前臂纵向不稳定的生物力学研究

目的研究前臂纵向不稳定的生物力学机制,为临床诊断及治疗提供可靠的理论依据。方法12具新鲜冷冻尸体上肢标本制成生物力学模型,固定于MTS858型生物材料实验机上加载恒定100N的轴向负荷,测试不同解剖状态对桡骨纵向位移及前臂纵向稳定性的影响。结果单纯切断骨间膜对前臂的纵向稳定性影响甚微。切除桡骨头,前臂的纵向稳定性降低,桡骨向近端移位明显,再切断骨间膜,将使上述改变加重。结论桡骨是维持前臂纵向稳定的主要结构,前臂骨问膜是次要稳定结构。桡骨头切除后骨间膜损伤是前臂纵向不稳定产生并发症的主要原因。     

射频热凝术联合臭氧自控硬膜外镇痛在腰椎间盘突出症中的应用

目的观察射频热凝术联合臭氧、自控硬膜外镇痛(Patient controlled epiclural analgesiaPCEA)在治疗腰椎间盘突出症中的疗效及安全性,并对该技术的推广应用做出评估。方法对116例经CT或MRI检查确诊的腰椎间盘突出症患者,采用射频热凝术联合臭氧、PCEA治疗。结果本组116例患者,经该方法治疗后,其中97例治疗效果达优级,17例治疗效果良好,2例效果可,优良率98.3%。治疗期间1例出现下肢肌力减退,降低利多卡因浓度和减小持续输注量后下肢肌力恢复,6例术后并发轻微头痛、头晕等不适,经卧床休息及静脉补液后,症状均于3d内消失。未见其他严重并发症。结论射频热凝术联合臭氧、PCEA治疗腰椎间盘突出症是一种创伤小、安全性高、并发症少、复发率低、疗效满意的方法。     

股骨颈骨折生物型全髋关节置换术后放置真空负压引流对围手术期失血量影响的病例对照研究

目的 :比较股骨颈骨折全髋置换术后放置真空负压引流瓶,不同负压下术后失血量的差异。方法 :选取2013年1月1日至2013年12月30日采用生物型全髋关节置换术治疗的74例股骨颈骨折患者,分成高负压引流组和低负压引流组。高负压引流组34例,男10例,女24例;平均年龄(75.94±9.02)岁;术毕放置60 k Pa负压真空负压引流瓶。低负压引流组40例,男13例,女27例;平均年龄(74.93±8.90)岁;术毕放置30 k Pa负压真空负压引流瓶。对术后伤口引流量、血红蛋白改变值、根据身高体重和手术前后红细胞压积(Hct)计算的所有患者总失血量等进行观察,并做统计学分析进行比较。结果:两组患者术后切口均Ⅰ期愈合,无感染发生。术后第1天,高负压引流组血红蛋白改变值为(41.74±15.69)g/L,总失血量(1 217.73±459.50)ml,术后引流量(312.94±103.44)ml;低负压引流组血红蛋白改变值(34.90±12.90)g/L,总失血量(904.01±381.58)ml,术后引流量(129.25±44.25)ml,高负压引流组的数值均高于低负压引流组。术后3 d,高负压引流组血红蛋白改变值为(46.00±13.29)g/L,总失血量(1 304.72±421.75)ml;低负压引流组血红蛋白改变值为(43.87±11.39)g/L,总失血量(1 196.78±344.20)ml,两组差异无统计学意义。结论:股骨颈骨折生物型全髋关节置换术后放置引流时,根据患者术前血红蛋白、红细胞压积等情况选择负压引流压力大小,老年性股骨颈骨折选择低负压引流更为合适。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

脊髓血管畸形血管内皮生长因子在脑脊液的表达

目的探讨脊髓血管畸形是否存在血管内皮生长因子(VEGF)表达,及其表达与临床特征之间是否存在相关性。方法在手术中留取56例脊髓血管畸形的脑脊液标本,其中动静脉畸形(SCAVM)23例,硬脊膜动静脉瘘(SDAVF)19例,海绵状血管瘤(CM)14例;以我院12例蛛网膜下腔阻滞病人脑脊液作为对照组,分别通过酶联免疫吸附方法(ELISA)测定脊髓血管畸形脑脊液中VEGF含量。结果SCAVM脑脊液中VEGF浓度为(277±66)pg/ml、SDAVF为(318±54)pg/ml、CM为(146±32)pg/ml均高于正常对照组(123±27)pg/ml。术前栓塞和出血均可导致脑脊液VEGF升高。结论VEGF与脊髓血管畸形的发生、发展存在一定关系,出血和栓塞均可影响VEGF的表达。     

髓内型海绵状血管畸形的临床研究(附15例报告)

脊髓海绵状血管畸形在临床上比较少见,国外报道也不多[1～3],单纯的脊髓髓内海绵状血管畸形(intramedullary spinalcord cavernous malformation,ISCC)就更少。随着MRI的广泛应用,此病例的报告不断增加。而显微神经外科手术技术的开展使得该病的治疗效果有了极大改善[4～6]。我科自2008年9月至2011年12月共收治15例脊髓髓内海绵状血管畸形患     

缺血后处理对大鼠脑缺血再灌注后紧密连接的保护作用及ZO-1蛋白表达的影响

目的观察缺血后处理对脑缺血再灌注后紧密连接的保护作用及相关蛋白ZO-1表达的影响。方法 45只Wistar雄性大鼠随机分为假手术(Sham)组、缺血再灌注(I/R)组、缺血后处理(IP)组。采用线栓法建立大鼠大脑中动脉缺血模型,脑缺血2 h后,I/R组予再灌注,IP组给予缺血后处理之后予再灌注。于脑缺血再灌注后24 h行TTC染色观察脑梗死体积,应用电镜观察紧密连接蛋白结构改变,Western blot观察ZO-1蛋白表达的变化。结果 IP组脑梗死体积明显小于I/R组,与Sham组相比,I/R组血脑屏障紧密连接开放,ZO-1蛋白表达明显减少;与I/R组比较,IP组紧密连接开放程度减轻及ZO-1表达增加。结论缺血后处理减小脑梗死体积;缺血后处理能够减轻紧密连接破坏,其保护机制可能与ZO-1蛋白表达增加有关。     

血管内介入治疗颅内巨大动脉瘤23例报告

颅内巨大动脉瘤是指最大直径大于25 mm的动脉瘤,治疗仍十分困难,我们采用血管内介入治疗23例颅内巨大动脉瘤病人,并取得良好效果,现结合有关文献分析报告如下.     

Pinacidil抑制线粒体和死亡受体通路减少大鼠脑缺血再灌注后神经元凋亡(英文)

目的探讨ATP敏感性钾通道开放剂pinacidil对大鼠脑缺血再灌注后神经元凋亡的保护作用及信号转导机制。方法 100 只Wistar 雄性大鼠随机分为四组:A 组(假手术组)、B组 (缺血组)、C 组 (KATP开放剂处理组)及D组 (KATP开放剂和阻断剂处理组)。用线栓法制备大鼠大脑中动脉缺血(middle cerebral artery occlusion,MCAO)模型,用DNA断端末端标记法(terminal-deoxynucleotidytransferase-mediated dUTP-biotin nick end labeling,TUNEL)检测神经元凋亡,用原位杂交方法检测caspase-3、caspase-8及caspase-9 mRNA的表达。结果 (1) C组12 h、24 h、48 h、72 h 时间点的凋亡细胞数较 B、D 组显著减少(P<0.05 或 P<0.01) ;B 组和 D组之间无显著性差异(P>0.05)。(2) C 组 caspase-3 mRNA 和 caspase-8 mRNA 在各时间点及 caspase-9 mRNA 在 12 h、24 h、48 h、72h 时间点的表达显著少于B组和D组(P<0.01或P<0.05),B组和D组之间无显著性差异(P>0.05)。结论 KATP通道开放剂能显著减少大鼠脑缺血再灌注后的细胞凋亡及caspase-3、caspase-8及caspase-9 mRNA的表达。KATP通道开放剂可能通过抑制线粒体通路和死亡受体通路降低神经元凋亡,保护缺血再灌注损伤后的脑组织。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.