保留后方韧带复合体在胸腰椎骨折治疗中的意义

[目的]探讨保留后方韧带复合体在胸腰椎骨折治疗中的意义。[方法]1998～2002年单一节段胸腰椎爆裂骨折治疗中保留后方韧带复合体44例，同期行胸腰椎爆裂骨折治疗切除后方韧带复合体者35例。两种方法分别有15例（定义为A组）和12例（定义为B组）行2次手术取出内固定物，比较AB两组间2次手术前后腰椎功能JOA评分。[结果]2次手术前腰椎功能JOA评分：A组平均24．5分（19～29分）；B组平均22．8分（19～29分），二者无显著性差异（P〉0．05）。2次手术后JOA评分：A组平均24．8分（20～29分），B组平均17．5分（13～26分）。二组有显著性差异（P〈0．05）。[结论]胸腰椎骨折治疗中保留后方韧带复合体，利于术后腰椎功能恢复。     

后路环周融合治疗老年人重度腰椎管狭窄症

[目的]探讨后路环周腰椎融合在老年人重度腰椎管狭窄症的应用和效果。[方法]2001年11月~2004年5月,采用后路腰椎间融合(PLIF)联合后外侧融合(PLF)的环周融合术治疗老年人腰椎管狭窄症83例。随访18~42个月,观察术后并发症,采用JOA评分评估治疗效果,X线片和CT判定植骨融合情况。[结果]术后所有患者12~14 d即可下地行走,3例出现症状性下肢深静脉血栓,10例腰腿痛一过性加重。末次随访腰腿痛明显缓解,JOA评分由术前平均(13.6±3.8)分改善至(22.3±4.6)分。椎间植骨均获骨性融合。[结论]后路环周融合术是治疗老年人重度腰椎管狭窄的安全、有效、合理的选择之一。     

Selective peripheral neurotomy (SPN) for spasticity in childhood

Overview Excess spasticity leads to disability that is marked by impaired locomotion, handicapping deformities and, if not controlled, discomfort and pain. Selective peripheral neurotomy in the child is indicated for severe focal spasticity, when botulinum toxin injections cannot delay surgery any longer. Materials and methods Preoperative motor blocks mimicking the outcome of the surgical procedure are essential to establish the objectives of neurotomy. In the lower limb, obturator neurotomy is indicated for spasticity in the adductor muscles, hamstring neurotomy for the knee flexion and tibial neurotomy for the spastic foot. Anterior tibial neurotomy is indicated for the extensor hallucis spasticity and femoral neurotomy for spasticity in the quadriceps. In the upper limb, neurotomy of the pectoralis major and teres major nerves is indicated for spasticity of the internal rotators of the shoulder. Neurotomy of the musculocutaneous nerve is indicated for spasticity of the flexors of the elbow, and neurotomy of median and ulnar nerves are indicated for spasticity of the pronators and flexors of the wrist and fingers. Conclusion Selective peripheral neurotomy is a valuable neurosurgical procedure in well-trained surgical hands for severe focalised spasticity.     

改进微波幅射器探头治疗宫颈糜烂疗效观察

目的：探讨改进的微波辐射器探头治疗宫颈糜烂的疗效。方法：将微波辐射器探头由双直线形、双针形、单针形等点线状改进成为“单舌形”和“双舌形”两种弧形平面探头，用于治疗宫颈糜烂。分析1999-2002年450例宫颈糜烂治疗资料，其中300例经微波治疗(A组)，150例经C02—激光治疗(B组)，随访1—3个月。结果：两组治疗后3个月内A组治愈率明显高于B组(P＜0．005)，总有效率A组明显高于B组(P＜0．025)。两组术中、术后不良反应比较：术中宫颈创面出血A组明显低于B组(P＜0．005)，术中腹痛、脱痂期出血量、术后局部感染率方面两组相似。结论：所改进的微波辐射器探头治疗宫颈糜烂治愈率高，操作安全，术后并发症少，医患乐于接受。     

阴道B超介导下后穹窿穿刺治疗盆腔囊肿

目的　介绍阴道B超介导下后穹窿穿刺治疗盆腔囊肿的方法和疗效。方法　 38例盆腔囊肿病人在阴道B超介导下行后穹窿穿刺术 ,并与 2 8例住院行经腹囊肿切除术病人进行对比。结果　阴道B超介导下后穹窿穿刺术治愈率 10 0 % ,复发率 2 6 %。与经腹囊肿切除术相比 ,手术时间短 ,术中出血少 ,病人可接受程度高 ,花费少 ,差异显著 (P <0 0 1)。结论　阴道B超介导下后穹窿穿刺治疗盆腔囊肿 ,方法简便、安全高效、创伤小、价廉 ,是一项理想的保守疗法 ,值得推广应用。     

铁调节蛋白2基因多态性与阿尔茨海默病及血管性痴呆的相关分析

Objective To evaluate the association of 2616c/T polymorphism in iron regulatory protein 2(IRP2)gene with Alzheimer disease(AD)and Vascular dementia(VD).Methods In this study,281 patients with AD,60 with VD,and 285 normal aged were recruited.The 2616C/T polymorphism in IRP2 gene was analyzed by using polymerase chain reaction-restriction fragment length polymorphism.And the cognitive function was assessed with the Mini-Mental State Examination(MMSE).Results (1)No significant difieFences were demonstrated in IRP2 genotype or allele frequencies between AD patients and controls(χ2=2.46,P=0.292;χ2=2.17,P=0.141 respectively).However,when AD patients were stratified by disease severity.the frequency of T allele carriers in the moderate to severe AD patients was 78.0%,significantly higher than that in controls(69.8%;χ2=4.106,P＜0.05).Logistic regression analysis demonstrated that the age-,sex-and ApoE-adiusted OR of modcrate to severe AD patient with T allele was 1.62(95% CI=1.03-2.54).The frequency of T allele carriers or T allele in VD patients was higher than that of controls,but the difference was not statistically significant(P＞0.05).(2)The frequency of tit genotype or T allele in the moderate to severe AD patients was significantly higher than that in mild AD patients(25.8%vs.12.5%,χ2=5.477,P＜0.05;51.9%vs.40.3%,χ2=5.803,P＜0.05 respectively).(3)MMSE scores of the AD patients with TT genotype was significantly lower than ones with CC or CT genotype(P=0.028;P=0.014 respectively).Conclusion The 2616C/T polymorphism in the IRP2 gene is possibly associated with moderate to severe AD.but not associated with VD.And the TT genotype may be a risk factor for cognitive impairment of patients with AD in Chinese Han.     

急性颈脊髓损伤并发抗利尿激素分泌异常综合征的诊断和治疗

目的探讨急性颈脊髓损伤并发抗利尿激素分泌异常综合征的临床特点、诊断和治疗方法。方法回顾性分析8例急性颈脊髓损伤并发抗利尿激素分泌异常综合征患者的临床资料。脊髓损伤分级:FrankelA级5例,B级3例;损伤节段:C4～53例,C5～63例,C6～72例。8例于受伤后3～7d行骨折椎体次全切除椎管减压、自体髂骨植骨融合及颈椎前路钢板内固定术。3例于术前,5例于术后3～7d发生低钠血症,所有患者低钠血症发生后第2～10d确诊SIADH,根据血钠水平,采用控制每日水量、补钠进行治疗。结果7例经10～21d治愈,血钠平均恢复至138(135～142)mmol/L,血浆渗透压、尿渗透压、尿钠均正常;1例C4骨折、FrankelA级者,因截瘫平面上升并发呼吸衰竭死亡。结论急性颈脊髓损伤并发抗利尿激素分泌异常综合征的发病机制与治疗措施不同于普通低钠血症,早期正确的诊治能降低患者病残率和死亡率,严格控制入液量及补钠为主要治疗方法。     

简易印模术对单个前牙烤瓷冠颈缘外观效果的作用观察

目的:观察和探讨两种印模技术对单个前牙烤瓷冠颈缘外观的改善效果。方法:40位患者用简易印模技术制取印模,制作93件镍铬合金烤瓷瓷冠,设为实验组,另35位患者以常规印模技术制取印模,制作71件镍铬合金烤瓷瓷冠,设为对照组。观察两组戴冠当时与两年后的颈缘适合性、颜色、牙龈形态与健康情况。结果:试验组有98%的合金瓷冠具有优良的边缘适合性,仅2件(2%)出现颈缘黑线,与对照组相比有显著差异(P<0.05)。结论:简易印模技术能更好的保证工作区模型的准确度,从而有效地改善了镍铬合金烤瓷冠颈缘的美观与龈组织的健康。     

硒抑制镍诱导的人肺成纤维细胞的DNA损伤

目的　探讨三氧化二镍(Ni2O3)对人肺成纤维细胞(human lung fibroblasts,HLF)的DNA损伤作用以及Na2SeO3的保护作用。方法　应用单细胞凝胶电泳(single cell gel electrophoresis,SCGE)检测DNA损伤。结果　Ni2O3 处理HLF细胞4 h,SCGE检测出DNA损伤程度高于对照组,差异有显著性(P<0.01)。而Ni2O3 Na2SeO3 处理组DNA损伤程度低于Ni2O3 组,差异有显著性(P<0.01)。结论　硒可抑制镍诱导的人肺成纤维细胞的DNA损伤。     

三维重建单(双)靶点定向置管引流术治疗高血压壳核出血

目的回顾性分析三维重建单(双)靶点定向置管引流术治疗高血压壳核出血的疗效,验证该方法的有效性和可行性。方法将133例壳核脑出血病人的CT定位扫描资料输入计算机工作站,对血肿进行三维重建,根据血肿量的大小和形状设计1～2个靶点和引流管路径。应用立体定向技术将引流管(外径5mm,内径3mm)送至颅内预定靶点,术中应用10ml注射器轻柔抽吸血肿液化部分,术后将尿激酶(1～2万IU)注入血肿腔内,夹闭引流管2h后自然引流,每12h重复1次。复查CT证实剩余血肿量为最初的10%~15%时拔除引流管。结果平均置管1.5 d(1～3d),平均血肿排空率92.8%。术后1个月病死率6.0%,远期随访(平均22个月)病死率11.3%,优良率74.4%。结论该方法治疗高血压壳核脑出血,血肿排空较彻底,疗效可靠,尤其适用于血肿量较大(>25ml)且形态不规则的颅内血肿。