改良Watson-Jones入路微创全髋关节置换术22例体会

目的 探讨改良Watson-Jones入路微创全髋关节置换术(THA)的技术要点和临床效果.方法 采用小切口经后外侧入路行全髋置换术22例(24髋);术前术后髋关节功能评定按Harris评分.评估内容包括切口长度、手术持续时间、术中失血量、术中和术后并发症及手术效果.结果 全部患者术后随访8～15个月,髋关节Harris评分均较术前提高.切口平均长度为9.5 cm,平均手术时间105 min,平均术中失血量500 ml.无伤口感染、骨折及血管神经损伤等并发症,随访时骨盆X线片未发现有假体松动、移位、断裂等迹象,大多数患者1个月后无需持拐辅助行走.结论 改良Watson-Jones入路微创全髋关节置换术不损伤周围肌肉、创伤小、术后恢复快、并发症少且几乎无后脱位.     

28例改良Watson-Jones入路微创全髋关节置换术的护理体会

目的探讨改良Watson-Jones入路微创全髋关节置换术（THA）的护理体会。方法对28例接受改良Watson-Jones入路微创THA患者实施精心的术前、术后护理和观察、预防并发症的产生。在术后指导患者早期下床活动和康复锻炼。结果患者术后平均住院7．9d。无1例发生感染、脱位、血管神经损伤等并发症。随访6个月～3年,髋关节功能良好,效果满意。结论围手术期护理,使患者密切配合治疗和护理,个体化渐进式指导早期康复训练,能够有效预防并发症的产生,使全髋关节置换术患者恢复快、康复效果满意。     

不同手术方式在全髋关节置换术中的应用效果观察

目的:探讨改良式后外侧小切口入路和改良式Watson-Jones入路在全髋关节置换术中的应用效果。方法:选取濮阳县人民医院2011年1月至2012年6月收治的54例髋关节疾病患者,根据知情同意权将患者分为两组,观察组实施改良式Watson-Jones入路,对照组实施改良式后外侧小切口入路,比较两组患者手术时间、切口长度、术中出血量、Harris髋关节功能评分;随访1 a并发症发生情况。结果:改良式WatsonJones入路手术损伤小、出血量少、手术时间短、切口长度短,和对照组相比差异有统计学意义(P<0.05);观察组3、6个月Harris评分高于对照组,差异有统计学意义(P<0.05);两组均未出现感染、血管神经损伤、下肢静脉血栓、髋关节脱位、假体下沉等并发症情况。结论:改良式Watson-Jones入路和改良式后外侧小切口入路在全髋关节置换术中均取得满意的效果,但观察组Watson-Jones入路术后近期效果优于对照组,明显减少了患者的痛苦,提高了生活质量,值得临床推广应用。     

Hardinge直接外侧入路微创切口全髋关节置换

目的探讨Hardinge直接外侧入路微创切口在全髋关节置换术中的初步应用。方法于2007年3月至2009年12月开展Hardinge直接外侧入路微创全髋关节置换术28例,应用小切口技术,从臀中肌与阔筋膜张肌间隙进入,保留后方关节囊与肌肉完整性,两步法进行股骨颈截骨,合理使用特殊体位及器械安置髋臼及股骨假体。结果 28例患者随访时间平均25个月,手术切口平均长度9.5cm;术中平均出血量240ml,术后平均引流量90ml;术中1例发生股骨假体周围骨折,1例发现髋臼前缘缺损。下地活动时间平均7d,术后6个月Harris评分平均值从术前46.2提高为88分。结论 Hardinge入路应用于微创全髋关节置换术,可获得满意的临床疗效。     

改良Watson-Jones入路微创治疗髋关节后脱位合并PipkinⅠ、Ⅱ型股骨头骨折

目的探讨改良Watson-Jones入路在髋关节后脱位合并PipkinI、II型股骨头骨折微创治疗中的应用。方法 7例髋关节后脱位合并PipkinI、II型股骨头骨折患者,PipkinI型1例、II型6例,全部采用改良Watson-Jones入路切开复位钛质空心螺钉内固定治疗。结果按照Harris评分：90-96分,平均92.5分。结论改良Watson-Jones入路是治疗髋关节后脱位合并PipkinI、II型股骨头骨折的理想手术入路。     

低位前外侧入路微创全髋置换术

目的:评价低位前外侧入路微创全髋关节置换术的可行性和早期临床效果.方法:17位患者18例髋关节进行前外侧入路微创全髋关节置换术,仰卧位,自大转子上2 cm为顶向前下切口,纵行切开髂胫束和臀中肌前部着点,由髋关节囊前方分离至髋臼前外缘.不脱位,经股骨颈截骨和取头,处理髋臼植入假体.患髋内收外旋股骨颈基底脱出切口外,股骨扩髓后植入假体.结果:手术切口平均长(10.5±2.1)cm.切口长短与体重正相关,髋臼病理改变和翻修者更长.手术时间平均为(101.7±14.6)min,术中出血量110～600ml,平均(302.2±77.3)ml;双侧髋关节置换1例.术后2～5 d患髋均可负重行走.随访7～22个月,Harris评分平均:术前44;术后6个月85.假体位置理想.无并发症.结论:经低位的前外侧入路行微创全髋关节置换术,需要特殊的髋关节拉钩和牵开技术.有创伤小、不损伤臀上神经、假体位置理想、术中可以处理较复杂病理改变、准确测量两侧下肢体长度、术后外展肌有力、早期康复等优点.     

后外侧单切口入路微创全髋关节置换术的临床报告

目的:报告后外侧入路微创全髋关节置换术的可行性和初步疗效。方法:自2002年8月至2005年8月,采用后外侧入路微创技术完成21例全髋置换术。结果:手术切口7.5cm~12cm,平均8cm;手术时间50分钟~90分钟,平均65分钟;术中出血量200ml~500ml,平均270ml;术后均放负压引流,24小时平均引流量100ml~350ml,(平均150ml)。平均随访时间2.5年(1年~4年),未发生全身及局部并发症。结论:后外侧入路单切口微创行全髋关节置换具有创伤小、出血少、恢复快,是值得推荐的微创全髋关节置换技术。     

改良Watson-Jones微创入路与改良Gibson后侧入路全髋关节置换术的临床疗效对比观察

目的:观察采用改良Watson-Jones微创入路,以及改良Gibson后侧入路应用于全髋关节置换术的效果对比。方法:采用随机平行对照法将我院2014年9月-2015年10月期间113例需行全髋关节置换患者,依据手术入路方式的不同分为对照组56例及观察组57例,对照组患者采用改良Gibson后侧入路,观察组患者采用改良WatsonJones微创入路,对比两组患者术中相关指标及术后髋关节功能恢复情况。结果:观察组术中出血量、切口长度、术后引流量、住院时间均低于对照组,手术时间长于对照组(P<0.05);观察组术后3、6、12、18个月Harris评分均高于对照组(P<0.05)。结论:经改良Watson-Jones微创入路行髋关节置换术,不会对关节的周围肌肉造成损伤,术后恢复快,可显著改善髋关节功能,值得临床推广应用。     

平卧位小切口外侧入路在人工髋关节置换术中的应用

目的：总结平卧位直接外侧入路行人工髋关节置换术（ THR）的方法和疗效。方法：采用平卧位直接外侧入路行人工髋关节髋置换术40例,45髋,男25例,女15例,平均年龄70岁。结果：手术切口平均约9．5cm,术中出血量平均250 ml,手术时间平均80分钟,术后24小时引流量平均200 ml。术后疼痛程度和持续时间均较常规入路显著改善。术后X线片显示假体位置良好,术后3天患者渐下地行功能练习,Harris评分平均98分。随访6-48个月,平均36个月,手术切口均获1期愈合,所有病例均未出现持续的跛行和Trendelenburg 征阳性。无感染、脱位或血管神经损伤等并发症出现。关节功能恢复良好。结论：平卧位小切口外侧切口进行髋关节置换术具有入路创伤小,暴露良好,术中假体安置更精确,手术操作更方便,麻醉安全,术后并发症少,患肢功能恢复好等优点,值得推广。     

外侧入路微创全髋置换术

目的：探讨微创下行人工全髋关节置换（THA）的手术适应证、技术要点。方法：采用外侧小切口（8～10cm）施行THA手术（微创THA组）47例（共50髋）；同期按常规方法行THA手术（常规THA组）41例（41髋）。对两组围手术期出血量、切口引流量、输血量、关节置换时间等指标进行比较。结果：微创THA组在围手术期出血量、术后切口引流量、输血量等均较常规THA组少，术后l周可扶双拐下地不负重行走，术后2周可扶单拐不负重行走，术后弃拐时间同常规THA组。结论：微创THA术后恢复快、围手术期出血少、软组织创伤小、关节置换时间短、假体功能良好，但应注意手术适应证及技术熟练程度。     

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.