强直性脊柱炎合并脊柱骨折的治疗

目的探讨强直性脊柱炎合并脊柱骨折的临床治疗.方法1992～2002年收治强直性脊柱炎合并脊柱骨折患者7例,5例患者采用保守治疗;2例行手术治疗,采用AESCULAP的MACS TL胸腰椎前路固定系统进行固定,观察疗效.结果2例颈椎损伤患者均因呼吸衰竭在1年内死亡;1例T12/L1损伤患者因褥疮感染于2年后死亡;2例应力性骨折患者经对症治疗3月后症状缓解;2例胸腰段骨折行手术治疗的患者,1年后复查脊髓神经损伤程度由原来B级恢复至C级.结论强直性脊柱炎患者一旦发生脊柱骨折,容易造成脊髓损伤;对脊髓损伤的患者,应争取早日行手术减压和内固定术.     

强直性脊柱炎伴胸腰椎骨折的手术治疗

目的探讨使用前路手术治疗强直性脊柱炎合并胸腰椎骨折的方法和效果。方法对2002年1月至2006年1月间河北医科大学第三医院脊柱外科收治的12例强直性脊柱炎(ankylosing spondylitis,AS)胸椎骨折的病例进行研究,男10例,女2例。均采用前路内固定手术进行治疗。按照脊柱骨折的AO分型,其中A型5例,B型3例,C型4例;本组胸腰椎骨折发生的部位在T7-L2之间。影像学分类:压缩骨折3例,爆裂骨折6例,混合型2例,牵伸性损伤1例。骨折累及三柱骨性结构者9例。不同程度的脊髓损伤10例。所有患者均行前路手术治疗。收集患者手术时间、出血量、术后神经症状的改善率等指标进行观察。结果术后对12例患者进行平均24.2个月的随访。结果如下:合并脊髓损伤的10例患者,神经系统功能均有恢复,12例患者的骨折部位均已骨性愈合。术中合并脊髓损伤1例,随访期内无内固定松动、脱落等合并症出现。结论手术治疗可以使大多数强直性脊柱炎患者骨折愈合良好,神经系统功能有不同程度恢复,前路钉棒系统治疗效果较好。     

脊柱脊髓损伤的急诊手术75例体会

目的:总结脊柱脊髓损伤手术治疗的临床体会。方法:回顾性分析2003年6月至2006年4月75例脊柱外伤合并脊髓损伤病人手术治疗的临床资料,其中颈前路减压钛板内固定16例,颈椎骨折脱位采用前、后路同时减压钛板内固定2例,胸椎及胸腰段骨折合并脊髓损伤采用后路全椎板或半椎板减压钉棒系统内固定25例,腰椎骨折合并脊髓损伤采用A—F及R—F共32例。结果:75例患者,经术后6个月至12个月随访,除1例上颈段(C3,4)骨折脱位严重者,术后第2天死亡。3例截瘫者肌力恢复不明显,但二便失禁功能有部分恢复。其余71患者术后肌力明显改善,肌力提高2级～3级,感觉过敏消失,麻木减轻,感觉平面下降。讨论:对于急性脊柱脊髓损伤,早期正确的外科手术治疗可这到解剖复位,脊柱稳定性的重建,有助于残存脊髓功能的恢复和促进早期康复,是一种有效的方法。     

后路椎弓根RSS内固定系统治疗脊柱胸腰段爆裂骨折合并脊髓损伤

目的：探讨脊柱胸腰段爆裂骨折合并脊髓损伤的手术治疗效果及椎弓根RSS内固定系统在脊柱胸腰段爆裂骨折合并脊髓损伤中的作用。方法：对30例脊柱胸腰段爆裂骨折患者合并脊髓损伤早期行后路切开复位椎弓根RSS内固定,其中11例行椎管切开减压,并对手术疗效进行评估。结果：30例患者术后随访9~21个月,平均17个月,总优良率86.5%。结论：后路椎弓根RSS内固定系在治疗脊柱胸腰段爆裂骨折合并脊髓损伤中疗效可靠。     

强直性脊柱炎合并脊柱骨折的临床分析

目的 探讨强直性脊柱炎合并脊柱骨折的临床特点及诊治方法.方法 选择2003年1月-2012年1月收治的强直性脊柱炎合并脊柱骨折的患者18例.其中行手术治疗11例,非手术治疗7例.结果 除1例颈椎骨折患者因呼吸衰竭死亡外,其余17例均得到随访,平均随访时间30个月.1例L4~5骨折患者术后7个月复查骨折未愈合,经再次手术,后路椎弓根钉更换,前路切开植骨融合,术后骨折愈合.非手术患者脊柱活动范围及后凸畸形程度等较入院前无加重.X线片显示椎体骨折愈合好,手术患者内固定物亦无松动和断裂现象.16例脊髓损伤患者中,10例1年后有不同程度恢复.结论 强直性脊柱炎合并脊柱骨折患者因病情特殊,应根据患者具体情况进行个性化处理.定期复查,密切关注骨折愈合情况及神经恢复情况,进行合理的功能锻炼,达到理想的治疗效果.     

陈旧性胸腰段脊柱骨折伴脊髓损伤的手术治疗分析

目的探讨胸腰段骨折伴发脊柱脊髓损伤采用不同手术入路治疗的效果。方法我院46例胸腰椎骨科合并脊髓马尾神经损伤的患者,分别采用前路减压和后路减压脊柱内固定的方法治疗。结果 3例全瘫患者,神经功能恢复为肌力Ⅳ级1例,恢复至Ⅲ级2例,无恢复1例,其余42例不全截瘫均独立行走及恢复正常劳动。结论胸腰段骨折伴发脊柱脊髓损伤,在条件允许的情况下,应尽早手术,同时根据不同病情采用不同的手术入路最大限度的为患者解除病痛。     

强直性脊柱炎合并脊柱骨折的外科治疗策略

目的：探讨清醒麻醉＋平衡体位下手术治疗强直性脊柱炎（ AS ）合并脊柱骨折的疗效。方法回顾性分析自2006年1月～2011年1月,对33例强直性脊柱炎合并胸腰椎骨折患者采用清醒麻醉＋平衡体位下行手术治疗,其中AS合并颈椎损伤14例,合并胸腰椎骨折19例,AS合并颈椎骨折者,入院后即行Halo-vest固定于平衡体位,在Halo-vest保护下行颈椎前路或后路减压融合为手术,AS合并胸腰椎骨折患者维持患者平衡体位,在清醒麻醉下行后路长节段椎弓根螺钉固定融合手术,经过10～43个月（平均24个月）的随访,随访内容包括术后1周,3,6,12个月X线片、CT,局部疼痛缓解情况（VAS评分）,植骨融合情况,内固定是否存在松动断裂现象,矫正角度有无丢失以及脊髓神经恢复情况（ Frankel分级）。结果所有患者均得到随访,16例脊髓损伤者,除1例无明显恢复外,神经功能均有恢复,33例患者骨折部位均骨性愈合,术后随访,无内固定松动断裂及矫正角度丢失,2例患者遗留胸背部疼痛（ VAS评分2分）,给予消炎镇痛药物治疗后好转。结论清醒麻醉＋平衡体位下行手术治疗是治疗AS合并脊柱骨折的一种有效的方法。     

爆裂型脊柱骨折伴脊髓损伤手术时机选择

目的：探讨爆裂型脊柱骨折伴脊髓损伤的手术时机对此类病人恢复的影响。资料与方法：1995年8月至2002年1月间收治爆裂型脊柱骨折伴脊髓损伤病人手术治疗31例，平均年龄33．6岁，男26例，女5例，平均随访时间2年5个月（2个月-6年）．符合Denis爆裂型骨折，根据损伤情况行Harrington棒固定11例，Dick钉固定18例，AF钉固定2例，受伤距椎板切除战压术时间：伤后6小时18例，24小时内10例，一周内手术2例，9天内手术1例，结果：脊髓损伤评定标准采用Frankcl法，术前A级18例，B级10例，C级3例，术后随访A级9例，C级2例，D级15例，E级5例．结论：爆裂型脊柱骨折伴脊髓损伤应该尽早手术，彻底战压，解除脊髓压迫，阻断脊髓继发性损害，可靠内固定．     

强直性脊柱炎合并脊柱骨折的临床治疗方法及效果研究

目的：研究强直性脊柱炎合并脊柱骨折的临床治疗方法及临床治疗效果。方法：选择2012年6月至2014年12月我院收治的强直性脊柱炎合并脊柱骨折患者48例作为研究对象,分析48例患者临床症状、治疗方法及临床治疗效果。结果：48例患者经手术治疗,有40例救治成功,有1例并发症严重抢救无效死亡,有7例复发,治疗后,复发患者病情有所好转,患者治疗成功率达83.3％。结论：强直性脊柱炎合并脊柱骨折易脱位,很容易对脊髓造成损伤,以手术的治疗方法,可以有效提高患者生活质量。要根据患者实际病情发展选择治疗方式,利于患者健康的进一步恢复,建议临床推广应用。     

前路手术治疗胸腰椎爆裂骨折78例分析

目的探讨胸腰椎爆裂骨折合并脊髓损伤的前路手术适应证。方法分析78例胸腰椎骨折伴不同程度瘫痪患者采用前路减压、植骨、内固定手术治疗疗效。结果随访2年以上,植骨全部融合,矫正度无丢失,内固定无松动及断裂,脊髓损伤恢复按Frankel分级,所有病例均恢复1-2级以上。结论对胸腰椎爆裂骨折合并脊髓不全损伤采用前路减压、植骨、内固定手术治疗效果肯定。     

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.