后路枕颈部4种螺钉技术的应变电测研究

目的：比较枕颈部后路4种不同植入方式的螺钉在施加生理载荷时所承受的应力,评价各自在生理环境中的机械性能。方法对16例新鲜人体枕颈部标本（含Oc-C3）,采用后路枕寰枢复合体经关节螺钉固定和SUMMIT系统枕颈固定。对固定后的经寰枕关节螺钉（Oc-C1组）、经寰枢关节螺钉（C1-C2组）、枢椎椎弓螺钉（C2 PS组）和枕骨螺钉（Oc Screw组）在生理载荷下三维六自由度运动时,运用应变电阻测定法测定4种螺钉的应力,数据进行统计学处理。结果在侧屈状态下,电测法测得的4种螺钉局部应变均接近于0。在前屈、后伸、左旋和右旋运动时,随着加载载荷增大,测得的应力均逐步增大。在前屈和旋转时螺钉不同程度承受拔出应力,在后伸时,螺钉所受的为压应力。枕骨螺钉（Oc Screw组）在屈伸和旋转运动状态下,在所有3种载荷下所承受的应力均大于其它3种植钉方法,差异有统计学意义（P＜0.05）。结论生理环境下,枕骨螺钉承受的拔出应力最大,其可能更易出现内植物相关并发症,具体应用时应结合临床实际。     

枕骨髁螺钉在枕颈融合中应用的研究进展

枕颈融合是治疗症状性枕颈不稳的惟一方法,目前虽然有很多用于枕颈融合的内固定系统,但都存在一定的缺点.枕骨髁是支持头部并与脊柱连接的惟一骨性结构,应用枕骨髁螺钉进行枕颈固定,具有很多优点.本文对枕骨髁螺钉在枕颈融合中应用的研究进展进行综述.     

枕颈融合术的研究进展

枕颈融合术是维持枕颈区域稳定的唯一手术方式.目前文献上已记载了许多用于枕颈融合的技术,传统的融合部位是颈椎固定至枕外隆突上,而新近国外报道颈椎可固定至枕骨髁上[1-2].本文对枕颈融合术近年来的研究进展作一综述.     

前置远端单螺钉钢板治疗NeerⅡ型锁骨远端骨折的有限元分析

目的：探讨前置远端单螺钉钢板系统治疗NeerⅡ型锁骨远端骨折的生物力学特点。方法：通过CT扫描获得一男性成年志愿者的锁骨，使用Solidworks、Mimics19.0软件处理获得前置远端单螺钉钢板及解剖锁定钢板两组锁骨钢板模型，后用ANSYS17软件进行网格划分，加载并记录分析两种固定方式在轴向压缩、三点弯曲、扭矩旋转的加载条件下的骨折位移和最大应力。结果：在轴向压缩载荷下，两组模型的整体最大等效应力及整体骨折最大位移无显著差异(P>0.05);在三点弯曲载荷下，两组模型整体最大等效应力无统计学差异(P>0.05),整体骨折最大位移有统计学差异(P<0.05);在顺时针扭矩载荷下，两组模型整体最大等效应力及整体骨折最大位移无统计学差异(P>0.05);在逆时针扭矩载荷下，两组模型最大应力有统计学差异(P<0.05),整体骨折最大位移无统计学差异(P>0.05)。结论：前置远端单螺钉钢板系统在模拟肩关节活动的情况下，比解剖锁定钢板更易发生应力集中的现象，但两组钢板模型都能提供坚强的内固定，前置远端单螺钉钢板可以为治疗复杂特殊的NeerⅡ锁骨远端骨折提...     

AXIS内固定系统在枕颈融合术中的应用

目的 探讨和评估AXIS内固定系统在枕颈融合术中的临床效果。方法 运用AXIS系统固定融合治疗8例严重的创伤性或肿瘤切除术后枕颈不稳定患者，对术后症状改善程度、植骨融合及固定效果进行随访观察。结果 8例患者平均随访10．5个月，局部症状及神经系统症状均有不同程度的改善。所有病例植骨均骨性愈合。AXIS内固定良好。结论 AXIS内固定系统固定枕颈部操作方便．钉孔匹配好．螺钉方向可调范围大，固定效果好．不影响植骨区。     

枕颈部疾患经口咽前入路手术治疗的进展研究

枕颈疾患手术对于提高患者的生存率起到越来越大的作用。治疗寰枕关节的严重不稳及神经压迫的外科手术中,枕颈融合是可供选择的措施之一,后路内固定包括椎弓根螺钉、经关节螺钉及侧块螺钉技术;经前路分颌下入路和口咽入路,经口咽前入路已经被临床证实是一种治疗枕颈部疾患有效安全的手术入路。     

枕颈融合术的护理配合

枕颈融合术是维持枕颈区域稳定的唯一手术方式.枕颈融合术虽然牺牲了寰枕和寰枢关节的活动度,但是通过C2以下活动的代偿,头颈部的活动可以满足日常生活的需要.我院采用经C1-C2关节螺钉固定技术可使枕颈交界处获得可靠的稳定性,枕颈融合率高.同时,该方法固定节段短,最大限度保留了颈椎的部分功能.现将手术配合及体会报道如下.     

枕颈CD在枕颈融合术中的应用

目的：探讨枕颈CD在枕颈融合术中的方法和疗效。方法：对25例不同原因引起上颈段失稳病例（新鲜骨折7例，陈旧性寰枢椎脱位18例），采用枕颈CD为内固定器械进行枕颈融合术，随访手术效果。结果：所有病例得到随访，随访期大于1年，25例均获得骨性融合。新鲜外伤所致3例神经损伤者，1例术前双手指麻木术后症状消失，术前不完全脊髓损伤者，1例术后神经功能由ASLA C组改善为D组，1例D级无改变，18例脊髓慢性压迫损伤病例神经功能改善率71％，1例前路减压时出现咽升动脉损伤并遗留脑缺血后遗症。所有病例未出现与内固定有关的神经脊髓损伤，椎动脉损伤和脑脊液漏等并发症。结论：枕颈CD固定可靠，操作简单，安全，并发症少，是枕颈融合内固定器材的良好选择。     

国人枕鳞厚度的测量及其临床意义

为给临床行枕颈融合内固定术提供解剖学资料,对50 块干燥完整的成人枕鳞下部的厚度进行了测量。结果表明枕鳞下部厚度不均匀,以枕外隆凸处最厚,为11 ～17 mm ,平均14 .3±2 .6 mm ;最薄部位位于枕外隆凸外下方小脑窝处,为1 .2 ～7 .6 mm ,平均2 .5 ±0 .7 mm 。骨质厚度从枕外隆凸起向外向下放射状递减,左、右无明显差异( P> 0 .05) 。同时对枕鳞下部厚度进行了分区和讨论,其中厚度大于8 mm 区域为枕颈融合枕骨螺钉内固定的最佳部位     

金属框架内固定应用于枕颈融合术患者围手术期护理

枕颈交界区不稳主要由外伤、先天畸形、类风湿和肿瘤等原因引起。由于枕颈失稳常伴有对颈髓的压迫或潜在的颈髓损伤的危害,因此,目前多主张手术固定融合。枕颈融合术是在其他治疗措施仍不足以保持其稳定时的一种永久性稳定措施。我科于2003年9月～2007年11月采用自制金属框架内固定治疗枕颈融合交界区不稳患者59例,术后精心治疗和护理,疗效满意。报告如下。     

Cervifix内固定系统在后路枕颈融合术中的运用

目的 探讨Cervifix内固定系统在上颈椎损伤行后路枕颈融合术的价值和作用.方法 对14例上颈椎损伤患者行后路自体髂骨植骨枕颈融合Cervifix内固定术.其中包括寰枢关节陈旧性脱位6例,枢椎齿状突骨折4例,C2椎体骨折并寰枢关节半脱位2例,C2、C3椎体骨折1例,Jefferson骨折1例.按ASIA分级：A级2例,B级4例,C级7例,D级1例.结果 14例患者均随访0.5～3a,平均1.75 a.所有病例植骨均融合,融合率100%.无1例发生Cervifix螺钉及固定棒松动断裂等并发症.术后按ASIA分级：A级1例,B级2例,C级3例,D级8例.瘫痪分级明显好于术前,差异有显著性（P〈0.01）.结论 Cervifix内固定系统能够有效地维持枕颈融合所要求的稳定性,固定效果良好,内固定后融合率高.     

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.