经肱三头肌两侧入路双钢板治疗肱骨髁间骨折17例

目的 观察经肱三头肌两侧入路AO双钢板内固定治疗肱骨髁间骨折的临床疗效.方法 对临床收治的肱骨髁间骨折Riseborough Ⅱ、Ⅲ型和部分Ⅱ型17例病例采用经肱三头肌两侧入路AO双钢板内固定.结果 17例患者手术切口均Ⅰ期愈合,全部骨折获得骨性愈合,肘关节功能满意.通过Cassebaum评分系统评价肘关节功能:优8...     

鹰嘴窝解剖钢板治疗肱骨髁间骨折12例临床体会

肱骨髁间骨折是严重的肘关节损伤之一，由于闭合复位困难，开放复位缺乏有效的内固定从而造成肘关节功能障碍、骨不连或畸形愈合者并不少见。尽管手术难度较大，并发症较多，但解剖复位、坚强内固定和早期的功能锻炼是治疗肱骨髁间骨折，恢复肘关节功能的三大要素。我科自2002年起，采用鹰嘴窝解剖钢板和常规尺神经前置治疗肱骨髁间骨折12例，术后早期行肌关节CPM功能锻炼，取得满意疗效。现报告如下。     

鹰嘴截骨入路双钢板固定治疗肱骨远端骨折

1811年肱骨髁间骨折最先被Desault描述。肱骨髁上髁间骨折传统的非手术治疗因很难重建关节面，手法复位后早期肘关节需外固定，易导致肘关节功能的丧失，近年来多趋向于手术治疗。由于其局部的解剖特点（肘关节缺乏骨性阻挡，位于鹰嘴窝水平，与肱骨干有35°～45°前倾角），以及伤后骨折端常粉碎和移位，使其手术治疗面临很大挑战，一直是创伤骨科较难治疗的骨折之一，而早期的解剖复位，牢固内固定和早期的功能锻炼是提高肘关节功能的关键。2004年5月至2006年9月，我们采用双钢板内固定治疗肱骨远端关节内粉碎骨折24例，取得了满意的疗效。[第一段]     

肱三头肌两侧入路与尺骨鹰嘴截骨入路治疗老年肱骨髁间骨折疗效的对比研究

目的 比较肱三头肌两侧入路与尺骨鹰嘴截骨入路治疗老年肱骨髁间骨折的疗效差异.方法 采用回顾性研究方法,收集我院2011年8月至2016年8月的老年肱骨髁间骨折41例(年龄＞65岁).根据手术方法不同分为肱三头肌两侧入路组(n=22)和尺骨鹰嘴截骨入路组(n=19).比较2组患者手术时间、术中出血量以及术后12个月的肘关节屈伸活动度及旋转活动度、mayo肘关节功能评分、肘关节Broberg-Morrey评分.结果 41例均获得随访12个月.在手术时间、术中出血量、术后12个月肘关节屈伸活动度及旋转活动度、mayo肘关节功能评分、肘关节Broberg-Morrey评分方面,2组差异均无统计学意义(P＜0.05).但肱三头肌两侧入路组中有异位骨化患者3例,1例术后出现尺神经损伤症状,术后予以对症处理,术后半年神经症状完全消失.尺骨鹰嘴截骨组中有异位骨化患者7例.结论 对于肱骨髁间骨折,应首先考虑选择经肱三头肌两侧入路,而对于粉碎程度高的C3型骨折,可选择尺骨鹰嘴截骨入路,但应尽量选择张力带钢丝固定尺骨鹰嘴,减少内固定物对肘关节软组织的激惹.临床技术熟练的情况下仍优先选择经肱三头肌两侧入路.     

人工全肘关节置换术

我们自1976年6月至1980年8月施行了6例(男4例,女2例)9次人工全肘关节置换术。右肘4,左肘2。年龄22～54岁。随访时间4月至4年4月,平均32.6月。手术适应症:二例化脓性肘关节炎,骨性强直在伸直位,窦道收口分别为6年与3年。一例肘关节滑膜软骨瘤病行关节切除成形术后形成连枷关节。三例为创伤性肘关节炎,其中一例肱骨内髁缺损,一例肱骨髁间骨不连,另一例为肱骨髁间及尺骨鹰嘴粉碎性骨折。人工肘关节材料及型式:全部人工肘关节均自上海引进,分二种:一种为鈷合     

不同手术入路改善肱骨髁间骨折患者肘关节功能的效果分析

目的分析经尺骨鹰嘴截骨与经肱三头肌两侧入路改善肱骨髁间骨折患者肘关节功能的手术效果。方法将85例肱骨髁间骨折患者随机分为两组,尺骨鹰嘴组行经尺骨鹰嘴截骨入路手术,肱三头肌组行经肱三头肌两侧入路,观察两组患者手术和肘关节功能恢复情况。结果肱三头肌组手术时间和术中出血量高于尺骨鹰嘴组（P〈0.01）;肱三头肌组Mayo肘关节功能评分和关节活动度优于尺骨鹰嘴组（P〈0.01）;肱三头肌组优良率81.40%高于尺骨鹰嘴组的59.52%（P〈0.05）;尺骨鹰嘴组C3优良率26.19%明显优于肱三头肌组的9.30%（P〈0.05）。结论经尺骨鹰嘴截骨入路与经肱三头肌两侧入路在改善肱骨髁间骨折患者肘关节功能方面各具优势,前者适合C3肱骨髁间骨折患者,后者适合C1或C2肱骨髁间骨折患者。     

经肱三头肌两侧入路双钢板法治疗肱骨髁间骨折体会

摘要:目的:探讨经肱三头肌两侧入路双钢板法治疗肱骨髁间骨折.方法:对17例肱骨髁间骨折采用经肱三头肌两侧入路双钢板内固定,术后早期行功能锻炼.结果:本组术后均获得随访,骨折愈合,关节功能良好.结论:采用肱三头肌两侧入路双钢板内固定肱骨髁间骨折,是治疗肱骨髁间骨折的良好方式,值得临床推广应用.     

肝关节僵硬的肱尺关节成形术

目的：探讨简便,有效的肘关节僵硬成形术。方法：通过整形尺髓鹰嘴窝的方法扩大肘关节的活动范围,结果：对１６例接受过肱尺关节成形手术的患者作了１８个月的随访观察,结果满意。结论：肱尺关节成形手术操作简便,缩短手术时间、,安全可靠效果确切。     

肘关节僵硬的肱尺关节成形术

[目的 ]探讨简便、有效的肘关节僵硬成形术 .[方法 ]通过整形尺骨鹰嘴窝的方法扩大肘关节的活动范围 .[结果 ]对 16例接受过肱尺关节成形手术的患者作了 18个月的随访观察 ,结果满意 .[结论 ]肱尺关节成形手术操作简便 ,缩短手术时间 ,安全可靠 ,效果确切     

肱三头肌劈开入路“Y”形锁定钢板治疗肱骨髁间骨折

目的:探讨经肱三头肌劈开入路"Y"形锁定钢板内固定治疗肱骨髁间骨折的手术方法及临床疗效。方法:采用经肱三头肌劈开入路"Y"形锁定钢板内固定治疗肱骨髁间骨折32例,男18例,女14例,年龄19～76岁。术前均行三维CT成像重建肘关节。结果:所有手术切口均甲级愈合,所有患者均获得随访,随访时间3个月～2年,平均12个月,骨折均于12周内骨性愈合。按Jupiter肘关节功能评分,优22例,良8例,中2例,优良率93.8%。结论:经肱三头肌劈开入路"Y"形锁定钢板内固定治疗肱骨髁间骨折,手术效果满意,患肢功能恢复理想。     

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.