目的 观察肿意膏治疗膝关节急性痛风性关节炎(GA)患者的临床疗效.方法 将160例患者随机分为观察组与对照组,每组各80例.对照组采用宣教、生活方式干预、依托考昔及非布司他治疗.观察组在对照组基础上于膝关节痛风性关节炎处贴敷肿意膏片治疗.比较两组治疗的有效率、治疗前后血浆白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)炎症指标及骨破坏因子人抗酒石酸酸性磷酸酶5b(TRACP-5b)、β-骨胶原交联(β-CTX)的水平,治疗前后两组患者的健康评价量表(SF-36)评分.结果 观察组治疗后总有效率为92.50％,高于对照组的77.50％(P＜0.05);治疗后两组IL-1、TNF-α、TRACP-5b均下降(P＜0.05),β-CTX无明显变化(P＞0.05);且观察组IL-1、TNF-α及TRACP-5b均低于对照组(P＜0.05);两组治疗后SF-36评分均高于治疗前.结论 肿意膏对膝关节GA患者的临床疗效较好,显著降低患者的炎症因子及骨破坏因子水平,提高患者的生活质量.

目的 观察理筋手法联合肿意膏外敷治疗肱骨外上髁炎急性期的临床效果并探讨其作用机制.方法 患者66例随机分为两组,对照组采取口服镇痛药治疗,治疗组采取中医理筋手法联合肿意膏外敷治疗,均治疗1周.记录并比较两组患者临床疗效、治疗前后VAS评分、肘关节活动度、握力及压痛评分.结果 治疗后两组VAS评分较治疗前均下降(P＜0.05),且治疗组低于对照组(P＜0.05).治疗后两组患肢压痛、握力、前臂旋前角度及肘关节屈曲角度情况优于治疗前(P＜0.05),且治疗组优于对照组(P＜0.05).治疗组总有效率明显高于对照组(P＜0.05).结论 理筋手法联合肿意膏外敷治疗肱骨外上髁炎急性期能有效减轻患者疼痛、改善关节活动,临床疗效显著.

目的 观察股骨大粗隆围刺配合针刺血海穴缓解老年股骨粗隆间骨折术后疼痛的临床效果并探讨其作用机制.方法 69例患者随机分为治疗组与对照组,对照组采取口服塞来昔布,治疗组采取口服塞来昔布加股骨大粗隆围刺配合针刺血海穴治疗,7d为1个疗程.结果 治疗后第3日,两组VAS评分均低于治疗前(均P＜0.05),且治疗3d后比较,治疗组VAS评分低于对照组(P＜0.05);治疗7d后,两组治疗后的VAS评分与治疗前比较,均明显降低(均P＜0.05),且治疗组降低更显著(P＜0.05).术后第1日,两组患者局部创伤反应均较重,肿胀明显,渗液较多,C反应蛋白(CRP)较高,高出正常值近10倍,通过采取治疗措施后,局部肿胀、渗液等创伤反应逐渐减轻,CRP迅速下降,治疗后第5日,局部肿胀明显减轻,渗液明显减少,与治疗前比较,两组患者CRP均低于治疗前(均P＜0.05),且治疗组降低更明显(P＜0.05).治疗后第10日,局部肿胀基本消退,已无渗液,治疗组患者的C反应蛋白基本恢复正常,对照组也大幅度下降,与治疗前比较,两组患者的CRP均低于治疗前(均P＜ 0.05),且治疗组CRP低于对照组(P＜0.05).两组患者术前伤侧髋关节因疼痛、畸形、骨折不稳定等功能极差,不能活动,经手术复位固定骨折及术后综合措施处理后,伤侧髋关节逐渐恢复,术后14d时,两组患者均可在床上行术肢髋关节主动活动功能锻炼,部分患者可以扶双拐术肢非负重下床活动.两组患者伤肢髋关节Harris评分与术前比较,均显著升高(均P＜0.05),且治疗组患者伤肢髋关节Harris评分高于对照组(P＜0.05).治疗组总有效率为83.33％,高于对照组的72.73％ (P＜ 0.05).结论 股骨大粗隆围刺配合针刺血海穴能明显缓解老年股骨粗隆间骨折术后患者疼痛.

翁双燕教授治疗妇科盆腔痛经验丰富,认为盆腔痛的病因为"瘀、痰湿",主张治疗时应辨病求因,针对病因治疗是第一要素,注重气血运行,痛证和气与血的关系密不可分;根据发病缓急,审时度势,急性期止痛治标为主,缓解期辨证求本,综合治疗为主;根据地区特点、气候特点以及患者年龄特点因时因地因人施治是治疗的关键.

目的:探讨血热型功能失调性子宫出血的中医处方用药规律.方法:按照二次文献研究方法,检索近30年治疗功能失调性子宫出血的相关文献,通过纳入排除标准,选择到目标文献109篇,再用描述性统计学方法进行分析整理.结果:最常用的方剂为清热固经方、两地汤、丹栀逍遥散、保阴煎和二至丸;常用于作为试验研究对比的中成药为宫血宁和固经丸;使用频次在30次以上的药物依次为:生地71次,白芍52次,地骨皮44次,阿胶40次,牡丹皮39次,黄芩38次,甘草、地榆各37次,墨旱莲34次,栀子32次.结论:用于治疗血热型功血的方剂中治疗阴虚血热证方剂使用频率更高,方剂功效以滋阴清热,凉血止血为主;中药中以清热凉血滋阴药为君药,兼顾主要病因;凉血止血、收敛止血、化瘀止血、补肾滋阴药物居于臣药位置,兼顾主要病因和次要病因.

国医大师段亚亭教授从脾论治女性黄褐斑,认为脾失运化是黄褐斑的根本病因,痰浊、瘀血是其病理产物.临证以健脾益气为主,或兼补肾、疏肝,并除湿化痰、活血祛瘀,补泻并举,标本同治,收效甚佳.

This study aims to discuss analgesia of intrathecal injection of tanshinone IIA to rats with neuropathic pain and changes of calcitonin gene-related peptide (CGRP) gene expression levels. Thirty-six healthy male Sprague Dawley rats were selected and divided into the normal group (N), blank control group (B), and tanshinone IIA (IIA) by using a random number table group. Each group had 12 rats. The N group received no treatment. The B group was administered with intrathecal injection of normal saline, and the IIA group was given intrathecal injection of tanshinone IIA. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of survival rats in different groups were tested. The cornu dorsal medullae spinalis of the L5 section of the rats that were killed were selected to test CGRP gene expression levels by reverse transcription polymerase chain reaction, CGRP positive cell rates of CGRP in tissues by immunohistochemical method, and CGRP protein expression levels in tissues by Western blot. MWT and TWL of the IIA and B groups after 1 and 2 weeks of treatment are significantly lower than those of group N (P < 0.05); however, those of the IIA group are higher than that of group B (P < 0.05). No significant differences are observed at any two moments in the N group (P > 0.05). However, significant differences are observed in the IIA group and B group at any two moments (P < 0.05). CGRP expression levels, positive cell rate, and protein relative expression of the IIA group and B group after 1 and 2 weeks of treatment are higher than those of the N group (P < 0.05). However, CGRP expression levels, positive cell rate, and protein relative expression of the IIA group are significantly lower than those of group B (P < 0.05). Intrathecal injection of tanshinone IIA has outstanding analgesia to rats with neuropathic pain. This condition is speculated to be related with inhibition of CGRP expression levels.

Objective To discuss the feasibility and clinical outcomes of mini-open reduction through lateral deltoid muscle and locking plate fixation in treatment of proximal humeral fractures.Methods A retrospective study was carried out on 39 patients with proximal humeral fractures treated with mini-open reduction through lateral deltoid muscle and locking plate fixation from September 2012 to September 2015.There were 7 males and 32 females,with a mean age of 66.8 years (range,33-86 years).According to the Neer's classification system,there were 26 patients with two-part fracture and 13 with three-part fracture.visual analogue scale (VAS),Constant-Murley shoulder score,time of bone healing and complications were evaluated for all patients.Results All patients were followed up for 12-48 months (mean,21.3 months).All fractures were proved to be bone healing with duration of (12.0 ± 2.7) weeks.The VAS was improved from preoperative (5.7 ± 1.0) points to (0.9 ± 0.6) points at the final follow-up (P ＜ 0.05).The Constant-Murley shoulder score was increased from preoperative (42.3 ±5.1) points to (89.2± 2.5)points at the final follow-up (P ＜ 0.05).Ranges of shoulder motion were improved with satisfactions.There were no complications like axillary nerve injury,loss of reduction,nonunion or humeral head necrosis.Conclusion For proximal humeral fractures,the miniopen reduction through lateral deltoid muscle and locking plate fixation has advantages of minimal invasion,excellent shoulder function,high rate of bone healing and low incidence of complications.

Objective:To investigate the feasibility and clinical efficacy of MIPPO technique combined with PILOS plate in the treatment of proximal humeral fractures.Methods:a retrospective analysis of 47 elderly patients who had two parts fractures of humerus surgical neck in our hospital from March 2012 to April 2015 with com plete follow-up data.22 cases were treated with MIPPO technique combined with PILOS plate.The clinical and radiographic evaluation was performed at 1st,2nd,3rd,6th,12th month after operation.The clinical evaluation was performed by the constant score of shoulder joint and the standard position of the humerus image was used to e valuate the fracture healing.25 cases of the same type of fracture were treated with emergency manual reduction and splint fixation.Results:all 47 patients were followed up within 1 year after treatment.Constant scores of the operation group were higher than the conservative treatment group at 1 st,2nd,3rd,6th,12th month after treatment,and the difference was statistically significant.The conservative treatment group had a constant score higher than 70 in 1 year after treatment,showing that the effect was still satisfying.There were no complications of axil lary nerve injury,vascular injury,loss of reduction,and nonunion in the operation group.Conclusion:MIPPO technique combined with PILOS plate,compared with the emergency manual reduction and splint fixation,in two parts fracture of humerus surgical neck of the elderly has the advantages of better and faster recovery at shoulder joint function,but the latter still has satisfactory curative effect.

重庆市名中医夏敏主任治疗妇科疾病疗效突出,尤其在治疗多囊卵巢综合征方面疗效显著,其经验丰富独特.她认为该病的发病原因主要有先天肾气不足,后天饮食不节、劳倦过度、情志过激等;脾虚运化代谢障碍、肝失疏泄、肾失封藏功能失常,是多囊卵巢综合征的病机.而脾虚是本病发生的根本,脾虚运化水谷功能减退,水谷精微转化障碍,以致气血生化乏源不能充养肾气、荣养胞宫;脾虚运化水湿失调,导致痰湿内生,阻闭经络,遮隔胞宫以致冲任失调、难以受孕是发病的关键.治疗上重视补充先天肾气不足,温肾填精,健运后天之脾气,健脾除湿,调理肝气之疏泄,疏肝理气;同时主张按年龄阶段分期治疗,青春期、育龄期治疗方案各不同,青春期以补肾为主,健脾为辅,育龄期以补肾为基础,健脾或疏肝为主;按有无生育要求论治,各有侧重,青春期或者无生育要求者调经促排卵为主,有生育要求者调经促孕并举.认为辨证与辨病相结合,分型论治,病证结合的诊疗模式更有助于提高临床疗效.

重庆市名中医夏敏主任治疗子宫内膜息肉有较好的疗效.她认为发生机制是肾、肝、脾功能失常,气血的运行失调,痰瘀互结于胞宫,脾虚失运化是疾病的本质,可伴有肾阳不足、肝气郁滞.治疗上重视健运脾气,除湿化痰,消癥散结,配合补肾、疏肝治疗;主张辨证与辨病相结合,分型治疗:脾虚者以健脾除痰湿为重点;肾虚者温肾化气为主;肝郁者以疏肝行气,活血化瘀为侧重点;有癥积者破血逐瘀,消癥散结;无明显癥块者给以化瘀敛膜药物.分阶段治疗:年轻有生育者使用手术配合中药两步治疗法,年龄大或伴无生育要求者可采用期待治疗;重视诊明病因,给予中西药结合治疗;根据各地气候及饮食居所特色,因地制宜更能提高临床疗效.

目的 分析副舟骨源性平足症发病特点.方法 回顾性分析2006～2014年副舟骨源性平足症患者的临床资料,分析副舟骨源性平足症的发病特点.结果 66例82足副舟骨源性平足患者,男24例,女42例,年龄15～90岁,平均(37.15±16.76)岁;单侧50例,双侧16例,其中64例为Ⅱ型副舟骨,2例为Ⅰ型副舟骨,由于副舟骨存在,胫后肌腱解剖异常而功能受损.根据平足症分期,Ⅰ期17例,Ⅱ期26例,Ⅲ期15例,Ⅳ期8例,柔韧性平足47例,僵硬性平足19例.结论 副舟骨源性平足症临床较为常见,为胫后肌腱功能障碍性平足症,各个年龄段均可能出现,其中女性、Ⅱ型副舟骨发病率高.副舟骨异常存在导致胫后功能失调为副舟骨源性平足原因.

>1病历资料患者男,59岁。因下楼梯时扭伤左足踝部伴肿胀3 h就诊于重庆市中医院门诊,受伤时踝关节极度内翻内旋。门诊体检:左踝部青紫肿胀,尤以外踝处为甚,左足外侧于跟骰关节处有一约3 cm x2 cm血肿,局部皮温高,触痛,踝关节内翻时疼痛加重,足背动脉搏动好,踝关节及足部感觉正常,足趾末端血运

目的 调查研究重庆地区副舟骨发生率和副舟骨源性疼痛与平足症患病率及多因素相关分析.方法 研究设计为现况研究,对重庆市西南医院和重庆市中医院体检患者调查及其足踝X线片进行分析,内容包括研究对象性别、年龄、地区、教育水平、劳动性质.采用单因素Logistic回归和多因素Logistic回归模型筛选副舟骨发生率高危地区和人群及副舟骨源性疼痛与平足症患病率的高危因素.结果 1447例纳入研究分析.其中副舟骨202例,总发生率为13.96％,其中Ⅰ型副舟骨19例(1.31％),Ⅱ型副舟骨157例00.85％),Ⅲ型副舟骨26例(1.80％).女性副舟骨发生率(17.26％)高于男性(10.86％),(x2=12.336,P＜0.01).副舟骨源性疼痛48例,患病率3.32％,副舟骨源性平足症14例,患病率为0.97％,均为Ⅱ型副舟骨.副舟骨源性疼痛患病率与年龄、地区、教育水平无关,女性及体力劳动为副舟骨源性疼痛患病率的高危因素.结论 重庆地区副舟骨发生率和副舟骨源性疼痛与平足症患病率较高,有必要在医护人员及广大群众加强该病的诊治宣教.

Objective To explore the therapeutic efficacy of percutaneous compression plate internal fixation in the treatment for elderly patients with interchanteric fractures. Methods All 17 patients with interchanteric fractures from March 2012 to January 2013 were treated with percutaneous compression plate internal fixation( Fracture classification: type A1. 2 with 3cases,A1. 3 with 4 cases,A2. 1 with 6 cases,A2. 2 with 3 cases,A2. 3 with 1 case). After operation,the patients did functional exercises at the early stage. Then the efficacy were evaluated and analyzed. Results Operation time was 30 ~ 80 min,with average time 50 min,blood loss was( 40 ~ 100) mL,with average volume 60 mL,time of X-ray exposure was 12 ~ 22 s,with average time 20 s. All 17 patients were followed up for 3 ~ 18 months. Postoperative function were evaluated according to Harris Hip Score,15 cases were excellent,and 2 cases were good,the excellent and good rate was 100%. Conclusion Percutaneous compression plate internal fixation is suitable for the elderly patients of interchanteric fractures,with shorter operation time,less blood loss,reliable fixation and less complications.

目的探讨封闭式负压引流对闭合性跟骨骨折切开复位切口愈合影响。方法该院2007年12月—2013年3月收治48例56侧跟骨骨折,随机分成两组,均行跟骨外侧L形切开复位内固定,36足术后行常规乳胶片引流,20足术后行封闭式负压引流,对两组患者切口干燥时间、引流量、切口愈合时间等进行统计学对比分析。结果乳胶片引流组切口干燥时间平均为12.08d,平均切口引流量223mL,愈合时间平均为22.33d,有5例切口皮肤裂开,其中3例感染;负压引流组切口干燥时间平均为3.55d,平均切口引流量367mL,愈合时间平均为14.65d,有2例切口皮肤裂开,无感染病例。结论负压引流可明显降低跟骨骨折术后手术切口并发症的发生。