肩关节镜治疗钙化性冈上肌腱炎的临床观察

[目的]探讨肩关节镜下治疗钙化性冈上肌腱炎方法和临床疗效。[方法]2008年6月～2010年10月,笔者对20例患有钙化性冈上肌腱炎的患者行关节镜下手术治疗。关节镜均自后方入路进入,所有病例行滑囊及冈上肌腱钙化病灶清除术,有6例行肩峰成形术。20例患者均在术前、术后采用UCLA肩关节功能评分标准和VAS疼痛评分评估惠肩改善情况。[结果]平均随访时间为13-3个月（9-25个月）,肩部疼痛和功能障碍消失或明显改善,平均VAS疼痛评分术前9．02±0．90分,术后1．33±0．58分。术后X线显示,仅2例患者钙化灶有少量残留,但术前症状消失。[结论]关节镜下行钙化灶清除并滑囊切除术,治疗钙化性冈上肌腱炎可靠有效。     

顽固性肩袖钙化性肌腱炎的关节镜治疗效果评价

目的 观察关节镜治疗顽固性肩袖钙化性肌腱炎的临床效果.方法 21例顽固性肩袖钙化性肌腱炎患者采用关节镜下钙化灶清除术,缝合清理后肩袖缺损较深的部分(＞50％),其中2例加行肩峰成形术.术前及术后随访采用加州大学肩关节评分系统(University of California at Los Angeles,UCLA)、Constant-Murley评分(Constant-Murley score,CMS)、视觉模拟评分法(Visual Analogue Scale,VAS)、美国肩与肘协会评分系统(American Shoulder and Elbow Surgeons' Form,ASES)、患者满意度评估其疗效评估.结果 所有患者均获随访,随访时间5～7年.VAS由术前(6.971±1.016)分减至术后(1.524±0.981)分;UCLA由术前(11.571±2.521)分提高到术后(30.190±1.991)分;CMS由术前(50.476±7.567)分提高到术后(89.571±3.627)分;ASES由术前(52.048±6.614)分提高到术后(91.667±4.139)分.术前术后VAS、UCLA、CMS、ASES评分比较差异均有统计学意义(P＜0.01).1例(4.76％)于术后3～7 d出现切口炎性反应,经对症处理后愈合;其余切口均工期愈合.结论 关节镜下钙化灶清理是治疗顽固性肩袖钙化性肌腱炎的有效方法.手术创伤小,术后恢复快,具有良好的临床效果和安全性.     

关节镜下完全清理钙化灶术对肩袖钙化性肌腱炎病人术后ASES、VAS及Constant-Murley评分的影响

目的分析关节镜下完全清理钙化灶术对肩袖钙化性肌腱炎病人术后美国肩肘协会评分系统评分(ASES)、疼痛视觉模拟评分(VAS)及肩关节功能Constant-Murley评分的影响。方法收集63例肩袖钙化性肌腱炎病人的临床治疗资料, 其中行关节镜下完全清理钙化灶术者31例作为观察组, 行关节镜下部分清理钙化灶术者32例作为对照组。比较2组手术时间、住院时间、主动最大活动度时间、被动最大活动度时间和术前及术后1、2、6、12个月的ASES、VAS及Constant-Murley评分。结果观察组住院时间、主动最大活动度时间及被动最大活动度时间均明显长于对照组(P < 0.01), 2组手术时间差异无统计意义(P>0.05)。2组术后1、2、6、12个月的ASES评分均高于术前(P < 0.05), 且观察组术后1、2个月ASES评分均明显低于对照组(P < 0.01), 但2组术后6、12个月ASES评分差异均无统计学意义(P>0.05)。2组术后1、2、6、12个月的VAS评分均低于术前(P < 0.05), 且观察组术后1、2、6个月VAS评分均明显高于对照组(P < 0.01), 但2组术后12个月VAS评分差异无统计学意义(P>0.05)。2组术后1、2、6、12个月的Constant-Murley评分均高于术前(P < 0.05), 且观察组术后1、2个月Constant-Murley评分均明显低于对照组(P < 0.01), 但2组术后6、12个月Constant-Murley评分差异均无统计学意义(P>0.05)。结论关节镜下完全清理钙化灶术应用于肩袖钙化性肌腱炎, 对病人术后远期ASES、VAS及Constant-Murley评分的改善效果与关节镜下部分清理钙化灶术相当, 但近期效果弱于关节镜下部分清理钙化灶术, 临床可根据病人具体情况灵活选择术式。     

关节镜下术中应用富含血小板血浆治疗顽固性肩袖钙化性肌腱炎的临床效果

目的 探讨关节镜下清除术中应用富含血小板血浆(PRP)治疗顽固性肩袖钙化性肌腱炎的临床效果.方法 将42例顽固性肩袖钙化性肌腱炎患者按随机数字表法分为PRP组和对照组各21例,两组均行关节镜下钙化灶清除术,PRP组术中于肩袖缺损处注入PRP,对照组术中于肩袖缺损处注入等量生理盐水.比较两组患者术前及术后1、3、6、12个月的加州大学(UCLA)肩关节评分系统、美国肩与肘协会评分系统(ASES)评分以及术后肩袖愈合情况.结果 两组UCLA、ASES评分比较差异均无统计学意义(P>0.05),但均随观察时间的延长而增高(P<0.05).两组术后12个月肩袖损伤愈合率的比较,差异无统计学意义(P>0.05).结论 关节镜下钙化灶清除术中应用PRP治疗顽固性肩袖钙化性肌腱炎在促进肩袖损伤愈合方面无明显效果.     

慢性钙化性冈上肌腱炎的关节镜下治疗

目的：探讨关节镜下治疗慢性钙化性冈上肌腱炎的手术方法与效果。方法：采用关节镜下手术治疗37例钙化性冈上肌腱炎患者,评估其术前、术后的X光片表现,采用视觉模拟法疼痛评分（VAS）,Constant-Murley评分和美国肩肘关节外科医师协会评分系统（ASES）分析患者术后的改善情况。结果：所有患者症状均得以缓解,5例患者术后X光片仍残留部分钙化灶,患者VAS、Constant-Murley及ASES评分均较术前改善（P〈0.05）。结论：关节镜下手术治疗钙化性冈上肌腱炎效果确切,尤其对保守治疗效果不佳的患者,是一种安全有效的治疗途径。     

关节镜下治疗钙化性肩袖肌腱炎的临床疗效研究

目的观察肩关节钙化性肌腱炎在关节镜辅助下治疗疗效。方法选择31例肩关节钙化性肌腱炎患者,经药物治疗后症状未见明显好转,行肩关节镜探查术,其中25例加行肩峰成形术,8例加行肩袖修补术。采用疼痛视觉模拟(VAS)评分系统评定患者手术疗效,采用欧洲肩肘外科协会评分系统(CMS)检测肩关节活动度及肩关节功能;结果 31例患者肩关节疼痛、活动度以及功能评分在术前与术后末次随访比较,有统计学意义(P0.01)。结论肩关节钙化性肌腱炎采用关节镜下治疗具有微创、恢复快、复发率低等优点,临床疗效满意。     

肩峰成形在关节镜下冈上肌腱缝合术中的作用

目的 观察关节镜下肩峰成形对冈上肌腱修复临床效果的影响。 方法 收集我单位2010 年3 月- 2011 年12 月收治的肩袖损伤患者34 例,关节镜下证实冈上肌腱全层撕裂。将患者随机分为2 组,即肩峰成形组和非肩峰成形组,每组17 例。术后采用Constant-Murley 肩关节评分系统（Constant-Murley Score,CMS） 和加州大学（University of California at Los Angeles,UCLA） 肩关节评分系统评价关节功能。 结果 两组患者术后CMS 评分和UCLA 肩关节评分差异均无统计学意义（P ＞ 0.05）。 结论 肩峰成形术对冈上肌腱全层撕裂的患者肩袖修复术术后效果没有明显影响。     

关节镜下全面处理肩峰下撞击综合征及其合并症

目的探讨通过关节镜微创治疗全面处理肩峰下撞击综合征及其合并症的方法及疗效。方法 2007年7月至2008年12月,对16例肩峰下撞击综合征患者行关节镜下微创手术,年龄34～65岁,平均(55.6±9.1)岁。术前均拍摄肩关节前后位和冈上肌出口位的X线片及行肩关节MRI检查,均行选择性封闭帮助确定诊断。13例患者除肩峰下撞击综合征外还合并其他疾患,合并冻结肩5例,合并肩袖撕裂5例,合并冈上肌钙化1例,合并肩锁关节炎2例。所有患者均行关节镜肩峰下间隙减压术,并对合并症进行全面处理:冻结肩行关节囊松解,肩袖损伤行肩袖修补或清创,钙化性腱炎行钙化灶清除和肩袖修补,肩锁关节炎行锁骨远端切除。结果随访时间12～31个月,平均(18±6.4)个月。ASES评分(美国肩肘外科学会肩关节评分):术前总分(42.7±13.4)分,随访(92.5±12.9)分,较术前提高(P=0.001);UCLA评分(加利福尼亚大学洛杉矶评分):术前(17.2±4.1)分,随访(31.1±3.4)分,也较术前提高(P=0.000),优良率为93.8%。结论肩峰下撞击综合征患者往往合并其他肩部疾患,需要结合病史、体检、影像学资料、选择性封闭试验和关节镜检查做出全面、准确的诊断。行关节镜肩峰下间隙减压术时对各类合并症进行全面处理,有利于取得良好的疗效。     

应用肩关节镜治疗钙化性肩袖肌腱炎的体会

目的:探讨关节镜治疗钙化性肩袖肌腱炎的方法与效果.方法:采用肩关节镜手术治疗16例钙化性肩袖肌腱炎患者,对比术前、术后的X光片表现,采用视觉模拟法疼痛评分(VAS),Constant - Murley评分分析患者术后的改善情况.结果:所有患者术后症状缓解明显,患者VAS、Constant - Murley评分均较术前改善(P＜0.05).结论:关节镜是治疗钙化性肩袖肌腱炎一种微创、快捷、安全有效的治疗途径.     

8例肩关节急性疼痛性钙化性肌腱炎的关节镜治疗

目的 探讨关节镜治疗急性疼痛性肩关节钙化性肌腱炎的临床效果.方法 8例保守治疗效果不满意的急性疼痛性肩袖钙化性肌腱炎患者根据Grtner放射学分类:Ⅰ型2例,Ⅱ型2例,Ⅲ型4例;所有病例采用关节镜下钙化沉积物清除术,其中2例加行肩峰成形术,在治疗前及术后行随访按Constant-Murley评分评估其疗效.结果 6例术后钙化沉积物消失, Ⅱ型1例和Ⅲ型1例有钙化物残留.8例术后平均随访16.2个月,肩关节疼痛及活动明显改善,Constant-Murley评分术前平均为22.2分,术后平均为88.5分,差异有统计学意义(P＜0.01).结论 关节镜下清除钙化沉积物具有疼痛缓解明显、关节功能恢复快、可同时处理肩关节内病变等优点,是保守治疗无效的急性疼痛性肩关节钙化性肌腱炎的有效治疗方法.     

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.