目的 研究腰椎间盘突出症(LDH)不同证候间患者CT影像学特点,分析证候程度与影像学指标的相关性.方法 选取LDH气滞血瘀证和肝肾亏虚证患者共150例,其中气滞血瘀证80例,肝肾亏虚证70例.测定并记录各证型CT影像学指标,应用中医证候量表量化证候程度,分析影像学指标与中医证候评分的相关性.结果 肝肾亏虚证患者的突出间盘CT值高于气滞血瘀证,椎体CT值低于气滞血瘀证(P<0.05).肝肾亏虚证、气滞血瘀证中医证候积分与髓核突出率呈正相关(P<0.001),与侧隐窝矢状径呈负相关(P<0.001),与椎体CT值、突出间盘CT值均无相关性.结论 肝肾亏虚证与气滞血瘀证LDH患者CT影像学特点不同,在一定程度上反映了患者中医证候的严重程度,为中医证候客观化辨证分型提供依据,丰富中医辨证内涵.

目的 观察解痉散瘀汤对椎动脉型颈椎病患者椎-基底动脉血流速度和脑血流量的影响.方法 选取2018年3月—2019年12月北京中医药大学东直门医院收治的64例椎动脉型颈椎病患者,按照随机平行分组法分为对照组与观察组各32例.对照组应用盐酸氟桂利嗪胶囊以及尼莫地平片进行常规治疗,观察组在对照组治疗基础上加用解痉散瘀汤治疗.2组均连续治疗4周,观察2组治疗前后眩晕症状评分,中医症状积分,左椎动脉、右椎动脉、基底动脉收缩期峰值血流速度(Vs)、舒张期血流速度(Vd)以及平均脑血流量变化情况,评估2组治疗后效果,并随访1年观察2组复发情况.结果 治疗后2组患者左椎动脉、右椎动脉、基底动脉Vs、Vd均较治疗前加快(P均<0.05),平均脑血流量均较治疗前明显升高(P均<0.05),观察组各项指标均明显快于或高于对照组(P均<0.05);治疗后2组中医症状积分及眩晕评分均较治疗前明显降低(P均<0.05),观察组各项评分均明显低于对照组(P均<0.05);观察组治疗总有效率为93.8％(30/32),明显高于对照组的78.1％(25/32),观察组复发率为3.1％(1/32),明显低于对照组的28.1％(9/32),差异均有统计学意义(P均<0.05).结论 应用解痉散瘀汤对椎动脉型颈椎病患者进行治疗,可明显改善椎-基底动脉血流速度和脑血流量,缓解临床症状,疗效确切.

Objective:To study the characteristics of the Pfirrmann classification of patients with lumbar disc herniation (liver-kid-ney deficiency syndrome ) and to explore the correlation between the two characteristics ,so as to provide an objective quantitative method for TCM syndrome differentiation and treatment ,and provide a clinical reference for integrative medicine therapy.Methods:A total of 50 patients with lumbar disc herniation in our hospital from November 2016 to December 2017 were selected.The clinical severity of the primary and secondary symptoms was assigned to the scores according to the diagnostic criteria .An integral scale of the symptoms and signs was established.According to the Pfirrmann grading of the patient′s intervertebral disc degeneration ,the collected data were processed by SPSS 20.0.The characteristics of the symptoms and signs of the lumbar disc herniation and the characteristics of each imaging index were discussed.Results:1)The total scores of symptoms and signs in 50 patients ranged from 8 to 23 points,about 15.04 ±3.76 points on average.There was a correlation between the scores of each main symptom and the to-tal score,and the second main symptom was higher than that of the first main symptom.The significance of the representative was greater,and there was no obvious correlation between the secondary disease and the total score .2)In the 50 patients,the mean score of the partial yang syndrome was 14.79 ±3.64,and the mean score of the partial yin syndrome was 15.56 ±4.01.There was no significant correlation between the positive scores and the total scores of symptoms and signs .3)According to Pfirrmann grade grad-ing statistics of intervertebral disc degeneration ,grade I had 3 cases,accounting for 6%.Grade II had 1 case,accounting for 2%. Grade III had 29 cases,accounting for 58%.Grade IV had 15 cases,accounting for 30%.Grade V had 2 cases,accounting for 4%.4)Symptoms and signs were correlated with the degree of herniation ,the position of herniation ,and intervertebral disc degeneration on radiographic findings,and were not significantly correlated with lumbar curvature and endplate degeneration .Conclusion:1)Pa-tients with liver-kidney deficiency syndrome of LDH have typical symptoms and signs ,and the symptoms of lumbar pain and lower extremity radiating pain are the most typical in the main symptoms ,and the lower limb radiating pain is more representative.Lower extremity numbness and weakness in the legs and knees were used as a reference in diagnosing the syndrome ,but the diagnostic value of leg and knee fatigue was higher than that of lower limb numbness.2)There was no significant correlation between yin and yang classification and the total score of symptoms and signs in patients with liver-kidney deficiency syndrome LDH ,and the severi-ty of their clinical symptoms and signs was not significant.3) There is a certain correlation between the scores of symptoms and signs of patients with hepatic-renal deficiency syndrome lumbar disc herniation and the degree of degeneration of intervertebral discs on imaging findings.The disc degeneration is more severe ,the scores of clinical symptoms and physical signs are higher.

Objective To explore the influences of extreme climate variations on immunity functions of organism based on correspondence between nature and human theory.Methods The golden hamsters were randomly divided into ZC group,ZS group,ZJ group,CG group,CD group,GWGS group,GWGS group.Limatic simulation chambers was used to simulate extreme climates.Samples were collected after 24 hours and 72 hours respectively.MT、IL-1、IL-6、CD3+、CD4+、CD8+ of serum was detected.Results (1) Survival rate of golden hamster was 62.5％ in hot and humid conditions,the remaining groups was 100％.(2)24 hours after the extreme climate,compared with ZC group,the content of IL-1,IL-6,CD3+,CD4+ in ZS group were significantly different;IL-1,CD8+ was significantly different in ZJ group;IL-1,IL-6,CD8+ was significantly different in CG group;MT,IL-1,L-6,CD3+ was significantly different in CD group;IL-1 was significantly different in GWGS group;MT,IL-1,IL-6,CD3+,CD4+,CD8+ was significantly different in CWGS group.(3)72 hours after the extreme climate,compared with ZC group,CD8+ was significantly different in ZS group;IL-1,IL-6,CD3+ was significantly different in ZJ group;IL-1,CD8+ was significantly different in CG group;MT,IL-6,CD3+ was significantly different in CD group;MT,IL-1,IL-6,CD3+,CD4+,CD8+ was significantly different in CWGS group.Conclusion (1) Extreme climate can have adverse effects on the body,especially in high temperature and high humidity.(2)High humidity has a long-lasting effect on the immune system.(3)There are some differences and hysteresis quality in the regulation of melatonin and immune function in different extreme climates.

Objective To observe the VAS scores,postoperative recovery effects and prognosis of the elderly with osteoporsis vertebral compression fracture treated by percutaneous puncture bone cement vertebral plasty.Methods A retrospective analysis was made to the clinical data of 80 elderly with osteoporsis vertebral compression fracture hospitalized during the period from Jan.,2015 to Jan.,2017;the elderly were divided into 2 groups:observation group (treated by percutaneous puncture bone cement vertebral plasty) and control group (treated by traditional open surgery);the operation time length,VAS scores,ODI scores and LAS scores of the elderly in the 2 groups were statistical analyzed and compared.Results LAS scores of the elderly in both groups after treatment were obviously lower than those before treatment (P＜0.05) while their VAS scores and ODI scores after treatment were of no obvious difference from those before treatment (P＞ 0.05);before treatment,no difference of statistical significance in VAS scores,ODI scores and LAS scores was found between the 2 groups (P＞ 0.05);after treatment,the LAS scores in observation group was much lower than that in control group (P＜ 0.05) while there existed no statistical difference in VAS scores and ODI scores between the 2 groups after treatment (P＞0.05).Conclusions Percutaneous puncture bone cement vertebral plasty shares similar VAS scores with traditional open surgery in treating elderly osteoporsis vertebral compression fracture while it can improve the postoperative recovery effects and prognosis.

目的:评估骨碎补在促进软骨再生治疗中的价值及作用机制.方法:选取健康新西兰大耳白兔100只,采用随机数值表法随机分为5组,每组包含20只实验动物.A、B组:改建后进行肾上腺髓质素(adrenomedullin,ADM)移植;C组:自体骨髓充质干细胞(MSCs)复合,并进行改建ADM移植;D、E组:进行hIGF-1基因转染的MSCs复合,并改建ADM移植.B、C、E组实验动物结合喂养40％骨碎补汤,每只每日150ml,用药4周.A、D组不结合使用口服骨碎补汤.每组均在第4、8、12w时处死5只实验动物,切取关节软骨缺损部位并进行组织学观察,采用Masson三色染色法评估软骨细胞的形态变化,采用Wakitani组织学评分进行各组间形态学比较.结果:E组实验动物关节软骨的表面有比较完整的潮线,大部分比较光滑,变薄区可见零散的浅淡着色的纤维组织.在第4、8、12周,各组Wakitani组织学评分逐渐下降,但结合骨碎补的B、C、E三组下降更为显著(P＜0.05),说明骨碎补可显著改善软骨组织缺损.结论:采用中药骨碎补结合工程软骨可以显著提高家兔膝关节软骨缺损修复的质量,为临床使用骨碎补治疗软骨病变提供了重要的依据.

Objective To explore the influence of extreme climate variations on golden hamster's immunity functions based on correspondence between nature and human theory. Methods Manual simulation climate was adopted to simulate six types of climates. When corresponding intervention was finished,blood samples were collected after 24 hours and 72 hours respectively. MT、IgG and IgM of serum was detected. Results (1) During the experiment,death rate was 36% of GWGS group while that was 0 of other groups. (2) Spleen index has no significant change during 72 hours after the extreme climate change. (3)24 hours after the extreme climate change,thymus index of most samples from ZS group,ZJ group and GWGS group was significantly different from that of ZC group(P<0. 05). 72 hours later after the extreme climate change,the difference gets more obvious(P<0. 01). (4) MT、IgG and IgM level of serum was sig-nificantly increased of 72 hours later after the sudden temperature drop and continuous low temperature. (5)The change law of MT、IgG and IgM level was increased(24h) before decreasing(72h) in GWGS and CWGS groups, the results all showed the remarkable difference compared with the ZC group 72 hours later after the extreme climate change. Conclusions (1) Damp-heat influencesimmunity system was more sig-nificantly than single pathogenic factor. ( 2 ) Thymus index is more sensitive to the change of extreme climate. (3) MT、IgG and IgMof serum is induced different types of immune responses by low or high tem-peratures and the influence is hysteresis nature.

Objective:To illustrate the effect of sudden increase and drop in temperature on immunity in normal conditions,and to lay the foundation of a further study on effect of extreme climate change on human bodies.Methods:Manual simulation system was adopted to simulate sudden increase and drop in temperature.Blood tests were applied for measuring serum MT,IL-1,IL-6 and T-lymphocytes of golden hamsters after 24 hours and 72 hours of intervention respectively.Results:1)Compared with the normal cli-mate group,IL-1and IL-6 levels in serum increased significantly during the 24 hours after a sharp increase in temperature (P <0.01).MT,IL-1 and IL-6 levels in serum decreased,almost the same as the normal control group content after a 72 h sharp in-crease in temperature;IL-1 levels increased greatly (P <0.01)after a 24 h sudden drop in temperature.MT,IL-1 and IL-6 lev-els in serum were significantly increased after a 72 h sudden drop in temperature.All data above showed statistical significance.2) Compared with the normal climate group,CD3 + and CD4 + levels significantly increased(P <0.05)after 24 hours of sharp in-crease in temperature.CD8 + level decreased,but the difference was not statistically significant(P >0.05).After 72 h,CD3 +and CD4 + levels were normal again,but CD8 + level continued to reduce,and the difference was statistically significant.CD3 +level increased and there was a significant difference after 72 h.CD4 + Contents had no significant change.CD8 + level significant-ly decreased after 24 h of intervention(P <0.05)and recovered to normal level when 72 h.CD4 +/CD8 + level tended to increase in sudden change of temperature(P <0.05)with statistical significance.3)After 24 h increase of temperature,MT and IL-6, CD3 + and CD8 + had positive correlation,and correlation indexes were 0.779,0.836,0.828;after 72 h increase of temperature, MT and CD3 +,CD4 + and CD8 + had positive correlation,and correlation indexes were 0.923,092,0.883,0.792;after 24 h de-crease of temperature,MT and CD3 +,CD4 + and CD8 + had positive correlation,and correlation indexes were 0.86,0.818,&nbsp;0.807,0.783;after 72 h decrease of temperature,MT and IL-1,IL-6,CD3 +,CD4 + and CD8 + had positive correlation.Con-clusion:Serum MT,IL-1,IL-6 and CD4 +/CD8 + levels all increased significantly in sudden change of temperature,which may be one of the main mechanisms of effect of abrupt climate changes on immunity.MT and CD3 +,CD4 + and CD8 + had significantly positive correlation,which may because of more secretion of MT,increased content of MT in serum,and the multiplication rate of T-lymphocytes improved,thus the immunity was developed to cope with sudden change of temperature.

目的：探讨适合我国当今中医学教育现状的骨科教学模式；方法：依据教学实践，分析不同教学模式的优劣；结果：任一教学模式必须在合适的教学对象和内容下实施，才能取得预期效果；结论：骨伤科教学要根据具体教学内容和授课对象灵活选用不同的教学模式。

Objective:To observe the clinical efficacy of water extract of eupolyphaga in the treatment of acute closed soft tissue injury.Methods:40 cases of acute closed soft tissue injury were randomly divided into two groups.The test group was given water extract of eupolyphaga for oral administration combined with Voltaren ointment for external use while the control group was only given Voltaren ointment for external use with a continuous treatment for 7 d.The pain,tenderness,swelling and functional activities were compared.Results:The excellent rate of the test group was 55.00%,among which two cases were cured;9 cases showed excellent efficacy;8 cases were effective;1 case was ineffective;the excellent rate in the control group was 10.00%,among which one cases was cured;1 case was markedly effective;11 cases were effective;7 cases were ineffective.Conclusion:The water extract of eupolyphaga plays a significant role in the mitigation of the main clinical symptoms and signs of acute closed soft tissue injury and has fewer adverse reactions.

Objective To discussi indications of four kinds internal fixations,which used in the treatment of intertrochanteric fractures.Methods There were 182 cases who underwent the treatment of intertrochanteric fractures in our hospital from August 2000 to May 2011(male 99 cases,83 female cases;age from 65 to 93 years old,average 79 years old).According to the Evans typing,There were Ⅰ35 cases,Ⅱ40 cases,Ⅲ 66 cases,Ⅳ34 cases,Ⅴ7 cases.Ⅰ,Ⅱ were both the stable types,Ⅲ,Ⅳ were both unstable types.The follow-up included postoperative complications,hip score and X-ray of fracture healing.Results Sixty five patients were followed for an average period of 4.6 years.Complications are included 16 cases of hip varas and 5 cases of retreated nails,without fixation failure.Harris hip score were excellent in 54 cases,good in 9 cases and poor in 2 cases,with excellent rate of 97%.The average X-ray healing time was 4.5 months.Conclusion In order to reduce postoperative complications,it should be fully to grasp thecharacteristics of the internal fixation.Choice of internal fixation should be appropriate.Stable fractures of the preferred sliding compression screw and side of the plate,the complex and unstable fractures should be preferred intramedullary fixation.

Intertrochanteric fracture is a common clinical disease,for which there are many therapies,main therapies in-cludes dynamic hip screw(DHS) internal fixation,dynamic condylar screw(DCS) internal fixation,Gamma nail internal fixa-tion and proximal femoral nail(PFN) fixation.This paper reviewed the literature about clinical application methods,indica-tions and defects of the four major methods in order to provide some basis for the appropriate selection of therapy.

目的探讨应用人工股骨头置换术治疗高龄股骨颈骨折的疗效。方法回顾性分析2008年3月至2010年10月,本组应用双极人工股骨头置换治疗32例高龄股骨颈骨折患者的临床资料,骨折Garden分型:Ⅲ型20例,Ⅳ型12例。结果手术时间为25～60min,平均为35min,出血量50～500m,l平均220ml。随访12～24个月,平均随访16个月,术后1年Harris评分平均为95·1分,终末随访优良率为87·5%。无切口感染、骨折、神经血管损伤、髋关节脱位、假体松动等并发症。结论双极人工股骨头置换术是治疗高龄股骨颈骨折的良好方法之一。

目的:观察腰骶段SPR手术结合针刺疗法治疗小儿脑瘫的临床疗效.方法:将70例脑瘫患儿随机分为观察组和对照组,每组各35例.观察组采用手术结合针刺法治疗,对照组单纯采用手术治疗.针刺每日1次,30次为1个疗程,共3个疗程.观察两组患者疗效及运动功能的改善程度.结果:两组脑瘫患儿的运动功能均有改善,观察组总有效率明显高于对照组(P<0.05).两组运动功能障碍治疗后均有明显改善,但观察组惠儿与对照组患儿比较差异有统计学意义(P<0.01).结论:手术结合针刺疗法治疗痉挛型小儿脑瘫优于单纯手术疗法,为探讨中西医结合治疗小儿脑瘫提供新思路.

目的:对本院骨科中西医综合疗法对激素性股骨头坏死的病历进行回顾分析,以完成髓芯减压术配合中药治疗SANFH的疗效评估,并在此基础上总结治疗经验和规律,以指导进一步临床应用和研究.方法:采用病历回顾分析方法及随访研究.结果:综合组在治疗前后Harris评分变化、影像学疗效及总疗效方面均优于中药组与手术组,中药组和手术组总疗效相比无显著性差异(P>0.05),综合组疗效高于中药组和手术组,与二者相比有显著性差异(P<0.05).结论:髓芯减压术同时配合口服木豆叶与中医康复治疗的综合疗法,疗效确切,优于单纯手术及单纯中药治疗.

OBJECTIVE:To explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy.METHODS:From March 2004 to April 2008, 27 patients included 19 boys and 8 girls, aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator, choosed fasciculus of low-threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position, turning body, sitting position, crawling, kneeling and standing position, walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension, motor function (GMFM), functional independence (WeeFIM) were observed after treatment.RESULTS:All patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30 +/- 0.47 and 1.25 +/- 0.44 before and after treatment;GMFM score were respectively 107.82 +/- 55.17 and 131.28 +/- 46.45; WeeFIM score were respectively 57.61 +/- 25.51 and 87.91 +/- 22.39. There was significant improvement before and after treatment (P < 0.01).CONCLUSION:Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy was used to treat spastic cerebral paralysis of the upper limbs is safe and effective method, which can decrease muscular tension and improve motor function, which deserves more wide use.

激素性股骨头坏死属难治疾病,发病率和致残率高,严重影响患者的生活质量。但激素性股骨头坏死确切的发病机制尚未十分清楚,限制了预防和治疗工作的开展。手术是遏制激素性股骨头坏死进程和防止塌陷的基本方法,但有其自身的局限性。中医药治疗激素性股骨头坏死有着显著优势,疗效满意,但单纯中医治疗也存在不足。探讨如何将西医手术和中医药的治疗优势有机结合,寻求一种疗效确切,费用低廉,副作用少的综合疗法,对于提高治疗激素性股骨头缺血性坏死的疗效,减轻患者和社会经济负担具有重要意义。而要创立治疗激素性股骨头坏死的独特指导原则,关键在中西医治疗激素性股骨头坏死的结合点的确定。

颈椎椎间盘突出症是以颈肩痛、四肢乏力、行走不稳,或头痛及眩晕为一组症状的疾病,经皮激光椎间盘减压术（per-cutaneous laser disc decompression,PLDD）是椎间盘突出症的微创治疗方法,1986年美国的Choy及德国的Ascher首先将该方法应用到临床[1],现将2000年11月至2008年1月收治