关节镜下联合修补技术治疗外侧半月板桶柄样撕裂临床疗效观察

目的 观察关节镜下运用联合修补技术缝合外侧半月板桶柄裂的手术方法 和临床疗效。方法 我院2012-06～2015-06期间共收治外侧半月板桶柄裂患者30例,均据半月板损伤情况予关节镜下修复手术,其中外侧半月板腘肌腱前方区域撕裂采用自内向外缝合手术治疗,半月板后角区域的撕裂采用Fast-Fix系统全内缝合,合并前交叉韧带损伤的患者同时进行关节镜下重建。采用临床评估、MRI检查、Lysholm评分分析临床疗效。结果 术前30例患者均存在关节间隙压痛、McMurray试验,21例存在交锁症状,MRI均存在异常征象,术前Lysholm评分(51.74±4.79)分。术后26例患者获随访,平均随访28个月(18~36个月)。其中无症状24例(92.3%),交锁复发1例(3.85%),关节间隙压痛1例(3.85%)。复查MRI,24例(92.3%)完全愈合,1例(3.85%)部分愈合,1例(3.85%)不愈合。膝关节活动度检查显示2例伸膝受限>10b。术后Lysholm评分(93.23±2.14)分。手术前后各差异有统计学意义。结论 关节镜下联合修补技术治疗对修复性外侧半月板桶柄样撕裂具有良好临床效果。     

关节镜下手术治疗少儿膝关节半月板损伤

目的探讨少儿膝关节半月板损伤的膝关节镜下微创手术治疗的特点及其临床效果。方法本组患者29例,8岁～16岁,平均11岁。临床症状:患膝疼痛27例,弹响17例,交锁史13例,膝关节活动受限7例,跛行6例,膝部肿胀3例。膝关节间隙压痛28例,麦氏征阳性27例,MRI检查,21例为阳性结果。所有患儿都采用关节镜下手术。术中见半月板边缘撕裂11例,桶柄样撕裂13例,其中撕裂缘嵌顿于髁间窝部5例,前角损伤3例,后角损伤2例。关节镜下半月板损伤部分切除术3例,半月板缝合术26例。半月板缝合术后配戴支具,由专科治疗师行康复治疗。结果本组患者随访15～182个月,平均38个月,所有患儿术后关节功能恢复正常。1例剧烈活动后时有膝部肿胀,无跛行。Lysolme评分:术前(62±9),术后(94±6),P<0.01;膝关节功能评分,术前(59±6),术后(93±5),P<0.01。结论半月板损伤是少儿膝关节痛的原因之一,应引起临床医师的重视。少儿半月板损伤后多表现为交锁和关节活动受限。镜下特征:滑膜炎表现明显;多为纵形或桶柄样撕裂。少儿半月板,对膝关节正常功能影响很大。应尽可能采用半月板缝合术治疗。少儿关节镜下半月板缝合术后应配戴支具,由专业治疗师进行规范的康复训练。     

42例膝关节外侧盘状半月板损伤患者应用关节镜治疗的临床分析

目的:分析对膝关节盘状半月板损伤患者行关节镜下手术治疗的有效性和安全性。方法:筛选本科收治的42例膝关节外侧盘状半月板损伤患者,并对其进行病例回顾性分析,所有患者均在关节镜下手术诊治。根据病变类型进行半月板全切除术、次全切除术、部分切除术和半月板成形术。术前和术后6个月分别进行Lysholm评分;术后观察记录患者感染、神经血管损伤等并发症情况。结果:术前平均评分为(68.13±12.12)分,6个月后为(88.72±11.19)分。手术前后评分比较差异有统计学意义(P0.01);手术优良率为78.57%;患者术后均未发生切口感染。随访期间无患者发生明显的血管神经损伤和静脉血栓等并发症。结论:膝关节外侧盘状半月板损伤患者应用关节镜治疗创伤小,恢复好,并发症较少,值得临床推广。     

老年人内侧半月板后根部损伤的关节镜治疗

目的 评估关节镜下半月板部分切除术治疗老年人半月板后根损伤的临床结果.方法 选择98例膝关节内侧半月板根部损伤的老年患者,均在关节镜下行内侧半月板部分切除术,总结其临床特点,术后随访3～5年,比较手术前后Lysholm评分改变,并统计患者对治疗满意率.结果 本组患者症状主要为膝关节内侧方和后方疼痛及下蹲起立困难,39例(39.8％)有绞锁.术后所有患者关节绞锁症状消失,90例(91.8％)疼痛症状有改善.平均Lysholm评分从术前(51.9±7.6)分提高到术后随访的(83.2±5.4)分(P＜0.01),82.6％患者对治疗结果满意.结论 关节镜下半月板部分切除术治疗老年人内侧半月板后根损伤有助于改善症状,是可以选择的治疗方式.     

关节镜下手术治疗膝关节半月板损伤39例临床观察

目的观察关节镜下手术治疗膝关节半月板损伤的临床治疗效果。方法对39例膝关节半月板损伤患者(观察组)应用关节镜下手术治疗,根据半月板损伤的类型分别进行处理,术后随访观察;并与40例半月板全切除术患者(对照组)进行比较,采用Lysholm膝关节功能评分评价手术治疗效果。结果所有患者均获得随访,平均随访时间(13.5±3.6)个月(2～32个月);观察组Lysholm-Ⅱ评分术前平均(45.1±2.1)分,术后平均(90.7±12.5)分,对照组术前评分平均(45.0±2.3)分,术后平均(75.3±11.8)分,两组治疗效果具有统计学意义(P0.01)。结论关节镜下手术治疗膝关节半月板损伤能最大限度地保留半月板,创伤小,恢复快,疗效佳,有利于早期功能锻炼。     

半月板囊肿的关节镜下手术治疗临床分析

目的探讨关节镜下半月板囊肿手术治疗的方法及其疗效。方法对21例半月板囊肿患者采取关节镜下囊肿切除,同时根据半月板损伤情况行半月板缝合或部分切除,并采用Lysholm评分在术前、术后对膝关节肿痛及活动受限等症状进行分析比较。结果全部患者均获随访,随访时间6~36个月,未见囊肿复发及明显术后并发症。Lysholm评分术前平均(71.3±5.6)分,术后显著增高到(94.8±3.2)分,术后膝关节评分较术前有明显增幅(P0.05)。结论通过关节镜下手术治疗膝关节半月板囊肿,不仅对膝关节肿痛及活动受限等症状有明显的改善,并且保留了创伤小、恢复快的微创手术优势。     

关节镜下治疗盘状半月板损伤的临床观察

目的:观察关节镜下手术治疗膝关节盘状半月板损伤的疗效。方法:对于行关节镜下外侧盘状半月板成形术24例26膝进行综合分析。关节镜检查后,依具损伤情况采用半月板成形术18例,次全切除术5例,全切除术3例。术后第2至3天开始肌力训练和关节活动练习。结果:本组24例手术全部成功,无手术并发症。24例获14～60个月(平均37个月)的随访。根据Lysholm评分做术前及随访时膝关节功能评定,术前评分平均54分(39～68分),随访时评分平均88分(64～100分),优良率为87.4%。结论:关节镜技术治疗盘状半月板损伤具有创伤小,能够精确切除失稳及破裂的半月板组织,术后恢复快,疗效可靠。     

关节镜手术治疗症状性膝关节外侧盘状半月板

目的 探讨关节镜手术治疗症状性膝关节外侧盘状半月板的疗效.方法 对在关节镜下手术治疗的88例（94膝）症状性外侧盘状半月板患者的临床资料进行总结分析.结果 所有病例均获随访6～24个月,术后症状均明显改善或消失.88例患者术前膝关节Lysholm评分为66.1±8.1,术后3个月为95.4±4.3,差异有统计学意义（P〈0.01）.其中≤25岁患者术后3个月Lysholm评分明显高于〉25岁患者（P〈0.01）.结论 关节镜手术治疗症状性膝关节外侧盘状半月板效果良好,早期治疗,效果更佳.     

膝关节外侧盘状半月板的关节镜下手术治疗

目的 介绍膝关节外侧盘状半月板的关节镜下手术治疗的方法及其疗效.方法 2001～2007年笔者共完成45例49膝的膝关节外侧盘状半月板关节镜下手术.手术采用常规髌下前内侧(AM)和前外侧(AL)关节镜入路,根据盘状半月板损伤的情况进行半月板全切或成型术,其中成型术8膝,全切次全切41例.结果 45例患者中3例失访, 其余患者术后随访6～84个月.手术前后采用Lysholm评分,手术前Lysholm评分平均为55分(40～71分),半年随访时93分(88～98分).结论 关节镜技术治疗盘状半月板损伤创伤小,术中能精确切除失稳破裂的半月板组织,术后患者恢复快,疗效佳.     

关节镜下膝关节盘装半月板损伤的治疗

目的 探讨关节镜手术治疗膝关节盘状半月板损伤的临床疗效.方法 2007年2月～2010年7月对34例膝关节盘状半月板损伤进行关节镜下手术治疗,28例行关节镜下盘状半月板部分切除成形术,6例行盘状半月板全切除术.术后早期进行关节功能锻炼.结果 无手术并发症.术后获得随访34例,随访时间3～26个月,平均12个月.按Ikeuch评定标准:优23例,良8例,可3例.结论 关节镜治疗膝关节盘状半月板具有微创、并发症少、恢复快等优势,是治疗盘状半月板损伤较为理想的手术方法.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.