关节镜治疗膝关节僵硬36例疗效分析

目的 探讨关节镜辅助下松解膝关节僵硬的处理方法,并观察其疗效.方法 回顾性分析遵义医学院附属医院骨一科从2008年1月至2014年6月收治共36例膝关节僵硬患者,通过关节镜辅助下行关节囊内粘连松解联合股四头肌“多点V字成型”松解延长术,术中松解膝关节达90°,术后行规范功能锻炼,并用膝关节活动度、Lysholm评分对治疗效果进行评价.结果 本组病例术后随访6 ～28月,平均20.5个月.术前:膝关节活动度平均伸直11.5°,屈曲29.2°,Lysholm评分平均50.2分;其中单纯行关节镜下关节囊内粘连松解14例,联合关节囊外行股四头肌“多点V字成型”松解延长术22例.术后:膝关节活动度平均伸直5.3°,屈曲102.6°,Lysholm评分平均92.3分.术前、术后各项指标P＜0.05,具有统计学意义.结论 膝关节镜微创技术松解膝关节僵硬具有创伤小、恢复快、疗效满意的效果.     

关节镜下松解膝关节粘连

目的探讨关节镜在膝关节粘连松解手术中的应用价值.方法关节镜直视下行膝关节粘连松解8例.结果随访6.0～23.5个月,平均11.4个月,膝关节的活动度较术前平均增加72°,无术中术后并发症.结论关节镜下手术行膝关节粘连松解具有创伤小、恢复快和疗效好等优点.     

关节镜治疗创伤性膝关节粘连12例

目的:探讨关节镜下治疗膝关节创伤性粘连的临床效果。方法:采用关节镜技术松解膝关节周围粘连治疗关节粘连强直。结果:患者在手术中膝关节都得到较好松解,术后住院时7～10 d,随访约9个月,关节活动95°～125°,平均105°,股四头肌肌力恢复,无其他并发症。结论:采用关节镜治疗创伤性膝关节粘连简单方便,能够明显减轻患者的痛苦,可短时间内恢复,术后并发症少,能取得较为满意的临床疗效,值得临床大力推广。     

关节镜下治疗关节内外粘连型屈膝功能障碍的方法与疗效分析

目的:探讨采用关节镜下松解膝关节内、外粘连所致的屈膝功能障碍的治疗方法与疗效。方法:对2003年1月～2005年12月屈膝功能障碍51例患者行粘连松解术,在关节镜下采用钩刀、刨刀、射频切除关节内髌上囊、内外侧间隙、髌下脂肪垫间隙、踝间窝等和关节外的股骨与股中间肌间隙、肌内外侧间隙的粘连以及配合手法松解和术后康复治疗。51例屈膝功能障碍病例经治疗后随访8～12个月,平均10.2个月。结果:屈膝活动度增强30°～80°,平均70°,膝关节Lysholm功能评分术前(55±8.2)分,术后(86±11.2)分(P<0.01)取得优于非关节镜手术治疗的满意疗效。结论:关节镜下关节内外粘连松解治疗屈膝功能障碍有效、创伤小、恢复快、值得推广。     

关节镜下松解治疗膝关节粘连僵硬

目的探讨关节镜下治疗膝关节粘连僵硬的价值。方法对我科用关节镜松解治疗创伤或术后膝关节僵硬的27例患者进行总结分析。结果所有病例在术中均能得到较好松解,屈曲达110°或以上,术后住院时间为7~10 d,术后经过平均随访11个月,关节活动度达95~125°,平均105°,股四头肌肌力V级,Lysholm s评分平均从术前47分(35~63分)提高到术后87分(80~98分),无骨折等合并症发生。结论关节镜下治疗膝关节粘连僵硬创伤小、效果好、恢复快、合并症少,值得推荐。     

关节镜下应用等离子刀行粘连松解术治疗膝关节粘连

目的 探讨应用关节镜及等离子刀行粘连松解术治疗膝关节粘连的方法、疗效和应用价值.方法 自2005年4月-2009年4月应用关节镜技术及等离子刀对32 例膝关节粘连患者施行松解手术,并对患者进行相应的术后康复训练.结果 32 例均获随访,术前膝关节活动度10°(伸)～80°(屈),平均45.5°;术后0°(伸)～130°(屈),平均110°,较术前平均增加65°.结论 应用关节镜技术及等离子刀治疗膝关节粘连手术创伤小,膝关节功能恢复好,疗效满意.     

关节镜下松解术治疗膝关节粘连

目的：探讨应用关节镜下粘连松解术治疗膝关节粘连的方法、疗效和应用价值。方法：自2004年10月-2008年12月应用关节镜技术对10例膝关节粘连病人施行松解手术,并对病人进行相应的术后康复训练。结果：10例均获随访,术前膝关节活动度5°-80°,平均30.5°;术后屈膝100°-130°,平均120°,较术前平均增加60°。结论：应用关节镜技术治疗膝关节粘连手术创伤小,膝关节功能恢复好,疗效满意。     

关节镜下治疗膝关节粘连及其中西医康复训练的临床观察

目的观察关节镜下松解及术后中西医结合康复训练治疗膝关节伸直型粘连的临床疗效。方法对30例关节伸直型粘连的患者在关节镜下进行松解治疗,术后对其进行康复训练指导。结果30例随访,时间8～20个月,屈膝度数平均由术前的42。增加到治疗后的108°,未见感染,骨折等并发症出现。结论关节镜下松解治疗膝关节粘连及术后中西医结合的的康复训练,损伤小,功能恢复快,可取得满意的疗效。     

微创综合疗法治疗膝关节纤维性强直11例

目的:介绍并评价关节镜下微创松解粘连结合术后早期康复训练的方法治疗膝关节纤维性强直的临床效果.方法:本组11例膝关节纤维性强直患者,采用常规4个入路,按照一定的顺序进行膝关节检查和松解,逐步松解和清理关节腔内的粘连带.手术松解与手法推拿交替进行,直至膝关节屈曲达110°以上,伸直0°.术后常规口服消炎镇痛药.第1天开始进行功能锻炼,术后14天拆线,拆线后继续功能锻炼1周,待膝关节屈伸活动度较稳定,不易反弹后方可出院,并继续行功能锻炼.结果:所有患者均得到了随访,平均随访6个月(3～10个月).膝关节平均活动度112°(100～130°),较术前平均增加67°(45～85°),能满足基本日常生活及工作需要,步态改善,跛行消失,关节无肿痛,无感染、皮肤坏死等并发症.结论:关节镜下微创松解粘连结合术后早期康复训练的方法是治疗膝关节纤维性强直的一种好方法,具有创伤小、松解彻底、恢复快、术后再粘连发生率低、并发症少等优点.     

关节镜下利用半腱肌腱重建晚期膝关节后交叉韧带损伤

目的 探讨关节镜下利用同侧半腱肌腱重建晚期膝关节交叉韧带损伤的临床疗效.方法 1997年1月-2006年6月,关节镜下利用半腱肌腱重建晚期膝关节后交叉韧带损伤26例.结果 24例获得24个月以上随访,采用lysholm膝关节功能评分法评估患膝手术前后的功能,术前平均36分,术后平均85分,优良率86%,术前26例膝后抽屉试验阳性,术后3膝弱阳性,术前22膝lachman试验阳性,术后2膝弱阳性,术后遗留膝关节运动后疼痛1膝,可忍受,1膝关节屈曲活动受限达25°,经膝关节粘连松解,功能完全恢复.所有病例未出现股后肌无力及隐神经损伤.结论 应用半腱肌腱重建晚期膝关节后交叉韧带损伤,恢复了膝关节交叉韧带的结构,及膝关节的稳定.该技术取材方便,手术方法简单,无需内固定.     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.