应用可吸收钉棒治疗关节内骨折

目的探讨可吸收钉、棒治疗关节内骨折的效果。方法1998年6月～2004年8月，应用自身增强一聚乙酯（self-reinforced polyglycolic acid，SR—PGA）、自身增强一聚丙酯（self—reinforced poly—L—Lacticacid，SR—PLLA）可吸收螺钉、棒，手术治疗关节内骨折35例，其中男30例，女5例。年龄4～62岁。均为关节内或关节周围松质骨骨折。手术时间为伤后3h～29d。应用SR—PGA全螺纹钉9枚，SR—PLLA拉力螺钉26枚，SR—PLLA固定棒15枚。术后行骨牵引或石膏外固定。结果患者术后获随访3～60个月，平均28个月，伤口均Ⅰ期愈合；骨折于1～3个月内达临床愈合，无再移位、感染及局部积液。患者关节功能恢复满意。根据美国骨科协会（AASO）关节功能评价：优26例，良7例，可1例，差1例，优良率94．3％。结论可吸收内固定钉、棒治疗关节内及关节周围骨折，免除了患者二次手术取出内固定物的痛苦，是一种有效和较为理想的方法。     

三维骨建模在全膝关节置换术中韧带平衡的作用

目的探讨以三维骨建模为基础、无需影像的计算机辅助系统在人工全膝关节置换术(totalknee arthroplasty,TKA)中韧带平衡的作用。方法2002年11月～2003年6月,采用后稳定型人工全膝关节,在Ceravision无需影像资料的三维骨建模系统导航监控下,辅助完成TKA21例。男5例,女16例,年龄64～79岁,平均72.4岁。其中2例既往行胫骨近端截骨术,1例行股骨远端截骨术。14例膝内翻,7例膝外翻。术前下肢全长X线正位片测量,内翻13°～外翻13°,平均2.36°;膝关节X线正位片测量,应力下内翻平均8.47°(内翻2°～内翻20°),应力下外翻平均3.63°(内翻7°～外翻12°)。结果术中导航系统测量,额面内翻12°～外翻10°,平均3.33°,与术前比较差异有统计学意义(P<0.05);额面应力下内翻平均6.47°(内翻0°～内翻24°),应力下外翻平均4.32°(内翻8°～外翻15°),与术前比较差异有统计学意义(P<0.05)。术毕导航系统测得膝内外翻平均0.175°(内翻2°～外翻3°),而术后下肢全长X线正位片测量平均0.3°(内翻3.5°～外翻1.5°),二者差异无统计学意义(P>0.05)。术后3个月关节活动度为105～130°,平均115°,膝关节额面松弛度0.2～0.5cm,平均0.27cm。人工膝关节胫、股骨假体取得满意的对位置入和韧带平衡,无关节失稳和髌骨脱位等并发症发生。结论以三维骨建模为基础、无需影像的Ceravision系统,具有三维立体定位、优化截骨,并通过旋转对位和韧带松解获得伸屈膝关节等距间隙与韧带平衡稳定的作用,近期临床疗效满意,可在TKA中常规使用。     

Primary angiitis of the central nervous system: MRI features and clinical presentation

We report the MRI features in a series of four patients with primary angiitis of the central nervous system (PACNS). Based on MRI features, clinical presentation, paraclinical investigations and laboratory tests, including cerebrospinal fluid (CSF) analysis, various differentials were considered. In two patients with MRI findings of cortical, subcortical and deep white matter lesions, lack of mass effect, focal areas of bleed and heterogeneous parenchymal, leptomeningeal or pial enhancement and a normal magnetic resonance angiography, a differential diagnosis of primary angiitis of the CNS was also considered. In all patients, an open brain biopsy was advised to establish a definitive diagnosis of PACNS. Here, we briefly discuss the MRI features, correlation with clinical presentation and paraclinical parameters for the diagnosis of this entity. We also briefly review the literature.     

小型移动数字成像系统下行经皮冠状动脉腔内成形术

目的 :探讨移动数字成像系统GE OECSeries 980 0进行经皮冠状动脉腔内成形术 (PTCA)的可行性和安全性。方法 :回顾分析 32例应用GE OECSeries 980 0X线机进行PTCA治疗冠心病的临床资料。结果 :①本组病例成功率为 90 6 % (2 9/ 32 ) ,血管成功率为 88 1% (37/ 4 2 ) ,病变成功率 83% (39/ 4 7)。成功病例狭窄由术前目测平均直径狭窄(92 8± 3 5 ) %减少到术后的 (6 5± 4 2 ) %。②AMI溶栓后补救性PTCA成功率高。结论 :应用GE OECSeries 980 0X线机能够满足心血管病区心脏介入治疗的需要 ,是安全可行的和具有良好的成本 效益比     

Freezing of gait in postmortem-confirmed atypical parkinsonism.

The frequency and pathophysiology of freezing of gait (FoG) in atypical parkinsonism is unknown. We analysed the frequency of FoG in postmortem-confirmed atypical parkinsonian disorders (APD) comprising corticobasal degeneration (CBD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Sixty-six patients with pathologically confirmed APD (CBD, n = 13; DLB, n = 14; MSA, n = 15; PSP, n = 24) formed the basis for a multicenter clinicopathological study. Clinical features at first and last clinical visit were abstracted from patient records on standardized forms following strict instructions. At the first visit (median 36 months after symptom onset), 24% of APD had FoG (CBD, 8%; DLB, 21%; PSP, 25%; MSA, 40%). Logistic regression analysis showed a significant association of FoG and urinary incontinence (P = 0.04) at first visit. At last visit, 47% of APD had FoG (CBD, 25%; PSP, 53%; DLB, 54%; MSA, 54%). Clinicopathological correlation based on routine postmortem examination failed to identify a consistent neuropathological substrate of FoG. This study demonstrates that (1) FoG is common in APD, and (2) urinary incontinence is significantly associated with FoG in these disorders. Whether FoG and urinary incontinence share similar neuropathological substrates remains to be determined by future studies.     

百年乐与人参黄芪合剂对心血管系统的药理作用比较

百年乐和人参黄芪合剂对心血管系统的作用研究表明:百年乐能加速小鼠肠系膜微循环障碍的恢复,增加离体兔耳血管的流量,使主动脉平滑肌松弛,对抗心肌缺氧,抑制血栓形成,其作用强于人参黄芪合剂。     

Successful choledochojejunostomy for choledochal stricture with preservation of the collateral parabiliary venous system following iatrogenic portal occlusion

We surgically treated a patient with biliary stricture and portal vein occlusion, after operation for gastric cancer with lymphadenectomy along the hepatoduodenal ligament, that had led to choledochal stone formation and a dilatated parabiliary venous system. A 57-year-old man without hepatic dysfunction exhibited hepatic duct dilatation with choledochal stone on ultrasonography and percutaneous transhepatic cholangiography, respectively. Pharmacoportography revealed occlusion of the portal vein and dilatation of the parabiliary venous system. Of various preoperative imaging studies used, enhanced computed tomography was most useful for delineating the surgical anatomy of the hepatoduodenal ligament. Complete preservation of the dilatated vessels, which functioned as the main portal collateral pathway, resulted in a successful choledocho-jejunostomy, with an uneventful postoperative course.     

Discrete time optimal control of linear time-delay systems

A discrete time optimal control for linear time-delay systems is developed to ensure that all closed-loop eigenvalues will lie inside a circular region centred at (β;, 0) with radius α. It is shown that by suitable manipulations the problem can be reduced to a standard discrete time quadratic regulator problem. An illustrative example is included to demonstrate the applicability of the proposed method.     

后路治疗胸腰椎爆裂骨折

目的：探讨后路环椎管减压，椎弓根钉系统复位固定并植骨治疗胸腰椎爆裂骨折的疗效。方法：1996－2001年，环椎环椎管减压，结合具有钉杆角的椎弓根钉系统复位固定，并横突及小关节突间植骨或椎间植骨治疗128例病人，从伤椎椎体前后缘高度恢复，Cobb角矫正度及神经功能恢复情况评价疗效。结果：128例病人脊髓神经损害无加重，神经功能有不同程度恢复；伤椎高度恢复理想，Cobb角明显减少，植骨融合成功108例（占84．4％），术后部分病例出现伤椎复位度丢失现象。结论：后路环椎管减压内固定治疗胸腰椎骨折效果好，应重视植骨融合以获得良好稳定性。