改良一侧PKP联合对侧PVP与双侧PKP治疗骨质疏松性椎体压缩骨折的对比研究

目的探讨同椎体一侧经皮椎体后凸成形术 (percutaneous kyphoplasty,PKP) 联合对侧经皮椎体成形术 (percutaneous vertebroplasty,PVP) 对治疗胸腰椎骨质疏松性椎体压缩骨折 (osteoporotic vertebral compression fractures,OVCFs) 的临床疗效。方法选择 2018 年 5~12 月收治的 67 例胸腰椎 OCVFs 患者。其中试验组 (改良一侧 PKP 联合对侧 PVP) 31 例,对照组 (传统双侧 PKP) 36 例。统计比较两组手术时间、术前与术后疼痛视觉模拟评分 (visual analogue scale,VAS)、骨水泥注入量和渗漏率、Cobb’s 角矫正情况以及椎体前缘和中部的高度变化,分析各项指标之间的差异是否具有统计学意义。结果所有患者术后症状均得到明显缓解,均未发生严重并发症。其中,试验组手术时间 (33.35±11.34) min,术前与术后 7 天 VAS 评分分别为 (7.60±2.34) 分和 (1.95±0.63) 分,椎体前缘高度分别为 (18.78±3.07) mm 和 (28.22±4.98) mm,椎体中部高度分别为 (19.21±4.35) mm 和 (30.82±3.31) mm,Cobb’s 角分别为 (26.84±4.79) °和 (13.66±3.13) °;对照组手术时间为 (42.10±12.26) min,术前与术后 7 天 VAS 评分分别为 (7.85±1.87) 分和 (2.11±0.45) 分,椎体前缘高度分别为 (20.31±4.76) mm 和 (26.76±2.21) mm,椎体中部高度分别为 (20.88±3.16) mm 和 (29.79±1.96) mm,Cobb’s 角分别为 (25.13±3.02) °和 (13.38±1.21) °。两组椎体前缘和中部高度、Cobb’s 角、VAS 评分术后与术前比较差异均有统计学意义 (P<0.05),但所有患者两侧缘高度改善率之间差异无统计学意义 (P>0.05)。组间比较,试验组手术操作时间低于对照组 (P<0.05),但椎体前缘和中部高度、Cobb’s 角度、VAS 评分的恢复改善差异无统计学意义 (P>0.05)。共有 9 例发生骨水泥渗漏 (试验组 5 例,对照组 4 例),渗漏率差异无统计学意义 (P>0.05)。结论改良一侧 PKP 联合对侧 PVP 与双侧 PKP 术式均能获得良好临床疗效。同时两种术式对疼痛改善程度、伤椎的复位效果以及骨水泥渗漏率方面差异无统计学意义,但改良一侧 PKP 联合对侧 PVP 在手术操作时间上明显优于双侧 PKP 术式。     

Median arcuate ligament syndrome

BackgroundMedian arcuate ligament syndrome (MALS) describes the clinical presentation associated with direct compression of the celiac artery by the median arcuate ligament. The poorly understood pathophysiologic mechanism, variable symptom severity, and unpredictable response to treatment make MALS a controversial diagnosis.MethodsThis review summarizes the literature pertaining to the pathophysiologic mechanism, presentation, diagnosis, and management of MALS. A suggested diagnostic workup and treatment algorithm are presented.ResultsIndividuals with MALS present with signs and symptoms of foregut ischemia, including exercise-induced or postprandial epigastric pain, nausea, vomiting, and weight loss. Consideration of MALS in patients' diagnostic workup is typically delayed. Currently, no group consensus agreement as to the diagnostic criteria for MALS exists; duplex ultrasound, angiography, and gastric exercise tonometry are used in different combinations and with varying diagnostic values throughout the literature. Surgical management involves decompression of the median arcuate ligament's constriction of the celiac artery; robotic, laparoscopic, endoscopic retroperitoneal, and open surgical intervention can provide effective symptom relief, but long-term follow-up data (>5 years) are lacking. Patients treated nonoperatively appear to have worse outcomes.ConclusionsMALS is an important clinical entity with significant impact on affected individuals. Presenting symptoms, patient demographics, and radiologic signs are generally consistent, as is the short-to medium-term (<5 years) response to surgical intervention. Future prospective studies should directly compare long-term symptomatic and quality of life outcomes after nonoperative management with outcomes after open, laparoscopic, endoscopic retroperitoneal, and robotic celiac artery decompression to enable the development of evidence-based guidelines for the management of MALS.     

Review of imaging and endovascular intervention of iliocaval venous compression syndrome

Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.     

解剖锁定钢板联合同种异体腓骨治疗肱骨近端骨折疗效的Meta分析

文题释义：肱骨近端骨折：肱骨近端包括肱骨头及大结节、小结节，中老年人骨质疏松及低能量损伤可导致肱骨近端骨折。 同种异体腓骨：取自于人体异体，经过加工处理，去除其免疫原性，保留其骨性结构，可用于移植修复骨缺损，起到支撑作用。 背景：肱骨近端骨折是临床常见骨折，但对肱骨近端内侧柱缺乏支撑的骨折目前仍是治疗难点，并发症常见，失败率较高。 目的：比较解剖锁定钢板联合同种异体腓骨与单纯解剖锁定钢板治疗肱骨近端骨折的疗效。 方法：使用计算机检索PubMed、Embase、Cochrane Library、Google Scholar、中国知网、万方、维普数据库，检索时间均从建库到2020年2月。检索国内外关于对比研究解剖锁定钢板联合同种异体腓骨与单纯解剖锁定钢板治疗肱骨近端骨折疗效的文献。2名研究员根据纳入和排除标准分别独立筛选文献，提取数据，评估文献中的偏倚风险。纳入12篇相关文献使用RevMan 5.2软件将以下指标进行Meta分析，包括影像学数据、功能评分和并发症。结果与结论：①通过文献检索、根据纳入和排除标准，12篇文献纳入研究，其中11篇为回顾性队列研究，1篇为随机对照研究；纳入研究文献质量高，但GRADE证据质量级别较低。②共纳入958例患者，其中解剖锁定钢板联合同种异体腓骨组411例，单纯解剖锁定钢板组547例；③Meta分析结果显示，解剖锁定钢板联合同种异体腓骨组术后1年肱骨头高度差值(MD=-2.40，95%CI：-2.49至-2.31)、颈干角差值(MD= -6.14，95%CI：-6.62至-5.67)、目测类比评分(MD=-0.22，95%CI：-0.35至-0.08)、肩关节功能评分(MD=4.12，95%CI：2.18-6.06)，上肢伤残评分(MD=-10.32，95%CI：-13.44至-7.19)、术后2年的目测类比评分(MD=-0.37，95%CI：-0.55至-0.19)、肩关节功能评分(MD=5.07，95%CI：2.86-7.27)、总体并发症(OR=0.31，95%CI：0.20-0.48)及肱骨头螺钉切出(OR=0.25，95%CI：0.11-0.55)均明显优于单纯解剖锁定钢板组(P < 0.05)，肱骨头坏死(OR=0.94，95%CI：0.47-1.88)，两组间差异无显著性意义(P > 0.05)；④因此，较弱的证据提示，肱骨近端解剖锁定钢板联合同种异体腓骨治疗肱骨近端骨折的短期疗效优于解剖锁定钢板，可减少并发症的发生，促进功能恢复。ORCID: 0000-0002-8486-3932(阳运康) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

锁定加压接骨板治疗桡骨远端骨折44例临床观察

目的：分析桡骨远端骨折患者行锁定加压接骨板治疗的效果。方法：选取我院2012年12月~2014年12月所收治的44例桡骨远端骨折患者作为研究对象，患者入院后均给予锁定加压接骨板治疗，采用Dienst功能评定标准对患者疗效实施评定，并采用X线来对患者的复位情况进行检查，随访12个月，观察并记录患者的治疗效果。结果：所有患者均完成为期12个月的随访，Dienst功能评定结果显示，37例患者疗效为优，6例患者疗效为良，1例患者疗效为差，患者治疗总有效率为97.73%。结论：桡骨远端骨折患者临床治疗时，采用锁定加压接骨板治疗方案，可有效强化患者临床疗效，改善患者预后生活质量，值得后续综合推广应用。     

“Evaluation of a Very Low-Cost and Simple Teleradiology Technique”

This paper describes and analyzes a proposed solution of fundamental limitative factor of teleradiology to overcome the teleradiology usages problems in underdeveloped and developing countries. The goal is to achieve a very simple and cost-efficient way to take advantage of teleradiology in anywhere even in remote and rural areas. To meet the goal of this study, the following methodology which is consists of two main procedures was done: (1) Using a digital camera in order to provide a digital image from radiographs. (2) Using an image compression tool in order to compress digital images. The results showed that there is no significant difference between digital images (non-compress and compress images) and radiographic films. Also, there was a logic relationship between the diagnostic quality and diagnostic accuracy. Since the maximum percent of diagnostic accuracy can be seen among “Good” quality images and the minimum to was related “Poor”. The results of our study indicate that a digital camera could be utilized to capture digital images from radiographic films of chest x-ray. To reduce the size of digital images, a lossy compression technique could be applied at compression percent of 50 or less without any significant differences. The compressed images can be sent easily by email to other places for consultation and also they can be stored with a smaller size.     

锁定加压钢板结合植骨术治疗胫骨平台骨折

目的探讨锁定加压钢板结合植骨术治疗胫骨平台骨折的临床效果。方法应用锁定加压钢板固定结合植骨术治疗32例胫骨平台闭合骨折患者。结果手术时间62~135(98.5±3.5)min。术后1周内行X线检查,30例患者获得解剖或接近解剖复位(占93.8%),2例患者功能复位(占6.2%)。患者均获得随访,时间5~16(8.2±1.5)个月。骨折均骨性愈合。膝关节功能评价根据HSS评分标准:优23例,良5例,可3例,差1例,优良率87.5%。结论应用锁定加压钢板固定结合植骨术治疗胫骨平台骨折术后并发症少,膝关节功能恢复良好,治疗效果满意。     

双锁定钢板内固定术治疗成人肱骨髁间骨折疗效观察

目的：探讨对成人肱骨髁间骨折患者行双锁定钢板内固定术的临床治疗效果。方法方便择取该院于2012年7月—2015年2月期间收治的成人肱骨髁间骨折患者94例，按照数字抽签法，将患者划分为治疗组与参照组，每组47例。对参照组患者行常规固定治疗，对治疗组患者行双锁定钢板内固定治疗，对比两组患者的临床治疗效果。结果两组患者的手术时间﹑住院时间对比差异无统计学意义(P>0.05)；对两组患者进行术后随访，均不存在切口皮肤坏死﹑深部感染以及尺神经损害等并发症；治疗组患者的治疗有效率为95.74%，参照组患者的治疗有效率为80.85%，数据组间差异有统计学意义(P<0.05)。结论对成人肱骨髁间骨折患者行双锁定钢板内固定术，固定效果良好，不存在固定松动情况，有利于患者快速恢复，提高患者生活质量，值得临床应用及推广。