不同内固定治疗老年股骨粗隆间骨折86例分析

目的:探讨动力髋螺钉(DHS)、Gamma钉、股骨近端髓内钉(PFN)在老年股骨粗隆间骨折中的应用。方法:对86例老年股骨粗隆间骨折分别行DHS、Gamma钉、PFN内固定治疗。结果:术后随访6～48个月,DHS组优良率85.7%,Gamma钉组优良率88.9%,PFN组优良率94.1%。结论:PFN是治疗老年股骨粗隆间骨折最牢固的髓内固定方式。     

股骨粗隆间骨折的手术治疗

目的：对股骨粗隆间骨折三种内固定方法（动力髋螺钉DHS、Gamma钉、股骨近端髓内钉PFN）手术治疗效果的观察和探讨。方法：对70例股骨粗隆间骨折行DHS、Gamma钉、PFN内固定治疗结果经术后随访12个月～2年,平均18个月。结果：在髋关节功能评分优良率：动力髋螺钉组91.4%,Gamma钉组94.1%,PFN组94.4%。结论：各种固定有其自身特点,PFN是治疗粗隆间骨折最牢固的髓内固定方式,尤其适用于不稳定粗隆间粉碎性骨折。     

不同方式治疗股骨粗隆间骨折的疗效对比分析

目的探讨动力髋螺钉（DHS）、股骨近端髓内钉（PFN）、Gamma钉治疗股骨粗隆间骨折临床疗效。方法对120例股骨粗隆间骨折的患者分为三组,分别行DHS内固定、Gamma钉内固定和PFN内固定,分析并比较三组患者术后的疗效。结果 PFN组和Gamma钉组的住院时间、手术时间、出血量都优于DHS组,统计分析显示有统计学意义（P〈0.05）;DHS组术后髋关节功能恢复优良率为85%,PFN组优良率为95%,Gamma钉组优良率为92.5%;PFN组和Gamma钉族分别与DHS组比较差异有统计学意义（P〈0.05）,而PFN组与Gamma钉组比较差异无统计学意义（P〉0.05）。术后并发症发生率DHS组为10%;Gamma钉组为7.5%;PFN组全部一期愈合,无并发症。PFN组分别与DHS组、Gamma钉比较差异有统计学意义（P〈0.05）,而DHS组与Gamma钉组比较差异无统计学意义（P〉0.05）。结论股骨近端髓内钉（PFN）以创伤小、功能恢复好、术后并发症少的优点,可作为治疗股骨粗隆间骨折手术治疗的首选方式。     

动力髋螺钉、股骨近端髓内钉、Gamma钉治疗股骨粗隆问骨折临床疗效比较

目的探讨动力髋螺钉（DHS）、股骨近端髓内钉（PFN）、Gamma钉治疗股骨粗隆间骨折的临床效果。方法将我院2009年5月-2012年5月138例股骨粗隆间骨折患者按照不同术式分为DHS组、PFN组、Gamma钉组,比较三组疗疗。结果三组总有效率无统计学差异（P〉0．05）;FN组与Gamma钉组术中、术后各项指标均优于DHS组（P〈0.05）;PFN组并发症发生率明显优于DHS组和Gamma钉组（P〈0．05）。结论股骨近端髓内钉治疗股骨粗隆间骨折疗效显著,值得临床推广。     

股骨粗隆间粉碎性骨折不同内固定疗效分析

目的:探讨不同内固定方式治疗股骨粗隆间粉碎性骨折的临床疗效。方法:选取2010年12月至2011年12月通许县中心医院接收的股骨粗隆间粉碎性骨折患者120例,分为3组,分别采用动力髋螺钉(DHS)内固定、微创Gamma髓内钉内固定和股骨近端髓内钉(PFN)内固定的方法进行治疗,对比其治疗效果。结果:经术后0.5~2 a随访,DHS内固定的总有效率为75%,Gamma髓内钉内固定的总有效率为80%,PFN内固定的总有效率为92.5%,PFN组的总有效率明显高于另外两组,3组比较差异均具有统计学意义(P<0.05)。结论:3种固定方式都有各自的优缺点,但PFN内固定治疗股骨粗隆间粉碎性骨折的临床疗效更好。     

老年股骨粗隆间骨折不同内固定治疗疗效观察

目的 探讨不同手术方式治疗老年股骨粗隆间骨折的临床效果.方法 回顾分析181例老年股骨粗隆间骨折,按AO分型:A1型98例,A2型60例,A3型23例.采用动力髋螺钉(DHS) 92例,解剖型钢板50例,空心螺纹钉8例,髓内钉固定31例.结果 随访163例,其中A1型88例,A2型52例,A3型23例.按患者所采用内固定方式分类:动力髋螺钉(DHS)固定88例,解剖型钢板49例,经皮空心螺钉3例,髓内钉固定23例.治疗结果根据黄公怡标准评定,动力髋螺钉(DHS)固定优良率97.7％;解剖型钢板固定优良率93.9％;空心螺纹钉100％,髓内钉(PFN)固定优良率100％,总优良率96.9％.结论 根据粗隆间骨折分类,采取不同手术内固定方式治疗可以提高老年人股骨粗隆间骨折的治疗效果,并且明显减少并发症.动力髋螺钉( DHS)及解剖型钢板是治疗老年股骨粗隆间骨折较好的方法,对于反向斜行粗隆间骨折我们主张用髓内钉固定(PFN),PFN较其他内固定侵袭性小,操作简便,手术时间短.骨折线位良好者可采用经皮空心螺纹钉.     

股骨粗隆间骨折不同固定方法疗效比较

目的 比较动力髋螺钉(DHS)、股骨近端髓内钉(Proximal femoral nail,PFN)和Gamma钉治疗股骨粗隆间骨折的疗效差别.方法 将我院在2006～2012年间收治的粗隆间骨折99例分为3组.A组28例,采用DHS治疗;B组34例,采用PFN或新改进的PFN (PFNA)治疗;C组37例,采用加长型Gamma钉治疗,对3组患者术中及术后恢复情况进行比较.结果 采用髋关节功能Harris评分系统评定,B、C组的优良率高于A组,差异有统计学意义(P＜0.05),B、C组之间差异无统计学意义.B、C组手术时间及术中出血量均少于A组(P＜0.05).结论 3种方法治疗股骨粗隆间骨折,Gamma钉、PFN疗效优于DHS.Gamma钉、PFN治疗股骨粗隆间骨折具有手术时间短、损伤小、出血少、固定牢靠、并发症少等特点,加长型Gamma钉能有效避免假体周围骨折,是老年股骨粗隆间骨折的理想内固定物.     

DHS Gamma钉与PFN治疗股骨转子间骨折的疗效分析

目的:探讨动力髋螺钉(DHS)与Gamma钉以及股骨近端髓内钉(PFN)治疗转子部骨折的临床经验,提高治疗转子部骨折的治疗水平。方法:2008年5月至2011年5月选用进口DHS,Gamma钉与AO产PFN治疗112例转子部骨折病人,手术使用骨科牵引床,C型臂影象增强器,DHS采用闭合复位切开内固定,Gamma钉和PFN采用闭合复位锁钉技术。结果:DHS组51例病人中50例3-4个月全部骨性愈合,髋关节屈伸活动恢复95%以上,旋转活动恢复恢复85%。一例出现股骨头切割及髋内翻畸形。Gamma钉组39例病人中1例髋内翻畸形并股骨外侧疼痛,全部病例3-4个月内骨性愈合。PFN组23例病人22例3-4个月全部骨性愈合,关节功能良好。结论:动力髋螺钉(DHS)与Gamma钉以及股骨近端髓内钉(PFN)是治疗转子部骨折的有效方法,三者各有其优缺点。根据三者生物力学性能的不同选择不同病例,可促进骨折愈合减少并发症。     

DHS和PFN治疗股骨粗隆间骨折疗效对比

目的 观察比较动力髋螺钉（DHS）和股骨近端髓内钉（PFN）治疗股骨粗隆间骨折的临床效果.方法 86例股骨粗隆间骨折患者采用DHS（DHS组49例）和PFN（PFN组37例）治疗,观察比较临床愈合时间、术后髋关节功能恢复程度、术后并发症等三项指标.结果 PFN组平均骨折愈合时间、骨折愈合优良率、术后并发症等优于DHS组,2组比较差异有统计学意义（P＜0.05）.结论 PFN是在伽玛（Gamma）钉基础上改良发展而来的内固定系统,其加强了骨折端的防旋、抗拉及抗压能力,骨折愈合时间短,疗效好,对于反粗隆间骨折及合并粗隆下骨折,首选PFN固定,而对于需要切开复位者,可选用DHS固定.     

股骨粗隆间骨折四种术式临床疗效分析

目的:探讨股骨髁上牵引,动力髋螺钉(DHS),Gamm a螺钉,股骨近端髓内钉(PFN)内固定治疗老年股骨粗隆间骨折的临床疗效。方法:总结分析采用股骨髁上牵引,DHS,Gamm a螺钉,PFN内固定治疗股骨粗隆间骨折86例。结果:本组均随访12~48个月,平均24个月,采用Kuderna疗效评判:优49例,良22例,可11例,差2例,死亡2例。结论:Gamm a螺,PFN内固定治疗股骨粗隆间骨折具有适应证广泛,生物学固定,手术创伤小,操作相对简单易撑握,固定牢靠,抗旋转性强,骨折愈合快,骨折术后并发症少的特点,是目前治疗股骨粗隆间骨折较理想的两种方法。     

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.     

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.     

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.