中华长城系统治疗胸腰椎爆裂骨折

目的探讨中华长城椎弓根钉系统治疗胸腰椎爆裂骨折的优越性,并评价其临床效果。方法选择后正中入路椎管减压或单纯使用中华长城内固定系统治疗胸腰椎爆裂骨折40例。结果经3~18个月随访,椎体平均高度由术前的前34.5%和后74.5%恢复到术后的前95%和后98.5%,Cobb′s角由术前平均16.0°恢复为术后平均1.5°。对脊髓损伤的患者Frankel分级平均提高1.5级。未出现椎弓根钉松动和断裂。结论中华长城系统治疗胸腰椎爆裂骨折操作安全、固定确实、椎弓根大小设计合理,具有较明显的优越性,有待进一步临床应用观察。     

计算机辅助手术的发展状况和展望——参加第17届国际计算机辅助放射学及手术大会（CARS 03）后记

计算机辅助手术和治疗(IGST)是一个新兴的多学科交叉的研究领域,近年来取得了飞速的发展.作为该领域顶级会议之一的国际计算机辅助放射学及手术大会(CARS2003)于2003年6月25至28日在英国伦敦伊丽莎白二世国际会议中心隆重举行了第17届会议.本文将对这次大会作一回顾和总结,内容包括科学论文方面的评论和产品展览方面的情况.     

Planning for minimally invasive unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) is considered the treatment of choice in patients with single compartment arthritis of the knee at early stages or with osteonecrosis limited to one compartment. However, results in the literature are still controversial and it is a technically difficult procedure. The main goal of UKA is to restore the articular space of the afflicted compartment, without influencing the limb alignment. Selection of patients and pre-operative planning are crucial. The necessity to improve functional results and to reduce immobilization of the patients has led to the development of minimally invasive surgery. Applied to UKA, this approach reduces blood loss and surgical time, causes fewer symptomatic postoperative complications, and permits earlier recovery compared to the traditional incision. The shorter incision makes careful pre-operative planning essential. We briefly review the indications for UKA, the pre-operative clinical and radiological assessment, and the surgical procedure. Proocedings of the Consensus Conference “TSS in hip and knee replacement” (Rapallo, Italy 22–24 June 2006)     

护理导师制教学法的临床应用研究

目的:为培养适应在新医学模式下开展以病人为中心整体护理工作的护理人员,改革传统临床教学模式,采用护理导师教学法,以提高教学质量.方法:制定导师职责,制定导师的选择聘任标准,制定导师培训方案,实施导师制教学法的临床过程,实行双向教学评价,通过以上活动达到提高教学质量的效果.结果:320余名实习学生调查表明,12%的学生认为护理导师教学法形式明显优于其它教学形式,82%的学生认为优于其它教学形式.结论:护理导师教学法提高了临床教学水平和导师的整体素质,也促进了临床护理质量和临床教学质量的不断提高.     

下肢静脉性溃疡的外科微创治疗

目的探讨下肢静脉性溃疡外科微创治疗的效果。方法对31例(33侧患肢)下肢静脉性溃疡通过静脉造影检查明确引起溃疡的原发病变,根据患肢血流动力学异常的种类和程度对10例(11侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗术;17例(18侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗、内镜深筋膜下交通静脉离断术;4例(4侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗、内镜深筋膜下交通静脉离断和股浅静脉瓣膜包窄术。溃疡一律行周缘环行缝扎。结果术后33侧患肢浅静脉曲张均消失,色素沉着、湿疹样病变均明显减轻;24侧小腿酸胀沉重感、疼痛、水肿12~16d消失;溃疡18~40d内愈合。随访1~36个月,平均14.8月,3侧(9.1%)肢体溃疡复发。结论纠正浅静脉、交通支静脉、深静脉功能不全和重视溃疡创面的处理是治疗下肢静脉性溃疡的有效疗法,静脉腔内激光治疗、内镜深筋膜下交通静脉离断术操作简便、微创、安全,联合股浅静脉瓣膜包窄术可以有效地减少下肢静脉性溃疡的复发。     

Validation of silver-stained nucleolar organizer regions for evaluation of invasive character of urinary bladder carcinoma in rats and mice

A series of 8 rat and 16 mouse invasive bladder carcinomas were investigated for the presence of silverstained nucleolar organizer regions (AgNORs) to clarify whether this parameter is applicable to the estimation of their invasive character. With regard to number of AgNORs per cell, neither rat nor mouse carcinomas showed any difference between invasive and noninvasive sites within the same tumor. However, the frequency of cancer cells bearing bizarre dots, irregular in size and shape, was significantly higher at sites of actual invasion. Quantitative data generated using an image analyzer revealed significantly lower values for NOR roundness and significantly larger NOR size in invasive sites than in noninvasive sites in all groups. Double staining for the proliferation marker proliferating cell nuclear antigen (PCNA) and AgNORs was performed on eight rat carcinomas and a close correlation between the two was confirmed. Thus the number of AgNORs in PCNA-positive cells was significantly greater than in PCNA-negative cells. Furthermore, a particularly strong correlation was observed for incidences of PCNA-positive cells and bizarre dots (P<0.01). The quantitative data also demonstrated significant differences in size and shape of dots. It is concluded that AgNORs have diagnostic value for the invasive character of bladder carcinomas.     

基质金属蛋白酶在脑创伤中的研究进展

脑创伤是目前严重危害人类健康的主要疾病之一，具有较高的致残率和死亡率。而继发性脑损伤是影响脑创伤发展和预后的重要因素之一，适当的治疗可以减轻或避免某些继发性损伤的病理变化，提高患者的疗效，改善预后。近年来，随着对基质金属蛋白基质系（matrix metalloproteinases，MMPs）的不断深入研究，金属蛋白酶系在继发性脑损伤中的作用日益受到人们的重视。本文就基质金属蛋白酶系在脑创伤方面的研究概述如下。[第一段]     

简易立体定位仪定位微创治疗高血压脑出血

目的　探讨高血压脑出血微创治疗的方法和手术时机的选择对该病疗效的影响。方法　对 12例高血压脑出血患者 ,采用脑内血肿定位仪微创血肿穿刺引流术清除血肿 ,观察疗效。结果　ADL1～ 3级 75 % ,病死率 8.3%。结论　颅内血肿定位仪定位微创血肿穿刺引流术 ,具有效果肯定、定位准确、损伤轻微、适应症广的特点 ,超早期治疗是预后的关键     

内科微创肺减容术的研究进展

传统的外科肺减容术治疗慢性阻塞性肺疾病（COPD）有严格的适应证，并且副作用大、并发症多。于是人们研究出多种基于同样原理但是采用内科微创技术的减容方法。目前常用的内科微创肺减容术有使用单向活瓣、生物蛋白胶等封堵支气管使靶肺萎陷、不张，或采用支气管内药物灌注肺泡加封堵使靶肺组织纤维化等。此外，还有人提出人工旁路增加呼出气量的方法。尽管目前还缺少大规模的随机对照临床试验结果，但是内科微创肺减容术已展现了其巨大的临床应用前景，也将为治疗COPD提供更多的选择。     

经皮微创锁定加压钢板内固定术的临床应用

目的探讨经皮微创锁定加压钢板内固定术的临床应用及其疗效。方法应用间接复位技术，通过建立骨折两端皮下隧道，采用锁定加压钢板内固定治疗胫腓骨干骨折15例，锁骨骨折12例，肱骨骨折4例。结果所有患随访4～18个月，平均10个月。骨折愈合时间：胫骨10～20周(平均12周)，1例骨折延迟愈合(20周)，无骨不愈合；锁骨6～10周(平均8周)，肱骨8～13周(平均11周)，均无骨折延迟愈合及不愈合。所有病例无感染及内固定失败等并发症。结论经皮微创锁定加压钢板内固定符合生物学固定(BO)原则，有利于骨折的愈合及软组织的修复。