股骨近端解剖锁定接骨板治疗老年股骨转子间骨折

目的 评定股骨近端解剖锁定接骨板治疗老年股骨转子间骨折的临床效果.方法 老年股骨转子间骨折45例,按Evans分型:Ⅲ型21例,Ⅳ型15例,Ⅴ型9例.应用股骨近端解剖锁定接骨板固定.根据患者临床症状及CR拍片判断骨折愈合情况,Harris髋关节评分系统评定患髋功能.结果 所有患者平均住院16 d,随访平均15个月,所有骨折愈合,无内固定失败,无股骨头坏死,依据Harris髋关节评分系统评定优良率88%.结论 股骨近端解剖锁定接骨板符合股骨解剖结构,固定可靠,对骨折端血运影响小,适合应用于股骨转子间粉碎性骨折.     

闭合复位加长型股骨近端防旋髓内钉治疗股骨干骨折合并同侧股骨转子间骨折的疗效分析

目的 观察闭合复位加长型股骨近端防旋髓内钉(PFNA)治疗股骨干骨折合并同侧股骨转子间骨折的临床疗效.方法 20例股骨干骨折合并股骨转子间骨折患者,均采用闭合复位加长型PFNA治疗.观察患者术后骨折愈合时间、髋关节功能Harris评分及并发症发生情况.结果 20例患者手术切口均一期愈合,术后随访14~20个月,20例患者均骨性愈合,股骨干愈合时间为17~24周,平均19周,股骨转子间骨折愈合时间为14~18周,平均15周.未次随访时髋关节功能Harris评分85~95分,平均92分;髋关节功能优17例,良3例;术后均未发生脂肪栓塞及深静脉血栓,无螺旋刀片切割、内固定松动、髋内翻及股骨头坏死等并发症发生.结论 采用闭合复位加长型PFNA治疗股骨干骨折合并同侧股骨转子间骨折,创伤小,内固定牢靠,术后并发症少,恢复快,临床疗效好.     

中药调理脾胃在治疗老年转子间骨折疗效分析

目的通过回顾性分析手术时间,术中出血量及术后髋关节功能恢复及全身情况,探讨抗螺旋刀片股骨近端髓内钉(PFNA)闭合复位内固定微创技术配合中药调理全身情况在治疗老年转子间骨折的临床疗效。方法回顾性分析我科2012年6月～2013年1月间,骨伤科住院病人32例,其中男性18例,女性14例。平均年龄76岁。其中股骨粗隆间闭合性骨折的住院患者24例。按AO分型诊断标准Al型6例,A2型12例,A3型6例。股骨粗隆下闭合性骨折8例,按AO分型诊断标准Al型2例,A2型2例,A3型2例,均采用闭合复位PFNA内固定治疗,术后通过中药调节脾胃,以改善全身情况。通过记录手术切口、时间、出血量及术后随访记录负重时间、骨折愈合时间,并应用Harris[1]髋关节功能恢复评分标准进行评定疗效。结果平均手术时间46分钟,平均出血量95mL,术后平均负重时间为8天,术后随访4～8个月,复查拍x线片骨折全部达到临床愈合标准,进行Harris髋关节功能恢复评分平均优良率95.4%。结论 PFNA微创技术结合中药调理脾胃在治疗老年股骨转子间骨折方面具有手术切口小,手术时间短、出血量少、术后全身情况恢复快,负重早、骨折达到临床愈合标准高及Harris髋关节评分优良率高等优点,是治疗老年股骨转子间骨折,尤其是骨质疏松性骨折值得推荐的内固定技术。     

股骨近端髓内钉与股骨近端锁定钢板治疗股骨转子间骨折的疗效比较

目的:比较股骨近端髓内钉(proximal femoral nail,PFN)与股骨近端锁定钢板(proximal femoral locking plate,PFLP)内固定治疗股骨转子间骨折的疗效。方法:将71例转子间骨折按内固定方法分为PFLP组32例和PFN组39例;按Evans分型分为稳定性骨折(EvansⅠ～Ⅱ型,31例)和不稳定性骨折(EvansⅢ～Ⅴ型,40例)。观察2组手术时间、术中出血量、骨折愈合时间、并发症及髋关节功能恢复情况。结果:病例均一期愈合,随访9～14个月,对于EvansⅠ～Ⅱ型股骨转子间骨折,2组术中失血量、骨折愈合时间和Harris评分差异均无统计学意义(P>0.05);对于EvansⅢ～Ⅴ型股骨转子间骨折,术中失血量PFN组少于PFLP组(P<0.01)。结论:对于EvansⅠ～Ⅱ型骨折,PFN与PFLP比较无明显优势;对于EvansⅢ～Ⅴ型骨折,PFN更有优势。     

闭合复位加DHS固定治疗老年股骨转子间骨折的疗效观察

目的:观察和研究闭合复位加动力髋螺钉(DHS)固定治疗老年股骨转子间骨折的临床疗效。方法:选取2010年1月至2013年3月已被我院收治的在C形臂X线机定位下采用闭合复位加动力髋螺钉(DHS)内固定法治疗的老年股骨转子间骨折62例,对其进行回顾性分析。按照Evans分型,Ⅰ型18例、Ⅱ型8例、Ⅲ型22例、Ⅳ型14例。结果:62例患者均获得随访,DHS切口均在一期愈合。随访时间3~24个月,平均12.5个月。所有患者骨折均在3~6个月内愈合,无头钉切割等因手术导致的并发症加重或者患者死亡。手术时间50~70min,平均58min,术中出血量20~50ml,平均30ml。术后关节活动12.5±5.6周,骨痂生成2.8±1.0月,下床活动10.6±2.3月。按照股骨转子间骨折疗效评定标准评价:优33例,良24例,可3例,差2例,优良率91.9%(57/62)。结论:采用闭合复位加小切口DHS内固定法治疗老年股骨转子间骨折的骨折愈合率高,并且操作简单、固定牢靠而损伤小和并发症少,是一种有效可靠的治疗老年股骨转子间骨折的方法。     

老年股骨转子间粉碎骨折PFN固定45例疗效分析

目的探讨老年股骨转子间骨折股骨近端髓内钉（PFN）治疗的方法，提高转子间骨折的治疗水平。方法2003年至2005年采用PFN治疗老年（平均年龄78．2岁）股骨转子间骨折45例。AO分型：31-A2型30例，31-A3型15例；按Evans分型：Ⅲa型复例，Ⅲb型11例，Ⅳ型12例。采用闭合复位穿钉，远端1-2枚锁钉固定治疗。结果随访43例，随访时间12～18个月，全部骨折愈合。按Harris髋关节功能评分标准，关节功能优良41例，无术后感染，无股骨头坏死，无近端锁钉穿出股骨头颈。发生近端锁钉部分退出3例，骨折愈合后行手术取出；发生患肢静脉血栓4例，获得治愈。结论采用PFN治疗转子间骨折创伤小，固定可靠，适合老年股骨转子间粉碎性骨折治疗。     

股骨重建髓内钉治疗同侧股骨干合并转子间骨折

目的总结分析股骨重建髓内钉治疗方案在同侧股骨干合并转子间骨折患者治疗中的应用效果。方法选择2012年1月-2014年2月期间我院收治的80例同侧股骨干骨折合并转子间骨折患者为研究对象,均给予股骨重建髓内钉治疗方案,观察患者骨折愈合情况以及髋关节功能Harris评分情况。结果 80例患者手术用时50~120 min,平均(85.6±10.5)min;术后随访3~6个月,骨折均顺利愈合,其中股骨干骨折愈合时间9~15周,平均(12.5±1.5)周。股骨转子间骨折愈合时间11~20周,平均(15.6±2.5)周;随访期间未发现切口感染、髓内钉固定断裂或松动等病例;其中2例患者肢体短缩约2 cm,但无明显跛行。2例患者出现股骨干骨不连,给予更换髓内钉、植骨,最终骨性愈合。Harris评分优52例,良21例,差7例,优良率91.25%。结论股骨重建髓内钉治疗方案对同侧股骨干合并转子间骨折患者治疗效果显著,且创伤小、固定牢靠,临床可以作为首选治疗方案。     

不同内固定方法治疗老年不稳定性股骨转子间骨折的疗效比较

目的:探讨动力髋螺钉(dynamic hip screw,DHS)和股骨近端锁定解剖钢板内固定治疗老年不稳定性股骨转子间骨折的疗效?方法:选取2004年6月~2013年2月采用手术内固定治疗的58例老年不稳定性股骨转子间骨折病例进行回顾性研究?按照Evans分型,Ⅰ型3度骨折38例;Ⅰ型4度骨折16例;Ⅱ型反粗隆骨折4例?其中38例采用DHS内固定,20例采用股骨近端锁定钢板固定?结果: 58例均获得随访,随访时间4~24个月,平均12.5个月?所有患者骨折均获得愈合,未发生因本手术导致的内科合并症加重或者患者死亡?按Harris髋关节功能评分标准评价:DHS组优18例,良8例,尚可6例,差6例,优良率68.4%;锁定钢板组优14例,良3例,尚可1例,差2例,优良率85%;二组差异有统计学意义(P < 0.05)?结论:与DHS相比,选用股骨近端锁定钢板治疗老年不稳定性股骨转子间骨折可能获得更好的临床疗效?     

亚洲型髋关节螺钉系统治疗老年股骨转子间骨折

目的 总结亚洲型髋关节螺钉系统治疗老年股骨转子间骨折的方法和疗效.方法 回顾性分析用亚洲型髋关节螺钉系统治疗老年股骨转子间骨折35例患者的临床资料.结果 35例平均手术时间(40±5)分钟,平均出血量(95±15)mL.所有患者均骨性愈合,无重大并发症,按照Harris髋关节评分标准,优良率88.6％.结论 亚洲型髋关节螺钉系统具有操作步骤简单、手术时间短、切口小、出血少、骨折固定牢靠、并发症少及患者可早期功能锻炼等优点,适合治疗老年股骨转子间骨折.     

骨钩辅助PFNA治疗不稳定股骨转子间骨折

目的 研究骨钩在辅助复位不稳定股骨转子间骨折股骨近端防旋髓内钉(PFNA)内固定治疗中的临床疗效.方法 选择应用骨钩辅助闭合复位PFNA内固定治疗不稳定股骨转子间骨折的患者63例.骨折按EvanS分类标准,Ⅰc型13例,Ⅰd型25例,Ⅱ型15例,均为闭合性骨折.统计患者的手术时间、术中出血量、骨折愈合情况、术后负重时间、在院时间、并发症及Harris评分评估患髋功能.结果 患者手术时间45～58 min,平均(50.0±4.5)min;术中失血量为80～150mL,平均(90.0±25.0)mL;术后负重时间为(9.0±2.4)周;X线片上骨折线消失并可正常行走时间为(9.0±2.4)周;术后在院时间7～15 d,平均(10.0±2.1)d.患者末次随访时的Harris评分为83～96分,平均(89.0±1.3)分,其中优55例,良5例,中2例,差1例,优良率87.6％.结论 骨钩微创操作在治疗不稳定骨粗隆间骨折有优势.     

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.