癌性上腔静脉综合征综合治疗疗效分析

目的探讨综合治疗对上腔静脉综合征(SVCS)的治疗效果.方法分析了35例恶性肿瘤并SVCS化疗、放疗、手术治疗的作用和副作用,并与同期单化疗、单放疗者疗效比较.结果 35例综合治疗症状消失时间分别是1周14例、2周 11例、>2周10例.结论恶性肿瘤并SVCS要局部和全身治疗相结合,综合治疗可弥补单一手段的局限性.     

三氮唑核苷治疗登革热

登革热是由登革病毒引起、经蚊传播的急性传染病 ,以发热 ,皮疹 ,肌肉骨关节剧烈疼痛 ,淋巴结肿大 ,白细胞减少等为主要表现。治疗采用综合治疗和对症处理。近年有部分报道使用抗病毒药治疗 ,能缩短本病病程。 2 0 0 0年 6月至 10月 ,本院共收治登革热患者 14 4例 ,对其中部分患者使用抗病毒药三氮唑核苷治疗 ,观察病程恢复情况 ,现报道如下。资料与方法一、病例选择及分组全部患者均为该年度流行区内、流行季节本院住院患者。患者具有典型临床症状、体征和化验相应诊断指标 ,全部患者临床分型均为典型登革热 ,无出血型、休克型、脑型。全体…     

立春、雨水,养阳护身

正一年之计在于春,冬季厚重的云层慢慢散去,万物苏醒,万象更新。春季是四季的开始,是万物生长的时节。《黄帝内经》这样总结:"春三月,此为发陈",万物生发,推陈出新。春季始于立春,立春作为二十四节气之首,是冬季蛰藏与春季发陈的分界线。中医讲究生气通天,人体的环境、状态、脏腑功能,都与天地环境、气候节气有着密不可分的联系。此时,我们该如何养护身体呢?《黄帝内经》有言曰:春夏     

甲泼尼龙联合常规治疗儿童重型手足口病观察

目的：探讨常规治疗基础上加用糖皮质激素甲泼尼龙治疗重型手足口病（HFMD）的疗效。方法：重型HFMD患儿120例随机分为激素组和非激素组各60例,非激素组给予常规治疗,激素组在此基础上加用甲泼尼龙2mg·kg-1·d-1治疗。5d后比较两组患儿退热时间、止痉时间、住院时间及疱疹消退时间。结果：激素组患儿发热、抽搐、疱疹消退时间明显优于对照组（P〈0.05）。但两组患儿住院天数差异无统计学意义（P〉0.05）。结论：标准治疗基础结合糖皮质激素治疗儿童重型手足口病HFMD有较好的临床疗效。     

基于GMER理念的“损伤与反应”教学

武汉大学基础医学院以全球医学教育最基本要求（global minimumess entialrequirement,GMER）为标准,注重医学生专业技能、创新能力与沟通交流能力的培养,采取小班授课、双语教学、文献阅读、实验和讨论等多种形式,开展以免疫学为主线,涉及病理学及病理生理学,探讨疾病的发生机制、诊断及治疗方法的“损伤与反应”整合课程,以期推动免疫学、病理学和病理生理学教学改革进程。     

基于3D打印股骨远端骨折标准件库接骨板的数字化内固定

BACKGROUND: On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fully meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE: To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtually. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during follow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. All patients were followed up. According to Schagzker criterion, the efficiency of 22 cases was excellent, 6 cases good and 2 cases average, and the excellent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via 3D printing navigation module is expected to achieve implant navigation and application.   中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

基于薄层CT数据的胫骨近端接骨板标准件库的建立及意义

目的　探讨胫骨近端接骨板标准件库建立的方法及临床意义。 方法　采集6套全规格胫骨近端接骨板薄层CT扫描的原始数据,导入Mimics14.0中进行三维重建,以STL格式文件输出至Geomagic对三维模型进行形态学优化。在Mimics中进行体积恢复。利用MedCAD绘制圆柱体状钉道模拟现实锁定钉方向,并完成带钉接骨板形态学标准件库建立。 结果　 (1) 完成186块带钉的接骨板标准件的建立;(2) 经Geomagic外观优化以及Mimics体积恢复,使接骨板三维模型具有较高仿真度。 结论　(1) 基于CT扫描的数据,通过逆向工程软件处理可以实现骨科接骨板的标准件库制备; (2) 接骨板与钉道选择性的组合方式适用于骨折内固定植入手术的数字化设计。     

3D打印截骨模块辅助下全膝关节置换术中与术前虚拟截骨的精确度比较

目的通过3D打印截骨模块辅助下全膝关节置换(TKA)中计算的截骨厚度和术前虚拟的截骨厚度的比较,评价3D打印截骨模块辅助下膝关节置换截骨的精确度。方法选择行初次单侧人工TKA患者20例,采用3D打印截骨模块辅助下行后稳定型人工TKA手术,术中将从股骨远端和胫骨近端所截下的骨质用游标卡尺测量与术前计算机计算的数值分析比较。结果20例患者全部获得随访,平均4.8个月。美国特种外科医院(HSS)评分由术前(48.8±2.1)分,术后3个月增至(88.6±2.8)分,差异显著(t=-22.36,P=0.00)。3D打印截骨模块辅助下TKA术后3个月机械胫骨角(MFT)为(2.2±1.3)°,与术前下肢MFT(8.4±2.6)°对比,同样具有显著性差异(t=7.56,P=0.00)。股骨远端截骨厚度术前计算值为(9.28±0.52)mm,术中测量值为(9.15±0.62)mm;胫骨平台最高点截骨厚度术前计算值为(10.18±0.49)mm,术中测量值为(10.25±0.45)mm;胫骨平台最低点截骨厚度术前计算值为(3.48±0.07)mm,术中测量值为(3.22±0.09)mm,三组术中与术前虚拟截骨厚度测量均无统计学差异(t=1.32,P=0.53;t=-0.78,P=0.49;t=1.68,P=0.68)。结论 3D打印截骨模块能够较精确指导中截骨,其术后膝关节活动功能好。     

基于三维编辑的四肢骨折快速虚拟复位

目的探讨四肢骨折快速的虚拟复位方法。方法采集临床四肢骨折薄层CT扫描数据计437例,数据输入Mimics 14.0,以Edit Mask In 3D的Lasso功能将骨折块分离为各个独立的Mask,三维重建后以Reposition将骨折块进行虚拟复位,过程合称为三维编辑。以Stopwatch软件进行操作计时。结果 437例骨折均完成虚拟骨折复位,平均骨折块数量为5.68±3.11个,平均复位时间为(1 173.71±790.85)s,单个骨折块复位时间为(194.16±49.26)s。结论通过三维编辑的方式,可以实现四肢骨折的快速高仿真虚拟复位。     

股骨颈骨折预测的Ansys非线性屈曲分析

目的 实施10例股骨颈骨折的Ansys非线性屈曲分析,模拟与生物力学实验一致的股骨颈骨折实验全程.方法 采用10个股骨上段标本进行有限元建模,以十字坐标轴及绘图辅助软件TweakWindow实施精确的载荷施加及条件约束,进行特征值屈曲分析及非线性屈曲分析.结果 实现可控制的股骨颈骨折预测的Ansys非线性屈曲分析的载荷施加及条件约束;全部分析在达到结构崩溃时自动终止,发生股骨颈骨折的极限载荷为( 12 324.07±4439.733)N,最大位移为(7.6067 ±2.2716) mm,截取载荷-位移曲线;通过应力等值线图可判断股骨颈骨折位置.结论 非线性屈曲分析是一种适用于骨折预测的有限元算法;通过十字坐标轴及绘图辅助软件可以实现精确可控制的载荷施加及条件约束,实现与生物力学实验一致的条件设置.