峰值保持功能在DSA图像中的应用

目的：探讨峰值保持功能在DSA图像中的应用价值。方法：分别采用常规方法与峰值保持功能显示,对80例行外周血管DSA术患者的图像进行处理,由经验丰富的DSA医、技师各2名对所有图像进行对比分析。结果：采用常规方法,图像显示良好的31例,图像显示一般的45例,效果差的4例;采用峰值保持功能处理,图像显示良好的58例,图像显示一般的15例,图像显示差的7例。结论：在DSA术中,采用峰值保持功能显示DSA图像,能得到良好的影像效果。     

MRI引导下肩关节穿刺造影

目的：探讨MRI引导下肩关节直接穿刺造影的方法及临床应用。方法：选取2008年4—10月间临床怀疑有肩袖损伤的患者40例（其中男29例,女11例;年龄22-70岁,平均35岁）,进行MRI引导下肩关节直接穿刺造影检查,对于肩袖结构及肌腱附着处、盂唇进行显示及诊断,所得结果与关节镜探查结果进行比较。结果：40例可疑肩袖损伤的患者中,28例经关节镜证实肩袖不同结构撕裂。MRI引导下肩关节造影清晰显示病变36例,造影剂外渗进入周围滑囊1例,关节腔内进入气体1例,无肩袖损伤2例。MRI平扫和造影检查共同诊断肩关节损伤26例,与关节镜结果一致。结论：MRI引导下前部直接穿刺肩关节造影是一种微创的显示肩袖损伤的检查方法,具有较高的准确率,可作为临床诊断肩袖损伤常规的检查方法。     

糖尿病患者造影剂肾病的研究进展

糖尿病患者造影剂肾病的发生率较正常人群高,可高达50％以上,临床表现以非少尿型急性肾功能衰竭者多见,往往需要透析治疗。造影剂肾病无特殊治疗方法,识别高风险患者是减少造影剂肾病的关键。     

Chronic REM-sleep deprivation induced laryngopharyngeal reflux in rats: A preliminary study

ObjectiveThe aim of this study was to investigate the relationship of chronic REM-sleep deprivation with laryngopharyngeal reflux (LPR) and its mechanism.MethodsForty healthy male SD rats (body weight 250–280 g) were randomly divided into four groups. The first three ones were test group, which underwent REM-sleep deprivation with different duration of time by modified multiplatform water surface method. The last group was the control one having normal sleep. All the animals were performed Dx-pH monitoring when finishing sleep deprivation, and sacrificed to study the gastric residual rate (GRR) and small intestine peristalsis (SPR) rate by charcoal meal method.ResultsAt prone position, the reflux incidence in the test groups fairly increased with the duration of sleep deprivation (p<0.05). The total number of reflux episodes at prone position in the test group rats with 3 months duration of sleep deprivation was significantly increased compared with that in the control ones (p<0.05). GRR in rats experiencing sleep deficiency for different duration all reduced significantly when compared to the control group (p<0.05). GRR and SPR presented continuous decline tendency with the duration of sleep deprivation (p>0.05).ConclusionsIt is suggested that chronic sleep deficiency could cause LPR in rats, which might result from the uncoordinated digestive tract motility caused by dysfunction of central nervous system after chronic REM-sleep deprivation. Our results implied that chronic REM-sleep deprivation might be one of the causes of LPR. Addressing sleep problems might help to decrease the prevalence of LPR and enhance its treatment efficacy.     

One-stage procedure for total knee arthroplasty in post-traumatic osteoarthritis of the knee with wound defect. Usefulness of navigation and flap surgery

Total knee arthroplasty in post-traumatic arthritis of the knee joint is a challenging situation. Difficulties are linked to malalignment, joint stiffness, or wound complications.The authors report on a case of post-traumatic intra-articular knee arthritis with tibial malalignment and a skin defect. Using computer-assisted surgery for implant positioning, and simultaneous pedicled flap surgery for wound coverage, IKS score at 2 years follow-up was 85 and 75 for clinical and function respectively.The results of total knee replacement in post-traumatic knee arthritis are not as satisfactory as in degenerative situations. In severe malalignment due to bone landmark changes following malunions, computer-assisted surgery gives immediate correct references for final positioning of implants and restoration of limb alignment. Implant selection must allow use of normal and revision components to fit the local anatomy. Commonly-used pedicle flaps such as the gastrocnemius flap are valuable to cover wound defects after prosthesis implantation. All these procedures can be used successfully in a one-stage surgical procedure.     

Feasibility of Augmented Reality–Guided Transjugular Intrahepatic Portosystemic Shunt

PurposeTo investigate an augmented reality (AR)–guided endovascular puncture to facilitate successful transjugular intrahepatic portosystemic shunt (TIPS).Materials and MethodsAn AR navigation system for TIPS was designed. Three-dimensional (3D) liver models including portal and hepatic vein anatomy were extracted from preoperative CT images. The 3D models, intraoperative subjects, and electromagnetic tracking information of the puncture needles were integrated through the system calibration. In the AR head-mounted display, the 3D models were overlaid on the subjects, which was a liver phantom in the first phase and live beagle dogs in the second phase. One life-size liver phantom and 9 beagle dogs were used in the experiments. Imaging after puncture was performed to validate whether the needle tip accessed the target hepatic vein successfully.ResultsEndovascular punctures of the portal vein of the liver phantom were repeated 30 times under the guidance of the AR system, and the puncture needle successfully accessed the target vein during each attempt. In the experiments of live canine subjects, the punctures were successful in 2 attempts in 7 beagle dogs and in 1 attempt in the remaining 2 dogs. The puncture time of needle from hepatic vein to portal vein was 5–10 s in the phantom experiments and 10–30 s in the canine experiments.ConclusionsThe feasibility of AR-based navigation facilitating accurate and successful portal vein access in preclinical models of TIPS was validated.     

Survivorship and clinical outcomes after multi-level anterior lumbar reconstruction with stand-alone anterior lumbar interbody fusion or hybrid construct

In multilevel disc disease, there is still uncertainty regarding whether multiple total disc replacement is more effective and safer than fusion. Our objective was to measure and compare the clinical outcome of multilevel hybrid constructs with stand-alone anterior lumbar interbody fusion (ALIF) using a retrospective analysis. Sixty-four patients with chronic low back pain determined to be from two or three-level degenerative disc disease were included. Thirty-three patients were treated with hybrid fusion and 31 with ALIF. Several parameters were retrospectively reviewed, including blood loss, operation time, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), and survivorship without the need for revision surgery. Telephone follow-ups were conducted to ascertain survivorship, clinical outcomes (VAS, ODI) and patient satisfaction. Operation time was longer in the hybrid group (p = 0.021). The hybrid group showed a significant improvement in VAS and ODI with 52.2% and 50.0% improvement versus 28.3% and 25.5% in the ALIF group (p < 0.05). At the telephone follow-up for patient satisfaction, 95.7% (n = 22) of the hybrid group were satisfied and 95.2% (n = 21) of the ALIF group were satisfied. Seventy-four percent (n = 17) in the hybrid group and 85.7% (n = 18) in the ALIF group would choose to do the initial surgery again. Kaplan–Meier analysis showed 80.5% survivorship for hybrids and 75.9% for ALIF at 5 years. With our clinical outcomes in VAS and ODI scores, these results, when taken together, indicate that hybrid fusion is a valid and viable alternative to ALIF fusion, with at least equal if not better clinical outcomes in terms of survivorship, back pain, and disability scores.     

起源于肝动脉的迷走胃左动脉血管造影研究

目的观察起源于肝动脉的迷走胃左动脉的解剖学特征,讨论其在肝及胃相关血管介入诊疗技术中的临床意义.方法回顾性分析1 000例肝动脉数字减影血管造影(DSA)影像资料,包括212例腹腔干动脉造影和788例肝总动脉血管造影,统计起源于肝动脉的迷走胃左动脉的发生率,描述其解剖学特征.结果共发现82例、84支起源于肝动脉的迷走胃左动脉(8.2%,82/1 000),其中起源于肝左动脉者74支,起源于肝固有动脉者10支.结论起源于肝动脉的迷走胃左动脉并不少见,认识此动脉对于肝、胃、血管造影中正确诊断和实施相关介入治疗具有重要意义.