可吸收螺钉治疗腕肘关节内骨折的临床研究

2005年5月至2008年10月我院采用可吸收螺钉治疗21例腕、肘关节内骨折，疗效满意。     

FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.     

Lichtenstein无张力修补腹股沟疝个体化治疗123例疗效分析

目的：探讨Lichtenstein无张力疝修补术对腹股沟疝治疗的效果。方法：采用聚丙烯网片,应用Lichtenstein术式对2000年2月—2009年10月实施无张力疝修补术123例患者的临床资料进行回顾性总结。结果：123例成人疝及复发疝患者术后恢复快,术后平均1d即可下床活动,平均住院天数为5.1d,无术后并发症,随访1~3年无复发且疗效满意。结论：Lichtenstein无张力疝修补术操作简单,术后恢复快,并发症少,疗效肯定,是临床上值得推广的首选术式。     

肘部尺神经筋膜瓣下前置的几点体会

目的观察肘部尺神经筋膜瓣下前置术治疗肘管综合征的临床效果。方法对35例（37侧）肘管综合征的患者进行手术治疗，其中采用传统尺神经前置术式20侧（A组），筋膜瓣下尺神经前置术式17侧（B组）。检测术前、术后尺神经运动传导速度（MCV）的变化，并进行随访观察。结果术后随访6个月～3年，参照张高孟等分级标准计算优良率，A组优良率为80％，B组优良率为94．12％。B组手术前、后MCV变化与A组比较差异有统计学意义（P〈0．05）。结论采用带血管蒂尺神经筋膜瓣下前置术式治疗肘管综合征的疗效明显优于传统术式。     

神经肌蒂移位预防失神经肌萎缩的实验研究

目的研究神经肌蒂移位对骨骼肌失神经肌萎缩的预防作用。方法选用SD大鼠48只,随机分为四组,每组12只。建立右下肢失神经胫骨前肌加腓骨长肌神经肌蒂移位为A组;右下肢失神经胫骨前肌加腓浅神经干埋植为B组;右侧腓总神经离断,胫骨前肌失神经对照为C组;正常对照为D组。每组随机均分为两批,分别于术后6周和12周进行步态分析、电生理检测、胫前肌湿重检测和肌纤维截面积检测,并进行评价。结果术后6周,A组在步态分析（神经功能指数为-47.20±12.30）、电生理检测、胫前肌湿重检测（0.3840±0.0246g）和肌纤维截面积（1040.98±120.54μm^2等各项指标都明显优于C组（分别为-114.40±14.84、0.1730±0.0191g和585.08±182.93μm^2,差异有统计学意义（P〈0.05）;胫前肌湿重、肌纤维截面积检测优于B组（分别为0.2940±0.0564g和763.92±82.68μm^2,差异有统计学意义（P〈0.05）。术后12周A组肌纤维截面积1360.10±261.45μm^2D组1544.57±266.92μm^2较差异无统计学意义（P〉0.05）,达到正常值范围;A组在步态分析（神经功能指数为-31.60±25.34）、电生理检测、肌纤维截面积方面均优于B、C两组,比较差异有统计学意义（P〈0.05）。结论神经肌蒂移位对失神经肌萎缩有预防作用,对失神经肌萎缩预防效果优于神经干埋植。     

下肢缺血再灌注损伤模型大鼠接受依达拉奉干预后的超微结构变化

背景：肢体缺血再灌注损伤中,氧自由基及细胞凋亡发挥重要的作用,通过抑制氧自由基生成及细胞凋亡,可减轻肢体缺血再灌注损伤。 目的：验证依达拉奉在大鼠肢体缺血再灌注损伤方面的应用及疗效。 方法：30只雌性SD大鼠,随机取20只,分别用自制气囊袖带环扎大鼠右后肢根部加压至40 kPa达到阻断血流,4 h后松解形成再灌注,制作肢体缺血再灌注损伤模型。造模成功后随机分为2组,依达拉奉灌注组于再灌注前5 min由左股静脉注射依达拉奉3 mg/kg,模型组及剩余10只(正常组)于相同时间点给予等量的生理盐水。于再灌注24 h,取每组大鼠右胫前肌,用透射电镜观察其超微结构变化,并采用RT-PCR对每组大鼠胫前肌中bcl-2 mRNA、bax mRNA进行半定量检测并计算bcl-2/bax比值。 结果与结论：①电镜结果显示：依达拉奉灌注组与模型组相比肌纤维较整齐,M线、Z线较清晰,线粒体肿胀减轻、其数量及嵴稍增多。②RT-PCR结果显示,缺血再灌注24 h后,右胫前肌bcl-2 mRNA的相对表达量以及bcl-2 mRNA与bax mRNA的比值：模型组显著低于依达拉奉灌注组(P < 0.05),而bax mRNA的相对表达量模型组高于依达拉奉灌注组,且两组均高于正常组(P < 0.05)。结果提示自由基清除剂依达拉奉可能通过改善线粒体等超微结构及促进bcl-2 mRNA、抑制bax mRNA的表达来减轻肢体缺血再灌注损伤,这可为肢体缺血再灌注损伤的治疗提供新的选择。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

B超联合肌电图诊断肘管综合征的应用

<正>本研究在以肌电图定位尺神经卡压部位的前提下,利用B超检测,发现尺神经受压迫后的特异性超声影像,分析卡压位置及卡压原因,同时进行卡压周围组织检测,发现其病因。为肘管综合征的诊断提供形态学与电生理学的数据,为超微创治疗肘管综合征提供理论与临床数据支持。1资料与方法1.1研究对象:2010年3月至2014年3月于山西医科大学第二医院骨手科临床诊断并经过手术治疗证实为单侧肘管