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。     

短节段椎弓根螺钉固定联合椎体成形术治疗伴有后凸畸形Kümmell病

目的 :探讨后路短节段椎弓根螺钉内固定联合椎体成形术治疗伴有后凸畸形Kümmell病的临床疗效。方法:回顾性分析2016年1月至2018年12月采用后路短节段椎弓根螺钉内固定联合椎体成形术治疗的24例伴有后凸畸形Kümmell病患者,其中男6例,女18例,年龄63～85(73.1±6.5)岁。比较患者术前、术后3 d及末次随访时的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),伤椎椎体前缘高度,受累节段矢状面Cobb角等指标以评价临床疗效,并观察手术并发症。结果:所有24例患者获得随访,时间12～24(15.5±3.2)个月。VAS评分由术前的5.21±1.06下降至术后3 d的2.38±0.58以及末次随访时的1.71±0.75;ODI由术前的(50.4±13.5)%下降至术后3 d的(20.9±8.0)%以及末次随访时的(16.7±9.6)%;椎体前缘高度由术前的(8.0±4.2) mm恢复至术后3 d的(18.1±5.0) mm以及末次随访时的(16.8±5.1) mm;Cobb角由术前的(19.5±6.3)°下降至术后3 d的(7.6±2.1)°以及末次随访时的(8.4±1.7)°。术后3 d和末次随访VAS、ODI、椎体前缘高度、Cobb角较术前明显改善(P0.05)。术后出现1例无症状骨水泥渗漏,1例浅表切口感染。结论:后路短节段椎弓根螺钉内固定联合椎体成形术治疗伴有后凸畸形Kümmell病具有手术创伤相对小、临床效果优良、椎体高度恢复良好、后凸角度纠正满意、并发症少等优势,是治疗伴有明显后凸畸形Kümmell病的一种较为安全有效的手术方式。     

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.     

“天玑”骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较

目的比较"天玑"骨科手术机器人辅助和徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折(OVCF)的疗效。方法回顾性分析西安交通大学医学院附属红会医院脊柱外科自2018年1月至2019年3月使用"天玑"骨科手术机器人辅助下穿刺完成椎体成形术的19例上胸椎OVCF患者(20个椎体)资料(机器人组)和自2016年1月至2017年12月徒手穿刺完成椎体成形术的21例上胸椎OVCF患者(21个椎体)资料(徒手组)。机器人组男5例,女14例;年龄62~88岁;徒手组男6例,女15例;年龄64~83岁。通过比较两组患者的手术时间、骨水泥注入量、术后并发症(骨水泥渗漏、感染和血管栓塞),术后1 d、末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎椎体前缘高度(AH)和伤椎后凸角(KA)观察疗效。结果机器人组和徒手组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。机器人组中19例患者(20个椎体)和徒手组中21例患者(21个椎体)均顺利完成单侧穿刺入路椎体成形术。40例患者术后随访6~12个月,平均8.3个月。机器人组的手术时间[(37.9±8.2)min]、骨水泥注入量[(2.3±0.9)mL]、骨水泥渗漏发生率(10.0%,2/20)均少于或低于徒手组[(46.2±9.4)min、(4.2±1.3)mL、42.9%(9/21)],差异有统计学意义(P<0.05)。两组患者均无感染和血管栓塞发生。术后1 d、末次随访时两组间VAS评分、ODI、AH和KA比较差异均无统计学意义(P>0.05)。结论相比于传统徒手穿刺椎体成形术,"天玑"骨科手术机器人辅助下穿刺完成椎体成形术治疗上胸椎(T1~T4)OVCF临床疗效满意,可减少手术时间和骨水泥注入量,并降低骨水泥渗漏的发生率。     

后路椎体次全切治疗胸腰段椎体成形术椎再骨折的疗效分析

目的探讨经后路椎体次全切治疗胸腰段椎体成形术椎再骨折的疗效。方法回顾性分析2017年6月至2019年10月河南省人民医院脊柱外科收治的28例胸腰段椎体成形术椎再骨折患者资料。男7例,女21例;年龄61~76岁,平均62.4岁;骨折椎体:T115例,T129例,L111例,L23例;既往手术方法:经皮椎体成形术治疗17例,经皮椎体后凸成形术治疗11例。手术方法:后路切除棘突、椎板,经侧方切除关节突、横突,部分切除椎体、骨水泥及上下椎间盘,神经减压,椎体间人工椎体固定,后路钉棒矫形固定。记录手术时间及术中出血量,比较患者术前和末次随访时后凸cobb角评价矫形效果;比较患者术前和末次随访时疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分评价脊柱功能改善情况。结果本组患者手术时间平均为182.1 min,术中出血量平均为996.2 mL。28例患者术后随访8~29个月(平均19.8个月),无明显神经功能损伤及其他严重并发症发生。cobb角由术前的41.3°±10.3°改善为末次随访时的6.4°±2.5°,VAS评分由术前的(7.3±1.8)分改善为末次随访时的(2.5±1.0)分,JOA评分由术前的(8.4±2.3)分改善为末次随访时的(21.3±2.5)分,以上比较差异均有统计学意义(P<0.05)。结论经后路椎体次全切治疗胸腰段椎体成形术椎再骨折,可一期进行骨水泥清除、椎管减压、椎间植骨融合,重建脊柱稳定性,有很好的疗效。     

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.     

Spinal metastases treated with bipolar radiofrequency ablation with increased (> 70 °C) target temperature: Pain management and local tumor control

PurposeTo investigate the safety and clinical efficacy of bipolar radiofrequency ablation (b-RFA) with increased (> 70 °C) target temperature for the treatment of spine metastases with the intent of achieving pain relief or local tumor control.Materials and methodsThirty-one patients with a total of 37 metastases who were treated with b-RFA with increased temperature and vertebroplasty from January 2016 to May 2019 were retrospectively included. There were 20 women and 11 men with a mean age of 62.4 ± 10.5 (SD) years (range: 40–78 years). Patients and metastases characteristics, procedure details and clinical outcomes were analyzed.ResultsMetastases were predominantly located in lumbar (22/37; 59.5%) or thoracic spine (13/37; 35.1%). Mean target temperature was 88.4 ± 3.5 (SD) °C (range: 70–90 °C). Technical success was 100% (37/37 metastases). One (1/37; 2.7%) major complication unrelated to b-RFA was reported. One (1/37; 2.7%) metastasis was lost to follow-up. Favorable outcome was noted in patients receiving b-RFA for pain management (16/20 metastases; 80%; mean follow-up, 3.4 ± 2.9 [SD] months) or with oligometastatic/oligoprogressive disease (6/6 metastases; 100%; mean follow-up, 5.0 ± 4.6 [SD] months). In patients receiving b-RFA to prevent complications, favorable outcome was noted in 6/10 metastases (60%; mean follow-up, 3.8 ± 4.8 [SD] months).ConclusionsB-RFA with increased target temperature has an excellent safety profile and results in high rates of pain relief and local metastasis control in patients with oligometastatic/oligoprogressive disease. Suboptimal results are achieved in patients receiving b-RFA to prevent complications related to the growth of the index tumor.     

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。