垂体后叶素对家兔血糖、血钾影响作用实验研究

目的:本实验研究以垂体后叶素注射家兔前、后取得全血而得到血清,分为对照组和实验组来研究垂体后叶素对家兔血糖、血钾影响作用。方法:以半自动生化分析仪、日立717测定,统计学配对设计方法、t检验处理,观察对照组与实验组比较,血糖差异(P<0.01)、血钾差异(P<0.01)。结果:垂体后叶素对家兔有明显升高血糖、升高血钾作用。结论:此项实验研究为糖尿病发病原因、机理进一步探讨,提供有力依据。     

关节镜下运用4股腘绳肌腱同期重建前后交叉韧带损伤

目的 关节镜下运用Intrafix和可吸收界面螺钉固定自体4股腘绳肌腱，同期重建前交叉韧带（anterior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL），评估其疗效。方法 ACL、PCL同时损伤的患者16例，关节镜下以自体4股胭绳肌腱作为重建移植物，应用可吸收界面螺钉固定移植物股骨端，Intrafix钉鞘和可吸收锥形钉固定胫骨端，同期行ACL和PCL损伤重建术。7例行内侧副韧带修补，4例行外侧副韧带复合结构修复，2例行内外侧同时修复。所有患者按照国际膝关节评分委员会（International Knee Documentation Committee，IKDC）评分标准进行术前评估，均为D级。术前Lysholm评分为（36．5±3．7）分。结果 随访时间为12～18个月，平均14．6个月。终末随访时，IKDC总体评价：A级6例（38％），B级9例（56％），C级1例（6％），无D级患者。Lachman试验0～2mm8例；3～5mm6例；6～10mm2例（P〈0．05）。屈70°前后总位移0～2mm10例；3～5mm5例；6～10mm1例（P〈0．05）。屈70°后位移0～2mm12例；3～5mm4例（P〈0．05）。术后2个月Lysholm功能评分为（90．4±2．9）分，终末随访时为（93．4±3．5）分，与术前相比差异均有统计学意义（P〈0．05）。结论 关节镜下以自体4股胭绳肌腱作为移植物，应用可吸收界面螺钉、Intrafix钉鞘和可吸收锥形钉固定股骨胫骨端同期重建ACL和PCL损伤，有利于早期积极的功能康复，膝关节功能恢复满意。     

Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion

Degenerative spondylolisthesis is characterized by the slippage of one vertebral body over the one below, with association of intervertebral disc degeneration and degenerative arthritis of the facet joints, which cause spinal stenosis. The aim of this study was to evaluate the clinical and radiographic results of 22 patients with symptomatic degenerative spondylolisthesis, operated on by decompressive laminectomy and instrumented posterolateral fusion associated with interbody fusion (PLIF). Mean age at surgery was 64 years (range, 57–72). Clinical results were evaluated on a questionnaire at the last follow-up visit concerning postoperative low back and leg pain, restriction of daily life activities, and resumption of sports activity. Lumbar spine radiographs were used to evaluate the status of fixation devices, the reduction of the spondylolisthesis, the lumbar sagittal balance and the presence of spinal fusion. No intraoperative or postoperative complications were encountered. There were no superficial or deep infections, fixation device loosening, or hardware removal. Mean follow-up time was 4 years (range, 3–6 years). Clinical outcome was excellent or good in 19 patients and fair in 3 patients. Preoperatively, mean forward vertebral slipping on neutral lateral radiographs was 5 mm, while postoperatively it decreased to 3 mm. Preoperatively, mean sagittal motion was 3 mm and angular motion was 8°, while postoperatively these values decreased to 1 mm and 1°, respectively. This study demonstrated that spinal decompression followed by transpedicular instrumentation associated with PLIF technique is a valid surgical option for the treatment of degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome, intended as relief of pain and resumption of activity, was improved significantly and fusion rate was high.     

Arthroscopic single-bundle reconstruction of posterior cruciate ligament with quadrupled hamstring tendon

Objective： To evaluate the technique and outcome of arthroscopic sipy, le-bundie reconstruction of posterior crudate ligament （PCL） with quadrupled hamstring tendon. Methods： From April 2001 to October 2004, 49 knees with PCL tears in 49 patients were verified with arthroscope in this department. Of them, 13 were combined with anterior cruciate ligament tears, 14 with disruptions of the posterolateral comer, 6 with ruptures of the posteromedial corner and medial collateral ligament, 9 with lateral meniscus tears, 5 with medial meniscus tears and 2 with popliteal vascular tears. All the damaged PCLs were reconstructed with single-bundie of autogenous quadrupled hamstring tendons under arthroscope. Biodegradable interference screws or blunt titanium interference screws were used for direct anatomic fixation of the reconstructed ligament. Results： After operation, no severe complications occurred at early stage in the 49 patients. All of them were followed up for 10-52 months with an average of 22. 0 months ＋ 10. 7 months. Lysholm score was remarkably improved from 30-60 （ mean： 47.96 ＋ 8. 16） preoperatively to 70-95 （ mean： 89. 08 ＋ 6. 10 ） at the last postoperative follow-up （ P 〈 0.01 ）. Furthermore, there was a significant improvement in International Knee Documentation Committee （IKDC） score from abnormal （ Grade C） in 10 knees and severely abnormal （Grade D ） in 39 preoperatively to normal （ Grade A ） in 20, nearly normal （ Grade B） in 24 and abnormal in 5 at the last follow-up. Of the 49 patients, 40 returned to the same activity level as before and 9 were under the level. Conclusions： Single-bundle reconstruction of PCL with quadrupled hamstring tendons has the advantage of minimal trauma in surgery and satisfactory outcome.     

Posterior instability near extension is related to clinical disability in isolated posterior cruciate ligament deficient patients

The purpose of this study is to evaluate the relationship between the magnitude of knee laxity and posterior instability at different knee flexion angles and clinical disability in isolated posterior cruciate ligament (PCL) deficient patients. Knee laxity at 20° and 70° of knee flexion were evaluated using KT-2000 arthrometer, and the posterior instability at 20°, 45° and 90° of flexion were evaluated using stress radiography. We assessed the differences in the knee laxity and the tibial translation between isolated PCL deficient knees and normal knees, and between the patients with giving-way during activities of daily living (ADL) and without giving-way. There were statistical differences in the knee laxity and the tibial translation at all knee flexion angles between the PCL deficient knees and normal knees. The magnitude of the knee laxity at 20° of flexion measured with KT-2000 arthrometer was significantly larger in the patients with giving-way than those in the patients without giving-way although there was no significant difference in the tibial translation at 70° between the two groups. The tibial translation in both medial and lateral compartments at 20° and 45° measured with stress radiography were significantly larger in the patients with giving-way than those in the patients without giving-way although there was not significant difference at 90° between the two groups. These results suggested that the magnitude of the knee laxity and the posterior tibial translation at shallow knee flexion angles would be related to giving-way during ADL in isolated PCL deficient patients.     

后房型人工晶体植入术后早期并发症临床分析及处理

报告468例500眼后房型人工晶体植入术后2周内出现的并发症发生率,其中角膜水肿73.6％,色素膜炎症反应88.4％,瞳孔变形12.8％,人工晶体表面渗出膜3.8％,后囊混浊13.8％,短暂性高眼压5.2％,晶体皮质残留5.8％,人工晶体偏位2.6％,前房出血3％。提高术后视力的关键是提高手术技巧以减少并发症的发生。     

Bilateral complete discoid medial meniscus combined with posterior cyst formation

Bilateral discoid medial menisci is an extremely rare condition of the knee and it can be associated to other pathological findings, including anterior portion cyst formation. We report on the clinical features, radiographic findings, treatment and results of one patient who presented a bilateral medial discoid meniscus combined with posterior portion cyst of the left knee. To the best of the author’s knowledge, this is the first case of bilateral medial discoid meniscus associated with posterior portion cyst formation.     

环孢霉素A致可逆性后部白质脑病综合征的MRI表现

目的探讨环孢霉素A诱发可逆性后部白质脑病综合征(PRLS)的MRI表现。资料与方法回顾性分析1例PRLS的临床资料和MRI表现并复习文献。结果MRI显示PRLS以顶枕叶为主的皮层及皮层下白质病变,病变多呈双侧对称性分布,偶可累及双侧颞叶后部及额叶,T2WI和液体衰减翻转恢复序列(FLAIR)对病变的显示有独特的作用,扩散加权成像(DWI)能够确定PRLS的临床分期。结论PRLS在MRI上具有特征性。MRI表现结合临床资料,对PRLS多能作出正确的诊断。     

后颅凹成血管细胞瘤的影像学特点及其诊断

目的：探讨成血管细胞瘤的影像学特点。材料与方法：报道１４例成血管细胞瘤的ＣＴ和ＭＲＩ所见，分析肿瘤的特点。结果：囊性肿瘤，在ＭＲＩ上表现为囊性病灶和附壁肿瘤结节；在ＣＴ上表现为该典型征象占８１．８％。混合性肿瘤３例，在ＣＴ和ＭＲＩ上表现实质性肿块、偏心性囊变和均一显著强化；后者还可见肿瘤旁和肿瘤内血管流空。结论：ＣＴ和ＭＲＩ均是诊断成血管细胞瘤的有效检查方法。成血管细胞瘤的特征性影像学表现是囊肿和突入囊内的壁结节，以及肿瘤的异常显著增强     

胸腰椎骨折伴脊髓损伤前后路手术适应证的选择

目的 通过107例胸腰椎骨折伴脊髓损伤病例的治疗,探讨前、后路手术适应证的选择。方法 31例经前路减压植骨,采用Z-Plate等内固定。76例经后路采用短节段椎弓根钉内固定。结果 两组均获得了满意的疗效。结论 选择前或后路手术,应综合考虑脊髓损伤程度、手术时机与技巧、骨折的部位、骨折类型和影像结果等,才能确实做到减压、恢复脊柱序列和坚强固定的目的。