关节镜下膝关节粘连松解

探讨关节镜下膝关节粘连松解术对治疗膝关节粘连的价值和特点。方法：在关节镜直视下,用探针和钩刀等器械,松解膝关节内粘连索带和挛缩组织,治疗膝关节屈曲受限病人15例。结果：平均随访1年8个月,关节屈曲活动度从术前平均30度,术后改善至平均120度,无1例发生皮肤坏死或骨折等并发症。结论：关节镜下粘连松解术具有创伤性小、恢复快、疗效好、属微创伤手术,是膝关节粘连僵硬的理想治疗方法。     

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.     

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.     

关节镜下松解膝关节粘连的疗效观察

目的:观察膝关节粘连关节镜松解的适应症和临床疗效.方法:应用关节镜松解术治疗膝关节粘连患者24例,平均年龄44岁(17～71岁).术前膝关节活动度10°～60°,平均37.5°,WOMAC评分9～22分,平均14分.术中使用等离子刀、钩刀及刨削器等在关节镜下进行粘连松解.术后镇痛、关节腔内注射玻璃酸钠、患肢主、被动功能...     

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。     

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。     

关节镜下膝关节粘连松解结合关节腔注射及其术后康复治疗膝关节粘连

目的探讨关节镜下膝关节粘连松解结合关节腔注射玻璃酸钠倍他米松及其术后康复治疗膝关节粘连的疗效。方法对47例膝关节粘连患者行关节镜下膝关节粘连松解术,术后关节腔内注射玻璃酸钠倍他米松,并早期进行康复锻炼指导,使用Judet分类[1]对术前和末次随访时膝关节活动度进行比较,观察疗效。结果本组47例,随访时间平均27.8个月(12个月～51个月),根据Judet的分类末次随访时优良率为93.6%,较术前的0%有显著改善。结论关节镜下粘连松解术结合关节腔注射玻璃酸钠倍他米松并积极进行膝关节功能康复是治疗膝关节粘连是有效,安全的方案。     

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。     

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.