椎体后凸成形术在骨质疏松性胸腰椎骨折中应用及风险防范

目的:介绍椎体后凸成形术在骨质疏松性胸腰椎骨折应用及常见并发症的防范.方法:通过33例46个椎体行椎体后凸成形术,术中均予以体感诱发电位监护.结果:46个椎体经球囊扩张后注入骨水泥,骨折复位满意,经7-24个月随访无重大并发症出现.其中并发症:骨水泥渗漏4例,一过性双下肢麻木1例,腰部穿刺部位疼痛1例.结论:经皮穿刺后凸成形术治疗骨质疏松性椎体骨折,疗效满意,通过正确操作,SEP监护等手段,能减少并发症出现,是一种疗效良好安全的治疗骨质疏松性胸腰椎骨折的微创新技术.     

经皮穿刺球囊扩张椎体成形术治疗骨质疏松性胸腰椎压缩性骨折

目的探讨经皮穿刺椎体成形术治疗骨质疏松性脊柱压缩骨折的疗效。方法对骨质疏松性脊柱压缩骨折患者32例进行经皮穿刺球囊扩张椎体成形术治疗,在C型臂X线机下,采用经皮穿刺,经椎弓根或椎弓根外侧穿刺,建立工作通道,置入球囊,加压注入造影剂扩张球囊复位骨折。记录球囊压以及容量,抽出造影剂取出球囊,注入骨水泥,骨水泥固化后拔除工作套管,完成手术。结果 32例患者术后腰背部疼痛基本消失,6～8h后可以离床活动,术后X线确认压缩骨折椎体复位明显,后凸畸形平均矫正8°（5～16°）,术后随访1～12个月,腰背痛无复发,伤椎高度保持。结论经皮穿刺球囊扩张椎体成形术治疗骨质疏松脊柱压缩骨折操作简便,能够迅速缓解疼痛,改善功能。     

PKP治疗胸腰椎压缩性骨折30例

目的 应用PKP治疗胸腰椎压缩性骨折的初步临床疗效评价.方法 回顾分析本科以可膨胀球囊扩张椎体后突成形系统(PKP)为主的综合治疗的30例胸腰椎骨折患者的临床特点、诊断与治疗方法.结果 30例患者中术后随访时间6个月-2年.患者均术后3-5天出院,术后患者疼痛均明显缓解,未发现骨水泥渗漏.结论 对骨质疏松引起的胸腰椎骨折患者,明确诊断后,可膨胀球囊扩张椎体后突成形系统(PKP)是一种简便、有效的术式.     

单侧椎弓根外上入路球囊扩张椎体成形治疗胸腰椎骨折

目的探讨单侧椎弓根外上入路球囊扩张椎体成形治疗骨质疏松性胸腰椎骨折的疗效。方法采用单侧椎弓根外上入路球囊扩张椎体成形手术治疗骨质疏松性胸腰椎骨折患者34例（51个椎体）,观察手术情况和疼痛缓解情况。结果34例患者,疼痛完全缓解15例,部分缓解16例,轻微缓解3例,所有患者术后脊柱疼痛均得以缓解;均获得随访2～18个月,44个新鲜骨折椎体前缘术后高度平均增高0.4cm,7个陈旧性骨折椎体术后高度平均增高0.1cm。结论单侧椎弓根外上方入路球囊扩张成形术治疗胸腰椎骨折疗效可。     

后路减压内固定治疗胸腰椎骨折合并脊髓损伤

目的探讨后路椎管减压、椎弓根螺钉内固定、椎体支撑重建治疗胸腰椎骨折合并脊髓损伤的方法.方法136例胸腰椎骨折合并脊髓神经损伤患者,后路彻底椎管减压脊髓神经松解,应用椎弓根螺钉内固定,同时在后外侧植骨融合的基础上或附加椎体间植骨融合,或附加骨水泥辅助固定椎弓根螺钉、椎体成形术,或附加椎体间置入Cage支撑融合等,观察神经脊髓损伤恢复情况,骨折脱位复位、融合愈合及内固定取出前高度丢失情况.结果按Frankel神经功能分级恢复评价,术前A级14例有3例恢复至B、C级,B级21例有12例恢复至C、D、E级,C级37例有32例恢复至D、E级,其他都有良好的恢复;椎体前缘高度平均恢复13.8 mm,椎体后缘高度平均恢复3.8 mm,Cobbs,角平均恢复14.20,5例骨折脱位复位不满意,4例内固定失败,14例椎体内固定取出前高度丢失10%～30%,6个月至1年植骨均顺利融合愈合.结论后路椎管减压,脊髓神经松解,椎弓根螺钉内固定,后外侧植骨融合是目前治疗胸腰椎骨折合并脊髓损伤较为理想的方法,骨水泥辅助固定椎弓根螺钉、椎体成形术及椎体间置入Cage支撑融合等,扩大了后路椎弓根螺钉内固定的手术适应证.     

椎弓根螺钉内固定联合椎体成形治疗老年新鲜胸腰椎骨折

目的 探讨后路椎弓根螺钉内固定联合椎体成形治疗老年新鲜严重胸腰椎骨折的可行性及临床效果。 方法 观察9例患者,患者年龄61~77岁,平均年龄68.2岁,均为新鲜的、压缩超过1/2或爆裂严重的椎体骨折。所有患者均采用后路椎弓根螺钉内固定复位胸腰椎骨折,经椎弓根穿刺于骨折椎体中注入适量骨水泥治疗胸腰椎骨折。对术前、术后1周及术后3个月骨折椎体的疼痛采用疼痛视觉模拟评分(VAS)及骨折椎体的Cobb角进行对比。 结果 随访6~12个月,术前、术后1周及术后3个月的VAS分别为6.78、1.44、0.22,术后2~3天患者即可下床活动。术后伤椎Cobb角恢复满意,椎管容积明显改善,内固定无松动及断裂,无邻近椎体压缩性骨折等,3例脊髓神经损伤患者术后明显改善。 结论 后路椎弓根螺钉内固定联合椎体成形治疗老年新鲜胸腰椎骨折术后能明显减轻患者疼痛,矫正后凸畸形,能让患者早期下床活动,减少老年患者长期卧床并发症,提高老年患者的生活质量,效果明显。     

经皮内窥镜辅助椎弓根钉内固定并椎体成形术治疗胸腰椎骨折

切开复位椎弓根钉内固定术治疗胸腰椎骨折已被广泛应用于临床,但术后内固定失败和椎体前缘高度丢失仍然存在,伤椎复位后椎体内存在空隙,呈"蛋壳"样畸形是其重要原因[1].我科2005年8月～2007年6月对16例胸腰椎骨折患者采用经皮微创手术,术中经椎弓根通道植骨椎体成形,取得满意效果,现报道如下.     

骨水泥注入椎体成形术治疗老年胸腰椎骨折

目的探讨经皮穿刺骨水泥注入椎体成形术治疗胸腰椎骨折的方法和疗效。方法回顾性分析2004年5月-2009年7月,对43例老年胸腰椎骨折采用经皮穿刺通过伤椎椎弓根灌注注射骨水泥行椎体成形术疗效总结分析。结果本组42例,每个椎体内注入骨水泥2.0~6.0mL,平均4.5mL。3例术中发生椎体外渗漏,因渗漏量较少,未进一步处理。随访12~30个月,平均21个月,除2例遗留腰部轻微疼痛外,其余病例均能较早地下地活动,功能恢复较满意。结论采取经注射骨水泥椎体成形术治疗胸腰椎骨折,手术操作简单,安全性高,是一种较好的治疗老年胸腰椎骨折的方法。     

椎弓根内固定和椎体成形术治疗胸腰椎骨折

目的探讨后路椎弓根内固定联合椎体成形术手术治疗胸腰椎骨折的效果.方法12例胸腰椎骨折患者,伤椎前缘压缩均＞50%,行后路切开复位短节段椎弓根内固定后,用骨水泥经伤椎椎弓根注入椎体成形术.所有病例均于术前、术后行X线或CT检查.术后随访6～12个月,平均10个月.结果手术均获成功,无骨水泥渗漏,无异物反应,术后随访无内固定失败乃伤椎高度明显丢失者.术前有神经症状的患者术后Frankel分级神经功能恢复1级或以上者8例,术前FrankelC级4例,术后无变化.结论后路切开复位椎弓根内固定和骨水泥椎体成形术为胸腰椎骨折提供了一种新的治疗方法.骨水泥椎体成形术有助于胸腰椎骨折术后椎体生理曲度及强度的重建.     

胸腰椎骨折内固定治疗中椎弓根螺钉的定位

目的术前对X线片及CT片进行测量解剖定位,探讨其在指导胸腰椎骨折椎弓根螺钉置入中的临床意义。方法通过对36例胸腰椎骨折患者术前X线片及CT片的研究,术中根据X线片及CT片测出的参数,指导椎弓根钉置入。结果术中经C臂X线机确认,术后再经X线及CT检查证实螺钉均在椎弓根内,粗细长短合适;椎体复位满意,椎管内减压充分,椎体高度及生理前凸恢复良好。结论经椎弓根螺钉内固定技术的关键是掌握好螺钉的进针点,进针角度及深度,因为椎弓根为螺钉的唯一通道,呈现个体化和节段性差异,故术前必须认真研究X线片及CT片。对X线片及CT片测量有助于个体化置钉,从而提高后路椎弓根内固定术的安全性和有效性。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.