低角度青少年特发性脊柱侧凸女性患者的骨密度分析

目的分析低角度青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)女性患者的骨密度(BMD)和骨矿含量(BMC),探讨其与年龄、生长发育、人体测量学和侧凸角度等的相关性。方法研究对象为218例Cobb角15～40°的女性AIS患者。运用双能X线骨密度吸收仪测定非优势侧股骨颈和腰椎的BMC/BMD。探讨这两个部位的BMC/BMD与患者的年龄、生长发育、人体测量学和侧凸角度等的相关性。结果所有患者的年龄平均为(13.4±1.4)岁,Cobb角平均为(28.3±6.2)°。股骨颈BMD平均为(0.827±0.103)g/cm2,腰椎BMD平均为(0.887±0.124)g/cm2,显著低于同龄健康女性儿童;股骨颈BMC平均为(3.49±0.56)g,腰椎BMC平均为(29.78±7.37)g。患者的BMC/BMD与Cobb角无显著相关,而与体重、身高、Risser征、月经状况、BMI和年龄显著相关。逐步回归分析显示,体重和年龄是影响患者BMD的主要因素。结论低角度女性AIS患者存在全身性的骨量减低,且与Cobb角无显著相关,而与生长发育和人体测量学相关指标显著相关。这提示AIS患者的骨量减低与生长发育和低体重有关。     

小肠粘膜下层的制备及细胞相容性的实验研究

目的了解猪小肠粘膜下层(SIS)的细胞相容性,探讨用SIS为生长载体复合骨髓基质干细胞(BMSCs)构筑组织工程骨的可能性。方法用物理和化学方法处理猪小肠粘膜下层,将兔骨髓基质干细胞与SIS进行体外复合培养,分别进行组织学、相差显微镜和扫描电镜观察。结果经物理和化学处理的SIS纯度高,孔隙多,胶原纤维未受损;BMSCs在SIS材料上生长、粘附、增殖,并能长入材料的孔隙内,分泌大量的细胞外基质成分。结论SIS的细胞相容性良好,不影响BMSCs的形态,对细胞生长和功能表达无抑制作用,可以用作骨组织工程的支架材料。     

联合切口径路全翻内置法鼓膜成形术

对各种慢性化脓性中耳炎采用联合切口径路全翻内置法行鼓膜成形术１１８例，取得良好效果，介绍了联合切口、全翻外耳道皮瓣和内置移植物的操作技术，探讨了该法取得良好效果的各种因素。     

Adenocarcinoma of the small intestine: 21-Year review of diagnosis,treatment, and prognosis

Background: The purpose of this study was to evaluate the tumor characteristics and treatment associated with an improved overall survival in patients with adenocarcinoma of the small intestine. Methods: The records of all patients with primary adenocarcinoma of the small bowel seen between January 1971 and December 1991 were reviewed retrospectively. The study comprised 38 patients, 22 (58%) with duodenal tumors, 11 (29%) with jejunal tumors, and five (13%) with ileal tumors. Results: Although not statistically significant, the patients with duodenal adenocarcinoma lived longer than the patients with jejunal or ileal lesions (p=0.77). The overall survival was 23% and seemed to correlate best with absence of lymph node metastases (p=0.04) and pancreaticoduodenectomy for localized duodenal tumors (p=0.04). The patient's age, duration of symptoms, disease-free interval, tumor location, type of recurrence, and histologic grade did not significantly influence survival. Conclusions: The lethality of small-intestinal adenocarcinoma appears to be related to a delay in diagnosis and treatment. When a definitive surgical procedure is performed before lymph node metastases appear, the patient's chance for long-term survival is greatly improved.Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

小切口复位组合式外固定器结合有限内固定治疗胫腓骨粉碎性骨折

胫腓骨粉碎性骨折,尤其是胫骨下1/3段骨折是发生骨延迟愈合或骨不连的常见骨折,临床上治疗方法颇多.2001年10月～2005年3月,采用小切口直视下复位,组合式外固定器结合有限内固定治疗胫腓骨粉碎骨折46例,效果良好.     

伸直位整复纸夹板外固定治疗第5掌骨颈骨折

自1998至2006年,采用我院传统的伸直位手法整复,纸夹板结合厚棉压垫、厚棉衬垫外固定治疗第5掌骨颈骨折30例,疗效满意,现总结报告如下。     

熵指数对异氟烷麻醉中切皮体动反应的预测作用

目的 研究熵指数(包括反应熵和状态熵)对异氟烷复合麻醉中切皮体动反应的预测作用并与双频谱指数(BIS)比较.方法 ASA Ⅱ级择期腹部手术患者20例,按切皮有无体动反应分为体动组(9例)和非体动组(11例).入室后常规监测,然后静注异丙酚、琥珀胆碱、芬太尼快诱导气管插管,持续吸入异氟烷,维持呼气末异氟烷浓度为1.3MAC,维持10min后开始手术,切皮前不用神经肌肉阻滞剂,如果发生体动,则按10%提高下一个患者异氟烷呼气末浓度,如果不动则按10%降低下一个患者异氟烷呼气末浓度.分别于入室、切皮前60s、30s、切皮后45s、120s对每例患者同时行熵指数和BIS监测.结果 两组患者的熵指数值有显著性差异(P＜0.05),而BIS无显著性差异(P＞0.05).反应熵和状态熵可以预测切皮体动,其预测概率(Pk)值分别为0.893 7和0.885 2,BIS不能预测切皮体动,Pk值是0.591 9,熵指数和BIS的Pk值之间有显著性差异(P＜0.05),Pk与反应熵和状态熵的Logistic回归方程分别为ln [Pk/(1-Pk)]=32.517-0.481x和ln [Pk/(1-Pk)]=28.728-0.438x.结论 熵指数监测可以预测异氟烷麻醉中的切皮体动反应,值得临床推广应用.     

中切口切开法重睑成形术

目的介绍一种简便有效，恢复快的中切口重睑成形术。详细阐述该方法的手术要点，重睑成形术所遵循的原则等。方法术前灵活定位，局部麻醉下做长15mm的小切口，去除切口内部分眼轮匝肌及睑板前脂肪．将上睑皮肤与睑板固定。结果采用中切口切开法重睑成形术180例，效果满意。结论中切口重睑成形术创伤小，恢复快，是一种简便有效的方法。术中应严格遵循无创操作，宁窄勿宽，对过度依赖额肌的患者，手术前后进行睁眼训练。     

Malignant Peripheral Nerve Sheath Tumor: An Unusual Cause of Intussusception

Malignant peripheral nerve sheath tumors (MPNST) are defined as any tumor arising from a peripheral nerve or showing nerve sheath differentiation. The majority of these tumors arise on the trunk, extremities, or head and neck region. The literature to date has fewer than 14 cases of MPNST arising in the gastrointestinal tract, and only two cases were ever reported in the small intestine, one of which was a recurrent disease. In this paper, we report the first US case of an MPNST arising in the small intestine and presenting as intussusception.