后路椎弓根螺钉内固定联合椎间植骨融合治疗Ⅱ、Ⅲ度腰椎滑脱的临床研究

目的探讨后路椎弓根螺钉内固定联合椎间植骨融合治疗Ⅱ、Ⅲ度腰椎滑脱临床疗效。方法回顾性分析我院2009年1月～2011年1月收治人院的30例腰椎滑脱症患者临床资料,所有病例均为Ⅱ、Ⅲ度腰椎滑脱。患者均采用后路椎弓根螺钉内固定联合椎间植骨融合治疗,观察手术前后临床症状及滑脱恢复情况、术后复位、疗效评价、材料生物相容性、术后椎间隙高度及BFS评分。结果30例患者术前均为Ⅱ、Ⅲ度腰椎滑脱,其中,19例行椎管、神经根管减压、复位固定、植骨融合治疗,11例只行复位固定、植骨融合治疗。获得随访30例,均超过12个月。30例椎间植骨全部融合,融合率为100％。BFS评分优良率达90．0％。结论后路椎弓根螺钉内固定联合椎间植骨融合治疗Ⅱ、Ⅲ度腰椎滑脱,操作简便、固定可靠,是临床治疗中的一种值得推广的方法。     

后路减压椎间植骨融合加RF椎弓系统内固定治疗腰椎滑脱症

目的探讨后路减压椎间植骨椎间融合RF系统内固定术治疗腰椎滑脱症的临床疗效。方法 2007年9月～2010年1月,对53例腰椎滑脱症患者经保守治疗无效后经后路减压椎间植骨融合RF椎弓根螺钉系统内固定治疗,并分析临床有效率和植骨融合率。结果本组53例均获随访,随访6～24个月。手术效果按照JOA评分标准评定：优31例,良15例,中5例,差2例。优良率86.8%。术后椎间融合率为100%。结论后路减压椎间植骨融合RF系统内固定术治疗腰椎滑脱症疗效可靠,具有复位满意、植骨融合率高和术后恢复快等优点。     

短节段椎弓根钉内固定加后路植骨治疗腰椎滑脱体会

目的：探讨短节段椎弓根钉内固定加后路植骨治疗腰椎滑脱症的临床效果和治疗原则。方法采用腰椎后路椎管减压、椎弓根复位、内固定同时植骨融合治疗腰椎滑脱患者26例,其中Ⅰ度滑脱6例,Ⅱ度滑脱17例,Ⅲ度滑脱3例。结果术后随访7～21个月（平均14个月）,25例骨性融合,骨性融合率为96%,临床疗效优良率为88.5%。结论后路椎弓根内固定加植骨融合治疗腰椎滑脱,能达到很好的复位及牢固的固定。手术操作简便,效果满意。     

后路减压、内固定与椎间融合器术治疗退变性腰椎滑脱症45例

目的:探讨运用后路腰椎管减压、内固定、植骨融合治疗退变性腰椎滑脱临床疗效。方法:从2006年8月至2012年10月,对45例退变性腰椎滑脱患者施行手术治疗。按Meyerding滑脱分类标准:其中Ⅰ度22例,Ⅱ度6例;L3-4滑脱5例,L4-5滑脱25例,L5-S1滑脱15例。本组45例均采用腰椎后路钉棒内固定及小关节后外侧植骨融合。结果:45例获得随访,术后平均随访15.3个月(10²2个月)。X线片显示:45例完全骨融合。临床效果评价:优32例,良9例,可6例。结论:后路减压、内固定与椎间融合器术治疗退变性腰椎滑脱效果良好,复位稳定。     

手术治疗腰椎滑脱伴发椎管内囊肿

目的探讨手术治疗腰椎滑脱伴发椎管内囊肿的临床疗效。方法对临床腰椎滑脱伴同节段椎管内硬脊膜外腔占位的25例患者实施后路减压、肿块切除、滑脱节段融合内固定术。25例患者的年龄为41～68岁,平均年龄为(54±6)岁;男15例,女10例;L4、L5节段滑脱14例,L5、S1节段滑脱11例;术前患者均伴不同程度腰痛及下肢放射症状。滑脱程度:Ⅰ度10例,Ⅱ度9例,Ⅲ度6例。术前常规行MRI检查,术后对肿块行病理检查。随访患者术后融合情况并进行日本矫形外科协会(JOA)评分。结果所有患者术中完整切除肿块,术后病理检查均示椎管内囊肿。随访6～12个月,所有患者均获得骨性融合。术后的JOA评分为(19.5±3.1)分,显著高于术前的(12.0±2.3)分(P<0.05)。结论腰椎滑脱常伴发椎管内囊肿,在彻底切除肿块的同时行滑脱节段融合内固定术有利于缓解患者的临床症状,防止囊肿复发。对腰椎滑脱患者术前须常规行MRI检查以免遗漏椎管内囊肿的诊断。     

360°环状融合内固定术治疗32例腰椎滑脱的疗效分析

目的观察腰椎减压360°环状融合内固定术治疗腰椎滑脱的治疗效果。方法对32名腰椎滑脱患者行环状融合内固定术的治疗效果进行回顾分析。结果360°环状融合内固定术患者随诊1～2年,取得了满意的疗效,恢复率为78％。结论360°环状融合内固定能提高植骨融合率及减轻术后下肢疼痛的症状。     

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。     

后路手术治疗退行性腰椎滑脱的临床探讨

目的探讨后路手术治疗退行性腰椎滑脱的临床效果。方法选取南阳市第一人民医院近年收治的接受后路手术治疗的42例退行性腰椎滑脱症患者,进行回顾性分析。结果所有患者手术顺利完成,术后恢复良好。术后随访6个月～3年,均获得骨性融合,未出现断钉、断棒或内固定松动、感染等不良并发症。结论后路手术治疗退行性腰椎滑脱疗效确切,但应严格掌握手术适应证,综合考虑患者各项情况,选取最合适的手术方式。     

椎间加盖植骨联合椎弓根螺钉内固定术治疗36例退行性腰椎滑脱症疗效观察

目的探讨后路椎间加盖植骨联合椎弓根螺钉内固定术治疗退行性腰椎滑脱症的临床疗效。方法选择该院2005年3月至2008年12月退行性腰椎滑脱症患者36例,采用后路环锯加盖椎间植骨联合椎弓根螺钉复位内固定术治疗。结果 36例均获得随访6~24个月,临床融合率为100%,临床疗效采用日本JOA下腰痛疗效评定标准,优21例,良13例,一般2例,优良率为94.4%。结论后路环锯加盖椎间植骨联合椎弓根螺钉内固定术治疗退行性腰椎滑脱症是一种安全、有效、经济且并发症少的方法。     

双开窗椎间植骨椎弓根钉固定治疗腰椎滑脱症

目的 分析双开窗椎弓根钉内固定加椎间植骨治疗腰椎滑脱症的手术疗效.方法 2005年5月-2007年8月.联合采用后路双侧椎板开窗神经根减压、椎弓根螺钉复位固定和椎间植骨融合治疗腰椎滑脱症患者36例,男12例,女24例,年龄36岁～78岁.滑脱节段:L3 1例,L4 22例,k5 13例.按照Meyerding分类:I度滑脱23例,Ⅱ度滑脱11例,Ⅲ度滑脱2例.结果 36例患者术后均获6个月～32个月随访.按JOA评分:优28例,良4例,中3例,差1例,优良率88.9%.术后x线显示所有病例均完全复位或基本完全复位.随访椎间融合好,内固定无松动.结论 采用后路双侧椎板开窗神经根减压、椎弓根螺钉复位固定和椎间植骨融合治疗腰椎滑脱症临床疗效理想,能有效地解除神经卡压,滑脱复位后不容易丢失,植骨融合率高,并发症发生率低,是治疗腰椎滑脱症的理想方法.     

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.