain VAS reduced from preoperative 6.0±2.6 to postoperative 2.9±2.5. The average leg pain VAS decreased from preoperative 6.7±3.3 to postoperative 2.8±1.6. The average ODI decreased from preoperative 44.3% to post-operative 27.1%. The Nakai good and excellent rate was 90%. The mean operative time 170 min, blood loss 160 ml, and postoperative stay in bed 7.5 d. The sagittal spondylolisthesis rate significantly decreased from preoperative 35.5%±2.5% to postoperative 8.3%±7.5%. The lordotic angle from preoperative 11.5°±1.7° in-creased to postoperative 16.8°±9.5°; the intervertebral disc height from preoperative (5.4±2.5) mm increased to postoperative (9.1±3.0) mm. According to Lenke judgement for fusion, complete fusion rate was 76%, in-complete fusion rate was 12%, nonfusion rate was 12%. Conclusion The minimally invasive microendo-scopic (METRx) assisted with a novel Sextant-R percutaneous pedicle screw systems for deformity reduction and fixation to treat adult isthmic spondylolisthesis, is not only a minimally invasive and safe surgical tech-nique, also an effective treatment for deformity reduction and fixation.     

单唾液酸四己糖神经节苷脂缓释微球保护大鼠脊髓继发性损伤的实验研究

目的:探讨经蛛网膜下腔给予单唾液酸四己糖神经节苷脂(GM-1)缓释微球保护大鼠脊髓继发性损伤的增强效应及其机制。方法:188只成年SD大鼠随机分为对照组8只,模型组60只,普通GM-1组60只和GM-1微球组60只。采用Nys- trom法制备脊髓压迫损伤模型(50g×5min),术后24,72,168和336 h检测大鼠运动功能、脑脊液中GM-1含量,术后8,24,72,168和336 h检测大鼠脊髓组织内SOD活力和MDA含量,以及脊髓Caspase-3表达情况。结果:与模型组比较,GM-1微球组大鼠BBB运动功能评分高,脑脊液中GM-1含量多,脊髓组织内SOD活力强和MDA含量少,Caspase-3表达明显,具有显著统计学差异(P<0.01),亦优于GM-1组,但无统计学差异。结论:蛛网膜下腔给予GM-1缓释微球对脊髓继发性损伤的保护作用更强,主要机制涉及抗自由基损伤和抗细胞凋亡。     

面部单侧萎缩1例

1临床资料 患者,女性,30岁,进行性右侧面部萎缩20年入院。患者5岁以后逐渐出现右侧颈部皮肤颜色变深。11岁时,发现右耳廓较左侧梢变小。肌肉萎缩从右侧颈部逐渐扩展到右侧面下部,部分皮肤呈褐色,似刀痕样改变。患者4岁时右侧枕部曾有外伤史。入院查体:右侧耳廓下部较左侧明显变小,右侧二腹肌、咀嚼肌、口周围肌肉、颧肌明显萎缩。右侧下面部皮肤萎缩,尤以右侧下唇明显,似刀痕样改变。右侧面部皮下脂肪明显减少。电生理检查提示:右侧面神经传导潜伏时较对侧延长。肌电图见束颤电位,运动单位电位减少。入院后做脑血管造影显示双侧颈总、颈内外动脉及其分支、椎动脉及其分支均正常。     

EDTA微波脱钙骨的免疫组化染色

目的：改进传统骨组织的脱钙方法，改善免疫组化效果。方法：采用20％EDTA微波脱钙法对兔骨组织进行脱钙。结果：EDTA微波脱钙法能够更好的保持骨组织结构和组织中的抗原物质，得到更好的免疫组化切片。结论：EDTA微波脱钙法优于传统脱钙法，更适合于骨组织脱钙和免疫组化制片。     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.