腰椎滑脱患者关节突关节形态的评价

目的文章探讨关节突关节形态对腰椎滑脱的影响。方法L4～5节段退变性滑脱25例(均年龄55岁)、后滑脱12例(均年龄53岁)和峡部裂滑脱11例(均年龄44岁)与32例(均年龄47岁)正常人进行对照检查。CT轴向扫描关节突关节,测量L3～4、L4～5、L5～S1关节突关节角度、关节宽度、关节面的深度和关节面形态。结果由上向下关节角度逐步从矢状向冠状转化。在L4～5节段退变性滑脱患者关节角度方向与对照组相比明显偏向矢状(P<0.01),退变性滑脱组和后滑脱组的关节宽度均大于对照组(P<0.01),退变性滑脱组的关节面深度比也有显著差异。峡部裂滑脱组的唯一差异是关节宽度显著减少(P<0.01)。结论结果提示关节突关节矢状排列可能是生长过程中形成的,某些患者发生腰椎退变时可能会出现滑脱。     

关节突关节形态与退变性腰椎滑脱的关系

目的 探讨关节突关节形态与退变性腰椎滑脱的方法。方法 首先对41例60岁以下（平均年龄55岁）有L4－5退变性滑脱的患者和32例（平均年龄53岁）正常人进行对照检查。用CT轴向扫描关节突关节，测量L3－4，L4－5，L5－S1关节突关节的角度，关节横向，关节面的深度和观察关节面形态。第二部分研究分别测量40例40岁以下和40例60岁以肯要痛患者的关节突关节角度，观察其关节。结果 退变笥滑脱患者与对照组相比，L4－5节段关节角度方向明显偏向矢状面，关节角度不对称和关节面深度比也有显著差异。第二部分2组下腰痛患者的关节突关节角度无统计学差异。结论 60岁以下的退变性腰椎滑脱患者存在着关节突关节形态异常，L4－5节段关节或矢状排列和／或同时伴有关节角不对称是腰椎早期滑脱的危险因素。     

腰椎滑脱患者关节突关节形态的评价

目的 文章探讨关节突关节形态对腰椎滑脱的影响。方法 L4－5节段退变性滑脱25例（均年龄55岁），后滑脱12例（均年龄53岁）和峡部裂滑脱11例（均年龄44岁）与32例（均年龄47岁）正常人进行对照检查，CT轴向扫描关节突关节，测量L3－4，L－4，5L5－S1关节突关节角度，关节宽度，的深度和关节面形态。结果 由上向下关节角度逐步从矢状向冠状转化。在L4－5节段退变性滑脱患者关节角度方向与对照组相比明显偏向矢状（P＜0．01），退变性滑脱组和后滑脱组的关节宽度均大于对照组（P＜0．01），退变性滑脱组的关节面深度比有显著差异，峡部裂滑脱组的唯一差异是关节宽度显著减少（P＜0．01）。结论 结果提示关节突变状排列可能是生长过程中形成的，某些患者发生腰椎退变性时可能会出现滑脱。     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景：腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少.目的：调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用.方法：测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值〈7°定义为小关节对称,差值≥7°定义为小关节不对称.对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级.结果与结论：①小关节是否对称在年龄及性别上差异无显著性（P 〉 0.05）.②小关节不对称与椎间盘退变程度之间无显著关联（P 〉 0.05）.③在L4～L5节段小关节不对称组比小关节对称组的小关节退变程度更重（P 〈 0.01）.提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4～L5节段,小关节不对称可能会引起小关节的退变.     

腰椎侧弯患者关节突关节形态及其临床意义

目的：研究下腰痛患者关节突关节形态与腰椎侧弯的关系。方法：37例腰椎侧弯的下腰痛患者，通过X线摄片和CT轴向扫描，测量L3／4、LA／5、L5／S1关节突关节形态。26例正常者作为对照。结果：在腰椎侧弯患者中L4／5节段关节突关节不对称为72％，L5／S1节段为49％。结论：腰椎侧弯与关节突关节不对称有关，可能是侧方不稳、滑脱的原因。     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景:腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少。目的:调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用。方法:测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值<7°定义为小关节对称,差值≥7°定义为小关节不对称。对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级。结果与结论:①小关节是否对称在年龄及性别上差异无显著性(P>0.05)。②小关节不对称与椎间盘退变程度之间无显著关联(P>0.05)。③在L4～L5节段小关节不对称组比小关节对称组的小关节退变程度更重(P<0.01)。提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4～L5节段,小关节不对称可能会引起小关节的退变。     

退行性变腰椎滑脱及腰椎间盘突出症患者的放射学评价

目的：观察退行性变腰椎滑脱和椎间盘突出患者关节突关节和椎板的结构变异。以揭示腰椎骨、关节及神经等结构的发育异常或先天性缺陷与下腰痛发生的潜在关系。方法：36例平均年龄39岁腰椎间盘突出症患者，35例平均年龄55岁退行性变腰椎滑脱患者及26例正常人摄制X射线正位片，CT扫描测量关节突和椎板形态(L4-5)。根据下关节突外间距是否比椎弓峡部间距宽和能否显示关节突关节间隙分为X(X1,X2，X3)型和W型，X1型和X2型下关节突均向侧方伸展，但X1型不显示关节间隙。X3型能见到一侧关节间隙。W型下关节突收窄，两侧关节间隙都能显示。结果：W型的关节突矢状排列，在正常组中少见(6．89％)，退行性变腰椎滑脱组占多数(45．71％)。X1型关节突冠状排列，在对照组(55．17％)和椎间盘突出组(58．33％)中占多数。X型的椎管大多数为三叶形并伴有侧隐窝狭窄，这可能与滑脱和骨关节炎有关。结论：结果提示W型是发生退行性变腰椎滑脱和椎管狭窄的潜在因素。     

MRI腰椎小关节积液影像对退行性腰椎动态不稳的预测价值

目的:分析腰椎退行性疾病患者MRI上L4,5小关节积液和X线上矢状位腰椎动力位不稳的相关性.方法:2006年1月～2009年12月在我院行腰椎MRI和站立位过伸过屈X线检查的98例L4,5腰椎退行性疾病患者,在轴状位MRI T2像上测量L4,5小关节积液和站立位过伸过屈侧位X线片影像评估腰椎不稳.记录L4,5小关节积液大小和动态不稳滑移参数.统计学分析是否小关节积液与腰椎动态不稳存在关系.结果:98例患者中,33例在站立位过伸过屈位X线片出现L4,5动态不稳,65例没有出现动态不稳.24例(73%)动态不稳患者出现小关节积液,平均滑移参数是11.6%(0%～32%),平均小关节积液数值是1.98mm(0～6.28mm).22例(34%)没有出现动态不稳患者例出现小关节积液,平均小关节积液数值是1.02mm(0～4.36mm).小关节积液大小与腰椎动态不稳存在联系,并有统计学意义(P<0.05).结论:在MRI上出现小关节积液信号提示腰椎退行性动态不稳,小关节积液量与腰椎动态不稳正相关.     

腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系

目的：研究腰腿痛患者关节突关节不对称与椎间盘退变和突出的关系。方法：通过151例腰腿痛患者CT片观察椎间盘突出状况和测定关节突关节角度,其中73例患者还做了MRI检查,了解关节突关节不对称与椎间盘退变的关系。结果：关节突关节不对称与椎间盘退变和突出有关,而椎间盘突出方向与关节面的偏向无关。结论：关节突关节不对称增加了椎间盘退变和突出的危险性。     

腰椎间盘置换对腰椎前凸的影响

背景：人工全椎间盘置换是近年来治疗腰背部疼痛可选择的方法之一,但有关置换后对腰椎矢状面影响的报道较少。目的：分析腰椎间盘置换后对腰椎前凸的影响。方法：回顾性分析17例曾因单节段退变性椎间盘疾病行腰椎间盘置换的患者影像学资料,数据测量包括置换前及置换后腰椎前凸角、病变节段前凸角、腰骶椎间角。结果与结论：17例患者随访均12个月以上。行椎间盘置换的患者中L4-5节段病变3例,L5-S1节段病变14例。与椎间盘置换前相比,椎间盘置换后平均病变节段前凸角、腰椎前凸角均显著增加(P<0.05);与椎间盘置换前相比,假体置入后腰骶椎间角增加,但差异无显著性意义。结果提示,对于单节段退变性椎间盘疾病腰椎间盘置换后有助于增加患者腰椎前凸和病变节段前凸角度,有助于改善患者腰椎矢状面平衡。置换后腰骶椎间角与置换节段假体置入角度无关。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.