切开复位"T"型钢板内固定治疗桡骨远端骨折的效果

目的探讨切开复位"T"型钢板内固定治疗桡骨远端骨折的临床效果。方法选取2015年10月至2017年5月平顶山市第五人民医院收治的202例桡骨远端骨折患者,按照固定方式分为观察组与对照组,每组101例。对照组接受手法闭合复位小夹板外固定治疗,观察组接受切开复位"T"型钢板内固定。对比两组住院时间、骨折愈合时间和并发症发生情况;随访1 a,统计两组治疗优良率。结果两组住院时间和并发症发生率比较,差异无统计学意义(P>0.05);观察组骨折愈合时间短于对照组(P<0.05);观察组治疗优良率[94.06%(95/101)]高于对照组[85.15%(86/101)],差异有统计学意义(P<0.05)。结论切开复位"T"型钢板内固定治疗桡骨远端骨折有利于促进骨折早期愈合,且可有效改善患者关节功能,效果显著。     

28例桡骨远端Barton骨折的手术治疗

目的探讨应用切开复位T形钛金属接骨板或结合螺钉、克氏针内固定治疗桡骨远端Barton骨折的临床疗效.方法对2002年8月至2005年6月收治的28例Barton骨折的病人,采用切开复位T形钛金属接骨板或结合螺钉、克氏针内固定,术后进行早期功能锻炼.结果所有病人均达到骨性愈合,无伤口感染、骨不连及内固定物断裂、脱出等并发症.根据改良Green and O'Brien临床评定标准综合评定,优20例,良8例.结论对于手法复位失败的桡骨远端Barton骨折采用切开复位T形钛金属接骨板或结合螺钉、克氏针内固定可获得满意的治疗效果.     

桡骨远端掌侧斜T型钢板治疗Barton骨折17例

目的:探讨掌侧斜T型钢板内固定治疗Balton骨折的疗效.方法:17例Barton骨折采取掌侧斜T型钢板内固定治疗.结果:术后随访时间4～17个月,根据改良.Mcbride功能评分,本组优10例,良5例,可2例.优良率达88.2%.结论:Barton骨折切开复位掌侧斜T型钢板内固定手术能创造稳定的内固定基础,恢复正常的解剖关系,早期进行功能锻炼.为获得最好的腕关节功能创造条件.     

T形钛合金钢板内固定治疗掌侧Barton 骨折

目的:探讨掌侧Barton骨折切开复位,T形钛舍金钢板内固定的手术方法和临床疗效.方法:手术切开复位,T形钛合金钢板内固定治疗18例掌侧Barton骨折.结果:术后随访6～31(平均13)个月,18例骨折全部愈合,采用Mehara关于掌侧Barton骨折功能评价标准评定,优12例,良5例,可1例.优良率达94.4%.X线显示掌倾角8～18(平均11.0)°,尺偏角16～26(平均22.4)°,桡骨轴向无短缩.结论:T形钛合金钢板内固定治疗掌侧Barton骨折,可达到解剖复位,其固定牢靠,骨折愈合好,最大限度地恢复了腕关节功能,效果满意,是较理想的治疗方法.     

桡骨远端骨折手术治疗效果观察

目的:探讨桡骨远端骨折患者手术切开复位"T"型钢板内固定的治疗效果.方法:采用"T"型钢板内固定治疗桡骨远端骨折40例(观察组),并随机选择同期采用闭合复位夹板外固定治疗的患者40例,比较两组术前和治疗后3个月掌倾角、尺偏角及桡骨轴向缩短移位等指标,治疗后1年的临床疗效.结果:两组治疗后掌倾角、尺偏角及桡骨轴向缩短移位等指标均明显好转,但是观察组恢复更好(P＜0.05);治疗1年后,观察组治疗优良率为85.00%,明显高于对照组的50.00%(P＜0.01).结论:手术切开"T"形钢板内固定治疗桡骨远端骨折,更有利于患者腕关节结构和功能的恢复,临床效果好,值得临床推广应用.     

Barton骨折治疗中T形钢板的临床应用

目的讨论分析Barton骨折T形钛合金钢板内固定的手术疗效.方法自2000年2月-2004年8月收治Barton骨折32例,其中22例切开复位T形钛合金钢板内固定.结果本组随访时间5～20个月,术后3～4个月,X线显示桡骨远端骨折全部愈合.采用改良Gartland和Wertey(GW)评分系统对腕部进行功能评定,优15例,良4例,总优良率86.36%,差3例.结论采用T形钛合金钢板内固定治疗Barton骨折,固定牢固,可达骨折解剖复位,有利于腕关节早期的功能锻炼,最大限度地恢复腕关节功能.     

掌侧入路锁定“T”型钛板内固定治疗桡骨远端骨折

目的总结掌侧入路锁定"T"型钛板治疗桡骨远端骨折的治疗效果。方法对45例桡骨远端不稳定骨折病人采用掌侧入路切开复位"T"型钛板固定术进行治疗,并对其术后关节功能进行评价。结果本组45例,完成随访18个月者39例,骨折完全愈合,腕关节功能按D ienst标准评价治疗效果,优24例,良12例,差3例,优良率为92.3%(36/39)。结论桡骨远端骨折采用掌侧入路锁定"T"型钛板内固定,具有手术损伤小、并发症少、功能恢复快等优点,是治疗不稳定桡骨远端骨折较理想的方法。     

掌侧入路斜T形钢板内固定治疗掌侧型Barton骨折

目的:探讨采用掌侧入路斜T形钢板内固定治疗掌侧型Barton骨折的临床疗效。方法:采用掌侧入路斜T形钢板内固定治疗掌侧型Barton骨折16例。结果:16例病人均获随访,随访时间8～20个月,平均12个月,所有病例均在3个月内愈合。根据Dienst标准评定疗效,优良率达93.75%。结论:掌侧入路钢板内固定治疗掌侧型Barton骨折具有固定牢固、并发症少、可以早期功能练习等优点,临床治疗效果满意。     

桡骨远端自锁钢板治疗桡骨远端骨折

目的探讨AO分类B、C型桡骨远端骨折的治疗方法及桡骨远端的自锁钢板应用于桡骨远端骨折治疗的疗效.方法对77例B、C型桡骨远端骨折采用手法复位石膏固定、切开复位T型钢板螺钉固定及切开复位自锁钢板内固定.结果全部病例均随访1年以上.优良率:手法复位石膏固定组为75.6%,切开复位"T"型钢板螺钉固定组为69.6%,切开复位自锁钢板内固定组为76.9%.结论手法复位能达到解剖或近似解剖复位并经石膏固定可达到良好固定者应采用非手术治疗;自锁钢板设计上优于传统T型钢板,用于B、C型桡骨远端骨折取得了较好疗效.     

经掌侧入路锁定钢板内固定治疗Barton骨折

目的探讨经掌侧入路锁定钢板内固定治疗Barton骨折的临床疗效.方法34例Barton骨折病人,掌侧型25例,背侧型9例,采用掌侧入路锁定钢板内固定,其中5例植骨,术后早期功能锻炼.结果34例患者获得随访,6~24个月,平均16个月.其中1例骨质疏松患者因术后未早期锻炼出现腕关节僵硬,效果差,其余33例骨折愈合良好,愈合时间6~12周、平均8.5周;无伤口感染、腕关节僵硬、血管神经压迫、急性骨营养不良、内固定失效及其他并发症;掌倾角、尺偏角、腕掌关节半脱位均获明显改善.按Deoliveiva评分标准,优26例,良5例,可2例、差1例,优良率91.2%.结论经掌侧入路:锁定钢板内固定治疗Barton骨折,手术创伤小,符合解剖学特点,固定牢靠,有利于早期功能锻炼.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.