优选前后精子顶体酶活性与IVF受精率相关性的研究

目的探讨优选处理前和处理后精子顶体酶活性的变化,及与体外受精(IVF)受精率的相关性。方法采用分光光度比色法,对接受IVF治疗的53例不育夫妇男方精液,分别测定优选处理前和处理后精子顶体酶活性,分析其与IVF受精率的相关性。结果优选处理后精子顶体酶活性与优选前比较有显著性差异(P<0.05);达到常规IVF标准并选择常规IVF治疗者,优选后的精子顶体酶活性与IVF受精率有相关性,精子顶体酶活性降低与IVF受精率降低有关。结论精子顶体酶活性与IVF受精率有相关性,并且通过精子顶体酶活性可以预测IVF受精率。     

经尿道切除技术在下尿路疾病中的应用（附128例报告）

目的 探讨经尿道切除技术（TUR）治疗下尿路疾病的适应证、操作方法、术中术后处理及并发症预防的要点。方法 应用经尿道汽化电切术（TURVP）和双极等离子汽化电切术（TUPKVP），分别以5％葡萄糖液和生理盐水作冲洗介质，选择性耻骨上膀胱造瘘，持续低压灌洗，术后气囊导尿管留置5～7天拔管，自行排尿。结果 经尿道前列腺双极等离子汽化电切术7例，经尿道前列腺汽化电切术58例，合计前列腺手术65例；腺性膀胱炎汽化电切术43例；膀胱肿瘤汽化电切术15例；后尿道狭窄等离子汽化电切术3例；精阜腺瘤汽化电切术2例。全部病例均一次手术完成，有效率（126／128）98．4％。无膀胱穿孔、电切综合征、大出血、真性尿失禁发生。前列腺术后尿道狭窄、排尿困难再次手术者2例，占3．08％，排尿疼痛、不适感6例，占9．23％，逆行射精4例，占6．15％。结论 TUR技术是一种微创、安全、迅速、有效、恢复快、并发症较少的腔内泌尿外科治疗方法，特别适用于下尿路疾病的手术；术中持续低压灌注对确保切割视野清晰、预防并发症至关重要。     

内科微创肺减容术的研究进展

传统的外科肺减容术治疗慢性阻塞性肺疾病（COPD）有严格的适应证，并且副作用大、并发症多。于是人们研究出多种基于同样原理但是采用内科微创技术的减容方法。目前常用的内科微创肺减容术有使用单向活瓣、生物蛋白胶等封堵支气管使靶肺萎陷、不张，或采用支气管内药物灌注肺泡加封堵使靶肺组织纤维化等。此外，还有人提出人工旁路增加呼出气量的方法。尽管目前还缺少大规模的随机对照临床试验结果，但是内科微创肺减容术已展现了其巨大的临床应用前景，也将为治疗COPD提供更多的选择。     

后路小切口人工全髋关节置换治疗老年人股骨颈骨折

目的:观察后路小切口人工全髋关节置换术(小切口-THA)治疗老年股骨颈骨折的临床效果。方法:本组24例65岁以上股骨颈骨折患者,女13例,男11例;年龄65～78岁,平均73.4岁。均为外伤后股骨颈头下型骨折,位线差,其中Garden分型为Ⅲ型10例,Ⅳ型14例,全部应用后路小切口技术行全髋关节置换术。结果:术后所有病例随访10～24个月,平均13个月。平均手术时间80min,手术切口平均长8.0cm,平均输血300ml,无局部及全身并发症出现。按UCLA(UniversityofCaliforniaLosAngeles)髋关节功能评分标准,本组UCLA评分由术前平均(11.0±3.8)分升至术后平均(24.3±4.5)分(P<0.01)。本组优17例,良4例,一般3例,优良率为87.5%。结论:后路小切口技术具有创伤小、出血少、恢复快的特点,可获得与常规后路相同的治疗效果,尤其适合老年股骨颈骨折患者。     

小切口动力髋螺钉治疗高龄股骨转子间骨折

[目的]探讨应用小切口动力髋螺钉(DHS)微创固定治疗高龄股骨转子间骨折的方法及临床效果.[方法]回顾性分析2001年8月～2006年1月应用闭合复位、小切口DHS固定治疗37例高龄股骨转子间骨折患者,其中男15例,女22例;年龄72～92岁,平均81.5岁.在C型臂X线机监视下,先将1～2枚克氏针经皮通过大转子打入股骨头上部.另将1枚导针按135°颈干角打入股骨头中央,在导针下做一长约4～5.5 cm纵切口,经导针拧入粗拉力螺纹钉.拔出导针将带套管接骨板沿肌层下插入,并将接骨板的套管套入螺纹钉的尾端.[结果]手术时间40～75 min,平均60 min.术中平均出血55 ml.术后与术前血红蛋白值比较无明显变化.37例均获11～18个月随访,骨折愈合时间10～15周.轻度髋内翻2例,无切口感染、内固定失效及旋转畸形.按董纪元疗效评定标准,优良率94.6%.[结论]小切口DHS微创技术具有手术时间短、出血少、创伤小、并发症少、康复快的特点,是治疗高龄股骨转子间骨折较理想的方法.     

Surgical treatment of complex tibial plateau fractures by closed reduction and external fixation. A review of 32 consecutive cases operated

Abstract Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained. Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for the optimal clinical long-term results.     

Epidemiological considerations following long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1992–2003

A nationwide laboratory-based surveillance system for invasive group A streptococcal (GAS) infections was conducted in The Netherlands from March 1992 until December 2003. Until 1996, all isolates submitted were evaluated clinically and demographically. During this period there was a transition from passive to active surveillance for some of the participating laboratories, corresponding to a national coverage of 50%. During active surveillance, participating laboratories submitted twice as many isolates from invasive GAS disease, whereas the relative submission of isolates representing very severe manifestations (toxic shock-like syndrome, fatality) did not increase. From 1997 onwards, invasiveness was defined solely on the basis of source of isolation (without clinical evaluation). During the period of microbiological and clinical evaluation, microbiological evaluation alone was found to be specific (> 99%), but had limited sensitivity (66%). Estimation of the true rate of invasive GAS disease should be based on an active surveillance system with inclusion of both microbiological and clinical data.     

Posaconazole salvage therapy allows successful allogeneic hematopoietic stem cell transplantation in patients with refractory invasive mold infections

We describe the clinical courses of 3 patients with hematologic malignancies (2 with acute myelogenous leukemia and 1 with multiple myeloma) who developed invasive fungal infections due to uncommon molds (Alternaria spp., Paecilomyces lilacinus, and Zygomycetes). Breakthrough invasive fungal infections of the sinus (n=1), lung (n=3), and pericardium (n=1) developed despite fluconazole prophylaxis and failed to respond to treatment with other licensed antifungal therapies, including amphotericin B (n=3), caspofungin (n=2), and voriconazole (n=3), and surgical intervention (n=2). Salvage therapy with posaconazole oral suspension resulted in successful outcomes in all 3 patients, who subsequently underwent allogeneic hematopoietic stem cell transplantation (HSCT) while on continued posaconazole therapy. The median duration of posaconazole treatment before HSCT was 5 months (range: 1.5-6 months). Posaconazole salvage therapy allowed successful allogeneic HSCT in 3 patients with refractory invasive mold infections.     

关节镜下应用“微骨折”方法修复关节软骨缺损

目的:探讨关节镜下应用“微骨折”技术对膝关节全层关节软骨缺损修复的效果。方法:对68例全层关节软骨缺损患者进行随机分组:实验组(35例),男17例,女18例,平均年龄35.1岁,采用关节清理后应用“微骨折”技术进行处理,即利用骨刀设计的特性和适度的锤击力量造成软骨下的骨组织微小骨折,刺激软骨生长。对照组(33例),男17例,女16例,平均年龄31.6岁,仅作关节清理术。结果:术后随访6~18个月,平均8.6个月,按Lysholm评分标准,实验组明显优于对照组(P<0.01)。结论:关节镜下应用“微骨折”技术能够显著减轻关节疼痛,增加关节活动度,改善关节功能,是一种简单有效的修复全层关节软骨缺损方法。     

关节镜辅助下微创经皮螺钉内固定治疗胫骨平台骨折

目的:探讨关节镜辅助下微创经皮螺钉内固定治疗胫骨平台骨折的可行性及疗效。方法:自2001年1月-2005年1月,应用膝关节镜检查及监测下经皮螺钉内固定治疗胫骨平台骨折27例,按照Schatzker分类法:Ⅰ型9例,Ⅱ型8例,Ⅲ型5例,Ⅳ型5例。所有病例均行经皮骨折有限显露复位,适当植骨,应用1~3枚松质骨拉力螺钉内固定,术后配合CPM功能锻炼。结果:本组随访6~24个月,平均15个月。骨折临床愈合时间3~4个月,平均3·5个月。无畸形愈合、感染、螺钉断裂。按Sanders膝关节功能评分法评定结果:优12例,良11例,中3例,差1例,优良率85·2%。结论:关节镜辅助经皮螺钉内固定是治疗胫骨平台骨折的有效方法之一,其对膝关节创伤小,可达解剖复位,固定可靠,患肢功能恢复好,并发症少。