腹部外科SIRS患者下丘脑-垂体-甲状腺轴的功能改变及机制探讨

目的：研究SIRS状态下下丘脑-垂体-甲状腺轴的功能改变并探讨其机制。方法：应用放射免疫分析方法测定25例病人的血清T3、T4、rT3、TSH、TRH水平,并与20例正常对照进行比较。结果：SIRS病人血清T3、T4水平低于对照组。TSH和TRH水平观察组高于对照组。结论：SIRS病人下丘脑-垂体-甲状腺轴的功能出现紊乱,其可能的机制是由于甲状腺本身的功能受到抑制以及应激刺激作用的结果。     

枕颈融合联合鼻内镜治疗枢椎肿瘤

目的探讨枕颈融合联合鼻内镜技术行颈椎重建和肿瘤切除治疗枢椎肿瘤的疗效及其预后。方法2005年7月以来,共收治5例枢椎肿瘤,采取后路枕颈融合联合前路鼻内镜肿瘤切除术治疗。结果5例患者术后颈椎稳定性均得到满意重建,肿瘤切除充分。其中2例瘫痪患者术后JOA评分较术前明显增加。结论枕颈融合联合鼻内镜技术治疗枢椎肿瘤,肿瘤切除率高,并发症低,为高颈段肿瘤的治疗提供了新的临床思路。     

Radioembolization with yttrium-90 microspheres work up: Practical approach and literature review

Radioembolization (RE) is a selective internal radiotherapy technique in which yttrium-90 blended microspheres are infused through the hepatic arteries. It is based on the fact that primary and secondary hepatic tumors are vascularized mostly by arterial blood flow whereas healthy hepatocytes obtain their blood supply mostly from the portal network. This enables high radiation doses to be delivered, sparing the surrounding non-malignant liver parenchyma. Most of the complications are caused by unexpected particles passing into the gastrointestinal tract through branches originating from the main hepatic arterial supply. Knowledge of this hepatic arterial network and of its variations and the technical considerations this raises are required in preparation for treatment. This work describes the specific anatomical features and techniques for this anatomy through recent literature illustrated by cases from our own experience.     

A Pictorial Review of Atlanto-axial Rotatory Fixation: Key Points for the Radiologist

Atlanto-axial rotatory fixation (AARF) is a rare condition which occurs more commonly in children than in adults. The terminology can be confusing and the condition is also known as 'atlanto-axial rotatory subluxation' and 'atlanto-axial rotary dislocation'. Rotatory fixation is the preferred term, however, as in most cases the fixation occurs within the normal range of rotation of the joint. By definition, therefore, the joint is neither subluxed nor dislocated. AARF is a cause of acquired torticollis. Diagnosis can be difficult and is often delayed. The radiologist plays a key role in confirming the diagnosis. The classification system proposed by Fielding in 1977 is most frequently used and will be discussed in detail. Given that this classification system was devised in the days before computed tomography (CT), as well as the fact that combined atlanto-axial and atlanto-occipital rotatory subluxation (AORF) is omitted from the classification, we propose a modification to the classification of this rare but significant disorder. The radiological findings in six cases of AARF will be illustrated, including a case with associated atlanto-occipital subluxation. The pertinent literature is reviewed and a more comprehensive classification system proposed. The imaging approach to diagnosis and the orthopaedic approach to management will be discussed.     

寰枢椎椎弓根钉板固定融合治疗上颈椎伤病临床体会

[目的]探讨经寰枢椎椎弓根钉板固定融合治疗上颈椎伤病的临床疗效。[方法]回顾2000年3月~2007年9月,徒手对50例上颈椎伤病患者进行后路经寰枢椎椎弓根钉板系统复位内固定,置入200枚寰枢椎椎弓根钉,在寰椎后弓及枢椎椎板间植骨融合,使寰枢椎复合体得到稳定。其中男36例,女14例;年龄20~65岁,平均41.52岁。Ⅱ型齿状突陈旧性骨折23例,齿状突不连12例,横韧带损伤15例。[结果]4例术后出现枕大神经痛,经对症治疗1个月后痊愈;2例螺钉穿破寰椎左侧椎弓根外侧壁,未发现脊髓、椎动脉损伤。48例获得随访,随访时间25~60个月,平均27.56个月,均获得骨性融合,未发现钉板断裂。所有患者X线片示寰椎完全复位,枢椎齿状突骨折处复位良好。CT片示螺钉与椎动脉及脊髓位置关系良好。按JOA评分标准,优34例,良13例,可2例,差1例;优良率94.00%。[结论]寰枢椎椎弓根螺钉结合钉板系统固定治疗上颈椎伤病,能显著增强寰枢椎间生物力学稳定性,植骨融合率高,该术式在寰枢椎融合术中具有较高的推广应用价值。     

后路椎弓根螺钉内固定治疗寰枢椎骨折脱位的临床体会

目的：探讨经后路椎弓根螺钉内固定治疗寰枢椎骨折脱位临床疗效。方法选取2011年6月至2013年12月在该院接受治疗的寰枢椎骨折脱位患者19例,经后路切开复位椎弓根螺钉内固定术。术后定期复查X线片了解骨折脱位矫正和后路植骨融合。参照日本骨科学会（JO A ）评分评估神经功能。结果患者植骨全部融合,内固定无松动,无断钉、断棒发生,JO A评分由术前（7．35±2．39）分改善至术后（13．21±2．53）分,差异有统计学意义（ P＜0．05）。结论后路寰枢椎椎弓根螺钉内固定治疗上颈椎损伤疗效满意。     

猕猴眼屈光生物学参数的检测

目的：观察人工繁育猕猴眼球的屈光生物学参数,为眼动物实验提供可靠的参考数据。方法采用电脑验光仪、IOL-Master、角膜超声测厚仪,对47只猕猴93眼的屈光度数、角膜曲率半径、眼轴长度、中央角膜厚度等屈光生物学参数进行测量。结果各年龄组猕猴眼中央角膜厚度比较无统计学差异（P>0.05）;眼轴长度在2.5岁以前随年龄的增长不断变长,2.5岁以后眼轴长度可能不再变化;0.5岁组角膜曲率半径最小,随年龄增长有变长趋势,1.5岁以后趋于稳定;等效球镜屈光度数越小,轴率比就越大,2.5岁~4.5岁期间轴率比维持在一个较稳定的范围。结论与人类相比,人工繁育猕猴眼中央角膜厚度更薄,眼轴长度更短,角膜曲率半径也更小,角膜曲率半径和眼轴长度的变化规律和人类接近,可作为理想的动物眼实验模型。     

平动汤对注意力缺陷多动障碍模型大鼠HPA轴功能的影响

目的:观察平动汤及利他林对注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)模型大鼠下丘脑-垂体-肾上腺轴功能的影响。方法:将6只WKY大鼠设为正常组,30只自发性高血压WKY大鼠分为模型组,利他林组,平动汤低剂量组,平动汤中剂量组,平动汤高剂量组,灌胃4周后,用放射免疫法测定大鼠血清中促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)及皮质醇的水平。结果:模型组大鼠ACTH水平高于正常组,皮质醇水平低于正常组(P0.05),提示模型复制成功。治疗后与模型组比较,平动汤中剂量组ACTH差异有统计学意义(P0.05);与利他林组比较,平动汤中剂量组ACTH差异有统计学意义(P0.05)。治疗后与模型组比较,平动汤中剂量组、利他林组大鼠血清皮质醇差异均有统计学意义(P0.05)。结论:平动汤可能是通过降低ACTH水平,提高皮质醇水平来调节下丘脑-垂体-肾上腺轴功能,达到治疗ADHD的目的。     

从肾-脾轴论治强直性脊柱炎

强直性脊柱炎（AS）是一种慢性进展性自身免疫性疾病,传统中医临床一般多从肾论治,根据现代医学的最新研究及中医生克制化理论提出肾虚督亏是AS的致病之本,脾病湿盛是发病关键,提出从肾-脾轴论治AS的治疗思路,并以温肾强督、健脾祛湿为其治疗大法,自拟基础方温肾健脾定脊汤。