ProPex根管测量仪测量磨牙牙齿操作长度准确性的临床评价

目的：评价分析ProPex根管测量仪测量磨牙牙齿操作长度的准确性.方法：选择116例根管治疗术的患者共130个磨牙383个根管,分为3组.A组：因根管欠充须再治疗者30个牙91个根管;B组：因修复治疗需要去髓术者46个牙130个根管;C组：慢性根尖周炎54个牙162个根管.以Propex测量牙齿操作长度.按此长度预备并充填根管,即刻拍摄X线片,观察并测量根管充填情况.结果：ProPex测量磨牙牙齿操作长度的准确率：A组86.8%,B组96.2%,C组85.8%.结论：ProPex可以比较准确地测量磨牙牙齿操作长度.     

基于体表标志估算静脉输液港导管置入长度的新方法

目的:分析右侧颈内静脉输液港导管置入长度的影响因素,并建立基于右侧胸骨第三肋间隙作为解剖标志测量导管长度的回归方程.方法:收集西安交通大学第一附属医院2017年9月至2018年7月行右侧颈内静脉植入式输液港的患者共190例为研究对象,均采用术中透视确定导管长度,并记录穿刺部位至右侧胸骨第三肋间隙的距离(SK-ICS).采用Pearson相关分析法分析实际置管长度与患者的年龄、身高、体质量、体质指数(body mass index,BMI)及SK-ICS的相关性,通过多元线性回归分析建立回归方程,并与其余3种常用公式进行对比.结果:导管长度与患者的身高、体质量及SK-ICS值存在正相关(P＜0.05),与BMI呈负相关(P＜0.05).通过多元线性回归分析得到回归方程:L=1.01xSK-ICS+0.151.该方程估算值与实际长度相比无明显差异(P＞0.05),而其余3种公式估算值均长于实际值.回归方程的绝对误差与百分比值均较低,预测置管长度准确性较高.结论:通过使用体表标志建立的回归方程对导管长度的估算具有一定的临床指导价值和推广意义.     

某三甲妇幼保健院超长住院日患者的分布特征分析与对策

目的:回顾性分析2019年江苏省某三甲妇幼保健院全年的超长住院日分布特征,探讨超长住院日的影响因素,并为医院管理提供数据支持。方法:分析该三甲妇幼保健院2019年全部出院患者并按照病案首页信息,将住院超过30天出院患者按性别、年龄、出院科室、疾病分类、费用等情况进行分类,利用Stata采用多元线性回归分析探讨超长住院日的影响因素。结果:2019年住院超过30天的患者共325例,占出院患者总数的0.87%。超长住院日患者中,小于1岁的患者占44.31%,排在前3位为儿科、小儿心胸外科、新生儿科,排在前3位的为新生儿呼吸窘迫综合征、肿瘤化学治疗疗程、乳腺恶性肿瘤。其影响因素用Stata做多元线性回归分析显示年龄和手术次数对超长住院日影响具有统计学意义(P<0.05)。年龄与超长住院时间呈反比,手术次数与超长住院日呈正比。结论:医院应提高诊疗水平,规范诊疗常规;加强对临床路径和单病种管理;加强监管力度,减少非适宜住院天数;加大对重点科室的监管,优化诊疗方案,严格控制非计划重返手术和手术并发症;完善分级诊疗制度,进一步提高就诊效率。     

3～12岁儿童眼轴长度、晶状体屈光力与屈光不正的关系

目的：探讨3～12岁儿童屈光参数发育特点,分析其与屈光不正的相关性。方法：描述性研究。共纳入2017年12月至2018年12月在重庆医科大学附属儿童医院眼科门诊就诊的3～12岁儿童600例 （1 200眼）,通过睫状肌麻痹检影验光及光学生物量仪（IOL-Master）获得等效球镜度（SE）、眼轴长度、角膜屈光力、前房深度,并计算晶状体屈光力。按年龄分成3组,分别为3～6岁组,7～9岁组和10～12岁组。按SE分成5组,分别为远视组、正视组、轻度近视组、中度近视组和高度近视组。 采用独立样本t检验、单因素方差分析及线性回归分析年龄、屈光与各屈光参数的关系。结果：3～6岁组,7～9岁组和10～12岁组SE（F=131.5,P<0.001）及晶状体屈光力（F=276.4,P<0.001）随年龄增长逐渐变小,眼轴长度（F=235.02,P<0.001）、前房深度（F=228.7,P<0.001）随年龄增长逐渐增大,角膜曲率（F=0.01,P=0.66）变化稳定。3组SE与眼轴长度呈负相关（r=-0.80、-0.85、-0.81,均P<0.001）,与晶状体屈光力呈正相关（r=0.98、0.92、0.91,均P<0.001）。轻度近视组,眼轴长度及晶状体屈光力与SE呈正相关性（r=0.545、0.601,P<0.001）;高度近视组眼轴长度及晶状体屈光力与SE呈正相关性（r=0.675、0.784,P<0.001[1]）。矫正年龄和性别后,眼轴长度解释SE 73.6%的变异,晶状体屈光力可解释SE 86.5%的变异。结论：眼轴长度与晶状体屈光力是影响屈光发育和近视发展的主要因素。     

屈光参差患者双眼血管密度与视网膜厚度的相关性研究

目的：研究屈光参差患者双眼在屈光度数、眼轴及OCTA黄斑区和视乳头区血流密度、黄斑区神经纤维厚度方面的差异,并研究眼轴与眼底血流密度及视网膜厚度的关系,分析其在屈光参差发生、发展中的临床意义。

方法：回顾性分析我院2018-05/11的符合纳入标准的屈光参差患者27例,所有患者均接受双眼的屈光度数、眼压、眼轴及OCTA黄斑区和视乳头区血流密度、黄斑区视网膜厚度的检查。应用SPSS 23.0软件,采用配对t检验分析对比患者双眼在各指标之间的差异。并分析眼轴和黄斑中心无血管区(FAZ)、脉络膜3.14mm²血流密度、黄斑区血流密度及视网膜厚度、视乳头血流密度的关系。

结果： 患者27例中,高度眼的屈光度数及眼轴均大于低度眼(t=-3.559、3.083,P<0.05)。高度眼和低度眼间在OCTA黄斑1mm及3mm浅层血流密度、深层血流密度、视网膜厚度上均无差异(P>0.05)。选取患者中高度眼较低度眼相比,视盘内血流密度大(t=2.36,P=0.022)和上鼻方(SN)血流密度小(t=-2.154,P=0.036)。屈光状态、黄斑中心凹浅层和深层血流密度、旁中心凹深层血流密度、黄斑中心凹及旁中心凹视网膜厚度与眼轴相关(r=-0.897、0.458、0.446、-0.328、0.301、-0.397,均P<0.05)。

结论：屈光参差患者高度眼较低度眼黄斑区3mm×3mm浅层和深层血流密度及视网膜厚度无差异,视盘内及上鼻方血流密度存在差异,余视乳头分区无差异。眼轴与屈光状态、黄斑中心凹浅层和深层血流密度、旁中心凹深层血流密度、黄斑中心凹及旁中心凹视网膜厚度相关。     

Intraoperative 3D imaging control during subthalamic Deep Brain Stimulation procedures using O-arm® technology: Experience in 15 patients

ObjectiveO-arm^® now gives us the opportunity not only to perform 2D but also 3D scans during deep brain stimulation (DBS) procedures. We present our experience with the intraoperative use of this device. Our objective was to measure the geometrical accuracy of electrode placement during surgical procedures driven under O-arm^® control.MethodsFifteen patients underwent STN-DBS. For the first 4 patients, 3D scans were performed at the end of the procedure. We calculated the accuracy of electrode positioning, i.e. the distance between final electrode positioning and the planned trajectory. For the next 11 patients, who underwent both intraoperative and final 3D scan, we also calculated the accuracy of the microelectrode positioning.ResultsAverage stimulation-induced improvement of UPDRS-III score was 52.5 ± 15%. For the first 4 patients, the mean electrode positioning accuracy was 1.46 ± 0.56 mm. For the 11 patients who underwent intraoperative 3D scan, the mean microelectrodes positioning accuracy was 1.59 ± 1.1 mm. Aberrant positioning was detected in two cases, and was analyzed by fusing 3D scan with preoperative MR images. The definite electrodes positioning accuracy was 1.05 ± 0.54 mm.ConclusionIntraoperative 3D scan is feasible, and can help us detect and correct early aberrant trajectories.     

超声引导经皮穿刺下腔静脉滤器置入术的初步研究

目的 探讨超声引导经皮穿刺下腔静脉滤器置入(IVCFI)术的可行性、安全性和临床实用价值。方法 在彩色多普勒血流显像(CDFI)引导下，对连续收治的31例下肢深静脉血栓患者行经皮穿刺IVCFI术。结果 31例患者术前CDFI检查下腔静脉、肾静脉及其最低人121显示清晰，下腔静脉平均内径19．7mm，无变异和血栓，符合所选滤器置入要求。在CDFI引导下，置入Vena Teeh永久型滤器31只，其中经右股静脉置入20只，左股静脉置入11只。术后CDFI和X线腹部平片均证实滤器置入位置正确，张开完全，无并发症，技术成功率为100％。随访结果，栓子俘获率29％，滤器无变形和移位，局部无血栓形成，也无滤器置入后肺血栓栓塞临床病例发生。结论 超声引导是经皮穿刺IVCFI术安全、可靠的方法，同时也是简便易行、无污染、费用低廉的实用方法。     

三叉神经根受照长度对伽玛刀治疗三叉神经痛疗效的影响

目的探讨伽玛刀治疗原发性三叉神经痛三叉神经根受照长度对疗效的影响。方法随访我中心2007年1月至2012年12月期间采用伽玛刀治疗的原发性三叉神经痛患者160例,分短照射组(1~2mm)和长照射组(3~4mm)两组,照射剂量均为75Gy,对比分析三叉神经根受射线照射长度与疗效之间的关系。结果病人特征包括性别、年龄、病程、随访时间等因素两组间无统计学差异(P0.05)。两组之间有效率无统计学差异(P=1.00),但并发症发生率差异显著(P0.01)。结论三叉神经根受照长度与并发症发生率具有相关性(P0.01),随着神经根受照长度增加并发症的发生率增加。     

Validity of a single-item measure to assess leg or back pain as the predominant symptom in patients with degenerative disorders of the lumbar spine

Purpose

Recent studies suggest that the location of predominant pain (back or leg) can be a significant predictor of the outcome of surgery for degenerative spinal disorders. However, others challenge the notion that the predominant symptom can be reliably identified. This study examined the validity of a single item used to determine the most troublesome symptom.

Methods

A total of 2,778 patients with degenerative disorders of the lumbar spine scheduled for surgery with the goal of pain relief completed a questionnaire enquiring as to their most troublesome symptom [“main symptom”; back pain (BACK) or leg/buttock pain (LEG)]. They also completed separate 0–10 graphic rating scales for back pain (LBP) and leg/buttock pain (LP) intensity. Receiver operating characteristics (ROC) analysis was used to determine the accuracy with which the “LP minus LBP” score was able to classify patients into their declared “main symptom” group. Sub-studies evaluated the test–retest reliability of the patients’ self-rated pain scores (N = 45) and the agreement between the main symptom declared by the patient in the questionnaire and that documented by the surgeon after the clinical consultation (N = 118).

Results

Test–retest reliability of the back and leg pain scores was good (ICC_2,1 of 0.8 for each), as was patient–surgeon agreement regarding the main symptom (BACK or LEG) (κ value 0.79). In the BACK group, the mean values for pain intensity were 7.3 ± 2.0 (LBP) and 5.2 ± 2.9 (LP); in the LEG group, they were 4.3 ± 2.9 (LBP) and 7.5 ± 1.9 (LP). The area under the curve for the ROC was 0.95 (95 % CI 0.94–0.95), indicating excellent discrimination between the BACK and LEG groups based on the “LP minus LBP” scores. A cutoff score >0.0 for “LP minus LBP” score gave optimal sensitivity and specificity for indicating membership of the LEG group (sensitivity 79.1 %, specificity 95.7 %).

Conclusions

The responses on the single item for the “main symptom” were in good agreement with the differential ratings on the 0–10 pain scales for LBP and LP intensity. The cutoff >0 for “LP minus LBP” for classifying patients as LEG pain predominant seemed appropriate and suggests good concurrent validity for the single-item measure. The single item may be of use in sub-grouping patients with the same disorder (e.g. spondylolisthesis) or as an indication in surgical decision-making.     

改进鼻饲管置入长度对重型颅脑损伤患者相关并发症的影响

目的 探讨改进胃管置管长度,对重型颅脑损伤患者鼻饲营养后胃肠道反应、并发症发生情况的影响.方法 选择复尔凯螺旋型鼻肠管.观察组53例,插入胃管长度为55～65 cm,当插至45～55 cm时,检查胃管在胃内后,再插入10 cm,使其到达幽门部.从胃管注入温开水20 ml,拔出导引钢丝,再次用注射器快速从胃管注入温开水10～20ml,使胃管在胃内不盘曲后固定.对照组52例,按传统的胃管置入方法,长度为45～55 cm.两组的鼻饲液均使用营养科自配的营养液.记录比较两组患者置管期间反流、呛咳、误吸、吸入性肺炎、腹泻、上消化道出血的发生情况.结果 观察组2例出现呛咳,无反流、误吸、吸入性肺炎发生,此4个指标发生率明显低于对照组(P＜0.01或P＜0.05);观察组发生腹泻5例、上消化道出血4例,对照组分别为6例、4例,经比较,差异无统计学意义(P＞0.05).结论 增加胃管插入长度后,食物直接刺激幽门部,可促进体液调节,减少胃肠道反应及并发症的发生.