基础研究显示有多种离子通道参与缺血性心脏病的发病机制,包括L型钙通道、T型钙通道、ATP敏感性钾通道、内向钠钾电流通道和晚钠电流通道.临床研究发现调控这些通道的功能可以改善心肌供血和心肌细胞代谢.本文对离子通道生物学研究作一简要论述,同时对不同离子通道阻滞剂缺血性心脏病治疗中的应用进行回顾总结,以期临床重视这类药物的研究和应用.

手舟骨骨折的发生率在腕部位于第二位,仅次于桡骨远端骨折.手舟骨骨折最常发生在跌倒手掌撑地,手舟骨在发生骨折时所承受的是挤压力,由于手舟骨的腰部较细,对挤压力的抵抗性小,故腰部容易发生断裂.供应手舟骨的主要血管从腰部进入该骨,腰部骨折极易损伤主要血管,导致舟骨内侧部缺血,血供障碍影响骨折的愈合.手舟骨骨折不愈合或缺血性坏死的发生均与其形态和血供的特殊性有密切的关系.因此,熟悉手舟骨的形态结构及血供特点,是治疗手舟骨骨折基础.

Vertebral artery oriifce stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood lfow and perfusion in the posterior circulation after inter-ventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso-nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery oriifce stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat-ment only. The intervention group received vertebral artery oriifce angioplasty and stenting+identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent function-al magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery oriifce stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

以兔为实验对象,模拟耳神经外科手术暴露小脑桥脑角的过程,观察内耳血供阻断不同时间与听觉损伤的关系,为提高耳神经外科手术的听觉保留效果提供借鉴. 一、材料与方法

Objective. To observe the regulating effects of vascular endothelial growth factor (VEGF) and angiotensinⅡ (ANG II) on the frog's pericardium, lymphatic stomata and angiogenesis so as to reveal their effects and mechanism on the mesothelial permeability, lymphatic stoma regulation and myocardial hypertrophy. Methods. VEGF and ANGⅡ were injected into the frog's peritoneal cavity so as to examine the changes of the pericardial stromata by using transmission electron microscopy, scanning electron microscopy and computerized imaging analysis. Results. Scattered distributed pericardial stomata were found on the parietal pericardium of the frog with a few sinusoid mesothelial cells, whose blood supply was directly from the cardiac chambers flowing into the trabecular spaces of the myocardium (because there are no blood vessels in the myocardium of the frog). The average diameters of the pericardial stomata in VEGF and ANGⅡ groups were 1.50 μ m and 1.79 μ m respectively, which were much larger than those in the control group (0.72 μ m, P< 0.01); the average distribution densities of the stomata were 8.25/0.1 mm2 and 12.80/0.1 mm2 in VEGF and ANGⅡ groups, which were also much higher than those in the control group (3.57/0.1 mm2, P< 0.01); the sinusoid areas in VEGF and ANGⅡ groups were 2442.95 μ m2/0.1 mm2 and 2121.79 μ m2/0.1 mm2, which were larger than that in the control group (995.08 μ m2 /0.1 mm2 , P< 0.01); no angiogenesis was found in the frogs of the experimental groups. Conclusions. VEGF and ANGⅡ could strongly regulate the pericardial stomata by increasing their numbers and openings with larger diameters and higher distribution density. They could also increase the sinusoid areas with the result of the higher permeability of the pericardium, which clearly indicated that VEGF and ANGⅡ could speed up the material transfer of the pericardial cavity and play an important role in preventing myocardial interstitial edema. Yet there was no strong evidence to show the angiogenesis in the myocardium.

Objective To study the endovascular treatment of artery rupture caused by injury on which surgery was impossibly performed. Methods All 76 patients underwent selective angiography to make accurate diagnosis. Endovascular occlusion of the target artery with a balloon catheter was accomplished and surgical vessel repair followed in 13 cases. Under the condition that the blood supply of the remote limb on which the artery rupture was detected remained normal, the injured artery was obstructed completely with either detachable balloon or coil in 63 cases.Results No complication, disability, or death was found in any case.Conclusions Occlusion of the blood flow of the target vessel with balloon catheter is an easy, effective and safe preoperational approach for patients who fail to be treated perfectly with direct surgery.

INTRODUCTIONThe reason for physical rotation compression on vertebral artery atG is that there isn' t intervertebral joints between at-lantoepistrophic transverse processes. At rear of vertebral artery be-tween atlantoepistrophic transverse processes is covered by inferioroblique muscle which originates from spinous process of axis andended at transverse process of atlas. When head rotates towardsright, inferior oblique muscle of left side will rotate towards left andforward which muscle belly enters interspace of first transverse pro-cess and compress vertebral artery. At the same time, right vertebralartery enters rear of atlantoepistrophic spinous process and isn' tcompressed that ensures blood supply of basal artery. When head andneck resume neutral position, inferior obhque muscle is replaced andcompression on left vertebral artery is decompressed, so inferioroblique muscle is the anatomic base of physical compression onvertebral compression.

BACKGROUND:Professor Sun JY first reported the exist of sulcus for vertebral artery at posterior arch of atlas.If vertebral artery is stimulated or compressed when passing through sulcus,artery spasm occurred leading to circulatory blocking and ischemia of brain tissue which blood was supplied by that artery.Dizziness,headache and other symptoms appeared,that is called sulcus syndrom.Therapeutic principles:Overcoming unstability between head and neck,restoring internal and external balance,dynamic and static balance;Removing stimulating and compressing factors to vertebral artery and peripheral sympathetic nerve and /or spinal nerve,ensuring normal blood supply of vertebral artery.

Background:Atherosclerotic Occlusion(ASO) is common among middle aged and elderly population to which atherosclerosis of vital organs,disorder of blood supply in limbs,as well as limbs numb or ulcer are secondary.Rate of disbilitation and amputee is high.So,management and prevention of disbilation are very important.

INTRODUCTION In this study,we investigated effect of hyperbaric oxygen(HBO) on the hypertension- induced basio- cerebral hemorrhage.The affected patients often showed signs of cerebral circulation disorder,spasm of vessels,insufficiency of cerebral blood supply and intracranial hypertension.

Sinus node dysfunction most often is found in the elderly as an isolated phenomenon. Although interruption of the blood supply to the sinus node may produce dysfunction, the correlation between obstruction of the sinus node artery and clinical evidence of sinus node dysfunction is poor.

作者用带血管的游离腓骨移植术治疗先天性胫骨假关节9例.随访观察9年以上者2例.本文将移植后的胫骨远近端的骨骺生长率进行了分析.阐述了治疗先天性胫骨假关节的有效方法,介绍治疗后胫骨远近端骨骺的变化及移植腓骨本身的变化.

我院自1980年2月至1982年8月采用"髋关节开窗引流减压术"治疗儿童股骨头缺血坏死41例,获得3年以上随访者31例,效果较好,现报告如下:手术方法手术在硬膜外麻醉或局麻下进行.平卧位,自髂前上棘下方1cm处沿缝匠肌向下内方作长5～6cm斜切口.切开浅层及深层筋膜后即可露出缝匠肌与股直肌的上部,此时可见旋髂浅动脉由上端跨过,一般应尽量将其拉向上方,如该血管走行较低,影响暴露,亦可将其结扎切断.

先天性食管闭锁手术时能否完成一期食管吻合,食管两端的距离是一重要条件.因此,为减少食管吻合张力,设法延长食管以缩小两端之问的距离是多年来临床研究的内容之一.我们在Livaditis食管肌层环形切开的基础上加以改进,自1982年4月共用此方法治疗先天性食管闭锁9例,本文将介绍我们的方法和体会.

儿童股骨头缺血坏死,其病理变化是股骨头骨骺的供血障碍引起了股骨头缺血坏死.

股骨近端的血运供应对髋关节的发育及某些疾病的发生十分重要,Trueta(1)Ogden(2)Chung(3)等曾报道生长时期殷骨近端的血运分布,但对不同时期的胎儿和新生儿血运变化的特点至今尚未见劲.本文通过灌注造影,切片观察探讨了胎儿新生儿股骨近端血运变化的特点,为研究一些髋关节疾病的病理提供了解剖学基础,也是探讨胎儿发育的重要资料.

本文报告用带蒂臀大肌瓣括约肌成形术治疗小儿闭肛术后肛门完全失禁6例.年龄5～11岁.5例术后随诊2个月～5年,失禁均已治愈;另1例术后一周明显好转,正在训练括约功能.6例术后均作了肛直肠测压对照检查,都恢复括约肌收缩反射和松弛反射,肛直肠压力差比术前升高1～4倍,高压区长度增加50%至3倍,患儿自主收缩臀大肌时,肛管括约部产生相当高的收缩压,达115～212mmH_2O,而手术前则为"零".作者认为手术年龄以5岁以上为合适,双侧带蒂臀大肌瓣左右交义成形肛门括约肌效果快而确实.保证肌瓣血循环和防止感染是手术成败的关键.

AIM: To study the changes in capillarity of skeletal muscle during acclimation to high altitude, and explore the effects of a certain extent physical activity under hypoxia on capillary formation and the role of vascular endothelial growth factor (VEGF) in this process. METHODS: 48 Wistar rats were divided into 3 groups: Ⅰ normoxic control; Ⅱ hypoxia and Ⅲ hypoxia+exercise. Rats of Ⅱ and Ⅲ groups were subjected to hypobaric hypoxia for 5 weeks (23 h/d). They were first brought to simulated 4 000 m altitude, where rats of the Ⅲgroup were forced to swim for 1 h/d (6 d/week). Then the animals were ascent to 5 000 m. Biomicrosphere method was used to determine blood flow of skeletal muscle. The mean fiber cross-sectional area (FCSA), capillary density (CD) and capillary/fiber ratio (C/F) of red portion of the lateral head of the gastrocneminus were assayed by myofibrillar ATPase histochemistry. VEGF and its receptor KDR were assayed with immunohistochemistry method.RESULTS: By comparison with the normoxic control, 5-week hypoxic exposure resulted in a decrease in cross-sectional area of skeletal muscle fiber and an increase in CD, but the C/F remained unchanged. The blood supply to the gastrocnemius was not changed. After 5-week-exercise at high altitude, the muscle fibers did not undergo atrophy. CD, C/F, and the blood flow at rest increased significantly. VEGF protein was found primarily in the matrix between muscle fibers; KDR were shown mainly in endothelial cells of capillary. VEGF was more strongly stained in the skeletal muscle of hypoxia-exercise rats.CONCLUSION: Hypoxia itself can not induce neovascularization. While exercise during hypoxic exposure can lead to capillary formation. VEGF and KDR may play roles in it. New capillary formation benefits the blood supply, oxygen delivery and working performance at high altitude.

作者在解剖1具成年男性尸体标本时,发现其左肾发育不完全,并有3支动脉供应,现报道如下:该例标本左肾发育不完善,肾门宽大,肾窦不完整,窦内结构外露.

从上个世纪50年代来,以解剖复位和坚强固定为宗旨的AO内固定技术,一直在骨折治疗领域中占据主导位置,但是解剖复位和坚强固定常常以严重损伤骨的血供为代价,由此而导致的术后骨不连、骨质疏松以及去内固定后再骨折等并发症屡见不鲜[1].近年来,以保护骨折局部的血供为原则的生物学固定(bio-logical osteosynthesis BO)新概念正在逐步形成[2],在BO原则指导下,为了保护骨折局部的血供,围绕内固定的形状、手术方式和入路等进行了诸多研究和尝试,接骨板和髓内钉是最常用的两类内固定物,现就两者在此方面进展作一综述.

四肢主干血管损伤能否得到及时正确的诊治常常关系到患者的安危、肢体的存活及功能恢复程度,特别是对于某些复杂的肢体创伤,术前因各种原因导致肢体缺血时间较长,尽快重建肢体血供显得极为紧迫和必要.根据目前国外文献[1-3]报道,我们尝试使用血管临时腔内转流(temporary intravascular shunts,TIVS)技术快速复通1例患者的损伤桡动脉,结果缩短了术中肢体缺血时间,报告如下.

肝细胞癌(hepatocellular carcinoma,HCC)典型的CT征象为平扫显示(稍)低密度影,增强扫描呈"速升速降"型强化,其病理生理学基础为HCC由肝动脉供血且血供丰富.而乏血供型HCC较为少见,增强扫描强化形式多样,容易导致误诊.本文对经过手术病理/肝穿刺活检或临床随访证实的12例乏血供型HCC进行分析研究,旨在加深对此类HCC的认识,提高术前诊断准确率.

肺癌的血供情况对肺癌的治疗及转移有着重要的影响[1]。肿瘤血供多少与治疗效果成正比目前已被公认，而肺癌瘤血管与肺动、静脉早期引流在肺癌的治疗、转移与转归等方面还不被人们所完全了解。本文就介入治疗肺癌过程中发现的15例支气管动脉与肺动、静脉早期引流的表现及治疗情况作以讨论，以期对肺癌中肺血管畸形引流有进一步的认识。

Objective:　To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures.　　Methods:　From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction.　　Results:　More than 6-month follow-up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection.　　Conclusions:　This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.

Osteocytes, the most abundant bone cells, form an interconnected network in the lacunar-canalicular pore system (LCS) buried within the mineralized matrix, which allows osteocytes to obtain nutrients from the blood supply, sense external mechanical signals, and communicate among themselves and with other cells on bone surfaces. In this study, we examined key features of the LCS network including the topological parameter and the detailed structure of individual connections and their variations in cortical and cancellous compartments, at different ages, and in two disease conditions with altered mechanosensing (perlecan deficiency and diabetes). LCS network showed both topological stability, in terms of conservation of connectivity among osteocyte lacunae (similar to the‘‘nodes’’ in a computer network), and considerable variability the pericellular annular fluid gap surrounding lacunae and canaliculi (similar to the‘‘bandwidth’’ of individual links in a computer network). Age, in the range of our study (15–32 weeks), affected only the pericellular fluid annulus in cortical bone but not in cancellous bone. Diabetes impacted the spacing of the lacunae, while the perlecan deficiency had a profound influence on the pericellular fluid annulus. The LCS network features play important roles in osteocyte signaling and regulation of bone growth and adaptation.