闭合复位弹性髓内钉与切开复位接骨板内固定在小儿股骨骨折中治疗效果比较

目的探讨比较闭合复位弹性髓内钉与切开复位接骨板内固定在小儿股骨骨折中治疗效果。方法随机将收治的60例小儿股骨骨折患者分为弹性髓内钉组与接骨板内固定组。结果弹性髓内钉组患儿手术时间、术中出血量、创口长度、术后愈合时间等手术及预后情况均明显优于接骨板内固定组,差异有统计学意义(P<0.05)。结论闭合复位弹性髓内钉具有手术时间短、术中出血量少、手术创口小、骨折愈合快的优点,具有更高的临床应用价值。     

闭合复位、自锁髓内钉固定治疗肱骨干骨折的疗效

目的探讨采用闭合复位、自锁髓内钉固定治疗肱骨干骨折的临床疗效。方法应用闭合复位、自锁髓内钉固定治疗肱骨干骨折41例。结果术后随访5～18个月,骨折均愈合,平均愈合时间4．2个月。肩关节功能按Neer评分：优秀13例,满意27例,不满意1例;肘关节功能按HSS评价标准：优24例,良17例。结论闭合复位、自锁髓内钉固定治疗肱骨干骨折具有创伤小、出血少、同定可靠、可早期进行肩肘关节功能锻炼、取钉快捷安全等优点,疗效满意。     

带锁髓内钉闭合复位穿钉治疗胫骨中下1／3段骨折

目的：带锁髓内钉闭合穿钉复位治疗胫骨中下1／3段骨折的临床应用。方法：对25例胫骨中下1／3段骨折应用闭合复位，23例行扩髓穿钉，2例未行扩髓穿钉，术后未使用任何形式的外固定支持，术后第1d，应用CPM进行关节功能锻炼，1周后进行关节主动锻炼。结果：25例均获随访，平均随访20个月(6月～30月)，骨折平均愈合时间12周(6周～16周)，最终功能按Johner-wruch标准：优22例，良3例，无断钉、骨折延迟愈合或不愈合、感染、脂肪栓塞、关节僵硬及再次骨折等并发症。结论：带锁髓内钉闭合复位穿钉治疗胫骨中下1／3段骨折具有内固定牢固、防止骨折端旋转、分离，血运影响小，术后不需外固定及能早期负重行走，骨折愈合率高，治疗效果可靠的特点，扩展了髓内钉的手术适应征。     

闭合复位逆行交锁髓内钉固定治疗股骨髁上A型骨折的临床应用

目的 探讨闭合复位逆行交锁髓内钉固定治疗股骨髁上A型骨折的临床经验及疗效.方法 2002年6月～2006年12月应用闭合复位逆行交锁髓内钉固定治疗股骨髁上A型骨折31例,男21例,女10例,平均年龄38.5岁(19～61岁).骨折类型按AO分类:A1型16例,A2型9例,A3型6例.术后早期膝关节行CPM功能锻炼.结果 全部病例均获随访,随访时间5个月～19个月,平均12个月.骨折全部愈合,愈合时间9～22周,平均13周.根据Merchen膝关节功能评定标准[1]:优19例,良9例,可2例,差1例,优良率90.3%.结论 闭合复位逆行交锁髓内钉内固定治疗股骨髁上A型骨折损伤小,固定牢固,术后早期可进行膝关节活动及功能锻炼,有利于骨折的早期愈合及膝关节功能的满意恢复,是治疗股骨髁上A型骨折的理想方法.     

交锁钉治疗下肢骨折138例临床体会

目的在于探讨交锁钉应用的手术适应症、交流术中操作技巧以及术后病人康复治疗方法。方法本文总结2005年2月-2010年7月此类手术138例,其中股骨骨折96例,胫骨骨折42例,术中复位后应用髓内钉固定,手术时间2h左右。结果术中拍X光片均显示骨折复位良好,交锁髓内钉位置佳。术后伤口均一期愈合,随访2-12月,骨折愈合良好,未出现骨折不愈合及髓内钉折断。     

带锁髓内钉闭合复位穿钉治疗胫骨骨折

目的 探讨带锁髓内钉闭合复位穿钉治疗胫骨骨折的临床应用。方法 对125例胫骨骨折应用闭合复位，113例行扩髓穿钉，12例未行扩髓穿钉，术后未使用任何形式的外固定支持，术后第1天，应用cPM进行关节功能锻炼，1周后进行关节主动锻炼。结果 125例均获随访，平均随访20个月(6～30个月)，骨折平均愈合时间12周(6～16周)，最终功能按Johner-wruch标准：优115例，良10例，无断钉、骨折延迟愈合或不愈合、感染、脂肪栓塞、关节僵硬及再次骨折等并发症。结论 带锁髓内钉闭合复位穿钉治疗胫骨骨折具有内固定牢固、防止骨折端旋转、分离，对血运影响小，术后不需外固定及能早期负重行走，骨折愈合率高，治疗效果可靠的特点，扩展了髓内钉的手术适应证。     

应用内钉术微创治疗老年股骨骨折的体会

目的分析59例老龄股骨骨折手术操作,探讨应用内钉术微创治疗老年股骨骨折。方法对2005年1月到2009年12月,我院应用内钉术微创治疗老年股骨骨折的59例病历、影像学资料及术后功能恢复情况进行随访、总结分析。结果术后4个月,42例患肢关节功能恢复正常,42例骨折全部愈合,骨折愈合时间为术后5～7个月,平均5.3个月。42例髓内钉在术后14～15个月取除,无再骨折现象。按Klemm功能恢复分级标准,优35例,良7例。结论应用微创髓内钉插钉技术治疗老龄股骨骨折患者,是目前一种较为理想的微创手术。     

弹性髓内钉治疗儿童股骨转子下骨折的疗效分析

目的:分析闭合复位弹性髓内钉内固定+髋人字石膏外固定术治疗儿童股骨转子下骨折的临床疗效。方法:选择股骨转子下骨折患儿13例,均采用C臂机下闭合复位,弹性髓内钉髓内固定辅助髋人字石膏外固定治疗,患肢术后参照Flynn髓内钉治疗股骨骨折的评分标准评价患肢功能。结果:13例患儿术后均无切口感染发生,一期愈合;随访12～18个月,均未出现髓内钉折断、骨折不愈合、骨骺损伤、患肢功能障碍等并发症;其中2例儿童术后出现钉尾激惹,弹性髓内钉取出后症状消失。所有患儿骨折均骨性愈合,末次随访时,患肢功能按Flynn评分标准,获优12例,良1例,优良率达100%。结论:规范化掌握复位级内固定技巧,闭合复位弹性髓内钉内固定+髋人字石膏外固定术治疗儿童股骨转子下骨折能获得满意的临床疗效,其微创、安全、有效,是目前比较理想的治疗方法。     

闭合复位弹性髓内钉内固定治疗儿童不稳定型胫骨干骨折的临床疗效分析

目的 探讨闭合复位弹性髓内钉内固定治疗儿童不稳定型胫骨干骨折的临床疗效。方法 回顾性分析2015年6月—2018年9月,蚌埠医学院第二附属医院收治的不稳定型胫骨干骨折患儿28例,男16例,女12例,平均年龄11.80岁,均采用闭合复位弹性髓内钉内固定治疗。术后定期复查X线评估骨折愈合情况,对比双侧膝、踝关节屈伸活动度,记录并发症发生情况,以Johner-Wruhs评定标准评价疗效。结果 术后随访时间6～24个月,平均12.80个月。术后6～12周X线示骨折线消失,骨折平均愈合时间为8.2周。末次随访时,患侧与健侧膝关节屈伸活动度对比、患侧与健侧踝关节屈伸活动度对比,差异均无统计学意义(P>0.05)。术中1例出现浅表静脉刺伤,术后2例出现皮肤激惹,无骨不连、骨骺早闭、髓内钉折断等并发症发生。按Johner-Wruhs评定标准评价,优20例、良8例,优良率为100.00%。结论 闭合复位弹性髓内钉内固定治疗儿童不稳定型胫骨干骨折,术后骨折愈合率高、功能好、并发症少、疗效好。     

闭合复位髓内钉固定技术联合中医治疗肱骨近端骨折的临床效果观察

目的：探讨闭合复位髓内钉固定技术联合中医治疗肱骨近端骨折的临床效果。方法：2017年9月—2018年9月至建湖县中医院就诊的肱骨近端骨折患者60例，按就诊的时间顺序对照随机数字表分为单纯闭合复位髓内钉固定组(髓内钉固定组)和闭合复位髓内钉固定技术联合中医治疗组(联合治疗组)。比较两组患者的肢体肿胀消退时间、骨折愈合时间，术后随访第1天，第2、4、6、8周的视觉疼痛模拟评分(visual analogue scale, VAS)，术后第4周及第8周的骨密度。应用Neer肩功能评分标准评估患者术后48周的患侧肩功能。结果：术后联合治疗组相较于髓内钉固定组患者患侧肿胀消退时间、术后住院时间、骨痂出现时间及骨折愈合时间均较短(均P<0.05)。术后第1天两组患者VAS比较差异无统计学意义(P=0.070)；术后第2、4、6、8周随访联合治疗组VAS值均小于髓内钉固定组(均P<0.05)；重复测量方差分析结果显示，联合治疗组VAS评分与髓内固定组差异有统计学意义(F=1 390.934, P<0.05)。术前及术后第4周两组患者骨密度间差异无统计学意义，术后第8周联合治疗组骨密度高于髓内固定组(P<0.05)，重复测量方差分析结果显示，两组骨密度比较差异有统计学意义(F=3 706.362, P<0.05)。术后48周，联合治疗组Neer肩关节功能评分优秀率为80.0%，髓内钉固定组优秀率为53.3%，差异有统计学意义(P<0.05)。结论：闭合复位髓内钉固定技术联合中医治疗肱骨近端骨折临床效果优，可在短期内缓解疼痛，缩短骨折愈合时间，增加骨密度，促进骨折患者的康复。     

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.     

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.