主-髂-股动脉闭塞性病变介入治疗的技术探讨及疗效观察

目的探讨主-髂-股动脉闭塞性病变介入治疗的技术要点。方法本组34例主-髂-股动脉闭塞的患者中，腹主动脉下段、双侧髂动脉完全闭塞8例，同时肾动脉受累3例；单侧髂动脉闭塞23例，其中病变累及股总动脉4例；单纯单侧股浅动脉长段闭塞3例。分别行闭塞段开通、经导管局部溶栓、血管腔内成形术(PTA)和内支架置人等多种介入方法综合治疗。结果除3例髂动脉闭塞未能开通外，8条腹主动脉，36条髂动脉，4条股总动脉和3条股浅动脉均得以开通，开通率为94％。共置入裸支架46枚，覆膜支架3枚。其中包括腹主动脉支架6枚，髂动脉支架34枚，股总动脉支架2枚、股浅动脉支架4枚和肾动脉支架3枚。在治疗成功的31例中，9例临床症状和体征得到缓解，21例明显改善，1例因长期慢性肾功能衰竭于术后第2天死亡；其中4例合并有并发症。术后平均随访21．5个月(2～53个月)，除2例分别在术后2个月和14个月发生支架内再闭塞行二次介入治疗外，其余患者症状均无加重或复发。结论综合应用多种介入方法治疗主-髂-股动脉闭塞性病变是一项安全有效的治疗手段，可获得满意的临床效果。     

主动脉-髂动脉闭塞介入重建术的中期随访

目的 评价主动脉-髂动脉闭塞介入治疗的中期疗效.方法 回顾性分析30例经介入治疗的腹主动脉.双侧髂动脉狭窄或闭塞患者的临床资料.30例中男24例、女6例,年龄35～75岁,平均(55±10)岁.采用导丝开通、导管溶栓、球囊扩张及支架置入等介入方法 治疗,出院后通过电话、信函、门诊复查等方式随访.结果26例腹主动脉-双侧髂动脉重建成功;3例分别因1条髂动脉开通失败仅腹主动脉.单侧髂动脉重建成功;1例主动脉-髂动脉重建失败.髂动脉破裂1例行WallGraft支架修补.术中发生远端动脉栓塞2例.1例一侧患肢缺血加重接受截肢.27例随访1～112个月,平均(41±9)个月.术后6个月髂动脉闭塞1例未能开通;25个月后双侧髂动脉闭塞1例,经球囊导管扩张治疗后3个月再闭塞,行双侧髂动脉支架置入.23例患肢均无症状再发或加重.结论主动脉-髂动脉介入重建术可有效恢复下肢血供,中期疗效良好.     

髂动脉闭塞介入治疗的临床观察

目的探讨髂动脉闭塞性病变介入治疗的技术要点。方法本组41例髂动脉闭塞的患者通过行闭塞段开通、经导管局部溶栓、血管腔内成形术（PTA）和内支架置入等多种介入方法综合治疗来观察效果。结果 41例患者介入治疗成功率达100%,治愈36例,好转5例,共9例血管闭塞者进行了溶栓治疗。术后随访2～24个月,平均18个月,除2例分别在术后11个月和8个月发生支架内再闭塞行二次介入治疗外,其余患者症状均无加重或复发。结论血管腔内介入治疗可作为治疗髂动脉闭塞可选择的手术替代方案,尤其是对于有高手术风险的患者,具有微创、简单、有效的优点。     

经皮血管腔内成形术治疗髂股动脉硬化闭塞症

目的评价经皮腔内成形术及支架植入术治疗髂股动脉硬化闭塞症的临床疗效。方法自1999年4月-2004年8月,为13例髂股动脉硬化闭塞症患者联合应用导管接触性溶栓和导丝机械性开通的方法开通闭塞段,行腔内成形及支架植入术,共植入25枚Wallstent支架,采用多普勒超声或DSA随访。结果13例患者均一次性开通血管闭塞段并植入支架。经8个月～5年(平均26.2个月)随访,1例于术后23d支架内急性血栓闭塞,经导管接触性溶栓治疗再次成功开通;1例于术后19个月临床症状加重,造影证实支架处髂总和髂外动脉闭塞并同侧股浅动脉闭塞,于外科行血管旁路术,其余病例于随访期内血流通畅,临床疗效满意。结论接触性溶栓结合导丝机械性开通法开通闭塞血管成功率高,血管腔内成形术作为髂股动脉硬化闭塞症的有效治疗方法创伤小,再狭窄率低。     

支架成形联合置管溶栓治疗TASC(Ⅱ)D型主髂动脉闭塞性疾病

目的探讨TASC(Ⅱ)D型主髂动脉闭塞性疾病血管内成形术辅助置管溶栓治疗的可行性、安全性及疗效,并对髂-股/股深动脉血管内成形术的可行性作一探索。方法 8例主髂动脉闭塞患者病变均为TASC(Ⅱ)D型,其中3例主动脉-髂总动脉-髂外动脉闭塞,主动脉闭塞长度为2~6 cm,1例腹主动脉远端重度狭窄伴右侧髂总动脉、髂外动脉闭塞,另外4例为双侧或单侧髂总动脉及髂外动脉闭塞。其中4例伴有股浅动脉长段闭塞。所有患者均采用PTA+内支架治疗,5例于血管内成形术后行辅助置管溶栓治疗。结果8例患者主髂动脉闭塞段病变均成功开通;4例伴股浅动脉长段闭塞患者仅行主/髂-股/股深动脉内支架成形术,而股浅动脉病变未予处理。技术均获成功,症状均获缓解,踝臂指数术前为0.58,术后为0.76。1例于术后出现左侧小脑小面积梗死,未发生严重后遗症。平均随访时间14个月,无再狭窄发生。结论慢性广泛主髂动脉闭塞病变,血管腔内成形术是一项安全有效的治疗措施,可获得较满意的临床疗效及近中期通畅率;支架植入后留置导管溶栓可以有效防止血栓形成的发生;髂-股深动脉血管内成形术可以达到改善患肢症状的治疗目的。     

改良“八爪鱼技术”治疗复杂瘤颈腹主动脉瘤一例

本文介绍1例复杂瘤颈腹主动脉瘤患者,男,78岁,瘤颈短,瘤体较大且严重扭曲,采用改良“八爪鱼技术”重建内脏动脉联合腹主动脉覆膜支架进行腔内修复治疗。术后3个月复查腹主动脉瘤完全隔绝,未见内漏,双肾动脉、肠系膜上动脉及双髂内、外动脉通畅,双肾中下极部分肾梗死,取得了较好的短期疗效。     

慢性主-髂动脉闭塞内膜下再通治疗的可行性及初步应用

目的 探讨经动脉内膜下途径治疗主.髂动脉闭塞的可行性与治疗方法.方法 对1例慢性主髂动脉闭塞患者经右肱动脉穿刺,使用超滑导丝自腹主动脉闭塞端穿入内膜下腔,分别向两侧髂动脉行内膜下再通.右侧导丝顺利重入髂外动脉真腔,左侧使用了双向内膜下再通技术.2支导丝经双侧股动脉穿刺点引出体外.经两侧股动脉用对吻技术行球囊扩张和支架置放(主动脉下端支架1枚,双侧髂动脉支架5枚).结果主-髂动脉闭塞经内膜下途径成功再通.治疗后主.髂动脉支架内腔形态良好,血流通畅.双下肢缺血症状完全消失,踝臂指数(ABI)由0.32上升至0.96.10个月随访未见再狭窄表现.结论 经动脉内膜下途径治疗主.髂动脉闭塞安全、可行,适用于慢性动脉硬化闭塞病变.     

三明治技术在腹主动脉瘤累及髂总动脉腔内治疗中保留髂内动脉的疗效分析

【摘要】 目的 分析三明治技术应用于腹主动脉瘤（AAA）累及髂总动脉腔内治疗保留髂内动脉的近期疗效。 方法 回顾性分析重庆医科大学附属第二医院2016年6月至2018年7月采用主动脉腔内修复术（EVAR）治疗的9例AAA累及髂总动脉患者（累及单侧髂总动脉3例，双侧6例），术中均接受髂内动脉三明治重建。术后观察和随访围手术期死亡率、腔内修复效果、内漏、支架一期通畅情况及手术相关并发症发生情况。 结果 9例患者EVAR术和髂内动脉三明治重建技术均获成功，围手术期无死亡。术中即刻造影显示9例支架均获通畅，瘤腔均成功修复。出现1例Ⅰ型内漏，2例Ⅲ型内漏，随访时自行消失；1例左上肢急性缺血，再次予急诊肱动脉修复术；3例左肱动脉切口处血肿形成，2例右股动脉穿刺点处血肿形成。术后1周、3个月、6个月复查CTA分别显示支架通畅9例、8例、8例，均无肠缺血、脊髓缺血或瘫痪症状。 结论 三明治技术在AAA累及髂总动脉腔内治疗中保留髂内动脉安全可行，术后臀肌跛行发生率低，近期随访支架通畅率可，值得临床推广，但远期效果尚需进一步随访及更大临床样本验证。     

急性Stanford B型主动脉夹层真腔次全闭塞治疗 ——单中心病例系列报道

【摘要】 目的 总结急性Standford B型主动脉夹层（AD）真腔次全闭塞患者的治疗经验。方法 回顾性分析2016年1月至2019年12月湖南省人民医院采用胸主动脉腔内修复术治疗的39例急性B型AD真腔次全闭塞患者临床资料。所有患者均接受主动脉覆膜支架腔内隔绝术,术中根据近端破口位置决定是否同时行左颈动脉或左锁骨下动脉重建修复（含支架开窗、烟囱支架）,远端受累分支血管根据AD真腔开通后具体情况选择保守、支架成形术或血液透析治疗。结果 39例患者共植入主动脉覆膜支架51枚（植入1枚27例, 2枚12例）,同时植入腹主动脉裸支架3枚,肠系膜上动脉支架8枚,髂动脉支架12枚,颈动脉原位开窗或烟囱支架9枚,锁骨下动脉开窗或烟囱支架枚17枚。介入治疗技术成功率为100%。围手术期并发症为肾功能不全15例（38.5%）;5例一侧肾动脉完全假腔供血遂接受覆膜支架开通;中重度肠道缺血表现8例（20.5%）,其中6例接受二次腔内治疗。围手术期死亡率为7.7%（3/39）,死因主要为重度肾功能不全和酸中毒多脏器衰竭。术后随访6～25个月,支架段假腔完全血栓化率为80.6%（25/31）,其中支架段主动脉完全重塑率为68%（17/25）。结论 B型AD真腔次全闭塞一经确诊,建议尽快手术。腔内开通过程需要多种技巧,部分患者两段式支架应用有利于真腔开通,降低假腔压力,促进血管重塑。     

内膜下血管成形术治疗下肢动脉慢性长段硬化性闭塞疾病

目的 探讨内膜下血管成形术(SIA)在治疗髂、股动脉慢性长段硬化性闭塞疾病方面的临床效果和应用价值.资料与方法 2003年5月至2008年8月,49例髂、股动脉慢性长段硬化性闭塞患者,采用SIA进行经皮腔内血管球囊扩张(PTA)+内支架置入.结果 全组治疗成功率93.88%(46/49),24例髂动脉闭塞SIA后,随访3～48个月,血流均保持通畅;22例股浅动脉闭塞SIA后,随访3～36个月,血流仍保持通畅为20例(90.91%),2例股浅动脉支架置入后12个月出现再阻塞,经局部溶栓,支架腔内血流均保持通畅.术前术后平均踝肱指数(ABI)分别为0.23(0.11～0.42)和0.87(0.67～1.06),两者比较差异有统计学意义(P<0.05).结论 SIA在髂、股动脉慢性长段硬化性闭塞的PTA+内支架置入治疗中,可显著提高成功率,减少并发症,是安全有效的方法.     

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.     

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.     

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).     

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.