有限内固定结合外固定治疗B、C型Pilon骨折

<正>2006年6月~2012年10月,我们对37例B、C型Pilon骨折患者采用有限内固定结合外固定治疗,取得良好疗效,报道如下。1材料与方法1.1病例资料本组37例,男28例,女9例,年龄21~63岁。开放骨折8例,闭合骨折29例。按AO分型:B型23例,C型14例。其中26例伴腓骨骨折。受伤至手术时间3 h~7 d。1.2手术方法椎管内麻醉。有腓骨骨折者先行固定,一般选用3 mm重建钢板或骨圆针髓内固定。胫骨选用前外侧小切口,不剥离皮下组织以免皮肤坏     

The measurement of serum cholinesterase activities by an integration strategy with expanded linear ranges and negligible substrate-activation

Objectives

To measure serum cholinesterase (SCHE) with an integration strategy.

Design and methods

At 54.0 μmol/L butyrylthiolcholine, SCHE initial rates were calculated with 50.0 μmol/L butyrylthiolcholine and maximal rates via an improved integrated method if substrate consumptions within 5.0 min were over 60%, or were determined by the classical initial rate method.

Results

The linear range was from 16 to 1560 nkat/L, and SCHE in clinic sera showed negligible substrate-activation.

Conclusion

This strategy was effective.     

Multiaxial high-modularity spinopelvis (HMSP) fixation device in neuromuscular scoliosis: a comparative study

Purpose

To compare radiological and clinical results in patients operated for neuromuscular scoliosis with pelvic fixation using high-modularity spinopelvic screw (HMSP) designed by authors.

Methods

Of 54 patients with neuromuscular scoliosis, group 1 comprised of 27 patients with conventional pelvic fixation; and group 2 comprised of 27 patients using HMSP. Results were evaluated radiologically and functionally. We compared preoperative and postoperative complications, especially the loosening or breakage of spinopelvis fixation device, failure of fixation, and the change of shadow around the spinopelvis fixation device.

Results

There was no difference of correctional power, preoperative average Cobb’s angle of each group was 79.8 and 75 to postoperative 30.2 and 28.3 (P < 0.05). Pelvic obliquity improved from average 18.3°–8.9° in group I and average 24.3°–12.5° in group II (P < 0.05). However, there was no difference between two groups (P > 0.05). Average blood loss was 2,698 ml in group 1 and 2,414.8 ml in group 2 (P > 0.05). Average operative time was 360 min in group 1 and 332 min in group 2 (P = 0.30). There was no difference found between two groups regarding gait and functional evaluation. On the all cases of group 1 and 2, the change of shadow around the spinopelvis fixation device was observed. There was one case of the fracture of spinopelvis fixation device in group I.

Conclusion

There was no difference of Cobb’s angle and correctional power between the groups using HMSP when compared with the group using standard spinopelvis fixation device. Therefore, HMSP can be used more effectively in case of neuromuscular scoliosis.     

长春瑞滨化疗性静脉炎动物模型的建立

目的探讨建立长春瑞滨化疗性静脉炎动物模型适宜的给药浓度,为化疗性静脉炎的发生机制研究提供实验基础。方法选择实验用健康家兔28只,采用随机数字表法分为四组各7只。均于一侧耳缘静脉注药建模。第1组注射生理盐水10mL作为阴性对照,其余3组将长春瑞滨用10mL生理盐水溶解,分别按12.5mg/m2、25mg/m2和50mg/m2剂量注射。结果长春瑞滨组静脉炎症反应出现于注射后24h,48h左右表现最显著,约于1周恢复。25mg/m2组、50mg/m2组注射后48h有典型的静脉炎病理变化,50mg/m2组4只家兔分别于药物注射后第7～10天死亡,25mg/m2组家兔无死亡。结论参照人体用量采用长春瑞滨25mg/m2于家兔耳缘静脉化疗,能较好建立化疗性静脉炎动物模型。     

中药浴联合穴位按摩佐治小儿发热效果观察

目的观察中药浴联合穴位按摩辅助治疗小儿外感发热的临床效果。方法将174例急性上呼吸道感染致发热患儿随机分为对照组(88例)和观察组(86例),对照组在常规治疗的基础上,给予温水洗浴;观察组采用中药洗浴联合穴位按摩。结果两组患儿洗浴前后体温、解热时间比较,差异有统计学意义(P0.05,P0.01)。结论两种辅助治疗小儿发热的方法均有效,中药药浴联合穴位按摩治疗的临床效果优于温水洗浴。     

Surveying quality of life in patients with Fabry disease by the SF-36 scale

Objective To test the availability of the SF-36 scale for the Chinese patient with Fabry disease (FD), the quality of life(QOL) and its probable influence factors were analyzed. Methods The data were obtained from 50 healthy volunteers and 57 patients with FD enrolled in nephrology department of Ruijin hospital from Jan, 2003 to Jan, 2013. The SF-36 scale was used to evaluate the QOL of patients and to compare the difference between the patientsandcontrols. Furthermore, the influencing factors were estimated by multiple linear regressions. Results Between the patientsandcontrols, the differences of 8 dimensionalitiy's scores had statistical significance, which claimed that the reaction was sensitive. Especially, in the patient group, the Pearson correlation coefficient among each domain of the SF-36 was lower than its Cronbach's α coefficient (0.934), which indicated good internal consistency reliability. The two common factors were much the same to the theory assume, which illustrated the construct validity was available. Even the acceptability of the patient’ group at 100% proved the scale was appropriate for patients with FD. In addition, in role-physical (RP) and bodily pain (BP) , the scores of the male patients were less than the females (P﹤0.01), declared that the QOL of the males was inferior to the females. In the physical function (PF) and the mental health (MH), the scores of the patients with angiokeratoma were less than the group without it, so the patients who had evident clinical symptoms more likely contributed to depression. Using multiple linear regression, age, gender and clinical types were chosen into regression equation by stepwise regression, and the main potential predictor was age. Conclusions The SF-36 scale applies to evaluate the QOL of patients with FD. It is critical to concern and manage the QOL of FD patients, especially in their mental health aspect.     

高压氧促进重度缺氧缺血性脑病新生儿智能康复的疗效观察

目的观察高压氧治疗重度新生儿缺氧缺血性脑病（HIE），促进患儿智能康复的近期、远期疗效。方法将同期住院的47例重度HIE患儿随机分为高压氰（HBO）组24例、对照组23例，两组接受相同的常规药物治疗至生后3个月，HBO组自生后8—10d开始接受HBO治疗，10d为1个疗程，每间隔10—15d进行下1个疗程，共4个疗程。两组患儿均按双盲原则，于生后7d、28d行新生儿行为神经（NBNA）测定，2岁时行Bayley婴幼儿发育量表（BSID）测试，于5岁时行韦氏学龄前儿童智力量表（WPPSI）测试，以评价HBO治疗重度HIE的近期与远期智能康复情况。结果HBO组28d时NBNA评分明显高于对照组（P〈0．01）；2岁时Bayley智力测定，HBO组心理发展指数（MDI）明显高于对照组（P〈0．05）；5岁时WPPSI智力测定，HBO组总智商（FIQ）和言语智商（VIQ）明屁高于对照组（P〈0．05）。HBO组智力缺陷发生率为12．5％（3／24），明显低于对照组39．1％（9／23）（P〈0．05）。结论HBO不仅可显著提高患儿的近期疗效，且能够明显改善患儿的远期预后，促进其智能康复，防治智力低下。     

自体CIK细胞辅助治疗非霍奇金淋巴瘤患者的临床观察

目的观察细胞因子诱导杀伤细胞(cytokine induced killer cells)辅助治疗非霍奇金淋巴瘤的安全性及近期疗效。方法对6例经病理确诊为非霍奇金淋巴瘤并且存在结外器官侵犯的患者,取其自体外周血单个核细胞,在含10%血浆的RPMI-1640培养基中添加Anti-CD3mAb和rhIL-2联合诱导单个核细胞为CIK细胞,并将细胞进行自体回输。结果CIK细胞输注后可见患者体内CD3 CD56 细胞较前增加,影像学复查显示肿块缩小,治疗过程中主要出现畏寒、发热,未观察到其他明显副作用。结论自体单个核细胞可以高效扩增CIK细胞,回输治疗非霍奇金淋巴瘤安全有效,且无明显毒副作用。     

推拿加鹿衔草为主组方干预老年性膝骨关节炎

目的:观察推拿和鹿衔草为主组方治疗老年性膝关节骨关节炎的干预效果。方法:选择2002-03/2004-06在上海交通大学附属第一人民医院推拿科、中医科门诊就诊的老年性膝关节骨关节炎患者86例,均自愿参加观察。按随机分组表分成4组,即推拿 鹿衔草组、推拿组、鹿衔草组及自我锻炼组,分别为22,22,22及20例。①推拿组患者取俯卧位,以滚法作用于患肢后侧5min,重点在部委中(、委阳(;取仰卧位,用滚法作用于患者患侧大腿股四头肌,着重于膝关节髌骨上部5min;继而以按揉与弹拨法交替作用于患肢,配合点按犊鼻、内外膝眼、阳陵泉、鹤顶、膝阳关、梁丘等(位;作屈膝法,配合膝关节伸屈、旋内、旋外被动运动;最后以擦法擦热患膝。3次/周,共治疗4周。②鹿衔草组患者服用汤药(鹿衔草为主的基础方),辩证加减。1剂/d,分2次口服,共服用4周。③推拿 鹿衔草组治疗方法:在推拿治疗同时服用鹿衔草为主组方的汤药,共治疗4周,方法同上。④自我锻炼组:进行知识教育,并嘱患者自行进行功能锻炼,包括牵张训练、主动和被动活动度训练及增力训练等,锻炼时间为4周。采用WOMAC评分(包括疼痛、僵硬、日常生活3大类,用0～100mm视觉量表评分法,分数越高患者的机体功能越差,对生活的影响程度也越大)和20m步行时间对治疗前及治疗4周后的膝关节功能进行评估,并在治疗4周后评估疗效,疗效评定标准:①有效:关节疼痛、肿胀消失,活动功能恢复正常,理化检查正常。②好转:关节疼痛、肿胀减退,活动功能好转。结果:86例患者均进入结果分析,无脱落。①各组患者治疗4周后的WOMAC评分和20m步行时间均较治疗前显著降低(P<0.05)。治疗4周后推拿 鹿衔草组的WOMAC评分显著低于自我锻炼组(P<0.05);推拿 鹿衔草组和推拿组的20m步行时间显著短于自我锻炼组(P<0.05)。②经过4周的治疗和锻炼,推拿 鹿衔草组、推拿组、鹿衔草组及自我锻炼组患者的治疗有效率分别为86%,82%,82%和60%,各组比较差异均无显著性意义(P>0.05)。结论:单纯推拿、单纯服用鹿衔草及自我功能锻炼均能有效治疗老年性膝关节骨关节炎,明显改善患者膝关节运动功能,但推拿加鹿衔草综合治疗的疗效更优。     

慢性子宫内膜炎合并不孕症患者 CD138 表达 及其与妊娠结局相关性研究

〔摘 要〕 目的：探究膜硫酸乙酰肝素蛋白多糖配体蛋白聚糖 –1（CD138）在慢性子宫内膜炎所致不孕症患者中的阳性表 达情况,并探究其对慢性子宫内膜炎致不孕症患者妊娠结局的预测价值。 方法：选取惠州市惠阳区妇幼保健院 2019 年 5 月 至 2021 年 1 月期间收治的 80 例不孕症患者,所有患者均进行子宫内膜活检,根据其子宫内膜苏木精 – 伊红染色法（HE） 染色结果分为病例组 22 例和阴性组 58 例。两组患者均进行子宫内膜 CD138 免疫组化检查,比较各组 CD138 阳性率。同 时对病例组患者予以规范的抗菌药物治疗,两组患者均随访6个月以上追踪受孕成功情况,并分析受孕成功者CD138阳性率。 结果：病例组 CD138 阳性率为 95.45 %,显著高于阴性组的 3.45 %,差异具有统计学意义（P ＜ 0.05）。随访 6 个月以上, 病例组患者经规范抗感染治疗后有 3 例宫内妊娠,阴性组患者经治疗后有 21 例宫内妊娠,其中 CD138 阳性者受孕成功率 显著低于 CD138 阴性者,差异具有统计学意义（P ＜ 0.05）。 结论：慢性子宫内膜炎合并不孕症患者的子宫内膜 CD138 阳 性率高,且 CD138 阳性表达的慢性子宫内膜炎合并不孕患者其宫内妊娠成功率低,因此临床有望可通过检测 CD138 诊断 慢性子宫内膜炎合并不孕,并预测其妊娠结局,为临床治疗提供指导。此外,积极治疗子宫内膜炎,使 CD138 由阳性转为 阴性有利于提高妊娠成功率。