切开与关节镜下Latarjet手术治疗肩关节前向不稳临床疗效的Meta分析

目的:通过Meta分析比较切开与关节镜下Latarjet手术治疗肩关节前向不稳的临床疗效差异。方法 :计算机检索PubMed、Medline、Embase、Cochrane、中国知网、万方、中国生物医学文献数据库和维普数据库,以查找关于切开和关节镜下Latarjet手术治疗肩关节前向不稳的回顾性或前瞻性队列研究或随机对照试验。选择二分类变量,如术后复发率、术中及术后并发症发生率;以及连续型变量,如肩关节外旋活动度,Walch-Duplay评分,Rowe评分,西安大略肩关节不稳指数(Western Ontario Shoulder Instability Index,WOSI)评分,术后视觉模拟评分(visual analogue scale,VAS),术后患者焦虑程度,手术时间和螺钉置入角度等结局指标进行分析。采用NOS偏倚风险评估标准(Cochrane协作网推荐)评价回顾性或前瞻性队列研究的文献质量,随机对照试验的质量评价采用改良Jadad量表。由2人独立进行文献筛选、文献质量评价及数据提取。使用RevMan 5.3软件进行Meta分析。结果:(1)共纳入9篇文献,其中8篇回顾性队列研究和1篇前瞻性队列研究,研究证据级别较低,共纳入956例患者,其中切开Latarjet手术436例,关节镜下Latarjet手术520例。(2)Meta分析结果显示,切开组术后肩关节WOSI评分优于关节镜下组(MD=93.74,95%CI:26.00~161.49,P=0.007),且螺钉置入角度明显小于关节镜组(MD=-6.44,95%CI:-12.08~0.81,P=0.02)。(3)切开Latarjet手术复发率低于关节镜下Latarjet手术,但二者差异无统计学意义(OR=0.84,95%CI:0.23~3.05,P=0.79)。(4)在肩关节外旋活动度、Walch-Duplay评分、Rowe评分、术后视觉模VAS评分、术后患者焦虑程度和手术时间等方面切开和关节镜下Latarjet手术之间差异无统计学意义(P0.05)。结论:切开和关节镜下Latarjet手术治疗肩关节前向不稳均能取得良好的临床疗效,且术后复发脱位率及并发症较低。切开和镜下Latarjet均为治疗肩关节前向不稳的可靠手术方式。但镜下手术较切开手术学习曲线长,需要一定量的手术积累,因此临床医生可根据手术技术熟练程度、喜好和患者的情况等因素选择镜下或切开手术。但研究中所纳入的文献皆为队列研究,证据等级不高,缺少随机对照试验,且样本量较小,未来仍需要大样本量、高证据等级的随机对照研究来确定两者之间的疗效差异。     

拇外翻术后转移性跖痛症的研究进展

拇外翻术后少数患者易发生转移性跖痛症,严重影响患者工作和生活质量。熟悉并了解其发病机制和治疗方法对于转移性跖痛症的临床预防、治疗及康复均具有十分重要的指导意义。目前临床上除保守治疗外,主要采用手术治疗的方法。但因各家学术观点不同,给临床医生在选择治疗法则及术式上造成诸多困难。本文综合了国内外当前主要学术流派的观点及看法,并简要评价,针对其常见发病机制及治疗方法进行综述。     

持续牵引在纠正桡骨远端不稳定骨折中桡骨短缩的作用机制探讨

目的：探讨持续牵引在桡骨远端不稳定骨折治疗中的力学机制。方法：采用复位外固定器治疗30例桡骨远端不稳定骨折,男4例,女26例;年龄18-85岁,平均61岁。按AO分型,其中A3型12例,B2型3例,C1型8例,C2型4例,C3型3例。分别测量患者术前与术后X线上的桡骨茎突与尺骨关节面之间的距离。结果：30例患者获得6-15个月的随访,平均11．2个月。测量X线结果为术前平均（0．55±0．22）cm,术后平均（1．07±0．23）cm,明显高于术前,差异有统计学意义（P〈0．01）。结论：复位外固定器提供的持续牵引其作用机制可以通过筋束骨理论、韧带整复原理及牵拉成骨理论解释。     

辛开苦降法对反流性食管炎模型大鼠食管黏膜细胞间隙的影响

目的观察辛开苦降法对反流性食管炎（reflux esophagitis,RE）模型大鼠食管黏膜细胞间隙的影响。方法 100只Wistar大鼠按照随机数字表法分为对照组、模型组、西药组、中药组,每组25只,共4组。对照组只行腹腔开关术,其余3组均采用改良部分贲门肌切开加外置幽门部分结扎术,制备RE大鼠模型。术后第3天西药组灌胃混合剂：吗丁啉片（3.2 mg/kg）＋奥美拉唑胶囊（4.3 mg/kg）＋铝碳酸镁片（161.4mg/kg）,中药组灌胃半夏泻心汤加减汤剂（5.7 g/kg）,1次约2.5 m L,1天2次,连续14天;同时对照组和模型组大鼠每天给予灌胃等量生理盐水。观察实验第7、14天各组模型食管下段p H值、黏膜大体标本、病理组织学变化,并测量各组食管黏膜上皮细胞间隙进行对照研究。结果与本组治疗第7天比较,西药组和中药组在第14天大鼠食管下段p H值均升高（P〈0.01）,食管黏膜肉眼积分均降低,上皮细胞间隙亦降低（P〈0.05）。与对照组同期比较,模型组大鼠食管下段p H值均降低（P〈0.01）,模型组大鼠食管黏膜肉眼积分升高,上皮细胞间隙亦升高（P〈0.01）。与模型组同期比较,中药组和西药组第7、14天大鼠食管下段p H值升高,食管黏膜肉眼积分降低（P〈0.01）,中药组和西药组第14天大鼠食管黏膜上皮细胞间隙亦降低（P〈0.01）。与西药组同期比较,中药组第7天大鼠食管下段p H值降低（P〈0.05）,中药组第14天大鼠食管黏膜肉眼积分和上皮细胞间隙均降低（P〈0.05）。结论辛开苦降法对RE动物模型有良好的治疗作用,并随疗程增加效果更加明显,其机制可能是通过对损伤黏膜良好的修复作用、增加下食管括约肌的压力及抑制胃酸实现的。     

经皮耳迷走神经刺激干预功能性消化不良模型大鼠的效应及机制研究

ObjectiveTo explore the effect and its possible mechanism of the intervention of transcutaneous auricular vagus nerve stimulation (taVNS) for the functional dyspepsia (FD) model rats.MethodsOf the 25 male SD rats, 6 rats were set as blank group, the other 19 rats were established to be the functional dyspepsia (FD) model by iodoacetamide intragastric administration, and 18 FD models were successfully established. The 18 model rats were randomly divided into a model group, a sham-taVNS group, and taVNS group, with 6 rats in each group. There was no intervention applied to the rats in the blank and model groups. Whereas, the rats in sham-taVNS group received stimulation to the rim of auricular concha of both sides, and those in taVNS group received stimulation to the cavity of auricular concha of both sides, for 30 min each time, once a day, 7 days in succession. After the intervention, the gastric sensitivity of the rats in each group under different pressure conditions in the stomach, the expressions of serum brain-gut peptide motilin (MTL), cholecystokinin (CCK), glucagon-likepeptide1 (GLP-1), and inflammatory factors IL-4, IL-10, and IL-1β were detected.Results(1) Gastric sensitivity: compared with the blank group, the gastric sensitivity of the model group was higher (P <0.05). Compared with the model group, the gastric sensitivity of the taVNS group was lower (P < 0.05). Compared with the sham-taVNS group, the gastric sensitivity of the taVNS group was lower (P <0.05).(2) Expression of brain-gut peptide: compared with the blank group, MTL was lower, CCK and GLP-1 were higher in the model group (all P <0.05). Compared with the model group, MTL was higher, CCK and GLP-1 were lower in the taVNS group (all P <0.05). Compared with the sham-taVNS group, CCK and GLP-1 were lower in the taVNS group (both P<0.05). (3)Expression of inflammatory factors: compared with the blank group, IL-4 and IL-10 were lower and IL-1β was higher in the model group (all P <0.05). Compared with the model group, IL-10 was higher and IL-1β was lower in the sham-taVNS group (all P <0.05), while IL-4 and IL-10 were higher and IL-1β was lower in the taVNS group (all P <0.05). Compared with the sham-taVNS group, IL-4 and IL-10 were higher and IL-1β was lower in the taVNS group (all P <0.05).ConclusionTaVNS can reduce the gastric sensitivity of FD model rats by peripheral anti-inflammatory action and regulating the abnormal secretion of brain-gut peptide.     

三棱火针加拔罐治疗腘窝囊肿30例

ObjectiveTo explore the therapeutic effect of the fire needling with the three-edged needle and the cupping on popliteal cyst.MethodsA total of 60 patients of popliteal cyst were divided into two groups, 30 cases in each one according to the random number table. In the fire needling group, the burnt-red three-edged needle was inserted to the deep layer of the cyst. After the fluid was squeezed out, the cupping was exerted. The treatment was given 1 to 2 times a week, for 4 weeks totally. In the western medication group, prednisolone acetate 25 mg was injected in the cyst capsule, once a week, for 4 weeks totally. The effective rate, recurrence rate and Rauschning–Lindgren grading were evaluated before and after treatment.ResultsThe total effective rate was 80.0% in the fire needling group and was 83.3% in the western medication group, without statistical significance in comparison (P > 0.05). The recurrence rate was 6.7% in the fire needling group and was 30% in the western medication group. The recurrence rate in the fire needling group was lower than that in the western medication group, indicating the statistical significance (P < 0.05). After treatment, Rauschning–Lindgren grade was different statistically as compared with that before treatment in either group (both P < 0.05). Rauschning–Lindgren grade was distributed in 0 to I in the fire needling group after treatment, which was different significantly as compared with the western medication group (P < 0.05).ConclusionThe combined treatment with the fire needling combined with cupping therapy achieves the satisfactory effect on popliteal cyst and the very low recurrence rate and it is easy in operation and deserves to be promoted in primary care.     

中医综合康复对桡骨远端骨折治疗后关节功能恢复的病例对照研究

目的:评价中医综合康复疗法对桡骨远端骨折治疗后关节功能恢复的临床疗效和优势。方法:自2014年5月至2015年10月在中国中医科学院望京医院门诊就诊,符合纳入标准的桡骨远端骨折关节功能障碍患者72例,分为试验组与对照组。试验组36例,脱落1例,男3例,女32例,平均年龄(61.78±8.61)岁;对照组36例,脱落2例,男7例,女27例,平均年龄(61.64±10.12)岁,最终完成69例。试验组予以中医综合康复治疗,对照组予以中药熏洗加功能锻炼治疗,均治疗3周。以握力、腕关节患者自评量表、Gartland和Werley(G-W)腕关节评价、焦虑自评量表(SAS)和总体疗效评价为评定标准,采集治疗前(基线)、治疗3周后以及骨折3个月时的数据并进行统计分析。结果:在3周治疗后及骨折3个月时,患侧腕关节总体疗效评价、G-W评价和PRWE评分,试验组均优于对照组;在患侧握力恢复方面,3周治疗过程中试验组疗效优于对照组,但骨折3个月时试验组与对照组握力恢复情况差异无统计学意义。对于患者的焦虑情绪而言,康复治疗前与治疗后相比较,试验组与对照组患者焦虑情绪均有所缓解,但在治疗过程中,试验组与对照组患者焦虑情绪缓解程度差异无无统计学意义。结论:中医综合康复方法对桡骨远端骨折后关节功能障碍疗效明显优于中药熏洗加功能锻炼的一般疗法。     

股骨头坏死患者生活质量临床研究

目的探讨股骨头坏死(ONFH)患者的生活质量及影响因素,为ONFH的治疗选择提供依据;探讨将生活质量作为其疗效评价的可行性。方法采用国际通用的SF-36量表对95例ONFH的住院患者和60例正常对照人群进行测量评分。155份量表的填写均为被调查者本人完成。95例ONFH患者按ARCO分期:Ⅰ期4例,Ⅱ期54例,Ⅲ期32例,Ⅳ期5例。界定Ⅰ～Ⅱ期为早期,Ⅲ～Ⅳ期为中晚期。将性别、年龄、职业、婚姻状况、文化程度、家庭收入等非疾病因素作为自变量,通过t检验、方差分析、多元逐步回归分析ONFH患者的生活质量及其影响因素。结果 ONFH组生活质量评分分别为躯体功能(PF)(69.42±16.16)分;躯体健康所致角色限制(RP)(24.11±34.91)分;躯体疼痛(BP)(67.02±14.36)分;总体健康(GH)(54.21±22.79)分;活力(VT)(65.42±22.65)分;社会功能(SF)(66.08±26.00)分;情绪问题所致角色限制(RE)(55.44±43.11)分;心理健康(MH)(65.73±18.96)分与正常组进行比较,差异有统计学意义(P0.01);早期和中晚期患者的PF、RP评分分别为(72.46±11.41)、(64.87±20.71)分和(19.74±31.60)、(38.16±37.10)分,差异有统计学意义(P0.05);非疾病因素对生存质量各维度均有影响,特别是文化程度和婚姻状况。结论生活质量的评价为ONFH治疗方法的选择提供了依据,把生活质量引入ONFH的疗效评价体系将更具有人性化。