射频汽化仪在关节镜下治疗膝骨性关节炎中的应用

目的：探讨射频汽化仪在关节镜下治疗膝骨性关节炎的效果。方法：自2000年3月～2007年3月,采用Arthro-Care 2000射频汽化仪对203例膝骨性关节炎进行关节镜下手术治疗。按Lysholm膝关节评分标准评价疗效。结果：182例得到随访,时间6～36个月,平均18个月,优61例,良83例,可32例,差4例,优良率79.1%。结论：射频汽化仪在关节镜下治疗膝骨性关节炎具有良好的效果,使手术更简便精确,副作用小,利于患者早期康复。     

关节镜下射频汽化仪治疗膝关节疾病

目的探讨射频汽化仪在关节镜下治疗膝关节疾病的疗效。方法利用SERFAS—Stryker射频汽化仪对27例膝关节疾病的患者进行镜下修整软骨面、切除炎性增生的滑膜和绒毛组织，清除、打磨骨赘，切除、修整损伤的半月板等手术治疗。结果术后全组病例关节无肿胀，关节积液少，疼痛缓解快，术后4d步行出院。结论射频汽化仪关节镜下治疗膝关节疾病疗效好，术中、术后出血少、疼痛轻，有利于病人的早期康复。     

膝关节半月板损伤关节镜下的诊断与治疗

目的：探讨关节镜在膝关节半月板损伤中诊断与治疗的价值。方法：对42例膝半月板损伤患者进行关节镜检查及治疗，行半月板部分切除、修整成形35例，大部分切除3例，表面修整4例，同时行镜下皱襞切除术3例，游离体摘除4倒、术后早期开始肌力训练和关节活动练习。结果：42例诊断明确，手术均获得成功。通过随访，优良率迭92．8％。结论：关节镜可对膝关节半月板损伤明确诊断、进行微创治疗，是诊治膝关节半月板损伤的好方法。     

关节镜下冷融切技术治疗膝关节半月板损伤的体会

目的 观察冷融切技术对膝关节半月板损伤的治疗效果。方法 22例膝关节半月板损伤，其中8例盘状半月板并有1例为盘状半月板弹响膝，在膝关节镜下采用冷融切技术对其中12例进行半月板部分切除，2例次全切除和8例半月板成形手术。结果 20例患者22个膝关节，术毕松止血带后未见半月板切除部位出血，术后膝关节未见明显肿胀，手术时间缩短。1例弹响膝术后当时检查膝关节弹响消失。术后3周患者下床负重行走良好，随访12个月，有两例患者下床负重行走时有膝关节轻微疼痛，在功能锻炼下消失。患者无术前半月板损伤的表现。结论 冷融切技术对半月板组织可直接气化、不出血、缩短手术时间，使关节镜下进行半月板损伤痛变部位的切除和半月板成形手术变得简单易行，并取得更为满意的治疗效果。     

冷融切技术对膝关节半月板损伤术后关节功能恢复的作用

目的：观察冷融切技术对膝关节半月板损伤的治疗效果。方法：22例膝关节半月板损伤，其中8例盘状半月板并有1例为盘状半月板弹响膝，在膝关节镜下采用冷融切技术对其中12例进行半月板部分切除，2例次全切除和8例半月板成形手术。结果：20例患者22个膝关节，术毕松止血带后未见半月板切除部位出血，术后膝关节未见明显肿胀，手术时间缩短。1例弹响膝术后当时检查膝关节弹响消失。术后3周患者下床负重行走良好，随访6个月。有2例患者下床负重行走时有膝关节轻微疼痛。在功能锻炼下消失。患者无术前半月板损伤的表现。结论：冷融切技术对半月板组织可直接气化、不出血、缩短手术时间。使关节镜下进行半月板损伤病变部位的切除和半月板成形手术变得简单易行。术后功能恢复效果满意。     

关节镜下治疗半月板损伤1617例分析

目的：观察关节镜手术治疗膝关节半月板损伤的疗效。方法：对2003—01／2008～10确诊为半月板损伤1617例患者,进行了关节镜下手术治疗。其中部分切除757例,次全切除成形350例,全切除398例,缝合112例。术后通过4～7个月的随访行疗效评定。结果：1617例均获得随访,疗效评定：优1028例,良306例,可188例,差78例。优良率在83％。结论：关节镜手术治疗半月板损伤的优势在于关节镜检查的准确性和关节镜手术的微创性。术后并发症少,关节功能恢复快,具有较高的优良率。     

关节镜下治疗130例膝关节半月板损伤

目的：观察采用关节镜技术治疗膝关节半月板损伤患者的效果。方法：对130例半月板损伤患者，采用不同的膝关节镜下治疗技术，对其疗效进行分析。结果：关节镜下半月板缝合优良率达90％，半月板部分切除成形术优良率为87％，半月板全切除优良率为68％，8例青少年半月板损伤镜下确定后于膝关节支架外固定优良率为100％。结论：(1)青少年半月板损伤可采用非手术治疗；(2)距结合部5mm以内的半月板损伤可采取镜下缝合技术，尽量避免切除半月板。     

冷融切技术对膝关节半月板损伤术后关节功能恢复的作用

目的:观察冷融切技术对膝关节半月板损伤的治疗效果。方法:22例膝关节半月板损伤,其中8例盘状半月板并有1例为盘状半月板弹响膝,在膝关节镜下采用冷融切技术对其中12例进行半月板部分切除,2例次全切除和8例半月板成形手术。结果:20例患者22个膝关节,术毕松止血带后未见半月板切除部位出血,术后膝关节未见明显肿胀,手术时间缩短。1例弹响膝术后当时检查膝关节弹响消失。术后3周患者下床负重行走良好,随访6个月,有2例患者下床负重行走时有膝关节轻微疼痛,在功能锻炼下消失。患者无术前半月板损伤的表现。结论:冷融切技术对半月板组织可直接气化、不出血、缩短手术时间,使关节镜下进行半月板损伤病变部位的切除和半月板成形手术变得简单易行,术后功能恢复效果满意。     

关节镜下治疗膝外侧盘状半月板损伤175例分析

目的探讨关节镜微创治疗膝关节外侧盘状半月板损伤的临床疗效。方法对175例膝关节外侧盘状半月板损伤的患者行关节镜手术治疗,其中完全型151例,不完全型24例。行部分切除成形79例,次全切除14例,完全切除54例,成形缝合28例。结果随访6～28个月,平均18个月,采用Lysholm评分对膝关节功能进行评定,术前平均58.3分（45～80分）,术后平均91分（70～100分）,术前术后比较差异有统计学意义（P〈0.05）。结论关节镜下治疗膝外侧盘状半月板损伤是较为理想的手术方法。     

射频汽化仪在肩关节镜手术中的应用

关节镜下手术是微创手术，手术精确，功能恢复快，随着关节镜技术和设备的不断发展，在关节镜下治疗和诊断肩关节滑膜炎、钙化性冈上肌腱炎、肩袖撕裂等手术越来越多。但由于肩峰下关节镜不能在止血带下操作，术中出血难以控制，导致镜下血盲现象。我院采用美围杰西公司生产的Arthro Care System-2000射频汽化仪在肩关节镜手术中使用，该设备可在低温下行关节内组织的切割、消融汽化、修整、紧缩、止血等处理,     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.