失去肝动脉血液供应后大鼠肝门部胆管周围血管丛变化的三维构像研究

目的 探讨完全失去肝动脉血液供应后，大鼠肝门部胆管周围血管丛（PBP）的形态学变化。方法 将SD大鼠随机分为两组，对照组仅游离胆总管、门静脉、腔静脉和肝总动脉，不做切断；实验组结扎肝动脉，并切断肝十二指肠韧带除门静脉以外的其它组织，阻断其它侧支血管对肝门部胆管的血液供应。术后应用计算机对大鼠肝门部组织切片进行PBP三维可视化构建，并对PBP内层微血管进行定量分析，对胆管壁组织进行病理学检查。结果 实验组肝门部胆管分叉部位PBP平面结构显示胆管扩张，胆管壁明显增厚，壁内微血管尖细，排列紊乱，内层微血管密度减低；PBP立体构像显示空间结构紊乱，不规则，微血管细小，管壁不均匀增厚。与对照组相比，实验组肝门部PBP内层微血管总数明显减少（P〈0．01），肝门部PBP内层微动脉数也明显减少（P〈0．05）。实验组肝门部胆管壁呈慢性增生性炎症改变。结论 失去含氧量高的动脉血液供应时，PBP形态结构将会发生一系列改变，胆管壁组织也将发生相应的病理变化。     

血管内皮生长因子定向转染诱导缺血心肌血管生成的研究

目的观察血管内皮生长因子（VEGF）质粒直接心肌注射对兔急性心肌缺血后侧支循环形成的影响。方法建立兔左冠状动脉结扎的急性心肌缺血模型，取缺血边缘区以先期构建的真核表达质粒pcDNA3／VEGF165和真核载体pcDNA3的DNA分别多点心肌注射，给药后2、4周取材分别行逆转录-聚合酶链反应（RT-PCR）和蛋白浓度分析、苏木素-伊红（HE）染色、VEGF染色。结果治疗组VEGF165 mRNA含量较对照组明显增多；蛋白浓度分析转染后VEGF165显著增多，高峰出现于实验后2周；治疗组缺血心肌新生血管数目明显多于对照组。结论VEGF165外源性基因能在转染心肌细胞后成功表达，促进了缺血心肌血管新生和侧支循环形成。     

Analysis of the angiographic findings in cases of childhood moyamoya disease

Summary Cerebral angiograms of 34 patients with childhood moyamoya disease have been analysed, this analysis having revealed the following findings. The blood flow to abnormal net-like vessels (ANV) in the base of the brain is mainly supplied from the internal carotid artery (ICA) in the early stage of this disease. In a later stage, however, the blood supply is mainly from the posterior cerebral artery (PCA). Though, no remarkable change was found in the volumes of ANV from the early to later stages of the disease, the leptomeningeal collaterals, the most prominent anastomoses in moyamoya disease, had a tendency to decrease during the later stage with the development of PCA stenosis. Eighteen occlusive PCA lesions were found in the proximal portion of the PCA in eight cases (44%), and in the distal in nine cases (50%). The incidence of aneurysm (1.5%) and intracranial bleeding was low as compared to cases of adult moyamoya disease.     

组织工程心肌补片对黑山羊陈旧性心肌梗死心功能和建立侧支循环的影响

目的探讨自体骨髓间充质干细胞(m arrow m esenchym a l stem ce lls,M SC s)-小肠黏膜下层(sm a llin testina l subm ucosa,S IS)构建的组织工程心肌补片,移植于陈旧性心肌梗死区后对心功能及缺血区建立侧支循环的影响。方法将已建立急性心肌梗死模型后6周的黑山羊16只,随机分为实验组和对照组,实验组抽取自体骨髓,经体外分离M SC s,进行培养、传代,以第3代细胞行5-B rdU标记并与S IS支架材料复合培养5 d,制备M SC s-S IS组织工程心肌补片。将其缝合至陈旧性心肌梗死区;对照组仅行假手术处理。于植入后6周,采用超声心动图观察两组动物心功能变化,数字减影血管造影选择性左冠状动脉造影观察缺血心肌侧支循环的建立。结果术后6周实验组及对照组:心博出量、左心室射血分数分别为42.81±4.91、37.06±4.75 m l和59.20%±5.41%和44.56%±4.23%,组间差异均有统计学意义(P<0.05);左心室舒张末期容积、左室收缩末期容积分别为72.55±8.13、83.31±8.61 m l和29.75±5.98、46.25±6.68 m l,组间差异均有统计学意义(P<0.05);左心室舒张功能各项指标分别为:E峰最大速度分别为54.85±6.35 cm/s和43.14±4.81cm/s(P<0.01);A峰最大速度分别为52.33±6.65 cm/s和56.91±6.34 cm/s(P>0.05)。超声心动图显示对照组左室腔扩张明显,室壁运动明显减弱,梗死区呈瘤样扩张,局部室壁反常运动;实验组左室腔明显小于对照组,室壁运动较对照组强,心尖梗死区扩张不明显。选择性左冠状动脉造影见实验组左冠状动脉前降支远端与回旋支间明显侧支循环建立。结论M SC s-S IS构建的组织工程心肌补片移植于黑山羊陈旧性心肌梗死区后侧支循环建立,心功能有明显改善作用。     

Radiographic Instability of the Ankle Joint After Evans' Repair

Forty-two unstable ankle joints were treated surgically by Evans' operation. the clinical postoperative results were correlated with the objective radiological stress examinations. the mean age of the patients was 29 years (15-60 years). the clinical and radiological follow-up examinations were performed 6 months after the operation. in the stress X-ray examinations a modified stress frame was used. Clinical instability was noted in four patients. in the radiological examination one patient had a pathological finding in the talar tilt test and 18 patients in the anterior drawer sign test. the radiological instability correlated poorly with the subjective end results. Six patients were estimated to have a poor result of the operation. Five of these patients had a positive anterior drawer sign in the stress X-ray examination and one had degenerative changes in the ankle. Although Evans' repair is a simple and reliable method of reconstructing ruptures of the lateral ligaments of the ankle joint, it is associated with a relatively high frequency of positive anterior subluxation on radiological stress examination. This finding can be explained by the anatomical and geometrical factors on the lateral side of the ankle joint.     

Defining the Origins of the Iliofemoral, Ischiofemoral, and Pubofemoral Ligaments of the Hip Capsuloligamentous Complex Utilizing Computer Navigation

Purpose  

To use computer navigation software to investigate the specific origins of the hip capsuloligamentous complex.     

源于全模型迭代CTP的多期相CTA在烟雾病中的诊断价值

目的探讨基于全模型迭代重建技术(IMR)低辐射剂量CT灌注容积数据重组的多期相CTA对烟雾病患者侧支循环的评估价值。方法搜集经DSA证实的18例烟雾病患者,利用基于IMR技术的CT灌注薄层原始数据重组出多期相CTA,由两名放射科医师对图像进行主观质量评价,以DSA为"金标准",多期相CTA和DSA对侧支血管评估结果进行一致性及相关性分析。结果多期相CTA与DSA在侧支血管评估方面一致性及相关性较好(k=0.778,P<0.01;r=0.864,P<0.01),图像质量与常规CTA相比差异无统计学意义。结论源于低辐射剂量CT灌注的多期相CTA,图像质量能满足临床诊断需求,能获得多时相血管信息,准确评估烟雾病患者侧支循环状态。     

门静脉高压侧支循环的螺旋CT表现

探讨肝硬化门脉高压侧支循环的螺旋ＣＴ表现。材料与方法,搜索肝硬化门脉高压患者５２例,其中２３例采用３ｍｍ薄层容积扫描,重建层厚１．５ｍｍ,并进行ＭＩＰ管重建。结果螺旋ＣＴ显示脐周静脉曲张１２例,胆囊周围静脉曲张８例,脾肾静脉侧支开放９例,腹膜后静脉曲线１０例,食管静脉曲张２４例,     

Synovialisation of the torn anterior cruciate ligament of the knee: comparison between magnetic resonance and arthroscopy

The aim of this study was to assess the accuracy of MR in the diagnosis of synovialisation of the anterior cruciate ligament (ACL) compared with arthroscopy. One hundred and forty-nine patients were examined with MR imaging and arthroscopy of the knee. The MR sign used to consider a synovialised ACL consisted of hypointense fibrillar tracts, disrupted and wavily, in its expected course. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), comparison of proportions (McNemar test) and Kappa values for agreement between MR imaging and arthroscopy were calculated. Of the 133 (89.3 %) ligaments without synovialisation at arthroscopy, 130 accorded with the MR results. Of the 16 (10.7 %) synovialised ligaments, 13 accorded with the MR results. Three false-positive and three false-negative MR diagnoses were identified. The agreement between both techniques was excellent (Kappa = 0.79; p = 0.000), without differences (McNemar test; p = 1). Sensitivity was 0.81, specificity 0.98, PPV 0.98 and NPV 0.81. Magnetic resonance imaging is highly reliability for synovialisation diagnosis. The imaging sign used to diagnose synovialised ACL (hypointense comma-like tracts in its expected course) is reliable. As this reparative process can simulate an intact ligament, knowledge of this sign is important in diagnosing synovialisation of ACL tears so as not to confuse it with normal ACL. Received: 17 June 1998; Accepted: 6 August 1998