脑动脉瘤破裂开颅夹闭和介入栓塞治疗的临床分析

目的 研究脑动脉瘤破裂在开颅夹闭和介入栓塞治疗上的临床特点，处理方法，危险因素及预后。资料与方法系统地回顾性分析78例(80枚)经开颅夹闭和介入栓塞治疗破裂的脑动脉瘤，男29例，女49例，年龄15．75岁，并将其分为A(介入栓塞42例)、B(开颅夹闭36例)两组，平均年龄A组为6l岁，B组为57岁。结果开颅夹闭治疗36例，1例重残，1例死亡；介入栓塞治疗42例，2例重残，无死亡病例；Hunt-Hess分级Ⅲ级以下两组治疗结果无统计学差异。结论介入栓塞治疗能处理形态各异和手术不能达到部位的动脉瘤，而大脑中动脉三分叉处宽颈或巨大动脉瘤开颅夹闭则优于介入栓塞治疗。     

超早期栓塞治疗对破裂颅内动脉瘤患者预后的影响

目的 分析超早期栓塞治疗对破裂颅内动脉瘤患者预后的影响.方法 根据栓塞时间将270例患者分成2组:A组(动脉瘤破裂后24 h内行栓塞治疗)135例和B组(动脉瘤破裂24 h后行栓塞治疗)135例,对两组患者的临床特征进行单因素和多因素分析,观察超早期栓塞对临床治疗效果的影响.结果 A、B两组患者入院时具有相似的临床及影像学特征.术后6个月临床结果显示,A组患者中预后良好(mRS 0～2分)122例(90.4％),而B组患者中预后良好110例(81.5％),两组比较,差异有统计学意义(P=0.036).多因素Logistic回归分析显示,超早期栓塞治疗(P=0.021;OR,2.536;95％CI:1.637～5.116)为患者预后的一个独立影响因素.结论 颅内动脉瘤破裂后24 h内进行栓塞治疗能够改善患者的预后.     

开颅夹闭术与介入栓塞术治疗颅内微小动脉瘤效果比较研究

目的比较开颅夹闭术与介入栓塞术治疗颅内微小动脉瘤的临床效果。方法选取自2013年2月至2017年1月宜宾市第二人民医院收治的150例颅内微小动脉瘤患者为研究对象。按随机数字表法将所有患者分为A组与B组,每组各75例。A组采用开颅夹闭术治疗; B组采用介入栓塞术。比较两组患者治疗效果,统计术中动脉瘤破裂发生情况及患者手术相关并发症发生率,采用格拉斯哥预后评分表(GOS)评定患者术后3个月短期预后情况,采用生活质量测定量表(QLQ-C30)评定患者手术前后生活质量的变化。结果 B组住院时间短于A组,两组比较,差异有统计学意义(P <0. 05)。B组脑血管痉挛发生率为16. 0%(12/75),显著高于A组的5. 3%(4/75),两组比较,差异有统计学意义(P <0. 05)。B组预后良好比例为96. 0%(72/75),显著高于A组的86. 7%(65/75),两组比较,差异有统计学意义(P <0. 05)。两组患者术后各维度评分均上升,且B组各维度评分均显著高于A组,两组比较,差异有统计学意义(P <0. 05)。结论开颅夹闭术与介入栓塞术治疗颅内微小动脉瘤均可获取较好的手术效果,但血管内介入栓塞微创,对机体创伤小,患者术后恢复速度快,生活质量高,但其手术难度高,学习曲线长,且脑血管痉挛发生风险大。     

颅内动脉瘤破裂急性期血管内栓塞治疗

闭塞颅内动脉瘤的方式主要有开颅动脉瘤夹闭和血管内栓塞治疗,随着血管内介入技术的提高和栓塞材料及设备的改进,颅内动脉瘤的介入治疗所占比例有增多的趋势。以下通过回顾性分析比较栓塞和手术夹闭治疗颅内动脉瘤的临床效果,评价栓塞治疗在颅内动脉瘤破裂急性期治疗中的应用。     

翼点与眶上外侧入路下行显微夹闭术治疗Hunt-HessⅠ～Ⅲ级急性期前循环破裂动脉瘤临床效果比较

目的 比较翼点与眶上外侧入路下行显微夹闭术治疗Hunt-HessⅠ～Ⅲ级急性期前循环破裂动脉瘤的临床效果。方法 选取榆林市第二医院自2014年4月至2016年4月收治的120例Hunt-HessⅠ～Ⅲ级急性期前循环破裂动脉瘤患者为研究对象。将患者随机分入A组和B组,每组各60例。两组患者均接受显微夹闭术,A组采用常规经翼点入路,B组采用经眶上外侧入路。比较两组患者的手术时间、切口长度、住院时间、术中动脉瘤破裂率、术中动脉瘤夹闭率、围术期并发症发生率,以及术后3个月的格拉斯哥结果评分(GOS)分级情况。结果 B组手术时间、切口长度、住院时间均短于A组,差异有统计学意义(P<0.05)。A组和B组术中动脉瘤破裂率、术中动脉瘤夹闭率、围术期并发症发生率、术后GOS分级情况比较,差异均无统计学意义(P>0.05)。结论 翼点和眶上外侧入路下行显微夹闭术治疗Hunt-HessⅠ～Ⅲ级急性期前循环破裂动脉瘤的临床效果相当,但经眶上外侧入路具有操作简便、手术创伤小、术后恢复快等优势。     

颅内动脉瘤的介入治疗临床分析

目的 探讨破裂后颅内动脉瘤血管内弹簧圈栓塞治疗的临床价值.方法 对14例破裂后颅内动脉瘤施行血管内弹簧圈栓塞治疗,所有病例均经CT血管成像和DSA明确诊断.结果 14例患者栓塞成功12例,1例术中破裂,1例行手术夹闭.12例中随访到5例,1例术后3月出现大量头发脱落,1例术后头痛持续2月,5例在6～12月随诊脑血管造影,瘤体栓塞完全,载瘤动脉通畅.结论 血管内弹簧圈栓塞动脉瘤是防止动脉瘤再破裂出血的有效方法.     

血管内介入治疗大脑动脉瘤对患者预后与应激反应的影响

目的探讨血管内介入治疗大脑动脉瘤对患者预后与应激反应的影响。方法选取2014年2月~2020年8月在本院诊治的大脑动脉瘤患者156例,随机分为介入组与夹闭组各78例。夹闭组给予开颅夹闭手术治疗,介入组给予血管内介入治疗,调查患者的预后情况并检测患者的应激反应指标表达变化情况。结果介入组的手术时间与术后住院天数少于夹闭组(P<0.05),住院费用多于夹闭组(P<0.05)。介入组术后14天的血管破裂出血、脑积水、血管痉挛、颅内感染等并发症发生率为2.6%,低于夹闭组的17.9%(P<0.05)。介入组术后14天的预后Glasgow状态好于夹闭组(P<0.05)。两组术前一天血清可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平对比差异无统计学意义(P>0.05),介入组术后3天、术后7天、术后14天低于术前1天(P<0.05),介入组低于夹闭组(P<0.05)。结论相对于夹闭手术治疗,血管内介入治疗大脑动脉瘤能提高患者的近期疗效,减少术后并发症的发生,促进患者康复,其作用机制可能与降低患者的应激反应有关。     

血管内栓塞治疗大脑前动脉A1段近端动脉瘤破裂十例

目的 探讨血管内栓塞治疗大脑前动脉(ACA)A1段近端动脉瘤的可行性和有效性.方法 2008年3月-2013年10月采用血管内栓塞治疗破裂的ACA A1段近端动脉瘤10例,回顾性分析其临床资料和疗效.结果 所有的患者血管内治疗均获得了成功,6例单纯采用弹簧圈栓塞术,1例单纯采用支架植入术,3例采用支架辅助弹簧圈栓塞术.术后即刻血管造影显示9例动脉瘤腔完全闭塞,1例单纯支架植入术见瘤腔内对比剂滞留,无手术相关的并发症发生.临床随访6～ 60个月未发生颅内再出血和缺血并发症.7例术后6～ 12个月行DSA随访,动脉瘤瘤腔完全性阻塞,未见载瘤动脉狭窄及闭塞.结论 采用血管内栓塞治疗破裂A1段近端动脉瘤是可行的、有效的.为保证成功栓塞,恰当的微导管塑形是必须的,必要时还需结合辅助技术.     

颅内动脉瘤血管内栓塞治疗分析

目的探讨颅内动脉瘤血管内栓塞治疗的手术时机、治疗方法、并发症及其预防措施。方法回顾性分析2009年7月~2012年7月在我院行颅内动脉瘤血管内栓塞治疗患者40例临床资料。另选同期进行开颅夹闭手术患者40例进行比较。结果经数字减影血管造影（DSA）检测结果显示,观察组与对照组在动脉瘤栓塞程度、术后并发症和随访结果上比较,差异均有统计学意义。结论血管内栓塞治疗颅内动脉瘤疗效切实可靠,安全、有效、微创,预后好,早期手术和及时术后处理是降低致残率、致死率的重要方法。     

颅内动脉瘤的手术夹闭及血管内栓塞治疗

目的　探讨手术夹闭及血管内栓塞治疗颅内动脉瘤的适应证和治疗效果。方法　回顾性分析我科 1992～ 2 0 0 3年收治的 345例颅内动脉瘤患者的术前状况、动脉瘤的大小、形状、部位、治疗效果及脑血管造影 (DSA)的随访结果。结果　 2 36例行开颅夹闭手术 ,2 1例出现各种术后并发症 ,6例因术后出血再次手术 ;死亡 9例 ;87例术后 3个月或 6个月DSA复查 ,其中 3例因动脉瘤夹移位而再次手术夹闭。 10 3例行血管内栓塞治疗 ,4例出现一过性偏瘫或失语 ,经保守治疗后消失 ;6 3例不同时期DSA随访 ,6 2例动脉瘤栓塞良好 ,未再显影 ,1例动脉瘤复发 ,再次栓塞。 6例保守治疗 ,自动出院。结论　手术夹闭适合于动脉瘤位于前循环、因血管痉挛或解剖原因微导管不能到位的、瘤体小于 3mm动脉瘤 ;动脉瘤破裂发生危及生命的颅内血肿者 ,应手术清除血肿 ,同时夹闭动脉瘤。血管内栓塞适合大多数动脉瘤 ,尤为适合于动脉瘤位于后循环动脉瘤 ,随着Remodeling技术和颅内血管支架的应用 ,宽颈动脉瘤适合血管内栓塞 ,适应证越来越宽。对于两种方法的治疗效果的比较缺乏大宗病例的长期随访。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）