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61.
《中国现代医生》2019,57(6):96-98+169
目的研究经会阴盆底超声在二维状态下对压力性尿失禁的应用价值。方法选取2017年6月~2018年6月年在牡丹江医学院附属红旗医院因压力性尿失禁就诊的患者40例作为研究对象,选取同期在我院因其他疾病就诊的女性患者30例作为对照组,在二维经会阴盆底超声情况下观察逼尿肌厚度、膀胱颈位置、尿道倾斜角、膀胱后角、膀胱颈下降距离、尿道旋转角、尿道内口有无开放。结果实验组患者在静息状态下及Valsalva最大化状态下、膀胱后角、膀胱颈下降距离及尿道旋转角较对照组患者明显增加(P0.05);逼尿肌厚度、膀胱颈位置及尿道倾斜角,实验组患者与对照组患者比较,差异无统计学意义(P0.05)。结论经会阴盆底超声对评价压力性尿失禁具有一定的临床应用价值。  相似文献   
62.
《中国现代医生》2019,57(20):64-68
目的采用Meta分析方法系统评价盆底仿生物电刺激治疗薄型子宫内膜的临床效果。方法检索中国知网、万方、维普、PubMed、Cochrane library电子数据库(1980年1月~2018年1月)关于比较盆底仿生物电刺激和对照方法治疗薄型子宫内膜的随机对照试验。由2名研究者根据纳入、排除标准独立筛选文献,提取信息,评价纳入文献的方法学质量,采用Revman5.3软件进行Meta分析。结果共纳入7个临床试验,共704例薄型子宫内膜患者进入分析。Meta分析结果表明盆底仿生物电刺激可以改善子宫内膜厚度[WMD=0.78,95%CI(0.62,0.95),P0.00001];可以提高薄型子宫内膜患者的妊娠率[RR=1.62,95%CI(1.25,2.09),P=0.0002];对子宫内膜血流阻力的影响差异无统计学意义[WMD=0.01,95%CI(-0.04,0.05),P=0.76];对冻融胚胎移植妊娠率的影响差异无统计学意义[RR=1.41,95%CI(0.88,2.26),P=0.15]。结论盆底仿生物电刺激治疗可以增加子宫内膜厚度,改善薄型子宫内膜患者的妊娠率。受纳入研究的数量和质量限制,上述结论尚需要开展更多高质量研究予以验证。  相似文献   
63.
目的 探讨腹腔镜广泛子宫切除术和盆腔淋巴结清扫术治疗早期宫颈癌的临床价值。方法 2010-06—2014-06间共实施47例经腹腔镜(腹腔镜组)和42例开放(开放组)广泛子宫切除加盆腔淋巴结清扫术,回顾性分析患者的临床资料。记录2组手术时间、术中出血量、淋巴结切除数量、胃肠功能恢复时间、住院时间、手术并发症发生率等。结果 腹腔镜组术中出血量、切除的淋巴结数、胃肠功能恢复时间、术后住院时间明显优于开放组(P0.05),2组手术时间无显著差异(P0.05)。腹腔镜组平均随访(28.8±6.6)月,并发症发生率为14.9%(7/47),开放组平均随访(26.2±5.8)月,并发症发生率为14.3%(6/42),2组差异无统计学意义。结论 腹腔镜下广泛全子宫切除加盆腔淋巴结清扫术治疗早期宫颈癌,安全有效,具有创伤小,恢复快等优势。  相似文献   
64.
Abstract A young male motorcyclist presented to the Pelvic Unit with an open-book fracture of his pelvis and an acute obstructed direct inguinal hernia. He was managed operatively and made an excellent recovery. Traumatic abdominal wall hernias are rare. This is a unique combination of injuries that the trauma surgeon should be aware of.  相似文献   
65.
Prevalence of symptomatic pelvic organ prolapse in a Swedish population   总被引:2,自引:4,他引:2  
Our aim was to estimate the prevalence of symptomatic pelvic organ prolapse (POP) in a Swedish urban female population. The cross-sectional study design included 8,000 randomly selected female residents in Stockholm, 30–79-year old. A postal questionnaire enquired about symptomatic POP, using a validated set of five questions, and about urinary incontinence and demographic data. Of 5,489 women providing adequate information, 454 (8.3%, 95% confidence interval 7.3–9.1%) were classified as having symptomatic POP. The prevalence rose with increasing age but leveled off after age 60. In a logistic regression model that disentangled the independent effects, parity emerged as a considerably stronger risk factor than age. There was a ten-fold gradient in prevalence odds of POP with parity, the steepest slope (four-fold) being between nulliparous and primiparous women. The prevalence of frequent stress urinary incontinence was 8.9% and that of frequent urge incontinence 5.9%. Out of the 454 women with prolapse, 37.4% had either or both types of incontinence.  相似文献   
66.
《Injury》2023,54(7):110761
ObjectivesHistorically, pelvic ring fractures (PRF) are considered to occur predominantly in the anterior ring and therfore to be mechanically stable. Combined anterior and posterior (A + P) PRF are expected to be less mechanically stable and therefore to be associated with higher levels of pain and reduced mobility compared to isolated anterior fractures. The current study investigates the clinical relevance of combined A + P PRF in elderly patients.MethodsA prospective multicentre cohort study was conducted in patients >70 years of age with anterior PRF after low-energy trauma diagnosed on conventional radiographs. All patients underwent an additional CT-scan. Patients were divided into two groups; isolated anterior or combined A + P fractures. Patients were treated conservatively with adequate analgesia for at least one week. If patients could not be mobilised after conservative treatment, surgical fixation was performed. Numerical Rating Scale (NRS) pain scores, dependence on walking aids and Activities of Daily Living scores (ADL) were measured at 2–4 weeks, and 3, 6 and 12 months after fracture.Results102 patients (age 81.1 ± 7.6 years) were included. Isolated anterior fractures were diagnosed in 25 (24.5%) and A + P fractures in 77 (75.5%) patients. Baseline characteristics did not differ between the two groups. Most patients were successfully treated conservatively and 5 (4.9%) underwent percutaneous trans-iliac, trans-sacral screw fixation after failure of conservative treatment. At 2–4 weeks post trauma, patients with A + P fractures had similar median pain scores (3 (range 0–8) vs. 5 (0–10), p = 0.19) and ADL scores (85 (25–100) vs. 78.6 (5–100), p = 0.67), but were more dependent on walking aids (92.8% vs. 72.2%; p = 0.02) compared to patients with isolated anterior fractures. There were no significant differences at 3 months. At one year follow-up the median NRS pain and ADL scores for both fracture groups were 0 and 100, respectively. Mortality was 10.8%, and additional loss to follow-up was 17.6%.ConclusionsThe vast majority of elderly patients with PRF have combined A + P fractures. The clinical implications of additional posterior pelvic ring fractures in elderly patients appears to be limited.  相似文献   
67.

Purposes

Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re-displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury.

Methods

A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma-related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self-Assessment Tool for Asians (OSTA) index, mechanism of injury, Young–Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction.

Results

The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young–Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96–73.28], p = 0.008), type of injury (OR 0.25, 95% CI [0.13–0.79], p = 0.027), common screws (OR 6.94, 95% CI [1.53–31.40], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18–65.46], p = 0.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16–34.06], p = 0.033), and lower OSTA index [OR 0.41, 95% CI [0.24–0.71], p = 0.001] were significantly related to screw loosening.

Conclusions

Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac–transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.  相似文献   
68.

Objective

Fluoroscopy is often used in the surgery of unstable pelvic ring fractures, and improved safety in implant placement is an issue. An anterior subcutaneous pelvic fixator (INFIX) combined with a percutaneous screw has been reported to be a minimally invasive and effective surgical technique for unstable pelvic ring injuries. However, although percutaneous screw fixation is minimally invasive, its indications for fracture fixation and fractures with large fragment displacements in the vertical plane remain controversial. Therefore, this technical note aims to describe a new technique for unstable pelvic ring fractures.

Methods

We describe a 360° fusion of the pelvic ring to treat unstable pelvic ring fractures, including vertical shear pelvic ring fractures, using an intraoperative CT navigation system. Seven patients were treated with 360° fusion for type C pelvic ring fractures. In surgery, after reducing the fracture with external fixation, intraoperative CT navigation is used to perform a 360° fusion with INFIX and minimally invasive surgical spinopelvic fixation (MIS-SPF). We will introduce a typical case and explain the procedure.

Results

A 360° fixation was performed, and no perioperative complications were noted. The mean blood loss was 253.2 ± 141.0 mL, and the mean operative time was 224.3 ± 67.4 min. In a typical case, bone union was obtained 1 year after surgery, and we removed all implants.

Conclusions

MIS-SPF has a strong fixation force and helps reduce fractures' horizontal and vertical planes. In addition, 360° fusion with intraoperative CT navigation may help treat unstable pelvic ring fractures.  相似文献   
69.
《Cirugía espa?ola》2023,101(8):548-554
IntroductionPelvic fractures due to high energy trauma present a high risk of associated injuries that compromise the functional and vital prognosis of the patients. The objective of this study was to analyze the relationship between traumatic pelvic fractures and their associated injuries according to the Tile classification.MethodsRetrospective observational study of patients who suffered traumatic pelvic fractures (Type A, B or C of the Tile classification) with concomitant associated injuries, analyzing hemoglobin levels, between 6/2013 and 1/2016.ResultsA total of 42 patients were included; of those 69% (n = 29) were males, mean age was 48 years. 45% (n = 19) suffered traffic accidents and 26.2% (n = 11) falls. There was a different proportion in pelvic injuries: Tile A (n = 15, 35.7%), B (n = 20, 47.6%), and C (n = 7, 16.6%) of cases. 54.8% (n = 23) underwent surgery, 21.4% (n = 9) needed temporary or definitive external fixation. Significant differences were found between Tile A type and scapula fractures (P=.032), and Tile B with sacral fractures (P=.033) and visceral injuries (P=.049), while there is a tendency without a statistical significal between Tile C and costal fractures. 61.9% (n = 26) needed blood transfusion; 9.5% (n = 4) presented hypovolemic shock.ConclusionsTile A pelvic fractures were associated with scapular fractures, and Tile B with transforaminal fractures of the sacrum and with visceral injuries (lungs, liver and genitourinary). The small number of Tile C prevent us to confirm an association with any pathology, although they are the ones which presnt more hemodynamically instability and thoracic injuries.  相似文献   
70.
黄创  徐飞  刘阳  刘彬彬  罗政强  王体沛 《骨科》2023,14(3):228-232
目的 探讨改良后路张力带钢板治疗因骶骨骨折导致的骨盆后环不稳定病人的临床疗效。方法 回顾性分析2015年6月至2018年6月我院采用改良后路张力带钢板治疗的7例因骶骨骨折导致骨盆后环不稳定病人的临床资料,其中男4例,女3例,年龄为23~63岁,Tile分型B1 1例,B2 1例,B3 1例,C1 3例,C2 1例。骶骨骨折Denis分区1区4例,2区3例。高处坠落伤3例,车祸伤4例。记录病人软组织激惹等并发症发生情况,采用Majeed评分标准评估骨盆功能。结果 病人手术时间平均为32 min,失血量平均为58 mL。所有病人均获得骨性愈合,愈合时间平均为19周。7例病人平均随访了16个月。根据Majeed评分,优6例,良1例,优良率100%。未出现软组织激惹、神经血管损伤、体表能触及钢板等并发症。结论 改良的后路张力带钢板能有效治疗因骶骨骨折导致的骨盆后环不稳定,安全有效,且软组织激惹较少。  相似文献   
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