斜刃针刀治疗屈指肌腱鞘炎的解剖学及临床研究

目的探讨斜刃针刀在治疗屈指肌腱鞘炎上的解剖机理以及优势。方法观测各指屈指肌腱鞘环状韧带A1环的宽度及体表定位,分别采用特型斜刃针刀和I型4号针刀治疗屈指肌腱鞘炎患者各24例,3个月后随访患者疗效及症状的改善程度。结果环状韧带A1总体平均宽度约为7.0mm;治疗组总有效率优于对照组,有显著性差异(P0.05)。两组VAS评分治疗前后比较,均有极显著性差异(P0.01);治疗前后VAS评分差值组间比较,有显著性差异(P0.05)。结论斜刃针刀治疗屈指肌腱鞘炎的目的主要是通过切开腱纤维鞘A1环,解除对屈指肌腱的束缚,能显著改善屈指肌腱鞘炎患者的临床症状及体征,远期疗效优于I型4号针刀,值得临床推广。     

Thermal-Fluid-Solid Coupling Analysis on the Temperature and Thermal Stress Field of a Nickel-Base Superalloy Turbine Blade

Based on the establishment of the original and improved models of the turbine blade, a thermal-fluid-solid coupling method and a finite element method were employed to analyze the internal and external flow, temperature, and thermal stress of the turbine blade. The uneven temperature field, the thermal stress distribution characteristics of the composite cooling turbine blade under the service conditions, and the effect of the thickness of the thermal barrier coating (TBC) on the temperature and thermal stress distributions were obtained. The results show that the method proposed in this paper can better predict the ablation and thermal stress damage of turbine blades. The thermal stress of the blade is closely related to the temperature gradient and local geometric structure of the blade. The inlet area of the pressure side-platform of the blade, the large curvature region of the pressure tip of the blade, and the rounding between the blade body and the platform on the back of the blade are easily damaged by thermal stress. Cooling structure optimization and thicker TBC thickness can effectively reduce the high temperature and temperature gradient on the surface and inside of the turbine blade, thereby reducing the local high thermal stress.     

Longitudinal osteotomy of lateral sacrum for malignant iliac tumor using modified threadwire saw

A longitudinal osteotomy of lateral sacrum for malignant iliac tumors using modified threadwire saw is conducted. This procedure issignificantly wide, rapid and safe.     

Effects of D-004, a lipid extract of the fruit of the Cuban royal palm (Roystonea regia) or the lipidosterolic extract of saw palmetto (Serenoa repens) on the sexual activity in male rats: A controlled, experimental study

Background: The etiology of benign prostatic hyperplasia (BPH) is not completely understood, but hormonal changes in aging men seem to be pivotal. Dihydrotestosterone, a potent, active metabolite of testosterone, is formed by the enzymatic action of prostate 5α-reductase and causes cell growth and hyperplasia. Consistent with this action, male sexual dysfunction has been clinically documented to be among the drug-related adverse events associated with 5α-reductase inhibitors. The lipidosterolic extract of saw palmetto (LESP) fruit (Serenoa repens) has been used to treat BPH. D-004, a lipid extract of Roystonea regia Royal palm fruit, has been found to prevent prostatic hyperplasia induced by testoste-rone in rodents and to competitively inhibit prostate 5α-reductase activity in vitro.Objective: The purpose of this study was to assess the effects of D-004 and LESP, administered as single or repeated doses, on the sexual activity in male rats.Methods: This controlled, experimental study was conducted at the Pharmacology Department, Centre of Natural Products, National Centre for Scientific Research, Havana City, Cuba. Adult male Wistar rats weighing 250 to 300 g were randomized into 5 groups: 2 groups treated orally with D-004 (400 and 800 mg/kg); 2 groups treated orally with LESP (400 and 800 mg/kg); and 1 control group orally administered a water vehicle. Sexual activity behavior (the number of mounts and intromissions, mount latency, and intromission latency) was assessed during 2 observation periods: 90 minutes after the initial dose and at the end of the 30-day treatment. Latency was defined as time elapsed between the first mount and intromission.Results: A total of 50 rats (mean [SD] age, 10 [3] weeks; mean [SD] weight, 295 [10] g) were included in the experiment. There were no significant difterences in the mean number of mounts, intromissions, mount latency, or intromission latency in the groups treated with single or repeated doses of D-004 or LESP (400 and 800 mg/kg) compared with the controls. There was also no between-group difterence in mating behavior among the active treatment groups. All rats survived up to study completion, with normal behavior (weight gain, food intake, daily observations, without any sign of toxicity). There were no observable adverse events during the study.Conclusions: D-004 and LESP administered as a single dose or repeated doses for 30 days did not significantly affect male rat sexual activity behavior compared with a vehicle control group.     

The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study

The treatment of unstable trochanteric femoral fractures is still challenging. The ideal implant should be easy to handle, allow for immediate full weight-bearing postoperatively and should have sufficient purchase in the femoral head/neck-fragment to limit cut-outs due to varus-deviation and rotation. The proximal femoral nail antirotation (PFNA), designed by AO, is an intramedullary device with a helical blade rather than a screw for better purchase in the femoral head and was tested in a clinical study. Consecutive patients with unstable trochanteric fractures (AO-classification 31.A.2 and A.3 only) were included and followed for 1 year. Primary objectives were assessment of operative and postoperative complications, whereas secondary objectives included surgical details, general complications and final outcome measurements. In 11 European clinics, 315 patients were included and treated with a PFNA. Almost all fractures healed within 6 months. Fifty-six percent of the patients regained the pre-trauma mobility and 18% died within the follow-up period. Forty-six implant-related complications--leading to 28 unplanned re-operations--were recorded, with four acetabular penetrations (three of which were after a new fall on that hip) and seven ipsilateral femoral shaft fractures as the most serious ones. As the joint-penetrations did not resemble the cut-out seen with other implants it is concluded that the PFNA--due to its helical blade--possibly limits the effects of early rotation of the head/neck-fragment in unstable trochanteric fractures and therefore seems currently to be the optimal implant for the treatment of these fractures especially in osteoporotic bone.     

Numerical Study of a Bio‐Centrifugal Blood Pump With Straight Impeller Blade Profiles

Computational fluid dynamic simulations of the flow in the Kyoto‐NTN (Kyoto University, Kyoto, Japan) magnetically suspended centrifugal blood pump with a 16‐straight‐bladed impeller were performed in the present study. The flow in the pump was assumed as unsteady and turbulent, and blood was treated as a Newtonian fluid. At the impeller rotating speed of 2000 rpm and flow rate of 5 L/min, the pump produces a pressure head of 113.5 mm Hg according to the simulation. It was found that the double volute of the pump has caused symmetrical pressure distribution in the volute passages and subsequently caused symmetrical flow patterns in the blade channels. Due to the tangentially increasing pressure in the volute passages, the flow through the blade channels initially increases at the low‐pressure region and then decreases due to the increased pressure. The reverse flow and vortices have been identified in the impeller blade channels. The high shear stress of the flow in the pump mainly occurred at the inlet and outlet of the blade channels, the beginning of the volute passages and the regions around the tips of the cutwater and splitter plate. Higher shear stress is obtained when the tips of the cutwater and splitter plate are located at the impeller blade trailing edges than when they are located at the middle of the impeller blade channel. It was found that the blood damage index assessed based on the blood corpuscle path tracing of the present pump was about 0.94%, which has the same order of magnitude as those of the clinical centrifugal pumps reported in the literature.     

Radical excision of malignant sacral tumors using a modified threadwire saw

BACKGROUND: Surgical treatment of malignant sacral tumors is difficult, and has a high rate of recurrence. OBJECTIVES: The aim of this study was to examine the wide margin of large and small malignant sacral tumors using a threadwire saw (T-saw). MATERIALS AND METHODS: We devised a flexible silver guide probe connected to a modified threadwire saw by a suture thread to perform osteotomies. We operated on 10 patients with sacral tumors using this device. The sacral excisions were performed via a posterior approach by four surgeons (two on each side) working simultaneously. RESULTS: We obtained a wide margin in all cases and no recurrence, after a mean follow-up of 4 years 2 months (range, 1 year 8 months-7 years 8 months). In one case, one nerve root on the right side was injured. CONCLUSIONS: Our new method is easier and faster than the conventional method in cases in which bilateral sacral nerve root canals require sectioning, and it produces a wide tumor margin.     

环锯减压与椎体次全切除治疗颈椎病的疗效观察

目的:比较环锯减压与椎体次全切除治疗颈椎病的优缺点。方法:回顾性分析1998~2002年长征医院采用环锯法颈前路减压植骨与采用椎体次全切除术治疗颈椎病共100例,对两组间平均手术时间及平均出血量、手术并发症进行比较,并随访神经功能的改善率。结果:环锯法平均手术时间62 min,平均出血110 ml,椎体次全切除术平均手术时间96 min,平均出血220 ml,两组间有显著差异;环锯法手术并发症为12%,椎体次全切除术是20%,两组间无显著性差异;环锯法术后3、12月JOA评分术后改善率83.4%,79.4%,椎体次全切除术后3、12月JOA评分术后改善率91.2%,87.6%,两组间有显著性差异。结论:环锯法是安全、可靠的,椎体次全切除术的手术疗效更佳,椎体次全切除术亦存在钛网下沉、钢板松动和临近节段退变等缺点。     

刀片断线矫治人工晶体植入术后角膜散光

对63例人工晶体植入术后2月～1年存在循规性角膜散光的患者，用刀片在裂隙灯显微镜下行角巩缘断线术，断线后角膜散光显著减少，尤其是在术后5个月内断线者，裸眼视力明显提高，因其不需特殊器械，故认为刀片断线是矫治人工晶体植入术后循规性角膜激光简便、省时、安全而有效的方法。     

无创呼吸机微涡轮研究

本文介绍了无创呼吸机总体组成结构、叶片型式。讨论了不同βb2角(叶片出口的几何角)对无创呼吸机效率、功率以及压力的影响,同时介绍了怎样确定微涡轮的叶片数和在无创呼吸机微涡轮中采用后弯式叶片的优点。