不同手术方法治疗腰椎滑脱合并腰椎管狭窄的临床疗效对比

目的比较分析采用两种不同手术方式对合并腰椎管狭窄的腰椎滑脱疾病患者实施治疗的临床效果。方法抽取过去一段时间内江西省信丰县人民医院收治的88例合并腰椎管狭窄的腰椎滑脱疾病患者,采用随机分组方式将其分为对照组和治疗组,平均每组44例。对照组采用颈后路之间融合术进行治疗;治疗组采用改良的颈椎间孔椎间融合术进行治疗。结果治疗组患者在手术治疗前后VAS评分的改善幅度大于对照组;腰椎滑脱合并腰椎管狭窄疾病手术治疗及格率达到90.9%,高于对照组的70.5%;围术期仅有1例出现不良反应,少于对照组的8例。结论合并腰椎管狭窄的腰椎滑脱疾病患者采用改良的颈椎间孔椎间融合术进行治疗,可以有效控制疼痛,减少不良反应,缩短治疗时间。     

脂肪颗粒在颈动脉中的运动及其对血液动力学的影响

很多研究表明, 动脉粥样硬化通常发生在具有复杂血液动力学的区域, 比如分叉动脉和弯曲动脉. 这些地方常伴随有低壁面剪切力或震荡壁面剪切力, 这是动脉粥样硬化形成的一大诱因. 使用计算流体力学软件对2D颈动脉分叉血管进行了模拟, 研究了脂肪颗粒在颈动脉中的运动及其对血液动力学的影响. 研究表明: 1)血管狭窄对于脂肪颗粒的运动有重要影响, 同时也影响栓塞的形成; 2)脂肪颗粒可能会黏附在血管壁面, 但由于血流的冲击作用, 脂肪颗粒会随后在壁面略微铺展; 3)颈动脉狭窄区域后方是下一个血栓的可能生长位点; 4)当栓塞形成时, 速度和壁面剪切力分布将变得复杂多变, 这对于血管是有害的.     

The clinical usefulness of preoperative dynamic MRI to select decompression levels for cervical spondylotic myelopathy

The study subjects included 54 patients with cervical spondylotic myelopathy who underwent a selective laminoplasty. The patients were divided into three groups according to the number of decompressed levels: two levels, three levels and four or five levels. The number of cord compressions at every intervertebral level was determined in the flexion, neutral, and extension position using a dynamic magnetic resonance imaging (MRI) scan in consideration of both static and dynamic compressions. For each group, the clinical outcomes were evaluated. Moreover, the patients were divided into two groups according to their age. Then, the appearance ratios of cord compression between the neutral and extension position were compared at each intervertebral level. The clinical outcomes were satisfactory. There were no statistical differences among the three groups, except for the age and operation time. The position of the neck influenced the number of cord compressions. The appearance ratios of cord compression, which were especially prominent at C2/3, C3/4 and C4/5, showed high scores in the aged. The preoperative dynamic MRI scan was clinically useful. In the aged, attention should be given to C2/3, C3/4 and C4/5.     

Calcification of aortic human valves studied in situ by Raman microimaging: following mineralization from small grains to big deposits

A Raman microimaging‐based approach has been used in the current study to evaluate formation and progression of calcification in situ in human stenotic aortic valves obtained during surgical valve replacement. The capability of the method to visualize distribution of the calcified deposits resulted in structural characterization of deposits in the various phases of development. A high spatial resolution of the method along with the confocal depth profiling enabled to identify extremely small salt inclusions (of ca. 0.5 µm in diameter), formed probably at the very early stage of calcification. Structurally, these inclusions are built from an octacalcium phosphate‐like compound that during grains' growth transforms into tricalcium phosphate, mixed with the salt containing the acidic phosphate groups (HPO₄²⁻) and, finally, into stable B‐type hydroxyapatite that is the only salt present in large‐area calcium salt deposits. Copyright © 2013 John Wiley & Sons, Ltd.     

Mass transfer to blood flowing through arterial stenosis

The present investigation deals with a mathematical model representing the mass transfer to blood streaming through the arteries under stenotic condition. The mass transport refers to the movement of atherogenic molecules, that is, blood-borne components, such as oxygen and low-density lipoproteins from flowing blood into the arterial walls or vice versa. The blood flowing through the artery is treated to be Newtonian and the arterial wall is considered to be rigid having differently shaped stenoses in its lumen arising from various types of abnormal growth or plaque formation. The nonlinear unsteady pulsatile flow phenomenon unaffected by concentration-field of the macromolecules is governed by the Navier–Stokes equations together with the equation of continuity while that of mass transfer is controlled by the convection-diffusion equation. The governing equations of motion accompanied by appropriate choice of the boundary conditions are solved numerically by MAC(Marker and Cell) method and checked numerical stability with desired degree of accuracy. The quantitative analysis carried out finally includes the respective profiles of the flow-field and concentration along with their distributions over the entire arterial segment as well. The key factors like the wall shear stress and Sherwood number are also examined for further qualitative insight into the flow and mass transport phenomena through arterial stenosis. The present results show quite consistency with several existing results in the literature which substantiate sufficiently to validate the applicability of the model under consideration.      

计及血浆层的局部狭窄血管内血液脉动流分析

本文研究了血浆层的存在对局部狭窄血管内脉动流动特性的影响。分析表明,在狭窄区域内,血浆层的存在明显地改变了血液流动的速度分布、纵向阻抗和压力梯度等特性,但几乎不改变纵向阻抗和压力梯度的幅角;而且这种影响与Womersley数、狭窄程度等因素有密切关系。分析血浆层影响下动脉狭窄流的特性,对于认识动脉粥样硬化的病理特性有重要意义。     

超声心动图在慢性风湿性心脏病诊断中的效果及符合率观察

为探讨经胸超声心动图(TTE)诊断慢性风湿性心脏病(RHD)的效果,本文选择了112例慢性RHD患者进行TTE检查,观察了TTE诊断慢性RHD瓣叶类型、狭窄、关闭不全、左房血栓的符合率。结果显示TTE诊断RHD瓣膜类型、瓣膜狭窄、关闭不全和左房血栓与介入/术中所见/病理结果一致性较高。本文证实TTE诊断慢性RHD瓣叶病变类型、瓣膜狭窄和关闭不全、左房血栓均具有较高检出率和诊断准确率。     

Bilateral Vocal Fold Posterior Glottic/Subglottic Stenotic Web Resected with Contact Tip Nd-YAG Laser

The standard treatment for respiratory failure remains endotracheal intubation, with periods of 22 or more days being commonplace. Posterior glottic stenotic web formation, from scarring in the posterior interarytenoid area, may occur after endotracheal intubation, thermal, corrosive, or direct surgical injury. A commonly used classification system for posterior glottic stenosis divides the occurrence into four types. Type I involves an interarytenoid scar band between the vocal folds that is anterior and separate from the posterior interarytenoid mucosa. Type II stenosis involves scarring of the mucosa or musculature of the posterior interarytenoid area. Types III and IV involve unilateral and bilateral cricoarytenoid joint fixation, respectively. Strobovideolaryngoscopy (SVL), rigid and flexible fiberoptic bronchoscopy, electromyography (EMG), radiologic imaging of the neck, larynx, and trachea as well as pulmonary function tests, including flow volume loops, provide important objective measurements of upper airway obstruction. A representative case of a professional voice user who suffered a Type II posterior glottic stenosis is presented. The treatment utilized a specific contact-tip neodymium-yttrium aluminum garnet (Nd-YAG) laser delivery system to achieve precise cutting, vaporization, and coagulation simultaneously, returning tactile touch technique to the airway/voice surgeon. Completely successful restoration of voice and airway have been maintained for 2 1/2 years postoperatively.