经单侧穿刺椎体后凸成形术治疗侧方椎体压缩性骨折

目的研究经单侧椎弓根穿刺椎体后凸成形术治疗侧方骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)的疗效。方法选择我院2009年10月~2011年10月收治的30例侧方OVCF患者,随机行凹侧或双侧球囊撑开椎体后凸成形术治疗,分别在术后1、6、12个月进行随访,对椎体高度恢复、脊柱后凸、侧凸Cobb角及并发症进行评价。结果术后1、6、12个月的随访结果比较发现,凹侧撑开及双侧撑开组患者椎体高度均较术前明显恢复(P0.05),脊柱后凸、侧凸Cobb角均较术前明显纠正(P0.05)。术后定期随访无丢失。凹侧撑开组与双侧撑开组之间比较,上述指标差异无统计学意义(P0.05)。结论经凹侧球囊撑开椎体成形治疗侧方OVCF,与双侧撑开相比疗效相当,可简化手术、缩短手术时间、减小创伤、减少费用,是治疗侧方OVCF的有效方式。     

冠状动脉内溶栓联合 PCI 治疗对急性心肌梗死患者的影响

〔摘 要〕 目的：观察冠状动脉内溶栓联合经皮冠状动脉介入（PCI）治疗对急性心肌梗死（AMI）患者血清小分子核糖 核酸（miRNA）序列与临床指标的影响。 方法：选取 2020 年 1 月至 2023 年 1 月鹤壁市人民医院收治的 74 例 AMI 患者资料, 根据治疗方案不同分为对照组和观察组,各 37 例。对照组单用 PCI 治疗,观察组采用冠状动脉内溶栓联合 PCI 治疗。比较 两组患者治疗前后血流分级情况、血清 miRNA 序列、心功能指标以及不良反应发生情况。 结果：治疗后,观察组患者急性 心肌梗死溶栓评分（TIMI）血流分级优于对照组,差异具有统计学意义（P ＜ 0.05）。治疗后,观察组患者 miRNA–210、 miRNA–146a 均低于对照组,miRNA–214、miRNA–155 均高于对照组,差异具有统计学意义（P ＜ 0.05）。治疗后,观察组 患者左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积指数（LVESVI）均低于对照组,左心室射血分数（LVEF） 水平高于对照组,差异具有统计学意义（P ＜ 0.05）。两组患者不良反应发生率比较,差异无统计学意义（P ＞ 0.05）。 结论：冠状动脉内溶栓联合 PCI 治疗 AMI 能够进一步调节 miRNA 序列水平,改善患者血流分级及心功能。     

渐进式心脏运动康复护理对冠心病经皮冠状动脉介入术后患者心功能的影响

目的探讨冠心病经皮冠状动脉介入术(PCI)治疗患者,在术后早期进行渐进式心脏运动康复护理干预对患者心功能的影响。方法选择2017-2018年营口市中心医院收治的冠心病并行PCI患者120例,随机分为对照组和干预组各60例。对照组进行常规护理,干预组在对照组基础上在术后进行6个月的渐进式心脏运动康复护理干预,对比干预后两组心功能改善情况。结果两组干预后射血分数(LVEF)均提高,干预前后组内及干预后组间比较差异均有统计学意义(P<0.05)。两组术前LVEF<50%者,干预后LVEF均增加,组内干预前后LVEF相比差异有统计学意义(PC0.05),组间干预后LVEF相比差异无统计学意义(P>0.05)。两组术前LVEF为50%?60%者,组内干预前后及组间干预后LVEF差异均有统计学意义(P<0.05)。两组术前LVEF>60%者,干预前后组内和组间LVEF相比,差异均无统计学意义(P>0.05)。结论渐进式心脏运动康复护理干预能够改善冠心病行PCI治疗患者术后的心脏泵血能力,但是这种效果受患者术前LVEF水平的影响。     

盆腔淋巴结清扫术后淋巴漏和淋巴囊肿的研究进展

淋巴漏和淋巴囊肿是泌尿外科盆腔淋巴结清扫术后常见的并发症,临床定义不明确,治疗方案多样而效果不确切,相关研究较少,无相关诊疗指南。本文主要对泌尿外科盆腔淋巴结清扫术后淋巴漏和淋巴囊肿的发生机制、高危因素、临床诊断、治疗方案和预防措施等方面进行综述。淋巴漏和淋巴囊肿发生机制包括淋巴液漏出和渗出;高危因素有高龄、开放手术和围手术期使用抗凝药物等;大部分患者通过营养管理、经皮导管硬化治疗等保守治疗可治愈;预防措施以封闭淋巴管及残端为主。     

Simultaneous bilateral hallux valgus surgery: Percutaneous or conventional? Early results of a matched study from a tertiary institution

BackgroundHallux valgus is bilateral in up to 84 % of cases. In the setting of simultaneous bilateral correction, we aim to evaluate if minimally invasive percutaneous surgery (MIS) provides any advantage compared to conventional open surgery.Methods52 feet (26 patients) undergoing simultaneous bilateral MIS surgery were matched by severity of deformity to 52 feet (26 patients) undergoing simultaneous conventional open surgery. Patients were followed for a minimum of six months. Pre- and post-operative radiographs and clinical records were reviewed.ResultsThere were no significant differences in pre-operative function or pain between both groups. Post-operatively, the mean hallux valgus angle (HVA) was significantly lower in the MIS group. (HVA MIS – 8.6; Open – 11.8, P = 0.013). There were no significant differences in post-operative outcome and patient satisfaction between both groups.ConclusionThis study demonstrates that simultaneous bilateral MIS hallux valgus surgery can be considered for patients with bilateral symptomatic hallux valgus.     

Evaluation of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Disc Herniation: A Retrospective Study

ObjectiveThe objective of the present study was to evaluate the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and open fenestration discectomy (OFD) in the treatment of lumbar disc herniation (LDH).MethodsPatients in our hospital with LDH who received PTED (n = 71) and OFD (n = 39) from 2013 to 2014 were retrospectively studied. Patient information, including age, gender, visual analogue scale (VAS) score for low back pain and leg pain, body weight, height, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and recurrence, was collected. The patients in the two groups were followed up for an average of 63 months after surgery.ResultsA total of 136 patients completed the operation and 110 patients were followed up completely. There was no significant difference in baseline data between the two groups (P > 0.05). The postoperative low back pain, leg pain, ODI, and JOA of the two groups were better than those preoperatively (P < 0.05). One week after surgery, the recovery of PTED patients was better than that of OFD. The ODI score of the PTED group was lower than that of the OFD group (10 [8, 12] vs 14 [11, 16]; P < 0.05), the waist VAS score of the PTED group was lower than that of the OFD group (2 [2, 3] vs 3 [2, 4]; P < 0.05), the leg VAS score of the PTED group was lower than that of the OFD group (1 [0,1] vs 1 [1, 2]; P < 0.05), while the JOA score of the PTED group was higher than that of OFD group [19(16, 20) vs 12(10, 17); P < 0.05]. There were no significant differences in ODI, JOA, waist and leg VAS scores between the two groups at 1 month after surgery and at subsequent follow‐up (P > 0.05). At the end of the follow up, 89.7% (35/39) of patients in the OFD group had excellent improvement in the JOA score, and 88.7% (63/71) of patients in the PTED group had an excellent improvement. There was no significant difference between the two (P > 0.05). There was also no significant difference in the recurrence rate between the two groups [(5/71) vs (3/39); P > 0.05]. [Correction added on 05 March 2021, after first online publication: “3/29” was amended to “3/39” in the preceding sentence.]ConclusionBoth PTED and OFD can achieve good mid‐term efficacy in the treatment of LDH but PTED has certain advantages, including the small incision, a shorter hospital stay, and quicker, earlier recovery. However, prospective randomized controlled studies with a larger sample size are needed.     

Value of preoperative urine white blood cell and nitrite in predicting postoperative infection following percutaneous nephrolithotomy: a meta-analysis

BackgroundTo evaluate to what degree preoperative urine white blood cell (WBC) and urine nitrite (NIT) values are predictive of postoperative infections following percutaneous nephrolithotomy (PCNL).MethodsA systematic literature search was performed of the PubMed, Embase, Cochrane Library, Wanfang Data, National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (CSTJ or VIP) online databases to identify relevant studies that examined the predictive value of urine WBC or NIT as risk factors for post-PCNL infection, and the search was finished on February 28, 2020. Two independent reviewers screened the relevant studies, extracted necessary data from the eligible case-control studies (CCS), and assessed the quality of included studies through the Newcastle-Ottawa scale (NOS). RevMan 5.3 software and the Stata 16.0 software were used to complete the statistical analysis of data. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs).ResultsAccording to the statistical analysis of 12 eligible studies involving 6113 patients, positive urine WBC (WBC+: OR =3.86, 95% CI: 3.03–4.91, P<0.001) and positive NIT (NIT⁺: OR =7.81, 95% CI: 5.44–11.21, P<0.001) in preoperative tests were identified as independent risk factors for postoperative infections following PCNL.ConclusionsIn summary, as risk factors for postoperative infections, the presence of preoperative urine WBC+ and NIT+ should be evaluated as part of clinical procedure, in order to reduce infections of PCNL.     

经皮冠状动脉介入治疗对冠心病患者术后焦虑和抑郁影响的研究

目的 评价经皮冠状动脉介入治疗对冠心病患者术后焦虑和抑郁影响。方法 600例冠心病患者根据是否在冠状动脉造影时接受支架植入术治疗分为支架组（n = 400）和非支架组（n = 200）,400例支架组患者根据术后是否接受心理干预治疗进一步随机分成干预组（n = 200）和非干预组（n = 200）。患者入院后1 d、PCI治疗后1 d、出院时分别采用焦虑自我量表和抑郁自我量表进行焦虑和抑郁评分,比较不同时间患者焦虑和抑郁评分。结果 3组患者平均年龄、性别构成、血红蛋白含量、总胆固醇含量、甘油三酯含量、低密度脂蛋白胆固醇含量和高密度脂蛋白胆固醇含量差异均无统计学意义（均P > 0.05）,具有可比性。入院后1 d,3组冠心病患者焦虑和抑郁评分差异均无统计学意义（均P > 0.05）;PCI治疗后 1 d,干预组和非干预组冠心病患者焦虑和抑郁评分均显著高于非支架组（均P < 0.05）,干预组和非干预组冠心病患者焦虑（t = 11.21,P < 0.01;t = 9.96,P < 0.01）和抑郁评分（t = 8.56,P < 0.01;t = 6.73,P < 0.01）均显著高于入院后1 d。出院时,3组冠心病患者焦虑和抑郁评分差异均有统计学意义（均P < 0.05）,干预组和非干预组冠心病患者出院时焦虑（t = 21.57,P < 0.01;t = 15.77,P < 0.01）和抑郁评分（t = 24.33,P < 0.01;t = 15.01,P < 0.01）均显著低于PCI治疗后 1 d,干预组焦虑和抑郁评分均显著低于非干预组（均P < 0.05）。结论 PCI治疗会加重冠心病患者术后焦虑和抑郁状态,而心理干预治疗可减轻焦虑和抑郁状态。     

Percutaneous transluminal coronary angioplasty - Histopathological analysis of nine necropsy cases

Summary From 1982 to 1984 nine of 300 patients undergoing transluminal coronary angioplasty died. The nine coronary arteries and one saphenous aorto-coronary by-pass graft affected by angioplasty were studied by light microscopy. The following types of lesions were found, frequently in association: rupture of the plaque, circumscribed or reaching to the intimal layer or extending beyond it, dissections (fissures) between arterial layers, intra-plaque haemorrhage, plaque emboli and thrombosis. In two cases the therapeutic approach was considered to be clinically and pathologically successful; the patients survived 24 h (case 6) and forty days (case 4). Case 6 which presented recent lesions indicative of success showed, in contrast with the other non-successful cases, rupture affecting not only the initimal layer but also deeper structures of the arterial wall. There were also more extensive fissures. Case 4 which presented late alterations indicative of success showed a plaque fracture whose borders were kept apart by fibrous tissue. In conclusion, we believe that angioplasty allows the re-establishment of arterial blood flow by provoking deep intimal and medial rupture producing a small fissure between the arterial layers and a widening of the lumen; in cases with good late results these alterations cicatrize leaving a wider arterial lumen.