组配式假体在Crowe Ⅰ、Ⅱ型发育性髋关节发育不良全髋关节置换术中的应用

目的 探讨应用组配式假体行全髋关节置换术（total hip arthroplasty, THA）治疗CroweⅠ、Ⅱ型发育性髋关节发育不良（developmental dysplasia of the hip, DDH）的短期临床疗效。方法 回顾性分析2016年10月至2017年10月,中国人民解放军总医院骨关节科收治的40例单侧Crowe Ⅰ、Ⅱ型DDH病人的临床资料,其中男5例,女35例;年龄为（36.90±10.30）岁（19~51岁）,股骨选用组配式假体,全部纳入组配式假体组。另选择既往40例术前设计采用普通锥形假体的单侧Crowe Ⅰ、Ⅱ型DDH病人作为对照组。比较两组病人的基本信息,术中及术后并发症发生情况,术前及术后6个月髋关节Harris功能评分,术后双下肢长度及偏心距差异等指标。结果 组配式假体组与对照组病人的术中股骨假体周围骨折发生率（5.0%比10.8%）、术后脱位率（2.5%比8.1%）、偏心距差异发生率（20.0%比37.8%）比较,差异均无统计学意义（χ²=0.276,P=0.600;χ²=0.353,P=0.553;χ²=2.997,P=0.083）。术后,组配式假体组的髋关节Harris功能评分较对照组高[（89.45±9.22）分比（84.69±8.77）分;t=2.077,P=0.041],双下肢不等长发生率低（17.5%比43.2%;χ²=6.081,P=0.014）。结论 在Crowe Ⅰ、Ⅱ型DDH中,组配式假体比普通假体更易获得双下肢等长及更佳的关节功能。     

血清瘦素对全髋关节置换术后假体周围骨密度和假体松动影响的临床研究

目的 探讨血清瘦素对全髋关节置换术后假体周围骨密度和假体松动的影响。方法 自2015年1月至2016年1月,前瞻性收集我院收治的全髋关节置换术患者165例,观察血清瘦素与患者术后假体周围骨密度、假体松动等临床特征的相关性。结果 术后1年时,与假体稳定的患者相比,假体松动的患者ROI1骨密度显著降低(0.69±0.14 vs. 0.78±0.12 g/cm3, P=0.019);ROI3区骨密度显著降低(1.46±0.22 vs. 1.62±0.25 g/cm3, P=0.041);ROI6区骨密度显著降低(1.20±0.21 vs. 1.40±0.26 g/cm3, P=0.014)。假体松动的患者术前血清瘦素低于假体稳定的患者(6.81±1.42 vs. 7.91±1.58 μg/L, P=0.026)。与身体体重指数≤25kg/m2的患者相比,身体体重指数>25kg/m2的患者术前血清瘦素显著降低(7.12±1.48 vs. 8.46±1.56 μg/L, P=0.000)。与术后1年时Harris评分<80分的患者相比,Harris评分≥80分的患者血清瘦素显著增加(8.09±1.61 vs. 7.09±1.52 μg/L, P=0.001)。术前血清瘦素与术后1年时ROI1和ROI6骨密度显著正相关(r=0.218和0.258, P=0.021和0.002)。结论 血清瘦素降低可能与全髋关节置换术后假体周围骨密度降低和假体松动有关。     

营养指导对全髋关节置换术老年病人预后的影响

目的 探讨营养指导对全髋关节置换术（total hip arthroplasty, THA）老年病人预后的影响。方法 选择2016年1月至2017年1月我院骨关节外科收治的因股骨颈骨折行择期THA的194例老年病人纳入观察组,2015年1月至2016年1月因股骨颈骨折行择期THA的152例老年病人纳入对照组,对照组给予常规饮食指导,观察组在营养科会诊后给予个性化饮食指导。比较两组病人入院第1天及术后第10天的血清前白蛋白（PA）、白蛋白（ALB）、血红蛋白（Hb）、血电解质水平、感染率及住院时间。结果 观察组168例（男96例、女72例）完成试验,对照组118例（男67例、女51例）完成试验。术后第10天,观察组的PA、ALB和Hb分别为（0.352±0.074） g/L、（34.077±1.291） g/L、（117.846±7.208） g/L,显著高于对照组的（0.262±0.049） g/L、（32.750±1.067） g/L、（106.932±1.723） g/L,差异均有统计学意义（P均＜0.05）;除了Ca²⁺外,观察组病人Na⁺、K⁺和Mg²⁺的水平均显著高于对照组,差异均有统计学意义（P均＜0.05）。观察组的住院时间为（11.84±3.26） d,期间发生感染5例（5/168,3.05%）;对照组的住院时间为（13.32±4.54） d,发生感染12例（12/118,10.17%）,差异有统计学意义（t=-2.960,P=0.003;χ²=5.142,P=0.013）。结论 术后营养指导可以改善THA老年病人的术后营养状况及预后,降低并发症发生率,有利于病人术后快速康复。     

髋臼原位重建及高髋关节中心技术治疗Crowe Ⅱ、Ⅲ型发育性髋关节发育不良的对比研究

目的 比较全髋关节置换术（total hip arthroplasty, THA）中行髋臼原位重建及高髋关节中心技术治疗Crowe Ⅱ、Ⅲ型发育性髋关节发育不良（developmental dysplasia of the hip, DDH）的临床疗效。方法 对2012年8月至2015年12月于我科行THA治疗Crowe Ⅱ、Ⅲ型DDH合并髋关节骨性关节炎（Tonnis Ⅲ期）的37例病例进行回顾性分析,根据髋臼重建方式分组：其中髋臼原位重建组17例,高髋关节中心重建组20例。比较两组病人的手术时间、手术出血量、Harris评分、影像学假体松动率。结果 37例病人平均随访41个月（25~63个月）。髋臼原位重建组的手术时间和手术出血量分别为（119±16） min、（413±36） ml,高髋关节中心重建组的手术时间和手术出血量分别为（92±21） min、（389±44） ml,两组间比较,差异均有统计学意义（t=29.561,P=0.021;t=0.682,P=0.231）。两组术后的Harris评分均较术前显著提高,但两组间术前及末次随访的Harris评分比较,差异均无统计学意义（P均＞0.05）。髋臼原位重建组中有2例少量植骨吸收,两组随访未见影像学假体松动。结论 高髋关节中心技术的手术时间较髋臼原位重建更短,两种技术治疗Crowe Ⅱ、Ⅲ型DDH的中期临床疗效较好,均可显著恢复病人的髋关节功能。     

机器人辅助人工全髋关节置换的短期疗效分析

目的　探讨机器人辅助人工全髋关节置换术（total hip arthroplasty, THA）的短期疗效。方法　回顾性分析2018年8月至2019年3月于我科采用MAKO机器人系统辅助植入臼杯行THA手术治疗的79例（100髋）病人的临床资料,纳入机器人辅助组,并选择同一手术医师施行的80例（100髋）徒手THA病人纳入对照组,均采用标准髋关节后外侧入路。收集比较两组病人的围手术期相关信息,如手术时间、住院时间、髋臼杯位置、术后下肢长度差异（limb length discrepancy, LLD）、围手术期并发症及髋关节Harris评分（hip Harris score, HHS）。结果　病人术后均得到3个月以上随访,两组均未发生髋关节脱位、无菌性松动、假体周围感染或翻修。机器人辅助组的手术时间为（95.92±15.64） min,明显长于对照组的（83.12±18.22） min,两组比较,差异有统计学意义（t=3.309,P=0.001）。两组的术后HHS均较术前显著改善,但组间比较,差异无统计学意义（P＞0.05）。机器人辅助组的前倾角、外展角、LLD和偏心距差异分别为19.05°±5.03°、41.14°±3.66°、（2.87±3.75） mm、（3.34±1.79） mm,对照组分别为16.91°±5.48°、40.35°±6.57°、（4.23±3.12） mm、（3.98±2.04） mm;两组的前倾角和LLD比较,差异均有统计学意义（P均＜0.05）,但两组间的外展角和偏心距差异比较,差异无统计学意义（P＞0.05）。机器人辅助组的手术假体位于Lewinnek安全区内的比例更高（91% vs. 82%）,但两组间比较,差异无统计学意义（χ²=3.468,P=0.063）。结论　机器人辅助THA能够优化髋臼杯假体植入的精确性,不增加手术的并发症,但其远期效果仍需进一步研究证实。     

人工全髋关节置换治疗陈旧性化脓性髋关节炎遗留关节畸形的临床疗效

目的 评价人工全髋关节置换术（total hip arthroplasty,THA）治疗陈旧性化脓性髋关节炎遗留关节畸形的临床效果。方法 回顾性收集2014年8月至2019年7月于新疆维吾尔自治区人民医院行THA治疗陈旧性化脓性髋关节炎的18例病人围手术期及术后随访资料。通过Harris评分评估髋关节功能,依据随访时X线片评估假体情况,记录随访过程中并发症发生情况。结果 18例病人随访（29.6±2.3）个月（24~35个月）。下肢短缩由术前的（4.17±1.24） cm改善至术后的（0.62±0.41） cm,差异有统计学意义（t=11.393,P＜0.001）;Harris评分由术前的（43.38±3.81）分提升至末次随访时的（87.61±4.21）分,差异有统计学意义（t=-30.484,P＜0.001）;其中优秀9例,良好6例,尚可3例,优良率为83%。切口脂肪液化1例,其余均愈合良好。术后脱位1例,进行翻修手术。随访期间未观察到假体周围骨折、假体周围感染、骨溶解、无菌性松动等并发症。结论 THA治疗陈旧性化脓性髋关节炎遗留关节畸形病人疗效满意,可显著改善髋关节功能,纠正下肢长度,提高病人生活质量。     

单侧双通道内镜单纯髓核摘除术对椎旁肌肉的影响

目的 研究单侧双通道内镜单纯髓核摘除术（unilateral biportal endoscopic discectomy，UBED）对于椎旁肌肉的影响，并评估椎旁肌肉改变与随访时间的相关性。方法 回顾性分析2020年3月至2021年12月就诊于我院脊柱外科并接受UBED手术治疗的42例病人的临床资料。所有病人在术前、术后、末次随访时均行MRI检查。收集病人基本信息、末次随访时间、MRI图像、腰部和腿部的疼痛视觉模拟量表（visual analogue scale，VAS）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）。结果 与术前相比，手术侧多裂肌术后信号强度、水肿面积均明显上升［41.02±14.40 vs. 19.14±10.11，（26.95±14.70） cm² vs. （10.17±5.41） cm²］；与非手术侧相比，术后手术侧多裂肌信号强度、横截面积、水肿面积占比明显升高［41.02±14.40 vs. 21.92±11.07，（39.27±12.82）cm² vs. （33.66±11.79）cm²，26.95%±14.70% vs. 11.53%±7.06%］；上述指标比较，差异有统计学意义（P＜0.05）。手术对于竖脊肌上述指标的改变未见统计学意义（P＞0.05）。手术侧多裂肌信号强度、水肿面积占比均与随访时间存在显著负相关（r=-0.53、r=-0.47）。结论 UBED对于椎旁肌肉的影响集中于手术侧多裂肌，但其损伤是可逆的。     

不同偏心距Corail股骨假体在全髋关节置换中的临床疗效研究

目的: 分析单侧初次全髋关节置换使用Corail颈干角135°不同偏心距股骨假体的术后影像学参数,对比双侧测量结果,分析术后股骨偏心距的重建及髋关节功能恢复,探讨Corail标准柄KS型与高偏心距柄KHO型股骨假体在初次全髋关节置换中的早期临床疗效。方法: 回顾性分析2015年1月至2017年6月使用强生Corail股骨柄假体行初次人工全髋关节置换186例单侧髋关节病变患者,根据术中使用不同偏心距股骨假体将患者分为高偏心距组和标准偏心距组。高偏心距组为Corail高偏心距假体KHO型52例,女20例,男32例;年龄21~71(50.6±13.2)岁;体质量指数(body mass index,BMI)(26.0±4.1) kg/m²。标准偏心距组为Corail标准股骨柄假体KS型134例,女57例,男77例;年龄18~77(47.3±14.0)岁;BMI(25.3±3.5) kg/m²。在术后髋关节正位X线片上测量外展力臂、股骨偏心距、髋臼偏心距、下肢长短差异,记录患者手术前后的Harris评分及相关并发症,分析假体的稳定性。结果: 高偏心距组患侧与健侧股骨偏心距、联合偏心距、外展力臂差异有统计学意义(P<0.05)。标准偏心距组患侧与健侧股骨偏心距、髋臼偏心距差异有统计学意义(P<0.05)。两组患者联合偏心距、外展力臂、下肢长短差异有统计学意义(P<0.05)。高偏心距组患侧髋关节外展力臂与股骨偏心距、髋臼偏心距和联合偏心距呈正相关性(r=0.633,P<0.001;r=0.384,P=0.005;r=0.690,P<0.001),健侧也得到了同样的结果(r=0.688,P<0.001;r=0.574,P<0.001;r=0.765,P<0.001)。标准偏心距组患侧髋关节外展力臂与股骨偏心距、髋臼偏心距和联合偏心距呈正相关性(r=0.734,P<0.001;r=0.418,P<0.001;r=0.749,P<0.001),健侧也得到了同样的结果(r=0.775,P<0.001;r=0.397,P<0.001;r=0.773,P<0.001)。高偏心距组双下肢长短差异与双侧联合偏心距的差异、双侧外展力臂的差异均有明显相关性(r=0.376,P=0.006;r=-0.346,P=0.012)。标准偏心距组双下肢长短差异与双侧联合偏心距的差异、双侧外展力臂的差异均无明显相关性(r=-0.009,P=0.919;r=-0.036,P=0.682)。两组患者术后末次随访Harris评分比较差异无统计学意义(P>0.05)。末次随访时,两组患者Trendelenburg阴性,假体均稳定。结论: Corail标准柄与高偏心距柄在单侧初次全髋关节置换中均可较好重建股骨偏心距,能很好重建髋关节的解剖结构和生物力学,维持双下肢长度及髋关节稳定性。虽有病例未能正常重建股骨偏心距,但并不影假体的稳定性和术后功能。     

直接前方入路全髋关节置换术学习曲线及其前后疗效分析

目的 研究采用直接前方入路（direct anterior approach, DAA）行全髋关节置换术（total hip arthroplasty, THA）的临床疗效,探讨直接前方入路全髋关节置换术（DAA-THA）的学习曲线及其前后期疗效。方法 回顾性分析2018年5月至2019年5月在绵阳市中心医院行DAA-THA的105例病人的手术时间、术中出血量、切口引流量、手术前后血红蛋白（hemoglobin, HGB）及白蛋白（albumin, ALB）差值、住院时间、术后假体位置（外展角、前倾角、股骨柄-髓腔轴线夹角）、肢体长度差（limb length discrepancy, LLD）、并发症及Harris髋关节功能评分等临床资料,探讨该术式学习曲线,比较分析学习曲线前后病例的上述各项指标。结果 病例均获得随访,随访时间为6~18个月,平均12个月。病人手术时间为（136.88±34.52） min,术中出血量为（248.43±131.44） ml,术后引流量为（233.07±122.35） ml,HGB差值为（27.16±11.01） g/L,ALB差值为（10.72±3.94） g/L,住院时间为（8.61±3.96） d。术后Harris评分为（79.82±5.95）分,前倾角为14.24°±5.62°,外展角为42.57°±7.25°,股骨柄-髓腔轴线夹角为2.66°±1.59°,LLD为（5.11±3.82） mm。手术时间、术中出血量、假体安放位置、住院时间在完成54例DAA-THA后趋于稳定。以54例为界,分为前期组（54髋）和后期组（51髋）。DAA-THA后期组的手术时间、术中出血量、住院时间、外展角、股骨柄-髓腔轴线夹角小于前期组,差异均有统计学意义（P均＜0.05）。DAA-THA前期组与后期组在术后引流量、HGB差值、ALB差值、前倾角、LLD、术后1、3、6个月Harris髋关节功能评分方面的差异均无统计学意义（P均＞0.05）。两组均无假体脱位发生,DAA-THA后期组的并发症发生率小于前期组,差异有统计学意义（P＜0.05）。结论 DAA-THA学习曲线为54例左右,度过学习曲线后,DAA-THA手术技术在多方面更加稳定与成熟,可以有效地减少手术时间及术中出血量,提高假体安放的准确性,缩短住院时间,降低并发症的发生,从而为病人提供更优的术后早期疗效。     

后外侧结构重建对后外侧入路全髋关节置换术后早期脱位的影响

目的 探讨后外侧结构重建对后外侧入路全髋关节置换术（total hip arthroplasty, THA）后早期脱位的影响。方法 回顾性分析2015年1月至2018年1月于我院行后外侧入路初次THA的病人120例,根据术中是否修补关节囊及外旋肌群将病人分为两组：观察组60例,舌形切开关节囊,术中将关节囊及外旋肌群原位缝合在大转子后方及臀中肌肌腱附着处;对照组60例,切除后关节囊,术中未进行外旋肌群修补重建。术后3个月内发生的脱位定义为早期脱位,比较两种方法对术后早期脱位率的影响。记录并比较两组病人的手术时间、术腔引流量、髋关节Harris评分。结果 观察组手术时间为（51.6±9.5） min,对照组为（45.1±7.5） min,对照组手术时间短于观察组,差异有统计学意义（t=2.008,P=0.036）。观察组术腔引流量为（129.6±11.9） ml,对照组为（136.8±12.4） ml,差异无统计学意义（t=1.187,P=0.269）。观察组未发现早期脱位,对照组早期脱位4例（4/60,脱位率为6.667%）,观察组术后Harris评分为（86.1±5.0）分,对照组为（85.9±5.5）分,差异无统计学意义（t=1.416,P=0.092）。结论 在后外侧入路THA过程中行后外侧结构重建的手术方式早期脱位率低,修补关节囊及外旋肌群对维持髋关节软组织平衡有一定意义。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.