髋臼横韧带与髋臼卵圆窝顶点作为解剖标志对髋臼假体植入的参照作用

目的探讨髋臼横韧带与髋臼卵圆窝顶点在人工全髋关节置换中对髋臼假体准确植入的参照作用,以供临床参考。方法选取自2012年6月至2014年1月郑州大学第一附属医院骨科实施初次非骨水泥型人工全髋关节置换术的60例患者为研究对象,术中采取髋臼横韧带与髋臼卵圆窝顶点为解剖标志,指导髋臼假体植入,术后测量髋臼假体的前倾角及外展角,与参考值进行比较。结果术后患者均达到Ⅰ期愈合,均未发生髋关节脱位等并发症,术后测量髋臼假体外展角为(40.4±3.7)°,与参考值(40.0±5.0)°比较,差异无统计学意义(P>0.05);前倾角为(20.9±3.6)°,与参考值(20.0±5.0)°比较,差异无统计学意义(P>0.05)。结论髋臼横韧带与髋臼卵圆窝顶点作为解剖标志在全髋关节置换术中对髋臼假体的精确植入起到可靠的参照作用。     

髋臼横韧带及髋臼切迹在髋臼假体定位中的临床应用

目的:观察髋臼横韧带及髋臼切迹在髋臼假体定位中的临床应用。方法:选取进行全髋关节置换术(THA)治疗的患者80例,随机分为观察组和对照组各40例,所有患者均在全身麻醉下行THA术,观察组使用髋臼横韧带及髋臼切迹作为标志辅助参考髋臼假体定位。对照组使用常规目测定位。术后2周观察患者髋臼外展角与髋臼前倾角与标准值之间的差异。结果:观察组患者前倾角与外展角与标准值无明显差异,对照组患者均明显高于标准值。结论:髋臼横韧带与髋臼切迹在THA中具有重要意义,能够对髋臼假体更为准确定位,以避免术后假体脱位等并发症发生。     

髋臼横韧带在全髋关节置换术中的作用

目的：探讨和分析髋臼横韧带在全髋关节置换中的作用。方法自2012年10月～2013年10月,对32例41髋的患者进行全髋关节置换术。术中重建髋臼和股骨近,所有病人均在真臼位置行全髋置换术,应用髋臼横韧带作为髋臼假体前倾的解剖参考标志,术后测量假体的前倾角。结果所有病例均于随访至6个月,均未发生脱位,术后髋臼假体的前倾角与正常值比较差异无统计学意义。结论正确放置臼杯的位置,是减少术后脱位的关键,而在放置过程中出现臼杯放置错误也是常见的。髋臼横韧带在全髋关节置换术中是确定臼杯前倾角的可靠标志。     

全髋关节置换术中髋臼假体定位的研究进展

关节脱位是全髋关节置换术(THA)术后常见的严重并发症,而髋臼假体定位不准确是导致关节脱位的主要因素.提高髋臼假体定位准确性可降低THA术后早期髋关节脱位率,减轻假体内衬磨损,延长髋臼假体使用寿命,使患者获得更好的髋关节功能.本文就髋臼假体定位方法的研究现状及进展作一综述,以期为临床提供依据.     

应用数字化技术研究异常髋臼的全髋关节置换术

目的应用医学三维重建软件和逆向工程技术为异常髋臼的人工全髋关节置换手术的髋臼选择提供精确的方法。方法筛选2008年2月~10月就诊于郑州大学第一附属医院的40例存在异常髋臼的全髋关节置换患者,按照治疗方法分为对照组与观察组,各20例。对照组采用常规法完成术中髋臼假体定位的手术方案。对观察组患者的骨盆及髋臼进行连续64层CT扫描,将数据导入Mimics 10.0软件重建患侧髋臼,明确髋臼假体的大小及位置;采用逆向工程技术重建髋臼假体模板;术中将髋臼假体模板与髋臼表面相匹配进行置入方向定位,术后对髋臼前倾角、外展角进行测量,并与对照组结果比较。结果观察组的髋臼假体外展角、前倾角、Harris评分均优于对照组,差异有统计学意义(P<0.05)。结论通过医学三维重建软件及逆向工程技术构建的髋臼假体模板可为存在异常髋臼的人工全髋关节置换术髋臼大小及定位提供有利的指导。     

全髋置换术中C臂X光机确定髋臼位相法的临床应用

目的在全髋关节置换术(THR)中,人工髋关节的稳定性取决于髋臼假体的精确安置。适当的髋臼角度,能够避免发生髋关节脱位以及撞击征和关节过度磨损,进而维持人工关节的活动度和稳定性。方法应用术中C臂X光机移位测量髋臼的前倾角、外展角来确定术中髋臼假体的置入角度,并与手术前后测定的髋臼位相参数和传统髋臼假体定位器置入假体的患者全髋术后的髋臼位相参数对比,探讨这种测定方法的应用价值。结果髋臼杯的精确安置可以使髋关节的生物力学得以优化,减少髋关节的脱位率和避免撞击。结论术中准确的纠正骨盆的前后倾斜、内外旋转和外展内收,以及髋臼杯的精确安放,可以提高假体置换术手术质量,减少术后脱位、假体撞击、关节活动受限以及聚乙烯磨损等并发症,促使人工关节的保存率得以延长。     

快速成形导航模板在髋臼发育不良全髋关节置换中的应用

目的:应用计算机辅助及逆向工程技术设计个性化导航模板,指导髋臼发育不良关节置换髋臼假体精确安放。方法:16例髋成人发育性髋关节发育不良病人应用全髋关节置换,男9例,女7例,年龄34～52岁,Crowe分期Ⅰ期10髋;Ⅱ期2髋;Ⅲ期2髋;Ⅳ期2髋。Harris髋关节功能评分在62～24分,平均42.6分。通过术前CT扫描的三维数据,设计髋臼旋转中心,建立发育不良髋臼的计算机数据模型,通过逆向工程技术制做与病人髋臼解剖完全吻合的导航模板,并应用于全髋关节置换手术。同时行术前、术后影像学及临床评估及术后随访。结果:16例病人术后的髋臼位置良好,外翻角在42°～55°,前倾角为12°～22°,下肢延长2～6CM,术后Harris髋关节功能评分在80.3分,无股神经和坐骨神经损伤等并发症。结论:计算机辅助快速成形导航模板应用于髋臼发育不良的全髋关节置换,能精确的控制髋臼假体的安放,对髋臼假体的前倾角和外翻角能精确的控制,并取得较好的疗效。     

髋臼钛板加自体髂骨植骨治疗全髋关节翻修术中严重髋臼骨缺损

目的观察髋臼钛板加自体髂骨植骨治疗全髋关节翻修术中髋臼严重骨缺损的临床效果。方法对21例全髋关节翻修术中髋臼严重骨缺损患者行髋臼钛板加自体髂骨植骨治疗,术后随访6个月至7.5a,根据临床症状及X线进行评估。结果 21例患者均获得随访,未见感染、假体四周骨折等并发症,X线显示髋臼骨床与植入骨完全愈合,髋臼钛板与植入骨、假体之间无完全性透亮带,无骨溶解和髋臼内衬位移病例。Harris评分75～93分,平均(85.46±8.26)分;优15例,良4例,可2例,优良率90.5%。结论髋臼钛板加自体髂骨植骨可有效修复髋臼骨缺损,为假体提供坚强的初始固定,具有恢复髋关节旋转中心的作用,且操作简单,疗效可靠。     

全髋关节置换术中髋臼周围骨赘处理分析

目的:探讨全髋关节置换术中髋臼上缘及后上缘骨赘处理与否对术后关节功能及并发症的影响。方法:随访我院2015年1月-2017年12月收治的286例行全髋关节置换术患者,按照髋臼处理与否,分为观察组与对照组,术前、术后髋关节功能评分(Harris评分)及行X线检查,对关节功能评分、骨化性肌炎发生率、髋臼骨折发生率进行分析。结果:观察组患者术后的Harris评分与对照组相比,差异不明显(P>0.05)。观察组患者骨化性肌炎发生率与对照组相比,差异不明显(P>0.05);观察组无明显骨折发生,对照组1例出现缺损骨折。结论:全髋关节置换术中不建议处理髋臼外侧缘及后上缘骨赘。     

小切口全髋关节置换术治疗8例髋臼发育不良

目的：探讨采用前外侧小切口人工全髋关节置换术治疗髋臼发育不良的可行性。方法：采用前外侧小切口全髋关节置换术对8例（10髋）髋臼发育不良患者进行了治疗．5例（6髋）髋臼进行了植骨。结果：手术切口长9～11cm，手术时间90～120min。术中出血200～400ml，平均312ml，Harris评分由术前38．40分恢复到术后92．80分。随访6个月～2年，平均1年2个月，无一例神经损伤，人工关节无松动．髋关节功能良好。结论：采用小切口全髋关节置换术可以选择性地治疗部分髋臼发育不良患者，出血少，创伤小．术后功能恢复快。     

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.