Evolution of left-sided thoracoscopic approach for long gap esophageal atresia repair

BackgroundLeft-sided repair for long gap esophageal atresia (LGEA) has been described for patients with a large leftward upper pouch, no thoracic tracheoesophageal fistula (TEF) nor tracheobronchomalacia (TBM), or as salvage plan after prior failed right-sided repair. We describe our experience with left-sided MIS traction induced growth process.MethodsWe retrospectively reviewed patients who underwent Foker process for LGEA at two institutions between December 2016 and November 2021. Patient characteristics, surgical techniques, and outcomes were reviewed.Results71 patients underwent Foker process. Of 34 MIS cases, 28 patients (82%) underwent left-sided repair (median gap length 5 cm) at median age 4 months with median 3 (range 2–8) operations and median 13.5 (IQR 11–21) days on traction until esophageal anastomosis. 9 patients (32%) underwent completely MIS approach, whereas 5 patients (18%) converted to open at first operation and 14 patients (50%) converted to open later in the traction process. Traction was internal in 68%, external in 11%, and combination in 21%. Median follow-up was 15.4 (IQR 7.5–31.7) months after anastomosis. 14% had anastomotic leak managed with antibiotics and/or esophageal vacuum therapy. Median number of esophageal dilations was 3.5 (range 0–13). 18% required stricture resection. 39% underwent Nissen fundoplication. None have needed esophageal replacement.ConclusionsFor multiple reasons including the tendency of both esophageal pouches to have a leftward bias, less tracheal compression by upper pouch, and clean field of surgery for reoperative cases, we now more commonly use left-sided approach for MIS LGEA repair compared to right side, regardless of left aortic arch.Level of evidenceLevel IV Treatment Study.     

分期微创治疗胫骨近端粉碎性骨折

目的：探讨分期微创治疗胫骨近端粉碎性骨折的临床应用。方法：选取自2004年2月～2007年5月47例胫骨中上段粉碎性骨折患者，其中合并开放伤35例，均采用分期微创方法治疗，并随访6-13月。结果：47例骨折均在术后3-6月愈合，患肢功能根据Johner-wruhs关节功能评定标准：优33例，良11例，可3例；优良率93．6％。结论：分期微创治疗胫骨近段粉碎性骨折，尤其合并开放伤者，疗效满意。     

不同比重干化学检测尿蛋白结果分析

目的分析不同比重下尿蛋白干化学定性结果与全自动生化分析仪定量结果,探讨尿比重对干化学检测尿蛋白的影响。方法 844份尿标本先经干化学检测尿蛋白,再用全自动生化分析仪定量检测尿微量白蛋白、尿肌酐,计算微量白蛋白/肌酐比值(UACR),统计分析不同比重下尿蛋白定性与定量结果。结果当干化学尿蛋白结果为阴性时,随着尿比重的增加,假阴性率下降,当1.030≤比重≤1.005时,假阴性率从34.1%下降到2.7%;当干化学尿蛋白结果为阳性时(±～+++),比重越高,假阳性率越高,随着比重下降,假阳性下降,比重≤1.005时没有假阳性。结论尿比重能明显影响干化学检测尿蛋白的准确性,对于比重过低或过高的标本,可以检测UACR或24h尿蛋白定量进行鉴别。     

Horseshoe-like macular tear following recurrent branch retinal vein occlusion

Background A macular hole can develop as a late complication secondary to a branch retinal vein occlusion (BRVO). We report about an atypical horseshoe-like tear occurring in the fovea after recurrent BRVO. Methods An interventional case report. Results In 1997, a 53-year-old man was seen with an occlusion of macular part of inferior temporal vein of the retina on the left eye. After experiencing several recurrent BRVO in this eye, 6 years later he presented with a horseshoe-like tear in the fovea. Visual acuity was 20/200. The patient underwent standard three-port vitrectomy and installation of C3F8 16%. Intraoperatively, massive traction of the vitreous was detected on the edges of the tear. Six months after the operation, the tear remained attached. The visual acuity was 20/200. Conclusions The uniqueness of the presented case is the occurrence of a macular tear following recurrent BRVO, its horseshoe-like shape and foveal location. To the best of our knowledge, this is the first report on a horseshoe-like tear seen in the fovea secondary to BRVO. We assume that chronic macular edema and retinal ischemia following BRVO were additional factors beside the vitreous traction, contributing to the formation of the macular tear. Anatomical closure of the tear and stabilisation of visual acuity can be achieved by vitreoretinal surgery. There is no financial interest to declare. No grant has been received in relation to this case. Presented as a poster at the 102nd meeting of the German Ophthalmologic Society, 2004 Berlin.     

推拿 颈椎牵引治疗椎动脉型颈椎病比较研究

目的:比较推拿与颈椎牵引治疗椎动脉型颈椎病(CSA)的临床疗效。方法:将60例患者随机分为A组和B组,A组以颈部为重点进行全身推拿(30例),B组进行颈椎牵引(30例),治疗前后观察两组的临床症状的变化。结果:A组临床治愈率及总有效率分别为26.7%和93.4%,B组分别为13.3%和86.7%,两组总有效率比较有统计学意义(P<0.05)。结论:A组疗效明显优于B组。     

延伸到骨干部的胫/腓骨远端粉碎性骨折的治疗方法比较

目的比较LCP、外固定支架、跟骨骨牵引治疗延伸到骨干部的胫/腓骨远端粉碎性骨折的临床疗效,为延伸到骨干部的胫/腓骨远端粉碎性骨折的治疗提供依据。方法2000-2008年2月采用以上三种方法治疗延伸到骨干部的胫/腓骨远端粉碎性骨折共151例,比较三种治疗方法的术中,术后指标如手术时间、术中出血量、住院时间、骨折不愈合、畸形愈合并经统计学处理。结果LCP组疗效最好,跟骨骨牵引组疗效最差,LCP组与其他两组相比,相差显著(P<0.05)。手术时间、出血量及住院时间三种治疗无明显差异(P>0.05).结论LCP组在延伸到骨干部的胫/腓骨远端粉碎性骨折的治疗疗效明显优于外固定支架和跟骨骨牵引组。用LCP治疗延伸到骨干部的胫/腓骨远端粉碎性骨折的方法值得推广应用。     

推拿定点拔伸侧扳法治疗颈椎病机制分析

颈椎病的治疗方法很多,通过对各种治疗方法疗效的比较和机理分析的研究,以及大量对此病治疗的临床报道,均可得出一个结论:无论手法配合中药内服外用还是配合针灸治疗,均好于单独使用针灸或单独中药内服外用的疗效。可见手法在治疗颈椎病中的重要性和必要性,而定点扳法是手法疗效取得的关键,是推拿所独有的效果,是药物、牵引、理疗和微创手术或局部给药所不能比拟的。推拿手法具有灵、便、廉的特点,如操作规范,也是一种安全有效的对因治疗方法,符合中医"治病求本"治疗原则。推拿没有手术疗法的高风险、高投入、损伤大和时间长的缺点,也没有西药对肝脏、肾脏和胃的损伤及刺激。与其他物理疗法相比,远期疗效更好。     

修复下颌骨缺损的内置式弧形牵引器的研制

下颌骨节段性缺损一直是颌面骨修复中的一大难题，为此，研制了一种能够修复下颌骨节段性缺损的弧形牵引器。手术分别造成2只山羊一侧下颌骨35mm、45mm的节段性缺损，再采用全层骨切开术制备转移盘，最后分别安置自行设计的2款内置式弧形牵引器。术后延迟期为7天，牵引速度为每天1mm，牵引频率为每天1次。固定期期间进行X线观察，固定期2周时，一只羊的X线片中可见带有弧度的新骨形成，另一只则未形成新骨。术后2个月处死取材，观察到新骨生长情况与X线片一致，其中新骨长度达35mm。可知此种牵引器在下颌骨重建中达到了一定的效果，但仍有待改进。     

骶管封闭配合三维牵引治疗腰椎间盘突出症

[目的]探讨腰椎间盘突出症临床有效治疗途径。[方法]对118例腰椎间盘突出症患者采用骶管封闭配合三维牵引治疗。[结果]结果本组118例,随访3-18个月,优62例,占52%,良43例,占36%,差10例,占8%,无效3例,占2%,有效率88%。[结论]骶管封闭配合三维牵引目前是非手术疗法中治疗腰椎间盘突出症比较安全,疗效较好的方法之一。