膝关节假体设计对全膝关节置换术后膝关节屈曲度的影响

施行全膝关节置换术（totalknee arthroplasty，TKA）旨在使严重膝关节疾患者缓解疼痛并改善功能水平。在衡量TKA术后功能的众多因素中，关节活动度（range of motion，ROM）一直是一个须着重考虑的问题，同时也是绝大多数膝关节评分系统的重要组成部分。一般来说，TKA术后膝关节105°～110°的屈曲度即可以满足患者日常生活的需要，绝大多数文献报道的术后远期屈曲度也保持在100°～115°之间。[第一段]     

增加胫骨平台后倾角度、后交叉韧带部分松解对全膝关节置换术后膝关节运动影响的实验研究

目的通过增加胫骨平台后倾角度或后交叉韧带（PCL）部分松解对全膝关节置换术（TKA）中屈曲间隙过紧进行处理,分析这两种方法对TKA术后膝关节运动学的影响。方法测量6例新鲜尸体膝关节标本在完整状态下、正常TKA、屈曲间隙过紧、增加胫骨平台后倾角以及PCL部分松解TKA术后膝关节屈曲0°、30°、60°、90°、120°时的前后松弛度、内外翻松弛度、旋转松弛度及最大屈曲度。结果屈曲过紧TKA与正常TKA相比,在屈曲30°、60°、90°和120°时前后松弛度、内外翻松弛度及旋转松弛度均显著较小（P〈0．05）。与屈曲过紧TKA相比,增加胫骨后倾角后,在屈曲30°、60°、90°和120°时前后松弛度、内外翻松弛度和旋转松弛度均明显增大（P〈0．05）。PCL部分松解与屈曲过紧TKA相比,在屈曲30°、60°、90°和120°时前后松弛度明显增加（P〈0．05）;旋转松弛度在屈曲30°、60°、90°时明显增加（P〈0．05）。与PCL部分松解相比,增加胫骨后倾角的内外翻松弛度在屈曲30°、60°、90°时明显较大（P〈0．05）;旋转松弛度在屈曲0°、30°、60°和90°时明显较大（P〈0．05）。屈曲过紧TKA的最大屈曲度（120．4°）与正常TKA（130．3°）及增加胫骨后倾角（131．1°）相比明显较小（P〈0．05）。增加后倾角与PCL部分松解（124．0°）相比,最大屈曲度较大,但差异无统计学意义（P=0．0816）。结论屈曲间隙过紧TKA术后膝关节的前后松弛度、内外翻松弛度、旋转松弛度和最大屈曲度均减小;增加胫骨平台后倾角后,前后松弛度、内外翻松弛度、旋转松弛度和最大屈曲度均明显增大;PCL部分松解仅能明显增大前后松弛度。因此对于TKA术中屈曲紧张的膝关节,增加胫骨平台后倾角比PCL部分松解能更好地改善膝关节的运动学。     

膝关节内翻屈曲畸形全膝关节置换的软组织平衡

目的探索对膝关节内翻屈曲畸形患者施行的全膝关节置换（total knee arthroplasty,TKA）软组织平衡技术。方法2001年1月～2005年12月,对实施的86例104膝骨性关节炎（osteoarthritis,OA）行TKA的膝内翻屈曲畸形患者进行回顾性研究,对术中的软组织平衡问题进行讨论。其中男19例23膝,女67例81膝;年龄57岁～78岁,平均66岁。行单侧TKA术68例,双侧18例。均为初次行TKA的OA患者。术前内翻角为6～34°,平均12.3°;其中软组织性内翻占总内翻角的56.7%,骨性内翻占43.3%。术前膝关节屈曲挛缩畸形10°以下21膝,10～19°45膝,20～29°22膝,30°以上16膝,平均18.9°。结果患者术前膝关节平均屈曲挛缩18.9°,术中除4例残留5°屈曲挛缩外,其余患者术中膝关节均能达到完全伸直。术后随访6～72个月,平均37个月,6例残留5～10°屈曲挛缩,余膝关节可达到完全伸直。术前内翻角6～34°,平均12.3°;术后测量股胫角170.3～175.6°,平均174.7°,其中2例残留内翻角〉3°。术中、术后发生并发症6例,其中内侧副韧带股骨起点损伤2例;髌骨弹响2例;脑栓塞及腔隙性脑梗塞各1例,经内科治疗后未遗留神经症状。均无皮肤坏死、切口感染及深部感染发生。结论软组织平衡是矫正膝关节内翻屈曲挛缩畸形的主要手段,良好合理的软组织平衡可使高度畸形的膝关节在TKA术后获得明显的功能恢复和畸形矫正。     

计算机导航辅助下微创膝关节单髁置换术的初步临床研究

目的探讨虚拟影像导航辅助下微创膝关节单髁置换的方法和疗效。方法在导航系统下进行小切口微创膝关节单髁置换术26例。统计切口大小、手术时间、出血量和48h引流量，进行HISS评分分析，测量下肢力线和关节活动度。结果在导航系统下顺利完成26例小切口微创膝关节单髁置换，手术切口大小为7—8cm，手术时间为70—90min，出血量为100-150mL和48h引流量80—150mL。术前HISS评分72分，术后2周为98分。术前髋膝踝角为5°-10°，术后2周为0°-200术前屈曲挛缩0°-10°膝关节活动度为100°-120°，术后2周屈曲挛缩0°-4°，膝关节活动度为125°-135°。26例均获随访，平均随访时间8．2个月，无感染、假体位置不良及髌股关节疼痛等并发症。结论计算机导航系统的应用解决了MIS-UKA操作中视野的局限，同时可以实时、动态地观察下肢力线变化、膝关节假体旋转对位和软组织韧带平衡情况，并提供几何学和形态学资料，对膝关节进行生物力学和解剖学的重建，提高了假体放置的精确性，使骨质和假体之间有了最大的贴合度，具有重要的临床价值。     

微创全膝关节置换术的早期临床疗效分析

目的比较不干扰股四头肌（QS）微创全膝置换术与标准全膝关节置换术的早期临床结果。方法2005年3月至2006年3月,采用QS微创全膝置换术完成26例单侧全膝关节置换术（QS组）,观察切口长度、手术时间、出血量、关节屈曲活动度,视觉模拟（VAS）疼痛评分、膝关节协会评分（KSS）、下肢胫股角和直腿抬高时间等,并与同期33例标准髌旁内侧入路TKA比较（标准组）。结果术后平均随访17个月（12～23个月）。平均切口长度QS组为（9．5±1．5）cm,标准组为（14．0±2．3）cm（P〈0．05）。止血带时间QS组为（83±16）min,标准组为（55±11）min（P〈0．05）。平均胫股角QS组为外翻（5．7±1．5）°,标准组为（6．0±1．4）°（P〉0．05）。VAS评分术后1、3和7dQS组明显低于标准组,术后6周VAS评分无差异。膝关节主动屈曲活动度术后1周QS组可达到（107±12）°,标准组为（95±11）°（P〈0．05）,术后6周和3个月组间差异有统计学意义（P〈0．05）,术后12个月平均屈曲度组间差异无统计学意义（P〉0．05）。直腿抬高术后1周QS组为23例（88％）,而标准组为21例（64％）（P〈0．05）。术后6周膝关节评分QS组为78±15,标准组为71±20（P〈0．05）。QS组1例出现有症状的深静脉血栓,标准组3例;QS组1例伤口愈合不良。所有病例未发现深部感染,神经血管损伤等并发症。结论采用QS微创全膝置换,术后疼痛轻,有利于早期伸膝功能和活动度的恢复,但手术技术要求高,应严格掌握手术适应证。     

全膝关节置换术后的手法松解

背景：全膝关节置换术后初期对部分屈曲角度不能超过90°的患者可能须进行麻醉下的手法松解，以改善关节活动度。本目的是评价全膝置换术后手法松解的治疗效果。方法：90例患者（113膝）因术后平均10周时患膝屈曲角度≤90。而进行了手法松解。分别于全膝关节置换术之前、手术、手法松解前、手法松解后即刻以及术后6个月、1年、3年、5年以量角器测量膝关节的屈曲角度。黑：90例患者中81例（90％）在手法松解后膝关节屈曲角度获得改善。膝关节平均屈曲角度在全膝关节置换术前102°，中皮肤缝合后111°，手法松解前70°。术后5年随访时膝关节屈曲角度较手法松解前平均提高35°（p〈0．0001，配对t检）。术后12周之内进行手法松解的患者与术后12周之后进行手法松解的患者相比，平均屈膝角度的改善程度无显著差，最终仍进行手法松解的患者其术前膝关节协会疼痛评分明显低于未进行手法松解的患者（更痛，p=0．0027）。结论手法松解可以改善全膝关节置换术后膝关节屈曲角度。术前疼痛明显的患者术后更趋向于须手法松解。可信水平：治疗性研究，Ⅲ级。进一步可信度参见作者介绍。     

全膝关节置换术后切口周围血供变化的研究

目的探讨全膝关节置换（TKA）术后切口周围血液供应的变化情况,以及膝关节不同屈曲角度对血供的影响。方法利用TSAH-100型近红外组织血氧参数无损伤监测仪,收集30例初次TKA患者术前及术后第1、3、7、14天膝关节位于0°,30°,45°,60°,90°时的切口周围的血氧饱和度。结果TKA术后14d内,患者切口周围的血供存在减低的变化曲线,术后第3天最低。随着关节屈曲角度的加大,切口周围的血供减低。结论TKA术后切口周围的血供减低存在切口愈合的风险,术后3d内关节屈曲角度应小于45°,术后1周内关节屈曲角度应小于60°。     

小切口与传统切口在全髋关节置换术中的临床疗效分析

目的比较外侧小切口和传统Gibson切口在THR中临床效果。方法2002年6月～2005年9月,采用小切口（n=47）和传统Gibson切口（n=50）行THR97例。记录手术时间,切口长度,术中、术后的出血总量,髋臼外展角度,髋臼前倾角,术后第1、3、6个月及最后次Harris评分。结果小切口组的手术时间为84.0±17.4min,传统切口组为90.0±19.8min（P〈0.05）;小切口组出血量为365.5±73.5ml,传统切口组485.8±114.6ml（P〈0.05）;小切口组术后X线片髋臼前倾角为23.5±3.3°,传统切口组为22.8±3.2°小切口组外展角为;46.5±6.2°,传统切口组为46.8±6.6°P〈0.05）。所有病人均获随访,平均随访19个月（12～30）。术后第1、3个月（随访时,小切口组的Harris评分为69.7±7.6、84.8±7.4分,传统切口组为57.4±7.3、70.6±7.3分（P〈0.05）;术后第6个月、末次随访时,小切口组的平均Harris评分分别为86.8±5.2、93.7±4.0分,传统切口组为84.0±4.8、92.2±4.0分（P〉0.05）。结论在全髋关节置换术中,采用小切口手术较传统切口手术具有创伤小,出血少,术后功能恢复快等优点,值得临床推广使用。     

膝关节屈曲90°连续缝合切口对全膝关节置换术治疗效果的影响

目的 比较膝关节屈曲90°连续缝合切口和膝关节伸直位连续缝合切口在全膝关节置换术（total knee arthroplasty,TKA）中的应用效果。方法 选择2017年1月至2019年1月我院收治的122例拟行TKA手术的病人,采用随机数字表法将病人分为两组,对照组（61例）采用膝关节伸直位连续缝合切口,观察组（61例）采用膝关节屈曲90°连续缝合切口。比较两组病人切口长度、缝合时间、手术时间、术后失血量、直腿抬高活动时间、屈膝90°活动时间、拆线时间、住院时间、Hollander切口愈合（Hollander wound evaluation scale,HWES）评分、美国纽约特种外科医院（American hospital for special surgery,HSS）膝关节评分、Rasmussen评分、膝关节活动范围（ROM）、疼痛视觉模拟量表（visual analogue scale,VAS）以及术后并发症差异。结果 两组切口长度、缝合时间、手术时间、术后失血量、直腿抬高活动时间、拆线时间、住院时间、HWES评分、并发症发生率比较,差异均无统计学意义（P均＞0.05）。观察组屈膝90°活动时间短于对照组,术后24 h、48 h的HSS评分、Rasmussen评分高于对照组,膝关节ROM大于对照组,术后24 h、48 h、72 h的VAS评分均低于对照组,差异均有统计学意义（P均＜0.05）。结论 膝关节屈曲90°连续缝合切口可减轻术后早期疼痛程度,利于膝关节功能恢复,且不增加并发症发生风险。     

个体化设置股骨开髓点与外翻角在股骨外弓患者人工全膝关节置换术中的应用

目的：探讨外移股骨开髓点并设置个性化股骨外翻角能否改善合并股骨外弓的人工全膝关节置换术（total knee arthroplasty,TKA）患者下肢力线。方法：2016年3月至2018年10月,收治50例（55膝）合并股骨外弓拟行TKA的膝内翻畸形的骨关节炎患者。男10例,女40例;年龄63.1~80.5（67.8±5.8）岁。单侧45例,双侧5例。55膝的骨关节炎分期均为Kellgren-Lawrence分级Ⅲ-Ⅳ级,病程2~10年。术前特种外科医院（Hospital for Special Surgery,HSS）评分疼痛（15.20±3.52）分,功能（8.30±2.96）分,活动度（10.15±2.85）分,肌力（4.20±1.95）分,屈曲畸形（5.50±3.05）分,稳定性（6.15±2.20）分,总分（47.93±3.39）分。股骨外弓角6.4~16.7（10.63±2.29）°,胫股角7.4~12.6（12.04±3.59）°,解剖股骨远端外侧角83.10~91.20（84.55±1.66）°,膝关节中心至下肢力线距离2.01~6.00（3.57±1.12） cm。置换术中均通过个性化设置股骨开髓点与外翻角,获得良好下肢力线。结果：术前股骨开髓点外移距离0.24~0.74（0.54±0.10） cm,股骨内外髁间距离6.86~8.12（7.27±0.27） cm。术前股骨外翻角（valgus correction angle,VCA）7.20~13.80（9.38±1.38）°;矫正后VCA''6.10~9.50（7.36±0.82）°。50例患者均获随访,时间3~36（13.5±5.8）个月。术后患者均获得良好的膝关节功能,术后3个月HSS评分疼痛（25.30±3.05）分,功能（18.25±2.05）分,活动度（16.05±0.75）分,肌力（6.20±2.10）分,屈曲畸形（8.80±1.85）分,稳定性（8.20±1.75）分,总分90.00~93.00（91.82±0.98）分,总分较术前提高（t=1.728,P=0.038）。术后X线片复查示,假体没有松动、下沉及骨溶解等征象发生;术后第2天负重位X线片上胫股角1.30~4.90（2.53±0.83）°,解剖股骨远端外侧角87.50~91.30（88.73±0.86）°,膝关节中心至下肢力线距离0.02~1.20（0.23±0.05） cm,均较术前改善（t=2.415,P=0.019;t=1.496,P=0.041;t=1.912,P=0.033）。结论：合并股骨外弓的TKA中通过外移股骨开髓点并设置个性化股骨外翻角能获得良好的下肢力线和膝关节功能。     

Hyperbaric Oxygen and N-Acetylcysteine Treatment in L-Arginine-Induced Acute Pancreatitis in Rats

ABSTRACT

Background: This study was designed to evaluate the combined effects of hyperbaric oxygen (HBO) and N-acetylcysteine (NAC) on acute necrotizing pancreatitis in rats. Methods: Experiments were performed in 50 male Wistar rats, which were divided into five groups (N = 10 for each group). The first group received normal saline (0.9% NaCl) intraperitoneal and served as the control group. In the second group, acute pancreatitis was induced by 3.2-g/kg body weight L-arginine intraperitoneal twice at an interval of 1 hr, which has been shown previously to produce severe necrotizing acute pancreatitis. In the third group, NAC treatment (1000 mg/kg) was given after 1 hr of the induction of acute pancreatitis twice 24 hr apart. In the fourth group, animals received HBO, 6 hr after the induction of pancreatitis twice 12 hr apart. In the fifth group, animals received together NAC as in Group 3 and HBO treatment as in Group 4. Groups 1, 2, and 3 were left under normal atmospheric pressures. Twelve hours after last treatment, the animals were killed by exsanguinations. Blood samples were studied for amylase, calcium, and lactate dehydrogenase (LDH), pancreatic histology, pancreatic tissue malondialdehyde, superoxide dismutase, and glutathione levels. Results: Acute pancreatitis is reduced by the treatment of NAC, HBO, NAC + HBO. HBO + NAC groups performed statistically the best in preventing L-arginine-induced acute necrotising pancreatitis. Conclusions: NAC especially combined with HBO, decreases oxidative stress parameters, serum amylase, calcium, and LDH levels, as well as histopathologic score.     

Invasive cholangiocarcinoma identified in congenital biliary dilatation in a 3-year-old boy

We herein report a 3-year-old male demonstrating invasive cholangiocarcinoma (CC) associated with congenital biliary dilatation (CBD). A 3-year-old Japanese boy was admitted to our hospital with abdominal pain and vomiting. Computed tomography and magnetic resonance imaging demonstrated a dilated extrahepatic bile duct. A diagnosis of Todani's type 1a CBD was made.Intraoperative cholangiography demonstrated the presence of pancreaticobiliary maljunction but could not reveal any tumor lesion in the bile duct. The excision of extrahepatic bile duct and gallbladder and Roux-en-Y hepaticojejunostomy were performed. On gross inspection, we could not find any tumor lesion in the resected specimen.However, the postoperative histopathologic examinations confirmed the presence of well-differentiated tubular adenocarcinoma with lymphovascular invasion. Most of the carcinoma remained within the mucosal layer, and the carcinoma was identified at both the distal and proximal surgical margins of the bile duct. We scheduled additional surgery to eradicate the residual carcinoma, but informed consent for the extra surgery could not be obtained.A close follow-up with abdominal computed tomography has been going on without either additional surgery or adjuvant chemotherapy about for 1 year. The patient has so far been clinically doing well without any obvious symptoms of recurrent disease. To our knowledge, this report is the youngest case of CC associated with CBD.     

无锡地区正常人群QCT法测定腰椎骨密度分析

目的了解无锡地区腰椎骨密度变化特点。方法采用QCT法测量626例正常人腰椎骨密度值,按5岁一个年龄组分性别进行统计学分析。结果男、女腰椎骨密度峰值均在26~30岁年龄组。男性峰值为133.42±12.69mg/cm3,女性峰值为136.88±10.69mg/cm3;50岁之前骨密度值女性高于同年龄组男性,而50岁之后女性低于男性。结论掌握了无锡地区正常人各年龄组腰椎骨密度正常数据及变化特征,为无锡地区腰椎骨密度正常值的建立和骨质疏松研究积累资料。     

Discrepancies in Serum Albumin Measurements Vary by Dialysis Modality

Background.?Serum albumin level is an important prognostic marker in patients with chronic renal failure. However there are discrepancies in the methods of estimation of serum albumin. The objective of this study is to evaluate the magnitude of the discrepancy in the serum albumin levels as measured by Bromcresol Green (BCG) and Bromcresol Purple (BCP) dye methods in patients on hemodialysis (HD) and peritoneal dialysis (PD) and to ascertain the clinical determinants of the discrepancy (ΔSA = BCG-BCP; g/dL) in each of the modalities. Method.?We measured serum and plasma albumin levels by BCG and BCP methods in 19 adult HD patients and 18 adult PD patients treated in the dialysis units of the University of Colorado Health Sciences Center. Similar measurements were performed in 10 normal adult subjects. In all groups, paired blood samples were taken to estimate the albumin in both serum and plasma. Nephelometry (NM) was subsequently performed on the serum of 13 of the HD patients, 14 of the PD patients, and each of the 10 normal subjects. Results.?We found that for both the dye methods serum and plasma albumin levels are almost identical in each of the three subject groups. In the normal subjects serum albumin estimated by BCP is in good agreement with NM values but BCG overestimates the albumin levels. In the PD group the discrepancy between the BCG and BCP (ΔSA) is statistically significant with the BCG averaging 0.59 ± 0.12 g/dL more than the BCP. The BCG values are closer to those obtained by the “gold standard”, NM. In the HD group the ΔSA is significantly (p<0.001) less than in the PD group (0.34 ± 0.11 g/dL). As for PD, BCG values are closer to NM values. Increasing age, female gender, and higher dialysis adequacy are associated with higher ΔSA in the HD but not in the PD group. Utilizing linear regression analysis we developed equations for each dialysis modality to convert albumin measurements from one method to the other. Conclusion.?We confirm that a discrepancy exists between the commonly used dye methods (BCG and BCP) for serum albumin estimation. This discrepancy is significantly lower in HD patients than in PD patients. Nephrologists should be aware of this discrepancy and appropriate corrections should be made during quality improvement analysis.     

Polycyclic aromatic hydrocarbons present in cigarette smoke cause bone loss in an ovariectomized rat model

A number of epidemiological studies have suggested that cigarette smoking is a risk factor for osteoporosis. Benzo(a)pyrene (BaP) and 7,12-dimethylbenz(a)anthracene (DMBA) are polycyclic aromatic hydrocarbons (PAHs) found in the tar fraction of cigarette smoke, as well as in car exhaust and furnace gases. We hypothesized that BaP and DMBA are responsible, through interaction with the aryl hydrocarbon receptor (AhR), for the bone loss and fragility seen in smoking-related osteoporosis. In this study four groups of 9-month-old Sprague-Dawley rats were examined. An intact group served as controls. A second control was the ovariectomized (ovx) group. The third group (ovx + E₂) were ovariectomized and also given a continuous basal dose of estrogen by implanted estrogen pellet (0.085 mg of 17β-estradiol per rat). The fourth group (ovx + E₂ + BaP/DMBA) was ovariectomized with an estradiol pellet, and received subcutaneous injections of 250 μg/kg of BaP/DMBA weekly for 15 weeks. The loss of ovarian function allowed the study of a direct effect of BaP/DMBA on bone while the concomitant estrogen repletion prevented ovx-related bone loss. Dual-energy X-ray absorptiometry (DEXA), histomorphometry, image analysis, and mechanical testing were used to determine the effect of the treatments on bone. The DEXA results showed a significant (p < 0.05) decrease in bone mineral density compared with intact controls with both ovx alone and with ovx + E₂ + BaP/DMBA treatment. The ovx + E₂ rats were similar to the intact controls. The osteoid parameters showed a significant increase (p < 0.05) with BaP/DMBA addition vs. intact controls, mimicking the ovx rats. The ovx + E₂ rats had osteoid parameters comparable to those of intact rats. Bone connectivity was decreased in the ovx and ovx + E₂ + BaP/DMBA animals. Connectivity of the ovx + E₂ rats was comparable to that of intact animals. A decrease in failure force was seen in three-point bending for the ovx + E₂ + BaP/DMBA group and in vertebral compression in both the ovx and ovx + E₂ + BaP/DMBA groups vs. intact controls. The mechanical properties of the ovx + E₂ rats were similar to those of intact rats. These results demonstrate that BaP/DMBA causes a loss of bone mass and bone strength, possibly through an increase in bone turnover. This is the first in vivo study linking environmental toxicants, found in the tar fraction of cigarette smoke and in urban air pollution, to loss of bone mass and strength in estrogen-replete ovx rats.     

Once Daily Calcineurin Inhibitor Monotherapy in Pediatric Liver Transplantation

This report describes a group of pediatric liver transplant recipients who have undergone once daily calcineurin inhibitor (CNI) monotherapy at Children's Memorial Hospital, Chicago, between January 1, 2001 and November 30, 2008. We defined success as normal liver enzymes at 1 year after dose change, with normal enzymes throughout all follow‐up. Patients who did not meet the set criteria or had lost an organ to chronic rejection were not considered for this therapeutic strategy. There were 147 patients in our organ transplant tracking record (OTTR) who were ≥ 5 years post liver transplant. Of these, 56 underwent reduced dose, once daily CNI monotherapy. Patients who met the set criteria were placed on once daily calcineurin inhibitor at half their previous dose. Fifty patients successfully achieved this dose change, while six patients failed at a mean of 3.7 ± 3.2 months following the dosing change. The mean interval from transplant was significantly longer in those patients who were successful compared to those who failed dose change (p < 0.05). Importantly, there have been no graft losses. Reduced dose, once daily CNI monotherapy is safe in carefully selected recipients, with a longer interval post liver transplantation increasing the likelihood of success.     

Braun吻合对胰十二指肠切除术后并发症影响的Meta分析

目的系统评价Braun吻合(BEE)对胰十二指肠切除术(PD)术后并发症的影响,重点分析对术后胃排空障碍(DGE)的影响,以探讨BEE的价值和意义,为临床应用提供循证医学方面的客观依据。方法计算机检索Cochrane Library、Pub Med、Embase、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普和万方数据库关于BEE的相关文献,检索时间均从建库至2016年3月。按Cochrane系统评价的方法评价纳入研究的质量,使用Rev Man 5.3软件对研究资料进行统计分析。结果共纳入10篇文献,总计1544例患者。Meta分析结果显示:所有纳入文献中BEE组术后总并发症发生率(OR=0.61,95%CI=0.47~0.81,P=0.0006)和术后总DGE发生率(OR=0.36,95%CI=0.19~0.67,P=0.001)要低于非BEE组。同样,采用国际胰腺外科研究学组(ISGPS)标准的8篇文献中,BEE组总DGE发生率(OR=0.36,95%CI=0.18~0.72,P=0.004),B级DGE发生率(OR=0.36,95%CI=0.11~1.17,P=0.09)和C级DGE发生率(OR=0.28,95%CI=0.16~0.48,P0.01)均要低于非BEE组。结论 Meta分析显示,BEE可以降低PD术后总并发症的发生率和DGE的发生率,尤其是可以降低C级DGE的发生率。     

术中神经监测技术在脊柱手术中的临床应用

术中神经监测(Intraoperative Neuromonitoring,IOM)伴随着科技和麻醉技术的发展,逐渐被推广并广泛使用,尤其在脊柱手术对脊髓和神经功能的有效监测,降低了手术风险。但在手术的施行过程中,引起监测信号变化的影响因素非常多。本文将对时下常用的几种监测方式进行回顾,并进一步讨论和分析在脊柱手术的过程中,监测信号变化的原因。