体外冲击波治疗股骨头缺血性坏死研究进展

股骨头缺血性坏死,尤其非创伤性股骨头缺血性坏死,主要累及青壮年患者,属于慢性进展致残性疾病。因此,股骨头缺血性坏死的治疗是骨科医生面临的比较棘手的问题。研究发现早期发现、诊断股骨头缺血性坏死,并进行有效的干预,有助于减轻疼痛、改善关节功能,并有可能避免股骨头病变进展、塌陷,从而保留自身关节形态与功能。目前对早/中期股骨头缺血性坏死的最佳治疗方案仍存在较大争议,而体外冲击波治疗(ESWT)源于一种高能机械波,具有多种生物学效应,并被证实有助于缺血性疾病治疗。根据股骨头缺血性坏死发生基本机制,国内外学者利用ESWT的生物力学效应治疗股骨头缺血性坏死并取得了较好的临床效果。相对于传统的治疗方式,ESWT具有非侵入性、刺激强度可调、副作用少等优势,并受到学者们越来越多的关注。本文将对ESWT在股骨头缺血性坏死中作用机制及临床应用做一综述,随着研究的深入,该疗法在治疗股骨头缺血性坏死中将具有更广阔的前景。     

自体骨髓间充质干细胞骨泥治疗早期股骨头缺血性坏死近期疗效分析

为了研究与探讨自体骨髓间充质干细胞骨泥结合髓心减压植骨治疗早期股骨头缺血性坏死的临床疗效。收集2014年2月~2015年2月于笔者所在医院由同一组关节科医生治疗且符合标准纳入研究的患者11例12髋。比较术前术后骨盆DR片、CT及Harris评分,评估该方法治疗早期股骨头缺血性坏死的临床疗效。术后平均随访9个月,所有患者髋关节疼痛症状基本消失,活动范围改善或接近恢复正常。自体骨髓间充质干细胞骨泥结合髓心减压植骨治疗早期股骨头缺血性坏死,可显著地改善髋关节活动功能,促进骨再生,具有明显的短期临床效果。     

科学研究的DNA共享与协作精神

股骨头坏死、髋关节脱位是骨科常见病,随着人们生活模式的改变发病率有所上升。对该病的成因、流行病学、病理转归、临床治疗策略与髋关节严重病损后功能重建等问题,学术界存在很大争议。作者提出从生物进化的角度、用自然重建理念做指导,应用髋关节分离牵拉术治疗股骨头坏死、骨盆补充截骨术重建青少年严重病损的髋关节功能人、组合性矫形手术治疗年长儿先天性髋关节脱位,获得了优良效果。因此呼吁:用自然重建理念治疗青少年股骨头坏死、髋关节脱位,降低人工假体置换对此类疾病的手术指证。     

自然重建理念治疗股骨头坏死、髋关节脱位

股骨头坏死、髋关节脱位是骨科常见病,随着人们生活模式的改变发病率有所上升.对该病的成因、流行病学、病理转归、临床治疗策略与髋关节严重病损后功能重建等问题,学术界存在很大争议.作者提出从生物进化的角度、用自然重建理念做指导,应用髋关节分离牵拉术治疗股骨头坏死、骨盆补充截骨术重建青少年严重病损的髋关节功能人、组合性矫形手术治疗年长儿先天性髋关节脱位,获得了优良效果.因此呼吁:用自然重建理念治疗青少年股骨头坏死、髋关节脱位,降低人工假体置换对此类疾病的手术指证.     

成人股骨头坏死的治疗进展

股骨头坏死（ONFH）是一种进展性和致残性疾病,保存自身股骨头是临床治疗所追求的最理想目标,早中期的治疗方案主要采用非手术疗法和保髋的姑息性手术,目前为止还没有一种治疗方法能达到理想的治疗效果。近年来,骨髓间充质于细胞（MSCs）移植治疗ONFH是目前研究热点之一,有望成为一种有效的治疗方法,晚期行人工髋关节置换术是唯一的和最佳的选择。因此,早期诊断,采用综合性治疗方案保全自身髋关节是治疗本病的主要方向。     

成人股骨头缺血坏死的早期CT诊断

成人股骨头缺血坏死（ANFH）是一种常见的髋关节病变,如何早期发现,获得最佳治疗时机,仍为长期研究的重点。     

成人股骨头缺血坏死的早期CT诊断

成人股骨头缺血坏死(ANFH)是一种常见的髋关节病变,如何早期发现,获得最佳治疗时机,仍为长期研究的重点[1].     

人工髋关节置换术后翻修治疗体会

近年来,随着我国开展人工关节置换术,临床取得了较好的效果,为老年股骨颈骨折、股骨头无菌性坏死、成人先天性髋关节脱位等患者解除痛苦。随着人工髋关节置换术的广泛开展,因手术人员的技术原因,以及假体的长期使用,术后并发症也随之增多,翻修术也成为必然。针对我院30例人工髋关节术后翻修适应证选择及假体选择。谈一些治疗体会。     

PFNA、DHS与FHR治疗老年股骨粗隆间骨折的疗效比较

比较股骨近端防旋髓内钉（PFNA）、动力髋螺钉（DHS）与人工股骨头置换术（FHR）治疗老年股骨粗隆间骨折的临床疗效。对2005年6月～2012年6月收治且获得随访的65例老年股骨粗隆间骨折患者进行回顾性分析,其中男27例,女38例。根据治疗方式不同分为三组：PFNA 组21例,DHS 组22例,FHR 组22例。比较三组患者手术时间、术中出血量、术后引流量、负重时间、术后并发症发生情况及术后3个月、6个月、12个月髋关节 Harris 评分等。结果65例患者均获随访12个月～24个月（平均12．0个月＆#177;3．4个月）,三种方法中,手术时间及负重时间比较,FHR 组时间最短,差异有统计学意义（P＜0．05）;术中出血量比较,DHS 组最少,差异有统计学意义（P＜0．05）;髋关节功能比较,FHR 组优于PFNA 组及 DHS 组,差异有统计学意义（P＜0．05）;术后引流量及术后并发症三组比较差异无统计学意义（P ＞0．05）。因此,对老年股骨粗隆间骨折患者,采用 FHR 手术可使患者术后早期下床,改善患者生活质量。     

脑转移瘤治疗方案的比较

脑转移瘤是成人最常见的颅内肿瘤之一,也是肿瘤患者致残与死亡的主要原因,然而目前还没有完全统一的治疗策略。本文利用比较治疗学相关原理和方法,从治疗方式、疗效、费用等方面对脑转移瘤的不同治疗方法进行比较和分析,为患者进行治疗上的选择提供帮助,同时指导和规范该类疾病治疗的临床决策,为临床治疗思路提供借鉴。     

Effect of head movement on the localization of sounds in the equatorial plane

Five experiments examined the effect of head movement on the localization of sound sources in the equatorial plane. Under most conditions, head movement produces poorer localization for sound sources in the equatorial plane. Only one condition demonstrated an improvement in localization with head movement. The sound source was located toward the side of the head and the source duration was long enough to permit reorientation of the position of the head with re-spect to the sound source.     

骨髓间充质干细胞移植治疗对心肌梗死后心功能的影响

目前心肌梗死常规治疗不能修复已死亡或者濒死的心肌,应用干细胞替代受损或死亡的心肌细胞来改善心功能,已成为近年来国内外研究的热点。骨髓间充质干细胞通过修复坏死心肌、促进血管新生等改善心梗后心功能,其移植治疗有望成为治疗心肌梗死的一个全新方法。     

对子宫肌瘤患者从医心理及治疗决策的思考

子宫肌瘤是妇科最常见的良性肿瘤,发病率高、恶变率低,目前治疗方法较多,但各有利弊;众多子宫肌瘤患者从医心理复杂,甚至难以配合治疗,医生应针对不同部位、大小、症状的肌瘤及患者的不同年龄、生育需求和心理状态,制定出个体化、人性化治疗方案,以期取得患者机体和心理均满意的和谐疗效。     

异位妊娠诊治的临床思考

异位妊娠是妇产科常见急症之一,也是目前早期妊娠妇女死亡的首要原因。其检查方法多种,治疗也趋于多样化。在异位妊娠的诊治中,我们应从整体上认识了解患者,掌握疾病的发展变化,作出最佳的诊治方案,并随时根据病情发展变化,对诊治方案做出相应的合理的改变。     

From Knowing to Discovering: Some Suggestions for Work with Anorexic Patients

ABSTRACT

In this article I offer some technical suggestions for psychoanalytic work with anorexic patients. Although focused on an outpatient setting, certain parts of the article will also have utility for inpatient work. As an outpatient therapist working with an anorexic patient, especially in the acute stages of the illness, there are case management demands that need immediate attention. The setting up the particular frame is required to augment the therapeutic work. The most urgent pressure felt by the clinician is the precariousness of the patient’s physical health. This can be experienced as if there is a gun to the head of the therapist. This deathly force must be carefully and constantly grappled with, and particularly so in the most symptomatic stages of the illness. The clinician must work with a patient who might die at any time, yet an anorexic patient cannot be managed the way a suicidal patient would be. The question of technique in this situation is a complex one. Above all, the patient must be met where s/he is. Notwithstanding the uniqueness of each patient there are some specific themes that often arise in the acute stage of the illness. Certain technical suggestions are offered.     

Monocular stereopsis with and without head movement

Random dots moving with various velocity gradients were presented to observers; the motion was yoked to head movement in one condition and to no head movement in another. In Experiment 1, 12 observers were shown motion gradients with sine, triangle, sawtooth, and square waveforms with amplitudes (equivalent disparities) of 12' and 1 degrees 53'. In Experiment 2, 48 observers were shown only the sinewave or square-wave gradient of 1 degrees 53' disparity either with or without head movement so that the observers' expectation to see depth in one condition did not transfer to another. The main findings were: (1) with 12' disparity, the head-movement condition produced perceived depth but almost no perceived motion, whereas the no-head-movement condition produced both perceived depth and perceived motion; (2) with 1 degrees 53' disparity, both conditions produced perceived depth and perceived motion; and (3) when the expectation to see depth was removed, the no-head-movement condition with the square-wave gradient produced no perceived depth, only motion. We suggest that monocular stereopsis with head movement can be achieved without perception of motion but monocular stereopsis without head movement requires perception of motion.     

Monocular without stereopsis with and head movement

Random dots moving with various velocity gradients were presented to observers; the motion was yoked to head movement in one condition and to no head movement in another. In Experiment 1, 12 observers were shown motion gradients with sine, triangle, sawtooth, and square waveforms with amplitudes (equivalent disparities) of 12′ and 1° 53′. In Experiment 2, 48 observers were shown only the sinewave or square-wave gradient of 1° 53′ disparity either with or without head movement so that the observers’ expectation to see depth in one condition did not transfer to another. The main findings were: (1) with 12′ disparity, the head-movement condition produced perceived depth but almost no perceived motion, whereas the no-head-movement condition produced both perceived depth and perceived motion; (2) with 1° 53′ disparity, both conditions produced perceived depth and perceived motion; and (3) when the expectation to see depth was removed, the no-head-movement condition with the square-wave gradient produced no perceived depth, only motion. We suggest that monocular stereopsis with head movement can be achieved without perception of motion but monocular stereopsis without head movement requires perception of motion.     

Seeing why they cannot see: Understanding the syndrome and causes of posterior cortical atrophy

Posterior cortical atrophy (PCA) is a syndrome defined by focal neurodegeneration of the parietal, occipital, and occipito‐temporal cortices and associated with progressive dysfunction of visual processing, praxis, numeracy and reading. The condition is most commonly caused by (and viewed as an atypical presentation of) Alzheimer's disease, although can also be caused by other degenerative diseases. The current paper examines the relationship of PCA to other degenerative syndromes, and considers what comparisons of these syndromes and disease phenotypes can tell us about underlying disease mechanisms. The focus then turns to neuropsychological investigations of the cognitive basis of symptoms which, although unusual in the broader context of a dementia clinic, are particularly characteristic of the PCA syndrome, before exploring implications for clinical management and patient and carer support.