双切口双钢板内固定治疗胫骨平台SchazkerⅤ、Ⅵ型骨折

目的探讨双切口双钢板内固定治疗SchazkerⅤ、Ⅵ型胫骨平台骨折的临床效果。方法 2006年1月至2009年6月中采用双切口双钢板内固定治疗SchazkerⅤ、Ⅵ型胫骨平台骨折23例,其中Ⅴ型11例、Ⅵ型12例,前外侧切口采用高尔夫型钢板固定,后内侧切口采用＂T＂形钢板或重建钢板固定。结果本组切口均一期愈合。23例患者均得到随访,随访时间平均17月（9～48月）,骨折无延迟愈合;膝关节功能采用HSS评分平均89分（80～94分）。结论双切口双钢板内固定治疗SchazkerⅤ、Ⅵ型胫骨平台骨折术后能提供持续、稳定的固定,有效防止骨折再移位,术后可早期功能锻炼,获得满意关节功能,可减少骨折不愈合、膝关节功能下降等并发症。     

后外侧切口双钢板治疗胫骨平台外侧及后外侧髁骨折

目的探讨后外侧切口双钢板治疗胫骨外侧平台伴后外侧髁骨折的手术方法及临床疗效。方法 2010年9月至2012年6月,采用后外侧切口双钢板治疗9例胫骨外侧平台伴后外侧髁骨折患者,男性6例,女性3例,平均年龄41.70岁,交通事故伤6例,高处坠落伤2例,重物砸伤1例,均为胫骨外侧平台伴后外侧髁骨折。术后采用Rasmussen膝关节功能和放射学评分法评估疗效,并观察神经损伤、皮肤坏死、切口感染等并发症出现情况。结果 9例患者均获得随访,时间4～19个月(平均12.11个月),骨折均愈合。术后Rasmussen膝关节功能评定评分标准:优5例,良3例,可1例,差0例,优良率为88.90%。术后Rasmussen放射学评分标准评价:优7例,良2例,可0例,差0例,优良率为100%。术后无神经损伤、皮肤坏死及切口感染,无内固定松动及断裂,无骨折不愈合及骨折再移位,无膝关节内外翻畸形。结论胫骨外侧平台伴后外侧髁劈裂塌陷骨折时,采用后外侧切口双钢板治疗,于直视下进行复位及固定,便于操作,术后近期疗效满意。     

复杂性胫骨平台骨折手术治疗68例

目的:对比观察不同切口入路治疗复杂型胫骨平台骨折的疗效。方法:双切口组32例采用前外侧后内侧双切口入路,结合T型钢板或1/2管型钢板作有限内固定,骨质缺损区植骨,用高尔夫钢板、T型或L型钢板固定外侧平台。正中切口组36例采用前正中纵向切口入路,结合胫骨外侧髁部L型标准外侧支撑钢板固定,内侧使用小的抗滑动钢板或小T型钢板固定。结果:双切口组优良率78.1%,正中切口组优良率80.6%,两组无明显并发症发生,优良率比较无显著性差异。结论:对于复杂型胫骨平台骨折,采用前外侧后内侧双切口入路,结合T型钢板或1/2管型钢板作有限内固定,高尔夫钢板、T型或L型钢板固定外侧平台;和采用前正中纵向切口入路,结合胫骨外侧髁部L型标准外侧支撑钢板固定,内侧使用小的抗滑动钢板或小T型钢板固定,均可收到较好疗效。     

胫骨中上段骨折合并胫骨平台骨折手术治疗48例

目的:探讨胫骨中上段合并胫骨平台骨折有效治疗方法。方法:胫骨中上段合并胫骨平台骨折患者48例,21例胫骨中上段骨折合并单纯外侧平台骨折患者,采取胫骨上段前外侧切口,2例合并单纯内侧胫骨平台骨折患者,采用内侧切口,选择胫骨近端段解剖型钢板内固定,合并髁问棘骨折的加用钢丝同定。25例合并双髁胫骨平台骨折患者中,9例骨折偏中前部则采取正中直切口或Y形切口,16例平台骨折部位位于偏后部采取两侧切口,内固定选择胫骨外侧放置长L形支持钢板,内侧放置短T形支持钢板。结果:共随访47例,随访时间12~24月。根据HSS膝关节临床功能评分,优30例,良12例,可4例,差l例,优良率89.36%。结论:对于胫骨中上段合并胫骨平台骨折手术治疗,首先选择好手术治疗时机,其次要具备良好的复位、稳定的内固定。合并单纯外侧平台骨折患者内固定选择胫骨近端段解剖型钢板,合并双髁胫骨平台骨折应选择双钢板内固定,可收到较好疗效。     

双切口双钢板内固定治疗复杂胫骨平台骨折的疗效分析

目的：探讨双切口双钢板内固定治疗复杂胫骨平台骨折的临床疗效。方法2010年1月至2014年1月对26例复杂胫骨平台骨折患者采取双切口双钢板内固定及植骨治疗。根据疼痛、行走能力、伸膝、关节活动度及关节稳定性评估手术效果。结果随访12～30个月,无1例患者术后并发膝关节内外翻畸形。有1例出现皮肤坏死。根据Rasmussen评分法：14例优,8例良,3例可,1例差。结论双切口双钢板内固定治疗复杂胫骨平台骨折是一种既简单又有效的治疗方法。     

双钢板法治疗Schatzker Ⅵ型胫骨平台骨折

目的观察双钢板法治疗SchatzkerⅥ型胫骨平台骨折的临床疗效。方法从2002年5月-2006年3月采用双钢板法治疗SchatzkerⅥ型胫骨平台骨折23例,术中使用前外侧加后内侧入路,利用有限切开技术行钢板内固定。结果术后23例患者均获得随访,时间12-35个月,平均17.5月。骨折均获骨性愈合。根据Rasmussen膝关节功能评分法进行综合评分：优14例,良5例,可3例,差1例。结论采用双钢板法治疗SchatzkerⅥ型胫骨平台骨折,固定牢靠,切口小,并发症少,结合早期合理的功能锻炼,疗效满意。     

应用解剖钢板治疗复杂胫骨平台骨折

目的：探索应用解剖钢板治疗复杂胫骨平台骨折的临床疗效。方法：应用解剖钢板治疗复杂胫骨平台骨折27例,术中使用前正中切口或前外侧切口,于胫骨外侧置入解剖钢板进行内固定。结果：27例均获得随访6-12个月,平均9．6个月。所有患者无骨折不愈合或延迟愈合,无骨筋膜室综合征及下肢深静脉栓塞。骨折平均愈合时间13．3周。术后膝关节功能使用HSS评分法评分78～98分,平均90．2分。结论：胫骨近端解剖钢板治疗复杂胫骨平台骨折提供了持续稳定的固定,防止骨折的二期移位和膝关节力线的畸型,可以保护膝关节周围软组织,减少手术并发症,膝关节功能满意。     

单切口双钢板内固定治疗胫骨平台双髁骨折21例

目的 探讨单切口双钢板法治疗胫骨平台双髁骨折的临床效果.方法 2006年4月至2008年1月采用单切口双钢板固定技术治疗胫骨平台双髁骨折21例,男16例,女5例;年龄28-66岁,平均48.2岁.所有病例均为双髁粉碎性骨折,受伤至手术时间为2-14d,平均7d.手术取膝前及下方正中切口,胫骨上段偏胫骨瘠外侧入路,后内侧用"L"或"T"形钢板固定支撑,外侧以高尔夫棒型钢板固定.结果 21例患者均获得随访,随访时间10-29个月,平均16.8个月.术后1个月患者膝关节屈曲50°-100°,平均82.1°;3个月膝关节屈曲90°-135°,平均115.7°.术后即刻胫骨平台内翻角(TPA)及胫骨平台后倾角(PA)度数与术后3个月比较,差异无统计学意义(均P>0.05).术后3个月TPA及PA度数与术后1年比较,差异无统计学意义(均P>0.05).术后无一例发生切口皮肤坏死、深部感染.结论 应用单切口双钢板固定技术治疗胫骨平台双髁骨折可减少手术创伤,内固定良好,植骨充分,术后可早期进行功能训练,临床效果满意.     

双切口外侧锁定钢板联合内侧支持钢板与双支持钢板内固定修复复杂胫骨平台骨折的临床对比分析

目的 探讨对复杂胫骨平台骨折患者实施双切口外侧锁定钢板联合内侧支持钢板与双支持钢板内固定修复治疗的效果.方法 将本院4年内收治的36例复杂胫骨平台骨折患者,随机将患者分为观察组和对照组,各18例.对照组实施双支持钢板内固定治疗,观察组实施双切口外侧锁定钢板联合内侧支持钢板治疗.结果 两组患者在手术时间、术中出血量、膝关节功能评分、骨折愈合时间、膝关节活动度以及术后并发症发生率上均没有明显差异,差异无统计学意义.但观察组患者在术后完全负重时间上明显的要低于对照组,差异有统计学意义(P<0.05).结论 无论是双切口外侧锁定钢板联合内侧支持钢板和双支持钢板内固定均可对复杂胫骨平台骨折患者起到较好修复效果,但在完全负重的时间上双切口外侧锁定钢板联合内侧支持钢板修复效果更佳.     

有限切开双切口双钢板内固定治疗胫骨平台复杂骨折

目的：探讨有限切开双切口双钢板内固定治疗胫骨平台复杂骨折的临床疗效。方法：2006年6月－2011年9月年笔者采用有限切开双切口双钢板内固定治疗胫骨平台复杂骨折33例。结果：本组33例均获随访，随访时间14～26个月，平均18．7个月。术后骨折愈合时间12—18个月，平均15个月。术后1年疗效评定，以“美国膝关节协会评分标准”为评估参照标准，其中优17例，良12例，可4例，差0例，优良率为87．9％；结论：有限切开双切口双钢板内固定是治疗胫骨平台复杂骨折的有效方法，它尽可能减少软组织并发症，并为骨折端提供坚强同定，有效防止骨折再移位及膝关节力线的改变，促进膝关节功能的恢复。     

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.