NRD辅助Ilizarov技术治疗胫骨感染性骨与软组织缺损

目的:探讨NRD辅助Ilizarov技术治疗胫骨感染性骨与软组织缺损的临床疗效。方法:选取2013年3月至2020年12月治疗的胫骨感染性骨与软组织缺损患者48例,男34例,女14例,年龄24~55(40.54±11.64)岁,分为研究组与对照组。研究组患者25例,男17例,女8例,年龄31~55(41.36±9.69)岁,采用NRD辅助Ilizarov骨搬移技术治疗。对照组23例患者,男17例,女6例,年龄24~53(38.61±8.76)岁,采用传统骨搬移技术治疗。通过两组患者的治愈率、复发率、针道感染发生率、抗生素使用时间、创面愈合时间、外固定携带时间、骨搬移时间、骨愈合情况、术后功能等指标评价治疗效果。结果:随访时间12~62(33.0±7.2)个月,末次随访时,两组患者的治愈率比较,差异无统计学意义(P>0.05),研究组复发率低于对照组(P<0.05),针道感染发生率低于对照组(P<0.05)。研究组的抗生素使用时间、创面愈合时间均少于对照组(P<0.05),两组之间的骨搬移时间、外固定携带时间差异无统计学意义(P>0.05),两组骨愈合情况、术后功能差异无统计学意义(P>0.05)。结论:NRD辅助Ilizarov技术治疗胫骨感染性骨与软组织缺损,可以达到满意的治疗效果,缩短了治疗周期及抗生素使用时间。     

微创截骨 Ilizarov 技术结合髓内钉行股骨延长的疗效观察

目的探讨微创截骨 Ilizarov 技术结合髓内钉进行股骨延长治疗股骨短缩畸形的效果。方法将 2013 年 1 月—2016 年 6 月收治并符合选择标准的 71 例股骨短缩畸形患者，随机分为试验组（36 例，采用微创截骨 Ilizarov 技术结合带锁髓内钉进行股骨延长）和对照组（35 例，采用单纯 Ilizarov 技术进行股骨延长）。两组患者年龄、性别、股骨短缩原因、股骨短缩长度、股骨合并畸形比例等一般资料比较差异均无统计学意义（P>0.05），具有可比性。记录并比较两组患者手术时间、术中出血量、延长速度、外固定器佩戴时间、针道感染例数、截骨愈合时间、术后 1 年膝关节活动度。 结果两组患者均获随访，随访时间 12～60 个月，平均 31 个月。试验组 1 例 1 针、对照组 7 例 9 针发生针道感染，均经更换固定针、积极换药、使用抗生素及加强护理后治愈；两组针道感染发生率比较差异有统计学意义（χ²=5.265，P=0.022）。试验组手术时间长于对照组，术中出血量大于对照组，外固定器佩戴时间、截骨愈合时间及术后 1 年膝关节活动度均优于对照组，差异有统计学意义（P<0.05）；两组延长速度比较差异无统计学意义（t=–1.581，P=0.153）。 结论微创截骨 Ilizarov 技术结合髓内钉进行股骨延长虽然增加了手术时间及术中出血量，但显著缩短了患者佩戴外固定器的时间，减少了针道感染概率，改善了术后关节功能。     

Efficacy of C-Mill gait training for improving walking adaptability in early and middle stages of Parkinson’s disease

BackgroundWalking adaptability is an obvious manifestation of Parkinson’s disease (PD). Augmented reality technologies such as interactive walkways may improve walking adaptability in patients with Parkinson’s Disease (PWP).Research questionHow effective is C-Mill gait adaptability training in the early and middle stages of PD for improving walking adaptability in motor subtypes of the disease?MethodsFifty-two patients with early- or middle-stage PD were divided into two groups according to motor subtype (postural instability/gait disorder [PIGD] and non-PIGD) and received 7 days of training (0.5 h every day, 2 h after medication) on an augmented reality treadmill with built-in visual targets and obstacles. Functional assessments were performed before and after intervention, including posture control and walking, C-gait assessment, and participant experience. The Parkinson Disease Quality of Life questionnaire was administered at 3-month follow-up.ResultsBoth the PIGD (n = 29) and non-PIGD (n = 23) groups showed improved tandem walking, obstacle avoidance, and overall score in C-gait assessment and Timed Up and Go test after C-Mill training. However, there were no differences between the two groups. The PIGD group showed improvement in visually guided stepping and Speed adaptations, whereas the non-PIGD group did not improve. The non-PIGD group reported they could complete the training with less exertion after the intervention and at the 3-month follow-up, these patients reported improvement in quality of life.SignificanceC-Mill gait adaptation training in the early and middle stages of PD improves walking adaptability in both motor subtypes. Cue strategies are the probable mechanism and may decrease fall risk after training. There was no difference between the groups in the improvements of perceived exertion and quality of life at follow-up. Although PIGD patients showed statistic improvements in visually guided stepping compared with non-PIGD patients, but the difference was not likely to be clinically meaningful. Specific effects of C-mill training for different types of PD were not observed in our study.     

磁导航脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病的疗效观察

目的：观察磁导航辅助脊柱内镜下腰椎融合术治疗单节段腰椎退行性疾病的临床疗效。方法：回顾性分析2021年1月～2022年1月在我院行脊柱内镜下腰椎融合术治疗的43例单节段腰椎退行性疾病患者的资料，其中C型臂组23例，磁导航组20例。两组患者的年龄、体重指数（body mass index,BMI）、患病时间、性别、节段、主诊断及慢性病等一般资料均无统计学差异（P>0.05）。比较两组患者的术中透视次数、置钉时间、置钉准确度、手术时间、手术出血量、术后引流量、卧床时间、住院时间和并发症发生情况，术前和术后1个月、3个月及1年的疼痛视觉模拟评分（visual analogue scak,VAS）及腰椎Oswestry功能障碍指数（Oswestry disability index,ODI），术后1年时腰椎CT评估融合情况。结果：磁导航组和C型臂组的透视次数、置钉时间、置钉准确度、手术时间、术中出血量和术后引流量分别为19.95±9.01次、24.80±9.77min、97.50%、163.40±20.77min、69.50±26.90mL、86.25±22.82mL和55.87±7.2...