自制牵引架在治疗手指骨骨折中的临床应用

目的 评价自制牵引架在手部指骨骨折中的治疗效果.方法 对11例(共19指)手部指骨新鲜闭合性骨折,采取闭合整复自制牵引架治疗21～28 d(平均24 d),术后平均随访2～6个月,从患手的关节活动范围和影像学检查进行疗效评价.结果 术后X线片显示所有骨折均解剖复位,平均24 d去除自制牵引架.1例患者1个手指出现针道感染.11例(19指)骨折患者均已骨性愈合,患者手指的关节活动范围恢复正常,均已恢复原来的工作.结论 自制牵引架技术是治疗新鲜闭合性指骨不稳定骨折的有效方法.     

仰卧整复手法治疗颈椎病的临床观察

颈椎病为临床常见病,有研究显示,该病近年来有发病率升高和发病年龄提早的趋势。推拿疗法治疗该病具有一定疗效［１～３］,但也有因手法操作不当引起不良反应的报道［４～５］,需要进一步加强研究。本课题组自１９９２年开始,对“仰卧整复手法”治疗颈椎病的临床疗效进行了观察,现总结如下。１　临床资料诊断标准：参照第１、２届全国颈椎病专题座谈会纪要［１～８］和国家中医药管理局制定的“中医病证诊断疗效标准”［９］进行诊断。①临床表现与影像学所见相符;②具有典型的颈椎病临床表现,而影像学所见正常者,应在排除其他疾病…     

胆囊穴穴位用药预防腹腔牵拉反应的临床观察

为观察胆囊穴Innovar复合阿托品、麻黄碱注射用于预防腹腔手术中内脏牵拉反应的效果。将60例胃癌手术病例随机分为两组。试验组A（n=30）：硬膜外麻醉后行双侧胆囊穴药物注射：对照组B（n=30）：仅单纯常规硬膜外麻醉。观察术中探查脏器时BP、HR变化．以及患者精神安定情况和恶心呕吐反应。结果：A组无明显恶心呕吐,患者安静,手术中HR、SBP、DBP相对平稳。提示胆囊穴行Innovar复合阿托品、麻黄碱注射,可抑制腹腔牵拉反应,减轻患者痛苦,利于术中麻醉管理。     

ADVANTAGES OF USING THIN ENDOSCOPE‐ASSISTED ENDOSCOPIC SUBMUCOSAL DISSECTION TECHNIQUE FOR LARGE COLORECTAL TUMORS

Background: Our purpose was to evaluate the effectiveness of a newly developed non‐invasive traction technique known as thin endoscope‐assisted endoscopic submucosal dissection (TEA‐ESD) procedure for the removal of colorectal laterally spreading tumors (LST). Patients and Methods: A total of 37 LST located in the rectum and distal sigmoid colons of 37 patients were eligible for outcome analysis. Twenty‐one LST were treated with TEA‐ESD and were then retrospectively compared to 16 LST that had previously been treated with standard ESD. Tumor size, en bloc resection rate, procedure time, combined number of different electrical surgical knives used during each procedure and associated complications were evaluated in this case–control study. Results: There was no statistically significant difference in tumor size between the TEA‐ESD group and the ESD control group (43.6 ± 16 mm and 42.4 ± 14 mm, respectively). All LST were successfully resected en bloc in both groups. Procedure duration was shorter for the TEA‐ESD group than the ESD control group, although the difference was not statistically significant (96 ± 53 minutes vs 116 ± 74 minutes; P = 0.18). The percentage of cases in which only one electrical surgical knife was used during the entire procedure was significantly higher in the TEA‐ESD group compared to the ESD control group (85.7% vs 31.3%; P = 0.0005). There were no perforations in the TEA‐ESD group while the ESD control group experienced one perforation. At the present time, TEA‐ESD is limited to the rectum and distal sigmoid colon. Conclusion: It was technically easier, safer and more cost‐effective to perform ESD for LST in the rectum and the distal sigmoid colon using the newly developed TEA‐ESD traction technique.     

ENDOSCOPIC SUBMUCOSAL DISSECTION (TWO‐POINT FIXED ESD) FOR EARLY ESOPHAGEAL CANCER

Background: We have been attempting to improve the safety, reliability and simplicity of endoscopic submucosal dissection for the treatment of early esophageal cancer and to shorten the time needed for this operation. Methods: The present study involved nine patients with well‐differentiated intramucosal early esophageal cancer over 20 mm in diameter. Two‐point fixed endoscopic submucosal dissection was carried out. Results: In all nine cases, the mucosal area to be dissected was successfully identified and kept under direct vision, allowing two‐point fixation of the mucosa with forceps and the hood during adequate counter‐traction. In this way, the respiration‐caused movement of submucosal tissue between the two fixing points was suppressed almost completely. Hemostasis and manipulation on blood vessels were easy with this procedure and dissection could be completed safely, without causing perforation. Conclusion: Endoscopic submucosal dissection with a transparent hood fitted with a mucosa‐holding forceps channel is highly useful, safe and simple when applied to the esophagus.     

玻璃体黄斑牵引综合征的手术治疗

目的 :探讨玻璃体手术治疗黄斑牵引综合征的方法、疗效。方法 :经裂隙灯前置镜、接触镜 ,荧光素眼底血管造影或光学相干断层成像术确诊的玻璃体黄斑牵引综合征共 16例 (16只眼 ) ,采用标准三切口玻璃体切除术切除患眼玻璃体后皮质 ,解除玻璃体视网膜牵引。结果 :16例患眼黄斑区牵引全部解除 ,经 3～ 15个月随访无复发 ;所有视力都有提高 ,术中术后未发现明显并发症。结论 :玻璃体手术是治疗玻璃体黄斑牵引综合征的有效方法。     

牵引定点复位法治疗腰椎间盘突出症1568例

应用牵引定点复位法治疗腰椎间盘突出症1568例。疗效观察结果:优42.2％;良39.7％;可13.12％;总有效率95.3％。认为疗效与年龄、病程、治疗次数、手法后腰围固定有一定关系。本文并对其手法治疗的机理进行了讨论。     

Appearance of age‐related macular degeneration in vitrectomized and nonvitrectomized eyes: an intraindividual case study

Purpose: This study analyses the consequences of vitreoretinal traction on the macula and in particular the impact of a vitrectomy on the development of the age‐related macular degeneration (ARMD). Methods: In this retrospective case study, 42 eyes of 21 subjects were examined. The vitreous of one eye must have been removed by vitrectomy at least 8 years ago. At that point in time, the patients had to be at least 50 years old, with a healthy vitreous body of the other eye and a healthy macula in both eyes. Both eyes were examined using an optical coherence tomography (OCT) scan, B‐scan ultrasound, a binocular slit‐lamp funduscopy and a fluorescence angiography (FAG) to evaluate the potential development stage of an ARMD and the vitreous status. Results: In the follow‐up examination, the patients had an average age of 73.6 years. In 0 of 21 vitrectomized eyes (0%), there were signs for an early ARMD. In 5 of 21 nonvitrectomized eyes (23.8%), we found ARMD‐like changes in the angiography and slit‐lamp examinations. Of these 21 eyes, five eyes presented persistent attachment of the posterior vitreous cortex to the macula, while 16 eyes showed complete posterior vitreous detachment. All five eyes (100%) with premonitory signs of an ARMD showed persistent attachment of the posterior vitreous to the macula. Conclusion: We demonstrated a positive relationship between a persistent attachment of the posterior vitreous cortex to the macula and early signs of ARMD. Although the precise mechanism of this relationship remains unclear, the role of chronic low‐grade inflammation, chronic oxidative and mechanical stress and an increase in VEGF is discussed. Persistent vitreous attachment is likely to be another risk factor for ARMD.     

便携式腰椎牵引器牵引治疗腰椎间盘突出症360例

目的 :观察便携式腰椎牵引器在治疗腰椎间盘突出症中的应用。方法 :使用便携式腰椎牵引器牵引治疗腰椎间盘突出症 ,同时以腰椎牵引床牵引治疗组作对照。结果 :治疗组 360例 ,临床观察和随访资料表明 ,优 2 75例 (占 76.4% ) ,良 71例 (占 1 9.7% ) ,优良率为 96.1 % ;对照组 2 70例 ,优 1 5 2例 (占 5 6.3% ) ,良80例 (占 2 9.63% ) ,优良率为 85 .93% ,两组对比差异有显著性 ( P<0 .0 1 )。结论 :便携式腰椎牵引器治疗腰椎间盘突出症 ,疗效显著 ,值得推广。