松质骨螺钉骨水泥强化的生物力学和组织学研究

目的通过动物实验观察不同骨水泥强化松质骨螺钉的生物力学和组织学变化动态,为骨质疏松骨折患者内固定提供理论基础。方法在10只杂种犬胫骨近端制作松质骨螺钉植入的动物模型,分别采用碳酸化羟基磷灰石水泥(CHC)和聚甲基丙烯酸甲酯(PMMA)强化,分别于术后5d、4、8、12和16周处死动物,观察螺钉拔出的生物力学和组织学变化。结果CHC强化的螺钉拔出力随手术后时间的延长而逐渐升高,16周时达到(512.5 14.5)N,而PMMA强化组螺钉拔出力则随手术后时间的延长而逐渐降低。CHC-骨界面结合紧密,并且随时间延长出现CHC降解和骨长入,而PMMA-骨界面形成一层纤维组织。结论CHC强化能够提高松质骨螺钉植入体内的稳定性,并且随植入时间延长而逐渐升高。     

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.     

计算机导航在骨科手术中的应用

目的将计算机导航技术应用于骨科手术,并对其进行初步分析。方法2004年2～12月,计算机导航系统辅助下共行134枚椎弓根螺钉固定,51枚股骨颈骨折空心钉内固定,58枚交锁髓内钉远端交锁螺钉固定。结果所有病例全部在导航下完成手术,术中明显减少C型臂X线机透视次数,未发生血管和神经损伤并发症。结论计算机导航手术安全有效,更有利于微创手术的开展。     

计算机导航辅助椎弓根螺钉固定的临床研究

目的椎弓根螺钉固定是脊柱病变切除后稳定性重建的标准方法。常规术中透视监测行颈胸节段椎弓根螺钉固定具有相当挑战性,本文旨在就计算机导航辅助椎弓根螺钉固定技术进行初步分析。方法2005年1月至2006年3月在计算机导航系统辅助下,对21例患者（年龄17～63岁,平均43．4岁）共行102枚椎弓根螺钉固定。术前采用0．75mm薄层螺旋CT数据扫描并导入计算机工作站进行脊柱三维重建;术中进行工具注册和匹配后对椎弓根螺钉固定进行实时显示。术后所有病例均采用CT和X线平片随访监测效果。结果手术顺利,螺钉大小选择合适,102枚椎弓根螺钉中100枚螺钉（98%）固定位置及方向准确,2枚椎弓根螺钉突破椎弓根外壁距离小于2mm。所有操作均未发生血管和神经损伤并发症。术中透视次数及手术室人员所受X线辐射量明显减少。结论计算机导航辅助椎弓根螺钉固定是一项安全的手术,且手术精度高。     

National intercomparisons of I radioactivity measurements in nuclear medicine centres in India

National intercomparisons of activity measurements of ¹³¹I, a radioisotope widely used for diagnosis and therapy of thyroid related ailments, were initiated in 1979 as a quality assurance program, towards improving radiation safety procedures and related dosimetry in Nuclear Medicine Centres (NMCs) in India. Oral administration of a known quantity of radioiodine to patients requires accurate radioactivity measurements to be performed on a well-calibrated isotope calibrators. Under or over estimation of the activity due to a faulty or uncalibrated isotope calibrator could provide misleading results. Calibration of isotope calibrators and the traceablity of subsequent measurements to the national standards laboratory is one of the essential basic radiation safety requirement of the IAEA. In view of the stringent quality assurance requirements for activity measurements imposed by Atomic Energy Regulatory Board, a National Intercomparison Program was initiated and to date ten such intercomparison programs have been conducted by the Radiation Safety Systems Division, of the Bhabha Atomic Research Centre. This program has benefited the participants by making their measurements traceable to the National Primary Standards. Over the years there has been a marked increase in the number of NMCs participating in the intercomparison programs. As a result, the number of institution showing large deviation from the correct value has decreased considerably over the years. This program thus, has enabled participating NMCs to check their isotope calibrators so as to ensure proper delivery of radiation dose to the patients and hence to optimise patient exposure.     

动力髋螺钉治疗股骨转子间骨折

目的 评价动力髋螺钉(DHS)治疗股骨转子间骨折的临床效果。方法 1996年3月～2002年3月用DHS共治疗患者29例．骨折按Evans分型，本组Evans ⅠA2例，Evans ⅠB 10例，Evans ⅡA 3例，Evanslib12例，Evans Ⅲ2例．结果 29例患者均获随访，随访12～48个月，平均26个月，根据Harris髋关节评分：优16例，良9例，中3例，差1例。结论 如能及时手术良好复位，DHS是治疗股骨转子间骨折的较好选择。     

Ethyl-EPA in Huntington disease—Potentially relevant mechanism of action

The pathomechanisms involved in the neuronal dysfunction in Huntington disease (HD) are still unresolved and may be heterogeneous. One potential mechanism might be related to the induction of mitochondrial dysfunction in the CNS. This might lead firstly to neuronal dysfunction and finally to the activation of apoptotic pathways. Several compounds, which should alleviate mitochondrial dysfunction, have been tested in preclinical models as well as in clinical trials of different scale. Recently we reported the efficacy of Ethyl-eicosapentaenoic acid (Ethyl-EPA) in patients with HD. Ethyl-EPA is a polyunsaturated fatty acid from the n − 3 group, which is in clinical development for HD and melancholic depression. In our trial with Ethyl-EPA in HD responding patients could be characterized by either a lower CAG repeat number or a chorea-predominant clinical expression of the disease. Here we would like to describe some evidence on the potential mechanism of action of Ethyl-EPA in HD. We specifically focus on pathways, which are known to be influenced in HD and are modified by Ethyl-EPA and which points to an involvement of mitochondrial function as a common target. Some attention is given to the NF-kappa B pathway and the c-Jun amino-terminal kinases (JNK) pathway, which both may lead to an activation of the antiproliferative factor p53 and consequently mitochondrial dysfunction. Further the effects of EPA or Ethyl-EPA in preclinical models of HD are described. The evidence from these studies led to the design of phase III clinical trials, which are ongoing.     

彩色多普勒超声心动图与核磁共振诊断主动脉夹层动脉瘤的对比研究

目的　通过彩色多普勒超声心动图 (CDUCG)和核磁共振成像 (MRI)诊断主动脉夹层动脉瘤 (AD)的影像学特征 ,比较两种无创检查技术诊断AD的临床价值。方法　对临床疑诊AD的患者行CDUCG心脏各切面探查 ,重点扫查并测量主动脉各节段异常超声征象 (夹层发生部位、内膜片跨度、管径宽度等 ) ,对相同患者行MRI检查时在扫描图像上辨认并确定夹层发生的部位、撕裂范围等。结果　CDUCG诊断Ⅰ型AD 4例 ,Ⅱ型 2例 ,Ⅲ型AD 1例。MRI对Ⅰ、Ⅱ、Ⅲ型AD均可明确诊断。本文 3例Ⅲ型AD经MRI确诊并检出附壁血栓 2例 ,1例Ⅰ型AD可疑 ,余结果同CDUCG。结论　两种技术诊断AD各有优缺点 ,CDUCG偏重于诊断Ⅰ、Ⅱ型 ,MRI适合各型AD的诊断。前者更为迅速、直观 ,重复性强 ,可了解心血管病变的全部信息 ;危急重症患者不宜或难以接受MRI检查。     

经皮椎板关节突螺钉固定的应用解剖及影像学研究

[目的]为经皮椎板关节突螺钉的器械设计及临床应用提供解剖学依据。[方法]利用30例干燥腰椎标本，用游标卡尺及量角器测量腰椎椎板上缘及下缘的厚度，椎板关节突螺钉的长度。通过影像学测量椎板的内倾角和下倾角。[结果]椎板的上缘薄而下缘厚。从L1～5椎板的厚度、螺钉的长度及从内倾角逐渐增加，而下倾角逐渐减小。[结论]上缘的厚度太薄不适合螺钉的放置。从L1～5使用4．5mm的皮质骨螺钉固定是安全的，但应该在椎板的下缘置人。注意下倾角和内倾角的变化。设计的瞄准器应该具有调节角度的装置。     

尿核基蛋白22检测在膀胱癌诊断中的价值

目的:探讨尿核基蛋白22(NMP22)在膀胱移行细胞癌诊断中的临床价值。方法:采用ELISA法定量分析16例膀胱移行上皮癌(TCC)、14例TCC术后随访患者和12例泌尿系良性疾病患者的尿NMP22含量,并同时行尿脱落细胞学检查。设定NMP22的临界值为10U/ml。结果:16例膀胱移行癌患者、14例膀胱癌术后随访患者和12例泌尿系良性疾病患者的尿NMP22中位值分别为31.65、5.41和6.74U/ml,前者与后两者均有统计学差异(P<0.001)。以10U/ml为界值,尿NMP22诊断膀胱癌的敏感性为93.7%,特异性为69.2%,阴性预测值为94.7%,准确性为78.6%。同期尿细胞学的敏感性为31.3%,特异性100%,阴性预测值为70.2%。结论:与脱落细胞学比较,尿NMP22测定有更高的敏感性,是一种较理想的早期膀胱移行细胞癌诊断指标,对预后判断亦有价值。