后凸成形术选择性治疗骨质疏松性胸腰椎爆裂型骨折临床研究

目的 探讨球囊扩张椎体后凸成形术选择性治疗老年骨质疏松性胸腰椎爆裂型骨折的可行性.方法选择7例无神经损伤且无严重椎管占位的老年骨质疏松性胸腰椎爆裂型骨折患者局麻下行球囊扩张椎体后凸成形术治疗,比较手术前后伤椎高度,观察术后患者症状改善及有无并发症发生.结果 7例无神经损伤的老年骨质疏松性胸腰椎爆裂型骨折患者顺利完成手术,术后24h内疼痛均明显缓解.骨折椎体前缘、中部高度基本恢复,患者均能于术后早期下地行走,未发现神经损伤、骨水泥渗漏,椎管狭窄等并发症.结论对无神经损伤且无严重椎管占位的老年骨质疏松性胸腰椎爆裂型骨折患者进行球囊扩张椎体后凸成形治疗有可行性.宜局麻下手术.如果操作准确,观察严密可避免椎管狭窄和骨水泥渗漏,能恢复伤椎的高度,并能早期活动和缓解疼痛.     

后凸成形术体外选择性治疗骨质疏松性胸腰椎爆裂型骨折

目的 体外评估球囊扩张椎体后凸成形术选择性治疗老年骨质疏松性胸腰椎爆裂型骨折的可行性.方法 在C型臂X线机透视下对11椎无严重椎管占位的老年骨质疏松性胸腰椎爆裂型骨折标本行椎弓根穿刺球囊扩张椎体后凸成形术,比较手术前后椎体高度、椎管矢状径及椎体生物力学特性,观察术后骨水泥分布及有无渗漏.结果 术后椎体平均高度为(24.82±1.61)mm,明显高于术前的(20.73±1.37)Inin(P<0.01).手术前后椎管矢状径测量结果差异无显著性(P>0.05).骨水泥在伤椎内集中分布于球囊扩张所形成的空间内,有1例出现骨水泥椎管内少量渗漏.生物力学测定结果显示,伤椎术后强度明显高于骨折前水平(P<0.05),术后刚度明显低于骨折前水平(P<0.05).结论 对无严重椎管占位的老年骨质疏松性胸腰椎爆裂型骨折标本选择性进行球囊扩张椎体后凸成形术可以恢复伤椎的高度和强度,且不造成继发椎管狭窄.     

经皮球囊扩张椎体后凸成形术治疗20例骨质疏松性压缩骨折

目的 总结经皮球囊扩张椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折的临床效果.方法 20例(20个椎体)骨质疏松性椎体压缩骨折患者,行经皮椎弓根途径椎体后凸成形术治疗,观察术后症状改善及骨折复位情况.结果 20例手术均顺利,疼痛于术后24h内均明显缓解,术后无脊髓神经根受损表现,X线片复查显示,病椎高度明显恢复,后凸畸形大部分矫正.结论 PKP治疗多节段性老年骨质疏松脊柱骨折安全有效,是值得推广应用的微创治疗技术.     

经皮球囊扩张椎体后凸成形术治疗老年骨质疏松性胸、腰椎压缩性骨折61例疗效分析

目的探讨经皮球囊扩张椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折的临床疗效。方法回顾分析2007年1月至2010年6月四川省广安市武胜县人民医院和四川省广安市人民医院收治的采用经皮球囊扩张椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折患者61例的临床疗效。结果疼痛完全缓解39例,基本缓解18例,缓解不明显者4例(均为陈旧性骨折)。椎体前缘高度恢复基本正常41例,椎体前缘高度恢复较差者20例。结论经皮球囊扩张椎体后凸成形术是治疗老年骨质疏松性胸腰椎压缩性骨折一种有效、安全、简单的方法,其创伤小、并发症少、对缓解腰痛明显且起效快,尤其适用于新鲜骨折患者,老年患者易于接受。     

球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的护理

目的:总结球囊扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折围手术期的护理。方法:116例胸腰椎体压缩性骨折的老年患者在DSA室局麻下行球囊扩张椎体后凸成形术。术前充分评估患者心理状态,完善术前准备,术后严格监测患者的生命体征,评估患者术后疼痛的程度和双下肢感觉运动功能情况,指导患者康复功能锻炼。结果:球囊扩张椎体后凸成形术后能有效减轻疼痛,运动功能明显改善,未发生护理并发症。结论:骨质疏松性椎体压缩骨折围手术期中,细致的护理配合手术治疗,能保证手术的最佳效果。     

经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的应用研究

目的 探讨经皮球囊扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效.方法 对38例(47个椎体)老年骨质疏松性压缩骨折患者采用PKP治疗,手术前、后在侧位X线片上测量手术椎体的高度及后凸Cobb角,进行视觉模拟评分(VAS),术后观察骨水泥渗漏情况,对其临床效果进行评价及随访.结果 38例术后椎体前缘及中线高度较术前恢复明显;术后Cobb角较术前明显变小,后凸畸形得到明显矫正,术后各时间点平均VAS评分均较术前明显降低.随访4～24个月,疼痛缓解明显,无复发.结论 经皮椎体后凸成形术治疗老年胸腰椎骨质疏松性压缩骨折具有微创、止痛效果好、无明显并发症及早期下地活动等优点,明显提高了患者生活质量.     

球囊扩张椎体成形术治疗骨质疏松性胸腰椎骨折

目的探讨经皮穿刺球囊扩张椎体成形术治疗骨质疏松性胸腰椎椎体压缩性骨折的疗效。方法采用经皮穿刺球囊扩张椎体成形术,治疗骨质疏松性胸腰椎椎体压缩性骨折,26例共31个椎体。结果手术前后对疼痛进行评分,结果差异均具有显著性（P〈0.01）,脊柱后凸畸形及椎体高度恢复明显,未见严重并发症。结论球囊扩张椎体成形术是一种新型的微创技术、操作简便,能够迅速缓解疼痛,改善功能,是治疗骨质疏松性胸腰椎椎体压缩性骨折的一种安全、有效的理想方法。     

经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折107例

经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）通过球囊的扩张恢复压缩椎体的高度,并通过注入骨水泥强化椎体,达到微创,迅速止痛,早期下床活动的治疗目的。本院采用PKP治疗骨质疏松性胸腰椎压缩性骨折107例,取得良好疗效,现报道如下。     

30例胸腰椎骨折球囊扩张椎体后凸成形术的护理

目的 探讨经皮穿刺球囊扩张椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折的护理.方法 对30例外伤致胸腰椎压缩骨折的患者在C型臂X光机透视下经皮球囊扩张椎体后凸成形术,术前行心理护理,体位训练.术后严密观察生命体征及有无并发症发生,指导康复锻炼.结果 30例患者术后2～3天均可下床活动,腰背部疼痛明显减轻或消失,无并发症发生.结论 球囊扩张椎体后凸成形术是治疗由于骨质疏松症导致胸腰椎压缩骨折的有效方法.具有手术时间短,创伤小,恢复快等特点.     

经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩骨折

目的:探讨经皮椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩骨折的疗效。方法:对45例胸腰椎压缩性骨折的50例椎体,采用经皮椎体后凸成形术治疗,观察治疗前后疼痛状况,椎体高度及Cobb角的改变情况,评价疗效。结果:全部病例疼痛完全解除或有明显缓解,术后椎体高度、Cobb角、VAS评分与治疗前相比,差异均有统计学意义。结论:经皮椎体后凸成形术治疗老年骨质疏松性性胸腰椎压缩骨折有效、安全。     

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.