上斜方肌肌皮瓣及肩胛冈上斜方肌骨肌皮瓣的显微外科解剖与颌面缺损修复的应用研究

目的探讨以颈横血管为蒂的上斜方肌肌皮瓣及肩胛冈上斜方肌肌皮瓣的应用解剖学基础及其在口腔颌面缺损修复中的应用.方法解剖观测32侧上斜方肌和肩胛冈的形态、血供、神经支配,并应用5例以颈横血管为蒂的上斜方肌肌皮瓣及肩胛冈上斜方肌骨肌皮瓣修复口腔颌面部缺损.结果①上斜方肌近似于梯形,平均长A缘174.63 mm、B缘157.18 mm、C缘86.98 mm、D缘80.95 mm,平均面积126.78 cm2;肩胛冈全长平均达131.21 mm;②颈横动脉干、颈浅动脉干及其升支动脉干平均长度分别为42.50 mm、27.80 mm、43.12 mm,起点外径分别为2.71 mm、2.39 mm、1.96 mm,升支分布肌纤维前发出0.5 mm以上小动脉3～6支;肩胛冈支长28.75 mm,起点外径0.50 mm;回流静脉与相应动脉伴行;③应用上斜方肌肌皮瓣及肩胛冈上斜方肌骨肌皮瓣修复口腔颌面部软硬组织缺损5例,均获成功.结论以颈横血管为蒂的上斜方肌肌皮瓣及肩胛冈上斜方肌骨肌皮瓣血管蒂长、管径较粗、手术易操作,且可带肩胛冈修复,适合于修复口腔颌面部缺损.     

弹筋拨络手法治疗菱形肌损伤80例疗效观察

菱形肌位于斜方肌的深面,在肩胛肌的内下方.它起自颈椎6～7和胸椎1～4的棘突,肌束斜行向外下,止于肩胛骨的脊椎缘[1].菱形肌的损伤也叫菱形肌紊乱,是引起肩背疼痛的一个重要原因.在日常生活和工作中,因肩挑、长时期的背负,较大重量的手提,及上肢用力不当,都可以造成菱形肌超量负荷,从而造成菱形肌的劳损.此外,一次超大重量的负荷或在耸肩情况下受到暴力打击,也常能导致菱形肌急性损伤性疾病.笔者运用中医骨伤科的弹筋拨络手法治疗此症,取得良好的临床疗效.     

家兔小腿三头肌肌内神经分布研究

目的　本文用Sihler’s肌内神经染色法进一步研究家兔小腿三头肌亚部的划分。方法　用Sihler’s肌内神经染色法对家兔小腿三头肌进行整肌染色。结果　经Sihler’s肌内神经染色后家兔小腿三头肌的肌质呈透明或半透明冻胶状 ,肌外形完整 ,肌内肌束走行方向及腱板肉眼可见 ,神经各级分支被染成蓝紫色 ,清晰可见神经分支在肌内的分布走行 ,腓肠肌外侧头由胫神经本干发出的 3支独立的第一级神经分支支配 ,而腓肠肌内侧头和比目鱼肌亦各由 1支独立的第一级神经分支支配。结论　①Sihler’s肌内神经染色法划分骨骼肌亚部更直观、更可靠。②腓肠肌外侧头可分出内侧、中间和外侧 3个亚部 ,腓肠肌内侧头和比目鱼肌无区分亚部的特征     

人尺侧腕屈肌亚部化研究

目的 拟用Sihler‘s肌内神经染色法证实人尺侧腕屈肌的肌亚部分。方法 用改良Sihler’s染色法对10侧人尺侧腕屈肌进行肌内神经染色，以观察肌内神经分支分布。结果 尺神经干发出2支神经分别进入尺侧腕屈肌尺侧半和桡侧半，尺侧半神经和桡侧半神经在各自半侧肌内发出数级神经分支，各级神经分支间有丰富的吻合。结论 尺侧腕屈肌可分为尺侧亚部和桡侧亚部，两亚部各有一独立神经支配。     

人胸锁乳突肌的亚部化研究

目的 对人胸锁乳突肌进行亚部划分，为胸锁乳突肌移植的取材提供形态学资料。方法 ①用20例(40例)成人尸体的胸锁乳突肌进行骨骼肌亚部化研究。②用5例(10侧)童尸的胸锁乳突肌进行Sihler‘s肌内神经染色。结果 人胸锁乳突肌可分为胸骨头亚部、锁骨头浅亚部、锁骨头深亚部3个亚部，每个亚部都有一级神经支支配，且在每个亚部的中部各自有一明显的神经终末分支密集区。结论 胸锁乳突肌可分3个亚部，在临床上可根据受区肌力和动幅的要求按亚部取材。     

大鼠胸锁乳突肌神经和斜方肌神经的中枢定位

用HRP逆行追踪法和图象分析研究了大鼠副神经的分支:胸锁乳突肌神经和斜方肌神经的中枢定位。标记细胞位于副神经脊髓核内,自同侧延髓锥体交叉尾侧至脊髓C_6节段。标记的胸锁乳突肌神经运动神经元偏向颅侧,斜方肌神经运动神经元偏向尾侧,两者的中枢定位略有不同,且有重叠现象。还对3只大鼠标记的胸锁乳突肌神经运动神经元进行图象分析测量。     

副神经与颈丛交通支的解剖学观测

目的:解剖观测副神经与颈丛交通支,为副神经的临床应用提供解剖学依据.方法:利用显微解剖方法,观测交通支的数量、来源、交通部位及副神经相关数据.结果:(1)91.94%的副神经存在交通支,以2支型为主;胸锁乳突肌深面、枕三角内和斜方肌深面交通支的数量分别占45.90%、10.66%和43.44%,分别以C3、C3和C4来源为主;(2)双侧交通支的数量和来源差异均无显著性(P＞0.05);(3)斜方肌深面汇入副神经的交通支,其汇入点均在副神经入肌点远端;(4)交通支汇入后副神经的外径和神经束数目的增加均具有显著性(P＜0.05);(5)仅观察到4.84%的副神经存在交通支汇入其胸锁乳突肌支.结论:交通支的汇入是副神经神经纤维的重要组成部分,对胸锁乳突肌,特别是斜方肌可能具有一定支配作用,故在颈部手术时应尽量加以保护;切取副神经作为神经移植供体时,应在交通支汇入前或完全汇入后切取.     

小针刀治疗肩胛提肌损伤（附34例临床报告）

肩胛提肌起自土四个颈椎横突，止于肩胛骨内上角，收缩时上提肩胛并使肩胛骨内旋。肩胛骨固定时，可使颈屈向同侧，头转向同侧，受肩背神经支配。     

家兔小腿三头肌亚部化研究

目的 用家兔小腿三头肌进一步探讨骨骼肌亚部化研究的实验方法.方法 大体解剖法;Silder's肌内神经染色法;整肌乙酰胆碱酯酶染色法;神经干乙酰胆碱酯酶染色法.结果 腓肠肌肌内有三块腱板将腓肠肌完全划分为三部分,即腓肠肌内侧头,腓肠肌外侧头的内侧亚部和外侧亚部;比目鱼肌、腓肠肌内侧头、外侧头的内侧亚部和外侧亚部各有独立的神经分支分布;比目鱼肌、腓肠肌内侧头和腓肠肌外侧头的内、外两个亚部的运动终板带也彼此独立;支配腓肠肌外侧头的神经横断面包含两束神经,而腓肠肌外侧头外侧亚部的神经横断面显示仅为一束.结论 ①腓肠肌外侧头可分出内侧和外侧两个亚部,腓肠肌内侧头和比目鱼肌无区分亚部的特征.②综合使用各种实验方法.更有助于亚部的划分.     

腋神经和肩胛上神经及其分支联合阻滞治疗肩周炎的应用解剖

目的：为阻滞治疗肩周炎提供解剖学基础。方法：在34侧经常规防腐处理的成人尸体标本上解剖出腋神经和肩胛上神经。结果：（1）腋神经在腋窝后发自臂丛后束,主要分支有前支和后支,腋神经穿四边孔处距皮肤距离为5．0cm,前支在四边孔中点外旁开3．0cm处,距皮肤3．5－4．0cm,后支在三角肌后缘中,下1／3交点处距皮肤距离为3．0cm。(2)肩胛上神经主要分支有冈上肌支和冈下肌支,肩胛上神经在肩胛横韧带处距皮肤和冈上肌支起始处距皮肤均为4．0－4．5cm,冈下肌支起始处距皮肤4．0cm。结论：对腋神经及其分支和肩胛上神经的冈上肌支、冈下肌支选择多点在正确的体表定位和熟练掌握穿刺浓度的基础上进行阻滞,可成为治疗肩周炎的有效方法。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.