颧骨颧弓骨折50例临床分析

颧骨颧弓骨折约占颌面外伤的20％-30％,以往多采用单纯复位加填塞及钢丝固定的方法进行治疗,但存在复位不充分,复位后固定强度差容易回缩移位或受压移位等缺点。近年来由于微型钛板的出现,多倾向于根据骨折复位的稳定度进行单纯复位或切开复位内固定的方法进行治疗。我院自1997年-2008年共收治50例颧骨颧弓骨折患者,现对其治疗方法和手术体会报告如下。     

颧骨颧弓骨折手术治疗21例报告

目的:讨论经口内前庭沟切口及下眼睑切口行颧骨颧弓骨折的手术治疗方法.方法:对在我科住院手术治疗的21例颧骨颧弓骨折患者的手术及固定方法进行总结分析.结论:优17例,良4例,优良率达100%.结论:口内前庭沟切口及下眼睑切口的进路具有操作难度及风险低、易于掌握、复位及固定方便可靠、经济性高等优点,是颧骨颧弓骨折手术的理想路径.内固定应根据骨折类型、移位程度和手术时机等多方面因素综合判定,固定比不固定更可靠.     

微型钛夹板坚固内固定在颧骨颧弓骨折中的应用

颧骨和颧弓是面部比较突出的部分，常因遭受外力直接打击而发生骨折，其中尤以颧弓骨折多于颧骨骨折。颧骨和颧弓骨折常造成面部畸形和张口受限等功能障碍，以往一般根据骨折移位情况采用保守或颧部牵拉等方法治疗。我科1999年10月～2002年12月对29例颧骨和颧弓骨折病人采用颞部改良式冠状切口和创口或创口延长手术切开复位、微型钛夹板坚固内固定治疗，取得了满意疗效。现报告如下。     

颧骨、颧弓骨折手术治疗46例临床分析

目的:探讨手术治疗颧骨、颧弓骨折的方法。方法:对46例颧骨、颧弓骨折患者采用局部小切口、微型钢板坚固内固定术式,并对手术及固定方法进行总结分析。结果:优32例,良14例,未出现明显后遗症,优良率达100%。结论:颧骨、颧弓骨折中以Z inggⅠ型多见,采用局部小切口、微型钢板坚固内固定术式,手术创伤小,无明显后遗症,既能保持面容外形完美,又能恢复咬牙合与咀嚼功能,值得推广。     

局部小切口结合可吸收接骨板治疗颧骨颧弓骨折效果观察

目的 探讨局部小切口结合可吸收接骨板内固定治疗颧骨颧弓骨折的疗效.方法 68例颧骨颧弓骨折患者被随机分为内固定材料钛板组(对照组)和可吸收接骨板组(观察组),各34例.比较两组并发症情况.结果 两组患者并发症发生情况差异无统计学意义(P＞0.05).两组患者伤口就Ⅰ期愈合,患者面部外形及功能恢复正常.结论 局部小切口结合可吸收接骨板内固定治疗颧骨颧弓骨折,具有切口小、安全、固定可靠及避免患者二次手术等优点,易于患者接受.     

颧骨弓伴发关节结节骨折的临床探讨

目的探讨颧骨弓伴发关节结节骨折的诊断及治疗方法。方法对30例颧骨弓伴发关节结节骨折的患者可疑骨折区行螺旋CT三维重建检查。18例关节结节骨折移位明显,其中10例行颧骨弓骨折或颧上颌骨折手术治疗,同时行关节结节骨折复位固定术,另8例未行关节结节骨折复位固定;12例关节结节骨折移位不明显者仅行颧骨弓骨折复位固定术。术后观察面部形态及张口度。结果螺旋CT扫描三维重建均能清晰显示患者的关节结节骨折部位、骨折的移位程度、与周围结构的空间关系。10例行颧骨弓骨折或颧上颌体骨折手术同时行关节结节骨折复位术者中,9例有效纠正畸形及改善张口度。8例关节结节骨折移位明显但未行关节结节骨折复位固定者,5例畸形及张口受限明显。另12例关节结节骨折未明显移位并未行固位术者,其面部形态可,其中2例张口轻度受限。结论螺旋CT三维重建对颧骨弓伴发关节结节骨折的诊断具有重要的价值;对关节结节骨折移位明显者,行颧骨弓骨折或颧上颌体骨折手术治疗的同时行关节结节骨折复位术,有助于纠正面部畸形及改善张口度。     

颧骨颧弓骨折36例手术复位和固定方法的临床分析

目的 分析颧骨颧弓骨折早期手术复位径路和固定方法。方法 对资料完整的36例颧骨颧弓骨折进行了分类．对不同类型骨折的治疗方法、固定方式、效果等进行了总结分析。结果 36例中33例早期手术复位和固定。33例中14例采取头皮冠状切口，9例采取局部小切口。应用坚固内固定及其与钢丝骨间栓结联用占90％（27/30），单纯钢丝骨间栓结为10％（3／30）。结论早期手术复位固定者达91、7％（33／36）．早期复住效果好。坚固内固定稳定性好。     

头部冠状切口颧骨颧弓多发性骨折微型钛板坚固内固定术

颧骨颧弓是面部比较突出的骨性支架 ,受损伤机会较多。对于颧骨颧弓的粉碎性骨折 ,骨折段移位明显 ,眶下缘塌陷移位 ,复视或伴有上颌骨骨折的病人 ,常规手术方法不能达到良好的复位及有效固定 ,尤其是陈旧性骨折效果更差。作者采用微型钛板坚固内固定术 ,效果满意。1　临床资料与方法从 1997年 7月至今共计 2 6例 ,男 2 0例 ,女 6例 ,平均年龄 2 0～ 4 8岁。受伤至手术时间 4ｈ～ 4个月。双侧颧骨颧弓粉碎性骨折 8例 ,单侧颧骨颧弓粉碎性骨折 18例 ,其中伴有上颌骨骨折 10例 ,伴有眶下壁骨折复视 12例 ,2例眼球缺失 ,其中 4例伴有鼻骨骨折、…     

颌面部小切口在面骨骨折中的应用

上颌骨及颧骨作为颌面中部的骨性支架维持着面部的基本形态。颌面部的创伤易导致上颌骨及颧骨的骨折 ,不仅造成面部的畸形 ,而且还伴随有相应部位的神经损伤及张口受限等功能障碍[1] 。在临床上我们采用面部较为隐蔽的小切口并结合口腔内切口 ,应用微型钢板或钛板治疗上颌骨骨折及颧骨、颧弓骨折收到了较好的效果。1　临床资料1.1　一般资料　本组 2 3例 ,男 15例 ,女 7例 ,年龄 17～ 5 4岁 ,平均 35 .5岁。经ＣＴ及常规Ｘ片显示上颌骨骨折 7例 ,单纯颧骨骨折伴明显移位 13例 ,颧骨颧弓骨折伴明显移位 3例 ,其中开放型骨折 8例。1.2　手术方…     

头皮半冠状切口在治疗颧骨颧弓骨折中的应用

目的:观察头皮半冠状切口加微型钛板坚固内固定在治疗颧骨颧弓骨折的应用疗效。方法:对34例采用头皮半冠状切口骨折复位加微型钛板坚强内固定治疗颧骨颧弓骨折的临床资料进行回顾性分析。结果:34例患者切口均Ⅰ期愈合,无术后并发症发生,面部外形及功能恢复均较满意。结论:头皮半冠状切口结合微型钛板坚强内固定治疗颧骨颧弓骨折,具有切口隐蔽、固定可靠、功能恢复满意的治疗效果。     

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.