内生软骨瘤的治疗进展

内生软骨瘤是临床上常见的骨肿瘤,最长累及手足的短管装骨,其次为长骨,有恶变的风险,且早期临床症状不明显,很容易被忽略,发现时常常较晚,因此骨骼受累较明显。内生软骨瘤的治疗分为保守治疗和手术治疗,手术治疗分为单纯病灶刮除术和病灶刮除+植骨术,无论采用何种治疗方式,都需要在早期配合康复训练,早发现早治疗可以防止恶变的发生,减少发生各种并发症的风险。本文通过分析内生软骨瘤的病因,发病机制,病理学表现,手术治疗及植骨材料等方面,总结最新的研究进展,旨在为临床选择适宜的治疗方法提供科学的思路。     

软骨瘤与骨化性纤维瘤的诊断与治疗

软骨瘤可发生于骨内(内生软骨瘤),也可发生于骨的表面(骨膜软骨瘤),可以是单一病灶,也可以是多发的(多发性内生软骨瘤病),软骨瘤也可伴有软组织血管瘤(Maffueei综合征).目的 讨论软骨瘤与骨化性纤维瘤的诊断与治疗.方法 根据患者的临床表现与辅助检查结果结合进行诊断并进行治疗.结论 内生软骨瘤一经诊断,应行病灶刮除术及自体骨植骨术.多发内生软骨瘤具有潜在恶性变可能,可恶变为软骨肉瘤或骨肉瘤.如有恶性变发生,应做大块切除术,必要时截肢.骨化性纤维瘤传统治疗一般刮除植骨,但极易复发.现在多主张局部广泛肿瘤切除并植骨,以减少复发可能.     

手部内生软骨瘤的外科治疗

目的探讨手部内生软骨瘤的手术治疗时机、方法及治疗效果。方法对66例手部单发或多发内生软骨瘤的患者分别采用病灶刮除自体骨植骨或人工骨植骨术治疗,术中对于瘤壁采用高渗盐水灭活,通过术后1～6年随访比较疗效。结果术后病理检查证实为软骨瘤。5例功能稍差,其余61例均获得满意疗效。结论手部内生软骨瘤早期治疗均可以达到防止手指畸形影响手部功能的效果,并能防止肿瘤恶变,减少复发。     

手部内生软骨瘤临床分析

目的探讨手部内生软骨瘤发生、临床表现、相关治疗问题。方法选取本组8例病人,采用手术刮除植骨治疗。结果8例病人中7例疗效显著,1例功能稍差。结论手部内生软骨瘤采用刮除软骨组织,进行骨移植临床上可以获得很好的疗效。     

末节指骨内生软骨瘤11例治疗体会

目的总结末节指骨内生软骨瘤的特点及治疗方法。方法对我院1998~2009-10间,收治的11例末节指骨内生软骨瘤患者临床资料进行了回顾分析,所有患者均行手术治疗,5例病人采取肿瘤刮除+植骨;瘤体>1.0 cm的1例病理骨折取自体髂骨植入,克氏针固定;2例45岁及51岁患者因费用问题选择肿瘤切除;3例行瘤腔刮除未植骨。结果术后全部病理证实为内生软骨瘤,伤口Ⅰ期愈合,随访6个月~5年,未出现复发,行肿瘤直接切除2例,手指末节外观正常,未影响正常生活。结论积极行外科手术治疗是内生软骨瘤的有效治疗手段。     

自体髂骨移植加锁定钢板内固定治疗短管状骨内生软骨瘤21例

目的：观察短管状骨内生软骨瘤外科治疗的临床疗效。方法对我院2003年7月至2012年7月期间收治的21例手足短管状骨内生软骨瘤(含合并病理性骨折)患者通过肿瘤刮除、自体髂骨植骨、锁定钢板内固定治疗,观察其疗效。结果21例患者术后标本病理均为内生软骨瘤,12~18个月取出钢板,短管状骨病变区骨性愈合,患指(趾)关节功能良好,无明显疼痛。取出术后继续随访,随访时间6~36个月,平均18个月。内生软骨瘤未出现复发,无病理性骨折发生。临近关节主动活动范围功能无明显受限。结论采用肿瘤刮除、自体髂骨植骨、锁定钢板内固定综合治疗短管状骨内生软骨瘤是安全有效的治疗方法。     

手部内生性骨软骨瘤的临床与病理分析

目的:探讨手部内生性软骨瘤的诊断、病理学特点及治疗方法。方法:对1999年7月至2007年8月经治的38例手部内生性软骨瘤的临床和病理资料进行分析总结。结果:29例获随访时间1a～6a,平均时间4a,其中5例出现复发,2例为骨巨细胞瘤误诊,均予再次手术切除;2例内生性软骨瘤出现恶性变化;其余病例均恢复满意。结论:内生性软骨瘤可见高分化和成熟的软骨组织可作为组织学诊断依据;恶性倾向的内生性软骨瘤应与软骨肉瘤进行鉴别;应用临床、影像学和病理学三方面的方法可提高诊断的准确性和防止误诊。手术局部切除或病灶刮除加植骨术为其主要治疗方法。     

儿童内生性软骨瘤

目的：内生性软骨瘤在软骨起源良性肿瘤中居第二位,仅次于骨软骨瘤,但临床上儿童发病少见。方法：本文回顾分析了１９７０年１月至１９９７年５月诊治的８例共２６处内生性软骨瘤。本组男４例,女４例,平均年龄９岁。术后均做病理检查证实。结果：２６处病变骨中,手足短骨１５处,四肢长骨６处,肩胛骨、胸骨、肋骨、髂骨、耻骨各１处。Ｘ线检查有较大的诊断价值。６例１２处患骨采用软骨瘤刮除加植骨术,２例３处采用单纯刮除术,均获满意疗效。结论：儿童内生性软骨瘤好发于手足短骨和四肢长骨,有恶变为软骨肉瘤的可能,故发现后应积极手术治疗,主张采用病灶刮除加植骨术。     

手部内生性骨软骨瘤的临床与病理分析

目的：探讨手部内生性软骨瘤的诊断、病理学特点及治疗方法：方法：对1999年7月至2007年8月经治的38例手部内生性软骨瘤的临床和病理资料进行分析总结。结果：29例获随访时间1a～6a，平均时间4a，其中5例出现复发，2例为骨巨细胞瘤误诊，均予再次手术切除；2例内生性软骨瘤出现恶性变化；其余病例均恢复满意。结论：内生性软骨瘤可见高分化和成熟的软骨组织可作为组织学诊断依据；恶性倾向的内生性软骨瘤应与软骨肉瘤进行鉴别；应用临床、影像学和病理学三方面的方法可提高诊断的准确性和防止误诊。手术局部切除或病灶刮除加植骨术为其主要治疗方法。     

手部内生性软骨瘤的手术治疗分析

探讨手部内生性软骨瘤的最佳手术方法,防止病理性骨折。方法本组15例采用手术刮除,12例未合并骨折者采用自体植骨填塞,3例合并骨折者采用自体骨植骨填塞并用交叉克氏针固定。随访6-24个月,无复发,骨折全部愈合,关节功能基本恢复。对内生性软骨瘤应尽早手术刮除,植骨填塞。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.