可吸收螺钉治疗踝部骨折并下胫腓关节分离

目的探讨可吸收螺钉在下胫腓关节分离并双踝骨折手术治疗中的作用。方法回顾性研究了下胫腓关节分离并内、外踝骨折45例，其中外踝骨折并下胫腓关节分离9例；双踝骨折并下胫腓关节分离15例；三踝骨折并下胫腓关节分离21例。在手术治疗上，9例外踝骨折并下胫腓关节分离者外踝用4—6孔钢板内固定。用可吸收螺钉通过钢板将腓骨胫骨固定，有1例出现内侧三角韧带裂伤，先行三角韧带修复；双踝骨折并下胫腓关节分离者，先行外踝复位，用可吸收螺钉通过钢板孔将腓骨胫骨固定，再行内踝切开复位可吸收螺钉固定；三踝骨折并下胫腓关节分离者。先行后踝复位，可吸收螺钉内固定，再行外踝复位，用可吸收螺钉通过钢板孔将腓骨胫骨固定，最后行内踝复位，可吸收螺钉内固定。结果术后2年随访优良率为95％。结论内踝、外踩骨折并下胫腓关节分离具有它的特殊性，主张应手术复位内固定。可吸收螺钉固定内踝和后踝骨折，可吸收螺钉通过钢板将腓骨胫骨固定。     

手术治疗合并下胫腓分离的踝关节骨折

目的总结合并下胫腓分离的踝关节骨折的手术治疗方法和效果。方法对32例合并下胫腓分离的踝关节骨折的手术疗效进行分析。在手术治疗上，采用螺钉或张力带固定内踝，钢板或螺钉固定外踝，螺钉固定后踝，单个皮质骨螺钉固定下胫腓关节。结果术后随访1～3年，骨折愈合良好，优良率90.6％。结论手术复住内固定是治疗合并下胫腓分离的踝关节骨折的必要选择，早期手术，解剖复位，可靠的内固定。早期合理的功能锻炼是提高疗效，减少和预防创伤性关节炎的关键。     

踝关节骨折脱位及韧带损伤的治疗

目的 探讨踝关节骨折合并下胫腓联合分离的治疗.方法 本组46例踝关节骨折,对内踝骨折复位采用螺钉及张力带固定,外踝骨折行金属板螺钉内固定,后踝骨折大于关节面1/4时,自后方复位加压螺钉固定.下胫腓联合损伤,行内外踝复位固定后仍有踝穴增宽者,以全螺纹螺钉固定下胫腓关节,另加石膏外固定.结果 随访6～15个月,平均9.5个月.所有患者骨折均一期愈合,骨折愈合时间为合并下胫腓联合分离10～18周,平均14.5周.根据Baird Jackson评分系统评分,疗效：优41例,良2例,可2例,差1例.结论 踝关节骨折合并下胫腓联合分离须行解剖复位,坚强内固定,术中应充分重视外踝复位及下胫腓联合稳定.     

踝部骨折并下胫腓关节分离的治疗体会

目的分析踝部骨折合并下胫腓关节分离的手术治疗要点。方法回顾踝部骨折合并下胫腓关节分离的病例82倒,左侧38例,右侧44例,双踝骨折者49例,单纯外踝或内踝骨折者分别为20及13例。踝部开放性损伤34例,闭合性损伤48例,踝关节骨折行解剖复位,内踝骨折螺丝钉或克氏针固定,外踝骨折行钢板螺钉固定。下胫腓关节分离用一枚长的拉力螺钉经腓骨外侧从腓骨后侧面向胫骨的前内侧面拧入,距踝关节面上方约2cm,大概与冠状面呈30度角。其中68例的拉力螺钉是通过腓骨钢板孔植入的。结果根据Leeds评价标准,本组优65例（79．3％）,良12例（14．6响,差5例（6％）,优良率93．9％。结论踝部骨折并下胫腓关节分离的治疗主要是踝关节复位后通过横穿拉力螺钉来达到复位及固定的目的。固定下胫腓联合的螺钉应在完全负重之前取出,以免螺钉断裂,一般时间为8-10周。     

踝部骨折并下胫腓关节分离的治疗体会

目的分析踝部骨折合并下胫腓关节分离的手术治疗要点。方法回顾踝部骨折合并下胫腓关节分离的病例82例,左侧38例,右侧44例,双踝骨折者49例,单纯外踝或内踝骨折者分别为20及13例。踝部开放性损伤34例,闭合性损伤48例,踝关节骨折行解剖复位,内踝骨折螺丝钉或克氏针固定,外踝骨折行钢板螺钉固定。下胫腓关节分离用一枚长的拉力螺钉经腓骨外侧从腓骨后侧面向胫骨的前内侧面拧入,距踝关节面上方约2cm,大概与冠状面呈30度角。其中68例的拉力螺钉是通过腓骨钢板孔植入的。结果根据Leeds评价标准,本组优65例(79.3%),良12例(14.6%),差5例(6%),优良率93.9%。结论踝部骨折并下胫腓关节分离的治疗主要是踝关节复位后通过横穿拉力螺钉来达到复位及固定的目的。固定下胫腓联合的螺钉应在完全负重之前取出,以免螺钉断裂,一般时间为8-10周。     

旋前外旋型踝关节骨折伴下胫腓联合分离的手术治疗

目的探讨旋前外旋型踝关节骨折伴下胫腓联合分离的手术疗效。方法26例旋前外旋型踝关节骨折合并下胫腓联合分离患者,行腓骨钢板螺钉固定,内踝加压空心拉力螺钉或克氏针内固定,18例后踝予加压空心拉力螺钉固定,所有下胫腓联合分离者均行下胫腓螺钉固定。术后12周拆除下胫腓螺钉。结果26例患者均手术成功,均获随访8～24个月。根据Baird-Jackson评分,优19例,良5例,可1例,差1例,优良率为92.3%。结论手术治疗旋前外旋型踝关节骨折伴下胫腓联合分离可恢复并稳定踝穴和距骨解剖关系,早期功能锻炼,临床疗效满意。     

踝关节骨折手术治疗分析

目的分析总结踝关节骨折的治疗要点。方法对64例踝关节骨折病例采用手术治疗,内踝用螺钉或张力带钢丝固定,外踝用钢板螺钉或张力带钢丝固定,后踝以螺钉内固定。结果按Denis—Weber分类法A型9例,B型32例,C型23例,治疗效果优良率89．1％．结论早期手术,解剖复位,坚强内固定和下胫腓关节固定以及早期功能锻炼可使踝关节功能得到良好的恢复。     

优化术式治疗踝关节骨折

目的 观察采用优化术式治疗不同类型踝关节骨折的治疗效果并对其适应症和手术方法 进行分析.方法 随访采用优化术式治疗的63例踝关节骨折(2003年1月～2006年10月),推荐各类型骨折所采用的切开复位内固定手术步骤,对男性41例(2例为双足踝关节骨折),女性20例;平均年龄42.5岁(年龄15～77岁)的这组患者术后结果 评估.根据Danis-Weber分类,B型33例,C型30例.受伤至手术时间2h～7d.内侧采用标准内踝切口显露内踝骨折,外侧采用腓骨后缘纵行切口显露外踝骨折,后踝采用跟腱内缘、外缘或内踝后侧弧形切口.下胫腓关节固定:以螺钉自外踝拧入,穿过下胫腓联合至胫骨远端.外踝固定:克氏针;克氏针钢丝张力带;解剖钢板;丝线;钢丝.内踝固定:螺钉(1～2枚);解剖钢板.复位满意的标准为:(1)踝关节的正常关系恢复.(2)关节面的外形轮廓光滑.结果 随访时间2mo～2.8a,平均26mo.随访时疗效评定根据Kofoed评分标准进行评定:优(85～100分)29例;良(75～85分)24例;及格(70～74分)8例;差(低于70分)2例;优良率为84.1%.本组病例未发生感染、骨不连、骨折畸形愈合等并发症,1例发生下胫腓固定螺钉断裂,1例外侧钢板断裂.结论 采用优化术式治疗不同类型踝关节骨折(重点涉及双踝)效果好,方法 简单,符合当今微创要求.内踝相对简单固定(小切口),合用外踝解剖钢板可使手术简单有效.可吸收螺钉治疗内踝骨折效果可靠,生物相容性好.踝关节多处骨折时,优先固定效果最牢固的一侧会更有利于手术操作.     

合并下胫腓联合分离的踝关节骨折脱位的诊断与治疗

目的:探讨治疗合并下胫腓联合分离的踝关节骨折脱位诊断治疗与临床效果.方法:回顾性分析手术治疗的合并下胫腓联合分离的踝关节骨折脱位患者24例.患者外踝均采用钢板固定;内踝:19例采用松质骨螺钉固定,3例采用三叶草钢板固定,2例采用克氏针固定;后踝:均采用松质骨螺钉固定;下胫腓联合均采用单枚螺钉经或不经钢板孔固定.结果:依据术后踝关节功能恢复情况,症状和 X 线征评定疗效:本组优15例,良6 例,可2例,差1例,优良率为87.5%.所有患者均未发生深部感染,断钉等情况.结论:术前全面评估,正确的手术方法及技术,精确的解剖复位固定是提高踝关节骨折疗效的关键.     

踝关节骨折合并下胫腓联合分离的治疗探讨

目的探讨踝关节骨折合并下胫腓联合分离治疗特点及关键步骤。方法对就诊于我院的42例踝关节骨折合并下胫腓联合分离的患者进行手术治疗。结果平均随访1年-3年，优良率达90．5％。结论踝关节骨折合并下胫腓联合分离具有其特殊性，应手术复位内固定，手术复位应达到解剖复位。     

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.