高频超声在儿童胫骨骨折弹性髓内钉内固定术中的应用价值

目的 评估高频超声在儿童胫骨骨折弹性髓内钉内固定术中的应用价值.方法 回顾分析2009年1月至2015年1月于承德医学院附属医院行闭合复位的50例胫骨干骨折患儿的临床资料.其中25例在高频超声监视下,应用弹性髓内钉行闭合复位内固定,最终C型臂透视确定,即高频超声组;25例C型臂引导下应用弹性髓内钉行闭合复位内固定,即对照组,所有手术由同一组医师完成.对两组的手术时间、出血量、C型臂透视次数、术后住院时间、愈合时间、内固定取出时间及手术并发痘进行比较分析.结果 两组手术时间、术后住院时间、愈合时间、内固定取出时间和手术并发症间比较均无明显差异(P＞0.05).高频超声组出血量为(17.44±3.96)mL,低于对照组(23.32±55.71) mL,差异有统计学意义(P＜0.05).高频超声组C型臂透视次数为(2.16±0.47)次,少于对照组(5.60±1.50)次,差异有统计学意义(P＜0.05).结论 高频超声在儿童胫骨骨折弹性髓内钉内固定术中临床疗效可靠,避免放射线的暴露,出血少,可以动态观察骨折复位,减少血管及神经损伤的几率,有很好的临床应用前景.     

41例胫骨骨折采用闭合复位加交锁髓内钉治疗临床体会

目的探讨C臂X光机透视下,闭合复位加交锁髓内钉内固定治疗各胫骨骨折的临床疗效。方法对41例胫骨骨折采用C臂X光机透视下闭合复位加交锁髓内钉内固定术。结果41例全部得到随访,骨折全部骨性愈合,膝踝关节功能良好,无一例感染。结论透视下闭合复位交锁髓内钉内固定治疗胫骨骨折损伤小,并发症少等是一种安全有效的方法。     

弹性髓内钉治疗儿童桡骨颈骨折26例

目的探讨应用闭合复位、弹性髓内钉治疗儿童桡骨颈骨折的临床疗效。方法我院骨科自2008年1月至2011年1月采用弹性髓内钉治疗儿童桡骨颈骨折26例。年龄为4岁4个月~14岁10个月,平均9岁1个月。术前根据X线片选择弹性钉的直径1.5~2.5 mm（直径为中段骨干髓腔内径的2/3）,不预弯弹性钉。手术均在C型臂电视X光机透视下进行,在桡骨远端骺板上方2 cm做2 cm小切口,导入1枚弹性髓内钉到达骨折端,采用闭合复位,当骨折复位满意后,用弹性髓内钉固定。结果本组全部病例均闭合复位成功,无一例切开。术后随访6~19个月,平均11个月,所有患者骨折愈合良好,无相关并发症。结论弹性髓内钉满足了儿童骨折理想愈合的所有条件,使用弹性钉治疗儿童桡骨颈骨折可以取得令人满意的结果。     

儿童桡骨颈骨折AO钛制弹性髓内钉治疗的临床分析

目的 分析儿童桡骨颈骨折的治疗及疗效.方法 对20例A、C型儿童桡骨颈骨折采取闭合复位、小切口AO钛制弹性髓内钉内固定治疗.结果 20例随访5-12个月,全部骨性愈合.术后10周完全恢复肘关节功能,无严重的并发症发生.结论 Ao钛制弹性髓内钉闭合复位内固定治疗儿童桡骨颈骨折,安全、微创、并发症少.     

闭合复位加交锁髓内钉内固定治疗胫骨骨折

目的 探讨C臂X光机透视下,闭合复位加交锁髓内钉内田定治疗胫骨骨折的临床疗效.方法 对4l例胫骨骨患者折采用C臂X光机透视下闭合复位加交锁髓内钉内固定术.结果 41例全部得到随访,骨折全部骨性愈合,膝踝关节功能良好,无一例感染.结论 透视下闭合复位交锁髓内钉内固定治疗胫骨骨折损伤小,并发症少,是一种安全有效的方法.     

胫骨干骨折患者交锁髓内钉术后动力化与未动力化的比较研究

目的对比分析在骨折间隙小于2.0mm的情况下,交锁髓内钉进行动力化与未进行动力化治疗胫骨干骨折的临床疗效。方法选取该院于2009年1月至2012年12月收治的157例采用带动力孔的交锁髓内钉闭合复位固定治疗胫骨干骨折且主要骨折间隙小于2.0mm的患者,将其中同意动力化的87例患者分入动力化组并进行髓内钉的动力化,其余70例患者未进行动力化,随访并比较两组的治疗效果。结果动力化组与未动力化组愈合时间的比较差异无统计学意义[(177.4±10.3)d vs.(179.7±9.6)d,t=1.444,P>0.05];内固定术后16周,动力化组的VAS评分明显高于未动力化组[(4.1±0.6)vs.(2.3±0.8),t=16.100,P<0.05)];动力化组术后膝关节疼痛率要明显高于未动力化组(28.7%vs.12.9%,χ2=5.764,P<0.05)。结论采用闭合复位交锁髓内钉内固定治疗胫骨干骨折,当主要骨折间隙小于2.0mm时,髓内钉动力化并不比未动力化更有优势。     

微型钢板及弹性髓内钉治疗儿童尺桡骨远端干骺端骨折的疗效分析

目的 探讨微型钢板及弹性髓内钉治疗儿童尺桡骨远端干骺端骨折的疗效.方法 23例手法复位失败的儿童尺桡骨远端干骺端骨折患儿行切开复位内固定术,桡骨远端应用背侧切口,予T形微型钢板固定;尺骨应用 闭合复位或尺背侧切口,予弹性髓内钉髓内固定,术后石膏固定3～4周.结果 本组均顺利手术,均获得随访,随访时间6～12个月,23例骨折均愈合,术后无骨折再移位发生.术后6个月行Daruwal功能分级功能评估,优19例,良4例,优良率100％.结论 微型钢板及弹性髓内钉治疗儿童尺桡骨远端干骺端骨折,手术入路安全,固定可靠,对骨骺无影响,对周围软组织干扰少,对前臂及腕部功能影响小.     

闭合复位微创经皮弹性髓内钉内固定治疗儿童长骨干骨折的临床疗效

目的：研究对儿童长骨干骨折后实施闭合复位微创经皮弹性髓内钉内固定治疗的应用效果。方法选取采用闭合复位微创经皮弹性髓内钉内固定治疗儿童长骨干骨折患者42例,观察其临床治疗效果。结果术中出血平均(35.1±8.2)mL;手术时间平均(45.2±9.1)min。所有病例均获随访,术后X线片显示骨折愈合良好,关节功能正常。结论临床采用闭合复位弹性髓内钉内固定治疗儿童四肢长骨干骨折,手术中用时较短,出血量较低,手术效果较好,是治疗儿童四肢长骨干骨折的较好方法之一。     

髓内钉闭合置钉导向器的研制及临床应用

目的 探讨应用自行设计研制的髓内钉闭合置钉导向器辅助髓内钉闭合置钉治疗四肢骨干骨折的方法及临床效果。方法 采用前瞻性随机对照研究方法,将2015年8月～2017年8月在我院住院符合纳入标准的60例四肢骨干骨折患者随机分为两组:试验组30例,男18例,女12例;平均年龄(35.06±5.31)岁;术中使用自行设计研制的髓内钉闭合置钉导向器。对照组30例,男16例,女14例;平均年龄(32.03±4.27)岁;术中不使用髓内钉闭合置钉导向器。60例患者均行闭合复位交锁髓内钉内固定术。观察两组患者的术中出血量、确定进针点并开口所需要的透视次数及手术时间、导针通过骨折端进入骨折远端的次数、骨折愈合时间及术后并发症等。结果 60例术后随访12～24个月,平均18个月,全部病例均骨性愈合。未出现伤口感染等并发症。试验组患者的手术时间[(97.94±8.28)min短于对照组(105.42±2.88)min,确定进针点并开口所需要的透视次数(3.58±1.20)次、导针进入骨折远端的穿针次数(1.16±0.16)次少于对照组[(2.86±1.13)次、(4.86±0.22)次],两组比较差异有统计学意义(P0.05)。两组患者的术中出血量及骨折愈合时间、术后并发症比较差异无统计学意义(P0.05)。结论 应用自制髓内钉闭合置钉导向器能辅助术者进行术中骨折闭合复位及髓内钉进钉点定位、闭合置钉,解决髓内钉的进钉点定位及闭合置钉困难的问题,适用于辅助四肢骨干骨折的髓内钉闭合置钉手术,具有很好的临床应用价值。     

弹性髓内钉治疗儿童股骨转子下骨折的疗效分析

目的:分析闭合复位弹性髓内钉内固定+髋人字石膏外固定术治疗儿童股骨转子下骨折的临床疗效。方法:选择股骨转子下骨折患儿13例,均采用C臂机下闭合复位,弹性髓内钉髓内固定辅助髋人字石膏外固定治疗,患肢术后参照Flynn髓内钉治疗股骨骨折的评分标准评价患肢功能。结果:13例患儿术后均无切口感染发生,一期愈合;随访12～18个月,均未出现髓内钉折断、骨折不愈合、骨骺损伤、患肢功能障碍等并发症;其中2例儿童术后出现钉尾激惹,弹性髓内钉取出后症状消失。所有患儿骨折均骨性愈合,末次随访时,患肢功能按Flynn评分标准,获优12例,良1例,优良率达100%。结论:规范化掌握复位级内固定技巧,闭合复位弹性髓内钉内固定+髋人字石膏外固定术治疗儿童股骨转子下骨折能获得满意的临床疗效,其微创、安全、有效,是目前比较理想的治疗方法。     

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.     

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.