932例中晚期恶性肿瘤的中医药治疗效果分析

目的:分析932例中晚期恶性肿瘤患者的临床疗效。方法:根据不同肿瘤经中医药治疗后的效果,进行回顾性分析和总结,客观评价其疗效。结果:在中晚期恶性肿瘤治疗方面中医药治疗能明显减轻化放疗的不良反应,使临床症状好转,卡氏评分提高,生存质量改善,在一定程度上能延长患者生存期。结论:中医药在恶性肿瘤的综合治疗中疗效好,毒性低,适用面广,值得临床推广。     

SRS MapCHECK半导体矩阵用于射波刀脊柱计划剂量验证的应用研究

目的:评估SRS MapCHECK半导体矩阵探测器用于射波刀脊柱计划剂量验证工作的适用性。方法:将SRS MapCHECK探测器安装于专用模体StereoPHAN开展研究工作,测试了射波刀固定和Iris可变准直器的单野计划,以及脊柱临床计划的质量保证（QA）计划,采用SNC Patient软件对比分析实测与计划剂量分布之间的差异,分别计算在2 mm/5%、2 mm/3%和2 mm/2%标准下的γ通过率。结果:在绝对剂量分析模式2 mm/5%,2 mm/3%和2 mm/2%标准下,固定和Iris可变准直器单野计划的γ通过率均为100.0%,脊柱QA计划的平均γ通过率分别为（99.3±1.2）%、（96.5±2.7）%和（93.5±5.3）%。结论:SRS MapCHECK半导体矩阵探测器在2 mm/5%和2 mm/3%的γ分析标准下适合用于开展射波刀脊柱临床计划的剂量验证工作。     

胸腰段骨折伴后方韧带复合体损伤经肌间隙固定疗效分析

105例胸腰段骨折伴后方韧带复合体损伤患者随机分为观察组（经椎旁肌间隙固定）和对照组（传统剥离椎旁肌入路短节段固定）,比较疗效。观察组术中出血量、住院时间、术后康复时间、术后14d视觉模拟评分（ VAS）均低于对照组;两组的不良反应、Cobb角度、椎体高度无显著差异（ P＞0.05）。胸腰段骨折伴后方韧带复合体损伤采用经肌间隙固定具有安全有效、损伤小等优点。     

体位复位法结合经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折20例疗效观察

经皮椎体成形术（P V P ）治疗骨质疏松性椎体压缩性骨折具有操作简单、经济,疗效满意等优点,但恢复椎体高度欠佳,骨水泥渗漏及相关并发症发生率高。我科通过体位复位,结合经皮椎体成形术治疗20例骨质疏松性压缩性椎体骨折患者,该方法能恢复椎体高度,减少骨水泥渗漏及相关并发症,疗效满意。现报告如下。     

自行研制的经皮胸腰椎椎弓根置钉三维定位器应用的可行性实验研究

目的 通过与"徒手"置钉进行比较,探讨自行研制的经皮胸腰椎椎弓根置钉三维定位器辅助在脊柱标本上进行经皮椎弓根穿刺的可行性.方法 对新鲜保留皮肤软组织的脊柱标本2具(32个椎体)行胸腰椎序列CT扫描,使用Mimics 13.1软件确定椎弓根轴心片,测定水平面椎弓根螺钉植入角度(TSA)及矢状面椎弓根螺钉植入角度(SSA).定位皮肤穿刺点,对应调节水平面及矢状面角度指示器刻度指导穿刺.椎弓根随机分为两组:一侧为自行研制的经皮胸腰椎椎弓根置钉三维定位器辅助组(定位器组),对侧为"徒手"置钉组(徒手组).定位器组在定位器及X线辅助下穿刺,徒手组在C型臂影像增强系统辅助下予"徒手"技术穿刺,置入克氏针,C型臂X线机证实穿刺成功.行椎弓根CT扫描,测量2种方法穿刺的实际TSA角及SSA角,将术前测定的椎弓根TSA角及SSA角与术后实际TSA角及SSA角对比,计算偏差率;比较两组的偏差率和X线曝光次数.结果 定位器组和徒手组的穿刺TSA角偏差率平均分别为10.83%±3.41%和19.08%±4.21%,差异有统计学意义(P＜0.05);定位器组和徒手组的穿刺SSA角偏差率平均分别为13.13%±4.37%和21.15%±6.78%,差异有统计学意义(P＜0.05).定位器组和徒手组接受X线辅助的次数平均分别为(3.0±1.2)次和(5.3±1.6)次,差异有统计学意义(P＜0.05).结论 与"徒手"置钉相比,应用自行研制的经皮胸腰椎弓根置钉三维定位器可有效提高手术准确度、降低手术难度、减少X线暴露.

Abstract：

Objective To test a self-designed 3-D guiding instrument for percutaneous insertion of thoracolumbar pedicle screws in cadaveric vertebrae. Methods Two fresh cadaveric vertebral specimens with skin and soft tissue were used first for standard CT lateral scanning ofT1 to L4.Software Mimics13.1 was used to create axial images of pedicles of vertebral arch.The points of percutaneous insertion of thoracolumbar pedicle screws,transverse screw angles (TSA) and sagittal screw angles (SSA) were measured.Thirty-two vertebral bodies were divided randomly into 2 equal groups for guiding instrument insertion and manual insertion with the aid of C-arm fluoroscopy.The quality of insertion was evaluated by postoperative CT scans.Angular deviations were determined by comparing the preoperative and postoperative TSA and SSA for the 2 groups.X-ray exposures were also compared between the 2 groups. Results The TSA angular deviation rate was ( 10.83 ± 3.41 ) ％ for the guiding instrument insertion group and ( 19.08 ± 4.21 ) ％ for the manual insertion group.The SSA angular deviation rate was (13.13 ±4.37) ％ for the guiding instrument insertion group and (21.15 ± 6.78) ％ for the manual insertion group.The guiding instrument insertion group needed 3.0 ± 1.2 X-ray exposures while the manual insertion group had 5.3 ± 1.6 X-ray exposures.All the differences were statistically significant. Conclusion The 3-D guiding instrument can facilitate the percutaneous insertion of the thoracolumbar pedicle screws by improving operation accuracy and reducing operation difficulty and X-ray exposures as well.     

尼莫地平对大鼠面神经损伤的保护作用及GDNF表达的影响

目的 探讨尼莫地平对大鼠面神经损伤的保护作用及对胶质细胞源性神经生长因子(GDNF)表达的影响.方法 96只大鼠按随机数字表法分为假手术组、单纯损伤组、尼莫地平预处理组、尼莫地平后处理组,后三组建立大鼠面神经电损伤模型.应用HE染色、Western blotting等方法,观察大鼠面神经损伤后不同时期(1、3、6月)GDNF的动态表达变化及尼莫地平不同给药时间对其表达的影响.结果 与单纯损伤组相比,尼莫地平预处理组大鼠面神经损伤程度减轻,GDNF表达升高,持续时间延长;尼莫地平预处理组GDNF表达和尼莫地平后处理组间比较差异有统计学意义(P＜0.05);尼莫地平后处理组GDNF表达在3月、6月时与单纯损伤组比较差异无统计学意义(P＞0.05).结论 预防性应用尼莫地平可以保护面神经,其机制可能是通过调节GDNF的表达而实现的.

Abstract：

Objective To study the protective function of nimodipine on facial nerve injury and its effect on the expression of glial cell line-derived neurotrophic factor (GDNF). Methods Ninety-six SD rats were randomly divided into sham-operated group, facial nerve injury group, nimodipine pretreatment group, and nimodipine post-treatment group. Rat models of facial nerve injury in thc later 3groups were established. The dynamic changes of expression of GDNF were observed by HE staining and Western blotting in different treatment groups and at different time points (1, 3 and 6 months after the injury). Restdts Compared with the facial nerve injury group, the nimodipine pretreatment and post-treatment groups had significantly less severe nerve damage and significantly up-rcgulated expression of GDNF (P＜0.05). The expression of GDNF in the nimodipine pretreatment group was statistically higher than that in the nimodipine post-treatment group (P＜0.05). However, the expression of GDNF in the nimodipine post-treatment group was not statistically different from that in the facial nerve injury group 3 and 6 months after the injury (P＞0.05). Conclusion Nimodipine has significant facial nerve protective effect, and one of the mechanisms of nimodipine to protect the facial nerve is to regulate the GDNF expression.     

SurvivinmRNA在胆囊癌中的表达及其对化疗预后的影响

目的 探讨凋亡抑制基因survivin mRNA在胆囊癌的表达及其与胆囊癌发生发展的关系.方法 应用逆转录一聚合酶链反应(RT-PCR)检测17例胆囊癌组织中survivin mRNA的表达情况,分析其与临床特征之间的相关性.结果 在17例胆囊癌组织中11例表达阳性,阳性率为64.7%,survivin mRNA在17例癌旁组织和12例胆囊腺瘤性息肉组织中均未检出;survivin mRNA的表达与患者的性别、年龄、是否有胆囊结石、病理分型、Nevin分期、转移无关(P＞0.05).结论 survivin mRNA在胆囊癌中的表达能促进胆囊癌的发生发展,阻断survivin mRNA的表达可为胆囊癌的治疗提供新的途径.     

锁骨钩钢板置入内固定后特有并发症的预防与对策

背景：近几年锁骨钩钢板在国内外逐步被推广应用于锁骨远端骨折和肩锁关节脱位,被认为是一种比较理想的治疗方法.随着使用率的增加,一些内固定并发症,如内固定后肩痛、肩峰撞击、肩峰溶解、脱钩、应力性骨折等逐渐显现出来.目的：分析锁骨钩钢板置入内固定修复锁骨远端骨折和肩锁关节脱位后产生并发症的原因,并总结其防治对策.方法：2006年3月至2014年5月贵阳市第四人民医院共收治锁骨钩钢板置入内固定修复锁骨远端骨折及肩锁关节脱位患者112例,其中锁骨远端骨折48例,肩锁关节脱位64例.锁骨远端骨折按Neer分型法,Ⅰ型16例,Ⅱ型32例;肩锁关节脱位64例均为Tossy Ⅲ型.其中肩关节上部悬吊复合体双重损伤4例.对患者的临床修复效果及内固定后并发症进行回顾性分析.结果与结论：103例获得随访并进入结果分析,其余病例因患者原因短期内失访,不予纳入结果分析.99例患者显示骨折端愈合及肩锁关节对位良好,并发症发生率为30.1％.采用Karlsson疗效评价标准,优79例,良16例,优良率为92.2％.提示锁骨钩钢板置入内固定修复锁骨远端骨折和肩锁关节脱位,根据个体化特点治疗,注意预防和处理其并发症,是可以得到理想疗效的.     

脊柱手术髂骨取骨并发症的回顾性分析

目的：探讨脊柱手术髂骨取骨并发症的发生率、原因及预防。方法：回顾性分析2009年5月到2011年9月取髂骨行脊柱融合术的患者131例,对取骨区并发症进行统计分析。结果：131例患者均接受问卷调查,其中,22例患者出现并发症（16.79%）,12例（9.16%）诉取骨处疼痛,3例（2.29%）出现局部血肿,7例（5.34%）诉取骨处麻木。结论：取骨处疼痛、麻木在髂骨取骨的并发症中发生率较高,手术操作得当可避免严重并发症的发生。