改良TIP尿道成形术:恢复尿道解剖结构

目的 分析尿道板背侧纵切卷管尿道成形术(TIP)基础上覆盖Buck筋膜联合尿道海绵体(BC)和背侧包皮筋膜组织(P)在无阴茎下弯或轻度阴茎下弯的小儿中远段型尿道下裂的治疗效果。 方法 回顾性分析104例中远段型尿道下裂患儿的病例资料。其中行BC-P-TIP手术72例(A组); 行传统术式TIP+背侧包皮筋膜组织(P-TIP手术)32例(B组)。术后1,3,12月进行门诊随访。术后3月参照尿道下裂客观评分系统(HOSE)对患儿进行手术效果评估,对两组病例的一般资料、HOSE评分、并发症情况进行统计学分析。 结果 A,B组术后3月HOSE评分平均分分别为15.42及13.90,差别有统计学意义(P<0.01)。A,B组的尿瘘发生率为8.3%及25%,差别有统计学意义(P<0.05)。A,B组的尿道狭窄发生率为4.2%及0%,差别无统计学意义(P>0.05)。 结论 BC-P-TIP改良术式相对于P-TIP术式能有效减少尿瘘发生,术后外观满意、排尿功能良好,手术操作简单易学,取材方便,解剖损伤小,且接近正常尿道的解剖结构,值得进一步探讨及推广。     

Postoperative Changes In The Tensor Fascia Lata Muscle After Using The Modified Anterolateral Approach For Total Hip Arthroplasty

The modified Watson-Jones approach to the hip has been described as a minimally invasive approach with the potential for fewer postoperative complications than the traditional approach. Because the approach relies on an intermuscular rather than an internervous plane, there is potential for injury to the superior gluteal nerve. The aim of this study was to evaluate incidence of tensor fascia lata (TFL) denervation in patients undergoing this approach. Twenty-six patients underwent total hip arthroplasty (THA) using a modified anterolateral approach. Postoperative MRIs were analyzed for signs of muscle denervation including atrophy, hypertrophy and fat replacement. At a median follow-up of 9.3 months, 74% of patients exhibited either atrophy or hypertrophy of the TFL and 42% exhibited fat replacement on MRI.     

The immediate effects of hallux valgus orthoses: A comparison of orthosis designs

BackgroundHallux valgus orthoses are available in a wide range of designs and materials, but the effects of their design on functional performance have not been fully investigated.Research questionThis present study aims to comprehensively analyze the immediate effects of soft and semi-rigid hallux valgus orthoses on balance, plantar pressure, hallux valgus angle, and subjective sensations.MethodsSixteen female subjects have participated in the study, including 10 subjects with healthy feet and 6 with hallux valgus. Three conditions are tested, including in the barefoot and using two types of commercially available hallux valgus orthoses. The subjects participate in static and dynamic (walking) tests with the use of the Novel Pedar® system. The peak pressure values in the hallux, lateral toes, first metatarsophalangeal joint, 2-4th metatarsal heads, 5th metatarsal head, medial midfoot, lateral midfoot and rearfoot in the various foot conditions are examined and compared. The hallux valgus angle of each subject is measured based on their footprint. Their subjective feelings towards the orthoses are also evaluated. A repeated-measures analysis of variance, and independent-sample t-test are performed.ResultsThe correction of the hallux valgus angle is statistically significant when the subjects with hallux valgus use the orthoses. In comparing the two types of orthoses, the use of the orthosis made of soft materials results in correction in the hallux valgus angle and higher wear comfort, and lower plantar pressure in hallux area.SignificanceThe results provide insights into the design of hallux valgus orthoses, thus offering practical reference for the selection of hallux valgus orthosis with compromise between functional performance and wear comfort.     

Low dose radiotherapy for plantar fasciitis. Treatment outcome of 171 patients

BackgroundAlthough the effectiveness of low-dose radiotherapy for chronic degenerative and inflammatory diseases has been documented in previous studies, patient-reported clinical outcomes are rarely available.ObjectiveThis study aimed to determine the effect of low-dose radiotherapy on patients with painful plantar fasciitis.MethodFrom 2002 to 2008, 200 patients older than 65 years of age with painful plantar fasciitis were treated in our hospital. Records from 171 of these patients were available for analysis. All patients were treated with an identical dose of 3 Gy using identical equipment and techniques. Response was evaluated with patient-reported questionnaires and clinical visits.ResultsMinimum-term follow-up was 18 months, with mean follow-up at 54 months. Three months after receiving low-dose radiotherapy, 67.3% of patients had no or mild pain, and 57.9% had no or discrete mobility restriction. At a mean of 54 months, 61.4% of patients had no or mild pain and 64.9% of patients had no or discrete mobility restriction; 60.8% of patients reported improved quality of life.ConclusionLow-dose radiotherapy is effective in most patients with painful plantar fasciitis. Due to minimal side effects and low costs, it represents an excellent treatment option compared to conventional therapies or surgery.     

Retropharyngeal space and lymph nodes: An anatomical guide for surgical dissection

Conclusions

Identification of the alar fascia is the key part of surgical dissection of the retropharyngeal lymph nodes (RPLNs). In cases where mandibulotomy is not performed for the removal of the primary tumor and/or the posterior pharyngeal wall is not incised, the medial or lateral approaches described in this paper can be performed.

Objective

Surgical dissection of the RPLNs may improve prognosis and locoregional control in oropharyngeal, hypopharyngeal and cervical esophageal carcinomas. There have been no previous anatomical studies concerning landmarks and approaches for the surgical dissection of the RPLNs. This study was designed to illustrate the fascial anatomy of the retropharyngeal region (RPR), provide anatomical guidelines for RPLN dissection and describe and compare approaches for surgical removal of the RPLNs.

Material and methods

Twelve fixed cadavers were used. Slices were obtained from the necks of the first three cadavers and the RPRs of the slices were dissected under an operating microscope. The other nine cadavers were dissected in a surgical position to expose the RPLNs and the fasciae of the RPR.

Results

In the coronal plane, the alar fascia divides the space between the buccopharyngeal and prevertebral fasciae into two compartments and constitutes the posterior border of the retropharyngeal space, which contains the RPLNs. The alar fascia, an important landmark for reaching the RPLNs, can be identified by the cervical sympathetic trunk, superior sympathetic ganglion and superior laryngeal nerve. Two approaches can be performed to remove the RPLNs, namely medial or lateral to the internal and external carotid arteries, internal jugular vein and vagus nerve.