小切口复位带锁髓内钉固定治疗下肢粉碎骨折

目的探讨小切口复位带锁髓内钉结合加钉治疗下肢长管状骨粉碎性骨折的疗效。方法自2005年1月至2008年3月本组23例采用小切口复位带锁髓内钉结合加钉治疗下肢长管状骨粉碎性骨折患者。其中男14例,女9例;年龄28～62岁,平均45岁。结果 23例患者术后随访6～15个月,平均10.5个月。愈合时间4～9个月,平均6.5个月,骨折全部愈合,无畸形愈合及不愈合。结论小切口复位带锁髓内钉结合加钉综合运用可以有效治疗下肢长管状骨粉碎性骨折,患者能够早期活动,是一种较为理想的方法。     

T型锁定加压钢板治疗桡骨远端粉碎性骨折初步报告

目的 探讨开放复位、锁定加压钢板（locking compression plate，IEP）内固定治疗桡骨远端粉碎性骨折的临床疗效。方法 回顾性分析2003年5月-2005年5月收治的35例桡骨远端粉碎性骨折病人，采用LCP系统切开复位内固定，9例病人进行植骨，术后早期功能锻炼。结果 全部病例获7～32个月的随访，平均17．2个月。X线显示骨折均愈合良好，无成角畸形，未发现晚期塌陷导致的背倾、钉板松动及骨折再移位病例，术后功能优良率94．29％。结论 早期切开复位行LCP内固定是治疗桡骨远端粉碎性骨折的理想方法。     

有限切开功能复位在下肢长管状骨骨折带锁髓内钉固定术中的应用(附213例报告)

[目的]总结带锁髓内钉治疗下肢长管状骨骨折的临床经验。[方法]带锁髓内钉治疗下肢长管状骨骨折213例，其中68例采用小切口或有限切口复位，严重粉碎性骨折达到功能复位。术后行包括CPM在内的有序功能锻炼。[结果]获得随访205例，时间8-29个月，平均13个月。Ⅰ期愈合189例，延迟愈合16例，经动力化或植骨后，全部骨性愈合，优良率为95．1％。[结论]带锁髓内钉是治疗下肢长管状骨骨折的理想方法，术中骨折复位与保护骨折块血供并重的观念是正确的。     

钛镍形状记忆合金环抱接骨板治疗四肢管状粉碎性骨折

目的 探讨钛镍形状记忆合金(TiNiSMA)环抱接骨板治疗四肢管状骨粉碎性骨折的临床也用价值。方法 对按AO分型的BI～C3型37例四肢管状骨骨折患者行切开复位，TiNiSMA环抱接骨板(部分加骨卡环)内固定。结果 术后随访10～31个月(平均15个月)，骨折均愈合良好，无内固定松脱及折断。结论 TiNiSMA环抱接骨板(部分加卡环)治疗四肢管状骨粉碎性骨折疗效满意，固定可靠；部分C3型骨折注意选择性使用，对中老年患者术后不必二次取出者更适用。     

经皮微创生物学技术的钢板固定治疗下肢长管状骨干骺部粉碎性骨折

目的探讨经皮微创生物学技术的钢板内固定治疗下肢长管状骨干骺部粉碎性骨折的临床价值。方法1999年4月～2001年10月,采用经皮微创生物学技术的钢板内固定治疗68例股骨或胫骨干骺部粉碎骨折的病人,术后早期功能锻炼。结果全部病例获得随诊,平均时间为10个月。65例术后X线检查显示复位和内固定位置满意,侧方成角8°1例,患肢缩短2cm2例。68例骨折全部愈合。按Klemm功能恢复分级标准,优56例,良10例,可2例。无深部感染、骨延迟愈合等并发症发生。结论应用经皮微创生物学技术的钢板内固定治疗长管状骨干骺部粉碎性骨折,可以达到医源性创伤小,骨折固定牢靠和早期功能锻炼的目的,具有重要的临床应用价值。     

锁定接骨板桥接式固定治疗锁骨中段长节段粉碎性骨折

目的探讨锁定接骨板(LCP)桥接式固定治疗锁骨中段长节段粉碎性骨折的临床应用及疗效。方法对48例锁骨中段长节段粉碎性骨折均采用LCP桥接固定治疗。结果随访6～30个月,平均12个月。骨折临床愈合时间平均12周(9～16周),无感染、骨不愈合及延迟愈合,无接骨板、螺钉断裂,未发生畸形愈合。结论 LCP桥接式固定治疗锁骨中段骨折符合生物学固定原则,具有手术简便、骨折愈合快的优点,减少了手术风险,具有临床推广价值。     

组合式外固定器结合有限内固定治疗长管状骨粉碎性骨折

目的：探讨长管状骨粉碎性骨折的治疗方法和疗效。方法：对42例长管状骨粉碎性骨折应用组合术外固定器结合有限内固定方法治疗。结果：随访6个月-3年。平均8个月。骨折全部骨性愈合。骨愈合时间平均3.7个月。针道感染3例（7.1%)。结论：组合式外固定器复合有限内固定，创伤小复位满意，固定可靠。是治疗长管状骨粉碎性骨折理想的方法之一。     

锁定加压接骨板治疗胫骨远端骨折疗效观察

目的探讨锁定加压接骨板(LCP)治疗胫骨远端骨折的临床疗效。方法 2006年7月～2008年6月我科共收治胫骨远端骨折经LCP处理28例,闭合性骨折19例,开放性骨折9例;采用胫骨内侧入路切开撬拨复位,胫骨远端锁定加压接骨板内固定,术后无需外固定。早期开始踝、膝关节功能锻炼。结果术后伤口均获得一期愈合,骨痂形成时间4～10周,平均7.2周。所有患者随访4～16个月,平均8.6个月;按照Lysholm及Baird-Jackson标准评分:优21例,良5例,中2例,优良率为92.9%。无并发症发生。结论 LCP治疗胫骨远端骨折具有操作简便、固定可靠、对骨膜损伤小等明显优点,对于胫骨远端邻近关节骨折,尤其是粉碎性骨折患者是比较理想的治疗方法。     

锁定钢板技术治疗重度粉碎性骨折及难治性骨折的临床研究

目的分析和总结锁定加压接骨板技术治疗四肢重度粉碎性骨折及难治性骨折的临床经验。方法 2010年1月～2011年4月对59例四肢重度粉碎性骨折及难治性骨折患者采用锁定加压接骨板技术治疗。结果本组59例,获术后随访53例,除1例股骨干粉碎性骨折术后发生钢板断裂,另1例胫腓骨开放性粉碎性骨折术后伤口出现浅表感染,其余51例骨折全部愈合,上肢骨折愈合时间为8～12周,下肢骨折愈合时间为10～20周,无锁定螺钉松脱、骨折变形、骨不连、骨感染等情况发生,伤肢功能恢复满意。结论锁定加压接骨板技术具有手术创伤小、固定可靠、可以早期活动、骨折愈合率高等优点,是治疗四肢重度粉碎性骨折及难治性骨折的理想方法,可以预期取得较好的临床效果。     

锁定钢板内固定微创治疗股骨粗隆下长节段粉碎性骨折

目的 探讨锁定钢板结合经皮微创钢板固定技术(MWPO)治疗股骨粗隆下长节段粉碎性骨折临床疗效.方法 股骨粗隆下长或多节段粉碎性骨折21例均采用MIPPO技术行锁定钢板内固定治疗.结果 21例获得随访,平均15个月(12～24个月).除1例术后骨不连行二次手术植骨后愈合外,余20例均于术后4～6个月愈合,平均愈合时间5.1个月.疗效采用Harris髋部功能评分标准:优15例,良5例,可1例.结论 锁定钢板结合MIPPO技术治疗股骨粗隆下长节段粉碎性骨折,符合骨折治疗的微创、损伤控制理念,固定可靠.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.