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71.
72.
血栓前体蛋白与心脏瓣膜置换术后的抗凝监测 总被引:8,自引:0,他引:8
目的:探讨血栓前体蛋白(TPP)在心脏机械瓣膜置换术后抗凝治疗监测中的意义,及制定术后抗凝治疗的合理方案。方法:比较抗凝组(60例)和对照组(20例)的国际标准化比率(INR)、TPP,并比较抗凝组中有、无房颤的病人华法林用量、INR和TPP,对抗凝组病人TPP和INR的关系作一元线性回归分析,比较各组的INR和血浆TPP浓度。结果:抗凝组与对照组相比,TPP低、INR高。抗凝组有房颤者的血浆TPP浓度高于窦性心律者。线性回归分析结果表明,TPP和INR无明显相关性。出血病人的血浆TPP浓度明显低于正常高限(6μg/ml)。结论:TPP是心脏机械瓣置换术后抗凝治疗理想的辅助监测指标。术后有房颤心律者的血栓栓塞危险性增加。抗凝治疗应同时检测INR和TPP。 相似文献
73.
Andrew Edwards Anthony M. J. Bull Andrew A. Amis 《Knee surgery, sports traumatology, arthroscopy》2007,15(12):1414-1421
The tibial attachments of the individual anteromedial (AM) and posterolateral (PL) fibre bundles and the entire attachment
of the anterior cruciate ligament are described, relating them to consistent bony landmarks; 55 fresh-frozen specimens were
measured. The fibre bundles were separated and excised at their attachments and their peripheries marked with a pen. High-resolution
scaled digital photographs were taken of each dissected specimen and transferred onto a computer for analysis. A wide variation
was found when using the posterior tibial axis, the anterior tibial surface and the medial tibial spine as reference points.
The most consistent measurements used the tibial interspinous “over-the-back” ridge as a datum. The attachments of the PL
and AM bundles were centred 10 ± 1 mm (mean ± SD) and 17 ± 2 mm anterior to the over-the-back ridge. They were 4 ± 1 and 5 ± 1 mm,
respectively, lateral to the medial tibial spine border. The positions of 6 mm circles in the posterior-medial limits of the
fibre bundles (representing tunnels in a double-tunnel reconstruction) were measured. The overall dimensions of the tibial
plateaux correlated significantly with many measurements. The results from this study could be used to guide ACL reconstruction
techniques. 相似文献
74.
Yukihisa Fukuda Savio L-Y Woo John C Loh Eiichi Tsuda Peter Tang Patrick J McMahon Richard E Debski 《Journal of orthopaedic research》2003,21(6):1107-1112
The loads needed to elicit a positive pivot shift test in a knee with an anterior cruciate ligament (ACL) rupture have not been quantified. The coupled anterior tibial translation (ATT), coupled internal tibial rotation (ITR), and the in situ force in the ACL in response to a valgus torque, an inherent component of the pivot shift test, were measured in 10 human cadaveric knee specimens. Using a robotic/universal force-moment sensor testing system, valgus torques ranging from 0.0 to 10.0 Nm were applied in nine increments on the intact and ACL-deficient knee in flexion ranging from 0 degrees to 90 degrees. At 15 degrees of knee flexion, the coupled ATT and ITR were significantly increased in the ACL-deficient knee when compared to the intact knee. Coupled ATT increased a maximum of 291% (6.7 mm, p<0.05), while coupled ITR increased a maximum of 85% (5.1 degrees, p<0.05). At 30 degrees, the increases in coupled ATT and ITR were significant at valgus loads of 3.3 Nm and greater with a maximum increase in coupled ATT of 137% (6.3 mm, p<0.05) and a maximum increase in coupled ITR of 38% (3.6 degrees, p<0.05). At 45 degrees, coupled ATT increased significantly (maximum of 69%, 4.4 mm, p<0.05), but only at torques > or =6.7 Nm. The in situ force in the ACL was less than 20 N for all flexion angles when a torque between 3.3 and 5.0 Nm was applied. Low valgus torque elicited tibial subluxation in the ACL-deficient knee with low in situ ACL forces, similar to a positive pivot shift test. Thus, application of a valgus torque may be suitable to evaluate ACL-deficient and ACL-reconstructed knees, since subluxation can be achieved with minimal harm to the ACL graft. This work is important in understanding one load component needed for the pivot shift examination; further studies quantifying other load components are essential for better comprehension of the in vivo pivot shift examination. 相似文献
75.
Ⅱ型浮膝损伤术后膝关节功能康复 总被引:2,自引:2,他引:0
目的:总结Ⅱ型浮膝损伤患者的治疗方法和手术后膝关节功能康复疗效。方法:回顾分析经治的68例患者,男57例,女11例;年龄17~60岁。68例共74侧肢体的Ⅱ型浮膝损伤-膝关节内骨折病例,其中双侧肢体Ⅱ型浮膝骨折6例。根据患者骨折类型、是否存在开放性损伤、软组织损伤程度分别采用内固定(髓内钉、解剖钢板)和支架外固定方法,术后均采用统一、系统的康复治疗。术后对治疗结果采用Karlstrom和Olerud的浮膝损伤治疗标准进行评价;使用χ2检验对两种固定方法治疗后膝关节功能康复效果差别进行显著性分析。结果:所有病例均得到1~4年的随访,平均24个月。内固定组优良率64.29%,支架外固定组优良率80.43%。内固定组与支架外固定组比较,膝关节活动受限度指标有统计学差异(P<0.05),说明Ⅱ型浮膝损伤应当注重对关节内骨折的复位和减少对膝关节周围软组织的破坏。结论:①早期功能恢复期支架组优于内固定组;②牵引后及术后早期系统的康复治疗有利于膝关节功能恢复和减少并发症;③伸膝功能锻炼应当在牵引治疗后即开始,膝关节屈伸功能锻炼在手术后3d进行。 相似文献
76.
77.
Bicarbon valve - European multicenter clinical evaluation 总被引:1,自引:0,他引:1
J.B Borman W.G.B Brands L Camilleri M Cotrufo W Daenen I Gandjbakhch C Infantes A Khayat F Laborde A Pellegrini A Piwnica B Reichart R Sharony R Walesby H Warembourg 《European journal of cardio-thoracic surgery》1998,13(6):685-693
Objective: Fifteen collaborating centers in eight countries present their pooled experience with the new Bicarbon™ bileaflet valve. Methods: Between 4/90 and 4/96, 1351 patients, 806 males and 545 females, aged 10 to 83, mean 58.4±12.4, underwent valve implantation. Operations: AVR, 726; MVR, 475; DVR, 150. Additional procedures: CABG, 211; TV repair, 64; other, 152. Results: Mortality: 67 early (seven valve related) and 56 late (40 valve related). Valve thrombosis: six obstructive, three non-obstructive; embolism: nine major cerebral, 37 other. Major bleeding: 29. Hemolysis: two clinically significant. Non-structural dysfunction: 24 paravalvular leaks, one leaflet interference. No structural failure! Endocarditis: 24. Reoperation 48: 22 non-structural dysfunctions, 14 endocarditis, seven thrombosis and embolism, five other. Estimated 5-year freedom from valve-related deaths is 97.2% for AVR and 92.4% for MVR; 4-year freedom from valve related deaths for DVR is 90.5%. Mean calculated NYHA improvement is 1.24. Conclusions: The Bicarbon mechanical prosthesis is well designed, durable, has good hemodynamic features and an acceptably low incidence of complications. 相似文献
78.
本文采用三维位移测量方法,测试10例离体人膝标本的胫股关节三维运动特性。发现屈膝过程中,胫股运动也具有典型的三维运动特点。其中在屈膝初期的30°内,胫骨内旋最明显并伴有胫骨内翻现象,平均内旋8°,内翻6-7mm,膝关节完全伸直时胫股扣锁使膝关节稳定,屈曲时胫股“解锁”使膝关节松弛,具重要的临床意义,同时提示,在解释传统的胫股扣锁现象时不应遗漏伴随发生的胫骨内/外翻现象。 相似文献
79.
自1981年以来进行了350例膝关节镜检查。明确诊断340例(97.1%),纠正诊断52例(14.7%),补充诊断47例(13.4%)。关节镜检查不仅有助于确定临床诊断,而且提高了手术的准确性。 相似文献
80.
We present improvements of a previously reported method of tracheoesophageal puncture for voice restoration in postlaryngectomy
patients. Our method utilizes a flexible endoscope to enable the tracheoesophageal puncture to be made under direct visualization
using only local anesthesia and intravenous sedation. After 3 days, the created tracheoesophageal fistula tract is mature
enough to allow placement of a voice prosthesis in the office. This allows the entire procedure to be performed in an outpatient
setting with minimal risk.
Received: 24 October 1996/Accepted: 24 January 1997 相似文献