ERAS结合腕关节镜治疗腕管综合征的临床研究

对比传统腕管切开减压术(OCTR)和加速康复理念下的腕关节镜下切开减压治疗腕管综合征(ECTR)的治疗效果。设计随机对照试验,自2016年4月～2017年4月共有60例腕管综合征患者纳入研究,随机分为试验组和对照组每组各30例。2组所有患者均在术后1个月、3个月、6个月、12个月进行随访。结果显示ECTR组的平均住院时间、手术时间术后VAS评分都远低于OCTR组。术后1个月时2组的肌电图和高频超声剪切波弹性成像对照组要优于试验组,但术后3个月以后两组的结果无差异。因此,ECTR对比OCTR在治疗CTS上术后效果无明显差异,但在减少患者住院时间、手术时间以及手术痛苦方面有明显的优势。     

加压空心钉固定技术对比锁定钢板技术治疗桡骨远端骨折的疗效分析

对比不同手术方法对桡骨远端骨折的疗效.收集我院自2008年10月到2012年12月桡骨远端骨折患者86例,双盲随机分成试验组和对照组,试验组采用无头加压空心钉内固定,对照组采用锁定钢板内固定,比较两组的平均手术时间和平均术中出血量.术后12个月采用Jakim标准进行腕关节功能评定,同时对随访患者的腕关节功能进行临床评分.试验组平均手术时间为（30.45±5.14）min,显著低于对照组的（63.42±8.14）min（P＜0.05）,而试验组平均术中出血量为（23.67±6.14）ml,少于对照组的（83.12±10.47）ml（P＜0.05）.术后随访试验组腕关节功能优良率为87.5%;对照组则为87.1% （P＞0.05）,试验组和对照组腕关节在功能、握力活动范围等方面评分存在显著差异,在疼痛评分上两组无明显差异.采用无头加压空心钉治疗桡骨远端骨折可以显著减少手术时间及术中出血,提高腕关节功能而且在疗效上与传统锁定钢板治疗桡骨远端骨折相比无明显差异.     

低浓度臭氧水与复方利多卡因对血液肿瘤口腔黏膜炎的疗效比较

比较低浓度臭氧水和复方利多卡因溶液漱口治疗血液肿瘤患者化疗所致口腔黏膜炎（OM）的临床疗效.将68例OM患者随机分为试验组和对照组,试验组采用0.5mg/L臭氧水漱口;对照组予以复方利多卡因溶液漱口,采用WHO分级标准每天评估OM的严重程度.结果试验组疗效优于对照组（P=0.001）,总有效率分别为97.0％和73.5％;试验组2级以上OM持续时间明显短于对照组（P=0.000）,分别为（4.30±2.37）天和（8.15±3.07）天;自漱口开始5天内,两组OM严重程度总体变化趋势差异有统计学意义（P=0.008）,第3天开始两组OM等级均逐渐减轻,对照组变化趋势较为平缓.本研究显示低浓度臭氧水漱口可以有效治疗血液肿瘤患者OM.     

Ⅰ期颈椎前后路手术治疗后纵韧带骨化症

为了探讨颈椎前后路手术治疗后纵韧带骨化症的疗效,对65例后纵韧带骨化症患者,Ⅰ期行颈椎前后路手术,采用JOA评分和X线,CT对手术效果进行评价.结果显示,按JOA标准评定,优良率为94%.术后X线及CT均示椎管有效矢状径增加,硬膜囊压迫解除.因此,颈椎前后路手术可以达到减压、稳定的目的,手术效果良好.     

膀胱尿道软镜联合筋膜扩张器治疗外伤后单纯性尿道狭窄

探讨膀胱尿道软镜联合筋膜扩张器治疗外伤后单纯性尿道狭窄的疗效.我院自2009年至今采用膀胱尿道软镜联合筋膜扩张器治疗外伤后单纯性尿道狭窄1 7例,其中悬垂部尿道狭窄1例,尿道球部狭窄12例,后尿道狭窄4例,回顾性分析其治疗过程,并对术前诊断、手术操作技巧及术后处理进行经验总结.17例患者手术均一次性扩张成功,手术时间25min～60min,平均37min,随访2个月～18个月,12例患者治愈,3例患者经治疗后可使扩张间期延长至3个月,其余2例患者仍需尿道扩张雄持.膀胱尿道软镜联合筋膜扩张器治疗外伤后单纯性尿道狭窄安全有效,可降低尿道扩张术风险.     

瑞格列奈联合甘精胰岛素治疗2型糖尿病合并慢性肾功能不全疗效观察

探讨甘精胰岛素联合瑞格列奈治疗2型糖尿病合并慢性肾功能不全的疗效.40例2型糖尿病患者采用甘精胰岛素和瑞格列奈联合治疗12周后患者血糖,肾功能和蛋白尿水平较对照组显著下降,治疗效果显著,值得临床推广使用.     

经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症

研究经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症的疗效.自2006年8月至2011年8月,采用经后路椎管扩大减压术治疗多节段颈椎后纵韧带骨化症27例,其中男19例,女8例,年龄48岁～82岁,平均63.6岁.手术前后用日本矫形外科学会(JOA)评分判断神经功能:用疼痛视觉模拟评分(VAS)评价颈肩痛程度.结果所有患者均获随访,随访时间为3个月～5年,平均18个月.术后JOA评分为13.3(10～17)分,较术前10.2(5～14)分有显著改善(t＝14.72,P＜0.01).术后症状优良率88.9％.仅2例出现C5神经根麻痹,为一过性.术后颈肩痛VAS评分平均为1.9(1～3)分,较术前5.2(4～6)分明显缓解(t＝14.25,P＜0.01).经后路椎管扩大减压术能使脊髓彻底减压,充分后移,避免C5神经根麻痹,是目前治疗该病的较好方法.     

生物反馈疗法对大学生考试焦虑的治疗作用

探讨生物反馈疗法对大学生考试焦虑的治疗作用。在某大学随机抽取学生1500名,采用考试焦虑量表进行筛查,选取焦虑组和对照组各30名。利用生物反馈疗法进行干预,采用脑电α波相对功率、肌电和皮电导联进行检测,每周2次,持续4周。结果表明：1.经过4周的干预,焦虑组干预前后各生理指标存在差异;2.生物反馈疗法干预考试焦虑在疗效上存在性别差异。结论：生物反馈疗法能有效降低大学生考试焦虑水平,对其治疗取得良好的效果。     

高强度聚焦超声配合FOLFOX4方案治疗晚期肝癌的临床观察

观察高强度聚焦超声(HIFU)配合FOLFOX4方案治疗晚期肝癌的疗效和不良反应.将58例晚期肝癌患者随机分成两组:热疗+化疗组(热化组)采用HIFU配合FOLFOX4方案,对照组为单纯FOLFOX4(单化组)治疗.结果显示热化组CRO例,PR18例,SD7例,PD2例,总有效率64.28%;单化组CR0例,PR11例,SD11例,PD7例,总有效率36.67%.两组差异均有统计学意义(P<0.05).H1FU配合FOLFOX4方案,治疗晚期肝癌近期疗效尚可,毒副反应较轻,值得临床推广试用.     

复合皮移植技术与传统方法治疗烧伤后大面积瘢痕效果比较

探讨分析整形术中应用复合皮移植技术治疗烧伤后大面积瘢痕的效果,以为临床外科应用提供依据。选取2012年9月~2017年12月笔者所在医院收治的因烧伤引起的大面积瘢痕整形患者104例,根据瘢痕修复方法分为研究组52例(经复合皮移植修复)、对照组52例(采用反复切取后躯干瘢痕皮的方法)。观察比较两组患者的疗效、治疗情况及安全性。研究组、对照组总有效分别为49例(94.23%)、41例(78.85%),P0.05。研究组、对照组1周平均创面愈合率分别为(28.74±8.13)%、(26.89±7.27)%,P0.05;研究组、对照组2周、4周平均创面愈合率分别为(66.38±9.77)%、(96.14±11.05)%和(55.25±9.64)%、(90.95±10.23)%,P0.05。研究组、对照组1周炎症反应积分分别为(-0.39±0.15)分、(-0.29±0.13)分,P0.05;2、4周分别为(1.46±0.17)分、(2.02±0.48)分和(0.75±0.12)分、(1.55±0.31)分,P0.05。研究组、对照组总不良反应分别为4例(7.69%)、12例(23.08%),P0.05。研究组、对照组平均治疗费用分别为(3.89±1.57)万元、(4.20±1.44)万元;创面愈合时间分别为(14.02±2.98)天、(18.35±3.14)天;P0.05。大面积烧伤瘢痕患者整形术中应用复合皮移植技术的治疗效果较佳,创面愈合率高,并发症少,安全性高,适合临床推广。     

体外冲击波与传统方法治疗腰椎间盘突出症疗效比较

比较放散式体外冲击波与传统保守治疗腰椎间盘突出症的临床疗效及生命质量评价。对2010年6月至fi013年6月收治且获得随访的257例腰椎间盘突出症患者进行分析,其中男139例,女118例。根据治疗方式不同随机分为两组,并在治疗前后应用日本骨科学会（JOA）下腰痛评分法及视觉模拟评分（VAS）进行疗效评价,应用健康调查评分量表SF-36进行生活质量评价。对患者进行随访1周～12周,平均（10．0±3．4）周,治疗组治疗后2周和4周VAS评分低于对照组,治疗后1周、2周及4周JOA评分高于对照组,治疗后4周、8周和12周的生理机能、生理职能、总体健康、情感职能和躯体疼痛得分高于对照组,差异有统计学意义（P〈0．05）。放散式体外冲击波治疗腰椎间盘突出症疗效较好,并能够较好地提高患者的生活质量。     

Self and external management compared with psychotherapy in the control of obesity

Seventy-four obese TOPS (Take Off Pounds Sensibly) members were assigned to one of five conditions: delayed treatment control, insight psychotherapy, self-management training plus external reinforcement, self-management training only, or external reinforcement only. The latter four groups met once per week for ten weeks and were seen at three and six months and followup. It was hypothesized that self-management plus external reinforcement would be superior to other conditions at both post-treatment and followup, and that this condition alone would produce continuing weight losses. Analysis of covariance on body weight, with pretreatment weight as covariate, indicated that self-management plus external reinforcement, self-management only, and external reinforcement only, did not differ in mean body weight at post-treatment. These three groups differed significantly from control and psychotherapy conditions, which did not differ from one another. Self-management plus external reinforcement produced better performance of techniques. At three and six month followup, differences between the four treatment conditions were no longer significant. Results are discussed in terms of evaluation of psychotherapy and behavior modification and durability of results.     

Dialectical behavior therapy adapted for suicidal adolescents

We report a quasi-experimental investigation of an adaptation of Dialectical Behavior Therapy (DBT) with a group of suicidal adolescents with borderline personality features. The DBT group (n = 29) received 12 weeks of twice weekly therapy consisting of individual therapy and a multifamily skills training group. The treatment as usual (TAU) group (n = 82) received 12 weeks of twice weekly supportive-psychodynamic individual therapy plus weekly family therapy. Despite more severe pre-treatment symptomatology in the DBT group, at post-treatment this group had significantly fewer psychiatric hospitalizations during treatment, and a significantly higher rate of treatment completion than the TAU group. There were no significant differences in the number of suicide attempts made during treatment. Examining pre-post change within the DBT group, there were significant reductions in suicidal ideation, general psychiatric symptoms, and symptoms of borderline personality. DBT appears to be a promising treatment for suicidal adolescents with borderline personality characteristics.     

各种传统医学在高血压治疗中的应用

高血压痛作为最常见的慢性病,其并发症具有较高的致残率及致死率。本文综述近年来各种传统医学在高血压病治疗中的应用,包括传统中医对高血压痛的病因机的阐述,应用中药内服、外服、针灸等临床效果观察,蒙医辨证分型论治高血压病;藏医对高血压病的认识及临床采用的金针疗法治疗高血压病;壮医特色壮药内服,壮医药线点灸刺血疗法对高血压病的临床疗效评价。以此说明传统医药治疗方法对改善高血压病症状较明显,其治疗手段多样,副作用较小,降压效果平稳持久,有效减少并发症的优势。     

王树楠对管子思想的解读和阐发

晚清时期,面对着中国社会的危机,管子思想倡导的富国强兵理念成为人们救时之良策。以王树楠为代表的晚清士人对管子思想进行重新进行解读和认知,在“尊王变法”、“商战攘夷”、“兴商富国”等方面赋予管子思想新时代的内涵。     

心理干预对急性冠脉综合征伴抑郁患者应对方式的影响

为了解心理干预对急性冠脉综合征（ACS）伴抑郁患者应对方式的影响,对42名ACS伴抑郁患者随机分为干预组和对照组,在入组时、入组3月后和6月后分别进行HAD（d）、MCMQ测评。结果显示入组3月后和6月后,干预组HAD（d）总分、回避因子分、屈服因子分较对照组降低,面对因子分较对照组升高,与入组时相比干预组HAD（d）...     

肿瘤患者的认知纠治及“圆桌诊疗”的启示

分析肿瘤患者认知过程中常见的不良认知,认为改变不良认知是治疗肿瘤的第一步。在认知纠治中,通过“圆桌诊疗”模式可巧妙地树立肿瘤患者的正确认识;有助于分析其错误的思维类型;并通过树立榜样的“示范”、成立自救组织与“集体疗法”以及提供沟通倾述的平台和管道,进而实现对肿瘤患者不良的认知纠治。“圆桌诊疗”的模式和方法正是在潜移默化中,通过融合了集体治疗、心理疏导、示范疗法、情境疗法、交友疗法等而起到了纠正不良认知的作用。     

The Use of Time Limits in Brief Psychotherapy: A Comparison of Six-Session,Twelve-Session,and Unlimited Treatment with Families

This study compared the relative effectiveness of two durations of time-limited psychotherapy with time-unlimited treatment and a waiting list control group. Thirty-seven families applying for treatment at a child guidance clinic were randomly assigned to one of four treatment conditions: (a) time-limited therapy of 6 sessions within 8 weeks; (b) time-limited therapy of 12 sessions within 16 weeks; (c) time-unlimited therapy; and (d) a waiting list control group in which families waited approximately four months before beginning treatment. Outcome was assessed from multiple sources: parents, child, therapist, family interaction ratings, and missed and canceled sessions. Analysis of data provided some evidence that families who received treatment fared better than those on the waiting list. There were no consistent differences between 6-session, 12-session, and unlimited therapy. A model is proposed for the further investigation of time-limited treatment.     

The Efficacy of Acupuncture in the Treatment of Major Depression in Women

The effectiveness of acupuncture as a treatment for major depression was examined in 38 women, randomly assigned to one of three treatment groups. Specific treatment involved acupuncture treatments for symptoms of depression; nonspecific treatment involved acupuncture for symptoms that were not clearly part of depression; a wait-list condition involved waiting without treatment for 8 weeks. The nonspecific and wait-list conditions were followed by specific treatment. Five women terminated treatment prematurely, 4 prior to the completion of the first 8 weeks. Following treatments specifically designed to address depression, 64% of the women (n = 33) experienced full remission. A comparison of the acute effect of the three 8-week treatment conditions (n = 34) showed that patients receiving specific acupuncture treatments improved significantly more than those receiving the placebo-like nonspecific acupuncture treatments, and marginally more than those in the wait-list condition. Results from this small sample suggest that acupuncture can provide significant symptom relief in depression, at rates comparable to those of psychotherapy or pharmacotherapy. Acupuncture may hold sufficient promise to warrant a larger scale clinical trial.     

冠脉介入治疗时期氯吡格雷抵抗的认识与思考——抓住本质，全面获益

急性冠脉综合征已步入药物洗脱支架进行血运重建的时期,双联抗血小板治疗是接受PCI治疗的常规手段。临床发现部分患者不能从氯吡格雷治疗中获益,存在氯吡格雷抵抗的现象。笔者就氯吡格雷抵抗的发生机制、临床意义及治疗对策进行描述,反映相关研究的趋势和方向,为未来更优化抗血小板治疗提出一种策略。