应用LCU股骨柄假体行全髋置换术的早期疗效

目的探讨应用LCU股骨柄假体行生物学固定型全髋关节置换术(total hip arthroplasty,THA)的早期疗效。方法回顾性分析2011年8月至2013年4月采用LCU股骨柄假体行THA术85例(90髋),男26例(28髋),女59例(62髋);年龄19~83岁,平均55岁;平均体重指数(23.33±3.13)kg/m2。单髋80例,双髋5例。发育性髋关节发育不良34例(38髋),股骨颈骨折14例(14髋),股骨头坏死17例(17髋),原发性髋关节骨关节炎18例(19髋),类风湿性髋关节炎1例(1髋),髋关节结核1例(1髋)。股骨侧假体均采用LCU股骨柄假体。髋臼采用陶瓷-陶瓷界面者78髋,陶瓷-聚乙烯12髋。对术后及随访时的影像学资料进行分析,末次随访时采用髋关节Harris评分标准评定疗效。结果 82例(87髋)患者术后获得随访,随访12~32个月,平均19个月,3例失访。术前髋关节功能Harris评分为(33.73±3.21)分,末次随访时髋关节功能Harris评分改善至(92.84±4.47)分,与术前比较差异有统计学意义(t=242.69,P0.01)。末次随访时大腿轻度疼痛1例,中度疼痛1例,无重度疼痛。末次随访时无一例出现骨溶解、假体松动,按Engh标准评定:所有获访者均获骨长入固定,其中股骨侧假体诊断为骨性固定者85髋,诊断为纤维性稳定者1髋。假体下沉小于2 mm者1髋,其余均无假体下沉。结论 LCU股骨柄假体行生物学固定型THA的早期疗效满意。     

解剖型羟基磷灰石喷涂Ribbed股骨柄和臼杯全髋关节置换术患者的8年随访观察

目的探讨解剖柄羟基磷灰石(HA)涂层Ribbed髋假体行全髋关节置换(THA)术后的中期疗效。方法自1999年6月至2002年5月,采用解剖柄HA涂层Ribbed髋假体施行非骨水泥固定THA手术患者126例,获随访71例84髋,男29例,女42例;年龄39～76岁,平均58岁。术前诊断包括股骨头缺血坏死18例(双侧9例),股骨颈骨折23例,髋关节发育不良14例(双侧4例),髋关节骨关节炎16例。术后7～10d,6个月和每年1次随访X线拍片,对髋关节功能依末次随访状况行Harris评分。结果依末次随访时取Harris评价法,获85～100分39例(46髋),75～84分32例(38髋)。轻微大腿痛3例3髋(4.2%),X线片显示轻微骨吸收3例(3髋)(4.2%),无一患髋需行翻修术。术后1～2年内股骨柄下沉1.5～2mm者2例(3髋),下沉2～2.5mm者1例(1髋),此后再无发现明显下沉患者。术后6个月至3年X线显示于HA涂层部位近段骨吸收于Gruen5、6区2例(2髋)和3、5区1例(1髋),所有患者的骨锚固和松质骨、皮质骨骨密度轻度增高现象,显示髋假体-骨固定良好。结论解剖柄HA涂层Ribbed髋假体的初始固定能促进早期骨长入达到生物固定目标,并阻遏聚乙烯磨屑髓内迁徙致大腿痛和骨吸收,其中期疗效肯定。     

锥形生物型股骨柄在股骨髓腔狭窄患者全髋关节置换术中的应用

目的 探讨锥形生物型股骨柄假体在股骨髓腔狭窄患者全髋关节置换术(THA)中的置入特点与临床疗效. 方法 2005年5月至2009年8月采用锥形生物型股骨柄假体对22例(23髋)股骨髓腔狭窄患者行THA,男2例2髋,女20例21髋;年龄20 ～ 60岁,平均37.6岁.股骨髓腔峡部直径平均为7.6 mm(7 ～8 mm).术前仔细测量股骨髓腔狭窄的直径与位置,选择合适柄型的生物型全髋关节假体与之匹配,其中选择三锥度生物型股骨直柄18髋,二锥度生物型股骨直柄5髋.随访时采用Harris髋关节评分标准评估患髋功能,X线片观察假体生物压配和固定效果. 结果 22例患者术后获28 ～ 72个月(平均38.5个月)随访.19髋术中选择的假体规格与术前设计一致,4髋术中选择的假体规格较术前设计小一号.22例(23髋)患者术后均即刻实现了股骨柄的生物压配.术后3个月X线片示均获广泛性骨长入,按Engh固定/稳定标准评定固定效果均为骨性固定.术后6个月Harris髋关节评分由术前平均(46.2±6.2)分改善至(90.2±5.1)分,末次随访时仍维持在(92.1±3.2)分.1例患者术后3d发生股骨头前脱位,经手法复位后回纳. 结论 对于生理性股骨髓腔狭窄患者,术中扩髓有限,周密而严谨的术前计划可准确地判断假体型号与置入位置,采用锥形生物型股骨柄行THA可取得良好疗效.     

羟基磷灰石涂层股骨柄假体全髋关节置换术的中期疗效

目的 评价羟基磷灰石涂层股骨柄假体伞髋关节置换术的中期疗效.方法 2000年2月至2001年2月,采用U2钛合金羟基磷灰石涂层股骨柄假体行非骨水泥全髋关节置换术65例(70髋),男20例,女45例;年龄40～82岁,平均63岁.术前诊断:股骨颈骨折30例,髋关节骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿髋关节炎2例,髋关节融合术后1例.分别于术后1周、3个月、6个月随访,以后每年随访1次,对髋关节功能(Harris评分)和X线片进行复查.结果 4例死于癌症,余61例(66髋)获7～8年随访,平均7.5年.末次随访时髋关节Harris评分85～100分,平均96分.3髋(4.5%)出现轻度大腿痛,无一髋需行翻修术治疗.术后1年内假体下沉小于1.5 mm者7髋,此后未再出现假体下沉.术后3～6个月在Gruen 2区和6区近段羟基磷灰石涂层部位出现典型的骨锚固征及松质骨和皮质骨密度增高影像.此后所有患者包括年龄大于70岁和Dorr C型髓腔者均无柄端周围的骨质增生或"底座征",也尤股骨近段或远段髓内骨溶解及假体松动.按Engh标准评定全部患者均获骨性固定.结论 羟基磷灰石涂层能增强股骨柄假体的初始固定,促进早期骨长入和生物学固定,阻止聚乙烯磨屑的髓内迁移和远段髓内骨溶解,用于非骨水泥全髋置换术中期疗效满意.     

羟基磷灰石涂层股骨柄假体全髋关节置换术的中期疗效

目的 评价羟基磷灰石涂层股骨柄假体伞髋关节置换术的中期疗效.方法 2000年2月至2001年2月,采用U2钛合金羟基磷灰石涂层股骨柄假体行非骨水泥全髋关节置换术65例(70髋),男20例,女45例;年龄40～82岁,平均63岁.术前诊断:股骨颈骨折30例,髋关节骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿髋关节炎2例,髋关节融合术后1例.分别于术后1周、3个月、6个月随访,以后每年随访1次,对髋关节功能(Harris评分)和X线片进行复查.结果 4例死于癌症,余61例(66髋)获7～8年随访,平均7.5年.末次随访时髋关节Harris评分85～100分,平均96分.3髋(4.5%)出现轻度大腿痛,无一髋需行翻修术治疗.术后1年内假体下沉小于1.5 mm者7髋,此后未再出现假体下沉.术后3～6个月在Gruen 2区和6区近段羟基磷灰石涂层部位出现典型的骨锚固征及松质骨和皮质骨密度增高影像.此后所有患者包括年龄大于70岁和Dorr C型髓腔者均无柄端周围的骨质增生或"底座征",也尤股骨近段或远段髓内骨溶解及假体松动.按Engh标准评定全部患者均获骨性固定.结论 羟基磷灰石涂层能增强股骨柄假体的初始固定,促进早期骨长入和生物学固定,阻止聚乙烯磨屑的髓内迁移和远段髓内骨溶解,用于非骨水泥全髋置换术中期疗效满意.     

初次混合式全髋关节置换术骨水泥柄的生存率分析

目的 探讨骨水泥柄全髋关节置换术后中期临床疗效.方法 接受骨水泥柄髋关节置换患者148例167髋,男95例106髋,女53例61髋;年龄28~87岁,平均62.8岁;体重45.2~87.4 kg,平均57.2 kg;身高146~184cm,平均161.5cm;平均体重指数21.4.临床疗效以Harris评分为标准,根据影像学资料评估股骨柄假体位置、骨水泥壳、假体周围骨重塑和骨溶解发生情况.以股骨假体无菌性松动和任何原因所致的假体翻修为终点,对假体生存率采用Kaplan-Meier分析.结果 106例114髋获得随访,随访时间6.5~9.5年,平均8.1年.术前Harris评分8~54分,平均42分;末次随访时76~100分,平均94分.无一例发生无菌性松动及假体翻修.6髋假体柄平均下沉1.83mm.16髋(14%)股骨侧出现<1mm的影像学透亮线,9髋(8%)Gruen Ⅰ区和Ⅶ区出现局灶性骨溶解所致斑点样影像学透亮区.106髋(93%)股骨侧有不同程度的皮质变薄或皮质松质骨化,均位于Ⅶ区.假体生存率为100%(95%可信区间.0.95-1.00).结论 采用第三代骨水泥技术固定股骨柄,可取得较好中期临床效果,但仍存在骨溶解、股骨近端皮质骨吸收重塑等潜在问题.     

混合型初次全髋关节置换术中骨水泥柄10年以上的随访研究

目的回顾性分析混合型初次全髋关节置换术（THA）中骨水泥柄的临床和影像学疗效及其相关影响因素。方法对1999年1月至2001年12月期间接受混合型初次THA治疗髋部疾病的患者126例（135髋）进行至少10年的随访。观察Harris评分、股骨假体位置、骨水泥壳及其周围骨质变化。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动导致翻修及单纯骨溶解病灶清除植骨术为随访终点。结果共有79例（85髋）获得10年以上随访。Harris评分由术前（44.5±18.8）分提高至末次随访时（92.1±5.6）分。截至随访终点,在Gruen 1区观察到2髋发生骨溶解,7区4髋发生骨溶解现象。共有4例（4髋）接受翻修手术,其中1例男性患者因骨溶解致髋臼假体松动,同侧股骨近端骨溶解,同期行右髋臼侧翻修及股骨侧骨溶解病灶清除植骨术。另3例因髋臼假体松动行髋臼侧翻修术,影像学及术中见股骨假体稳定。以无菌性松动为随访终点,股骨假体生存率为100%;以无菌性松动翻修、单纯骨溶解病灶清除植骨术为随访终点,股骨假体生存率为98.8%（95%可信区间,12.23~12.32）。结论混合型初次THA术中骨水泥假体的远期生存率令人满意;采用第3代骨水泥技术固定的股骨柄取得与现代非骨水泥假体柄相近的远期生存率。     

大转子延长截骨在全髋关节翻修术中应用的临床评价

目的 回顾性研究采用大转子延长截骨(extended troehanteric osteotomy,ETO)行全髋关节翻修术后股骨柄的位置变化,评价ETO在股骨假体稳定件髋关节翻修术中的作用.方法 1998年1月至2007年6月,采用ETO对股骨柄或骨水泥壳固定稳定性全髋关节33例33髋进行翻修.翻修术后采用Harris评分和MOMAC评分评估髋关节功能,摄动态X线片观察截骨块愈合、假体位置改变及股骨柄与股骨髓腔匹配等情况.结果 25例随访12～103个月,平均63个月.Harris评分由术前平均38.4分,提高到末次随访时88.7分;WOMAC评分由术前平均56.2分,降至末次随访时42.8分.大转子截骨块均在术后4～10个月骨性愈合.3例发生股骨柄下沉.平均3.4mm.股骨柄假体出现外翻、内翻各1例.无术中或术后骨折、钢丝断裂、感染、假体周围骨溶解以及异位骨化发生.术后关节脱位1例.结论 对假体固定稳定性股骨柄进行翻修,采用ETO有利于假体的安全取出,术后截骨块愈合率高,延长截骨不影响假体稳定性.股骨柄下沉、位置改变、截骨块骨折等并发症发生率低.     

生物型全髋关节置换术治疗伴有股骨头颈短缩的髋臼内陷症

目的 探讨生物型全髋关节置换术(THA)治疗伴有股骨头颈短缩的髋臼内陷症的手术技巧和疗效.方法 回顾性分析2008年8月至2012年3月采用THA治疗的15例(17髋)伴有股骨头颈短缩畸形的髋臼内陷症患者资料,男6例6髋,女9例11髋;年龄21 ～68岁,平均45.6岁.髋臼内陷症按Dunlop诊断标准分度:轻度1髋,中度11髋,重度5髋.股骨头颈短缩程度:轻度短缩5髋,中度短缩8髋,重度短缩4髋.术后随访行X线片检查观察假体与骨界面骨愈合的情况,采用髋关节Harris评分标准评定患髋功能. 结果 15例患者术后获10 ～ 46个月(平均28.5个月)随访.15例患者17髋术后均立即实现了髋臼及股骨柄的生物性压配.术后3个月X线片显示均获广泛性骨长入,达骨性固定.末次随访时无假体松动和髋臼再次内陷.术后6个月髋关节Harris评分由术前平均(43.1±4.8)分改善至(91.2±5.2)分,末次随访仍维持在(92.5±3.1)分,术后6个月、末次随访时分别与术前比较差异均有统计学意义(P＜0.05). 结论 生物型THA治疗伴有股骨头颈短缩的髋臼内陷症疗效良好,术中操作要点是选择短头试模进行髋关节复位,在保持髋关节张力情况下对髋关节囊及周围软组织挛缩由里向外依次分层松解.     

股骨大转子延长截骨在假体稳定股骨柄翻修中的应用

目的 评估大转子延长截骨在股骨假体固定稳定型全髋关节翻修术中应用的中期临床效果.方法 1998年1月至2005年6月对27例患者(27髋)采用大转子延长截骨对股骨柄和(或)骨水泥壳固定稳定的全髋关节翻修.临床随访评估包括Harris评分和WOMAC评分,术前Harris评分平均42.7分,WOMAC评分平均55.6分;影像学评估包括术后拍摄X线片,对比观察截骨块愈合时间、是否存在截骨延迟愈合或不愈合,截骨块是否发生移位以及假体是否下沉等.结果 共19例患者(19髋)获得随访,平均随访时间5.3年.无一例发生术中或术后骨折.术后Harris评分平均87.3分,WOMAC评分平均46.3分.所有患者大转子截骨块均于术后6个月内愈合.无股骨大转子截骨块向近端移位,3例发生股骨柄下沉,平均下沉3.4 mm,无钢丝断裂.结论 对于假体固定稳定型股骨柄翻修,采用股骨大转子延长截骨有利于手术操作和翻修假体的植入和固定,有利于截骨块的愈合,降低术中、术后并发症发生率,中期疗效显著.     

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.     

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。     

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。     

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.     

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。     

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。     

Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre

BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.     

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.     

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.