Objective To investigate the effectiveness of posterior non-decompression surgery in the treatment of thoracolumbar fractures without neurological symptoms by comparing with the conventional posterior decompression surgery. Methods Between October 2008 and October 2015, a total of 97 patients with thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms were divided into the decompression surgery group (51 cases) and the non-decompression surgery group (46 cases). There was no significant difference in gender, age, cause of injury, injury segment, the thoracolumbar injury severity score (TLICS), combined injury, disease duration, and preoperative relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score between 2 groups (P>0.05). The operation time, intraoperative blood loss volume, postoperative drainage, bed rest time, hospitalization time, and relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, and VAS score, ODI, JOA score at preoperative and postoperative 3 days and 1 year were recorded and compared. Results The operation time, intraoperative blood loss volume, and postoperative drainage in non-decompression surgery group were significantly less than those in decompression surgery group (P<0.05). There was no significant difference in the postoperative bed rest time and hospitalization time between 2 groups (P>0.05). In decompression surgery group, 4 cases had cerebrospinal fluid leakage and healed after conservative treatment. All incisions healed by first intention, and no nerve injury or infection of incision occurred. All patients were followed up 10-18 months (mean, 11.7 months). The recovery of vertebral body height was satisfactory in 2 groups, without secondary kyphosis and secondary nerve symptoms. The imaging indexes and effectiveness scores of 2 groups at 3 days and 1 year after operation were significantly improved when compared with preoperative ones (P<0.05). The intraspinal occupying percentage, VAS score, and ODI at 1 year after operation were significantly lower than those at 3 days after operation in 2 groups (P<0.05), and JOA score at 1 year after operation was significantly higher than that at 3 days after operation (P<0.05). Relative anterior vertebral height at 1 year after operation was significantly higher than that at 3 days after operation in non-decompression surgery group (P<0.05); and there was no significant difference in decompression surgery group (P>0.05). At 3 days, the intraspinal occupying percentage and JOA score in non-decompression surgery group were higher than those in decompression surgery group (P<0.05), and VAS score and ODI at 3 days in non-decompression surgery group were lower than those in decompression surgery group (P<0.05). No significant difference was found in the other indexes between 2 groups at 3 days and 1 year after operation (P>0.05). Conclusion Compared with the posterior decompression surgery, posterior non-decompression surgery has the advantages of less bleeding, less trauma, less postoperative pain, and so on. It is an ideal choice for the treatment of thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms under the condition of strict indication of operation.
【摘要】 目的 探討血漿胰蛋白酶原激活肽(trypsinogen activation peptide,TAP)水平與重癥急性胰腺炎(severe acute pancreatitis,SAP)胰腺壞死的關系。方法 2008年6月1日—2008年12月31日,采用ELISA法測定本院的35例SAP患者血漿TAP水平,并與胰腺增強CT掃描結果作對比,分析血漿TAP水平與胰腺壞死的關系,以及SAP無胰腺壞死組與SAP胰腺壞死組血漿TAP水平的差異。結果 入院時血漿TAP水平預測胰腺壞死的最佳截值點是10.43 nmol/mL,其敏感性、特異性、陽性預測值、陰性預測值分別為75%、73.9%、60%、15%,陽性比為2.87,陰性比為0.338。入院第1天血漿TAP水平預測胰腺壞死的最佳截值點是6.91 μmol/L,其敏感性、特異性、陽性預測值、陰性預測值分別為90.9%、65.2%、55.6%、6.3%,陽性似然比為2.61,陰性似然比為0.001。SAP胰腺壞死組入院時、入院第一天血漿TAP水平高于SAP無胰腺壞死組(Plt;0.05)。結論 血漿TAP水平變化與SAP病情變化密切相關,病程早期檢測血漿TAP水平有助于SAP患者胰腺壞死的預測
【摘要】 目的 探討六味地黃丸對糖尿病合并高血壓病所致慢性腎臟疾病（chronic kidney disease，CKD）患者腎損害及胰島素抵抗的影響。 方法 收集2008年7月1日-2010年7月1日在成都市第五人民醫院住院部及門診就診的120例糖尿病合并高血壓病患者相關資料，隨機分為對照組和治療組各60例，對照組給予西醫治療，治療組在西醫治療的基礎上加用六味地黃丸，12周為1個療程。觀察治療前后尿白蛋白∕尿肌酐（ACR），內生肌酐清除率（Ccr）及胰島素抵抗指數（HOMA-IR）、C反應蛋白（CRP）、血脂等指標的變化。 結果 治療后治療組與對照組比較，ACR（P=0.012）、血清CRP（P=0.000）和低密度脂蛋白（P=0.014）差異有統計學意義。HOMA-IR治療前后結果差異有統計學意義（Plt;0.05），但與對照組比較差異無統計學意義（Pgt;0.05）。 結論 六味地黃丸可改善腎損害實驗室指標，改善胰島素抵抗，減輕體內炎性反應，改善脂代謝異常。【Abstract】 Objective To investigate the efficacy of Liuwei Dihuang pill on patients with chronic kidney disease (CKD) induced by diabetes mellitus and hypertensive diseases in terms of renal injury and insulin resistance. Methods We collected the clinical data of 120 patients with diabetes mellitus and hypertensive diseases in the Fifth People’s Hospital of Chengdu from July 1, 2008 to July 1, 2010, and randomly divided them into two groups. In the control group, patients only received therapy of western medicine, while for patients in the treatment group, Liuwei Dihuang pills were added on the basis of western medicine treatment with a treatment course of 12 weeks. Before and after the treatment, urinary albumin / urinary creatinine (ACR), creatinine clearance rate (Ccr) and insulin resistance index (HOMA-IR), C-reactive protein (CRP), and lipids were evaluated and compared. Results After treatment, ACR (P=0.012), serum CRP (P=0.000) and low-density lipoproteins (LDL) (P=0.014) for the treatment group were significantly different from those for the control group. HOMA-IR for the treatment group before and after the treatment was significantly different (Plt;0.05), while there was no statistical difference between the two groups in HOMA-IR (Pgt;0.05). Conclusion Kidney-nourishing therapy with Liuwei Dihuang pill can improve the laboratory indicators of renal injury or insulin resistance, reduce the inflammatory response in vivo, and ameliorate disorders of lipid metabolism.
【摘要】 目的 評價生長抑素聯合中藥在治療重癥急性胰腺炎中的有效性。 方法 應用國際Cochrane協作網系統評價方法對生長抑素聯合中藥治療重癥急性胰腺炎的隨機對照試驗（RCT）進行系統評價。計算機檢索MEDLINE（Ovid）、PubMed數據庫、中文科技期全文數據庫（VIP）、萬方數據庫、中國期刊全文數據庫（CNKI）、中國生物醫學文獻數據庫（CBM）。檢索時間均為建庫至2009年9月。文獻檢索語種為英語和中文。 結果 共納入8個RCT，436例患者，所有納入試驗在治療末均未進行隨訪。Meta分析結果顯示，生長抑素聯合中藥治療組（治療組）的病死率（13/188，6.9%）明顯低于單純生長抑素治療組（對照組）（24/174，13.7%），差異有統計學意義[Peto OR=0.46，95%CI（0.22，0.94），Plt;0.05]。治療組平均住院日低于對照組[WMD=-7.01，95%CI（-7.89，-6.13），Plt;0.000 01]。治療組腹痛緩解時間明顯低于對照組，其差異有統計學意義[WMD=-0.77，95%CI（-0.82，-0.72），Plt;0.000 01]。治療組與對照組治療第7天APACHE Ⅱ評分均下降，治療組下降幅度大于對照組，兩組比較差異有統計學意義（Plt;0.05）。治療組并發癥發生率（26/91，28.6%）與對照組（35/88，39.8%）相比，其差異無統計學意義[Peto OR=0.61，95%CI（0.32，1.13），P=0.12]。 結論 生長抑素聯合中藥治療在改善重癥急性胰腺炎的病死率、平均住院時間、腹痛緩解時間、APACHE Ⅱ評分下降幅度優于單純生長抑素治療。