高黏度骨水泥治疗骨质疏松性锥体压缩骨折患者围手术期护理

目的 探讨高黏度骨水泥椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折患者围手术期护理.方法 30例患者采用高黏度骨水泥PVP治疗骨质疏松性椎体压缩骨折,通过术前常规护理及心理、饮食干预,术后指导四肢康复锻炼和严密观察骨水泥渗漏,及时给予相应的护理措施.结果 30例患者在护理干预下积极配合PVP治疗,术后疼痛明显减轻.结论 术前充分地准备,术后正确的指导和精心的观察、护理,能够帮助患者尽快地恢复日常生活活动能力,减轻疼痛,提高生活质量.     

地塞米松调节骨髓基质细胞成脂及成骨分化的组织化学研究

目的：观察地塞米松对骨髓基质细胞分化成脂肪细胞的影响,探讨激素性股骨头缺血性坏死的发病机制。 方法：骨髓基质细胞在含有不同浓度地塞米松的培养基中培养,苏丹Ⅲ染色作脂肪细胞计数。采用生化分析仪 测定细胞内甘油三酯含量及碱性磷酸酶活性。结果：脂肪细胞数随地塞米松浓度增大及作用时间延长而增多。 实验组甘油三酯含量明显高于对照组。碱性磷酸酶活性随地塞米松浓度增大而降低。结论：地塞米松能够直接 诱导骨髓基质细胞分化成脂肪细胞,减少其向成骨细胞分化,这可能与激素性骨坏死的发病机制有关。     

机器人辅助膀胱憩室切除术联合单纯前列腺切除术(附3例报告)

目的探讨机器人辅助腹腔镜下行膀胱憩室切除术(RABD)联合单纯前列腺切除术(RASP)的可行性和优越性。方法 2013年8月至2014年12月应用RABD联合RASP治疗良性前列腺增生(BPH)合并巨大膀胱憩室患者3例。前列腺体积分别为100、105、120 ml,术前残余尿分别为100、160、300 ml。膀胱憩室体积平均分别为90、150、280 ml。结果 3例手术均获成功,3例手术时间分别为90、110、130 min,术中出血量分别为60、100、120 ml,术后均膀胱冲洗2 d,住院时间分别为7、9、11 d,随访6~14个月无尿失禁及尿潴留发生。结论应用RABD联合RASP治疗BPH合并膀胱憩室患者使手术效率提高,操作更精确,手术更安全,疗效满意。     

地塞米松调节骨髓基质细胞成脂及成骨分化的研究

目的　观察激素对骨髓基质细胞脂肪特异性基因aP2mRNA及成骨基因Ⅰ型胶原mRNA表达的影响。方法　以地塞米松 (1× 10 -7mol/L)作为诱导剂 ,采用完整细胞斑点印迹分子杂交方法检测实验组和对照组中aP2和Ⅰ型胶原mRNA表达。结果　实验组aP2mRNA含量4847.7± 40 6 .4明显高于对照组 15 7.6± 10 .8,其Ⅰ型胶原mRNA含量 44 2 .3± 5 7.8明显低于对照组 5 35 3 .6± 36 4.6。结论　地塞米松能够从基因调控水平诱导骨髓基质细胞向脂肪细胞分化 ,减少其向成骨细胞分化 ,这可能与激素性骨坏死的发病机制有关。     

后路经椎弓根半椎体切除融合内固定治疗半椎体畸形

目的 评价后路经椎弓根半椎体切除、植骨内固定治疗半椎体畸形的疗效.方法 回顾性分析2007年6月至2009年6月共30例接受经椎弓根半椎体切除、植骨内固定治疗的先天性半椎体畸形病例,比较术前、术后脊柱全长正侧位片及脊柱侧凸Cobb角.结果 术前冠状面主弯Cobb角平均46.52°,术后Cobb角14.64°,侧凸平均矫正率68.51%,术前术后主弯Cobb角比较差异有统计学意义(P<0.05);无内固定断裂、出现神经症状病例.结论 后路经椎弓根半椎体切除、融合内固定治疗半椎体畸形可有效地矫正畸形.     

脊柱侧弯患者术前术后骨盆矢状位参数分析

目的:探讨脊柱侧弯患者术前术后腰骶部的矢状位参数的相关性及临床意义。方法:回顾2009年1月至2011年9月资料完整的20例无症状成年志愿者与20例脊柱侧弯患者,均为男6例,女14例,排除其他脊柱后凸畸形及老年性脊柱退行性变,在包含双侧股骨头的全脊柱站立位片上测量腰椎前凸角(LL),骨盆入射角(PI),骶骨水平角(SS),骨盆倾斜角(PT)等参数,与健康成人组(20例)比较,并进行各参数间的相关性分析。结果:根据特发性脊柱侧弯术前及术后患者分组并与健康成人对比,PI、PT、LL与SS,差异均具有统计学意义(P<0.05),PT、SS均与LL轻度相关,PT与SS的相关系数无统计学意义。PI在正常人、术前、术后均与SS和PT存在明显相关性(P<0.05)。结论:手术前后的LL均与骨盆参数PI和SS存在明显相关性,术前评估骨盆参数有助于术中确定最适宜的LL值。     

甲泼尼龙预干预脊髓缺血再灌注损伤对热休克蛋白27和肿瘤坏死因子α表达的影响

Objective To observe the effect of methylprednisolone (MP) pre-intervention on ex-pressions of heat shock protein 27 (HSP27) and tumor necrosis factor alpha (TNF-α) in cells in rat spinal cord following ischemia-reperfusion injury. Methods One hundred and fifty male Sprague-Dawley (SD) rats were randomly divided into 3 equal groups: group A (control) in which the abdominal aorta was exposed without any treatment, group B in which the abdominal aorta was clipped for 30 minutes before reperfusion for 3 bours to establish a model of ischemia- reperfusion injury, and group C in which intravenous MP injection was conducted 30 minutes before the establishment of the ischemia-reperfusion injury model. Three hours later the spinal cords were harvested. Pathological changes of spinal cord cells were observed with HE staining and expressions of HSP27 and TNF-α in spinal cord cells were observed with immunohistochemical staining. The motor function of hind-limbs before was evaluated before sample harvest. The data were analyzed with SPSS software. Results There were significant differences between groups A and B in the expressions of TNF-α and HSP27. Compared with group B, the expression of TNF-α decreased and HSP27 increased in group C, with statistically significant differences between the 2 groups. The motor function score of hind-limbs decreased in group B but improved in group C. Conclusions Since MP can decrease the expression of TNF-α and up-regulate the expression of HSP27, it has a potency of neuro-protection. Spinal cord ischemia-reperfusion injury can be avoided or decreased after MP pre-intervention.     

甲泼尼龙预干预脊髓缺血再灌注损伤对热休克蛋白27和肿瘤坏死因子α表达的影响

Objective To observe the effect of methylprednisolone (MP) pre-intervention on ex-pressions of heat shock protein 27 (HSP27) and tumor necrosis factor alpha (TNF-α) in cells in rat spinal cord following ischemia-reperfusion injury. Methods One hundred and fifty male Sprague-Dawley (SD) rats were randomly divided into 3 equal groups: group A (control) in which the abdominal aorta was exposed without any treatment, group B in which the abdominal aorta was clipped for 30 minutes before reperfusion for 3 bours to establish a model of ischemia- reperfusion injury, and group C in which intravenous MP injection was conducted 30 minutes before the establishment of the ischemia-reperfusion injury model. Three hours later the spinal cords were harvested. Pathological changes of spinal cord cells were observed with HE staining and expressions of HSP27 and TNF-α in spinal cord cells were observed with immunohistochemical staining. The motor function of hind-limbs before was evaluated before sample harvest. The data were analyzed with SPSS software. Results There were significant differences between groups A and B in the expressions of TNF-α and HSP27. Compared with group B, the expression of TNF-α decreased and HSP27 increased in group C, with statistically significant differences between the 2 groups. The motor function score of hind-limbs decreased in group B but improved in group C. Conclusions Since MP can decrease the expression of TNF-α and up-regulate the expression of HSP27, it has a potency of neuro-protection. Spinal cord ischemia-reperfusion injury can be avoided or decreased after MP pre-intervention.     

机器人辅助腹腔镜下肾上腺复杂肿瘤手术(附光盘)

目前,传统腹腔镜肾上腺切除术(laparoscopic adrenalectomy,LA)已成为治疗大部分肾上腺肿瘤的首选方法,但其在处理一些复杂性肾上腺肿瘤时仍较困难。达芬奇机器人手术系统在泌尿外科领域的广泛应用和发展是当今世界临床医学发展的里程碑。机器人辅助腹腔镜下肾上腺切除术(robot-assisted laparoscopic adrenalectomy,RALA)使得一些不适合传统腹腔镜手术的肾上腺肿瘤的微创治疗成为可能。本文就达芬奇机器人手术系统、RALA用于复杂肾上腺肿瘤治疗、RALA的手术步骤和技巧做一概述。     

本体感觉神经肌肉促进法对5km越野后肌疲劳的作用及最佳干预时机

背景：5km越野训练后会使人体出现肌疲劳,常导致各种程度的肌肉酸痛和肌无力等,而神经肌肉促进法可改善关节和肌肉柔韧性。目的：观察感觉神经肌肉促进法对新入学军校学员5km越野训练后肌疲劳的干预作用及最佳干预时机。方法：选择新入学的健康军校男学员,均进5km越野训练。分别在训练前、后针对双下肢、骨盆带肌肉采用本体感觉神经肌肉促进法干预,并设置正常训练组作对照。在训练前,训练后第1,3,5天分别评定其肌疲劳度,并检查相关血液生化指标。结果与结论：训练后第1,3,5天全部对象肌疲劳度和相关血液生化指标肌红蛋白、谷丙转氨酶、谷草转氨酶、乳酸脱氢酶和肌酸磷酸激酶的平均增幅差异均为训练后神经肌肉促进干预组〈训练前神经肌肉促进干预组〈正常训练组（P〈0.05）。结果表明经本体感觉神经肌肉促进法干预可以降低5km越野训练后相关血生化指标的增高,减轻肌损伤,降低肌疲劳。训练结束后当天行本体感觉神经肌肉促进法干预为最佳时机。