86例医源性子宫内膜异位症临床分析

目的:探讨医源性子宫内膜异位症发病机制、诊断及最佳治疗方法,预防盆腔外医源性子宫内膜异位症的发生和降低其复发率。方法:回顾性分析86例医源性子宫内膜异位症患者的临床资料。结果:86例医源性子宫内膜异位症患者中83例行手术治疗。其中腹壁切口瘢痕子宫内膜异位症56例,42例病灶位于皮下脂肪组织,病灶侵及腹直肌前鞘7例,病灶侵及腹直肌5例,侵及腹膜2例,腹壁手术瘢痕多发异位结节3例;术后随访2例复发,均为应用局部麻醉者。其他部位的内异症手术27例,其中会阴切口瘢痕内异症侵及肛门扩约肌3例,阴道壁内异症侵及阴道直肠膈3例,术后分别加用达那唑治疗3~6个月,经随访27例均无复发。2例腹壁子宫内膜异位症单纯应用药物治疗者,在治疗期间症状明显减轻,但肿块无明显缩小,均于停药后短期内再次出现症状。阴道后穹窿内异症1例,用达那唑治疗9个月,停药随访8年未复发。结论:医源性子宫内膜异位症最好的治疗方法是手术切除,采用硬膜外或骶管麻醉为宜;对手术不能彻底切除者加用治疗内异症的药物是最好方法;严格操作规程、提高手术技巧,可以避免医源性内异症的发生。     

闭合复位克氏针内固定治疗儿童肱骨髁上骨折的疗效

目的 探讨闭合复位克氏针内固定治疗儿童肱骨髁上骨折的疗效。方法 在C臂机辅助下行闭合复位克氏针内固定治疗150例GartlandⅢ型肱骨髁上骨折患儿。记录手术时间、术后3 d Baumann角、骨折愈合时间、肘关节功能及活动度。结果 患儿均获得随访,时间3～12个月。手术时间40～50(46.7±5.4)min,术后3 d Baumann角2°～6°(2.5°±0.8°)。骨折均愈合,时间48～62(54.6±5.4) d。术后3个月采用肘关节Flynn评分评价疗效：优138例,良8例,可4例,优良率97.33%。末次随访时,患儿肘关节屈曲120°～140°、伸直0°～8°,前臂旋前80°～90°、旋后70°～80°。145例术后桡动脉博动恢复或改善,患侧末梢血运良好;5例患侧末梢血运良好,桡动脉博动于术后3～5 d恢复正常。结论 闭合复位克氏针内固定治疗儿童肱骨髁上骨折术后并发症少,患儿功能恢复好;术中使用C臂机透视能够清晰地了解骨折移位情况,可有效保障手术安全及固定效果。     

经后路复位椎弓根钉内固定术治疗强直性脊柱炎合并寰枢椎脱位的疗效观察

 目的 观察经后路复位椎弓根钉内固定术治疗强直性脊柱炎合并寰枢椎脱位的临床疗效。方法 某院2009-04至2013-06共收治10例强直性脊柱炎合并寰枢椎脱位患者,均采用经颈后路复位椎弓根钉内固定术治疗,采用JOA法和Frankel分级对治疗效果进行评估。结果 本组病例获(21.0±11.1)个月随访。所有患者症状均明显改善,术前JOA评分(12.7±1.7)分,术后JOA评分(15.4±4.0)分,手术前后对比差异有统计学意义(P<0.05)。5例脊髓损伤患者Frankel分级从术前D级恢复至E级。所有病例术中未出现椎动脉、静脉窦及脊髓损伤,术后未出现内固定松动、断裂,随访期间寰枢椎无再移位、失稳,植骨融合满意。结论 经后路复位椎弓根钉内固定术是治疗强直性脊柱炎合并寰枢椎脱位的安全有效的方法。     

静脉移植CXCR-4基因转染骨髓间充质干细胞在脊髓损伤鼠体内的迁移与分化

背景:研究发现,基质细胞衍生因子1/CXCR-4轴具有介导骨髓间充质干细胞定向迁移的作用.目的:观察静脉移植CXCR-4基因转染间充质干细胞治疗脊髓损伤的可行性.方法:利用脊髓横切法构建C57BL/6小鼠T10脊髓损伤模型,造模后7 d抽签随机分成3组:实验组经尾静脉注射CXCR-4基因转染同种异体骨髓间充质干细胞悬液,对照组与空白对照组分别注射同种异体骨髓间充质干细胞悬液及无细胞培养基.移植后第7,14,21,28天利用激光共聚焦显微镜、免疫组织化学双标染色法检测脊髓损伤部位绿色荧光蛋白阳性细胞迁移存活及分化情况,并采用BBB评分评估小鼠神经运动功能恢复情况.结果与结论:实验组移植后各时相点损伤灶内绿色荧光蛋白阳性细胞集聚明显,数量不断增多,迁移率明显高于对照组与空白对照组,来源于骨髓间充质干细胞的神经细胞占移植细胞的比例亦高于对照组与空白对照组,小鼠神经运动功能恢复明显.说明静脉移植CXCR-4基因转染的骨髓间充质干细胞表现出对脊髓损伤灶更强的定向迁移能力,且能在损伤灶内存活、分化,发挥修复损伤脊髓作用.     

地震后被转移伤员创伤后应激障碍及心理状况分析

目的 调查地震后被转移伤员创伤后应激障碍(PTSD)的发生及其心理健康状况.方法 采用PTSD症状自评和诊断工具及症状自评量表(SCL-90),在地震后40 d对354例被转移伤员的PTSD的发生和心理健康状况进行评估.结果 (1)地震后40 d,有82例(23.2%)伤员发生PTSD,女性55例(55/200,27.5%),男性27例(27/154,17.5%),女性发生率高于男性,差异有统计学意义(P＜0.05);在不符合PTSD诊断的伤员中,199例(199/249,79.9%)存在再体验症状,164例(164/249,65.9%)存在麻木或回避症状,208例(208/249,83.5%)存在过度唤起症状.(2)PTSD患者的SCL-90总分(209.00±68.78)分、强迫症状因子(2.38±0.61)分、人际关系敏感因子(2.18±0.87)分、抑郁因子(2.50±0.86)分、焦虑因子(2.42±0.90)分、敌对因子(2.47±0.87)分,高于非PTSD患者[(153.08±5.63)分、(1.71±0.64)分、(1.50±0.60)分、(1.71±0.69)分、(1.70±0.76)分、(1.66±0.73)分;P＜0.05,P＜0.01].(3)地震后被转移伤员的SCL-90总分、躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性和其他因子得分高于全国常模组(P＜0.05,P＜0.01).结论 地震后部分被转移伤员出现PTSD,相当多的伤员遭受了不同程度的心理影响,应予以长期关注.

Abstract：

Objective To investigate the incidence of post traumatic stress disorder ( PTSD ) and mental status in the transferred wounded after Wenchuan earthquake. Methods At the 40th day after earthquake, 354 wounded were evaluated by the PTSD Symptoms Self Rating Scale, and Symptom Checklist 90 ( SCL-90 ). The diagnosis of PTSD was made according to DSM-Ⅳ criteria. Results After 40 days, 82( 23.2% )suffered PTSD in these wounded, including 55 females( 55/200,27.5% ) and 27 males( 27/154,17. 5% ), the rate in women was significantly higher than that in men. In those non-PTSD wounded, 199patients 199/249,79.9% ) had re-experienced symptoms, 164 patients( 164/249,65.9% ) had numbness/escaping symptoms, 208 patients( 208/249,83.5% ) had excessive arousing symptoms. The SCL-90 total score( 209.00 ±68.78 ), obsession( 2. 38 ± 0. 61 ), human relation sensitivity( 2. 18 ± 0. 87 ), depression ( 2. 50 ±0. 86 ), anxiety( 2.42 ± 0. 90 ) and hostility factor( 2.47 ± 0. 87 ) score of the PTSD were higher than those of the non-PTSD[( 153.08 ± 5.63 ),( 1.71 ± 0. 64 ),( 1. 50 ± 0. 60 ),( 1.71 ± 0. 69 ),( 1.70 ±0. 76 ),( 1.66 ±0. 73 );P ＜0. 05 -0. 01] . The SCL-90 total score and somatization, obsession, depression,anxiety, hostility, phobia, crankiness, psychosis and the other factor score of the wounded were higher than those of the national norm group( P ＜ 0. 05 - 0. 01 ). Conclusion Considerable number of the transferred wounded existed PTSD symptoms in experienced earthquake disaster, they need to be intervened for a long period.     

重庆市大学生自杀未遂者社会距离与社交限制的研究

目的 了解重庆市大学生中有无自杀未遂者对10种不同特征人群的社会距离和接纳程度的异同点.方法 采用<自杀态度与心理健康状况问卷>,在重庆市随机抽取的11所大学中调查9808名大学生,通过统计描述、t检验分析比较有无自杀未遂的大学生对10种不同特征人群(曾犯罪入狱、患高血压病、有过自杀行为、是同性恋、有过严重抑郁症、感染艾滋病毒、家人自杀死亡、有过吸毒、住过精神病院及曾酗酒)的社会距离和接纳程度.结果 在抽取的9808名大学生中有自杀未遂者169例,自杀未遂报告率为1.7%.有无自杀未遂大学生对于10种不同特征陌生人的社会距离,有9项均分高于50分,前三位均是感染艾滋病毒、有过吸毒、住过精神病院.有无自杀未遂大学生在对有过吸毒(有自杀83.38±21.82,无自杀78.55±21.55,t=2.88,下同)、住过精神病院(79.27±21.23,75.67±21.31,t=2.17)、同性恋(66.87±24.77,74.14±21.94,t=-4.25)、曾酗酒(66.72±21.80,61.00±22.80,t=3.23)及患高血压(56.65±20.40,53.36±21.05,t=2.01)的陌生人社会距离分值差异有统计学意义(P<0.05).有无自杀未遂大学生对处于10种不同特征已认识的人的社会距离,有7项均分高于50分,前三位均是住过精神病院、有过吸毒及曾酗酒.有无自杀未遂大学生在对同性恋(35.28±30.38,42.83±30.76,t=-3.14)、有过严重抑郁(56.59±28.49,61.64±25.56,t=-2.53)及有过自杀行为(51.46±28.19,56.56±26.35,t=-2.48)的已认识人群的社会距离分值差异有统计学意义(P<0.05).结论 重庆市大学生对10种不同特征人群总体的社会距离和社交限制较大,自杀未遂大学生对某些人群的社会距离和社交限制较无自杀未遂者要小,可据此对自杀未遂者采取针对性干预措施.

Abstract：

Objective To explore the attitude towards 10 different populations with different characteristics on their social distance and acceptance among those people with or without suicidal attempts among college students in Chongqing.Methods 9808 college students were randomly selected from 11 universities in Chongqing and administered a self-constructed questionnaire"Suicide Attitude and Mental Health Status Questionnaire".A t-test was employed to analyze the social distance and degree of acceptance of college students with or without suicide attempts towards different groups as criminals,hypertensive,with suicide actions,homosexuals,depressive disorder,HIV infection,drug addiction,death of family members,hospitalization history in mental service and alcohol addiction.Results 169 college students had suicide attempts;the reporting rate of suicide attempts was 1.7%.Among college students.the scores higher than 50 on nine items related to social distance towards strangers with those 10 different characteristics and the top three were on those with HIV infection,drug addiction and hospitalization history in mental service.There were differences(P<0.05)in scores of social distance attitude towards strangers with drug addiction(with suicide attempts 83.38±21.82,without suicide attempts 78.55±21.55,t=2.88).hospitalization history in mental service(79.27±21.23,75.67±21.31,t=2.17),homosexuality(66.87±24.77,74.14±21.94,t=-4.25),alcohol addiction(66.72±21.80,61.00±22.80,t=3.23)and hypertension(56.65±20.40,53.36±21.05.t=2.01)between college students with or without suicide attempts.College students scored higher than 50 in 7 items of social rejective attitudes towards acquaintances,of those with hospitalization history in mental service,drug and alcohol addiction ranked the top three.It showed statistical significances in social rejection attitudes towards acquaintances with homosexuality(35.28±30.38,42.83±30.76,t=-3.14),severe depression(56.59±28.49,61.64±25.56,t=-2.53)and suicide behaviors(51.46±28.19,56.56±26.35,t=-2.48)between students with or without suicide attempts.Conclusion College students in Chongqing kept quite far social distance and restrictive behaviors in college students with or without suicide attempts.Targeted interventions on suicide attempters should be carried out accordingly.     

髋臼骨折术后创伤性关节炎发生的相关危险因素分析

目的探讨影响髋臼骨折手术治疗后创伤性关节炎发生的相关危险因素。方法 2000年1月至2009年1月我院收治年龄为20～60岁,行手术治疗的髋臼骨折患者共88例,术后并发创伤性关节炎23例。根据可能影响创伤性关节炎发生的相关危险因素,采用χ2检验及logistic回归分析方法分析各因素是否与创伤性关节炎的发生有关。结果 Logistic回归分析显示,手术时机、骨折类型、复位质量及术后其它并发症的发生是影响髋臼骨折术后功能恢复的独立危险因素。结论选择恰当的手术时机、正确对骨折类型进行分型、提高手术技巧及加强对术后相关并发症的防治可降低创伤性关节炎的发生率,提高患者术后的生活质量。     

后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核

目的探讨后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核的临床效果。方法自2006年1月～2009年1月共治疗胸椎及胸腰段脊柱结核37例,对其中椎体破坏较严重、有明显后凸及侧弯畸形的17例患者采用后路Ⅰ期病灶清除植骨内固定矫正畸形。术前神经功能评价按Frankel分级标准:B级1例,C级8例,D级7例,E级1例。结果随访12～36个月,平均18个月。局部疼痛和下肢放射性麻痛症状均缓解,术后Frankel分级明显改善(C级1例,D级5例,E级11例),植骨均达骨性融合标准。脊柱后凸Cobb角从术前的(36.8±9.0)°降至术后的(17.5±3.5)°,差异具有统计学意义(P0.05);随访1年未见明显矫正丢失(与术后比较,P0.05)。结论后路Ⅰ期病灶清除植骨内固定能够彻底清除病灶,矫正后凸畸形,可用于治疗部分重度胸椎、胸腰段脊柱结核。