MED治疗腰椎间盘突出症远期疗效分析

目的探讨显微内窥镜下椎间盘切除术（MED）治疗腰椎间盘突出症的技术改进及远期临床效果。方法回顾性分析83例（101个椎间盘）腰椎间盘突出症经MED治疗的效果。结果 83例均完成镜下手术操作,无神经根或脊髓硬膜损伤并发症,随访0.5～7年,采用M annab评定标准进行分级,结果优74例,良6例,可1例,差2例。结论 MED技术是一种安全、有效的治疗腰椎间盘突出症的手术方法,创伤小,出血少,术后恢复快,远期疗效满意。     

椎间盘镜下髓核摘除术和经皮椎间盘切吸术治疗单节段中央型椎间盘突出症的远期疗效比较

目的比较椎间盘镜下髓核摘除术(MED)与经皮椎间盘切吸术(PLD)治疗中央型腰椎间盘突出症的适应证、远期疗效及并发症,探讨两种术式的临床应用优势。方法回顾性分析2000年1月至2002年3月行手术治疗的单节段中央型腰椎间盘突出症患者,其中应用MED治疗23例,应用PLD治疗40例,分别比较两组手术适应证范围,病变节段,手术时间和出血量,术后卧床时间,术后住院时间,Oswestry功能障碍指数(oswestry disability index,ODI)及MacNab评分。用配对t检验κ检验及Fisher精确概率法等方法进行统计学分析。结果 MED组平均随访时间为(5.1±0.6)年,PLD组平均随访期为(6.6±0.7)年。MED组的远期ODI、MacNab评分要好于PLD组,而MED组的住院时间、住院费用则明显长于或多于后者,两组比较差异有统计学意义;远期并发症发生率分别为MED组3.49%,PLD组未出现手术相关并发症。结论 MED及PLD治疗腰椎间盘突出症均具有创伤小、恢复快、长期疗效好的特点,PLD临床普及率广,而MED相对学习曲线长,技术要求较高,手术风险较大,但MED的临床远期疗效高于PLD。     

腰椎间盘突出症经椎管内胶原酶溶解术后MED治疗体会

目的探讨经椎管内胶原酶术失败的腰椎间盘突出症的MED治疗。方法对45例经椎管内胶原酶溶解术治疗失败的腰椎间盘突出症患者采用MED手术,观察经胶原酶溶解术后椎管内情况及对手术过程的影响。结果45例均获得随访,时间3—6个月,40例腰腿痛合并麻木症状完全缓解,5例残留肢体轻度麻木症状。按改良的Macnab疗效评定标准：优40例,良5例。结论对椎管内胶原酶溶解术治疗失败的患者应用MED进行治疗,具有损伤小,术后恢复快,对腰椎稳定性影响小等优点;同时,手术困难程度增加,选择手术的时机也很重要。     

腰椎间盘镜下髓核摘除术治疗腰椎间盘突出症疗效分析

目的 探讨显微内镜椎间盘摘除术(microendoscopic discectomy,MED)治疗腰椎间盘突出症的疗效.方法 回顾性分析32例经MED治疗腰椎间盘突出症效果.结果 32例中27例完成镜下操作,随访4～54个月,优24例,良3例;术中出血30～400ml,平均120ml,切口长度平均2cm.中转开放手术5例,马尾神经损伤1例,硬膜损伤1例,损伤椎管内静脉丛3例.结论 MED具有手术切口小、创伤小、出血少、神经根减压彻底、不影响脊柱稳定性、术后恢复快等优点,但易出现较多的并发症.     

椎间盘镜与小切口手术治疗腰椎间盘突出症的临床对比分析

目的:分析比较显微内镜椎间盘髓核摘除术(MED术)和小切口开窗减压髓核摘除术治疗腰椎间盘突出症的临床疗效,探讨两种术式治疗腰椎间盘突出症的优点及适用范围。方法:对资料完整的110例行MED术或小切口手术的腰椎间盘突出症患者的资料进行分析,其中MED术(MED组)56例,男37例,女18例,平均年龄39.6岁(28～63岁),病变节段:L4-530例,L5S123例,L4-5、L5S1双节段3例;小切口术(小切口组)54例,男29例,女25例,平均年龄42.3岁(26～73岁),病变节段:L4-527例,L5S121例,L4、5、L5S1双节段6例。比较两种治疗方法在手术切口长度、手术时间、术中出血量、术后卧床时间、镇痛药使用、平均住院日、临床疗效等指标。结果:MED组和小切口组的平均随访时间分别为13.5、15.3个月,MED组与小切口组比较,手术切口长度、术中出血量、术后卧床时间、镇痛药使用、平均住院日均显著少于小切口组,但手术时间长于小切口组,两组差异具有显著意义(P<0.05)。临床疗效参照Macnab标准评定,MED组:优37例,良13例,可6例;小切口组:优33例,良12例,可6例;两组疗效比较无显著性差异(P>0.05)。结论:同小切口手术比较,MED术具有切口小、组织损伤轻、恢复快等优点,小切口手术也具有其优势及适应症,临床应用中应掌握手术指征,采用合理术式,以获得最佳疗效。     

微创与开放式髓核摘除术治疗腰椎间盘突出症术后再次手术原因分析

目的 比较椎间盘镜下髓核摘除术(microendoscopic discectomy,MED)与开放式髓核摘除术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效,分析其再手术的原因.方法 LDH患者1862例,其中行MED术(MED组)1276例,行开放式髓核摘除术(开放组)586例.采用改良Mcnab评分法评定治疗结果,随访8～60个月,平均随访39.2个月.结果 1518例获随访,MED组和开放组分别为1059例和459例,术后最近随访满意率(Mcnab评分优良者)分别为91.31%和93.25%.MED组术中出血量、住院时间、恢复原工作的时间明显少于开放组(P＜0.05),但住院费用高于开放组(P＜0.05).MED组和开放组术后再手术率分别为6.89%(73/1059)和2.61%(12/459),有显著差异(P＜0.05);术后平均复发时间MED组早于开放组,分别为5.6个月和31.2个月(P＜0.05).两组均未发生诊断错误和术中定位错误.结论 侧隐窝狭窄未解除和原位椎间盘突出是MED术后复发的主要原因;继发性腰椎管狭窄和神经根黏连是开放式髓核摘除术后复发的主要原因.     

腰椎间盘镜手术与常规开窗手术炎性细胞因子动态观察

目的：比较椎间盘镜手术与常规开窗手术治疗腰椎盘突出症围手术期肿瘤坏死因子（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）促炎性细胞因子的变化。方法：正常对照组30例，腰椎间盘突出症患者75例随机分为两组：椎间盘镜组（MED）39例和常规开窗组36例。75例术前1d、术后1、6、12d抽取外周静脉血，测定血清中TNF-α、IL-6、IL-8水平并比较。结果：75例术前TNF-α、IL-6、IL-8水平均高于正常对照组；同组手术前后比较：术后6d，MED组TNF-α、IL-6、IL-8降至术前水平，而常规开窗组仍明显高于术前。结论：椎间盘镜手术治疗腰椎间盘突出症创伤小，炎性反应轻，与术后患者恢复快的临床结果相一致。     

椎间盘镜下髓核摘除术治疗青壮年腰椎间盘突出症的临床疗效及并发症分析

目的：探讨后路椎间盘镜下髓核摘除术（Microendoscopic Discectomy,MED）治疗青壮年腰椎间盘突出症的临床疗效及并发症。方法回顾性分析623例青壮年腰椎间盘突出症行后路椎间盘镜下髓核摘除术治疗的临床资料。疗效评定采用疼痛视觉类比评分（VAS）和Oswestry功能障碍指数评分（ODI）。结果术后3月VAS、ODI评分与术前比较差异有统计学意义（P＜0.05）,发生并发症47例,发生率7.54%,术后经过营养神经、硬膜囊修补及再手术、抗感染等治疗,所有病例均治愈。结论后路椎间盘镜治疗腰椎间盘突出症治疗青壮年腰椎间盘突出症具有损伤小、出血少、病人住院时间短的优点,医生熟悉掌握椎间盘镜的常规操作及镜下腰椎间盘的解剖可大大减少该手术的并发症。     

椎间盘镜和小切口开窗髓核摘除手术疗效比较

目的比较椎间盘镜(MED)与小切口开窗髓核摘除术治疗腰椎间盘突出症的临床疗效,探讨各自的手术适应证。方法200例腰椎间盘突出症患者分为两组,行MED和小切口开窗髓核摘除术各100例。结果按Naka i疗效评价标准,MED组优72例,良21例,可5例,差2例;小切口开窗手术组优70例,良20例,可6例,差4例。两组并发症主要为术后复发MED组2例,小切口开窗组3例;椎间盘炎各1例。无神经根及脊髓损伤。结论两种手术方式疗效均较为肯定,术后疗效大体一致,MED术中出血少,平均住院时间短,但对于多节段椎间盘突出、巨大型、游离型、中央型以及合并椎间盘钙化的手术,小切口开窗疗效较为显著。     

经皮腰椎间盘髓核摘除术治疗老年性腰椎间盘突出症42例疗效分析

目的探讨经皮腰椎间盘髓核摘除术(APLD)治疗腰椎间盘突出症高龄患者的临床效果。方法本组治疗病例42例,男29例,女13例,最大年龄75岁,最小65岁,平均年龄68.7岁。结果平均手术时间45min,基本无出血,平均住院时间10d,全组手术伤口一期愈合,无明显瘢痕,随访时间0.5~2年。疗效按Nakai分级评定,优30例,良9例,可3例,差0例。结论经皮腰椎间盘髓核摘除术治疗高龄腰椎间盘突出症,术式创伤口小,可视,操作精细,术后卧床时间短,并发症少,效果优良,是治疗高龄椎间盘突出症的一种可靠的方法。     

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.     

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）