骨水泥分布指数对椎体成形术后症状性邻近节段骨折的影响

目的 探讨骨水泥分布的评价方式及其对椎体成形术后邻椎骨折的影响.方法 回顾分析2011年4月~2014年4月在我院诊断为骨质疏松压缩骨折并接受椎体成形手术的患者(54~91岁)143例,术后随访1年.134例完成随访,其中18例发生邻近节段骨折,为再骨折组,116例未发生邻近节段骨折,为对照组.所有患者术后均复查X线,将骨水泥按照形态和位置分为5种类型.根据术中注射骨水泥的量和椎体体积计算骨水泥的量体指数.分析两组患者的年龄、性别、骨密度、骨水泥量、骨水泥分布指数、量体指数、骨水泥渗漏等的差异.选择有差异的变量纳入Logistic回归进行多因素分析.结果 再骨折组的骨密度显著低于对照组(P<0.05),骨水泥渗漏的发生率显著高于对照组(P<0.05).两组患者骨水泥分布指数有统计学差异(P<0.05).但是,两组患者性别、年龄、骨水泥量及量体指数均无显著性差异(P>0.05).Logistic回归分析表明,低骨密度、骨水泥渗漏和骨水泥的不同分布类型显著影响邻椎骨折的发生率.结论 骨水泥分布指数低、骨水泥渗漏及低骨密度可能是椎体成形术后邻椎再骨折的危险因素.     

经皮椎体成形联合椎旁注射治疗骨质疏松脊椎压缩性骨折

目的：经皮椎体成形（PVP）联合椎旁注射治疗骨质疏松脊椎骨折的疗效和探讨。方法：采用经皮椎体成形联合椎旁注射治疗骨质疏松脊椎压缩性骨折患者20例（14椎体）,均为后壁完整的持续疼痛性脊椎压缩性骨折。手术过程为经单侧或双侧椎弓根穿刺后,以专用注入系统注入骨水泥强化椎体,并在椎旁注射药物,观察术后病状改善情况。结果：20例患者手术均顺利完成,在术后2小时内疼痛明显缓解,所有病例均未出现骨水泥渗漏,血管神经受压等并发症[1]。结论：治疗骨质疏松性脊椎压缩骨折的微创术式可以采用经皮椎体成形、联合椎旁注射药物治疗的方法,它可以较快的使疼痛缓解,改善脊椎屈伸功能。     

经皮椎体成形术后骨水泥渗漏的影像学表现及相关因素探讨

目的:探讨经皮椎体成形术后骨水泥渗漏的X线征象及其相关因素与预防。方法:分析28例46椎经皮椎体成形术后患者的影像及临床资料,其中转移性肿瘤4例5椎,椎体血管瘤2例2椎,骨质疏松性压缩性骨折9例23椎,外伤性压缩性骨折13例16椎。结果:22例32椎出现骨水泥渗漏,渗漏率69.6%(32/46),静脉丛渗漏23椎,其中并发肺栓塞3例及下腔静脉骨水泥栓子1例,椎间盘渗漏4椎,针道渗漏8椎,椎旁软组织渗漏3椎,椎管内渗漏4椎。结论:经皮椎体成形术骨水泥渗漏率较高,术中加强监控及术后X线常规检查有利于尽早发现、处理骨水泥渗出,严格的掌握手术适应证及良好的手术技巧可减少并发症的发生。     

CT引导下经皮穿刺椎体成形术的初步应用

目的　探讨CT引导下行经皮穿刺椎体成形术的特点和疗效。方法　 8例 (13个椎体 )腰背痛患者 ,其中 7例 (12椎 )骨质疏松性椎体压缩骨折 ,1例 (1椎 )椎体恶性肿瘤。在CT定位及引导下进行经皮穿刺椎体成形术。术中间断扫描调整穿刺针位置及注射聚甲基丙烯酸甲酯骨水泥。记录手术时间及骨水泥注射量 ,术毕CT扫描了解骨水泥分布。用疼痛视觉模拟评分法(VAS)进行疗效评估 ,随访 2～ 5个月 (平均 4个月 )。结果　 8例 (13个椎体均穿刺成功 ,骨水泥注射量 0 .5～ 2 .8ml,平均 (1.9±0 .6 )ml,手术时间每椎体 85～ 15 0min[平均 (118± 30 )min]。出现骨水泥少量椎管内硬膜外静脉内漏 1椎 ,无临床症状。止痛效果 8例有效 ,VAS术前 7.8± 1.1,术后 2 4h3.8± 1.3,与术前比较明显减轻 (P <0 .0 5 ) ,平均术后 4月随访VAS 2 .9± 1.8,显示疗效维持。结论　经皮穿刺椎体成形术有明显止痛效果。CT引导下进行该手术具有穿刺准确的优点 ,但不能实时监测骨水泥注射情况和手术耗时较长。     

旋转3D-RA椎体重建在PVP术中的应用

目的探讨数字平板探测器三维旋转血管造影（3D-RA）重建功能在椎体成形术中的应用价值。方法60例共103节椎体压缩性骨折患者,在椎体成形术前、进针过程中、及注入骨水泥后分别行三维旋转采集并立即作三维重建,以观察椎弓根、椎体形态及骨皮质的完整程度,进针针尖的方向和位置,观察骨水泥在椎体内的分布情况以及骨水泥的渗漏情况。结果所有病例中2例椎弓根不完整,2例椎体后缘不完整。进针过程中2例穿破椎弓根皮质,2例针尖穿破椎体前缘皮质,术中重新调整针尖方向。注入骨水泥后三维重建发现6例椎管内漏,8例椎间盘漏及椎旁漏。所有病例均未经外科手术治疗。结论椎体三维重建（3D-RA）在PVP术前可以指导进针,术中可观察进针方向和位置,术后可观察骨水泥在椎体内的分布情况及骨水泥渗漏情况,特别是在下颈椎、上胸椎的PVP术中有较大的应用价值。     

Sky膨胀型骨扩张器在骨质疏松性椎体压缩骨折后凸成形中的初步临床应用

目的:探讨Sky骨扩张器经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的近期临床疗效。方法:对18例24个椎体的骨质疏松性压缩骨折患者,应用Sky骨扩张器进行经皮椎体后凸成形治疗,观察患者术前、术后疼痛视觉模拟评分(VAS),测量手术前后各病椎椎体前缘、后缘高度,进行比较和统计学分析。结果:24个椎体均为单侧经椎弓根穿刺成功完成手术,失血量平均每例约15ml,每个椎体平均手术时间47min,每个椎体注入骨水泥(4.2±0.8)ml,分布均超过中线。2例骨水泥外漏为沿针道返流,但无临床症状。所有患者疼痛缓解,VAS评分术前(8.2±1.6)分,术后3天(3.1±2.3)分;随访5个月～23个月,随访VAS(2.7±2.8)分(P<0.01)。伤椎前缘平均高度术前17.35mm,术后20.05mm(P<0.01);伤椎后缘平均高度木前22.78mm,术后23.49mm(P<0.05)。结论:Sky骨扩张器是经皮脊柱后凸成形术的新型器械,是治疗骨质疏松性椎体压缩骨折的安全、有效的微创治疗方法。     

老年骨质疏松性脊柱骨折骨水泥微创注射治疗报告

目的 观察骨水泥微创注射治疗老年骨质疏松性脊柱压缩性骨折手术治疗中的应用.方法 骨质疏松性椎体压缩骨折30例(33个椎体),平均年龄76.5岁.C型臂透视下经皮穿刺在病椎单侧注入骨水泥,进行临床和影响学评价分析.结果 本组患者均获得4-25个月随访,平均12.4个月.30例患者术后局部疼痛及临床症状得改善.并于术后次日下床活动.术后X线检查显示椎内骨水泥分布均匀,未有外漏.结论 骨水泥微创注射可有效安全的缓解骨质疏松椎体压缩性骨折引起的疼痛,具有微创,安全并发症少等的优点.     

经皮椎体成形二次穿刺骨水泥注入治疗弥散不良的骨质疏松性椎体压缩骨折

目的:探讨经皮椎体成形二次穿刺骨水泥注入治疗上终板、下终板区域弥散不良的骨质疏松性椎体压缩骨折(OVCF)的临床疗效.方法:回顾性分析采用经皮椎体成形手术治疗的OVCF患者病例,其中34例在手术中发现骨水泥在临近上终板或下终板区域弥散不良,遂调整穿刺角度进行二次穿刺和骨水泥注入.观察并记录手术前、手术后第1天以及末次随...     

明胶海绵在经皮椎体成型术预防渗漏中的应用价值

经皮椎体成形术和椎体后凸成形术是近年来治疗老年骨质疏松椎体骨折的一个热点，然而，由于骨水泥易渗漏而使手术风险增大。因此术中如何预防骨水泥渗漏成为减少手术并发症、拓宽手术适应症的关键。自2003年6月以来，我们采用经穿刺针推入明胶海绵条行局部栓塞以预防骨水泥外渗的方法治疗骨质疏松椎体骨折患35例39椎，取得了较好的临床效果。[第一段]     

经皮椎体成形式骨水泥注射器的改进及临床应用

目的：评价经皮椎体成形术（percutaneous vertebroplasty,PVP）中定向骨水泥注射器治疗骨质疏松性椎体压缩性骨折的疗效及优缺点。方法：回顾性分析2017年2月至2018年2月采用定向骨水泥注射器手术治疗骨质疏松性椎体压缩性骨折22例（25椎）患者的临床资料,对手术过程中细节、骨水泥注射位置及分布、骨水泥渗漏情况、手术疗效、术后并发症等结果进行评价;并与采用传统骨水泥注射器手术的25例（25椎）患者资料进行对比,进一步评价其临床应用疗效。结果：患者均顺利完成手术,定向治疗组术后X线示骨水泥于骨折部位较为均匀分布,弥散良好;骨水泥渗漏率为28%,无椎体骨水泥向椎体后缘及椎管内渗漏;术后伤椎高度及椎体后凸Cobb角度均得到改善（P < 0.05）;术前、术后2 d与术后3个月的10分制视觉模拟（visual analogue scale,VAS）评分和Oswestry功能障碍指数（oswestry dissbility index,ODI）评分均得到改善（P < 0.05）。且相较于传统组,使用定向骨水泥注射器能够有效提高伤椎高度（P < 0.05）,骨水泥渗漏发生率较低,但伤椎Cobb角度的恢复没有传统组明显（P > 0.05）。结论：定向骨水泥注射器能够有效起到定向性注射骨水泥的作用且对治疗压缩程度不是很严重的疼痛性骨质疏松性椎体压缩性骨折具有良好的临床疗效。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.