脊柱转移性肿瘤患者行经皮椎体成型术的护理

目的：探讨脊柱转移瘤病人行椎体成型术后的护理方法。方法：报告了78例脊柱转移瘤患者应用经皮椎体成型术（PVP）治疗的术前术后的观察及护理。对PVP治疗的脊柱转移瘤患者进行密切观察,观察其疼痛缓解及并发症的发生情况,并对疼痛及出现的并发症给予针对性的护理。结果：经PVP术治疗后,大部分患者术后疼痛症状明显减轻,生活质量有不同功能改善。结论：护士的认真观察,能够为PVP术后效果提供可靠的保证;术前后的综合护理可明显减轻患者痛苦。     

经皮椎体成形术治疗脊柱转移瘤疗效的MRI评价

目的判断MRI检查结果能否为临床脊柱转移瘤患者经皮椎体成形术(PVP)术后疗效客观评价提供可靠的指标。方法回顾性分析36例患者75节椎体转移瘤采用单纯PVP治疗的临床及医学影像学检查资料。术前及术后进行疼痛视觉模拟评分(VAS)。根据MRI检查显示分为3组:病灶完全消失并持续12周为完全缓解(A组);病灶出现骨化或肿瘤体积缩小,无新转移灶出现并连续保持12周为部分缓解(B组);通过测量肿瘤体积反映病灶扩大,表示无效(C组)。然后比较3组术前、术后12周疼痛缓解程度。结果 3组间术前VAS差异无统计学意义(P>0.05),术后C组疼痛缓解不明显,A组比B组疼痛缓解程度大,疼痛缓解程度差异有统计学意义(P<0.05)。表明MRI客观检查结果与临床主观评价一致。结论 PVP是治疗脊柱转移瘤的有效方法,MRI检查能为临床脊柱转移瘤患者PVP术后疗效提供可靠的客观评价。     

经皮椎体成形术治疗脊椎转移性肿瘤

目的探讨经皮椎体成形术(PVP)在脊椎骨转移瘤中的治疗效果。方法应用PVP治疗脊柱转移性肿瘤40例共46个椎体。在X线电视监视下或CT引导下经皮穿刺至病变椎体后注入适量骨水泥(聚甲基丙烯酸甲酯,PMMA),观察术后止痛效果、脊椎稳定性情况及并发症情况。结果40例穿刺全部成功,术后1~3d,患者的疼痛均有不同程度缓解疼痛完全缓解(CR)30例33个椎体、疼痛部分缓解(PR)8例10个椎体、轻度缓解(MR)2例3个椎体、疼痛无缓解(NR)0例;病变脊椎稳定性良好,术后影像学检查显示24例26个病椎的肿瘤区域被PMMA完全均匀充填加固,另16例20个椎体大部分充填。术中及术后均无严重并发症,随访1~3月效果良好。结论PVP可作为脊椎骨转移瘤缓解疼痛的方法之一,并可加强病变椎体的稳定性。     

CT引导下微波消融联合经皮椎体成形术治疗脊柱转移瘤的安全性与有效性

【摘要】 目的 探讨微波消融（MWA）联合经皮椎体成形术（PVP）治疗脊柱转移瘤的安全性和疗效。方法 回顾性分析 2019年6月至2021年 6 月收治的 46 例行MWA联合PVP治疗的脊柱溶骨性转移瘤患者的临床资料。比较患者治疗前和随访期间的疼痛视觉模拟量表（VAS）评分、功能障碍指数（ODI）评分、美国脊髓损伤协会神经学检查（ASIA）等级、骨转移患者生活质量特异性评估表（QLQ-BM22）评分,评估患者疼痛缓解、脊柱功能状态改善、脊髓神经功能改善和生活质量变化。统计分析患者术后并发症、复发和存活时间。结果 46例患者中,5例患者消融中出现中、重度疼痛,静脉推注吗啡后症状缓解;2例患者出现一过性神经症状,立即停止消融对症处理后症状消失。骨水泥注入过程中有11例患者出现轻度骨水泥渗漏,所有并发症均为轻微程度。术后随访6～26个月,6个月有40例患者影像学无肿瘤进展。术后各时间点 VAS、ODI、QLQ-BM22评分均明显优于术前（均 P＜0. 01）,术前和术后各时间段ASIA分级差异均无统计学意义（均P＞0. 05）。死亡患者10例（存活时间为7～26个月）,生存时间为（13.20±7.65）个月,去除随访时间＜12个月的患者,1年生存率为66.6%（12/18）。结论 MWA联合PVP治疗脊柱转移瘤是一种安全有效的治疗方法,能在一定程度上改善患者脊柱功能状态提高其生活质量。     

经皮穿刺椎体成形术治疗脊柱转移瘤

目的　评价经皮穿刺椎体成形术治疗伴有疼痛或脊柱不稳椎体转移瘤的作用。方法　在CT引导下 5 4位患者 5 7次操作中共 72例次椎体接受经皮穿刺椎体成型术治疗。其中 46次操作为了止痛 ,5次为了稳定脊柱 ,6次二者兼之。采用随访统计对治疗效果评价。结果　在 5 2次止痛操作中 ,39次获得了明显的疼痛症状缓解 ,7次获得轻度缓解 ,6次无改善。随访至 6个月时73.6%的改善效果仍稳定 ,1年 65 .6%的治疗仍有效。针对脊柱稳定性的治疗 ,随访没有发现任何移位、变形等改变。 3次操作由于骨水泥的刺激出现神经放散痛 ,2次操作由于推移肿瘤组织而压迫脊髓。结论　脊柱转移瘤的椎体成型术治疗是一种微创操作 ,其可立刻获得止痛效果并长期有效 ,可维持脊柱稳定防止椎体压缩导致截瘫     

脊柱转移瘤的MRI诊断(附20例报告)

本文对20例经手术病理证实的脊柱转移肿瘤的原发肿瘤及转移部位进行了分析。脊柱转移瘤的MRI特征性表现：（1）受累椎体呈长T1低信号，长T2高信号表现。（2）多发转移瘤的“跳跃征”。（3）椎间盘一般不受侵犯。复习文献对脊柱转移瘤的诊断和鉴别诊断进行了讨论。     

射频消融联合人工骨椎体成形术治疗脊柱转移瘤28例

目的探讨射频消融(RFA)联合注射用人工骨椎体成形术(PVP)治疗脊柱转移瘤临床疗效。方法对28例脊柱转移瘤患者进行多点RFA治疗后,注射自固化磷酸钙人工骨行PVP。观察手术并发症、术后椎体稳定性及复发情况。分别采用视觉模拟评分(VAS)和脊柱ODI评分,对比术前及术后1、3、6、9、12个月患者疼痛及脊柱功能。结果所有患者均手术成功,无严重并发症。术后随访12个月内,所有病例均无椎体肿瘤复发征象,无骨折发生。术后12个月内,Cobb角与术前相比无显著改变。VAS和ODI评分在术后1个月均较术前显著降低(P<0.01),并维持稳定水平;术后12个月与术后1个月相比无显著差异(P>0.05)。结论 RFA联合人工骨PVP治疗脊柱转移瘤效果显著,可长期维持椎体稳定性。     

经皮椎体成形术治疗椎体压缩骨折15例

经皮椎体成形术（PVP）是治疗脊椎病变的一项新技术,具有增加椎体强度、防止骨折移位和止痛效果确切等优点。2001年10月～2004年6月,我们采用PVP治疗椎体压缩骨折15例（23个椎体）,疗效满意。     

骨填充网袋辅助经皮椎体成形术治疗伴椎体后壁破损的脊柱转移瘤

目的 探讨经皮椎体成形术(PVP)在骨填充网袋辅助下治疗因转移瘤致椎体后壁破损性骨折的疗效及安全性.方法 31例患者因脊柱转移瘤致椎体后壁破坏而接受骨填充网袋辅助PVP治疗,共43节病变椎体.所有患者原发肿瘤均诊断明确.PVP术前1d,术后1d、3d、1个月、3个月和末次随访采用视觉模拟评分(VAS)评估疼痛程度,Oswestry功能障碍指数(ODI)评估患者运动功能状态.术后记录骨水泥渗漏情况.结果 43节椎体PVP手术成功率100％.术前VAS评分8.2±0.4,术后1d降至2.5±0.7;术前VAS评分均明显高于术后1d、3d、1个月、3个月和末次随访,差异有统计学意义(P均＜0.05).术后ODI均较前明显降低(P均＜0.05),患者运动功能状态得到改善.术后影像学(DSA、CT)证实无严重骨水泥渗漏事件发生.结论 PVP在骨填充网袋辅助下治疗因转移瘤致椎体后壁破损性骨折是安全可靠的,并能获得良好的止痛效果及改善患者运动功能状态.     

射频消融联合椎体成形术治疗脊柱转移瘤105例

目的 探讨射频消融(RFA)联合经皮椎体成形术(PVP)治疗脊柱转移瘤的临床疗效与安全性.方法 分析2009年6月至2011年6月于无锡市第四人民医院及上海市第六人民医院行RFA联合PVP或单纯PVP治疗脊柱转移瘤362例,选择其中具有完整资料的226例为研究对象,其中RFA联合PVP组(A组)105例,153节椎体;单纯PVP组(B组)121例,190节椎体.比较患者疼痛缓解情况,采用配对t检验对所得数据进行统计学分析.比较两组骨水泥的外漏率、外漏类型,采用R×C列联表x2检验进行统计学分析.结果 疼痛缓解根据WHO标准,A组术后1d、1周、1个月、3个月的有效率为分别为83.8％、86.9％、87.2％和82.2％;B组同期有效率分别为81.0％、83.6％、84.1％和80.5％,经配对t检验,术后随访时间段两组患者疼痛均得到明显缓解(P＜0.05),两组间疗效差异无统计学意义(P＞0.05).A组和B组骨水泥外漏发生率分别为17.6％和37.4％,采用C列联表x2检验,差异有统计学意义(P＜0.05);A组未出现神经根压迫症状,B组有3例患者出现神经根压迫症状,用激素、脱水、止痛对症治疗后好转.结论 RFA联合PVP与单纯PVP治疗脊柱转移瘤均具有良好的止痛效果,两组术后疗效对比分析差异无统计学意义;A组骨水泥外漏少于B组,PVP之前行RFA可减少骨水泥外渗.     

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）