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1.
青少年特发性脊柱侧凸患者顶椎关节突中Ⅰ型胶原的表达   总被引:3,自引:0,他引:3  
目的比较青少年特发性脊柱侧凸(AIS)患者顶椎凸、凹侧关节突中Ⅰ型胶原的表达.方法选取11例AIS患者顶椎凸、凹侧下关节突,HE染色观察顶椎关节突的病理改变.分别培养从患者顶椎凸、凹侧下关节突获得的成骨细胞,鉴定后,In-cell Western法比较患者顶椎凸、凹侧下关节突成骨细胞合成分泌Ⅰ型胶原的差异.结果AIS患者顶椎关节突关节软骨呈现退变征象,软骨下骨形态学无明显改变.顶椎凹侧关节突成骨细胞分泌的Ⅰ型胶原(112.00±7.26)较凸侧(106.36±8.63)多(P<0.05).结论AIS患者顶椎凸、凹侧关节突中成骨细胞基因表达存在差异,值得进一步从基因水平进行研究.  相似文献
2.
Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions: Group A was hook-screw-rod (hybrid) internal fixation type, Group B was screw-rod (all pedicle screws) internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients (7 males, 41 females) were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A (P=0.003). The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A (P=0.003). The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted (both P〉0.05). The decompensation rate at final follow-up in these 2 groups were 4% (1/25) and 7.1% (1/14) respectively, with no significant difference (P〉0.05).  相似文献
3.
Objective To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis.Methods By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who underwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed.Results There were 17 King type Ⅱ patients (PUMC type: Ⅱb1 13, Ⅱc3 4). The coronal Cobb angle of thoracic curve before and after operation were 56.9°and 21.6° respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8° and 12.1° respectively, and the mean spontaneous correction rate was 64.8%.At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5° and 15.2° respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation.One patient had 12° of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the thoracic and lumbar curves.Conclusion Posterior selective thoracic fusion can be safely and effectively performed in King type Ⅱ patients with a moderate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.  相似文献
4.
目的:观察导引手法综合治疗青少年特发性脊柱侧凸症(AIS)的临床疗效。方法:应用脊柱平衡导引术和脊柱平衡手法综合治疗AIS 60例,共治疗6个月。观察治疗前后侧凸Cobb角改变情况,肺活量(VC)、第一秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、每分钟最大通气量(MVV)等肺功能变化及相关安全性指标。结果:治疗后,痊愈12例,有效45例,无效3例,总有效率为95%;治疗后,Cobb角明显减小(P〈0.01),肺功能VC、FEV1/FVC和MVV显著改善(P〈0.01,P〈0.05);且未发现明显副作用。结论:导引手法治疗轻度AIS疗效确切。  相似文献
5.
Objective :To introduce a key-vertebral-screws technique (KVST) in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique. Methods: Seventeen consecutive patients with scoliosis extending to main thoracic spine, who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility, surgical correction rate, fulcrum bending correction index (FBCI) in main thoracic curves. Universal Spine System (USS) instrumentation was used in 15 cases, Monarch in another 2 cases. The severity of the curves was measured by Cobb's method using RadWork 6.0 software. Preoperative standing AP radiographs, preoperative fulcrum bending anterioposterior (AP) radiographs, postoperative standing AP radiographs, and most recent follow-up standing AP radiographs for spine were measured and recorded. All the data were analyzed with two-sample paired t-test by Origin 7.0 software. Results: Infection and neurological complications were not noted. No major complications were found. Just one case had some axial back pain, which got a full recovery from physiotherapy for 2 weeks. In the X-ray, there was an average correction of 71.5 % of the fused main thoracic curves, which had no significant lose of correction in final follow-up. For the whole fused main thoracic curves, the fulcrum bending flexibility were lower to operation correction rate (P=0. 013). The average FBCI was 123%. From the data, the more rigid curves (especially fulcrum bending flexibility 〈50%), the more correction rate operation could get, compared with fulcrum bending flexibility. Conclusion: (1) KVST is a good method in the surgical treatment of thoracic scoliosis, which can get satisfying result with lower medical cost. (2) Fulcrum bending flexibility is lower than operative correction rate by KVST in main thoracic curves (P〈0. 05). In the more rigid curves assessed by fulcrum-bending radiograph, the operative corrective could be gained, especially in the curves which FBCI is lower than 50%.  相似文献
6.
目的:观察乌司他丁(UTI)对青少年特发性脊柱侧凸(AIS)患者围手术期炎症因子(IL-6、 TNF-α、 IL-10、 IL-4)表达的影响.方法:20例AIS患者,ASAⅠ~Ⅱ级,择期行侧凸矫形术,随机分为2组.UTI组(n=10):于麻醉后手术前将10 000 U/kg的UTI溶于100 ml生理盐水中,微泵持续静滴,若手术时间超过4 h,追加1次,方法同前.对照组(n=10):用等量生理盐水替代.术中连续监测心电图(ECG)、脉搏血氧饱和度(SpO2)、呼气末CO2分压(PETCO2)、中心静脉压(CVP)与桡动脉压,维持平均动脉压(MAP)在(60±5) mmHg(1 mmHg=0.133 kPa).分别于麻醉前(T1)、诱导后10 min(T2)、给药后1 h(T3)、拔管后30 min(T4)及术后24 h(T5)抽取静脉血,测定血浆各细胞因子蛋白及其mRNA的表达.结果:在T3、 T4、 T5时,对照组血浆IL-6、 TNF-α水平及其mRNA拷贝数明显高于T1(P<0.05或P<0.01);UTI组血浆IL-6、TNF-α水平及其mRNA拷贝数与T1相比无显著差异,且明显低于对照组(P<0.05或P<0.01).在T4、 T5时,对照组血浆IL-10水平及其mRNA拷贝数与T1比明显升高(P<0.05);UTI组血浆IL-10水平及其mRNA拷贝数明显高于T1水平(P<0.01),且明显高于对照组(P<0.01).两组各时间点血浆IL-4水平及其mRNA拷贝数未见显著改变.结论:UTI可抑制AIS患者围手术期促炎细胞因子IL-6、 TNF-α及其mRNA产生;并可促进血浆抗炎细胞因子IL-10在蛋白与mRNA水平的增高.  相似文献
7.
鱼包瑞林 《河北医学》2006,12(7):609-611
目的:评价M ilwaukee支具治疗青春期特发性脊柱侧凸的效果。方法:从1989年至2002年保守治疗青春期特发性脊柱侧凸81例(cobb角≤40度),平均年龄13岁(11~16岁)。55例配带M ilwaukee支具治疗,26例临床观察。结果:所有病例均获随访,平均随访时间6.5年(3~9年)。支具组49例畸形及临床观察组16例畸形获满意矫正(X2=8.45,P<0.01)。结论:M ilwaukee支具治疗可使青春期特发性脊柱侧凸在早期获得充分矫正。  相似文献
8.
目的:了解三亚市中小学生特发型脊柱侧凸畸形(AIS)的患病情况。方法采用横断面研究方法,随机抽查三亚市城乡10所中学10~16岁中学生6952名,其中男生3750名,女生3202名。首先通过观察体检者的肩部和肩胛骨的对称性以及Adams试验筛选出疑似患者。对于AIS疑似患者,进一步采用全脊柱正侧位X射线摄片来明确脊柱侧凸诊断。结果6952名中小学生中共检筛出AIS疑似患者375名(男性191名,女性184名),其中358名疑似患者接受进一步检查,最终明确AIS患者88名(1.27%),男性42名(0.60%),女性46名(0.66%),男、女比率为1:0.91,但二者患病率比较差异无统计学意义(χ2=1.39,P>0.05)。结论三亚市公立学校中小学生AIS患病率为1.27%,男女患病率相当。  相似文献
9.
目的 探讨医疗体操、手法治疗、矫形支具治疗对儿童青少年特发性脊柱侧弯的临床效果。方法 选择2008年11月~2013年9月通过特发性脊柱侧弯普查发现及在自贡市第一人民医院就诊的特发性脊柱侧弯患者80例,分为医疗体操组(30例)、手法治疗组(25例)及矫形支具组(25例),医疗体操组采用自编医疗体操进行干预,手法治疗组根据解剖学特点采用综合性手法进行操作;矫形支具组应用矫形支具进行干预;疗程9~12月。观察并比较三组Cobb角变化情况。结果 治疗后三组Cobb角分别为:医疗体操组(17.00±8.00)°,手法治疗组(20.15±7.75)°,矫形支具组(11.86±5.07)°。医疗体操组治疗前后Cobb角比较差异有统计学意义(P=0.031);矫形支具组治疗前后Cobb角比较差异有高度统计学意义(P=0.000);而手法治疗组治疗前后比较差异无统计学意义(P=0.325)。治疗后医疗体操组与手法治疗组间Cobb角比较差异有统计学意义(P〈0.05);治疗后矫形支具组与手法治疗组之Cobb角比较差异有高度统计学意义(P〈0.01);治疗后医疗体操组与矫形支具组间Cobb角比较差异有高度统计学意义(P〈0.01)。结论 自编医疗体操、矫形支具对儿童青少年特发性脊柱侧弯疗效显著。  相似文献
10.
目的观察右美托咪啶对青少年特发性脊柱侧弯矫形术后谵妄的影响.方法选择青少年特发性脊柱侧弯患者160例,年龄7~16岁,ASAⅡ-Ⅲ,麻醉诱导插管后随机分为2组(n=80),SS组:舒芬太尼0.2μg/(kg·h)泵注,呼气末七氟醚靶浓度1%-2%吸入维持麻醉;SSD组:舒芬太尼0.2μg/(kg·h)泵注,呼气末七氟醚靶浓度1%~2%吸入,右美托咪啶0.2μg/h泵注维持麻醉,调整七氟醚靶浓度维持BIS值40。60,应用血管活性药维持MAP65—75mmHg.术毕记录手术时间、术中出血量、输血量、七氟醚用量、舒芬太尼用量、右美托咪啶用量、呼吸恢复时间、麻醉恢复时间、清醒时间、术后2h内躁动发生情况及术后3d谵妄发生情况.结果2组患者手术时间、术中出血量、输血量、舒芬太尼用量、呼吸恢复时间、麻醉恢复时间、清醒时间差异无统计学意义,SS组七氟醚用量明显多于SSD组(P〈0.05),术后2h内躁动发生率及术后3d谵妄发生率也明显高于SSD组.结论术中辅助应用右美托咪啶0.2μg/h可减少青少年特发性脊柱侧弯术后谵妄的发生.  相似文献
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