损伤单元矢状位非稳定区对称椎弓根系统内固定结合植骨融合术治疗胸腰椎骨折

目的探讨损伤单元矢状位非稳定区对称椎弓根系统内固定结合植骨融合术治疗胸腰椎骨折的安全性与有效性。方法选取 2011 年 11 月—2015 年 11 月收治的单节段胸腰椎骨折患者 65 例，其中男 41 例，女 24 例；年龄 23～60 岁，平均 36.7 岁。骨折部位：T₇ 1 例，T₉ 2 例，T₁₀ 4 例，T₁₁ 8 例，T₁₂ 14 例，L₁ 19 例，L₂ 13 例，L₃ 3 例，L₄ 1 例。AO 分型：A 型 34 例，B 型 27 例，C 型 4 例。美国脊柱损伤协会（ASIA）分级为 A 级 1 例，B 级 2 例，C 级 6 例，D 级 15 例，E 级 41 例。胸腰椎损伤分类及损伤程度评分（TLICS）：4 分 9 例，5 分 29 例，6～8 分 23 例，9～10 分 4 例。受伤至手术时间 2～12 d，平均 5.3 d。定义伤椎连同上、下间隙及其所对应的后方结构作为 1 个损伤单元，将此损伤单元在矢状位上分为 3 区：Ⅰ区，椎体上 1/3、上位关节突关节、上位椎间隙及其对应的后方韧带复合体；Ⅱ区，椎体中 1/3、椎弓根、椎板、棘突及棘上韧带；Ⅲ区，椎体下 1/3、下位关节突关节、下位椎间隙及其对应的后方韧带复合体。非稳定区为损伤单元中主要受累区域。以非稳定区为中心上下对称植入椎弓根螺钉固定，结合植骨融合进行治疗。观察患者术前、术后即刻及末次随访时神经功能恢复情况、伤椎前缘高度比、矢状面 Cobb 角恢复情况。 结果65 例患者均顺利完成手术，术中发现脑脊液漏 3 例，予以相应处理后痊愈。所有患者均获随访，随访时间 12～24 个月，平均 17.3 个月。无内固定物松动、移位及断钉、断棒等并发症发生。植骨均达到骨性愈合，愈合时间 10～13 个月，平均 11.4 个月。末次随访时神经功能 ASIA 分级为 A 级 1 例、B 级 1 例、C 级 3 例、D 级 9 例、E 级 51 例，较术前显著改善（Z=–2.963，P=0.014）。术前、术后即刻及末次随访时伤椎前缘高度比分别为 53.2%±6.8%、91.3%±8.3%、89.5%±6.6%，矢状面 Cobb 角分别为（16.3±8.1）、（2.6±7.5）、（3.2±6.8）°。术后即刻及末次随访时伤椎前缘高度比及矢状面 Cobb 角均较术前显著改善，差异有统计学意义（P<0.05）；术后即刻及末次随访间比较差异无统计学意义（P>0.05）。 结论依据损伤单元分区理论设计椎弓根植钉原则，实施非稳定区对称椎弓根系统内固定植骨融合术治疗胸腰椎骨折安全、可靠，临床效果满意。     

孕产妇乙型流感临床特点及治疗体会

目的:探讨孕产妇乙型流感的临床特点及影像学特征,为诊断、治疗、病情评估和预后判断提供依据。方法:对6例孕产妇乙型流感患者的临床特点、诊疗措施和影像学变化特征进行回顾性分析。结果:6例均有发热、咳嗽症状,肺部体征不明显。胸部影像学表现为肺炎征象3例,支气管感染征象3例。剖宫产5例,手术均取活婴,1例孕34周病情稳定出院待产。6例患者均未发生呼吸衰竭,全部治愈。5例剖宫产患者平均住院6.6 d。结论:孕产妇乙型流感多症状重而体征轻,影像学检查显示局限性病毒性肺炎或支气管感染征象,预后较好。晚孕患者密切观察病情适时行剖宫产术。     

经皮椎弓根钉棒微创内固定系统结合伤椎植骨 治疗胸腰椎骨折的临床效果

目的 探讨经皮椎弓根钉棒微创内固定系统结合经椎弓根伤椎椎体内植骨治疗胸腰椎骨折的临床 疗效。方法 2015 年2 月-2016 年1 月安徽医科大学第一附属医院骨科无需减压的胸腰椎骨折患者40 例，随 机分为两组，观察组20 例在“C”型臂透视引导下应用微创内固定系统结合伤椎椎体内植骨治疗；对照组20 例切开复位椎弓根内固定取髂骨植骨治疗，比较两组患者的临床参数和影像学指标。结果 两组患者均顺利 完成手术，获得随访13 ～ 24 个月，观察组和对照组术后伤椎Cobb''s 角低于术前（P <0.05）；观察组和对照 组术后椎体前缘高度高于术前（P <0.05）。观察组术中出血量优于对照组（P <0.05）；观察组的手术时间优 于开放组（P <0.05）；观察组术后引流量优于对照组（P <0.05）；观察组的术后胸腰段Cobb''s 角（过屈位/ 过伸位）优于对照组（P <0.05），且观察组术后伤椎均未出现“蛋壳”效应。结论 经皮椎弓根钉棒微创系统 结合伤椎植骨治疗胸腰椎骨折手术创伤小、出血少、安全可靠、矫正效果满意、术后恢复快、保留胸腰段活 动度，并有效防止伤椎出现“蛋壳”效应，能够即刻增加伤椎椎体的骨容量及前柱的抗压稳定性，值得临床推广。     

青少年先天性分节不全型脊柱侧凸治疗探讨

背景:先天性脊柱侧凸分为形成障碍型、分节不全型及混合型三型。目前国内外对先天性脊柱侧凸的治疗研究主要集中于形成障碍型脊柱侧凸,而对于分节不全型脊柱侧凸的治疗研究较少。目的:评价经后路凹侧肋椎关节松解联合单极或双极楔形截骨治疗青少年先天性分节不全型脊柱侧凸畸形的安全性和初步临床效果。方法:2004年11月至2009年12月经后路凹侧肋椎关节松解联合单极或双极楔形截骨治疗青少年先天性分节不全型脊柱侧凸患者24例(单极截骨10例,双极楔形截骨14例),男女各12例,年龄13～22岁,平均16.7岁;侧凸Cobb角50°～139°,平均84.1°;侧凸柔韧性5.1%～30.0%,平均17.0%;C7中垂线与骶骨中垂线距离0.8～6.3cm,平均2.54cm;1处分节不全18例,2处分节不全3例,3处分节不全3例。结果:手术时间5.3～11.2h,平均7.9h;术中出血1500～4500ml,平均2980ml。无1例因截骨间隙加压闭合而致脊髓剪切损伤。1例术中发生胸膜破裂,术后行胸腔闭式引流术,2周后痊愈。1例因T5椎弓根螺钉侵入椎管压迫脊髓出现左下肢不全瘫,术后4h拔出该螺钉,3个月后左下肢不全瘫完全恢复。术后侧凸Cobb角6°～51°,平均26.8°;术后C7中垂线与骶骨中垂线距离0.3～2.5cm,平均0.76cm。平均随访32.2个月,末次随访患者侧凸Cobb角9°～53°,平均28.6°,平均矫正率66.7%,矫正率平均丢失2.1%;冠状面C7中垂线与骶骨中垂线垂直距离0.3～2.6cm,平均0.81cm,平均矫正率63.3%,矫正率平均丢失2.4%。所有患者均达骨性愈合,内固定无松动、断裂,矫形无明显丢失,术后未发生失代偿现象。结论:经后路凹侧肋椎关节松解联合单极或双极楔形截骨技术治疗中、重度青少年分节不全型脊柱侧凸能较好改善脊柱柔韧性,增加截骨面加压闭合的安全性。     

腰椎管内神经鞘瘤误诊为腰椎间盘突出症1例

目的 总结1例腰椎管内神经鞘瘤被误诊为腰椎间盘突出症病人的诊疗过程,积累该类病人的临床诊疗经验.方法 回顾性分析2019年10月阜阳市人民医院脊柱病区收治的1例腰椎管内神经鞘瘤易被误诊为腰椎间盘突出症病人诊疗的临床资料,探讨其疾病特点及易被误诊原因.结果 病人主诉腰痛伴左下肢麻木、疼痛1年,加重2周.入院诊断:腰椎间盘...     

血清醛固酮水平对持续性心房颤动患者首次导管消融术后复发的预测价值

目的 探讨血清醛固酮水平对持续性心房颤动患者首次导管消融术后复发的预测价值.方法 连续选取2018-10～2019-09于阜阳市人民医院首次接受导管消融治疗的持续性房颤患者51例.房颤复发的定义为消融3个月后发生持续时间≥30 s的房颤、房扑、房速.术后随访1年,根据随访结果分为复发组与未复发组,分析相关因素在房颤复发...     

HIIT is most effective than mict on glycemic control of older people with glucose metabolism impairments: A systematic review and metanalysis

IntroductionPhysical exercise can improve glucose metabolism; however, the best type, volume, intensity, and frequency aren't knowledge. High-Intensity Interval Training (HIIT), an emergent exercise type implicated as a short time-efficient exercise to improve metabolic health, needs more investigation regarding the traditional Moderate-Intensity Continuous Training (MICT).ObjectiveTo identify the effects of MICT and HIIT on glycemic control of older people with glucose metabolism impairments.MethodsOur research question was based on the PICO model and the systematic review of the literature according to the guidelines of the preferred report items for systematic reviews and PRISMA meta-analyses. An extensive search was conducted in the Web of Science, PubMed, and Scielo databases. Only English language papers were included. The keywords used were "HIIT and metabolism of the elderly", "HIIT and glucose metabolism of the elderly", and "MICT and metabolism of the elderly", which were crossed with the Boolean operators "AND" and "OR" or both according to the guidelines of the PRISMA.ResultsSeventy papers were retrieved in the initial search. After applying all inclusions and exclusion parameters, 63 articles were excluded. In the end, six papers were classified as eligible for this study. All data categorically demonstrates that both HIIT and MICT can improve glucose metabolism with a larger effect size towards the HIIT model after the meta-analysis, pointing to HIIT as the most effective strategy.ConclusionBoth modalities can improve glucose metabolism in the elderly with a clear advantage for HIIT over MICT.     

4,300 steps per day prior to surgery are associated with improved outcomes after pancreatectomy

BackgroundDecreased preoperative physical fitness and low physical activity have been associated with preoperative functional reserve and surgical complications. We sought to evaluate daily step count as a measure of physical activity and its relationship with post-pancreatectomy outcomes.MethodsPatients undergoing pancreatectomy were given a remote telemonitoring device to measure their preoperative levels of physical activity. Patient activity, demographics, and perioperative outcomes were collected and compared in univariate and multivariate logistic regression analysis.Results73 patients were included. 45 (61.6%) patients developed complications, with 17 (23.3%) of those patients developing severe complications. These patients walked 3437.8 (SD 1976.7) average daily steps, compared to 5918.8 (SD 2851.1) in patients without severe complications (p < 0.001). In logistic regression analysis, patients who walked less than 4274.5 steps had significantly higher odds of severe complications (OR = 7.5 (CI 2.1, 26.8), p = 0.002).ConclusionAverage daily steps below 4274.5 before surgery are associated with severe complications after pancreatectomy. Preoperative physical activity levels may represent a modifiable target for prehabilitation protocols.     

Postoperative day one systemic inflammatory response syndrome is a powerful early biomarker of clinically relevant pancreatic fistula

BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) is the most feared complication following pancreaticoduodenectomy (PD). There is increasing evidence that very early postoperative factors can be helpful to identify high-risk patients. The aim of this study is to analyze whether postoperative day one (POD1) systemic inflammatory response can be used as an early biomarker of CR-POPF development.MethodsAll patients undergoing PD from 2014 to 2020 were considered. Variables were extracted from a prospectively held database. Clinical and perioperative variables, including POD1 systemic inflammatory response syndrome (SIRS) and C-reactive protein level were collected. To elucidate the independent role of early CR-POPF biomarkers, multivariate hierarchical logistic regression analyses were planned.ResultsOut of 243, 213 patients were included in this analysis. CR-POPF occurred in 49 (23.0%) patients and 90-day mortality was 1.4%. POD1 SIRS was reported in 65 (30.5%) patients. Following hierarchical logistic regression analyses, CR-POPF was independently associated with body mass index (OR = 2.787, p = 0.003), soft pancreatic texture (OR = 4.258, p = 0.002) and POD1 SIRS (OR = 50.067, p = 0.001).ConclusionPOD1 SIRS is powerfully associated with CR-POPF and therefore it could be used as a tool to optimize postoperative care of PD patients. Further prospective studies are needed to validate these findings.