SR治疗腰椎滑脱的疗效观察

对12例腰椎滑脱采用SR对峡部崩裂腰椎复位固定、植骨融合、椎管减压手术。结果：复位满意。症状改善明显，优良率为91．6％，融合率为100％。结果表明，运用SR治疗腰椎滑脱疗效满意。     

Tenor内固定移骨融合治疗腰椎滑脱并椎管狭窄31例

目的：观察Tenor内固定系统治疗腰椎滑脱合并腰椎管狭窄的早期疗效。方法：对腰椎滑脱31例采用腰椎管减压、横突间植骨和Tenor内固定系统手术治疗。术前X线Megerding分度，I度滑脱12例，Ⅱ度滑脱19例；L4／5滑脱26例，L5S1滑脱5例。结果：术后平均随访18个月(6-24个月)，比较手术前后X线片滑脱的程度及临床症状，31例患者中27例症状完全消失，优良率87．1％，12例I度滑脱病人及16例Ⅱ度滑脱完全复位，Ⅱ度滑脱复位率为84．2%。结论：Tenor内固定系统加横突间植骨，椎管减压是治疗腰椎滑脱合并椎管狭窄的良好方法。     

窗式减压峡部植骨术治疗椎弓崩裂腰椎滑脱症1例

目的 探讨腰椎椎弓峡部裂伴Ⅰ度滑脱行窗式减压峡部植骨术的疗效.方法 对20例腰椎椎弓峡部裂伴Ⅰ度滑脱患者实施窗式减压单纯峡部植骨术.随访2～7年,平均3.6年.根据症状改善情况及影像学资料评价手术疗效进行分析.结果 窗式减压单纯峡部植骨在症状改善优良率分别为85.0%,植骨融合率分别为95.6%.结论 对于腰椎椎弓峡部裂伴Ⅰ度滑脱患者窗富式减压单纯峡部植骨治疗方法疗效满意,融合率高.单纯嵌入式植骨的术式简单,并发症少.     

脊椎钉棒固定系统并椎体间植骨治疗腰椎滑脱症30例分析

腰椎滑脱症常因退行性及峡部裂造成,腰椎滑脱是中老年产生腰腿痛的重要原因之一,常合并椎间盘突出,椎管狭窄。目前治疗腰椎滑脱有多种手术方法,都有其一定的适应症和缺点。我院从2005年至2008年采用后路椎弓根螺钉将滑脱椎体提位复位,椎管减压,椎间植骨融合治疗腰椎滑脱症30例,疗效满意,现分析报告如下。     

腰椎滑脱症椎管减压及脊椎“H”形植骨融合术

腰椎滑脱是引起腰腿疼痛较为常见的疾病。患者多为腰椎骨化不全,潜在的软骨缺损,形成先天性峡部不连。再加上某种程度的外伤或劳损,引起峡部疲劳骨折,造成骨不连所致之前滑脱。当椎体滑脱时,因上下椎管前后移位,可致椎管进一步狭窄,促进退行性变,峡部纤维性软骨增生,压迫马尾或侧隐窝内神经根,引起椎管狭窄症。本病非手术治疗无效。近年来,作者进行手术治疗,就五年来椎管减压“H”形植骨融合术后随访13例的疗效观察报告如下。     

Moss椎弓根内固定系统治疗腰椎滑脱症

目的对Moss椎弓根内固定系统治疗腰椎滑脱症的疗效进行评估。方法自2002年2月，2005年8月，我院对28例Ⅰ—Ⅱ度腰椎滑脱症患者行后路椎管减压、Moss椎弓根内固定系统复位固定和椎体间植骨融合术。结果26例随访平均2．6年（1—4．6年）。15例Ⅰ度滑脱和7例Ⅱ度滑脱完全复位，另4例Ⅱ度滑脱复位达90％，解剖复位率为91％；融合率按Lneke标准：A级65％，B级23％，C级12％；JOA评分优良率91％。结论Moss椎弓根内固定系统操作简单、固定牢固，适用于Ⅰ，Ⅱ度腰椎滑脱症的手术治疗。     

腰椎滑脱症RF-Ⅱ复位后路减压椎间融合术

目的：探讨后路腰椎管减压、RF-Ⅱ复位、Vigor Spacer椎间融合器和小关节突间植骨治疗腰椎滑脱并腰椎管狭窄临床疗效。方法：从1999年6月2002年6月，对37例腰椎滑脱患进行腰椎管减压、RF-Ⅱ复位内固定、Vigor Spacer椎间融合和小关节突间植骨的手术治疗。其中Ⅰ度滑脱27例，Ⅱ度滑脱10例；L4,3滑脱12例，L6S1滑脱15例：23例为峡部裂性，4例为退行性。结果：随访10-38个月，平均23．6个月。通过对术前术后临床症状和X线片滑脱复位程度比较，37例中33例症状完全消失，优良率89．2％;27例Ⅰ度滑脱完全复位，10例Ⅱ度滑脱8例完全复位，椎间融合率97．3％：椎间高度由术前平均4．1mm恢复至术后11．7mm，且无高度丢失。结论：后路减压、RF-Ⅱ复位内固定、Vigor-Spacer椎间融合和小关节突间植骨治疗腰椎滑脱，效果良好，复位稳定满意。     

RF椎弓根系统加后路减压融合治疗腰椎滑脱

目的探讨RF椎弓根系统加后路减压融合治疗腰椎滑脱症的疗效。方法39例腰椎滑脱症患者经保守治疗无效后采用RF-Ⅱ椎弓根螺钉系统进行后路减压融合手术治疗,其中退变性腰椎滑脱22例,峡部裂性腰椎滑脱17例,Ⅰ度滑脱12例,Ⅱ度滑脱18例,Ⅲ度滑脱9例。比较手术前后临床症状及X线片。结果所有患者术后随访均超过6个月。退变性腰椎滑脱及峡部裂性腰椎滑脱患者术后神经功能改善率分别为81.8%和82.3%;脊柱活动改善率分别为86.4%和88.2%;腰背痛改善率分别为86.4%和88.2%;下肢疼痛改善率分别为90.9%和94.1%;椎体复位满意率分别为90.9%和88.2%。出现并发症共6例,其中术中并发症3例,发生率为7.7%;术后并发症3例,发生率为7.7%。结论RF椎弓根螺钉系统能使腰椎滑脱得到较为确实的复位和固定,脊柱融合率高,临床效果满意。     

360度环状融合内固定术治疗腰椎滑脱

目的总结后路环状融合内固定术治疗腰椎滑脱症的手术疗效。方法对34名行腰椎滑脱后路环状融合内固定术的患者进行回顾性研究。所有患者术前均经CT或椎管造影证实为腰椎滑脱合并锥管狭窄,其中Ⅰ度滑脱6例,Ⅱ度滑脱23例,Ⅲ度滑脱5例。结果本组31例患者获随访5月～3年,3例患者失访。随访期间所有患者均达到骨性融合。滑脱复位率为94％,无椎弓根钉松动、断裂及脊柱再滑脱现象。临床疗效评价：优20例,良9例,可2例,差0例,优良率为93．5％。结论后路环状融合内固定术有利于神经根充分减压,有利于植骨融合,应作为治疗严重腰椎滑脱的首选手术方法。     

单枚椎间融合器加椎弓根螺钉治疗峡部裂型腰椎滑脱

目的探讨腰椎管减压,单枚椎间融合器后路置入,椎弓根螺钉内固定术治疗峡部裂型腰椎滑脱的临床疗效。方法对14例Ⅱ～Ⅲ度峡部裂型腰椎滑脱的患者行经后路椎管减压,椎体间置入自体骨及斜向置入单枚融合器,椎弓根螺钉内固定术。结果14例患者均在8～20个月,平均12个月随访。所有患者术后8—12个月均获得骨性融合,其中1例术后1年发生椎弓根螺钉断钉,但椎体间骨块融合。结论腰椎管减压,单枚椎间融合器后路斜向置入椎间植骨,椎弓根镙钉内固定术可达到减轻术前症状,提供术后腰椎即刻稳定,远期达到腰椎椎体间骨性融合是治疗峡部裂型腰椎滑脱的有效方法。     

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.     

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.