自由式岛状穿支皮瓣修复内眦及鼻根区缺损的临床效果

目的探讨自由式岛状穿支皮瓣修复内眦及鼻根区皮肤缺损的疗效。方法自2016年1月至2019年5月采用自由式穿支皮瓣修复内眦及鼻根区皮肤缺损患者21例,其中良性肿瘤6例,基底细胞癌10例,鳞状细胞癌5例。根据缺损创面的大小设计自由式岛状穿支皮瓣,包括以滑车上动脉为蒂的额部皮瓣,内眦动脉或鼻旁动脉为蒂的鼻唇沟皮瓣等;皮瓣大小为1.0 cm×2.2 cm～2.6 cm×3.5 cm。结果 21例患者自由式岛状穿支皮瓣全部成活。术后随访5～24个月,皮瓣外形良好,皮瓣色泽与缺损区接近,质地较柔软,睑裂闭合良好,供区瘢痕不明显。其中2例因皮瓣臃肿行二期修整术。结论自由式岛状穿支皮瓣修复内眦及鼻根区缺损创面,具有血供可靠,色泽质地与受区相近的特点,且皮瓣设计灵活,手术时间短,供区损伤较小,是修复内眦及鼻根区组织缺损较理想的皮瓣。     

应用足底角形穿支皮瓣修复足跟及前跖底缺损

目的 探讨应用足底角形穿支皮瓣修复足跟及前跖底缺损的方法及临床效果.方法 以缺损部位为皮瓣头端设计角形穿支筋膜皮瓣,弓形侧及凹陷侧均应切开深筋膜,并携带跖腱膜,将其旋转推进覆盖创面,皮瓣内尽可能包含2～3个穿支血管,必要时可结扎源血管(足底外侧动脉或足底内侧动脉),以利于增加皮瓣旋转推进距离.2010年1月至2012年10月,设计应用角形穿支皮瓣修复7例足底皮肤缺损,缺损范围约1.5 cm×2.0 cm～4.0 cm×5.0cm,皮瓣切取面积为7 cm×3 cm～13 cm× 7 cm.结果 术后6例角形穿支皮瓣全部成活,另1例皮瓣远端出现裂开坏死,残留小创面经换药、二期全层皮片移植愈合.供、受区伤口愈合良好,经3个月至2年随访,色泽、质地、外形及功能均恢复较好.结论 应用足底角形穿支皮瓣,供区缺损无需切取皮片移植,由足底同源性厚实坚韧皮肤修复,是修复足底部负重区软组织缺损的一种较优越方法.     

局部角形穿支皮瓣的临床应用

目的：探讨局部角形穿支皮瓣在修复全身各处软组织缺损中的临床疗效。方法本组共26例患者。缺损面积为1.0 cm×2.0 cm~13.0 cm×13.0 cm,根据缺损面积形状在其邻近周围用多普勒血流探测仪探测穿支血管,设计不同大小的角形穿支皮瓣带蒂转移,Ⅰ期修复缺损,供区直接缝合。结果26例皮瓣均成活。10例面部切口均Ⅰ期成活,1例躯干供瓣区少许切口裂开,2例四肢皮瓣远端淤血,表皮剥脱均经短期内换药后愈合。结论局部角形穿支皮瓣带蒂转移可灵活应用于全身各处软组织缺损的修复。皮瓣设计成角形易于旋转和推进,穿支血管可确保皮瓣的成活率,在修复局部软组织缺损中有着良好的应用前景。     

游离腓动脉穿支串联皮瓣修复腕掌背皮肤缺损

目的 探讨以腓动脉穿支为血管蒂,通过游离穿支血管链串联皮瓣修复手腕部两处不同部位皮肤缺损的临床应用及疗效.方法 2008年7月至2011年12月,采用以游离腓动脉穿支串联皮瓣修复手腕掌背部两处皮肤软组织缺损共7例.单纯皮肤缺损4例,合并骨关节、血管、神经及肌腱损伤3例;腕掌侧皮肤缺损面积5.8 cm×4.5 cm～8.2 cm×7.0 cm,腕背皮肤缺损面积4.6 cm× 3.2 cm～ 7.5 cm×6.8 cm;均为亚急诊修复.两皮瓣由腓动脉皮支血管链相连,小腿供区创面宽度小于4.0 cm直接拉拢缝合,较大创面取全厚皮片游离植皮.结果 术后7例14块皮瓣全部存活,2例远端皮瓣出现水泡,经拆线减张后结痂愈合.术后7例获得6～24个月的随访,平均10个月.皮瓣外形满意、质地柔软.皮瓣供区植皮区愈合良好,无水泡及破溃.结论 应用腓动脉穿支为血管蒂,通过游离腓动脉穿支皮动脉血管链串联皮瓣移植修复腕、掌部软组织缺损的方法可行、有效,可获得较好的临床效果.     

多源性供血的角形穿支皮瓣修复颜面部大面积软组织缺损

目的探讨应用多源性供血的角形穿支皮瓣修复各种原因所致颜面部大面积软组织缺损的方法及临床效果。方法选择2015年6月至2020年7月安徽医科大学第一附属医院整形外科收治的颜面部大面积缺损患者, 术前使用多普勒超声血流探测仪测定并标记颜面部主干源血管区域及穿支浅出点的位置;术中根据创面大小、周围皮肤松弛度, 以及创面远端至所选择的穿支皮瓣蒂的距离, 并参考郎格氏线, 设计多源性供血的角形穿支皮瓣, 角形穿支皮瓣头端约等于缺损宽度、长约为缺损宽度的3.0～3.5倍。切开皮瓣远端, 紧贴浅表肌腱膜系统浅层, 由近及远锐、钝性分离, 形成较大的穿支蒂皮瓣, 保留皮下穿支周围少量纤维组织蒂, 将皮瓣旋转推进无张力覆盖、修复受区缺损创面, 供区可直接拉拢缝合或稍作松解后闭合。术后随访, 观察创面愈合情况、瘢痕情况及有无相关恶性肿瘤的复发及转移。结果共选择9例颜面部大面积缺损患者, 男4例, 女5例, 年龄35～81岁, 平均58岁。皮瓣面积10.0 cm×6.0 cm～14.0 cm×7.0 cm。9例患者皮瓣均存活, 切口一期愈合。经3～24个月随访, 未见癌肿复发、明显瘢痕、皮瓣臃肿或后遗面部畸...     

足底内侧动脉皮穿支蒂岛状皮瓣修复前足皮肤缺损

目的总结逆行足底内侧动脉皮穿支蒂岛状皮瓣修复前足皮肤缺损的临床效果。方法2004年8月至2007年5月采用足底内侧动脉皮穿支蒂岛状皮瓣修复前足皮肤软组织缺损创面，临床应用7例，皮瓣面积为9cm×6cm～7cm×5cm，修复受区创面大小为8cm×5cm～6cm×5cm。结果术后皮瓣全部成活，随访3～35个月，皮瓣质地良好，外形不臃肿，供区愈合良好。结论足底内侧动脉皮穿支蒂岛状皮瓣血运可靠，设计灵活，手术切取简便安全，是修复前足皮肤软组织缺损创面的理想方法。     

穿支蒂螺旋桨皮瓣修复足踝部软组织缺损25例临床分析

目的 探讨穿支蒂螺旋桨皮瓣在足踝部软组织缺损创面修复中的应用效果.方法 自2007年7月到2011年12月,对足踝部软组织缺损患者采用穿支蒂螺旋桨皮瓣修复25例,穿支动脉来源分别为腓动脉18例,胫后动脉6例,足背动脉1例.皮瓣面积4cm×10cm～9 cm×33 cm.结果 供区直接缝合9例,游离植皮16例,有3例皮瓣术后出现静脉淤血,2例经滴血疗法最终皮瓣成活,1例皮瓣远端1/3坏死,经清创后游离植皮治愈.所有患者均获随访,随访时间1～26个月,所有皮瓣蒂部平整,外表美观,患者较为满意.结论 穿支螺旋桨皮瓣操作简单、安全有效,在足踝部软组织缺损创面的修复中比其他带蒂皮瓣更具优越性.     

小腿穿支血管蒂螺旋桨皮瓣修复足踝部软组织缺损

目的 报道穿支血管蒂螺旋桨皮瓣在小腿下段及足踝部软组织缺损修复中的应用价值. 方法 2008年6月至2011年3月,共收治小腿下段及足踝部软组织缺损6例,缺损范围8 cm ×7 cm～ 18 cm×11 cm.采用VSD覆盖创面,待创面肉芽组织新鲜、感染控制后,应用胫后动脉穿支血管蒂螺旋桨皮瓣修复4例,腓动脉穿支血管蒂螺旋桨皮瓣修复2例,皮瓣范围9cm×8 cm～21 cm×12 cm.结果 术后5例全部成活,1例出现皮瓣小部分坏死;1例出现表浅水泡;1例出现短暂的静脉淤血;在大的螺旋桨皮瓣患者中出现短暂一过性的小腿水肿.获随访7～26个月,皮瓣质地优良,色泽接近正常,局部稍饱满,外观功能恢复良好,患者满意.结论 穿支血管蒂螺旋桨皮瓣血供可靠,手术操作相对容易,供区损伤小,成功率高,应该被考虑作为小腿下段及足踝部软组织缺损修复的适宜方法之一.     

应用胸背动脉穿支带蒂皮瓣修复前臂残端创面的初步报告

目的 总结胸背动脉穿支带蒂皮瓣修复前臂残端创面临床应用结果. 方法 2001年9月至2006年5月,应用胸背动脉穿支带蒂皮瓣修复5例同侧前臂残端软组织缺损.其中男4例,女1例,年龄20～44岁(平均37岁).右侧3例,左侧2例.皮瓣切取范围:30 cm×9 cm～40 cm×9 cm,平均34 cm×9 cm. 结果 1例术后发生小的受区切口表浅感染,经换药逐渐愈合,改良的穿支皮瓣全部成活,术后经过顺利,随访1.5～5.0年,平均2.8年.受区外形满意,没有发现明显的供区功能障碍,取得了较满意的效果. 结论该皮瓣以胸背动脉穿支为血供,具有血供丰富,血管解剖恒定,血管蒂长以及皮瓣较薄等优点,带蒂移植适宜修复同侧前臂软组织缺损.     

带蒂腹壁下动脉穿支皮瓣修复大腿肿瘤术后创面

目的 探讨腹壁下动脉穿支皮瓣修复大腿肿瘤切除术后创面的效果.方法 自2002年1月至2009年1月,采用腹壁下动脉穿支皮瓣修复大腿肿瘤切除术后创面15例,皮瓣面积13 cm×10 cm～40 cm×10 cm,血管蒂长11～16 cm.根据缺损区皮肤松弛程度决定采用直接缝合或皮瓣移植修复.结果 术后14例皮瓣全部成活,1例皮瓣远端坏死约4 cm×1 cm,经换药创面痊愈.10例获随访1个月至2年,皮瓣色泽、质地与外形良好,患者行走及下蹲功能很好.结论 带蒂腹壁下动脉穿支皮瓣能修复大腿肿瘤切除术后创面,皮瓣范围大、供区隐蔽,效果理想.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。