腹腔镜与开腹直肠癌低位前切除术后吻合口瘘发生率的比较

目的探讨腹腔镜与开腹直肠癌低位前切除术后吻合口瘘发生率的差异。方法2000年9月至2005年12月由同一组医师连续对距肛缘5～8cm的直肠癌患者实施腹腔镜下根治术(LP术组)53例及传统开腹根治术135例,比较两组和两组内患者造口与未造口者发生吻合口瘘的差异。结果LP术组造口与未造口者吻合口瘘的发生率分别为4.6%(1/22)与6.5%(2/31),χ~2=0.088,P>0.05;差异无统计学意义。OP术组造口与未造口者吻合口瘘的发生率分别为2.3% (1/43)与8.7%(8/92),χ~2=1.024,P>0.05;差异无统计学意义。LP术组与OP术组行造口的患者吻合口瘘发生率比较,P=0.455,差异无统计学意义;LP术组与OP术组未行造口者的吻合口瘘发生率比较,P=0.288,差异也无统计学意义。结论腹腔镜行直肠癌低位前切除术与开腹手术相比,不会增加吻合口痿的发生率。     

髋臼内壁内移截骨全髋置换治疗成人髋臼发育不良的有限元分析及临床意义

目的 通过计算机辅助设计有限元分析,找寻髋臼内壁截骨的合适内移范围,为临床工作提供理论依据.方法 利用SolidWorks 2005软件,建立髋臼发育不良骨盆的三维模型,模拟髋臼内壁内移截骨术式,使髋臼内壁骨从未完全陷入盆腔内保持2 mm骨性接触处开始,逐渐内移至完全陷入盆腔内7 mm处,每隔1 mm为1个实验组,分成10个实验组.每组髋臼人为划成4个象限,分别对各组假体臼-骨界面间进行计算机模拟对比力学实验分析,测量出髋臼假体-骨界面间的Mises应力及剪切应力值,找寻出应力分布较为均匀的实验组.结果 Mises应力及剪切应力均有1个象限内的值较大,通过2次统计学分析计算,得出实验结果.结论 当髋臼内壁内移至未完全陷入盆腔内1 mm处到完全陷入盆腔内1 mm处的范围内,髋臼假体-骨界面间的应力分布均匀,最佳位置在完全陷入盆腔内1 mm处.     

髋臼粉碎性骨折合并压缩性缺损的治疗与对策

目的探讨治疗髋臼粉碎性骨折合并压缩性缺损的手术方法.方法1997年7月～2005年2月,收治髋臼粉碎性骨折合并压缩性缺损43例,其中陈旧性骨折25例,新鲜骨折16例,畸形（大于90 d）2例;复杂骨折与缺损34例,简单骨折与缺损9例.缺损体积3～9 cm^3,平均4.5cm^3.采用改良髋臼入路,应用髋臼三维记忆内固定系统（ATMFS）三维记忆锁定碎骨;髋臼碎骨关节面整复法;自体髂骨髋臼后壁解剖性重建法;自体骨＋人工骨填塞及骨腊隔离法等术后相关措施.结果所有患者随访5～86个月,平均15.7个月.粉碎骨折关节面粉碎＋填补压缩体积至头臼解剖复位31例;自体髂骨后壁“解剖性重建头臼解剖复位”12例;40例患者经过平均5.3个月患侧髋关节功能达到健侧水平,1例股骨头缺血性坏死,2例异位骨化＋股骨头缺血性坏死导致髋关节骨融合.结论本文介绍了治疗髋臼粉碎性骨折合并压缩性缺损的新方法与措施,有效地提高了股骨头与髋臼解剖对应率,为髋关节功能的恢复提供了新的思路.     

应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损

自1999年1月-2005年3月,应用胫前肌瓣修复胫骨骨髓炎合并软组织缺损13例,同时辅以中药治疗,获得较满意的效果,现报告如下。1临床资料本组13例,男9例,女4例;年龄18⁶7岁,平均32岁。致伤原因:车祸伤6例,挤压伤4例,烧伤1例,坠落伤2例。胫骨上1/3段1例,中1/3段2例,下1/3段5例,中下2/3段5例。病程12d³0个月,外露骨有干燥、硬化、发白、变黑,周围有肉芽、瘢痕组织、脓性分泌物等。外露骨纵形长0·6⁸·0cm,皮肤缺损面积最大为4cm×10cm。2治疗方法2·1手术方法在硬膜外麻醉下,股部上止血带,术区常规消毒。首先切除溃疡及外露胫骨周围瘢痕,清除髓腔内分泌物及     

Evaluation of clinical outcomes in anterior cruciate ligament surgery

Clinical outcomes data can be used to facilitate patient management decisions, assess clinician and organizational performance, and to provide evidence for the effectiveness of surgery and rehabilitation. The validity of the inferences made from outcomes data are dependent on the validity of the outcomes measures themselves and the circumstances under which the data were collected, analyzed, and interpreted. Clinical outcomes may include measures of impairment of body structure and function, activity limitation, and participation restriction. However, because the relationship between impairment and the resulting activity limitation and participation restriction is not direct, and because activity limitations and participation restrictions are of the utmost concern to the athlete, the primary clinical outcome should be measures of activity limitation and participation restriction. Activity limitation and participation restriction may be measured either through direct observation of performance or by general or specific measures of health related quality of life. Clinical outcomes data must be collected systematically to ensure valid inferences from the data.     

Surgical strategy of one stage surgery of anterior release combined with posterior correction in treatment of severe scoliosis

Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon. Methods :Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thorac icplasty. Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80. 6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average. Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.     

几种手性药物对映体的HPLC分离与生物样品分析

使用ＣＨＩＲＡＬ－ＡＧＰ柱，通过优化色谱条件，以ＨＰＬＣ法对３种手性药物ＳＦＺ－４７〔（±）－３Ｈ－１，２－二氢－２－（４－甲基苯胺基）－甲基－１－吡咯里嗪酮〕，ＫＭＢＺ－００９〔（±）－反式－４－苯基－５－（邻氯苄基）－吡咯烷酮－２〕和地丙苯酮〔（±）－２′－（２－羟基－３－（特戊胺基）丙氧基）－３－苯基苯丙基酮〕进行了对映体的直接分离，达到良好的分离效果．在此基础上测试了动物血浆样品中ＳＦＺ－４７的对映体，对其药物动力学的对映体选择性进行了初步研究．     

生物组织和细胞中多胺的高效液相色谱测定

本文对分离所得的生物样品经丹酰化反应在μ—Bondapak—C_(18)柱上,以甲醇-四氢呋喃-醋酸-水系统为流动相,采用多阶梯度反相高效液相色谱荧光检测法,测定了未成熟的大鼠前列腺、附睾、精囊等组织及生殖细胞和间质细胞中多胺的含量。其中流速为1ml/min,激发波长为370nm,发射波长为530nm,纸速为5mm/min。内标为1,10-二氨基癸烷。本法测定腐胺,精胺和精脒的精密度分别为3.63%,1.65%,2.11%;生物样品的回收率为99.6%～100.3%;三种多胺的最低检出量依次为0.2ng,0.4ng和0.8ng。