人工股骨头置换治疗老年股骨颈骨折—骨水泥与非骨水泥型假体的比较

目的对比骨水泥型和非骨水泥型两种假体在治疗股骨颈骨折中的应用差别。方法回顾了本机构近3年65岁以上股骨颈骨折实施人工股骨头置换的病例共221例,按应用骨水泥型和非骨水泥型假体进行分组。随访时间为1、3、6、12个月。比较两组间的手术时间、出血量、并发症发生率、术后下地时间、髋关节Harris评分等。结果两组在手术时间、术中并发症及下地时间存在差异,出血量、输血量、术后并发症及功能评分无差异。结论两种假体都能很好的应用于股骨颈骨折的治疗,需注意围手术期并发症的发生。     

水泥与非水泥股骨头置换治疗高龄股骨粗隆间骨折的临床疗效对比

[目的]对比观察骨水泥型与生物加长柄型股骨头置换术治疗高龄不稳定性股骨粗隆间骨折的临床疗效。[方法]对本院采用股骨头置换治疗的36例高龄不稳定性股骨粗隆间骨折患者进行回顾性分析,其中骨水泥组16例,非水泥组20例。观察记录两组手术时间、术中术后出血量、术后大腿疼痛、患者满意度、死亡率、早期并发症和髋关节Harris评分。对两组指标进行统计分析比较。[结果]两组患者在手术时间、术中术后出血量、术后大腿疼痛、术后早期并发症发生率差异无统计学意义,末次随访时两组Harris评分均显著进步,骨水泥组下地时间更早。非水泥组粗隆间骨折愈合良好,两组近期随访无假体移位、松动及下沉。[结论]两种假体治疗高龄不稳定性股骨粗隆间骨折临床疗效均满意,骨水泥型假体下床早,有利于早期功能恢复,可减少术后并发症,提高生活质量。     

生物型与骨水泥型股骨头置换治疗高龄股骨颈骨折的对比

目的探讨生物型股骨假体与骨水泥型股骨假体在治疗高龄股骨颈骨折中的应用。方法将海南省人民医院骨科2008年1月至2013年1月间收治的155例符合标准的高龄股骨颈骨折患者分为生物型组和骨水泥组,收集病历资料并进行随访,比较分析两组病例的均衡性、有效性及安全性。结果所有155例患者均安全度过围手术期,并获得1~5年,平均34个月的随访,两组均取得96%以上的优良率,两组间比较差异无统计学意义(P0.05);两组患者在住院时间上比较差异无统计学意义(P0.05),但在手术时间、术中出血量及术后并发症等方面差异有统计学意义(P0.05)。结论生物型与骨水泥型股骨头置换均是治疗高龄股骨颈骨折的有效方法,但生物型假体在临床安全性上优于骨水泥型。     

骨水泥型人工股骨头置换治疗高龄股骨颈骨折

目的探讨骨水泥型人工股骨头置换治疗高龄股骨颈骨折的近期疗效。方法对30例高龄股骨颈骨折患者采用骨水泥型人工股骨头置换治疗。根据Harris评分法评估临床效果。结果 30例均获得随访12~24个月。患者髋关节功能均恢复良好,未发现感染、髋内翻、假体松动下沉、关节脱位者。髋关节功能根据Harris评分,优17例,良9例,中4例,优良率86.67%。结论应用骨水泥型人工股骨头置换治疗高龄股骨颈骨折患者手术风险小、费用低、并发症少,术后可早期下床活动,提高了生活质量,疗效可靠。     

小切口人工股骨头置换治疗80岁以上股骨颈骨折

目的 探讨前外侧小切口人工股骨头置换治疗高龄股骨颈骨折的治疗效果.方法 自2004年8月～2008年12月,对38例80岁以上移位型股骨颈骨折患者施行人工股骨头置换治疗,A组:前外侧小切口入路,18例,B组:后外侧入路,20例.比较两组切口长度、手术时间、术中出血量、输血量、术后12 h引流量以及并发症.结果 随访6～10周,平均8周.手术持续时间相似,A组切口比B组小,A组术中出血量、术后12 h引流量、输血量明显低于B组.结论 小切口人工股骨头置换具有出血少、创伤小、少输血、恢复快的优点,尤其适合高龄股骨颈骨折患者.     

骨水泥型半髋置换治疗高龄股骨颈骨折的疗效分析

目的探讨骨水泥型半髋置换治疗高龄股骨颈骨折患者的临床疗效。方法回顾性分析在我院骨科接受手术治疗的21例高龄股骨颈骨折患者,平均年龄84岁。术前按Garden分型,Ⅲ型14例;Ⅳ型7例。所有患者均采用骨水泥型半髋置换治疗。结果患者手术时间平均为60 min,术后均无神经、血管损伤和假体周围骨折等并发症发生。术后随访6～24个月,平均14个月,按Harris评分标准进行功能评定:优16例,良3例,可2例,优良率90.5%。结论骨水泥型人工半髋置换手术治疗高龄股骨颈骨折创伤小;术后髋关节功能恢复良好;可早期下床活动;明显提高患者术后生活质量;临床效果满意。     

人工髋关节置换治疗高龄非稳定性股骨转子间骨折

目的 探讨人工髋关节置换治疗高龄非稳定性股骨转子间骨折的疗效.方法 23例高龄非稳定性股骨转子间骨折患者,6例行全髋关节置换,17例行人工双极股骨头置换.所有病例均使用人工加长柄型骨水泥假体.结果 23例均获随访,时间6～36个月,未发现假体松动、脱位、下沉及感染,髋关节功能接近伤前水平,基本能生活自理,其中3例类风湿性关节炎患者术后关节功能较术前明显改善.结论 人工髋关节置换治疗高龄非稳定性股骨转子间骨折是一种效果确切的治疗方法,可早期下地锻炼,减少并发症和病死率,提高老年人的生存质量.     

人工股骨头置换术治疗高龄股骨粗隆间不稳定型骨折临床观察

目的分析人工股骨头置换术治疗高龄股骨粗隆间不稳定型骨折患者的临床效果。方法对44例70岁以上高龄股骨粗隆间骨折患者实施骨水泥型人工股骨头假体置换术,观察治疗效果及随访情况。结果 44例均顺利完成置换手术,手术时间58~86 min,术中出血量210~450 m L,术后住院时间8~14 d。患者术后均获随访6~24个月。依据Harris髋部评分标准,术后髋关节功能优良率88.64%(39/44)。随访期间未发生假体松动、假体周围骨折、关节感染等并发症。结论对于高龄股骨粗隆间不稳定型骨折,实施人工股骨头置换术,创伤小,并发症少,能促进术后早期功能锻炼,提高术后功能恢复效果。     

高龄股骨颈骨折患者的手术治疗分析

目的评价70岁以上高龄股骨颈骨折患者AO中空加压螺钉内固定和人工股骨头置换的治疗效果。方法对54例70岁以上高龄股骨颈骨折患者分别进行AO中空加压螺钉内固定和人工股骨头置换治疗,其中AO中空加压螺钉内固定20例、人工股骨头置换治疗34例,术后平均随访时间2.8年,分别比较两组麻醉时间、手术时间、出血量、术后引流量、术后并发症和Harris评分。结果人工股骨头置换组术后优良率76.5%显著高于内固定术组65.0%(P<0.05),术后并发症少、关节功能好。内固定组麻醉时间短,出血量、术后引流量均少于人工股骨头置换组(均P<0.05)。结论高龄股骨颈骨折的术式选择应结合患者的年龄、骨折类型、全身状况等综合考虑,70岁以上老年股骨颈骨折患者应优先选择人工股骨头置换术。     

股骨头置换和内固定治疗高龄股骨颈骨折疗效比较

目的比较股骨头置换术与切开复位内固定术治疗高龄患者股骨颈骨折的疗效,探讨股骨头置换术在股骨颈骨折治疗中的意义。方法对2003年3月至2007年8月我院采用股骨头置换术治疗的18例股骨颈骨折患者与23例采用内固定术治疗（闭合或切开复位）的患者进行随访,从手术时间、术中出血量、术中x线暴露次数、术后负重时间、术后再手术率及术后关节功能等方面比较两组的差异。结果股骨头置换组和内固定组在手术时间、术中出血量上无显著差异,但股骨头置换组X线暴露次数、术后负重时间、再手术率及关节功能恢复方面差异显著。结论股骨头置换术治疗高龄股骨颈骨折疗效优于内固定术。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.