峡部裂性与退变性腰椎滑脱MSCT扫描解剖学因素的对照研究

目的利用多层螺旋CT(multi-slice spiral CT,MSCT)对峡部裂性与退变性腰椎滑脱解剖学因素进行对比分析。方法选取108例腰椎滑脱患者,滑脱椎体均为L4,其中峡部裂性腰椎滑脱(峡部裂组)54例,退变性腰椎滑脱(退变组)54例,均经MSCT检查确诊。分别测量2组病例的骶骨倾斜角、腰椎前凸角、椎间关节角度、椎弓峡部宽度、滑脱距离、滑脱指数。结果峡部裂组年龄、腰椎前凸角、椎弓峡部宽度小于退变组,关节突关节面与矢状面夹角、滑脱指数大于退变组(P<0.05或P<0.01);2组骶骨倾斜角差异无统计学意义(P>0.05)。结论峡部裂性腰椎滑脱患者发病年龄早于、滑脱指数大于退变性腰椎滑脱患者;椎弓峡部发育不良或形态改变(纤细)为峡部裂性腰椎滑脱发病的重要因素;椎间关节面与矢状面夹角变小以及腰椎前凸角增大在退变性腰椎滑脱形成中起一定作用。更多还原     

关节突关节矢向化与退变性腰椎滑脱关系的研究进展

退变性腰椎滑脱(Degenerative lumbar spondylolisthesis,DLS)是临床常见的脊柱退行性改变疾病的一种。发病机制目前不清楚,可能跟患者的工作性质、劳作强度、日常作息习惯有关,未发现与遗传有关。退变性腰椎滑脱的患者可以没有临床症状,大部分就诊患者存在腰骶部疼痛的临床表现。临床诊断退变性腰椎滑脱主要依靠腰椎正侧位X光片以及腰椎螺旋CT扫描助诊。腰椎发生退变性滑脱时,附件骨及所组成的关节突关节角(Articular facet joint angle,FJO)的形态及角度会发生改变,这个角度可以评价关节突关节角的矢向化程度。利用螺旋CT后处理工作站ADW对腰椎患者的数据处理后,测量L2-3、L3-4、L4-5、L5-S1双侧关节突关节矢向化的角度(α1与α2)的大小,后期通过横向与未发生腰椎滑脱患者的比较、纵向与不同年龄组DLS患者的比较,研究FJO矢向化与DLS二者的因果关系。本综述将着重介绍腰椎退变性滑脱时,相应水平关节突关节角度的大小及矢向化的程度的测量方法与相关概述。     

基于CT观察退变性腰椎滑脱症与关节突关节角及关节椎弓根角的关系

目的:基于CT观察探讨退变性腰椎滑脱(DLS)与关节突关节角和关节椎弓根角的关系。方法:回顾性收集2020年1月至2022年6月四川省骨科医院收治的169例DLS症患者纳为DLS组,另选取同期于我院体检并伴有腰腿疼痛但未腰椎滑脱的169例年龄匹配患者作为健康组;对比DLS组和健康组的临床资料,单因素以及多因素logistic回归分析影响DLS的危险因素;通过平滑曲线拟合分析关节突关节角和关节椎弓根角与DLS的曲线关系,构建贝叶斯网络模型并对其预测效能进行验证。结果:单因素分析结果显示DLS组在BMI、椎间盘退变、全身关节松弛、腰椎结构及曲度发生改变、韧带松弛、骨质疏松、脱钙、腰椎小关节突病变、合并糖尿病方面均高于健康组(P<0.05);DLS组的关节突关节角与健康组相比减小,关节突关节角不对称以及退变程度为1、2级的人数比例上升,椎弓根角显著增大(P<0.05);多因素分析结果表明BMI增加、椎间盘退变、腰椎结构及曲度发生改变、韧带松弛、骨质疏松、脱钙、全身关节松弛、腰椎小关节突病变、合并糖尿病、关节突关节角减小、关节突关节角不对称、关节突关节的退变以及椎弓根角的增加都是导...     

腰椎关节突关节角度与峡部裂及退变性脊柱滑脱的关系探讨

目的 探讨腰椎关节突关节面角度变化与退变性及峡部裂性脊柱滑脱的关系.方法 对37例脊柱滑脱患者(L4～5退变滑脱22例;L5～S1峡部裂滑脱15例)与25例正常人进行对照检查.结果 退变性滑脱患者关节突关节角度与对照相比明显偏向于矢状位(P＜0.01);而峡部裂滑脱患者关节突关节角度与对照组相比无明显差异(P＞0.10);退变性滑脱患者关节突关节不对称与对照组相比无明显差异(P＞0.05),峡部裂滑脱患者关节突关节不对称与对照组差异有统计学意义(P＜0.05).结论 退变性腰椎滑脱关节突关节面方向更接近矢状位,峡部裂腰椎滑脱患者关节突关节面无一定方向性,关节突关节角度的不对称可能对峡部裂的形成有一定影响.关节突关节角偏向矢状方向有早期出现滑脱的危险;关节突关节不对称提示峡部裂发生的可能.     

退变性腰椎滑脱与腰椎小关节形态改变相关性分析

目的通过腰椎小关节的骨关节炎分级、关节矢状角、终板下关节角在不同滑脱程度的退变性腰椎滑脱患者中的改变,探讨退变性腰椎滑脱程度与腰椎小关节形态相关性。方法回顾性分析2009年10月～2011年11月L4/5退变性腰椎滑脱患者43例,Ⅰ度退变性腰椎滑脱29例为A组,Ⅱ度退变性腰椎滑脱14例为B组;Weishaupt关节炎影像学法对L4/5小关节炎进行分级;CT测量L4/5小关节矢状角、L4终板下关节角。不同退变性腰椎滑脱组的骨关节炎分级,关节矢状角和L4终板下关节角及两侧对称性比较。结果 A组和B组骨关节炎均无0级,其中,A组1、2、3级分别为4、11、14例;B组分别为1、6、7例,两组骨关节炎分级无差异（P〉0.05）。A组L4/5关节矢状角、L4终板下关节角[（28.69±8.97）°、（115.91±6.51）°]与B组[（28.23±11.89）°、（117.90±7.23）°]比较,差异无统计学意义（P〉0.05）;两侧关节矢状角对称性差异、终板下关节角对称性差异A组[（9.06±4.45）°、（5.21±3.90）°]与B组[（12.80±4.95）°、（8.25±3.62）°]比较,差异有统计学意义（P〈0.05）。结论腰椎小关节矢状角、终板下关节角的不对称性影响退变性腰椎滑脱的滑脱程度。     

退变性腰椎滑脱与相关解剖学因素关系探讨

目的 利用多层螺旋CT扫描探讨退变性腰椎滑脱（degenerative lumber spondylylisthesis,DLS）与相关影响因素的关系,为临床诊治提供指导.方法 选取笔者科室2010年4月～ 2013年12月共55例DLS患者（排除外伤、手术及移行椎等脊柱变异）,其中男性9例,女性46例,滑脱部位均为L4.对照组选取同时间段无腰椎滑脱、年龄构成相似的病例55例,其中男性9例、女性46例.对两组病例关节突关节角度、退变程度、腰骶角等因素与腰椎滑脱关系进行分析研究.结果 两组患者关节突关节与矢状面夹角、腰骶角均值采用独立样本t检验,前者t=-3.68,两者有统计学差异,后者t=0.74,两者无统计学差异,椎间关节退变程度x2 =47.778,差异有统计学意义.结论 DLS组与对照组两组患者腰骶角无明显差异,而关节突关节面与矢状面夹角、椎间关节退变程度之间差异有统计学意义,因此认为后面两因素是退变性腰椎滑脱发生的重要因素,其可能是互为因果、协同促进的关系.     

腰椎关节突关节角度与峡部裂及退变性脊柱滑脱的关系探讨

目的探讨腰椎关节突关节面角度变化与退变性及峡部裂性脊柱滑脱的关系。方法对37例脊柱滑脱患者（L4-5，退变滑脱22例；L5-S1，峡部裂滑脱15例）与25例正常人进行对照检查。结果退变性滑脱患者关节突关节角度与对照相比明显偏向于矢状位（P〈0．01）；而峡部裂滑脱患者关节突关节角度与对照组相比无明显差异（P〉0．10）；退变性滑脱患者关节突关节不对称与对照组相比无明显差异（P〉0．05），峡部裂滑脱患者关节突关节不对称与对照组差异有统计学意义（P〈0．05）。结论退变性腰椎滑脱关节突关节面方向更接近矢状位，峡部裂腰椎滑脱患者关节突关节面无一定方向性，关节突关节角度的不对称可能对峡部裂的形成有一定影响。关节突关节角偏向矢状方向有早期出现滑脱的危险；关节突关节不对称提示峡部裂发生的可能。     

后路减压椎间植骨融合术对退变性腰椎滑脱症脊柱骨盆参数的影响及疗效分析

目的探究后路减压椎间植骨融合术(PLIF)对退变性腰椎滑脱症脊柱骨盆参数的影响及疗效。方法选取180例退变性腰椎滑脱症患者分为对照组86例和观察组94例,分别采用腰椎后外侧融合术(PLF)、PLIF手术治疗,比较两组患者手术前后(6个月)Oswestry功能障碍指数(ODI)、视觉模拟疼痛量表(VAS)评分以及腰椎前凸角(LL)、骨盆倾斜角(PT)、骨盆投射角(PI)、骶骨倾斜角(SS)等脊柱骨盆参数指标情况。结果术前,对照组和观察组ODI、VAS评分差异无统计学意义(P>0.05);术后6个月,对照组和观察组ODI、VAS评分较术前均降低,但观察组降低幅度大于对照组,差异有统计学意义(P<0.05)。术前,对照组和观察组LL、PT、PI、SS水平差异无统计学意义(P>0.05);术后6个月,对照组和观察组LL、PT、PI、SS较之前均改善,但观察组改善幅度大于对照组,差异有统计学意义(P<0.05)。结论 PLIF手术应用在退变性腰椎滑脱症的治疗中效果明显,值得推广。     

退变性腰椎滑脱的脊柱-骨盆矢状位参数特征分析

目的 探讨退变性腰椎滑脱患者脊柱-骨盆矢状位参数特征及这些参数与腰椎滑脱的关系。方法 选择2016年6月至2018年6月我院收治的42例退变性腰椎滑脱患者（退变性腰椎滑脱组）和58例无滑脱的退变性腰椎疾病患者（对照组）作为研究对象。收集两组研究对象的一般资料,在脊柱全长正侧位X线片上测量骨盆倾斜角（PT）、骨盆投射角（PI）、骶骨倾斜角（SS）、腰椎前凸角（LL）、胸腰椎后凸角（TLK）、胸椎后凸角（TK）、矢状面躯干偏移（SVA）等矢状位参数,比较两组研究对象一般资料和矢状位参数的差异。以腰椎滑脱率为因变量,脊柱-骨盆矢状位参数为自变量,采用logistic回归模型分析腰椎滑脱程度的危险因素。结果 两组研究对象年龄、性别、身高、体质量差异均无统计学意义（P均>0.05）。退变性腰椎滑脱组和对照组患者PT、PI、SS、LL、TLK、SVA差异均有统计学意义（P均<0.05）,而两组间TK差异无统计学意义（P>0.05）。对退变性腰椎滑脱组进行logistic回归分析,发现LL、PT是影响腰椎滑脱程度的危险因素（P均<0.05）。结论 退变性腰椎滑脱患者矢状位参数PT、PI、SS、LL、TLK、SVA明显改变,LL、PT是影响腰椎滑脱程度的危险因素。     

骨质疏松性胸腰段椎体压缩骨折脊柱—骨盆矢状位参数与腰椎滑脱的相关性研究

目的：分析骨质疏松性胸腰段椎体压缩骨折脊柱—骨盆矢状位参数与腰椎滑脱(DLS)的相关性。方法：选择我院2020年1月—2022年1月诊治的骨质疏松性胸腰段椎体压缩骨折DLS患者107例，将其纳入观察组。另在同期按照1∶1原则纳入单纯骨质疏松性胸腰段椎体压缩骨折患者107例，将其纳入对照组。由骨科专业影像学医生使用X线片拍摄，对患者的脊柱—骨盆矢状位参数进行收集，包括解剖学参数中骨盆投射角(PI)、胸椎后凸角(TK)及姿势相关性参数中骨盆倾斜角(PT)及骶骨倾斜角(SS)。DLS程度参考SDSG小组制定滑脱分级标准进行判断，并根据结果分成低度滑脱(低PI组、正常形态组、非正常形态组)、高度滑脱(平衡组、失衡组)亚组。结果：观察组患者PI、TK、PT、SS均大于对照组(均P<0.05)。低度滑脱PI、TK、PT、SS均小于高度滑脱(P<0.05)。非正常形态患者TK、PT、SS均大于低PI组、正常形态组(P<0.05);除PI外，PI组、正常形态组比较差异无统计学意义(P>0.05)。失衡组PI、PT、TK高于平衡组(P<0.05),SS低于失衡组(P<...     

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.