桡骨远端不稳定骨折不同固定方式的对比观察

目的：比较小切口克氏针联合外固定支架固定与切开复位锁定加压钢板内固定治疗桡骨远端不稳定骨折的临床疗效。方法随机将我院收治的桡骨远端不稳定骨折患者64例分为2组,分别给予小切口克氏针联合外固定支架固定（联合固定组）,和切开复位锁定加压钢板内固定（钢板固定组）治疗,比较2组患者的手术情况、临床疗效和并发症发生情况。结果联合固定组手术时间和术中出血量显著低于钢板固定组（P<0.01）;治疗后1年随访,2组在腕关节活动度、骨折复位和功能恢复均取得了较好的效果,差异无统计学意义（P>0.05）。术后并发症联合固定组5例、钢板固定组3例,2组均未发生严重并发症。结论小切口克氏针联合外固定支架固定治疗桡骨远端不稳定骨折操作简单,患者创伤小,固定可靠,不影响早期功能锻炼,费用相对较低,值得在基层医院推广。     

锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的解剖复位及关节功能恢复对比

目的探讨锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的解剖复位及关节功能恢复的效果。方法将我院收治的40例桡骨远端复杂关节内骨折患者作为研究对象,比较采用锁定加压钢板治疗(对照组,20例)与应用克氏针结合外固定支架治疗(观察组,20例)在术后骨折愈合及腕关节评分方面的差异性。结果两组术后骨折愈合及并发症情况比较均无典型差异(P0.05);C1、C2两种类型桡骨远端复杂关节内骨折术后腕关节评分比较无显著差异(P0.05),但C3型骨折对比结果显示观察组明显优于对照组(P0.05)。结论采用锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折均可取得较为满意的效果;而C3型骨折采用克氏针结合外固定支架治疗效果更佳,建议优先选用。     

经肱桡肌腱入路桡骨远端骨折内固定手术疗效分析

目的:分析经肱桡肌腱入路桡骨远端骨折内固定手术疗效。方法:将60例桡骨远端不稳定骨折患者随机分为观察组及对照组各30例;对照组采用掌侧入路显露挠骨远端骨折后完成接骨板的内固定,观察组采用经肱桡肌腱入路桡骨远端骨折内固定手术治疗;比较两组患者的手术时间、术中出血量、骨折愈合时间、并发症、桡骨掌倾角、尺偏角、掌倾角和整体临床治疗效果。结果:两组患者手术时间比较无统计学差异(P>0.05),且观察组术中出血量及骨折愈合时间均显著低于对照组(P<0.05);治疗后两组患者治疗临床疗效比较无统计学差异(P>0.05);治疗后两组患者桡骨掌倾角、尺偏角、掌倾角均显著改善(P<0.05),但两组桡骨掌倾角、尺偏角、掌倾角指标比较无统计学差异(P>0.05);治疗后观察组并发症发生率明显低于对照组,且差异存在统计学意义(P<0.05)。结论:采用经肱桡肌腱入路桡骨远端骨折内固定术治疗后,可显著提高临床疗效,并降低并发症发生率。     

闭合复位外固定支架固定治疗桡骨远端骨折的临床效果观察

目的:观察闭合复位外固定支架固定治疗桡骨远端骨折的临床效果。方法:选取2013年1月—2018年1月本院收治的65例桡骨远端骨折患者,将其中行闭合复位外固定支架固定治疗的33例患者设为观察组,行切开复位内固定术治疗的32例患者设为对照组。对比两组手术指标、腕关节活动度及并发症。结果:观察组手术时间、骨折愈合时间较对照组短,术中失血量较对照组少,差异具有统计学意义(P<0.05);术后,观察组Gartland-Werley评分高于对照组,差异具有统计学意义(P<0.05);观察组并发症总发生率(3.03%)略低于对照组(15.63%),但差异无统计学意义(P>0.05)。结论:闭合复位外固定支架固定治疗桡骨远端骨折较切开复位内固定术具有创伤小、操作简便、术后易恢复等优势,且具有较佳的治疗安全性。     

外固定支架与钢板内固定治疗不稳定型桡骨远端骨折的疗效对比

目的：：观察并对比不稳定型桡骨远端骨折治疗过程中外固定支架与钢板内固定2种方案的治疗效果。方法：取我院收治的80例桡骨远端不稳定骨折患者为本次研究对象,根据治疗方案不同将其均分为A组与B组各40例,其中A组接受闭合复位外固定支架治疗,B组则实施切开复位锁定钢板内固定治疗,观察2组手术时间、术中出血量、骨折愈合时间、住院时间、并发症发生率、腕关节功能。结果：与A组相比,B组手术时间、骨折愈合时间以及住院总时长更长,术中出血量更多,组间差异具有统计学意义(P<0.05);2组治疗优良率以及并发症发生率并无显著差异,不具有统计学意义(P>0.05)。结论：在不稳定型桡骨远端骨折的治疗方案中,外固定支架以及切开内固定均可获得满意的治疗效果。其中外固定支架不会造成过于严重的术创,可促进患者康复;而切开内固定处理对于关节功能恢复有较好的促进效果。     

掌侧锁定加压钛板与外固定支架治疗不稳定桡骨远端C型骨折的临床疗效分析

目的 对比分析掌侧锁定加压钛板与外固定支架治疗不稳定桡骨远端C型骨折的临床疗效.方法 对该院2014年3月至2016年2月收治的78例不稳定桡骨远端C型骨折患者的临床资料进行回顾性分析.将患者按照不同治疗方式分为掌侧锁定板组与外固定支架组,每组39例,观察不同治疗方式治疗患者的临床疗效.结果 外固定支架组患者术中出血量、手术时间、住院时间及骨折愈合时间均少于掌侧锁定板组(P<0.05);术后3 d、6周、24个月,掌侧锁定板组患者掌倾角、尺偏角及桡骨高度明显优于外固定支架组(P<0.05);末次随访显示,两组患者掌屈活动度、背伸活动度、视觉模拟评分(VAS评分)、Gartland-Werley评分比较差异无统计学意义(P>0.05);两组患者术后切口感染、腕管综合征及拇指伸长肌腱断裂发生率比较差异无统计学意义(P>0.05).结论 两种治疗方式均有较好的临床疗效.外固定支架治疗具有手术时间短、住院时间短等优点;而掌侧锁定加压钛板能在直视下复位骨折,且在掌倾角、尺偏角及桡骨高度恢复等方面明显优于外固定支架术,更加适合不稳定桡骨远端C型骨折患者.     

锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的解剖复位及关节功能恢复对比

目的比较锁定加压钢板与克氏针联合支架外固定对桡骨远端复杂关节内骨折解剖复位及功能恢复的效果。方法对收治的桡骨远端关节内骨折患者进行回顾性分析,筛选获得1年以上随访病人80例,根据手术方法不同分为两组,A组38例采用锁定加压钢板进行治疗;B组42例采用克氏针联合支架进行外固定术治疗。结果两组术后愈合及并发症组间比较差异无统计学意义（P＞0.05）。两组患肢缩短均达到解剖复位效果,组间比较差异无统计学意义（P＞0.05）。腕功能恢复：C1、C2型骨折患者两组效果差异无统计学意义（P＞0.05）;C3型骨折患者B组效果优于A组（P〈0.05）。结论对于桡骨远端复杂关节内骨折的治疗中C1、C2型骨折,锁定加压钢板治疗与克氏针联合支架外固定治疗都可作为一种选择,无优劣之分;C3型骨折,克氏针联合支架外固定的治疗效果比锁定加压钢板效果好,可作首选治疗方式。     

桡骨远端粉碎性骨折临床治疗分析

目的：探讨桡骨远端粉碎性骨折的治疗方法,对其手术效果进行观察。方法将该院收治的80例桡骨远端粉碎性骨折患者随机分为观察组与参考组,各为40例,给予观察组患者外固定支架联合克氏针固定治疗,给予参考组患者传统手术治疗,比较两组手术效果、骨折愈合时间及并发症发生情况。结果观察组患者康复优良率为95%,参考组患者康复优良率为72.5%,两组数据比较差异有统计学意义（P〈0.05）;观察组患者骨折愈合时间明显短于参考组,患者并发症发生率低于参考组差异有统计学意义（P〈0.05）。结论针对患者病情采取合适手术治疗方案对于有助于促进患者骨折愈合,减少并发症。     

微型外固定支架联合克氏针对粉碎性掌指关节骨折的疗效

目的观察微型外固定支架联合克氏针治疗粉碎性掌指关节骨折的效果。方法选取2018年4月至2019年4月在三门峡市中心医院治疗的60例粉碎性掌指关节骨折患者,按照随机数表法分为对照组和观察组,各30例。对照组接受内固定克氏针治疗,观察组接受微型外固定支架联合克氏针治疗。对比两组骨折愈合效果及术后并发症发生情况。结果观察组骨折愈合总优良率(93.33%)较对照组高(73.33%),差异有统计学意义(P<0.05);观察组并发症发生率(3.33%)低于对照组(13.33%),差异有统计学意义(P<0.05)。结论微型外固定支架联合克氏针治疗粉碎性掌指关节骨折效果较好,能帮助患者进行早期锻炼。     

桡骨远端T型锁定接骨板治疗桡骨远端不稳定性骨折的临床效果

目的探讨桡骨远端T型锁定接骨板治疗桡骨远端不稳定性骨折的临床效果。方法 60例桡骨远端不稳定性骨折患者分为观察组和对照组,每组30例。观察组患者给予桡骨远端T型锁定接骨板治疗,对照组患者给予外固定支架治疗,术后随访3个月,对患者行X线片检查,测量并记录2组患者的骨性愈合时间、掌倾角、尺偏角及腕关节活动度。结果 2组患者骨性愈合时间、掌倾角及尺偏角比较差异均无统计学意义(P>0.05)。观察组患者背伸、掌屈活动显著优于对照组,桡偏显著轻于对照组,差异均有统计学意义(P<0.05)。2组患者尺偏、旋前、旋后情况比较差异均无统计学意义(P>0.05)。观察组和对照组患者治疗效果优良率分别为90.0%和70.0%,观察组患者优良率高于对照组,差异有统计学意义(P<0.05)。观察组和对照组患者并发症发生率分别为6.7%和10.0%,2组患者并发症发生率比较差异无统计学意义(P>0.05)。结论应用桡骨远端T型锁定接骨板治疗桡骨远端不稳定性骨折对桡骨远端的骨性及腱鞘结构的影响较小,手术操作较为方便,可保持背侧软组织的完整性,复位效果好,固定可靠,疗效满意,且并发症少。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

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.