下肢静脉瓣膜功能不全的治疗现状及临床研究意见

下肢静脉曲张是人们熟知的外科常见病，在公元前1500年已有文字记载。随着下肢静脉系统解剖学知识的积累，尤其是关于下肢静脉及其瓣膜结构与功能、下肢静脉血流动力学的深入研究，检测技术的不断改进，最终形成了下肢慢性静脉功能不全（chronic venous insufficiency of the lower exfremifies，CVI）的概念。现今，CVI作为一组病症的总称，包含了先天性、原发性及继发性下肢静脉功能不全，造成下肢静脉血液逆流和（或）回流障碍，引起下肢静脉系统与微循环高压及相应的临床表现：浅静脉曲张、浮肿、色素沉着等皮肤改变，静脉性溃疡。下肢静脉瓣膜功能不全属于CVI范畴。本文就下肢静脉瓣膜功能不全的治疗变更、今后临床研究两个方面，简述如下。     

下肢静脉溃疡的病因学研究和治疗现状

下肢静脉曲张、静脉性溃疡和溃疡复发的发病率分别为20．0％、0．5％～3．0％和67．0％，10年以上病史的溃疡发生率为10％，内外科治疗结果无统计学差异，说明静脉性溃疡课题的社会性和艰巨性。为此，对下肢静脉的临床解剖、病理生理、血流动力学改变和治疗现状的介绍，对课题的进一步深入研究，不无裨益。     

下肢浅静脉曲张的微创治疗

下肢浅静脉曲张是常见病，据美国疾病流行病学调查，总人口中20％患有慢性静脉功能不全(chronic venous insufficiencv，CVI)，其中女性占20％～25％，男性占10％～15％．根据不同病因，下肢浅静脉曲张传统手术包括各种深静脉瓣膜重建、交通静脉结扎、大隐静脉高位结扎和曲张浅静脉结扎及抽剥术。近10年来，因科学技术的飞速发展，使     

外科手术在治疗慢性静脉功能不全中的作用

下肢慢性静脉功能不全（chronic venous insufficiency，CVI）是外科临床的常见病和多发病，我国的发病率约为8％-13％。按1995年American Venous Forum所认同的概念及诊断和分类标准，多种血管疾病均可导致CVI的发生。按病因可分为原发性、继发性和先天性；按血流动力学可分为血液反流性病变和血液回流障碍性病变；按解剖学可涉及浅静脉、深静脉和交通静脉三个系统。外科手术主要针对原发性、血液反流性疾病，范围可涵盖浅静脉、深静脉和交通静脉。     

非血栓性髂静脉受压综合征在下肢慢性静脉功能不全中的诊治意义

目的 探讨非血栓性髂静脉受压综合征(NIVCS)在下肢慢性静脉功能不全中的诊治意义.方法 对210例下肢慢性静脉功能不全(CVI)伴NIVCS患者的治疗成功率、疗效及并发症进行分析.结果 本组男116例,女94例,左下肢192例,右下肢18例,平均年龄55.7岁.介入球囊扩张+支架植入或联合浅静脉手术共210例,技术成功率100.0％.浅静脉曲张治愈率95.8％,下肢肿胀缓解率76.9％,疼痛缓解率80.2％,溃疡愈合率75.0％.平均随访32.4个月,支架总通畅率100.0％.结论 纠正NIVCS或联合抗返流手术能明显改善CVI患者的症状,提出NIVCS可能是部分CVI的基础疾病.     

下肢慢性静脉功能不全外科治疗的现状与争议

下肢慢性静脉功能不全(chmnic venous insuffciencv，CVI)是常见的血管外科疾病，多种静脉疾病均可导致静脉功能不全，按其病因可分为原发性、继发性、先天性；按解剖范围可分为浅、深和交通静脉3个系统。下肢CVI的外科治疗主要用于原发性CVI和部分继发性CVI的病例。虽深静脉瓣膜重建术对纠正深静脉反流确有一定疗效，     

内镜筋膜下交通静脉结扎术治疗静脉性溃疡

下肢交通静脉功能不全在慢性静脉功能不全（chronic venous insufficiency,CVI）肢体皮肤改变,特别是静脉性溃疡发病中的作用早已为人们所注意,早在19世纪60年代,Gay就认识到下肢静脉性溃疡中存在交通静脉功能不全现象。目前虽尚存在一些争沦,但大多数学者仍持认可态度。功能正常的交通静脉由于瓣膜的作用,可保证由下肢浅静脉系统向深静脉系统的单向回流;而当其功能不全时,下肢深静脉的血流就会通过功能不全的交通静脉逆流入浅静脉,引起小腿浅静脉淤血、     

改良式修眉刀应用于小儿输液备皮

目的探讨不同方法静脉给药对下肢深静脉血栓形成溶栓效果。方法将90例下肢深静脉血栓形成患者随机分为对照组、观察1组、观察2组，每组各30例。三组患者于患肢末梢静脉给药溶栓治疗；在此基础上观察1组采用止血带压迫浅静脉；观察2组采用弹力绷带压迫浅静脉。结果对照组总有效率63．3％，观察1组96．7％，观察2组93．3％，观察1、2组与对照组比较，差异有显著性意义（均P〈0．01）；观察1、2组比较，差异无显著性意义（P〉0．05）。结论压迫浅静脉行患肢末梢静脉给药治疗下肢深静脉血栓效果显著。而用止血带压迫浅静脉行患肢末梢静脉给药溶栓治疗，因其护理观察直接，操作方法简单、取材经济方便，且可根据需要随时调节，是一种理想的静脉给药的辅助溶栓治疗方法。     

腔内激光闭合术联合点状切口穿通支离断术治疗下肢静脉性溃疡

慢性静脉功能不全（chronic venous insufficiency，CVI）所致的下肢静脉性溃疡临床常见，但治疗困难。穿通支静脉瓣膜功能不全引起的下肢静脉高压，是静脉性溃疡发生的主要原因。本研究采用腔内激光闭合术联合点状切口穿通支离断术治疗下肢静脉性溃疡24例，报道如下。     

激光联合泡沫硬化剂在下肢浅静脉曲张中的应用前景

<正>下肢浅静脉曲张是常见的疾病,属于下肢慢性静脉功能不全(chronic venous insufficiency,CVI),因静脉倒流引起的病征之一。CVI根据病因可分3大类:先天性瓣膜功能结构及关闭功能异、原发性浅静脉或深静脉瓣膜功能不全和继发性静脉瓣膜功能不全,其临床表现为下肢浅静脉扩张,呈团状或"蚯蚓"状静脉团,下肢出现水肿、沉胀、乏力、瘙痒、皮肤色素沉着、湿疹甚至溃疡。国外成人患病率为20.0%~40.0%~([1])。     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.     

Analysis of the impact of the course of hydration on the mechanical properties of the annulus fibrosus of the intervertebral disc

Purpose

The aim of this study was to determine the impact of free hydration on the mechanical parameters of the annulus fibrosus (AF) of the intervertebral disc (IVD), determined in a standard manner. Attention was also given to the hydration occurring in real time and geometric changes resulting from swelling of the AF.

Methods

Uniaxial tensile tests of multilayer samples of the AF with bone attachment were performed for two groups: samples subjected to 30 min of hydration prior to the mechanical test, and control samples, which were not subjected to additional hydration.

Results

As a result of hydration, the values of both the failure stress (σ _UTS) and the tensile modulus (E) were lower than in the control group. A decrease in these values was observed for the AF from both the anterior and posterior parts of the IVD.

Conclusions

The tests showed a significant dependence of the determined mechanical parameters on the cross-sectional area. The larger the cross-sectional area, the lower the obtained value of stress. By contrast, the value of the stiffness coefficient is independent of the cross-sectional area. The differences in mechanical parameters are related mainly to water absorption into structures of the AF during hydration. This is confirmed by microscopic analysis of geometric dimensions of the AF during hydration conducted in real time. The greatest changes occurred in the radial direction, where the thickness increased by 2.05 mm, while in the axial direction the main change concerned an increase in height by 0.69 mm. There were negligible changes in the circumferential direction.