手术时机对老年股骨转子间骨折手术疗效和预后的影响

目的:研究手术时机对老年股骨转子间骨折手术疗效和预后的影响。方法:选取113例老年股骨转子间骨折患者作为研究对象,根据手术时机不同将其分为早期手术组(入院1周内进行手术)59例和延期手术组(入院1周后进行手术)54例,分别对两组患者的手术时间、术中出血量、住院时间、住院费用进行观察和比较;对两组患者术前、术后6个月、12个月的日常生活能力评分量表(ADL)评分、Harris髋关节功能评分进行评价和比较;对两组患者均连续随访12个月,观察和比较随访期间两组术后并发症的发生率及两组术后6个月、12个月的病死率。结果:早期手术组患者的手术时间、住院时间均短于延期手术组,术中出血量、住院费用均少于延期手术组(P0.05)。早期手术组患者术后6个月和12个月的ADL评分分别为56.23±10.06、68.14±16.61,Harris髋关节功能评分分别为78.26±7.60、83.35±11.64,而延期手术组术后6个月和12个月的ADL评分分别为41.84±12.26、66.25±15.98,Harris髋关节功能评分分别为66.09±7.06、82.54±12.59,两组术后均较术前显著提高,而且早期手术组术后6个月时的ADL评分和Harris髋关节功能评分均明显高于延期手术组(P0.05)。早期手术组患者的术后并发症总发生率为16.9%,显著低于延期手术组46.3%(P0.05)。两组患者术后6个月病死率和术后12个月病死率的差异均无统计学意义(P0.05)。结论:早期手术能够提高老年股骨转子间骨折手术的治疗效果,减少术中出血量和费用,缩短手术时间和住院时间,降低术后并发症的发生率。     

老年髋部骨折手术时机选择与术后疗效分析

目的 探讨老年髋部骨折患者手术时机选择对术后疗效的影响.方法 选择2006年7月至2008年6月手术治疗的髋部骨折患者267例,入组后根据手术时机将患者分为早期手术组(入院2 d内手术)和晚期手术组(入院2 d后手术),详细记录患者的并存症、手术细节、术后并发症等.观察两组患者住院期间并发症发生率和死亡率、住院时间、出院时功能恢复情况、术后6和12个月的死亡率以及功能恢复情况.结果 符合入选标准116例,早期手术组45例,晚期手术组71例.两组性别、年龄、并存症等一般情况差异无统计学意义,术中麻醉方式、出血量、固定方式两组亦无统计学意义.早期手术组住院时间、住院期间肺部并发症发生率较晚期手术组明显减少;住院期间、术后6、12个月死亡率和晚期手术组相比差异不统计学意义;出院时、术后6个月日常生活能力评分(the activities of daily living,ADL)较晚期手术组高,差异有统计学意义.术后12个月晚期手术组ADL评分和早期手术相似,差异无统计学意义.结论 在排除自身情况差异后,术后早期(出院时、术后6个月)早期手术患者独立生活能力较晚期手术者恢复好,但从远期来看(术后12个月)二者差异无统计学意义.早期手术者和晚期手术者死亡率的差异无统计学意义.     

老年髋部骨折手术时机选择与术后疗效分析

目的 探讨老年髋部骨折患者手术时机选择对术后疗效的影响.方法 选择2006年7月至2008年6月手术治疗的髋部骨折患者267例,入组后根据手术时机将患者分为早期手术组(入院2 d内手术)和晚期手术组(入院2 d后手术),详细记录患者的并存症、手术细节、术后并发症等.观察两组患者住院期间并发症发生率和死亡率、住院时间、出院时功能恢复情况、术后6和12个月的死亡率以及功能恢复情况.结果 符合入选标准116例,早期手术组45例,晚期手术组71例.两组性别、年龄、并存症等一般情况差异无统计学意义,术中麻醉方式、出血量、固定方式两组亦无统计学意义.早期手术组住院时间、住院期间肺部并发症发生率较晚期手术组明显减少;住院期间、术后6、12个月死亡率和晚期手术组相比差异不统计学意义;出院时、术后6个月日常生活能力评分(the activities of daily living,ADL)较晚期手术组高,差异有统计学意义.术后12个月晚期手术组ADL评分和早期手术相似,差异无统计学意义.结论 在排除自身情况差异后,术后早期(出院时、术后6个月)早期手术患者独立生活能力较晚期手术者恢复好,但从远期来看(术后12个月)二者差异无统计学意义.早期手术者和晚期手术者死亡率的差异无统计学意义.     

腰椎间盘突出症的手术和非手术治疗94例对比研究

目的：探讨腰椎间盘突出症的非手术治疗适应性。方法回顾性分析９４例确诊的腰椎间盘突出症患者,分为两组：非手术治疗组４４例。疼痛缓解后,进行腰背肌锻炼;手术组５０例,确诊后３天内进行手术治疗,术后５～７天开始进行腰背肌锻炼。两组腰背肌锻炼均在６个月以上,且不进行重体力劳动平均随访２年９个月。结果：非手术治疗组治愈为９０．９％,手术组治愈率为９４．０％,两组比较无显著性差异（Ｐ〉０．０５）。结论：并非所     

关节镜下保留残端手术与常规手术重建前交叉韧带疗效比较

目的比较关节镜下保留残端手术与常规手术重建前交叉韧带(ACL)的疗效。方法采用关节镜下自体腘绳肌腱单束重建治疗66例膝关节ACL断裂患者,其中采用常规手术方法重建治疗37例,保留残端手术方法重建治疗29例。结果 66例均获随访,时间12~28个月。常规手术组及保留残端手术组术后前抽屉试验和Lachman试验比较差异均无统计学意义(P0.05);采用Lysholm、IKDC评分评价膝关节功能:两组术后比较差异均有统计学意义(P0.05),保留残端组优于常规手术组。结论关节镜下保留残端手术与常规手术行自体腘绳肌腱单束重建治疗膝关节ACL损伤都能获得满意的临床疗效,但关节镜下保留残端手术有利于移植物的再血管化及本体感受器的恢复。     

CT引导经皮脊柱内窥镜治疗老年腰椎间盘突出症

[目的]探讨CT引导经皮脊柱内窥镜治疗老年腰椎间盘突出症的方法与疗效,总结临床经验。[方法]自2010年6月²012年9月,对246例老年腰椎间盘突出症患者,按照手术方式分为传统手术组114例、CT引导经皮脊柱内窥镜组132例。记录两组患者围手术期观察指标:手术时间、切口长度、术中出血量、术后应用镇痛药物例数、术后卧床时间和住院时间;术后随访采用Oswestry功能障碍指数(owestry disability index,ODI)对两组患者术前、术后1周和1、3、6、12个月的日常生活能力进行评定。[结果]在手术时间、切口长度、术中出血量、术后应用镇痛药物例数、术后卧床时间和住院时间比较上内窥镜组明显优于传统手术组,差异具有统计学意义(P<0.01)。术后随访122012年9月,对246例老年腰椎间盘突出症患者,按照手术方式分为传统手术组114例、CT引导经皮脊柱内窥镜组132例。记录两组患者围手术期观察指标:手术时间、切口长度、术中出血量、术后应用镇痛药物例数、术后卧床时间和住院时间;术后随访采用Oswestry功能障碍指数(owestry disability index,ODI)对两组患者术前、术后1周和1、3、6、12个月的日常生活能力进行评定。[结果]在手术时间、切口长度、术中出血量、术后应用镇痛药物例数、术后卧床时间和住院时间比较上内窥镜组明显优于传统手术组,差异具有统计学意义(P<0.01)。术后随访12²4个月,两组患者术前ODI指数比较差异无统计学意义(P>0.05),两组术后各期ODI指数均较术前有显著改善,但脊柱内窥镜组术后ODI指数改善明显优于传统手术组(P<0.01)、术后恢复更快。[结论]CT引导下设计和实施穿刺具有精确、安全、个性化操作的优点,CT引导经皮脊柱内窥镜治疗老年腰椎间盘突出与传统开放性手术比较具有微创、精准、恢复快等优点,疗效满意,是治疗老年腰椎间盘突出症的理想方法。     

肝移植时代常规手术治疗门静脉高压症作用的探讨

目的探讨肝移植术与常规手术(断流术、分流术)在治疗肝炎后肝硬化门脉高压症中的作用。方法对303例门脉高压症患者的外科治疗进行回顾性分析。常规手术组239例,肝移植手术组64例,术后随访3个月至5年,观察再出血率和死亡率。结果Child A或B级患者常规手术疗效较好,ChildC级患者常规手术疗效差。肝移植手术组Child C级患者死亡率(20.9%)显著低于常规手术组Child C级患者死亡率(57.5%)。结论有出血史但肝功能属Child A或B级,常规手术术后能维持较好的肝脏功能和生活质量。肝功能极差,常规手术不能取得满意疗效者,肝移植术是惟一有效的治疗措施。     

肝移植时代常规手术治疗门静脉高压症作用的探讨

目的 探讨肝移植术与常规手术（断流术、分流术）在治疗肝炎后肝硬化门脉高压症中的作用。方法 对303例门脉高压症患者的外科治疗进行回顾性分析。常规手术组239例，肝移植手术组64例，术后随访3个月至5年，观察再出血率和死亡率。结果 Child A或B级患者常规手术疗效较好，Child C级患者常规手术疗效差。肝移植手术组Child C级患者死亡率（20．9％）显著低于常规手术组Child C级患者死亡率（57．5％）。结论 有出血史但肝功能属Child A或B级，常规手术术后能维持较好的肝脏功能和生活质量。肝功能极差，常规手术不能取得满意疗效者，肝移植术是惟一有效的治疗措施。     

关节镜与传统开放手术治疗臀肌挛缩症的比较研究

[目的]比较关节镜和传统开放手术治疗臀肌挛缩症的疗效及可行性.[方法]回顾分析116例双侧臀肌挛缩症患者的临床资料,观察组为关节镜手术组56例,对照组为传统开放手术组60例,根据蔡斌等[1]疗效标准评价疗效,并对两组切口长度、手术时间、出血量、术后镇痛药物应用、下床活动时间、术后住院时间、手术并发症、复发率等进行比较.[结果]经术后6个月～11年的随访,两组疗效比较,差异无显著性(P＞0.05),但关节镜组切口长度、术中出血、术后镇痛药物应用、下床活动时间、术后住院时间等5项指标明显优于切开手术组,差异有统计学意义(P＜0.05);手术疗效、复发率与切开手术组无显著差异,两组手术时间比较差异无统计学意义(P＞0.05).[结论]与开放手术相比,关节镜治疗臀肌挛缩症具有创伤小、出血少、术后并发症发生率低、恢复快、手术瘢痕小、可早期进行功能锻炼,有利于关节功能的恢复等优点,且疗效肯定,是一种值得推荐的手术方法.     

脾破裂保脾手术应用价值

探讨脾破裂患者脾保留手术的应用价值。脾破裂患者80例,分为脾切除组(35例)和脾保留手术组(45例)。观察两组患者手术一般情况和术后并发症发生率,比较两组患者手术前和手术后3个月时免疫功能指标和生活质量。结果显示,脾保留手术组手术时间较脾切除手术组长,而术中出血量和住院时间较脾切除手术组少(P0.05);两组患者手术前的IgG、IgM和IgA水平无明显差别,术后3个月,脾切除术组的上述指标较手术前无明显改变,而脾保留手术组的上述指标较术前明显增高(P0.05);两组患者术后发热、再出血等并发症发生率无明显差别;两组患者手术前生活质量评分无明显差别,术后3个月时,两组患者的生活质量评分均较手术前增高,脾保留手术组增高更明显(P0.05)。结果表明,脾保留性手术可维持脾破裂患者的免疫功能,提高其生活质量。     

Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study–confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon’s canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.     

Multistate Comparison of Cost,Trends, and Complications in Open Versus Endoscopic Carpal Tunnel Release

Background: Surgical carpal tunnel release is performed by either open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR). The purpose of this study was to assess differences in intraoperative and postoperative complications, trends, and costs between OCTR and ECTR. Methods: State Ambulatory Surgery and Services Databases (SASD) files for California, Florida, and New Jersey were queried for patients who underwent OCTR and ECTR between 2000 and 2014. Patient demographics, comorbidities, intraoperative and postoperative complications, and cost were compared between OCTR and ECTR. The frequency of each procedure was used to formulate trends in OCTR and ECTR. Results: A total of 571 403 patients were included in this study. Sex was significantly different by a small percentage (OCTR = 64.8% female, ECTR = 65.4% female). A higher proportion of Hispanic patients underwent ECTR (P < .001). The patients who underwent OCTR had a greater comorbidity burden in terms of diabetes and rheumatoid arthritis (P < .001). None of the aforementioned complication rates were statistically significant between the 2 procedures. Endoscopic carpal tunnel release was significantly more costly by almost $2000. Open carpal tunnel release has remained stable over the years studied, whereas ECTR increased 3-fold. Conclusions: Our findings demonstrate no significant differences between OCTR and ECTR regarding intraoperative and postoperative complications and patient outcomes. Endoscopic carpal tunnel release was found to be significantly more costly.     

A cost-utility analysis of open and endoscopic carpal tunnel release

BACKGROUND

Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced.

OBJECTIVE

To use a decision analytical model to compare ECTR with OCTR in an economic evaluation.

METHODS

Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature.

RESULTS

The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the ‘win-win’ quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR.

CONCLUSIONS

There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively.     

感觉过敏型腕管综合征的治疗

目的 报道7例感觉过敏型腕管综合征的诊治特点.方法 收集与分析2002年3月至2005年3月间128例腕管综合征中感觉过敏型7例的病情及治疗特点.其中女性4例、男性3例.4例应用内镜治疗,3例切开治疗,经1～4年随访,平均随访时间1.5年.结果 内镜治疗中2例疗效差,均在术中插入扩张导管时出现异常疼痛,另外2例基本满意.3例切开治疗中,2例疗效差,1例基本满意.3例基本满意中,2例内镜插入导管时均未出现疼痛,另1例为单纯切断腕横韧带,并在神经外膜下注射激素.结论 感觉过敏型腕管综合征是一组特殊病例,保护神经外膜是治疗关键.     

内窥镜下治疗腕管综合征89例报告

目的 :探讨应用内窥镜技术治疗腕管综合征 (ECTR) ,从腕管内切断腕管横韧带 ,解除其对正中神经压迫的手术方法及技巧。并对其术后疗效进行分析 ,介绍内窥镜下治疗腕管综合征的经验与疗效。方法 :局部麻醉 ,皮肤 1cm切口 ,在内窥镜下切断腕管横韧带。松解受压的正中神经。据Kelly疗效评定标准 ,对其术后疗效进行分析评价。结果 :临床应用 165例 192腕 ,手术时间平均 10min ,出血少 ,术后随访 89例 98腕 ,优 73腕 ;良 2 0腕 ;一般 3例 ;差 2例 ,其中 2例发生术后正中神经粘连 ,行 2次手术。结论 :内窥镜技术治疗腕管综合征 (ECTR)皮肤切口小 ,组织创伤轻 ,手术时间短 ,术后不需石膏外固定 ,不残留手术瘢痕。注意手术适应证 ,是一种安全有效的微创手术方法。     

Carpal tunnel syndrome grading system in rheumatoid arthritis

The grading system of Hashizume and Hirooka for carpal tunnel syndrome (CTS) was modified to refine the system for surgical treatment selection for specific subsets of CTS in patients with rheumatoid arthritis (RA). The grading system uses clinical signs and symptoms of CTS, including pain indications, to identify surgical subsets of patients to facilitate treatment selection. Retrospective analysis of the system included radiographic and electromyographic findings. Twenty-nine hands of 21 adult patients with CTS in RA were graded in the current study. Eight hands with mild synovitis received conservative treatment only. Endoscopic carpal tunnel release (ECTR), using Okutsu's universal subcutaneous endoscopic system with a clear cannula, was performed in 11 hands with moderate synovitis. Open carpal tunnel release (OCTR) combined with flexor tenosynovectomy was performed in 9 hands with severe synovitis. One more hand required OCTR after ECTR when malignant RA was diagnosed. Clinical results, evaluated using Kelly's criteria, were: excellent in 19 hands, good in 5, fair in 4, and poor in the 1 patient with malignant RA. Clinical symptoms of CTS improved in all but the latter patient. Although the sample size in the current study is small, the results appear to warrant further study to determine the clinical utility of the grading system. Received: April 2, 2001 / Accepted: November 1, 2001     

Effectiveness and safety of endoscopic versus open carpal tunnel decompression

Purpose

To evaluate the effectiveness and safety of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) using a meta-analysis of data from randomized controlled trials.

Materials and methods

Electronic searches of the Cochrane Register of Controlled Trials (CENTRAL, Issue 11 of 12, Nov 2012), PUBMED (1980 to Dec 2012), and EMBASE (1980 to Dec 2012) were used to identify randomized controlled trials that evaluated endoscopic vs open methods for treatment of carpal tunnel syndrome. Studies to be used were independently identified by two researchers. The methodological quality of the studies was assessed by the Cochrane Collaboration tool for assessing risk of bias.

Results

Fifteen randomized controlled trials involving 1,596 hands were included. Based on the Cochrane Collaboration tool for assessing risk of bias, four studies were rated as high quality, five studies were rated as moderate quality, and six were rated as low quality. Our meta-analysis indicated that ECTR resulted in better recovery of pinch strength, earlier time of return to work, but a higher rate of reversible nerve problems (including neurapraxia and numbness) than OCTR. ECTR also resulted in a lower rate of irreversible nerve damage (P > 0.05), wound problems (including wound infection, wound hematoma and wound dehiscence) and reflex sympathetic dystrophy (P > 0.05) compared with OCTR. Our meta-analysis revealed no obvious statistical differences in relief of symptoms (pain and paraesthesia), recovery of grip strength and reoperation rate.

Conclusion

Our meta-analysis of available randomized controlled trials demonstrated that ECTR and OCTR were similar in relief of symptoms, but ECTR resulted in better recovery of function and earlier return to work and was safer than OCTR.     

腕管综合征术后柱状痛的临床研究

目的 探讨腕管综合征常规手术后柱状痛的原因.方法 2006年12月至2008年10月,对27例(30侧)腕管综合征的患者,采用常规腕管切开正中神经松解术进行治疗,术后随访测量柱状痛的面积及发生柱状痛患腕的功能.结果 术后随访10～30个月,11侧出现手术切口周围柱状感觉麻木区,8侧出现切口周围单侧或双侧柱状痛.结论 在出现柱状痛或柱状感觉麻木的患者中,柱状痛的面积和切口长度呈正相关;有无柱状痛不是评价腕管切开减压术(OCTR)疗效的标准;切口的类型与柱状痛的发生无相关.     

Factors associated with trigger digit following carpal tunnel release

BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome.Carpal tunnel release(CTR) surgery may be a risk factor for trigger digit development;however,the association between surgical approach to CTR and postoperative trigger digit is equivocal.AIM To investigate patient risk factors for trigger digit development following either open carpal tunnel release(OCTR) or endoscopic carpal tunnel release(ECTR).METHODS This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit.Patients were stratified according to the technique utilized for their CTR,either open or endoscopic.The development of postoperative trigger digit was evaluated at three time points:within 6 mo following CTR,between 6 mo and 12 mo following CTR,and after 12 mo following CTR.Firth's penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit.Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit.RESULTS A total of 47 hands developed postoperative trigger digit following 967 CTR procedures(4.9%).In total,64 digits experienced postoperative triggering.The long finger was most commonly affected.There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR.Furthermore,there were no significant independent risk factors for postoperative trigger digit;however,within group analysis revealed a significant interaction effect between gender and surgical approach(P=0.008).Females were more likely to develop postoperative trigger digit than males after OCTR(OR=3.992),but were less likely to develop postoperative trigger digit than males after ECTR(OR=0.489).CONCLUSION Patient comorbidities do not influence the development of trigger digit following CTR.Markedly,gender differences for postoperative trigger digit may depend on surgical approach to CTR.     

Endoscopic versus open carpal tunnel release: a randomized trial

PURPOSE: This study compared the outcomes in patients assigned to either endoscopic carpal tunnel release (ECTR) or traditional open carpal tunnel release (OCTR). METHODS: An unbalanced randomized clinical trial (91 endoscopic, 32 open) was conducted. Short-term and long-term outcomes were evaluated by a blinded assessor. The primary outcome measures were symptom severity measured on a self-report scale and nerve/vascular complications. Secondary outcomes included the McGill pain questionnaire, grip strength, pinch strength, sensory threshold (NK PSSD device, NK Biotechnical Corp, Minneapolis, MN), and time to return to work. RESULTS: Both groups improved on all outcomes. No differences were observed in primary outcomes between the groups at either baseline or follow-up at 1 week, 6 weeks, or 12 weeks after surgery. No significant complications occurred in either group. Grip strength and pain were significantly better at 1 and 6 weeks in the endoscopic group although differences dissipated by 12 weeks. No significant differences occurred in other secondary outcomes. Long-term satisfaction was lower in the endoscopic group, attributable to a 5% rate of re-operation. Lower rates of endoscopic release have occurred at our center once these results were available to surgeons and patients. CONCLUSIONS: No substantive difference in benefit was shown for these 2 methods of carpal tunnel release.