计算机导航全膝关节置换系统

医学影像技术，计算机技术和空间示踪技术的发展与结合产生了计算机辅助骨科手术（computer assisted orthopaedic surgery,CAOS），该技术亦被称为计算机手术导航，计算机导航极大地提高了人工全膝和全髋关节置换手术的准确性和可重复性。近两年，计算机导航人工全膝关节置换技术在欧美得到了较为广泛的开展；从其初期的应用报告提示该系统可以极大地改善术中，术后下肢的力学对线，辅助术中软组织平衡调节，改善术后关节的活动范围，取得了很好的近期临床效果。     

GSS内固定治疗胸腰椎骨骨折

目的探讨通用型脊柱系统(GSS)复位内固定治疗胸腰椎骨折的疗效。方法对26例胸腰椎骨折的病例采用通用型脊柱系统(GSS)内固定、后外侧或后外侧加椎体间植骨融合治疗。结果随访8个月-31个月,平均18个月。椎体前缘高度由术前42.1%恢复至术后83.5%,椎体后缘高度由术前78.2%恢复至术后93.7%,Cobb角由术前18.5°恢复至术后3.6°。神经功能按Frankel分级法评价,恢复满意。结论通用型脊柱系统(GSS)结构合理、操作方便、固定坚强,是治疗胸腰椎骨折的有效方法。     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

Objective To investigate the feasibility of the low tube voltage setting and personalized contrast agent application in 64-row multi-slice spiral CT pulmonary angiography.Methods Ninety patients with high risk of pulmonary artery embolism were sequentially enrolled in the study and divided into 3 groups employing completely randomized design: (1) Regular group included 30 patients using 120 kV and fixed dose of 70 ml contrast agent, (2)Another 30 patients were in 120 kV group, using 120 kV and the contrast amount was determined according to the patient weight (1.0 ml/kg), (3) The remaining 30 patients were included in 100 kV group, using 100 kV and the contrast amount was also determined according to the patient weight(1.0 ml/kg).Administration of contrast agent was completed within 20 seconds for all the patients, followed by 20 ml of saline.The objective and subjective indexes for assessing CT image quality, CT dose index volume (CTDIvol) and effective received dose (ERD) were compared between 120 kV group and 100 kV group; then the contrast media volume, injection rate, objective CT image indexes and subjective indexes for image quality was compared between the 100 kV group and regular group.The variance analysis and post hoc test were employed for the statistical analysis.Results Compared with 120 kV group(3.4± 0.7), the image quality of 100 kV group(5.2±1.8)had higher noise(52.9%), but subjective index for the image quality demonstrated no differences(q=0.272 ,P=0.063)in mediastinum window while CTDIvol and ERD decreased for 34.9%[(9.5±0.0) vs (14.6±0.0) mGy]and 36.8%[(3.8±0.6) vs (2.4± 0.4) mSv].The mean CT values on pulmonary artery of 100 kV group[(269.2±54.7) HU]were 13.4% (31.8/237.4) higher than the 120 kV group[(237.4±62.9) HU], but there was no statistical differences eornpared to normal group(q=0.172,P=0.260).Conclusion Using low kV setting (100 kV) to reduce radiation dose is proved to be effective and feasible in 64-MSCT pulmonary angiography.Personalized contrast agent injection has clinical application value for specific patient group.     

腰痛的诊断与鉴别诊断的思维方式

腰痛是临床上最常见的症状之一。引起腰痛的疾病很多 ,如外科、内科、妇科、泌尿科及神经科的某些疾病均可引起。因此 ,对每一例腰痛的患者都必须仔细询问病史 ,认真地进行检查 ,从多方面进行分析考虑 ,才能作出正确的诊断。1　诊　断1.1　按腰痛的性质诊断1.1.1　由腰背筋膜、骶棘肌、韧带、关节囊的损伤 ,劳损或肌肉纤维织炎等引起的腰痛。如急性腰肌劳损、棘上或棘间韧带损伤、椎间关节韧带损伤、腰骶关节损伤、急性后部小关节紊乱、棘间韧带劳损、髂腰韧带劳损———肌筋膜性腰痛[1 ] 。1.1.2　腰痛剧烈并有典型放射性坐骨神经痛者。如…     

脑静脉系血栓形成的临床研究

脑静脉系血栓形成(CVST)的临床表现缺乏特异性，因此多因延误诊治而导致严重后果。近年来由于CT、MRI及DSA等的应用，对该病的认识、诊断、治疗有了较大的提高。现将我院近3年经临床及影像学检查证实的脑静脉系血栓形成的18例住院患者的病因、临床表现、影像学诊断等方面的临床资料进行回顾性分析，报告如下。     

单孔置双管引流治疗慢性硬膜下血肿(附62例分析)

1对象与方法 我院自2000年5月～2006年8月采用单孔置双管引流治疗62例慢性硬膜下血肿病人．其中男41例，女21例；年龄33～76岁，平均57岁。外伤至手术时间3周～2年。有头部明确外伤史50例。人院时GCS13～15分53例，9～12分4例，3～8分5例。均经CT平扫或MRI确诊，血肿多位于额颞顶部。单侧血肿54例，双侧血肿8例。血肿量50～150ml，平均85ml。     

吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响

Objective To evaluate the effects of morphine preconditioning-postconditioning on ischemia-reperfusion (I/R) injury in isolated rat hearts. Methods Male SD rats weighing 180-200 g were killed after intraperitoneal injection of heparin 500 U/kg. The hearts were immediately removed and perfused in a Langendorff apparatus with K-H solution gassed with 95%O2-5%CO2 .HR and left ventricular systolic pressure (LVSP) were measured from a fluid-filled latex balloon in the left ventricle. Global myocardial ischemia was induced by interrupting perfusion for 45 min followed by 60 min reperfusion. Forty isolated rat hearts were randomly divided into 5 groups (n = 8 each): group 1 (I/R); group II morphine preconditioning (M1 ); group Ⅲ morphine postconditioning (M2); group IV M1 + M2; group V 5-hydroxydecanoate (5-HD) + M2. Group M1 was perfused with K-H solution containing morphine 3.0 μmol/L for 20 min 30 min before ischemia followed by 10 min normal K-H solution perfusion. Group M2 was perfused with K-H solution containing morphine 3.0 μmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Group 5-HD + M2 was perfused with K-H solution containing morphine 3.0 μmol/L+ 5-HD 10-4 mmol/L for 10 min at the beginning of reperfusion followed by 50 min normal K-H solution perfusion. Myocardial CK-MB activity was measured and myocardial infarct size (IS/AAR) detennined (by 2,3,5-triphenyl tetrazolium staining) at the end of 60 min reperfusion. Results The preconditioning, postconditioning and combination of preconditioning and postconditioning with morphine 3.0 μmol/L perfusion for 10 min all provided cardio-protective effects in terms of IS/AAR and myocardial activation of CK-MB. Conclusion Although the combination of morphine preconditioning and postconditioning can protect the heart against I/R injury, the effects are similar to those of either of them alone, and the reason may be that either of them alone protects the heart against I/R injury via activating mitoKATP .     

P16INK4a 与肾脏疾病的研究现状

各种肾脏疾病的发生、发展都与其固有细胞增殖、肥大、凋亡或分化转型有关,从而导致各种肾脏疾病的发生发展,最终引起肾功能衰竭,甚至癌变.无论何种病因其调控皆发生于细胞周期水平,细胞周期各调节蛋白异常都可能影响肾脏疾病的进展和预后.P16INKK4a 作为一种重要的周期负性调控蛋白.与肾固有细胞增殖、凋亡、衰老及癌变有关.因此,探讨其在肾脏的生理和病理作用.可能为肾脏疾病的防治提供新的方法 和手段.     

肝门部胆管成形空肠袢皮下埋置术治疗肝胆管结石的临床观察

为探讨肝门部胆管成形空肠袢皮下埋置术治疗肝胆管结石的效果，笔者回顾性分析近5年来采用肝门部胆管成形空肠袢皮下埋置术治疗23例肝胆管结石患者的临床资料。全部病例手术成功;对2例结石复发患者利用纤维胆道镜通过皮下埋置的空肠袢取石后治愈。本组结果提示本术式系一种理想的治疗肝胆管结石的方法，能为手术后结石复发的治疗提供一条方便快捷的通道。     

第五届国际生殖内分泌学术会议纪要

秋日的北京凉爽宜人，2005年9月9～12日，由北京协和医院、国家人口计生委科学技术研究所主办，国际妇科内分泌协会和中国医学科学院协办，并由生殖医学杂志承办的第五届国际生殖内分泌学术会议在北京隆重举行。来自中国、美国、加拿大、英国、意大利、荷兰、比利时、芬兰、巴西、日本、菲律宾、