经皮椎体后凸成形术治疗胸腰椎骨折的临床疗效观察

目的：探讨经皮椎体后凸成形术治疗胸腰段椎体压缩性骨折的临床疗效.方法：2003年6月～2005年9月收治74例胸腰段椎体压缩性骨折患者,根据手术方法不同分为A组（椎体后凸成形术组,24例）和B组（椎弓根螺钉固定组,50例）.比较两组术前术后椎体前缘、中线、后缘高度变化,疼痛视觉模拟评分（visual analogue pain scale,VAS）,手术时间,出血量等方面的差异.结果：两组对椎体高度的恢复比较无统计学意义,A组的手术时间和出血量较B组少,差异有统计学意义（P＜0.01）,术后VAS评分A组较B组低（P＜0.01）.结论：经皮椎体后凸成形术与椎弓根螺钉系统治疗椎体压缩性骨折具有相似效果,但经皮椎体后凸成形术具有创伤小、手术时间短、出血量少等微创优点.     

NEW DEVICE TO PERFORM COAGULATION AND IRRIGATION SIMULTANEOUSLY DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING AN INSULATION‐TIPPED ELECTROSURGICAL KNIFE

Background: Although bleeding is an unavoidable complication of endoscopic submucosal dissection (ESD), endoscopic hemostasis using an insulation‐tipped electrosurgical knife (IT) knife is impossible because an insulator is mounted at the tip of the knife. We have developed a new type of hood which could perform both coagulation and irrigation simultaneously. Methods: Our new device was fabricated by drilling a side hole in the cap portion of a conventional transparent hood followed by attaching a machined papillotomy knife to the exterior surface of the hole. Results: Our new hood was useful for hemorrhage during ESD using IT knife. Conclusions: With this method, endoscopic hemostasis using IT knife is easy, as hemostatic procedure can be performed under irrigation and coagulation using conventional endoscopy.     

纤维组织粘合剂的实验研究

本文应用“冷沉淀”法制备纤维组织粘合剂。对纤维组织粘合剂中主要成份和含量进行了测定,并测定了主要理化性质,建立了动物实验模型,观察了实验兔对纤维粘合剂的反应。     

高强度聚焦超声及其医学应用

HIFU技术的研究在国内外已掀起了热潮．到目前为止．HIFU技术已得到广泛的实验和临床支持。本文将对HIFU治疗设备的总体结构做一阐述．并讨论其在医学领域中的应用及发展方向。     

凝血酶受体结构与功能的研究现状

凝血酶（ｔｈｒｏｍｉｂｉｎ，Ⅱａ）是一种生成于损伤处血管内皮细胞多功能蛋白酶，它是参与凝血过程各个环节反应中的关键酶。在发挥止血作用的同时，还可能诱导炎症、增生及修复等反应。最近发现的凝血酶受体（ｔｈｒｏｍｂｉｎ ｒｅｃｅｐｔｏｒ，ＴＲ）分子可能为解释上述现象提供了一个理论框架。同时，ＴＲＮ端被Ⅱａ切下的４１个氨基酸片段是否具有特殊功效，值得研究探讨。     

Comparison of the effect of intravenous ketoprofen, ketorolac and diclofenac on platelet function in volunteers

Background : Nonsteroidal anti–inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis which may result in impaired platelet function. Because NSAIDs have different abilities to inhibit cyclo–oxygenases we compared the effect of intravenous ketoprofen, ketorolac and diclofenac on platelet function in volunteers. Methods : Ten healthy male volunteers were given ketoprofen 1.4 mg kg^-1, ketorolac 0.4 mg kg^-1 and diclofenac 1.1 mg kg^-1 in saline i.v. on three different occasions, at more than one–week intervals, in a randomized double–blind crossover study. Platelet function was evaluated before (sample 0), 2 (sample 2) and 24 h (sample 3) after the beginning of the infusion. Results : Two of the volunteers had no secondary platelet aggregation in their aggregation curves before the experiment (sample 0, studied three times) and their results were excluded from the final analysis. Diclofenac inhibited adrenaline (0.9 μg–ml^-1) induced platelet aggregation less (median maximal aggregation 22.5%) than ketoprofen (18.3%) and ketorolac (15.7%) (P<0.05) in sample 2. In the ketorolac group in sample 3 an impairment of adrenaline (0.9 ng ml^-1) induced platelet aggregation was still seen (26.7%) (P<0.05) but not in the other groups. Diclofenac did not affect adenosine diphosphate (ADP) induced platelet aggregation. However, ketorolac caused an impairment in ADP (3 μM and 6 μM) induced platelet aggregation and ketoprofen in ADP (6 μM) induced platelet aggregation in sample 2. Bleeding time was prolonged (P<0.05) after ketoprofen and ketorolac (sample 2) but not after diclofenac. Platelet retention on glass beads was unaffected by the tested drugs. Conclusion : Ketoprofen, ketorolac and diclofenac caused a reversible platelet dysfunction. Diclofenac had the mildest effect, while platelet dysfunction was still seen 24 h after the beginning of ketorolac.     

经皮椎体成形术与椎体后凸成形术治疗胸腰椎压缩性骨折的临床疗效比较

目的比较经皮椎体成形术与椎体后凸成形术治疗胸腰椎压缩性骨折的临床疗效。方法对98例胸腰椎压缩性骨折，根据手术方法不同分为椎体成形组和椎体后凸成形组。比较两组术前术后椎体前缘、中线、后缘高度变化，疼痛视觉模糊评分（VAS），手术时间，出血量等方面的差异。结果两组对椎体高度的恢复比较差异有统计学意义（P〈0．01），VAS、手术时间和出血量比较差异无统计学意义（P〉0．05）。结论经皮椎体成形术与椎体后凸成形术具有创伤小、手术时间短、出血量少等微创优点，而椎体后凸成形术具有较好的复位作用。     

Estenia瓷树脂复合体制作冠桥的强度测试

目的:探讨Estenia瓷树脂复合体的强度,并与其他几种树脂材料进行比较,为临床选择冠桥树脂材料提供参考。方法:采用Estenia瓷树脂复合体体外模拟下颌第一磨牙单冠和第一磨牙缺失3个单位固定桥的形态,测试单冠的抗压强度和固定桥的抗弯强度,并与Artglass、Solidex、Targis3种树脂材料在相同实验方法下测试得到的结果作比较。结果:Estenia瓷树脂单冠的折裂最大载荷均值为600.20N,Estenia瓷树脂桥的折裂最大载荷均值为302.53N。结论:Estenia瓷树脂复合体的强度高于Artglass﹑Solidex和Targis树脂复合体。     

Intraoperative measurement of activated partial thromboplastin time and prothrombin time with a new compact monitor

A prospective study was conducted to evaluate a new compact portable coagulation monitor (Ciba–Corning Biotrack 512 Monitor), which enables the clinician to perform instantaneous activated partial thromboplastin time (APTT) and prothrombin time (PT). 126 patients scheduled for heparinized and nonheparinized vascular surgery, and gynaecological surgery, were included. A drop of capillary or venous whole blood was applied in disposable cartridges to successively perform APTT and PT, and the results of the tests were compared with conventional laboratory methods, performed in two different laboratories (Lab. A and B). Comparisons between Lab. A. and Lab. B. enables determination of the bias, precision, and percent of outliers (patients whose values differed more than 20%) in conventional methods. The reference value was defined as the mean of Lab. A. and Lab. B. values. For PT, there were no statistical differences between the capillary and venous samples performed with the portable monitor, and the reference value, for the bias, the precision and the proportion of outliers. For APTT, there were no statistical differences between the capillary and venous samples performed with the portable monitor, and the reference value, for the bias and the precision. The percent of outliers, however, was significantly greater with the venous sample of the compact monitor than with the reference (48 versus 22%), and even if it did not reach the statistical significance ( P = 0.07) it was also higher with the capillary sample performed with the Ciba Monitor than with the reference (33%). In conclusion the assessment of blood coagulation using this new compact monitor could be of major interest during the intraoperative period when immediate results are mandatory, even if PT is more accurate than APTT with this new method.     

大鼠脊髓慢性压迫及减压后神经细胞凋亡及其相关基因的表达

目的：观察慢性压迫性脊髓损伤后及减压后神经细胞凋亡和Bcl-2mRNA，P53mRNA,CASPASE-3神经功能恢复的影响。方法：将55只同龄Wistar大鼠，置入后路渐进式压迫装置，制作成慢性压迫性脊髓损伤模型。随机分为假手术对照组（A组5只），慢性脊髓压迫组（B组25只），减压组（C组25只）。应用原原位末端脱氧核糖核苷酸转移酶介导dUTP标记（TUNEL）技术及原位杂交检测方法，观察各组细胞凋亡率及细胞凋亡相关基因Bcl-2mRNA、P53mRNA、CASPASE－3在慢性压迫性脊髓损伤后及减压后的表达，分别于损伤后及减压后1、3、7、14、28d对慢性脊髓损伤区进行细胞凋亡及原位杂交检测。结果：A、B、C三组均发现神经细胞凋亡及细胞凋亡相关基因Bcl-2mRNA、P53mRNA，CASPASE－3的表达，A、B、C三组细胞凋亡率及阳性细胞灰度值比较，差异有显著性意义（P＜0．05）。阳性细胞表达程度与细胞凋亡的减少及神经功能的恢复相一致。结论：慢性压迫性脊髓损伤可导致大量的神经细胞凋亡，同时激活内源性保护机制，使脊髓发生适应性改变，减压可能通过激活此机制而减轻神经细胞凋亡，起到保护作用。