弧形带锁髓内钉固定并植骨治疗肱骨干骨折骨不连

自1997年3月-2004年12月,对肱骨骨折骨不连采用弧形带锁髓内钉并植骨治疗,手术顺利,疗效良好,报告如下。1临床资料本组48例,其中男36例,女12例;右侧32例,左侧16例;年龄22~65岁。致伤原因:交通事故伤22例,高处坠落伤10例,走路跌伤8例,其他伤8例。骨折类型:粉碎性骨折30例,横断骨折10例,斜面骨折8例。首次治疗方法:外固定架固定28例,钢板固定14例,石膏固定4例,夹板固定2例。合并糖尿病4例,高血压8例。首次手术至本次手术时间:8个月以下16例,8~12个月18例,12个月以上14例。2治疗方法术前健侧正位X线片测量选择髓内钉长度,患侧侧位X线片测量选…     

腹腔镜和开腹肝切除对机体肝脏功能的影响

目的 研究腹腔镜肝切除（LH）和开腹肝切除（OH）两种手术方式对机体肝脏功能的影响，评估LH的创伤反应。方法 将8个月内收治的40例行肝切除患者，随机分为LH组和OH组，比较两组手术前后部分肝功能指标的变化。结果 两组术后ALT，AST和LDH均迅速升高，与术前相比差异显著，而且OH组明显高于LH组。两组手术前后ALP及γ—GT变化不大，但术后该两指标值OH组明显高于LH组。两组术后TBIL和DBIL均有所增高，但相差不明显，而与术前比较，OH组升高幅度大于LH。结论LH对肝功能的影响小于OH，提示LH对机体的创伤小于OH，有利于减少LH术后肝衰竭。     

外固定支架与非扩髓髓内钉治疗开放性胫骨骨折的疗效比较

目的比较外固定支架与非扩髓髓内钉治疗开放性胫骨骨折的临床疗效。方法对2002年1月～2004月12月急诊治疗的156例开放性胫骨骨折患者资料进行回顾性分析，其中93例采用单臂外固定支架治疗，63例采用非扩髓髓内钉治疗。对两组患者的一般资料、骨折AO分型、软组织Gustilo分型、术后骨折愈合时间、骨折延迟愈合例数及并发症进行统计学分析。结果外固定支架组和非扩髓髓内钉组的骨折平均愈合时间分别为7．8个月（3～18个月）、5．3个月（2．12个月）。非扩髓髓内钉组在骨折愈合时间、骨折延迟愈合及骨折畸形愈合方面明显优于单臂外固定支架组（P〈0．05）；两组在感染发生率方面差异无统计学意义（P〉0．05）。结论非扩髓髓内钉治疗开放性胫骨骨折具有骨折愈合时间短、畸形愈合少等优点。对于严重污染的创面及全身多发伤患者，外固定支架的临时固定是首选。     

153Sm-citrate-HA滑膜切除术治疗类风湿关节炎患者57例近期疗效分析

目的观察^153 Sm-柠檬酸-羟基磷灰石（citrate—HA）滑膜切除术治疗类风湿关节炎（RA）所致膝关节滑膜增生的近期疗效。方法对57例RA患者103个有明显滑膜增生的膝关节行关节腔内注射^153 Sm—citrate．HA5×37MBq（0．5～1m1），比较治疗前后关节症状（疼痛、肿胀、积液、功能活动度、上下楼及蹲站受限）变化情况，按优效、良效、微效、无效4级标准评判疗效，并对不同X线分期患者的疗效进行分析。结果治疗后1周开始起效，在半年内疗效逐渐明显，患者关节症状逐渐减轻甚至消失；总有效率为98．1％，其中Ⅰ、Ⅱ期患者的优效率分别为100％和91．3％。结论^153 Sm-citrate—HA滑膜切除术对RA滑膜增生性变是一项简单、安全、有效的治疗方法。     

经皮TriGen髓内钉与股骨近端髓内钉治疗老年股骨转子间骨折的疗效比较

目的 比较经皮TriGen髓内钉（美国Smith Nephew公司）与股骨近端髓内钉（PFN）（瑞士AO／SYNTHES公司）治疗股骨转子间骨折的临床疗效，探讨治疗老年股骨转子间骨折更为合理的方法。方法 分析本院2001年10月-2005年1月收治的股骨转子间骨折患者56例，年龄〉60岁。随机分为两组：A组21例，采用经皮TriGen髓内钉固定；B组35例，采用PFN固定。对两组手术切口长度、手术时间、术中出血量、术中输血、术后引流量、骨折愈合时间、术后至出院时间、髋关节功能优良率进行分析比较。结果 两组间手术切口长度、手术时间、术中出血量、输血量、术后引流量、手术至出院时间比较，差异均有统计学意义（P〈0．05）。术后部分负重时间、骨折愈合时间、髋关节功能评价等差异均无统计学意义。结论 与PFN固定相比，经皮TriGen髓内钉具有手术时间短、出血量少、手术组织损伤小等优点，降低了手术风险，用于治疗老年股骨转子间骨折具有一定优势。     

Comparing diffusion-weighted and T2-weighted MR imaging for the quantification of infarct size in a neonatal rat hypoxic–ischemic model at 24 h post-injury

PURPOSE: In a neonatal rat model of hypoxic-ischemic (HI) brain injury, using T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), we aim to determine the best MRI method of lesion quantification that reflects infarct size. MATERIALS AND METHODS: Twenty 7-day-old rats underwent MRI 24h after HI brain injury was induced. Lesion size relative to whole brain was measured using T2WI and apparent diffusion coefficient (ADC) maps, applying thresholds of 60%, 70% and 80% contralateral control hemisphere mean ADC, and at day 10 post-HI on pathology with TTC staining. Multiple linear regression analysis was used to study the relationships between lesion size at MRI and pathology. RESULTS: Lesion size measurement using all MRI methods significantly correlated with infarct size at pathology; using T2WI, r=0.808 (p<0.001), using 80% ADC, 70% ADC and 60% ADC thresholds, r=0.888 (p<0.001), 0.761, (p<0.001) and 0.569 (p=0.014), respectively. Eighty percent ADC threshold was found to be the only significant independent predictor of final infarct volume (adjusted R(2)=0.775). CONCLUSION: At 24h post-HI, lesion size on DWI, using 80% ADC threshold is the best predictor of final infarct volume. Although T2WI performed less well, it has the advantage of superior spatial resolution and is technically less demanding. These are important considerations for experiments which utilize MRI as a surrogate method for lesion quantification in the neonatal rat HI model.     

Construction and validation of a Parkinson's disease mutation genotyping array for the Parkin gene.

Parkin mutations account for the majority of familial and sporadic early onset Parkinson's disease (EOPD) cases with a known genetic association. More than 100 mutations have been described in the Parkin gene that includes homozygous, compound heterozygous, and single heterozygous mutations. We have designed a Parkin mutation genotyping array (gene chip) that includes published Parkin sequence variants and allows their simultaneous detection. The chip was validated by screening 85 PD cases and 47 controls previously tested for Parkin mutations. Similar genotyping microarrays have been developed for other genetically heterogeneous diseases including age-related macular degeneration. Here, we show the utility of a genotyping array for Parkinson's disease by analysis of 60 subjects from the Genetic Epidemiology of Parkinson Disease (GEPD) study that includes 15 early-onset PD case probands and 45 relatives.     

99mTc-depreotide生长抑素受体显像的临床应用研究

生长抑素受体显像近年来研究较多，depreotide已成为其研究热点之一。Depreotide在诊断与鉴别诊断临床常见的孤立性肺结节方面有其独特优势；此外，^99mTc—depreotide生长抑素受体显像在乳腺癌、甲状腺癌、淋巴瘤等肿瘤及甲状腺相关性眼病等非肿瘤性疾病也有一定应用前景。     

Local anesthesia for inguinal hernia repair in adolescents

Background Many centers use local anesthesia for adult inguinal hernia surgery in the setting of day-case surgery. There are no reports on, or guidelines for, use of anesthesia for inguinal hernia surgery in adolescents. We describe our initial experience with the use of local anesthesia and intravenous sedation for inguinal hernia surgery in adolescents in the setting of a day-surgery facility. Methods The charts of 14 consecutive adolescent patients (aged 12–17) who had inguinal hernia surgery from July 2004 to March 2005 were reviewed retrospectively. Intravenous sedation was administered 1–3 min before injection of local anesthetic. Sedation consisted of midazolam 0.085 mg kg⁻¹ and either fentanyl 0.85 μg kg⁻¹ or ketamine 0.085 mg kg⁻¹, according to the preference of the anesthesiologist. Additional sedation with half the initial dose was administered if required. Local anesthesia using a combination of lignocaine and bupivacaine was administered by the surgeon with infiltration in the skin and deep tissues. Results Fourteen adolescents aged 12–17 years (mean 14.8 ± 1.37), weighing 34–100 kg (mean 61.2 ± 16.5), had 15 inguinal hernia repairs with sedation and local anesthesia. All the patients were male. All completed the surgery with sedation and local anesthesia. None required conversion to general anesthesia. There were no immediate or subsequent complications. Mean time from the end of surgery to discharge home was under 2 h (mean 106 ± 36 min). Examination of patient charts did not reveal any complaints regarding the surgery or the postoperative course at the postoperative follow up visit. Conclusions The use of local anesthesia with intravenous sedation for inguinal hernia repair in the adolescent age group seems feasible and requires further prospective study.