酥胆麒麟膏用于痔瘘术后换药的药效学与毒理学研究（二）

本文通过设一个阳性对照组（马应龙鹰香痔疮膏），一个空白对照组（凡士林）及酥胆麒麟膏大、中、小三个剂量组（１０％、２０％、４０％浓度）进行三个方面的实验研究，证实酥胆麒麟膏具有止血、抗菌、生肌长皮等综合作用，局部外用无毒副作用，安全性高。其止血、生肌长皮作用，优于马应龙麝香痔疮膏；抗金葡萄茵的作用与银灰散相同；抗大肠杆菌的作用犹于银灰散。尤其是２０％酥胆麒麟膏的以上多种作用优于１０％浓度的，等效于４０％浓度的，可作为临床使用时的最佳浓度。     

Radiology of postnatal skeletal development

The development of the second cervical vertebra is complex. The dens (odontoid process) develops two primary ossification centers that usually coalesce within three months following birth. These centers are separated from the primary ossification center of the vertebral centrum by a cartilaginous region—the dentocentral synchondrosis. This synchondrosis is a slow growing, bipolar physis similar to the triradiate catilage of the acetabulum. It contributes to the overall heights of both the dens as well as the vertebral body. Anatomically the dentocentral synchondrosis is below the level of the C1–C2 articulations. This cartilaginous structure is continuous throughout the vertebral body with similar cartilage in both the facet regions as well as the neurocentral synchondroses. These various carulaginous continuities progressively close—first, the connections to the facet regions, next the neurocentral synchondroses, and finally the dentocentral synchondrosis. Remnants of the incompletely closed dentocentral synchondrosis must be distinguished from a fracture, which usually propagates along this structure as a physeal injury in infants and children. The cartilaginous epiphysis at the tip of the dens may be transverse or may form a cleft (V) shape. At eight to ten years, a secondary ossification center—the ossiculum terminale—develops in this proximal dens epiphysis. Fusion of the ossiculum terminale with the rest of the dens occurs between ten and thirteen years.     

Cement-augmented anterior screw fixation of Type II odontoid fractures in elderly patients with osteoporosis

Background contextClosed reduction and internal fixation by an anterior approach is an established option for operative treatment of displaced Type II odontoid fractures. In elderly patients, however, inadequate screw purchase in osteoporotic bone can result in severe procedure-related complications.PurposeTo improve the stability of odontoid fracture screw fixation in the elderly using a new technique that includes injection of polymethylmethacrylat (PMMA) cement into the C2 body.Study designRetrospective review of hospital and outpatient records as well as radiographs of elderly patients treated in a university hospital department of orthopedic surgery.Patient sampleTwenty-four elderly patients (8 males and 16 females; mean age, 81 years; range, 62–98 years) with Type II fractures of the dens.Outcome measuresComplications, cement leakage (symptomatic/asymptomatic), operation time, loss of reduction, pseudarthrosis and revision surgery, patient complaints, return to normal activities, and signs of neurologic complications were all documented.MethodsAfter closed reduction and anterior approach to the inferior border of C2, a guide wire is advanced to the tip of the odontoid under biplanar fluoroscopic control. Before the insertion of one cannulated, self-drilling, short thread screws, a 12 gauge Yamshidi cannula is inserted from anterior and 1 to 3 mL of high-viscosity PMMA cement is injected into the anteroinferior portion of the C2 body. During polymerization of the cement, the screws are further inserted using a lag-screw compression technique. The cervical spine then is immobilized with a soft collar for 8 weeks postoperatively.ResultsAnatomical reduction of the dens was achieved in all 24 patients. Mean operative time was 64 minutes (40–90 minutes). Early loss of reduction occurred in three patients, but revision surgery was indicated in only one patient 2 days after primary surgery. One patient died within the first eight postoperative weeks, one within 3 months after surgery. In five patients, asymptomatic cement leakage was observed (into the C1–C2 joint in three patients, into the fracture in two). Conventional radiologic follow-up at 2 and 6 months confirmed anatomical healing in 16 of the19 patients with complete follow-up. In two patients, the fractures healed in slight dorsal angulation; one patient developed a asymptomatic pseudarthrosis. All patients were able to resume their pretrauma level of activity.ConclusionsCement augmentation of the screw in Type II odontoid fractures in elderly patients is technically feasible in a clinical setting with a low complication rate. This technique may improve screw purchase, especially in the osteoporotic C2 body.     

Elderly patients are at increased risk for mortality undergoing surgical repair of dens fractures

Objective

Dens fractures are common cervical injuries in advanced aged patients. The presented study was undertaken to analyze the clinical results and risks of surgically treated patients with dens fractures over 70 years.

Methods

Data of 28 patients (17 female, 11 male) over 70 years treated from September 2004 to October 2009 were recorded. Clinical and radiological parameters were obtained including type of fracture, associated cervical and/or other injuries, comorbidities, symptoms, neurological condition, surgical strategy, postoperative course and complications.

Results

89% were in a good neurological condition before surgery (ASIA E or D). In most cases, surgery was performed at an early stage after trauma (21 patients within 5 days). Ventral screw fixation was the preferred surgical strategy (64%). A slight worsening of neurological functions immediately after operation was only seen in one patient. Five patients died in the early and 2 in the late postoperative course which means a treatment mortality of 25%. Among the surviving patients two had general medical complications.

Conclusion

Type II dens fractures are a common fracture of elderly patients. Our results are good concerning the neurological functions. Surgical and general medical complications were acceptable. However, the study also underlines that mortality rate is high and therefore treatment options should be well-considered in this high risk group.     

柴胡加龙骨牡蛎汤联合腹针治疗脑卒中后抑郁疗效观察

目的:观察柴胡加龙骨牡蛎汤联合腹针治疗脑卒中后抑郁的临床疗效。方法:将94例失眠患者随机分为对照组和治疗组各47例,对照组采用氟哌噻吨美利曲辛片治疗,治疗组采用柴胡加龙骨牡蛎汤联合腹针治疗,两组均连续治疗6周后判定临床疗效,比较两组患者治疗前后汉密尔顿抑郁量表(HAMD)评分及Barthel指数(BI)变化。结果:两组患者治疗后HAMD评分较本组治疗前明显降低(P<0.05),BI评分较治疗前明显升高(P<0.05),且治疗组治疗后HAMD评分低于对照组(P<0.05),BI评分高于对照组(P<0.05)。两组患者治疗后中医证候积分与治疗前比较,差异有统计学意义(P<0.05);两组患者中医证候积分差值比较,差异有统计学意义(P<0.05)。结论:柴胡加龙骨牡蛎汤联合腹针治疗脑卒中后抑郁可改善患者抑郁症状。     

复方血竭微乳对豚鼠皮肤刺激性实验观察

目的：对复方血竭微乳进行皮肤刺激性试验,以了解其安全性。方法：将复方血竭微乳及空白微乳约0．5ml涂于豚鼠完整皮肤及破损皮肤,在完整皮肤和破损皮肤进行一次给药和多次给药皮肤刺激性试验,观察复方血竭微乳及其空白微乳是否会引起豚鼠皮肤刺激性。结果：复方血竭微乳及其空白微乳一次给药对完整皮肤组和破损皮肤组均未出现红斑、水肿等现象,无刺激现象;复方血竭微乳及其空白微乳多次给药对破损皮肤有轻微刺激作用。结论：复方血竭微乳多次给药对豚鼠完整皮肤无刺激性,对破损皮肤有轻度刺激性,但给药后72h刺激性反应自行消退。     

血竭总黄酮对血小板聚集、血栓形成及心肌缺血的影响

目的：观察血竭总黄酮对大鼠及兔血小板聚集，血栓形成及心肌缺血的影响。方法：采用体外血小板聚集，大鼠体内深静脉血栓形成及结扎冠状动脉所致急性心肌缺血实验模型，结果：血竭总黄酮对体外ADP放导的大鼠血小板聚集及PAF诱导的兔血小板聚集有一定的抑制作用，可明显抑制大鼠实验性深静脉血栓形成及结扎冠状动脉所致急性心肌缺血面积。结论：血竭总黄酮具有一定的活血化瘀和抗血小板，抗血栓形成作用。     

血竭聚乳酸缓释微球的制备及体外释药研究

目的：制备血竭聚乳酸缓释微球,并对其体外释药特性进行考察。方法：以聚乳酸为载体,采用乳化溶剂挥发法制备血竭聚乳酸O/W型缓释微球,考察了微球的粉粒学特征,并进行了体外溶出研究。结果：所制备的血竭聚乳酸微球外形圆整,载药量为21.97%,包封率为55.76%,16 h体外累积释药量为76.71%。结论：血竭聚乳酸微球具有很好的缓释能力,使用前景广阔。     

中药材血竭的X衍射Fourier谱分析

采用粉末X衍射法,对3个血竭样品进行分析,获得了血竭的标准X衍射Fourier因语及特征标记峰,表明此法在中药材鉴定中有着广阔的应用前景。     

薄层扫描法测定七厘散内血竭中的苯甲酸含量

用薄层扫描法测定七厘散中苯甲酸含量,以控制其中血竭的含量。结果表明方法简便、准确,可作为七厘散的质控标准。