椎-基底动脉系统脑梗死118例病情恶化危险因素分析

目的 探讨椎-基底动脉系统(VBS)脑梗死病情恶化的危险因素.方法 将符合入选标准的439例VBS梗死患者根据病情是否进展恶化分为两组:进展性卒中组(PS组)和非进展性卒中组(nPS组),采用单因素和多因素回归分析,分析进展性脑卒中的危险因素.结果 单因素分析显示,PS组与nPS组比较,在VBS狭窄积分、神经功能缺损评分(NIHSS)、血压分级、心房纤颤(AF)发生情况及空腹血糖(FBS)、纤维蛋白原 (Fib) 水平、溶栓和降纤治疗方面差别均有统计学意义(P＜0.05),而两组的低密度脂蛋白胆固醇(LDL-C)水平及抗凝和抗血小板治疗情况间差别均无统计学意义(P＞0.05).多因素回归分析显示VBS狭窄积分、NIHSS、高血压、高血糖、AF、溶栓或降纤治疗与病情进展恶化相关.结论 VBS狭窄积分、NIHSS、高血压、高血糖、AF是VBS脑梗死病情恶化的危险因素,溶栓或降纤治疗能够部分逆转脑梗死病情恶化的发生和发展过程.     

Insufficiency fractures of both femoral necks in a young adult caused by osteoporosis: a case report

Insufficiency fractures of femoral necks due to osteoporosis of unknown aetiology occurring coincidentally on both sides in young adults, have not been described in English literature so far. A 18-year-old young girl presented with a 3-month history of gradual onset of bilateral thigh pain and progressive inability to walk. At the first look, plain radiographs of both hips showed no gross abnormal findings other than some tips on reduced bone mineral density of the femoral necks. MRI was ordered upon a high suspicion of fracture and T1-weighed MRI showed a linear low signal on both femoral necks. Dual-energy X-ray absorptiometry of the lumbar spine and femoral neck showed low mineral density. She was treated surgically with in-situ internal fixation using cannulated screws. The bilateral thigh pain was resolved and walking started immediately after the treatment. Insufficiency fracture of the femoral neck due to osteoporosis should be kept in mind even in young adults complaining of atypical pain without evidence of unusual activities. We used both the terms of stress fracture and insufficiency (osteoporotic) fracture interchangeably as the mechanism of fractures resemble each other.     

眩晕宁和氟桂利嗪及尼莫地平联合复方丹参片治疗椎-基底动脉供血不足性眩晕的疗效观察

目的探讨不同用药方案治疗椎-基底动脉供血不足性眩晕的疗效及成本效果。方法将120例椎-基底动脉供血不足性眩晕患者随机分为眩晕宁组(A组:治疗组40例)、氟桂利嗪组(B组:观察组39例)及尼莫地平合用复方丹参片组(C组:对照组41例),60d后观察3组患者临床疗疗效。结果 A组总有效率为95.0%。B总有效率为84.6%,C总有效率为总有效率为73.2%。3组相比,具有显著性差异。结论眩晕宁(A组)是治疗椎-基底动脉供血不足性眩晕的最佳方案。     

椎基底动脉供血障碍时内耳微循环的变化及其调节

本文用自行设计制作的椎基底动脉部分脑缺血动物模型，用激光多普勒（ＬＤＦ）测定椎基底动脉缺血前后耳蜗血流（ＣＢＦ）和前庭血流（ＶＢＦ），血管阻断后耳蜗和前庭血流分别减少４６０４ＡＢＬ％和３２４７ＡＢＬ％。颈内静脉注入罂粟碱和切除一侧颈上神经节后测定内耳血流，证明在内耳血流调节中，肌源性因素起重要作用，而交感神经的调节作用微弱。     

椎基底动脉脑缺血动物模型

报告结扎一侧颈总动脉、部分阻断基底动脉所造成的椎基底动脉脑缺血动物模型。血管阻断后基底动脉内血细胞流动减少、血流变慢；脑干电图示波幅减低、频率减低；脑干听诱发电位出现反应阈增高、潜伏期延长和波幅减低；耳蜗血流减低４７．４１ＡＢＬ％。证明这是一个研究椎基底动脉供血障碍基础和临床的实用、有效和符合临床特点的动物模型。     

丽珠利脉胶囊治疗椎基动脉供血不足

目的 探讨丽珠利脉胶囊治疗椎基动脉供血不足的疗效。方法 采用随机前瞻性对照法，对31例住院病人应用丽珠利脉胶囊治疗，和脑复康组作对照，主要观察临床治疗效果，主要表现眩晕、视觉障碍、眼球震颤、Romberg征、直线行走改善时间及血液流变学改善情况。结果 丽珠利脉治疗组较脑复康组治疗效果明显，主要症状体征改善时间缩短，血液流变学亦明显改善，无明显副作用。结论 丽珠利脉胶囊为治疗椎基动脉供血不足安全有效药物。     

心气虚证左室舒张功能的临床及实验研究

采用微机检测心机械图,获取心功能参数。结果64例心气虚证与正常人比较,左室舒张和收缩功能均低下(P<0.01),而肺、脾胃、肾气虚证与正常人比较左室舒张功能参数无显著差别;心气虚证患者,左室舒张性能指标舒张时间振幅指数(DATI)较收缩性能指标左室射血前期/左室射血期(PEP/LVET)更为敏感,DATI和PEP/LVET异常率无显著差别,但两者正常、异常间有交叉,说明心气虚证有单纯心收缩或舒张功能异常。随机双盲法证实,益心补气的益心合剂能改善心气虚证异常的心收缩和舒张性能。实验选用狗急性心肌缺血动物模型,尝试性探讨缺血心肌的"心气"变化,短暂心肌缺血及复灌过程中"心气虚"表现,同临床结果一致。     

骶骨衰竭骨折的18F-FDG PET/CT显像分析

目的 探讨骶骨衰竭骨折的¹⁸F-FDG PET/CT显像特点。方法 回顾性分析接受¹⁸F-FDG PET/CT检查、诊断为衰竭骨折的8例患者的资料。结果 8例患者均发现骶骨有不同程度的异常放射性摄取增高,最大标准摄取值（SUV_max）为2.7~7.2。病变位于骶骨左侧翼4例、双侧骶骨翼及岬部2例、双侧骶骨翼1例、骶骨左侧翼及岬部1例;8例发生骶骨翼的纵行骨折,6例位于S1~2椎体,2例累及S3椎体,3例发生骶骨岬部的横行骨折,2例位于S2椎体,1例位于S3椎体;骶骨骨质密度增高5例、密度未见改变3例。结论 骶骨衰竭骨折的¹⁸F-FDG PET/CT显像有一定特点。     

Risk factors associated with sacral stress fractures: a systematic review

Objectives:The objective of this study was to examine and identify risk factors associated with the development of sacral stress fractures in order to improve diagnosis in clinical practice.Methods:Electronic search strategies in PubMed, CINAHL, Scopus, and SPORTDiscus were combined with a hand search to identify articles for inclusion. Studies were considered if they described patient cases in which imaging confirmed diagnosis of a sacral stress fracture, and the diagnosis included whether the fracture was a sacral insufficiency or sacral fatigue stress fracture.Results:In those that developed sacral insufficiency fractures, the risk factors that were most prevalent included osteoporosis, pelvic radiation therapy, rheumatoid arthritis, long-term corticosteroid therapy, and postmenopausal, each with a prevalence of 100%. Risk factors with 100% prevalence in those diagnosed with sacral fatigue fractures included recent increase in training intensity and deficient diet.Discussion:A pattern of signs and symptoms are consistent among subjects with sacral stress fractures. Patients being unsuccessfully treated for low-back and buttock pain who fit the risk factor profiles for sacral stress fractures should be referred to a physician for further diagnostic workup.