超声二维应变评价正常人左室扭转和径向位移的初步研究

目的应用超声二维应变技术（2DS）探讨正常左室扭转及径向位移运动特征,构建左室-扭转位移环。方法健康成人志愿者58例,取胸骨旁左室心尖和心底短轴观对各水平旋转及径向位移进行定量分析,计算左室扭转及径向位移,构建左室-扭转位移环,并记录心底部与心尖部旋转角度峰值和左室扭转角度峰值及达峰时间,收缩期及等容舒张期左室径向位移。结果正常人扭转运动主要表现为心底部顺时针旋转和心尖部逆时针旋转,心脏整体表现为心动周期内逆时针方向为主的扭转运动。左室扭转-位移环均呈＂8＂字构型。收缩期及等容舒张期左室扭转与径向位移呈线性相关。结论应用2DS技术可无创性评价正常人左室扭转及径向位移运动特征,构建左室-扭转位移环。     

Can rotatory knee laxity be predicted in isolated anterior cruciate ligament surgery?

Purpose

Despite the overall success of the surgical anterior cruciate ligament (ACL) reconstruction, some patients still present with instability symptoms even after the surgery, mainly due to the presence of associated lesions. At present, the pivot shift test has been reported to be the benchmark to assess rotatory knee laxity. The purpose of this study was to quantitatively evaluate rotatory knee laxity at time-zero in order to determine whether detected post-reconstruction laxity was predictable by its value measured before the reconstruction, which was hypothized to be influenced by the presence of associated lesions.

Methods

Rotatory knee laxity was retrospectively analysed in 42 patients, including two different ACL reconstructions. The maximal anterior displacement and the absolute value of the posterior acceleration reached during the reduction of the tibial lateral compartment were intra-operatively acquired by using a navigation system and identified as discriminating parameters. For each parameter, statistical linear regression analysis (line slope and intercept) was performed between pre- and post-reconstruction values.

Results

No statistically significant influence of the initial posterior acceleration on the post-reconstruction outcome was found (line slope, p > 0.05), although a statistically significant line intercept was indeed identified (p < 0.001). A statistically significant influence on the surgery outcome was instead found for the initial value of the anterior tibial displacement (line slope = 0.39, p = 0.004), meaning that, on average, about 40 % of the post-reconstruction lateral compartment displacement could be explained by the corresponding pre-reconstruction value. Both of these findings highlighted the importance of intra-operative quantification of rotatory knee laxity to identify correct indications for the surgery.

Conclusions

This study provided important implications for the future possibility of defining a quantifying tool able to assess rotatory knee laxity during ACL reconstruction. This could allow detection of additional injuries to secondary restraints by easily performing rotatory knee laxity tests, which in turn could reduce post-surgical recurrence of knee instability.     

运用数字体相关方法追踪呼吸过程中肺部肿瘤和胸腔的运动

目的 研究数字体相关（digital volume correlation,DVC）方法测量肺部肿瘤和胸腔随患者呼吸运动的变形及位移情况的可行性。方法 利用DVC跟踪胸腔内组织三维运动的算法,通过四维CT成像技术拍摄肺癌患者一个完整的呼吸过程。以吸气开始为初始状态,确定肿瘤和胸腔位置,运用DVC软件,分析初始状态下肺部4个特征体域在20%、40%、60%、80%和100%呼吸相位下以及胸腔上4个特征体域在100%呼吸相位下的三维位移值。结果 肿瘤的位移和变形的误差在1 mm以内,胸腔的位移和变形的误差在0.5 mm以内;肿瘤在呼吸过程中沿人体竖直方向运动最大,胸腔在吸气结束时刻沿人体前后方向运动最大。结论 DVC测试技术可用于检测呼吸过程中肺部肿瘤和胸腔等胸部组织的位移和变形情况。本研究为基于DVC方法实现肺部肿瘤无创、非射线、实时的图像引导放射治疗提供了依据。     

Clinical Study of Acupoint Injection in Treating Lumbar Intervertebral Disc Protrusion

目的：观察穴位注射治疗腰椎间盘突出症的临床疗效。方法：将156例腰椎间盘突出症患者随机分为观察组80例（弥可保注射液）和对照组76例（维生素B12注射液），采用穴位注射受压神经根相应节段夹脊穴的方法。结果：观察组有效率为86．3％，对照组有效率为78．9％，两组疗效比较P〈0．01，差异有统计学意义。结论：“弥可保”注射液穴位注射治疗腰椎间盘突出症的临床疗效明显高于维生素B12穴位注射。     

Observation of the therapeutic effect of treating lumbar intervertebral disc protrusion by acupuncture therapy

目的：观察针刺病变腰椎两侧经穴治疗腰椎间盘突出症的临床疗效。方法：将180例腰椎间盘突出症患者随机分为治疗组60例，针刺对照组60例，西药对照组60例，治疗20天后进行疗效比较。结果：治疗组有效率96．7％，针刺对照组为80．0％，西药对照组为81．7％，治疗组与对照组差异有显著性意义（P〈0．05）。结论：针刺病变腰椎两侧经穴是治疗腰椎间盘突出症的有效方法。     

经皮穿刺臭氧注射术治疗腰椎间盘突出症的临床研究

目的探讨经皮穿刺臭氧注射术对腰椎间盘突出症的疗效及安全性。方法64例患者经CT或MRI检查证实为腰椎间盘突出症,均表现为腰背痛及下肢麻痛,其中间盘膨出23例,突出41例。在C形臂X线透视监视下采用21G多侧孔酒精穿刺针经皮穿刺至腰椎间盘,实施盘内及椎间孔臭氧注射术。盘内注射10 ml,椎间孔注射15 ml,臭氧浓度为盘内50μg／ml,椎间孔40μg/ml。结果术后5 d总有效率为90．6％(58／64例),显效26例(40．6％),有效32例(50％),无效6例(9．38％),随访3～6个月,总有效率84．4％(54／64例),无任何严重并发症发生。结论经皮穿刺臭氧注射术是治疗腰椎间盘突出症的一种安全、有效的方法。     

踝三针对腰椎间盘突出根性痛大鼠中枢镇痛递质的影响

目的:探讨踝三针对腰椎间盘突出根性痛镇痛作用的机制。方法:雄性SD大鼠60只随机分为正常对照组、假手术对照组、模型对照组、来比林对照组、常规体针组、踝三针治疗组,分别采用肌肉注射药物来比林、常规穴针刺、踝三针穴位针刺治疗。测各组机械痛阈值和5-羟色胺(5-HT)含量。结果:大鼠痛阈值踝三针治疗组与模型对照组同时点比较显著增高(P<0.05);30 min时点痛阈值来比林对照组、常规体针组显著高于模型对照组,踝三针治疗组与来比林对照组、常规体针组比显著增加(均P<0.05)。5-HT测量值踝三针治疗组与模型对照组、来比林对照组在相同时点比较差异具有非常显著性意义(P<0.01);30 min时点5-HT测量值踝三针治疗组显著高于常规体针组(P<0.05)。结论:踝三针镇痛作用与脑内5-HT递质含量增加密切相关。     

Outcome of Displacement Bone Marrow Transplantation for Inborn Errors of Metabolism

The concept of displacement bone marrow transplantation arose from our work at Westminster 1970–1973, by which time we had extended the donors from matched siblings to other family and unrelated donors. DBMT is not a panacea, but can be applied to about 7% of understood inborn errors, where it is possible to devise in vitro tests to predict in vivo donor effects. Its use to install donor bone marrow as a component factory for the life of the recipient, and the importance of immunoprophylaxis are summarised. Worthwhile correction has been achieved for 48 previously fatal genetic diseases, partial correction for another five, but there has been failure for three diseases. Some 80% of our patients were not found in known families and could not have been prevented.     

踝三针治疗腰椎间盘突出症根性痛临床观察

目的:观察踝三针对腰椎间盘突出症根性痛镇痛作用。方法:380例患者随机分为踝三针组、常规针刺组、药物组。踝三针组依据不同的突出节段分别取根痛1、根痛2、根痛3,采用提捏进针法,沿皮刺入;常规针刺组取肾俞、气海俞、突出相应节段的夹脊穴、次等穴,采用平补平泻手法;药物组采用来比林针0·9g加生理盐水2mL常规臀部肌肉注射。结果:踝三针、常规针刺、药物来比林3种治疗方法起效时间分别为6分钟、27分钟、18分钟;3组患者镇痛的维持时间分别是24·48小时、8·93小时、6·36小时,踝三针较其他两种治疗方法差异有显著性意义,而常规针刺组与药物组比无显著差异。3组治疗后各时间点镇痛的评分变化趋势比较差异均有非常显著性意义(P<0·01)。3种治疗方法对0·5、1、24、48小时时点直腿抬高试验测量值的影响差异有极显著性意义(P<0·001)。结论:踝三针对腰椎间盘突出引起的根性痛有显著镇痛效果。