不同入路椎体后凸成形术治疗老年胸腰椎单椎体骨质疏松性压缩骨折疗效比较

目的探讨双侧与单侧椎弓根入路椎体后凸成形术治疗单椎体老年胸腰椎骨质疏松性压缩骨折的临床治疗效果。方法选择72例老年性胸腰椎骨质疏松性压缩骨折患者,经双侧椎弓根入路40例,经单侧椎弓根入路32例,对两组进行疗效评定。结果单侧组与双侧组术后VAS疼痛评分、伤椎前缘恢复高度、后凸Cobb's角纠正度数、Barthel指数无统计学差异(P0.05)。但双侧组的左右两侧椎体高度差值、骨水泥注射体积、骨水泥椎体内弥散体积较单侧组有优势,差异有统计学意义(P0.05)。结论经单侧与双侧椎弓根入路椎体后凸成形术能恢复椎体的高度、缓解疼痛、矫正后凸畸形、改善患者生活质量,但经双侧椎弓根入路在骨水泥注射体积、骨水泥椎体内弥散体积及伤椎左右两侧高度差值方面优于经单侧椎弓根。     

单侧与双侧经椎弓根入路椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效比较

目的对比经单侧椎弓根入路与双侧椎弓根入路行椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效。方法 47例骨质疏松性椎体压缩性骨折患者,其中23例采用单侧椎弓根入路,另24例采用双侧椎弓根入路,记录和比较两组患者手术时间、骨水泥注入量、住院时间,术前、术后一周、末次随访时的视觉模拟疼痛程度(VAS)评分,Oswestry功能障碍指数(ODI)评分。在患者术前、术后一周内及随访期间拍摄伤椎正侧位片或CT,了解椎体前缘高度和Cobb角的变化。结果单侧椎弓根入路组手术时间明显短于双侧组,骨水泥注入量少于双侧组,住院时间两者并无差异,两组患者术后较术前疼痛均得到明显缓解,功能及椎体高度、后凸畸形均得到恢复,两组间比较差异无统计学意义。结论经单侧椎弓根入路与双侧椎弓根入路行椎体后凸成形术的临床疗效无明显差别,但单侧椎弓根入路具有手术时间短、术中放射线投照次数少的优势。     

单侧与双侧穿刺经皮椎体成形术治疗Kummell's病的临床对比

目的 比较单侧与双侧椎弓根入路椎体成形术治疗Kummell's病的临床疗效与安全性.方法 回顾分析2006年1月～2011年1月行椎体成形术的Kummell's病患者,对比单侧与双侧椎弓根入路患者的临床疗效、手术时间、骨水泥灌注量、骨水泥渗漏率、骨折椎体高度恢复程度及后凸矫正度数.结果 单侧组手术时间明显短于双侧组(P＜0.05),两组间骨水泥注入量、渗漏率、术后椎体前缘压缩改善程度、椎体中央压缩改善程度及后凸矫正度数、随访VAS评分差异均无统计学意义(P＞0.05).两组术后24 h、术后3个月及末次随访时VAS评分均明显低于术前,差异均有统计学意义(P＜0.05).结论 单侧及双侧经椎弓根入路椎体成形术在治疗Kummell's病时均可取得满意的止痛效果,两者临床疗效无显著差异.在PVP治疗Kummell's病时采用单侧穿刺即可.     

应用单、双侧椎弓根入路椎体后凸成形术(PKP)治疗老年胸腰椎压缩性骨折的疗效观察

目的 :观察应用经单、双侧椎弓根入路椎体后凸成形术治疗老年胸腰椎压缩性骨折的临床疗效。方法 :对我院收治的76例患老年胸腰椎压缩性骨折患者的临床资料进行回顾性分析,根据治疗方法的不同将其分为单侧组和双侧组。为单侧组患者采用单侧椎弓根入路椎体后凸成形术进行治疗,为双侧组患者采用双侧椎弓根入路椎体后凸成形术进行治疗,并对比观察两组患者的手术时间、进行术中放射投照的次数、手术前后的VAS评分。结果 :两组患者的手术时间、在术中进行放射投照的次数相比较,差异显著(P<0.05),有统计学意义。两组患者在进行手术前后的VAS评分相比较,差异不显著(P﹥0.05),无统计学意义。结论 :在为老年胸腰椎压缩性骨折患者进行经皮椎体后凸成形手术治疗时无论选择双侧或单侧椎弓根入路均可获得显著的临床疗效。与应用双侧椎弓根入路椎体后凸成形术相比,应单侧椎弓根入路椎体后凸成形术治疗此病的手术时间较短、进行X线投照的次数较少,此法值得在临床上推广应用。     

单侧与双侧椎弓根入路椎体成形术治疗骨质疏松性椎体压缩性骨折的临床疗效对比

目的分析和比较单侧与双侧椎弓根入路椎体成形术治疗骨质疏松性椎体压缩性骨折(OVCFs)的临床效果。方法选取我院2012年1月-2013年1月收治的46例骨质疏松性椎体压缩性骨折患者,通过随机数字表法分为观察组(n=23)和对照组(n=23),观察组患者采用单侧椎弓根入路椎体成形术治疗,对照组患者采用双侧椎弓根入路椎体成形术治疗,对比两组患者临床治疗效果。结果两组患者治疗后及治疗后1年VAS评分、Cobb角、椎体高度改善优于治疗前,观察组患者X线照射时间、手术时间、骨水泥用量少于对照组(P<0.05),渗漏率比较差异无统计学意义(P>0.05)。结论单侧与双侧椎弓根入路椎体成形术在治疗骨质疏松性椎体压缩性骨折中均具有一定的临床效果,但单侧椎弓根入路椎体成形术具有手术时间短、X线照射时间短、骨水泥使用量少等优势,值得临床推广应用。     

采用横突-椎弓根单侧入路经皮穿刺手术治疗腰椎骨质疏松性骨折

目的 比较采用经横突-椎弓根单侧入路和经椎弓根双侧入路时经皮后凸成形术(PKP)治疗腰椎骨折(OVCF)的疗效差别。方法 选取2018年8月至2022年8月收治的60例符合纳入标准的骨质疏松性椎体压陷性骨折(OVCF)患者，分为经横突-椎弓根单侧入路组(A组，30例)和标准双侧椎弓根入路组(B组，30例)。收集两组的X线透视次数、骨水泥注入量、手术时长、术前术后疼痛量表评分数值(VAS)、骨水泥弥散率等指标，并进行组间比较。应用SPSS 18.0统计学软件对所收集数据进行分析比对后得出结果。结果 A组的手术用时、X线透视次数、骨水泥注入量数值小于B组，A组的骨水泥分布弥散率也低于B组，差异有统计学意义(P<0.05)。两组手术前后VAS评分差异经比较无统计学意义(P>0.05)。结论采用经横突-椎弓根单侧入路和经椎弓根双侧入路PKP手术治疗OVCF的疗效基本一致，但采用经横突-椎弓根单侧入路PKP的手术用时、X线辐射量、骨水泥注入量相对减少。     

双侧与单侧经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的临床疗效分析

目的对比分析经椎弓根双侧与单侧经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCF)的临床疗效。方法收集我院2018年1月至8月采用经椎弓根入路行PKP治疗的OVCF患者资料85例,依术中采用双侧与单侧PKP分为双侧组41例与单侧组44例。比较2组患者手术时间、术中透视次数、骨水泥渗漏率、末次随访椎体新发骨折率,术前术后疼痛视觉模拟评分、伤椎前缘高度、伤椎后凸Cobb角、Oswestry功能障碍指数评分。结果双侧组手术时间、术中透视次数大于单侧组,差异有统计学意义(P<0.05)。2组骨水泥渗漏率、末次随访椎体新发骨折率比较,差异无统计学意义(P>0.05)。对比2组组内术后术前术后疼痛视觉模拟评分、伤椎前缘高度、伤椎后凸Cobb角、Oswestry功能障碍指数评分,差异有统计学意义(P<0.05);而组间上述指标比较,差异无统计学意义(P>0.05)。结论经椎弓根双侧与单侧PKP治疗OVCF具有相似的治疗效果,但单侧PKP具有手术时间短和术中透视次数少的优势。     

双侧与单侧PKP治疗骨质疏松性椎体压缩性骨折的疗效比较

目的：比较单侧与双侧经椎弓根穿刺椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩性骨折（OVCF）的临床疗效。方法：回顾性分析2011.06—2013.07在我院行PKP治疗的58例（76椎）骨质疏松性椎体压缩骨折病人的临床资料,其中28例经双侧椎弓根穿刺,30例经单侧椎弓根穿刺,术后患者均得到随访,根据VAS评分、影像学资料、Oswestry评分标准分别对患者疼痛、椎体高度和Cobb角、日常活动功能进行疗效比较。结果：所有手术均顺利完成,患者疼痛缓解明显,病人无严重手术并发症。有7个椎体发生骨水泥渗漏,均未出现临床症状。术后3天、12个月时,两种穿刺方法椎体高度、椎体后凸Cobb角、VAS评分及Oswestry功能评分均较术前有明显改善（p<0.05）。虽然单侧及双侧入路组组间比较差异无统计学意义（P>0.05）,但单侧入路组手术时间及骨水泥用量显著小于双侧入路组（P<0.05）。结论：两种不同穿刺方法治疗骨质疏松性椎体压缩性骨折均是安全有效的;在伤椎高度的恢复、椎体后凸Cobb角、VAS评分及Oswestry功能评分方面,单侧穿刺组临床疗效与双侧穿刺组相似,但单侧组具有手术时间短、骨水泥用量少等优点。     

单侧与双侧经皮穿刺椎体成形术治疗骨质疏松性胸腰椎压缩性骨折疗效比较

目的比较单侧与双侧经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎压缩性骨折的临床效果。方法选择2014年3月至2015年3月于黄冈市中心医院行PVP治疗的骨质疏松性胸腰椎压缩性骨折患者76例,其中38例采取单侧椎弓根入路(单侧PVP组),38例患者采取双侧椎弓根入路(双侧PVP组),对2组患者的治疗效果进行比较。结果双侧PVP组患者的手术时间、X线照射时间及骨水泥注入量显著大于单侧PVP组(P<0.05)。2组患者治疗后病变椎体高度、椎体后凸Cobb角及Oswestry功能障碍指数(ODI)与治疗前比较均有显著改善(P<0.05),但治疗后2组患者病变椎体高度、椎体后凸Cobb角及ODI比较差异均无统计学意义(P>0.05)。2组患者术后3 d及3、12个月时腰背部疼痛视觉模拟评分法(VAS)评分显著低于术前(P<0.05),但术后3 d及3、12个月时2组患者腰背部疼痛VAS评分比较差异均无统计学意义(P>0.05)。结论单侧与双侧椎弓根入路PVP治疗骨质疏松性胸腰椎压缩性骨折均能取得良好的治疗效果,但单侧椎弓根入路可缩短手术时间和X线照射时间,减少骨水泥注入量。     

单、双侧椎弓根入路PVP治疗骨质疏松性椎体压缩骨折

摘要：[目的] 比较单侧椎弓根入路经皮椎体成形术(percutaneous vertebroplasty,PVP)与双侧椎弓根入路经皮椎体成形术治疗单节段骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果。 [方法]选取我院2014年1月-2016年8月OVCF患者72例,均为单发椎体压缩骨折,随机分为单侧椎弓根入路的观察组(36例)和双侧椎弓根入路的对照组 (36例)。对两组手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏、伤椎高度压缩率、椎体后凸 Cobb 角、视觉疼痛模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)等进行统计学分析。[结果]所有患者均获得完整随访,平均随访时间15.2个月(12-21个月)。两组年龄、性别、伤椎节段差异无统计学意义(P>0.05),观察组手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏率均少于对照组 (P<0.05)。两组椎体高度压缩率、椎体后凸 Cobb 角与术前比较,均显著改善(P<0.05),而两组间椎体高度恢复率、椎体后凸Cobb角恢复率差异无统计学意义(P>0.05)。两组内患者各时间节点的VAS、ODI评分较前均有显著改善(P<0.05),观察组术后3天VAS评分高于对照组（P<0.05）,而两组间其他时间节点VAS评分及ODI评分比较均无明显差异（P>0.05）。[结论]两种手术治疗OVCF临床疗效相似,而单侧椎弓根入路PVP具有手术时间短、术中透视次数少、骨水泥渗漏发生率低的优点,单侧椎弓根入路手术近期止痛效果可能不及双侧入路手术,但远期效果一致。单侧椎弓根入路PVP能够作为OVCF可选的治疗方案。     

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.