椎旁肌间隙入路伤椎置钉技术短节段固定治疗无神经损伤胸腰椎骨折

目的研究椎旁肌间隙入路伤椎置钉技术短节段固定治疗无神经损伤胸腰椎骨折的临床效果。方法选取2016年2月至2018年6月南阳市第一人民医院收治的82例无神经损伤胸腰椎骨折患者,根据手术入路分为对照组和研究组,各41例,对照组行后正中入路伤椎置钉短节段固定,研究组行Wiltse肌间隙入路伤椎置钉技术短节段固定,对比两组手术时间、术中出血量、术后疼痛程度和腰椎功能、Cobb角(头侧上端锥上缘垂线与尾侧端椎下缘垂线交角)畸形矫正率。结果研究组手术时间短于对照组,术中出血量少于对照组(均P<0.05)。研究组术后3、6个月视觉模拟评分法(VAS)评分低于对照组,日本骨科协会评估治疗(JOA)评分高于对照组,Cobb畸形矫正率高于对照组(均P<0.05)。结论椎旁肌间隙入路伤椎置钉技术短节段固定治疗无神经损伤胸腰椎骨折,可有效缩短手术时间,减少术中出血量,矫正Cobb角畸形,减轻腰椎疼痛,改善腰椎功能。     

椎旁肌肌间隙入路联合伤椎椎弓根螺钉内固定治疗无神经损伤胸腰椎骨折

目的：观察经椎旁肌肌间隙入路伤椎置钉短节段椎弓根螺钉内固定对单节段无神经损伤胸腰椎骨折的治疗效果。方法选取单节段胸腰椎骨折患者13例,采用椎旁肌间隙入路伤椎置钉短节段椎弓根螺钉内固定治疗,观察患者术后伤椎矢状面Cobb角、伤椎椎体前缘高度、疼痛、脊柱功能和并发症发生情况。结果本组患者手术均顺利完成,术后均获1年随访,切口甲级愈合;术后伤椎矢状面Cobb角均较术前明显缩小,手术前后比较差异有统计学意义（ P﹤0.05）;术后伤椎椎体前缘高度较术前明显增高（ P﹤0.05）;术后VAS评分及ODI均较术前明显下降（ P﹤0.05）。治疗过程中均无感染、内固定松动或断裂等并发症发生。结论经椎旁肌肌间隙入路伤椎置钉短节段椎弓根螺钉内固定能有效纠正单节段胸腰椎骨折伤椎前缘高度,纠正后凸畸形,不良反应少。     

椎旁肌间隙入路伤椎置钉技术短节段固定治疗无神经损伤胸腰椎骨折的临床效果

目的研究无神经损伤胸腰椎骨折患者接受椎旁肌间隙入路伤椎置钉短节段固定治疗的临床效果。方法选取2016年2月至2017年12月南阳市第二人民医院收治的74例无神经损伤胸腰椎骨折患者,按照手术方案分为对照组和观察组,每组37例。对照组接受传统胸腰椎后侧正中切口入路跨伤椎置钉技术治疗,观察组接受椎旁肌间隙入路伤椎置钉技术短节段固定治疗。对两组患者手术情况、术后恢复情况、手术前后伤椎前缘高度和后凸Cobb指数进行比较。结果观察组患者术中失血量较对照组少,下床活动时间和骨折愈合时间较对照组短,差异有统计学意义(均P<0.05)。术后1周、1 a观察组患者伤椎前缘高度、后凸Cobb指数均优于对照组,差异有统计学意义(均P<0.05)。结论无神经损伤胸腰椎骨折患者接受椎旁肌间隙入路伤椎置钉技术短节段固定治疗可减少术中失血量,加快术后恢复,促进骨折愈合,改善伤椎前缘高度和后凸Cobb角,有较好的临床应用价值。     

伤椎植骨结合伤椎置钉治疗胸腰段骨折的临床观察

目的探讨伤椎植骨结合伤椎置钉6钉固定治疗胸腰段骨折的临床疗效。方法回顾分析2009年1月至2011年6月应用伤椎植骨结合伤椎置钉6钉固定治疗胸腰段骨折37例,随访6～28个月,平均13.2个月,观察术后即刻椎体高度恢复、后凸畸形改善情况和末次随访时矫正高度丢失情况、后凸角度丢失、神经功能恢复及内固定情况。结果 26例神经功能损害者末次随访时22例神经功能得到不同程度恢复,4例无变化。术后即刻椎体前缘高度恢复满意,后凸畸形基本矫正。末次随访时未发生内固定断裂,伤椎高度和后凸角丢失轻微。结论伤椎植骨结合伤椎置钉6钉固定固定治疗胸腰段骨折是治疗胸腰段骨折的有效方法。     

经伤椎置钉短节段固定治疗胸腰段脊柱骨折的疗效分析

目的分析经伤椎置钉短节段固定治疗胸腰段脊柱骨折的疗效。方法选取2015年4月至2017年4月我院收治的35例胸腰段脊柱骨折患者作为观察对象,所有患者均采用经伤椎置钉短节段固定治疗,比较治疗前后椎体高度及椎体复位情况。结果术后6个月伤椎前缘高度比明显高于术前,Cobb角明显低于术前,差异具有统计学意义(P0.05)。结论经伤椎置钉短节段固定有利于矫正胸腰段脊柱骨折后凸畸形,强化钉棒系统内固定稳定性,防止术后椎体高度严重丢失现象,安全可靠。     

经伤椎置钉与跨节段螺钉内固定治疗胸腰椎骨折的疗效比较

目的：比较经伤椎置钉与跨节段螺钉内固定治疗胸腰椎骨折的临床疗效。方法将68例胸腰椎单节段骨折患者随机分为两组,对照组33例采用传统跨节段4钉内固定法治疗,观察组35例采用经伤椎置6钉内固定法治疗,比较两组手术切口长度、手术时间、术中出血量、脊髓神经损伤Frankel分级改善评分及术后伤椎矫正率、伤椎高度远期丢失率、术后Cobb角矫正值、Cobb角远期丢失值等。结果两组手术切口长度、手术时间、术中出血量、Frankel分级改善评分方面比较差异均无统计学意义（ P＞0．05）;观察组术后Cobb角矫正值、伤椎高度远期丢失率及Cobb角远期丢失值均明显好于对照组（ P＜0．05）。结论经伤椎置6钉内固定治疗胸腰椎骨折能提供更加坚强牢靠的内固定,减少脊柱后凸畸形矫正率丢失及维持伤椎前柱高度。     

后路短节段联合伤椎置钉固定治疗胸腰段脊柱骨折

目的 观察后路短节段联合伤椎置钉固定治疗胸腰段脊柱骨折的临床效果.结果 选择胸腰段椎体骨折患者54例,采用后路短节段内固定联合伤椎置钉的手术方法进行治疗,对患者术前术后的x线片进行测量,测量其伤椎高度恢复的比例以及后凸角度的纠正情况.结果术前骨折椎体高度(57.5±16.4)%,节段后凸角度(20.7±9.5).;术后骨折椎体高度(93.5±11.5)%,节段后凸角度(5.9±7.4)°.手术前后骨折椎体高度和节段后凸角度差异均有统计学意义(均P<0.01).结论 有条件地应用伤椎置钉技术有利于后路术中复位以及纠正后凸畸形,并且增加内固定系统的强度.     

结合伤椎椎体成形术治疗胸腰段脊柱爆裂骨折?经 Wiltse 肌间隙入路短节段椎弓根钉固定

目的：评价经 Wiltse肌间隙入路短节段椎弓根钉结合伤椎椎体成形术治疗胸腰段脊柱爆裂骨折的临床疗效。方法选择32例单节段胸腰段脊柱爆裂骨折患者经 Wiltse 肌间隙入路短节段椎弓根钉固定结合伤椎椎体成形术治疗,随访观察患者术前、术后、末次随访时伤椎前、后缘高度、脊柱后凸 Cobb 角、疼痛视觉模拟评分(VAS),术后 Beaujon-Lassale 功能评分。结果术后1周伤椎前、后缘高度,脊柱后凸 Cobb 角均较术前有显著改善(P <0.05),术后1周患者 VAS 评分较术前明显降低(P <0.05)。末次随访 Beaujon-Lassale 功能评分为(19.4±2.6)分。随访期间2例患者出现腰背部疼痛症状,术后1个月症状完全恢复;2例椎管内渗漏发生,3例术中发生骨水泥椎旁渗漏,但患者均未出现神经症状。结论经 Wiltse 肌间隙入路短节段椎弓根钉固定结合伤椎 PVP 是治疗胸腰段脊柱爆裂骨折的有效方法之一,具有创伤小、出血量少、并发腰痛少等优点。     

前路短节段内固定+伤椎置钉术与后正中小切口非融合手术治疗胸腰段脊柱骨折的疗效比较

目的:观察前路短节段内固定+伤椎置钉术与后正中小切口非融合手术治疗胸腰段脊柱骨折的疗效比较.方法:选取收治的86例胸腰段脊柱骨折患者随机分为两组,对照组行前路短节段内固定+伤椎置钉术治疗,试验组术式选择后正中小切口非融合手术,记录两组手术效果(手术时间、术中出血量、术后切口愈合时间、伤椎Cobb角矫正率),对比其术后1...     

椎旁肌间隙入路微创手术与传统后正中入路手术在脊柱胸腰段骨折中的比较

目的：比较椎旁肌间隙入路微创手术与传统后正中入路手术治疗脊柱胸腰段骨折的疗效差异。方法回顾分析80例无神经症状无须减压的胸腰椎骨折患者,按照手术方式不同分为2组,即经椎旁肌间隙入路微创手术治疗的椎旁肌组（43例）和经传统后正中入路手术治疗的传统组（37例）。比较2组的手术时间、术中出血量、Cobb角矫正率、术后引流率、术后腰背部疼痛VAS等指标。结果椎旁肌组的手术时间（75.3±17.9）min、术中出血量（13.9±40.6）mL及术后引流量（84.6±24.8）mL显著少于传统组[（92.8±14.9）min、（231.3±35.3）mL、（160.4±44.5）mL]（P<0.05）。椎旁肌组的术后2、3周的疼痛VAS评分[（2.8±0.4）、（1.1±0.3）]显著低于传统组[（4.3±0.7）、（2.9±0.7）]（P<0.05）。2组的术后Coob角矫正率及椎弓根螺钉置入准确率比较,差异无统计学意义。结论椎旁肌间隙入路微创手术法治疗脊柱胸腰段骨折较传统后正中入路手术法,具有操作更简单、创伤更小、出血量更少、更易恢复等优点,值得临床上进一步推广使用。     

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.