改良双腔球囊导管在插管失败的输卵管阻塞介入再通术中的应用价值

目的探讨改良双腔球囊导管在插管失败的输卵管阻塞介入再通术中的应用价值。方法回顾45例输卵管阻塞性不孕患者,应用常规法行介入再通术,其中输卵管开口插管失败采用改良双腔球囊导管行介入再通,统计分析常规法组与联合改良双腔球囊导管法组(联合法组)的输卵管开口插管成功率、输卵管阻塞的开通率。结果输卵管阻塞性不孕患者45例,共阻塞输卵管90条,采用常规法输卵管开口插管成功32条,其中开通成功31条,插管成功率为35.56%,开通率96.88%。采用联合法输卵管开口插管成功90条,输卵管开通83条,插管成功率为100%,开通率92.22%,7条输卵管因阻塞病情严重无法开通,其中双侧均未能开通1例。所有患者术中均无严重并发症发生。随访12个月,妊娠率48.65%。常规法组与联合法组输卵管开口插管成功率差异具有统计学意义(χ^2=85.574,P=0.000),而输卵管开通率差异无统计学意义(χ^2=0.248,P=0.619)。结论对于常规法输卵管开口插管失败者,采用联合改良双腔球囊导管可提高输卵管开口插管成功率。采用改良双腔球囊导管介入再通与常规法开通效果相当,可作为常规介入再通输卵管开口插管失败的备选方案。     

直丝弓矫治器和Begg矫治器治疗安氏Ⅱ类1分类错[牙合]畸形疗效比较

目的:对比不同矫治器对错[牙合]畸形患者面高度及前后牙咬合关系的影响。方法:选取于笔者医院接受矫治的83例错[牙合]畸形患者,根据患者矫治器类型分为直丝弓组和Begg组,分别为42例和41例。比较并分析两组患者治疗前后牙咬合关系、硬组织、磨牙及面高度的变化情况。结果:矫治后,两组患者OJ-PPV、OB-PP、LMA-MPV、LMA-MPV均降低,Begg矫治组OJ-PPV水平显著高于直丝弓矫治组,OB-PP、LMA-MPV、LMA-MPV水平显著低于直丝弓矫治组,差异均具有统计学意义(P<0.05);两组患者LAFH、LAFH/TAFH、PFH/TAFH水平均升高,其中Begg矫治组患者LAFH水平显著低于直丝弓矫治组,差异均具有统计学意义(P<0.05);两组患者LMA-MP、LMC-MP水平均升高,差异具有统计学意义(P<0.05);矫治前后,两组患者SNA、SNA、ANB水平均无统计学差异(P>0.05)。结论:两种矫治器对错[牙合]畸形患者硬组织变化均无明显影响,其中Begg矫治对患者前后牙咬合关系改善作用更强,直丝弓对患者面高度的改善能力更强。     

Migration of a Kirschner wire from the greater trochanter to the popliteal fossa: a case report

Migration of Kirschner (K) wires from the upper extremity joints has often been reported, but it is less common from the lower extremities. In this report, we describe an 85-year-old man treated, during a hip replacement procedure, with a K-wire because of a trochanteric fracture; after one year, the K-wire was found in the popliteal fossa. This report illustrates the first case of K-wire migration in the popliteal area of the knee and suggests avoiding the use of free K-wires without any tension banding.     

The Doppler guide wire: clinical applications in neuroendovascular treatment

The application of Doppler-tipped guide wires to measure blood flow velocity in coronary and peripheral arteries has been described previously as a valuable means of functional assessment in interventional cardiological procedures. In animal studies intravascular Doppler has been used in the cerebrovascular system, and this appears to be an important field of application for this new technique. We used intravascular haemodynamic monitoring by the Doppler guide wire during neuroendovascular procedures in patients with different cerebrovascular diseases and evaluated the clinical feasibility of the method. We found it a safe technique which complements morphological angiographic information with valuable functional data. Further studies may be expected to demonstrate the relation of flow parameters to clinical outcome. Received: 16 January 1996 Accepted: 30 January 1996     

膝前框形钢丝内固定治疗髌骨骨折

目的　总结采用钢丝环扎 +膝前方框形张力带钢丝内固定法治疗髌骨骨折的经验和临床效果。方法　对 3 5例髌骨骨折应用此方法治疗 ,其中男性 2 4例 ,女性 11例 ,3 0例获得 3～ 2 4个月随访。结果　优 19例 ,良 10例 ,可1例 ,优良率 96 7%。术后未出现骨折再移位 ,无伤口感染。愈合时间 6～ 12周。结论　该方法符合生物力学原理 ,操作简便 ,适应证广 ,能早期关节活动 ,是治疗髌骨骨折的理想方法之一。     

压力导丝在冠状动脉内支架置入中的意义

目的　通过与血管内超声 ( IVUS)相比较 ,探讨压力导丝在评价冠脉内支架置入即刻效果 ,指导优化支架置入中的作用。方法　 5 1例患者置入冠脉内支架后先后予血管内超声和压力导丝检测判断是否达到相应的理想支架置入标准。若未达标准 ,则进一步采用更高压力同样球囊或更大球囊再扩张。结果　支架置入后 IVUS判断 3 1例达到标准 ,不需再扩张 ,15例不满意者再扩张支架 ,支架内截面积增加 2 4 .3 % ( P<0 .0 5 ) ,最终 4 1例 ( 89% )得到满意 IVUS,5例因超声导管未跨过支架无超声资料 ;压力导丝检测 3 5例达到标准 ,不需再扩张 ,16例不满意者再扩张支架最终 4 5例 ( 88% )得到满意结果 (心肌部分血流储备 ,FFRmyo>0 .90 )。血管内超声和压力导丝两者在判定理想支架置入方面有很好的相关性 ,符合率达 90 %。以血管内超声检测作金标准 ,应用受试者工作特性曲线 ( ROC)计算心肌部分血流储备 FFRmyo预测理想支架置入的最佳临界点为 0 .90。结论　压力导丝是指导冠脉支架置入更方便、安全的有效手段 ,有广泛推广应用的价值     

CPM在髌骨骨折张力带内固定术后的应用

目的 探讨CPM在髌骨骨折改良张力带内固定术后的应用效果。方法 早期应用CPM治疗髌骨骨折行改良张力带内固定术后病人156例。结果 所有病例均得到随访，临床疗效优良率为98％。结论 在髌骨骨折行改良张力带内固定术后早期应用CMP，可显著利于膝关节功能恢复，提高治愈率。     

Dual microcatheter and guidewire snare technique for retrieval of intravascular foreign body: technical note

A transjugular snare technique was used to retrieve a stretched, residual mechanical detachable coil which extended from the cavernous sinus to the femoral vein, obliterating the transpetrosal route for further embolisation. The coil was snared by a microguidewire. Our new technique is described in this paper. Received: 19 April 1995 Accepted: 31 July 1995     

经峡部内固定植骨治疗腰椎峡部不连

本文介绍一种手术治疗腰椎峡部不连和轻度滑脱的新方法。手术直接在峡部缺损处修整植骨，并采用通过峡部缺损间隙的加压螺钉和环绕双侧横突基底部至棘突下缘的节段性横突钢丝作内固定，以期使峡部缺损处达到骨性愈合，恢复椎弓的连续性。临床应用本方法治疗腰椎峡部不连和轻度滑脱１７例，均获近期（术后７～２５个月）的随访。Ｘ线复查示植骨愈合１６例，骨性愈合率９４％。按Ｈｅｎｄｅｒｓｏｎ标准评价，临床优良率达９４％。     

Fixation of Kirschner wires: a comparison between hammering and drilling k-wires into ribs of pigs

Kirschner wire (K-wire) fixation is a well-accepted method for stabilization of fractures. However, the rotary drill traditionally used for insertion leads to a considerable amount of complications (33%). Another method for insertion was tested which might possibly reduce these complications—hammering. Forty-four K-wires were inserted into the ribs of pigs using a drilling and a hammering technique. Peak extraction force, peak torque, and insertion time were measured. The mean peak extraction forces for drilling and hammering were 57.4 and 129.0 N, respectively. The mean peak torque for drilling and hammering were 2.4 and 5.7e−02 Nm, respectively. Using the drilling technique, it took 73.6 s to insert the K-wire compared with 18.4 s for hammering. At the exit site, there were splinters of bone in 18 of the 22 hammered K-wires and in 2 of the 22 drilled K-wires. This study showed that hammering K-wires into ribs of pigs gives better initial fixation and results in a shorter insertion time.D.B. van Egmond is deceased.