手术内固定治疗掌指骨骨折效果分析

目的应用微型钢板及克氏针内固定治疗掌指骨骨折,评估其临床效果。方法采用微型钢板治疗掌指骨骨折25例(27处),克氏针内固定治疗35例(41处),比较两种手术治疗效果。结果经过4~14个月随访,微型钢板内固定组骨折均达解剖复位,全部愈合,其中1例(1处)延迟愈合,平均愈合时间5.1周。克氏针内固定组有3例(3处)延迟愈合,1例(1处)骨折不愈合,余骨折全部愈合,平均愈合时间8周。按FAFS评分标准,微型钢板组优19例,良4例,差2例,优良率为92.00%;克氏针组优20例,良5例,差10例,优良率为71.43%。两组优良率比较差异有显著性(P<0.05)。结论微型钢板质薄、体小、坚强,固定牢靠,能早期功能锻练,其疗效优于克氏针固定,是掌指骨骨折的一种理想固定方法。     

掌指骨折治疗方法的选择

目的比较采用微型钢板螺钉、微型外固定支架与交叉克氏针固定治疗掌、指骨折的临床效果。方法微型钢板螺钉内固定治疗组26例32处骨折；微型外固定支架外固定组36例40处骨折；交叉克氏针固定治疗组40例48处骨折。术后平均随访1、2年。以TAFS标准评价术后掌指关节及指间关节功能。结果微型钢板固定组优良率为84．4％，微型外固定支架外固定组优良率为85％，交叉克氏针固定组优良率为85％。结论三种方法比较差异无统计学意义，各有优缺点．对不同的骨折应采用不同的方法治疗。     

微型外固定架治疗Bennett骨折20例报告

①目的探讨微型动力型外固定架治疗Bennett骨折方法及其疗效。②方法应用微型外固定架治疗25例Bennett骨折,根据受伤时间和骨折类型选择治疗方法,主要采用闭合外固定架固定,骨折不稳定者可加用闭合复位克氏针固定,闭合复位失败则行切开复位克氏针加外固定架固定。③结果20例病例获得随访,随访时间为6~15个月,平均9个月。20例骨折均完全愈合,闭合复位愈合时间平均为7周、切开复位愈合时间平均为9.5周。评价近远期并发症,总优良率为95%,术后未发生严重并发症,疗效满意。④结论采用微型外固定架治疗Bennett骨折,方法简单,损伤小,复位固定可靠,可有效降低术后关节疼痛、关节活动受限和创伤性关节炎的发生率,是治疗Ben-nett骨折的有效方法。     

三种不同固定方法在掌指骨开放性骨折急诊治疗中的效果分析

目的回顾性研究采用克氏针、微型钢板、微型外固定支架三种不同固定方法在急诊治疗掌、指骨开放性骨折的临床效果。方法对分别采用克氏针、微型钢板、微型外固定支架三种不同固定方法行急诊手术治疗的129例144处掌指开放性骨折患者进行随访,观察其愈合率、开展功能锻炼时间、临床愈合时间及并发症发生情况,分析治疗效果。结果三种不同固定方法在治疗掌指骨开放性骨折的愈合率无统计学差异（P〉0.05）;微型钢板、微型外固定支架开展功能锻炼时间明显优于克氏针;微型钢板、微型外固定支架的骨折临床愈合时间优于克氏针;微型外固定支架和微型钢板的关节活动功能优良率优于克氏针;三种不同固定方法均存在不同程度的并发症,不同的并发症发生率有差异。结论急诊条件下开放性掌指骨骨折的固定方法应根据骨折的具体类型、软组织损伤情况进行灵活选择,会带来良好的临床效果。     

2种内固定方式治疗掌骨干骨折的疗效分析

目的:研究并分析克氏针内固定和微型钢板内固定治疗掌骨干骨折的疗效。方法:回顾性分析作者所在医院切开复位内固定手术治疗的97例136处掌骨干骨折病例,随机分为交叉克氏针治疗组(49例68处)及微型钢板治疗组(48例68处),以TAFS评分为评价标准,并记录感染、骨折延迟愈合、骨不连等并发症发生情况。结果:克氏针固定组68处骨折,优良率为76.47%。骨折愈合时间为9～12周,平均9.7周。微型钢板固定组68处骨折,优良率为89.71%。骨折愈合时间为8～10周,平均8.8周,无骨不连发生。2组TAFS评分差异有统计学意义(P0.05)。结论:微型钢板治疗掌骨骨折在术后关节功能恢复情况、骨折愈合时间、并发症发生等指标上明显优于交叉克氏针固定,是掌骨骨折较为理想的治疗手段。     

重建钢板和克氏针治疗锁骨骨折的效果比较

目的探讨重建钢板和克氏针治疗锁骨骨折的临床效果。方法临床治疗102例,其中重建钢板内固定89例,克氏针内固定13例。结果随访6~28个月,平均10个月,术后切口无感染,手术切口均为甲级愈合。重建钢板内固定骨折延迟愈合1例,无钢板螺钉松动、断裂,骨折全部愈合,肩关节功能锻炼恢复良好。克氏针内固定治疗骨折延迟愈合1例,不愈合1例,畸形愈合1例,重建钢板固定治疗锁骨骨折的优良率高于克氏针固定(P<0.05)。结论重建钢板内固定治疗锁骨骨折,复位良好,固定牢靠,并发症少,可以早期活动肩关节,治疗效果满意。     

微型钢板与克氏针治疗掌指骨骨折疗效比较

目的评估微型钢板治疗掌指骨骨折的临床疗效。方法采用微型钢板治疗掌指骨骨折25例(28处),克氏针内固定治疗31例(35处),比较两种手术的治疗效果。结果经2~12个月随访,微型钢板内固定组25例(28处)骨折全部愈合,其中2例(2处)延迟愈合,骨折平均愈合时间4.6周。参照TAFS评分标准,优16例,良6例,差3例,优良率88%。克氏针内固定组3例(3处)出现畸形愈合,5例(5处)延迟愈合,1例(1处)骨不连,余骨折全部正常愈合,骨折平均愈合时间7.8周,优20例,良3例,差8例,优良率74.2%。两组间优良率有显著差异(P<0.05)。结论微型钢板治疗掌指骨骨折固定牢靠,能早期功能锻炼,其疗效明显优于克氏针组。     

微型钢板与交叉克氏针内固定治疗掌骨骨折临床比较

目的比较交叉克氏针与微型钢板内固定治疗掌骨骨折的临床效果。方法回顾性分析60例掌骨骨折患者临床资料,其中交叉克氏针固定组28例(35处),微型钢板固定组32例(41处),根据TAFS评分标准评估2组患者术后功能恢复及感染等情况,并进行比较。结果交叉克氏针固定组优10例,良12例,差6例,优良率78.5%;微型钢板固定组优19例,良8例,差5例,优良率84.3%,2组比较无统计学意义(P>0.05);2组患者均未出现骨折延迟愈合或不愈合,且2组间伤口感染率比较无统计学意义(P>0.05)。结论交叉克氏针和微型钢板在掌骨骨折的治疗中均具有较好的疗效,由于微型钢板的费用较高,对于2种固定方法均可应用的患者,应优先采用交叉克氏针固定。     

掌指骨骨折的不同手术方法临床效果对比

目的:按照不同的手术方法行手部掌、指骨骨折的治疗预后对比.方法:通过病例回顾分析,收集我医院2012年9月至2015年9月间80例患者(共95指),根据治疗方法分为三组,依次为交叉克氏针固定组(A组)、交叉克氏针加张力带固定组(B组)、微型钢板螺钉固定组(C组),分析愈合时间、骨折愈合失败率、创口感染率及手部功能恢复状态.结果:骨折愈合时间,不能愈合,并发症调查,微型钢板螺钉固定组结果最好,交叉克氏针固定组最差,差别没有统计学意义(P>0.05);优良率交叉克氏针固定组最低,有统计学意义.结论:微型钢板螺钉内固定和交叉克氏针加张力带效果好,内固定优势明显,但交叉克氏针有存在价值,不可完全取代.     

外固定架的临床应用

目的 总结外固定架在骨折中的应用.方法 回顾性分析我科于1999年8月至2009年12月应用外固定架治疗长骨骨折51例,男32例,女19例.其中内固定术后失效3例,内固定术后骨不连2例,内固定术后畸形愈合1例,内固定术后深部感染1例,局部浅表感染3例.闭合性骨折30例,开放性骨折21例(Gustilo I型1例,II型14例,III b型4例,III c型2例).闭合复位6例,开放复位45例.予自体髂骨植骨13例,胫骨拉力螺钉固定8例,腓骨克氏针固定3例,钢板固定7例,股骨拉力螺钉固定2例,尺骨远端克氏针固定2例;局部皮瓣转移5例,创面游离植皮4例,股骨畸形愈合截骨矫形术1例.结果 随访8～42个月,平均20个月,无一例失访.1例老年患者术后死于癌症晚期.1例Oustio IIIb骨折患者骨不连,其余病例均骨折愈合,无骨感染和畸形愈合发生.1例股骨骨折因针道感染,II期改梅花钉内固定;2例开放性胫腓骨骨折,因延迟愈合、断端移位而改带锁髓内钉内固定.结论 外固定架是治疗长骨骨折的一种主要方法,有其独特优势,提高外固定架稳定性,降低针道感染和固定针松动,有助于提高治疗效果.     

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.