跨腕关节支撑钢板外固定架治疗桡骨远端粉碎性骨折的生物力学实验

目的比较跨腕关节支撑钢板与外固定支架治疗桡骨远端粉碎性骨折的生物力学特性。方法取16个新鲜前臂标本的桡骨远端,制备AO C3型不稳定性骨折模型。标本随机分为A、B、C、D 4组（n=4）,A组为钢板固定组,B组为钢板结合克氏针固定组,C组为外固定架固定组,D组为外固定架结合克氏针固定组。每组标本在生物力学实验机上依次进行抗压缩、抗弯曲、抗扭转实验,并收集数据进行比较。结果生物力学结果显示,在轴向压缩以及弯曲试验中,钢板组稳定性要强于外固定架组（P〈0.05）;在扭转试验中,两组间差异无统计学意义（P〉0.05）;结合克氏针固定后,可以增加钢板组与外固定架组的抗弯曲和抗扭转的强度（P〈0.05）。结论对于桡骨远端粉碎性骨折,跨腕关节支撑钢板固定在抗压缩和抗弯曲的稳定性上,要强于外固定架,而在抗水平扭转的稳定性上两种方法无差异;结合克氏针固定,可以增加跨腕关节支撑钢板和跨腕关节外固定架,抗弯曲以及抗扭转的稳定性。     

三种方式治疗四肢枪击伤骨折的体会

目的：探讨治疗四肢枪击伤骨折的手术方法及适应证。方法对稳定骨折用单臂外固定架;对粉碎性骨折用 Ilizarov 全环外固定架;对骨缺损的骨折用Ⅰ期短缩原位延长法。结果所有患者伤口愈合良好,无感染,3组骨折平均11个月愈合。有2例膝关节、3例踝关节僵硬,2例下肢用单臂外固定架在负重后畸形。结论 Ilizarov 全环外固定架具有微创和可靠的稳定性。Ⅰ期短缩原位延长法可使骨折端对位良好、愈合牢固,还能将断裂的组织和伤口直接吻合。单臂外固定架与全环外固定架相比稳定性差,在下肢骨折中应少用。     

组合式骨外固定架在骨科临床的应用

骨外固定架是将上、下折段穿针，在皮外将所穿针固定在外固定架上，从而达到骨折两端良好的对位和固定目的。此法既不是单纯内固定，也不是单纯的定外固定，是一种二者兼而有之的固定方法。该固定方法已有100多年的历史，但直到50年代后才被重视和发展，并广泛应用于新鲜骨折、骨折不连结、开放粉碎骨折及肢体延长等，起到了过去内固定及外固定所不能达到的效果。目前国内的外固定架有半环式、四边式、全环式以及组合式等，我们所用的全部为组合式外固定架。     

外固定支架配合中药治疗胫腓骨骨折的临床疗效

目的本研究旨在观察单臂外固定支架、全环Ilizarov式外固定架配合中药治疗胫腓骨骨折的临床疗效。方法将纳入病例的64例胫腓骨骨折患者作为观察对象,随机分为治疗组、对照组,尽量确保两组在病种,病情程度等方面具有可比性。患者全部随访,随访时间8～21个月,平均时间16．5个月。治疗组患者33例,给予单臂外固定支架治疗;对照组31例患者,给予全环Ilizarov式外固定架治疗。2组均配合口服中药组方。观察两组在骨折治疗的治疗效果。结果治疗组在骨折治愈后肢体功能恢复程度方面各项指标均比对照组有显著差异（P〈0．05）,具有统计学意义。结论微创术式单臂外固定支架配合中药组治疗胫腓骨骨折,可以促进骨痴生长,加速骨折愈合,有利于骨折肢体功能的恢复。     

组合式外固定支架治疗四肢骨折118例分析

外固定支架起始于1840年，由Malgaigen首创，经历单钉、双钉靠全皮带连接，发展为固定架和固定架可调节型。1931年Bover始有不锈钢，直至50年代~70年代以Hoffmann、Ilizovov等为代表发展为近代各类不同支架。70年代国内首先由李起鸿教授等引进。支架分类为①单边或称单侧半针外固定支架；②双边式外固定支架；③四边式；④半环、全环三角式外固定支架。近年来首都医科大教授研制的组合式外固定支架得到较广泛的应用。我院自1997年7月引用于各类四肢骨折，至今使用治疗不同类型骨折共118例。现报告如下。 临床资料 1 一般资料：本组共118例…     

肱骨近端骨折患儿的外科治疗方案研究

目的:探讨切开复位克氏针内固定和切开复位外固定架治疗儿童肱骨近端骨折的临床效果和并发症。方法:选取2013年1月-2015年1月于本院住院治疗的64例肱骨近端骨折患儿,根据手术治疗方法分为两组,切开复位克氏针固定组36例,切开复位外固定架组28例,比较两种外科治疗方案对患儿的治疗效果。结果:两组患儿住院时间、骨折愈合时间、术后并发症比较差异无统计学意义(P0.05);固定架组手术时间、手术出血量和切口长度少于克氏针组,两组比较差异均有统计学意义(P0.05)。固定架组术后Neer评分及术后1、2、3个月骨折愈合率均高于克氏针组,两组比较差异有统计学意义(P0.05)。克氏针组患儿主观满意度为80.6%,低于固定架组100%,两组比较差异有统计学意义(P0.05)。结论:切开复位外固定架治疗儿童肱骨近端骨折对于损伤严重、移位严重的患者是较好的治疗方式,手术操作简单、损伤小,有利于患儿的上肢恢复和早期功能锻炼。     

单边外固定架结合克氏针有限固定治疗桡骨远端开放性骨折26例疗效分析

目的 应用单边外固定架结合克氏针有限固定治疗桡骨远端开放性骨折的治疗体会.方法 回顾性分析采用腕关节外固定架结合克氏针有限固定治疗桡骨远端开放性骨折26例,对26例30肢进行6～39个月随访(平均22.1个月).结果 26例获得随访患者30侧骨折均获得骨折愈合,优19例,良5例,可2例,优良率92.3%.结论 腕关节外固定架结合克氏针有限固定治疗桡骨远端开放性骨折操作简单,并发症少,疗效满意.     

不同手术方式治疗儿童肱骨近端骨折的临床观察

目的 比较切开复位克氏针内固定和切开复位外固定架治疗儿童肱骨近端骨折的效果.方法 2010年10月至2013年8月南阳市中心医院小儿外科行克氏针和外同定架治疗的肱骨近端骨折的患儿62例.其中克氏针内固定组患儿40例,外固定架组22例.比较两种手术方式的临床效果.结果 两组患儿手术时间[(40.3±7.2)min比62.3±6.7)min]、手术出血量[(28.9±14.5)ml比(71.7±17.5) ml]、切口长度[(32.4±11.3) cm比(63.3±13.2) cm]和术后肩关节Neer评分[(96.8±9.8)分比(92.3±8.5)分]等方面外固定架组要优于克氏针组,差异有统计学意义(P＜0.05).而在住院时间、骨折愈合时间和术后并发症方面差异无统计学意义(P＞0.05).结论 对儿童肱骨近端骨折,切开或闭合复位外固定架治疗,手术操作简单易行,对干骺端损伤小,固定可靠利于早期功能锻炼,对术后上肢功能的恢复具有良好的效果.     

应用Ilizarov外固定架治疗外伤性足下垂

目的 探讨Ilizarov外固定架牵拉技术治疗外伤性垂足畸形的疗效。方法应用Ilizarov外固定架牵拉技术治疗外伤性垂足畸形22例,术中将准备好的牵拉架套入小腿及足部的相应位置。在每个钢环对应的胫骨、跖骨、跟骨平面交叉穿入2mm克氏针并固定于Ilizarov牵拉架上,术后2～3d开始旋转调节螺纹杆上的旋钮,使足环带动惠足逐渐背伸使垂足畸形逐渐得以纠正。当垂足畸形矫至或超过中立位后停止牵拉并继续佩戴牵拉架固定1～2个月以巩固疗效。结果所有患者均获得随访,时间5～12个月,平均7．5个月,垂足畸形均得到矫正,行走步态良好,未发生跖骨骨折、皮肤坏死、神经、血管损伤等并发症。结论应用Ilizarov外固定架牵拉技术治疗外伤性垂足畸形具有创伤小、操作简单,畸形纠正彻底并能早期活动的优点。     

锁骨骨折克氏针内固定的不稳因素

目的研究锁骨骨折克氏针内固定存在的不稳定因素。方法分析术后出现克氏针失稳的情况,从锁骨的解剖结构和骨折力学改变及克氏针缺陷等方面探索失稳的原因。结果锁骨骨折克氏针内固定不稳的因素较多,但主要是锁骨骨折力学改变及克氏针存在缺陷所致。结论锁骨呈“S”形和螺旋状,其整体形状不在同一矢状面,螺旋形的结构在骨折后容易出现旋转应力,骨折内固定因旋转应力不均出现移位;克氏针两端光滑,其轴向加压作用几乎不存在。而内固定锁骨只单用一根克氏针,缺乏双面或多面交叉,完全不能抵抗骨折产生的旋力,在多种肌力的作用下骨折易产生分离,克氏针容易出现不稳定。将克氏针尖端加工出螺纹, 使骨折产生轴向加压,是减少骨折不稳定的关键。     

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.