显微血管减压术治疗舌咽神经痛的临床疗效分析

目的探讨显微血管减压术(MVD)治疗舌咽神经痛(GPN)的安全性及远期临床疗效。方法回顾性分析39例行显微血管减压术治疗的舌咽神经痛患者的临床资料。所有患者均采用乙状窦后-幕下入路进行显微血管减压手术,术后定期随访。结果所有患者术后早期疗效显著,随访时间为1~9年,平均为4.9年。随访过程中1例患者术后2年出现舌咽神经痛症状复发,1例患者术后1.5年舌咽神经痛症状部分复发。术后出现声音嘶哑及吞咽困难患者4例、脑脊液漏患者1例,均在随访过程中恢复。结论显微血管减压术是治疗舌咽神经痛安全有效且远期效果良好的方法,术前影像学检查对于责任血管的判断有重要意义。     

Suprascapular nerve entrapment in young kayaker: a case report

ABSTRACT

Kayaking has become one of the most popular paddle sports throughout the world. The shoulder is the most commonly injured area of the body among kayaking participants as a result of acute traumatic events and chronic overuse injuries. Therefore, kayaking participants may often seek advice for shoulder problems and there is a scarcity of studies regarding shoulder injuries in this population. In this case report, we present a young male recreational whitewater kayaker with a severe suprascapular nerve (SSN) entrapment who presented with shoulder pain and inability to perform his sport. He was initially evaluated elsewhere and was treated with nonsteroidal anti-inflammatory medications and physical therapy for presumptive diagnosis of subacromial impingement. After 5 months of failed non-operative treatment, the patient sought a second opinion with our group. SSN entrapment diagnosis was confirmed by a thorough careful physical examination, magnetic resonance imaging and electrodiagnostic study. Given the failure of non-operative treatment, the patient was treated with arthroscopic SSN decompression and successfully returned to kayaking without symptoms. While SSN entrapment has been reported in a variety of sports, especially those involving overhead movements, this is the first case report of SSN entrapment reported which impaired participation in kayaking. This case report supports the consideration of SSN entrapment in the differential diagnosis of painful shoulder among kayaking participants and highlights the importance of undressing the patient and examining the posterior shoulder for atrophy, winging or deformity.     

Cell therapy for osteonecrosis of femoral head and joint preservation

Osteonecrosis of femoral head (ONFH) is a disease of the femoral head and can cause femoral head collapse and arthritis. This can lead to pain and gait disorders. ONFH has various risk factors, it is often progressive, and if untreated results in secondary osteo-arthritis. Biological therapy makes use of bone marrow concentrate, cultured osteoblast and mesenchymal stem cell (MSC) obtained from various sources. These are often used in conjunction with core decompression surgery. In this review article, we discuss the current status of cell therapy and its limitations. We also present the future development of biological approach to treat ONFH.     

Management of Neonatal Hypotension and Shock

The current standard approach to manage circulatory insufficiency is inappropriately simple and clear: respond to low blood pressure to achieve higher values. However, the evidence for this is limited affecting all steps within the process: assessment, decision making, therapeutic options, and treatment effects. We have to overcome the ‘one size fits all’ approach and respect the dynamic physiologic transition from fetal to neonatal life in the context of complex underlying conditions. Caregivers need to individualize their approaches to individual circumstances. This paper will review various clinical scenarios, including managing transitional low blood pressure, to circulatory impairment involving different pathologies such as hypoxia-ischemia and sepsis. We will highlight the current evidence and set potential goals for future development in these areas. We hope to encourage caregivers to question the current standards and to support urgently needed research in this overlooked but crucial field of neonatal intensive care.     

Impaction Bone Grafting Augmented With a Wire Coil by the Lightbulb Technique for Osteonecrosis of the Femoral Head

BackgroundOsteonecrosis of the femoral head (ONFH) is a debilitating disease that primarily affects the hips of young adults. The purpose of this study is to report the mid-term results of impaction bone grafting augmented with a wire coil using the lightbulb technique for ONFH.MethodsFrom 1998 to 2016, 50 hips with late precollapsed or early postcollapsed ONFH (28 hips with Association Research Circulation Osseous [ARCO] IIC and 22 with IIIA) were treated by impaction bone grafting augmented with a wire coil using the lightbulb technique. The survival rate was analyzed with conversion to total hip arthroplasty (THA) as the end point.ResultsThirty-one of the 50 hips had a successful clinical result without conversion to THA at a mean follow-up of 109.2 months. The 5-year survival rate was 68%, 82.1%, and 50% for the entire cohort, ARCO stage IIC, and ARCO stage IIIA, respectively. The 19 hips that had failed were converted to THA at an average of 52.8 months. The multivariable Cox proportional hazards model showed that an ARCO stage IIIA disease, a lateral lesion, and a necrotic index ≥0.67 were the independent risk factors for conversion to THA.ConclusionAs a head-preserving procedure, the lightbulb technique using impaction bone grafting augmented with a wire coil is worthwhile for patients in an earlier stage of disease and smaller lesion size to postpone the need for THA.     

逐级减压套扎法治疗胃底静脉曲张临床观察

目的比较逐级减压套扎法与硬化剂治疗胃底静脉曲张的疗效差异,以期为临床提供参考。方法选择萍乡市第二人民医院消化内科2018年9月～2019年3月收治的胃底静脉曲张病例80例,随机分为两组,每组各40例,治疗组采取逐级减压套扎治疗。对照组采用传统硬化剂注射法治疗。治疗结束后比较两组患者治疗有效率、并发症发生情况、静脉曲张消除率及再出血率。结果 (1)治疗后,治疗组总有效率高于对照组,差异有统计学意义(P0.05)。(2)两组间并发症发生率比较,差异均无统计学意义(均P0.05)。(3)首次治疗后治疗组静脉曲张消除率高于对照组,两组差异具有统计学意义(P0.05)。全部患者随访3个月,治疗组再出血率低于对照组,两组差异具有统计学意义(P0.05)。结论逐级减压套扎法革新手术方式明显提高疗效,减少复发率,减轻患者负担,具有明显的实用性和先进性,值得在医疗机构推广,尤其是在基层医院,具有良好的社会效益和经济效益。     

不同类型原发性三叉神经痛的手术疗效分析

目的 探讨不同类型的责任血管及压迫特点对原发性三叉神经痛手术疗效的影响。方法 回顾性分析2002~2012年微血管减压术治疗的212例原发性三叉神经痛的临床资料。根据术中发现责任血管类型分为动脉压迫（155例）、静脉压迫（24例）和混合压迫（33例），根据术中发现责任血管压迫特点分为接触压迫型（123例）和粘连包裹型（89例）。结果 手术总有效率为95.8%，动脉压迫、静脉压迫和混合压迫有效率分别为98.1%、95.8%和84.8%，接触压迫型和粘连包裹型有效率分别为98.4%和92.1%。结论 微血管减压术是治疗原发性三叉神经痛的有效方法，动静脉混合压迫以及术中粘连包裹可能是影响手术疗效的因素。     

Ethnic variation in deep lateral orbital anatomy and its implications on decompression surgery

Aim: To describe differences in the deep lateral orbital wall (specifically, trigone) between Chinese, Malay, Indian and Caucasian subjects

Methods: Single-centre retrospective Computed Tomogram (CT)-based study; 20 subjects of each ethnicity were used from existing databases, matched for gender, average age and laterality. Subjects below 16 years of age were excluded. DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) and OsiriX version 7.5 (Pixmeo., Switzerland) were used to measure deep lateral wall length, thickness and volume, as well as orbital depth and statistical analyses performed using Statistical Package for Social Sciences version 21 (IBM, USA).

Results: In each group, there were 12 males (60%) and average age was not significantly different (p = 0.682–0.987). Using Chinese subjects as a reference, in Chinese, Malay, Indian and Caucasian subjects, mean trigone thickness was 13.68, 14.02, 11.60 (p < 0.001) and 13.80 mm, curved total wall length 45.23, 42.29 (p = 0.048), 41.91 (p = 0.020) and 45.00 mm, curved trigone length 23.03, 22.61, 17.19 (p = 0.011) and 18.76 mm (p = 0.030) and trigone volume 3120.97, 3221.01, 1613.66 (p < 0.001), 2498.46 mm³ (p = 0.059) respectively. Similarly, perpendicular orbital depth was 27.54, 24.97, 22.12 (p = 0.001) and 25.93 mm and diagonal orbital depth was 34.19, 33.27, 29.48 (p = 0.01) and 34.63 mm respectively.

Conclusions: Indian and, to a lesser extent, Caucasian subjects have smaller trigones compared to their Chinese and Malay counterparts. Indian subjects also have shallower orbits and due care should be taken during decompression surgery.