术中电生理检测在外周神经损伤中的应用

目的 探讨电生理检测在外周神经手术中应用的临床价值。方法 对16例17条外周神经分三组行术中电生理检测，指导术中决策和判断预后，并与术前肌电图结果或核磁共振检查结果对比。结果臂丛损伤组9例，术中体感诱发电位与核磁共振对检查完全根性损伤的检出率，经，检验差异无显著性。对臂丛损伤的大体定位，术前结合体格检查、肌电图及核磁共振结果的诊断与术中电生理检测结果完全吻合。四肢外周神经损伤组5条神经，3条术前肌电图结果与术中检测完全相符，2条不符。神经肿物组3条神经，在摘除神经瘤体后，术中电生理检测提示1例好转，2例出现不同程度的神经受损改变，术后随访与术中电生理检测的提示相符。在本组所有17条神经中，共有5条神经因术中电生理检测结果而改变了手术方案。结论 外周神经术中电生理检测的准确性优于术前的肌电图检查及核磁共振检查，具有准确、简便、实时等特点，可直接指导术中手术方案的选择；对神经肿块等原因引起的神经压迫损害，术中电生理检测可评价手术疗效，判断预后。     

软组织激光全息扫描鼻眶窝的三维数字图像分析

目的　介绍三维扫描仪在非接触条件下采集面部软组织精确数据的方法 ,为临床整形提供标准的鼻眶窝三维测量数据。方法　应用三维激光扫描仪和Geomagic软件 ,采集 12例标准汉族人的颜面轮廓 ,并对鼻眶窝进行数据测量和分析。结果　通过三维激光扫描和逆向工程软件可以再现出面部形态有意义的任一角度的三维图像 ,且精确度达到 0 0 1mm ,实验初步确定了鼻眶窝最低点的三维定位 ,描述了鼻眶窝的三维形态特征。结论　此方法可以全面反映鼻眶窝与周围结构形态学上的相互关系 ,三维激光扫描是实现术前设计、手术模拟和术后效果评价的新途径     

应用皮瓣、黏膜肌瓣及硅胶假体隆鼻隆颌矫治面中凹陷畸形

目的寻求以比较简便的方法改善面中部凹陷和鞍鼻畸形。方法应用鼻小柱基底皮瓣和上唇双侧口腔黏膜肌瓣并以硅胶假体填充隆鼻隆颌矫治面中凹陷畸形。结果用此方法于隆鼻同时行面中部凹陷充填,效果满意。结论这使一个比较复杂的畸形,用较简便的方法得以矫正,创伤小,并发症少,并且经济、有效,值得推广应用。     

经电子胆道镜螺旋水刀碎石治疗胆道结石

目的　探讨经电子胆道镜应用螺旋水刀击碎肝内胆管结石的方法。方法　经电子胆道镜治疗孔插入直径 1 .6mm ,长 3m的内镜手柄 ,螺旋水刀喷嘴对准结石 ,采用压力 30～ 70bar和脉冲 1～ 2次 /s进行碎石 ,击碎后的结石用取石网取出或用水冲出。结果　本组 1 7例 ,碎石 30次 ,每次 1～1 .5h ,其中在手术中应用 6例 ,术后应用 9例 ,在手术中和术后均应用 2例 ,1 7例中共有 5 2枚直径 1～ 1 .5cm的肝内胆管结石被击碎并取净 ,无并发症发生。结论　应用螺旋水刀碎石效果可靠安全 ,不会损伤和击穿胆管 ,碎石过程不产生热量 ,易操作、压力易调整 ,无痛苦。本研究拓展了螺旋水刀的新用途 ,为治疗肝内胆管结石提供了一种新方法     

髌前滑膜血管瘤1例

患者,男,58岁,因右膝关节前侧肿胀7d于2012年4月2日入院。自诉入院前7d于田间长时间蹲位劳作后感觉右膝关节肿痛,未在意,未及时就诊。经休息右膝关节肿胀未见减轻,遂来我院就诊。入院查体:右髌骨前方明显肿胀,可触及一约8cm×6cm×3cm囊性肿物,质软,有波动感,深压痛明显,     

MRI STIR序列对非神经根源性腰痛患者的诊断价值

【摘要】 目的：观察MRI检查中短T1反转回复（short T1 inversion-recovery,STIR）成像技术对于非神经根源性腰痛患者腰椎退变性病变的显示能力,评价其临床应用价值。方法：2010年9月～2011年6月对在我院就诊的有腰痛症状但无神经根放射痛症状的患者进行腰椎MRI扫描,共纳入130例患者,其中男89例,女41例,年龄17~81岁,平均48.3±16.0岁。病史均超过1年。MRI扫描序列包括：矢状面TSE-T1WI、TSE-T2WI、STIR序列,横断面TSE-T2WI序列。对STIR图像及TSE-T2WI图像上腰椎退变性病变进行观察,观察内容包括：L1～S1椎间盘退变情况、椎间盘突出/膨出的节段及程度、腰椎小关节骨质增生情况、棘间韧带水肿情况和腰背部皮下软组织水肿情况。分别对STIR序列与TSE-T2WI序列发现腰椎间盘退变、椎间盘突出/膨出、椎小关节病变、腰部软组织病变的能力进行比较。结果：130例非神经根源性腰痛患者中,STIR序列对于腰椎间盘退变、棘间韧带水肿及腰背部皮下软组织水肿的检出数分别为482个、118节和25例,TSE-T2WI序列检出311个、42节和8例,两序列检出率有显著性差异（P<0.05）;STIR与TSE-T2WI序列对于腰椎间盘突出/膨出和椎小关节骨质增生的检出数均为182个和71个,无差异。两序列均发现5例腰椎滑脱,19例腰椎管狭窄。结论：MRI STIR序列对非神经根源性腰痛患者腰椎间盘退变、棘间韧带水肿及腰背部皮下软组织水肿显示能力优于MRI T2WI。     

Age trends of bone mineral density and percentile curves in healthy Chinese children and adolescents

The clinical utility of dual-energy X-ray absorptiometry (DXA) measurement requires appropriate normative values, designed to be diverse with respect to age, gender and ethnic background. The purpose of this study was to generate age-related trends for bone density in Chinese children and adolescents, and to establish a gender-specific reference database. A total of 1,541 Chinese children and adolescents aged from 5 to 19-years were recruited from southern China. Bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) were measured for the total body (TB) and total body less head (TBLH). The height-for-age, height-for-BA, and BMC-for-BA percentile curves were developed using the least mean square method. TB BMD and TBLH BMD were highly correlated. After 18 years, TB BMD was significantly higher in boys than girls. For TB BMC and TBLH BMC, gender differences were found in age groups 12 years and 16–19 years; however, the TBLH BMD was significantly different between genders >16 years. The head region accounted for 13–52 and 16–49 % of the TB BMC in boys and girls, respectively. Furthermore, the percentages were negatively correlated with age and height. This study describes a gender-specific reference database for Chinese children and adolescents aged 5–19 years. These normative values could be used for clinical assessment in this population.     

罗格列酮对多囊肾囊肿衬里上皮细胞p38促分裂原活化蛋白激酶信号通路的影响

Objective To investigate the effect of rosiglitazone on p38 mitogen-activated protein kinase (p38MAPK) pathway in polycystic kidney cyst-lining epithelial cells. Methods The cyst-lining epithelial cells (PKD cells) from human polycystic kidney were treated with rosiglitazone (10 μmol/L), peroxisome proliferator-activated receptor-γ (PPARγ) inhibitor GW9662 (10 μmol/L), rosiglitazone (10 μmol/L) +GW9662 (10 μmol/L), p38MAPK specific inhibitor SB203580 (10 μmol/L), SB203580 (10 μmol/L)+ rosiglitazone(10 μmol/L) for 2 hours followed by epidermal growth factor (EGF) stimulation. Protein expressions of p38, phuspho-p38 (p-p38) and proliferating cell nuclear antigen (PCNA) were detected by Western blot. p38 mRNA was examined by RT-PCR. Expression of c-fos and c-jun was observed by immunocytochemistry. Results (1) EGF markedly up-regulated the expressions of p38, p-p38, PCNA, c-fos anti c-jun compared with control group (P<0.01). (2) Compared with EGF treated group, rosiglitazone significantly reduced p38 activation and mRNA expression (P<0.01, respectively). Rosiglitazone, rosiglitazone+SB203580 could significantly down-regulated p-p38, PCNA, c-fos and c-jun expression (P<0.01, respectively) with no significant difference between these two groups. (3) GW9662 partially reversed the reduction effect of rosiglitazone. Conclusions Rosiglitazone can inhibit proliferation of autosomal dominant polycystic kidney disease cyst-lining epithelial cells partially through down-regulating p38 activation and reducing c-fos, c-jun and PCNA expression. The above effect of rosiglitazone is in part PPARγ-independcnt.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

经颅多普勒超声检查在颈椎病诊断的参考价值

目的　探讨经颅多普勒超声检查在颈椎病诊断的参考价值。方法　分别对 36例颈椎病病人和 2 0名正常成人进行经颅多普勒超声检查 ,并对椎—基底动脉收缩期峰值血流速度 (Vp)、舒张期末峰值流速 (Vd)以及双侧的差值进行统计学分析。结果　 36例颈椎病病人其中血流速度减慢的 2 9例 ,双椎动脉 Vp、Vd的均值与 2 0例正常对照组比较有显著差异 (P<0 .0 1) ;血流速度增高的 7例与 2 0例正常对照组比较仅 Vp相差显著 (P<0 .0 1) ,而 Vd无显著差异(P>0 .0 5 ) ;36例颈椎病患者两侧椎动脉血流速度差值与正常对照组两侧椎动脉血流速度差值进行比较有显著差异(P<0 .0 1)。结论　经颅多普勒超声检查可作为颈椎病辅助诊断的依据