四种股骨转子间骨折内固定物的力学对比疗效评价

四种股骨转子间骨折内固定物的力学对比疗效评价范卫民陶松年王道新，等（南京医科大学第一附属医院骨科）中华骨科杂志１９９６，１６（４）∶２２９作者对Ｒｉｃｈａｒｄｓ钉（滑动加压螺纹钉）、Ｊｅｗｅｔｔ钉、斯氏针和麦氏鹅头钉进行了力学测试，结果经方差分析显示...     

四种股骨转子间骨折内固定物的力学对比及疗效评价

四种股骨转子间骨折内固定物的力学对比及疗效评价范卫民陶松年王道新，等中华骨科杂志１９９６，１６（４）２２９作者对Ｒｉｃｈａｒｄｓ钉（滑动加压螺纹钉）、Ｊｅｗｅｔ钉、斯氏针和麦氏鹅头钉进行了力学测试，结果经方差分析显示，Ｊｅｗｅｔ钉的强度最大，Ｒｉｃｈ...     

股骨转子间骨折两种鹅头钉临床应用比较

目的：探讨治疗股骨转子间骨折的临床效果。方法：Wastom—Jone切口,显露骨折处,先用拉力螺钉固定小转子,后置放滑动加压鹅头钉或麦氏鹅头钉,术后第2天开始CPM锻炼。结果：全部58例得到随访骨折全部愈合,髋关节功能基本恢复正常,无髋内翻发生。结论：滑动加压鹅头钉结合拉力螺钉固定小转子,辅以CPM锻炼治疗股骨转子间骨折比麦氏鹅头钉内固定术疗效肯定。     

股骨转子间骨折30例治疗体会

目的探讨股骨转子间骨折的治疗。方法回顾30例股骨转子间骨折病例,男14例,女16例;年龄25～88岁,平均69.6岁。Evans分型,Ⅰ型2例,Ⅱ型6例,Ⅲ型12例,Ⅳ型10例(3例合并转子下粉碎骨折)。所有患者均行手术治疗,其中闭合穿针或空心加压螺纹钉7例,角钢板6例,DHS12例,Gamma钉5例。结果优20例,良5例,可4例,术后死亡1例。结论对股骨转子间骨折应重视内科合并疾患的围手术期治疗,积极手术治疗,选用坚强的内固定。     

双颈滑动加压螺纹钉的研制

双颈滑动加压螺纹钉的研制范卫民陶松年王道新殷国勇刘峰（南京医科大学第一附属医院骨科，南京２１００２９）关键词股骨转子间骨折；内固定治疗股骨转子间骨折的方法很多，但均非尽善尽美。为此，我们自行设计了双颈滑动加压螺纹钉（简称双颈钉）。双颈钉由一个双套筒钢...     

老年股骨粗隆间骨折不同治疗方法比较

目的探讨老年股骨粗隆间骨折的恰当治疗方法。方法 168例患者,采用非手术治疗39例;手术治疗129例,其中斯氏针8例,空心钉11例,麦氏鹅头钉37例,角钢板21例,DHS 35例,Gamma钉17例,分析比较其治疗效果。结果非手术组优良率为71.8%,手术组为91.5%.非手术组不愈合及畸形愈合率为30.8%,手术组不愈合及畸形愈合率为9.3%.非手术组并发症发生率为28.2%,手术组为22.5%,2组比较有显著性差异(P<0.01)。非手术组病死率为5.1%,手术组无1例术中或住院期间死亡,2组比较差异无显著性(P>0.05)。结论各种内固定及治疗效果各有优缺点,斯氏针、麦氏鹅头钉、角钢板不适合老年股骨粗隆间骨折,手术时机以5 d左右为宜。老年股骨粗隆间骨折的治疗应根据患者全身情况、骨质条件、骨折类型来确定。     

滑动加压螺纹钉的力学研究及疗效评价

对滑动加压螺纹钉（Ｒｉｃｈａｒｄｓ钉）进行了力学测试，结果显示，滑动加压螺纹钉的力学性能较可靠。３１例临床资料分析发现，滑动加压螺纹钉的临床效果理想。作者认为，滑动加压螺纹钉有动力性和静力性加压作用，它结构牢固，固定效果可靠，病人可早期下地活动，是当今治疗股骨转子间骨折比较理想的内固定物。其不足之处是无有效的抗旋转作用。     

改良螺纹钉治疗股骨颈及粗隆间骨折

改良螺纹钉治疗股骨颈及粗隆间骨折潘嘉蓉股骨颈或粗隆间骨折是常见的老年性骨折，治疗方法甚多，一般可分为单钉（如三翼钉、加压螺钉）、多针（斯氏针、螺纹针）、加压鹅头钉、髓内Ｅｎｄｅｒ钉及带锁髓内钉等内固定方法。多针内固定方法疗效是肯定的，但还存在一些问题...     

带翼鹅头加压钉和折尾钉结合治疗老年股骨转子间骨折

使用带冀鹅头加压钉和折断式加压螺旋钉结合内固定方法治疗老年股骨转子间骨折４１例，随访３８例，随访时间６￣２２个月，平均１３．２个月，所有病例全部愈合，无髋内翻，无钉板分离，按王福权评定标准，优２８例，尚好７例，差３例，优良率９１％，此法操作简便，创伤小，抗扭转子强，不易发生髋内翻，各型股骨转子间骨折均适用，对高龄病人或有较重并发症者尤为适用。     

小切口加压空心钉治疗股骨转子间骨折151例分析

目的：小切口微创结合双头螺纹加压空心钉治疗股骨转子间骨折的可行性。方法：C臂透视下牵引复位，局麻下股外侧皮肤小切口，“品”字形旋入3枚双头螺纹加压空心钉。结果：150倒长期随访，优良率95．3％。结论：小切口微创结合双头螺纹加压空心钉治疗股骨转子间骨折方法简单，疗效确切，术后并发症少，值得基层医院推广应用。     

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.     

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.