目的 探讨三维计算机辅助导航技术在骶髂螺钉微创固定中的应用及技术要点.方法 回顾性分析2015年3月至2015年12月采用闭合复位、计算机辅助导航下微创行骶髂螺钉内固定手术,10例患者获得随访,其中男6例,女4例;年龄26~58岁,平均41岁;交通事故伤4例,重物压伤3例,高处坠落伤2例,楼道摔伤1例.均伴有其他脏器损伤或其他部位骨折.均采用闭合复位,计算机辅助三维导航下空心钉内固定.结果 10例患者皮肤切口长1~2 cm,术后骨盆X线片及三维CT示骨折均获良好复位,螺钉植入位置精确.术后切口均I期愈合,无感染及内固定失败发生,无神经、血管及其他脏器损伤等并发症发生.结论 三维导航系统用于骶髂螺钉固定,创伤小、术中失血少、并发症发生率低,手术更加微创精准.

丙型肝炎是一种由丙肝病毒引起的肝脏急慢性炎症,目前世界上约有2亿人感染丙型肝炎病毒(hepatitis C virus,HCV)~([1]),中国约有3700万～4 000万~([2]).感染者约80%发展成慢性肝炎,在慢性丙肝感染中,HCV不仅导致所感染的肝细胞凋亡,也会干扰肝脏免疫细胞的正常功能,从而免于被免疫系统所清除,同时会导致肝脏免疫病理变化,产生纤维化,最终导致肝癌~([3]).HCV感染后大约10%～15%的感染者在感染后能通过病毒特异性免疫应答清除病毒而旱自限性过程.

乙型肝炎(HB)是一种世界范围内流行的传染病.据估计,全球约20亿人曾经感染HB病毒(HBV),慢性感染者约有3.5～4亿人,每年有100万人死于HBV所致的肝硬化、肝衰竭及原发性肝癌~([1]).我国为HB高发国家,人群HBV感染率约为9.09%~([2]),HB已成为严重的社会问题.

Objective To explore the association between IL-28B genetic variation,susceptibility and spontaneous clear-ance of hepatitis C virus.Methods A total of 411 hepatitis C patients(255 male and 186 female) and 100 healthy con-trols were enrolled in the study.The rs12979860 SNP of IL-28B was identified from each cohort using pyrosequencing technology.HCV-RNA was tested in hepatitis C patients.The IL28B genetic variation was compared between hepatitis C patients and healthy controls,and chronically infected and spontaneously cleared HCV groups to assess the effect of SNP.Results The minor allele frequency(rs12979860) of Chinese population was 6%.There was no genotype and allele fre-quency(rs12979860) difference between hepatitis C patients and healthy controls(P = 0.066,P = 0.072).The level of HCV-RNA in genotype CC was significantly higher than genotype CT groups(P = 0.02).There was no significant differ-ence between genotype CC and CT among individuals who spontaneously clear HCV(P = 0.64).There was no significant difference in SNP genotype(rs12979860) between chronically infected groups and healthy controls.Conclusion The SNP genotype rs12979860 may not be the predisposing gene of hepatitis C and the CC genotype cannot predict the course of spontaneous clearance of hepatitis C.

目前,尽管90~95的骨折能够愈合,但骨不连仍是目前骨折治疗所面临的难题之一.引起股骨干骨折骨不连的诸多原因和机制非常复杂,而治疗股骨干骨折的各种固定方式又有较多选择,因此对此种情况的治疗方法存在颇多争议.

目的:探讨老年患者全髋关节置换术(THR)后深静脉血栓(DVT)的防治。方法:对45例THR术后患者联合应用药物和物理方法,防治DVT的发生。结果:45例中有44例没有发生DVT,有效率达97.7%。结论:应用药物和物理方法联合防治THR术后DVT的发生经济、安全,值得临床推广。

OBJECTIVE:To evaluate the clinical effect of external tissue expansion in the repair of massive skin and soft tissue defects.METHODS:From August 1998 to January 2004, 10 patients with massive skin and soft tissue defects ( the area ranging from 10 cm x 4 cm to 24 cm x 15 cm) , including 7 with wounds in the leg, 2 with wounds in knee region, and 1 with wounds in the forearm, were enrolled in the study. All patients were subjected to external tissue expansion together with external skeletal fixation for 2 -3 weeks, then the wounds were closed with suturing or supplemented with skin flaps.RESULTS:The defects were closed completely after external expansion in 4 cases, and in other 5 cases the wounds were significantly decreased in area, and the residual wounds were covered with free skin grafting. In I case the wound could only be reduced in size, and the residual wound was closed with a local flap. Follow-up from 1 to 12 months showed that the wounds were closed with normal cutaneous sensation and good appearance.CONCLUSION:External skin expansion is a simple, economical method for repair of massive skin soft-tissue defect, which can significantly be reduced or entirely closed.

目的 利用RNA干涉(RNAi)技术使特定的基因(Nogo)沉默,探索脊髓损伤的治疗方法.方法 设计有小发夹结构的两条DNA序列,PCR扩增带有U6启动子的小发夹,腺病毒包装重组体,转染少突胶质细胞,采用Western blot法分析Nogo-66的蛋白表达水平.结果 成功地构建了靶向Nogo基因RNAi的带有U6启动子的小发夹重组体,Nogo-66蛋白表达水平明显下降.结论 靶向RNAi小发夹重组体经腺病毒包装后,成功转染少突胶质细胞并能有效抑制Nogo-66基因的表达.

目的探讨胸腰椎肿瘤侧前方减压脊柱稳定性的重建方法。方法9例胸腰段肿瘤全部行左侧前方椎体次全切除、椎管减压钛网植骨融合TSRH短节段内固定。结果术后随访6~12个月(平均9个月),螺钉无松动,TSRH短棒无断裂,6个月内钛网内植骨全部融合,无假关节形成,瘫痪得到不同程度恢复,效果满意。结论TSRH加钛网植骨融合固定牢靠,内固定材料生物相容性好,无须外固定,植骨融合快,瘫痪恢复满意,特别适合于椎体肿瘤切除后脊柱重建,是治疗胸腰椎肿瘤的有效方法。

Objective To obtain NOGO gene RNA interference (RNAi) small hairpin human involving U6 promotor by PCR.Methods The specific primers were designed, up primers including human U6 promoter and down primers including NOGO reverse complement target sequence were synthesized. Small hairpin RNA (shRNA) including human U6 promoter was directly amplified by PCR. PCR products can be cloned with T-vector. Digestion production was analyzed by 1% agarose gel electrophoresis. The plasmid 430 bp gene fragment was verified as positive recombinant plasmid to be sequenced. Results NOGO gene RNAi shRNA including human U6 promotor was amplified successfully.Conclusions The shRNA can be amplified quickly, easily and cheaply by PCR.

Objective To analyze factors which could affect the long-term prognosis of stroke patients treated with a rehabilitation program. Methods A total of 104 patients with acute stroke were included in this study. All were treated with a Bobath rehabilitation program beginning in hospital as soon as the patient's condition had stabilized, and followed by a rehabilitation program in a community health center or at home after discharge from the hospital for 6 months. Fugl-Meyer Assessment and the Modified Barthel Index scores were assessed before and 6 months after rehabilitation treatment, and various related factors were recorded. The relationship between each patient's prognosis and the related factors was analyzed through multinomial logistic regression. Results Four factors: state on admission, cognition, depression, and familial support level were found to be significantly correlated with motor function and ADL scores after rehabilitation. Incontinence and age were significantly correlated only with the ADL score. Conclusion Certain factors predict the long-term prognosis of stroke patients receiving rehabilitation. Interventions aimed at improving the patients'cognition and depression as well as strengthening the patients' family support would benefit patients' long-term prognoses.

Objective:To study the clinical value of the three-stage rehabilitation programm in patients with stroke. Methods: 74 patients with stroke of middle cerebral artery territory were included in the study. All patients were divided into two groups randomly and followed up for 6 months. Patients in treatment group were treated with prescriptive training of three-stage rehabilitation ,while patients in control group were only received general training. Scales of Fugl-Meyer Motor Function Scale (FMA), NIH Stroke Scale (NIHSS) and Modified Barthel Index (MBI) were utilized to assess patients's function respectively ;and the complications of stroke were recorded before and at the end of each month during the followed-ups. Results: There were no statistical differences in scores of FMA,NIHSS and MBI between the two groups (P0.05) before the trainings. At the end of 6 months, the scores of treatment group were significantly improved than those in all control group (P0.05) the number of patients with stroke complications in treatment group were significantly less than that in control group (P0.05). Conclusion: Establishing standard three-stage rehabilitation programm for patients with stroke may make the rehabilitation treatment more efficient. It would combine the work of stroke unit, rehabilitation ward and community medical service center efficiently.

目的了解脑卒中患者的认知功能损伤情况以及比较LOTCA与MMSE量表评定的效能.方法采用MMSE、LOTCA量表评定93例脑卒中后患者认知功能.结果脑卒中后患者MMSE量表评定显示左、右侧脑损伤在地点定向、近事记忆力、语言理解、句子书写、图形描绘等分项中存在差异(P<0.01).LOTCA量表评定显示右侧大脑半球损伤组在定向力、知觉功能、模仿模拟能力等分项评分明显高于左侧大脑半球损伤组(P<0.01),左侧大脑半球损伤组在视觉空间觉、视运动组织及LOTCA量表评定等评分显著高于右侧大脑半球损伤组,左、右侧大脑半球损伤组在意念运动性失用、物体失认、注意力障碍等方面具有显著性差异(P<0.01).结论脑卒中患者中左、右侧大脑半球损伤后的各种认知功能障碍表现不一,LOTCA量表评定较MMSE量表评定更适合于脑行为功能研究.

目的评价脑脊液中ADA活性值测定在结核性脑膜炎早期诊断中的价值,探讨其合适的阳性分界值.方法本研究为回顾性研究,入选各种类型脑膜炎总计154例,依据最后诊断分结脑组、病毒性和化脓性脑膜炎三组.分析病人在治疗前所测定的脑脊液ADA活性值.结果结脑组ADA活性较其他两组均明显升高(P＜0.01),病毒性和化脓性脑膜炎两组之间差异不显著(P＞0.05),ROC曲线表明CSF中ADA活性测定有诊断意义(P＜0.05),将ADA阳性分界值分别定为7 u/L和10 u/L,其灵敏性和特异性有所变化.结论测定脑脊液中的ADA浓度有助于结脑病人的早期诊断,其阳性分界点定在7～10U/L较为合适.

Aim: To observe the curative effect of electrical stimulation of cerebellar fastigial nucleus (FN) and rehabilitation therapy in patients with acute cerebral infarction. Methods: Totally 139 patients with acute cerebral infarction of internal carotid artery were included in the study. All patients were assigned into three groups: treatment group (n = 49, treated with electrical stimulation of FN and rehabilitation), rehabilitation group (n = 46, treated with rehabilitation) and control group (n = 44, receiving drug treatment only). Other treatments were according to the routine of department of neurology. All the patients were evaluated with national institutes of health stroke scale (NIHSS), Fugl-Meyer Assessment (FMA) and modified Barthel index (MBI) before and 8 weeks after treatment. Results: There were no significant differences in the scores of NIHSS, FMA and MBI among the three groups before treatment (P > 0.05). After treatments, the scores of NIHSS in the treatment, rehabilitation and control groups were 3.53 ± 3.28, 4.67 ± 4.14 and 5.73 ± 4.54, respectively, and there were significant differences among the groups (F=4.323, P=0.016); while the scores of FMA and MBI in the treatment and rehabilitation groups were both better than those in the control group (P < 0.05). Conclusion: Combination of electrical stimulation of cerebellar FN and rehabilitation therapy can effectively ameliorate the functional prognosis of patients with acute cerebral infarction.

目的:观察巴氯酚（Baclofen）结合康复治疗对脑卒中痉挛性偏瘫患者关节活动度、运动功能和ADL等方面的影响。方法:对144例脑卒中痉挛性偏瘫患者,随机分为治疗组和对照组。治疗组84例,服用巴氯酚结合康复治疗;对照组60例,只接受康复治疗。在治疗前和治疗后12周分别进行Ashworth,FMA和MBI量表评定以观察疗效。结果:治疗后Ashworth评定治疗组显效率为67.86%（上肢）,63.60%（下肢）,有效率为86.90%（上肢）,89.29%（下肢）;对照组显效率为41.60%（上肢）,45.00%（下肢）,有效率为76.67%（上肢）,78.33%（下肢）。两组患者关节活动度、运动功能和生活能力均有明显改善（P＜0.01）,但治疗组明显优于对照组（P＜0.05）。结论:巴氯酚结合康复治疗能明显改善脑卒中偏瘫肢体的痉挛状态,提高患者的关节活动度、运动功能和生活能力。

随着脑卒中治疗措施的完善和进步,脑卒中死亡率有明显的下降,如何通过康复手段改善患者功能状态,提高日常生活能力(ADL)日益显得重要,与此相关的大量试验和临床研究也得以开展.随着康复技术的发展和完善,结合先进康复器械的综合治疗措施已经开始在临床应用,本文将对卒中后的康复治疗做一综述.

Aim: To study the influence of different intensities of rehabilitation therapy on the prognosis in patients with stroke during the acute period. Methods: Totally 74 patients with acute stroke were randomly assigned into treatment group (receiving intense rehabilitation therapy for six months) and control group (receiving common rehabilitation therapy for six months). All the patients were evaluated with Fugl-Meyer assessment (FMA), national institute of health stroke scale (NIHSS) and modified Barthel index (MBI) before and six months after rehabilitation training, and scales of western aphasia battery (WAB) were also assessed in patients with aphasia, and the functional recovery between the two groups were compared. Results: There were no significant differences in the scores of FMA (29.35 ± 22.67 vs 30.26 ± 19.19), NIHSS (8.94 ± 3.64 vs 8.75 ± 4.26), MBI (23.82 ± 13.84 vs 25.47 ± 15.57) and WAB (60.23 ± 18.50 vs 57.33 ± 16.79) before treatment between the two groups ( P > 0.05). There were obvious improvements in the functional recovery six months after treatment, and the scores of FMA (85.84 ± 19.68 vs 71.59 ± 25.21), NIHSS (2.01 ± 0.034) vs (3.53 ± 0.54) and MBI (88.24 ± 17.95) vs 74.42 ± 24.70) were significantly different between the two groups(P < 0.05), and the difference of the scores on WAB (87.74 ± 13.9) vs 71.24 ± 15.63) were extremely significant (P < 0.01). Conclusion: Proper intense rehabilitation may enhance the prognosis of function in patients with stroke, especially in those with aphasia.

Objective To study the efficacy and mechanism of electro -acupunc- ture treatment in patients with acute stroke. Methods A prospective single -blind randomly controlled study was used in patients with stroke. 64 cases was randomly di- vided into treatment group and control group. Electro -acupuncture therapy was used in treatment group and placebo needle technique was used in control group. Scores of NIHSS, FMA and MBI were recorded before treatment, 10 and 20 days after treat- ment. Brain SPECT -rCBF image was performed in 33 cases before treatment, and 20 days after treatment. The value of rCBF in each brain region were analyzed. Results The scores of NIHSS, FMA and MBI in treatment group was significantly higher than controled group and value of rCBF in bilateral motor cortexes in trealmard group was signiflicantly increased compared with contreled group. Conclusion Placebo needle technique could be efficiently applied in the study of electro -acupuncture treatment in patients with stroke. Combine electro -acupuncture with modem neuro -rdhabili- tation theory would effectively improve motor function in patients with stroke. The re- sults of brain SPECT -rCBF image showed that the mechanism of electro -acupunc- ture treatment may related to neuronal plasticity and brain function reorganization.

患者,男,3岁,因"突发头痛,继之神志不清1小时"入院.否认高血压及糖尿病病史.入院时血压180/110mmHg,呈浅昏迷状态,双侧瞳孔2mm,等大等圆,对光反射迟钝,颈部抵抗感,左侧肢体肌力0级,右侧肢体有自主运动,左侧Babinski征(+).头部CT示:脑桥背侧出血并破入第四脑室.