人工肱骨头置换治疗肱骨近端粉碎性骨折

目的探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的疗效。方法对8例肱骨近端粉碎性骨折(NeerⅣ型)患者行人工肱骨头置换术,术中同时修复受损的肩袖和关节囊,术后患肩早期进行功能锻炼。结果术后随访6～34个月,病人主观满意度为86.5%,肩关节疼痛评分4.6分,主动活动度:平均外展91°、前屈95°、外旋35°、内旋至L2水平,术后三角肌、肩内旋肌、外旋肌力平均为4.5、4.1、4.2分,肩关节功能评分为3.5分。X线片示肱骨头位置良好,无假体松动或断裂。结论对肱骨近端粉碎性骨折,人工肱骨头置换是一种有效的治疗方法,能明显减少术后肩关节疼痛,最大限度恢复其运动功能。     

人工肱骨头置换治疗肱骨近端粉碎性骨折18例

目的探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的临床效果。方法 2005年至2010年,对18例肱骨近端粉碎性骨折患者行人工肱骨头置换,术后按美国UCLA评分系统进行疗效评价。结果术后随访按美国UCLA标准评分,优（34～35分）3例,良（28～33分）13例,中（21～27分）2例,差（0～20分）0例。术后肩关节活动度：平均上举110°（70°～150°）,外旋40°（30°～55°）,内旋65°（40°～80°）。1年后随访,所有病例大、小结节均愈合,无感染、肩袖损伤、脱位等并发症。结论人工肱骨头置换治疗肱骨近端粉碎性骨折短期疗效良好,远期效果需要进一步随访观察。     

人工肱骨头置换治疗高龄肱骨近端粉碎性骨折

目的 探讨人工肱骨头置换术在治疗高龄肱骨近端粉碎性骨折中的疗效.方法 对高龄肱骨近端粉碎性骨折21例行人工肱骨头置换术.结果 本组获12～35个月的随访,按美国肩肘外科评分系统,平均89.8分,未出现假体松动现象,无感染及假体周围骨折发生.结论 采用人工肱骨头置换治疗高龄肱骨近端粉碎性骨折可以明显改善患肩功能,但远期疗效有待进一步观察.     

人工肱骨头置换治疗肱骨近端粉碎性骨折

目的探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的疗效及技术要点。方法2001年1月至2004年6月，对21例肱骨近端四部分骨折患者行人工肱骨头置换术，男12例，女9例；年龄45-72岁，平均64．6岁。患者均于受伤后2周行人工肱骨头置换术，使用单极人工肱骨头假体骨水泥固定。68个国人肱骨近端骨标本，男36个，女32个；年龄41-58岁，平均47．9岁；均无骨性疾病。分别测量肱骨头后倾角和肱骨头最高点至大结节最高点的垂直距离。结果术后随访1．5-5年，平均3．9年。X线片显示，肱骨头假体位置均满意，2例术后假体近端周围即出现透亮带，但临床无松动迹象。16例患者无疼痛，4例偶感肩部疼痛，1例时常伴肩部疼痛。所有患者上肢肌力均基本正常，日常活动无困难。按Neer评分标准，优7例，良11例，可3例，优良率86％。评价为可的3例中，2例患者上举受限，经理疗和功能锻炼后症状无明显改善；1例患者肩部上举疼痛，服用非甾体抗炎药结合理疗后疼痛好转，对日常生活和睡眠无明显影响。无肩部感染、肩关节不稳、神经损伤等并发症。国人肱骨近端骨标本的肱骨头后倾角，左侧26．59°±1．36°，右侧26．85°±1．61°；肱骨头最高点至大结节最高点的垂直距离：左侧（6．63＋1．13）mm，右侧（6．80＋1．02）mm。结论应用人工肱骨头置换术治疗肱骨近端四部分骨折疗效满意。术中大结节和肩袖的重建是术后关节功能好坏的重要因素。将假体安放于恰当的位置（人工肱骨头的最高点至肱骨大结节最高点的垂直距离应为6-8mm，人工肱骨头的后倾角应在30°-35°）及适当的早期功能锻炼是手术成功的关键。     

3D技术辅助下半肩置换治疗老年性肱骨近端粉碎性Neer Ⅳ型骨折

目的：观察比较借助3D打印技术行半肩置换术与切开复位锁定钢板治疗中老年性肱骨近端粉碎性骨折（Neer Ⅳ型）的肩关节功能、并发症、临床效果。方法：2012年3月至2018年4月收治31例中老年肱骨近端粉碎性骨折（Neer Ⅳ型）,男4例,女27例;年龄55～94岁,平均71岁;病程1～3年。其中采用切开复位锁定钢板内固定（ORIF组）20例,采用3D打印技术辅助下半肩置换术（HA组）11例。通过CT数据借助Mimics软件,在计算机上模拟骨折重建,测量出骨折端到肱骨头高度,大结节到肱骨头高度,肱骨头后倾角,辅助半肩置换。术后随访,行X线检查,观察两组并发症发生率,并对肩关节功能进行Neer评分。结果：31例患者获得随访,时间1～3年,平均2年。HA组无假体松动、断裂和下沉,人工肱骨头完好,大小结节骨折不愈合1例,Neer评分84.18±3.55;ORIF组肱骨近端骨吸收8例,骨折不愈合1例,内固定松动1例,Neer评分55.91±10.78;两组肩关节功能Neer评分比较,差异有统计学意义（P<0.05）。结论：3D技术辅助半肩置换与切复锁定钢板固定治疗中老年肱骨近端粉碎性骨折（Neer Ⅳ型）并发症少,功能恢复较切复内固定好。     

人工半肩关节置换治疗高龄肱骨近端粉碎骨折

目的探讨半肩关节置换治疗高龄肱骨近端粉碎骨折的临床效果。方法1995年5月至2007年6月,对10例高龄肱骨近端粉碎骨折患者进行半肩关节置换治疗。结果术后随访均按美国UCLA的评分标准进行评分,优（34～35分）2例,良（28～33分）7例,中（21～27分）1例,无差病例。术后肩关节活动范围上举（90.5±6.2）,°外旋（62.0±4.5）,°内旋（75.6±2.1）°。1年后随访,所有病例大小结节均愈合,未发现假体松动、感染及假体周围骨折、关节不稳、脱位等并发症。病人主观满意度：除1例假体远端骨折患者重新行假体远端骨折内固定外,其余均较满意。结论只有重建肱骨正常长度,确定固定大小结节,进行持之以恒、规范的肩关节功能康复锻炼,才能使半肩关节置换治疗肱骨近端粉碎骨折获得满意疗效。     

半肩置换治疗严重肱骨近端骨折的临床结果分析

目的评价半肩置换治疗严重肱骨近端骨折的临床疗效,并对影响治疗结果的因素进行分析。方法2001年7月至2005年5月共收治42例患者,平均年龄63岁,术后随访时间12～48个月,平均29个月。对所有患者进行主观评价,同时对活动度、肌力、稳定性、活动顺滑度进行评估。随访时拍摄肩关节X线片,27例患者拍摄术后双侧肱骨全长位片;15例患者行术后肩关节CT检查。结果根据Constant-Murley评分19例患者非常满意（45％）,17例满意（40％）,6例不满意（15％）,总满意率达到85％。术后主动前屈（100±32）°,外旋（16±11）°,内旋后伸达L2水平。结论采用人工肱骨头置换术治疗严重的肱骨近端骨折可取得良好手术效果,但需要严格掌握手术适应证。术中肱骨长度恢复不佳、假体后倾角度过大、大小结节固定不确切、愈合不良、大结节吸收及异位骨化等是造成效果不满意的原因。     

人工肱骨头置换术治疗老年肱骨近端粉碎性骨折

目的 探讨人工肱骨头置换治疗老年肱骨近端粉碎性骨折的临床疗效.方法 采用可调式骨水泥型人工肱骨头置换术治疗15例老年肱骨近端粉碎性骨折患者.结果 患者均获随访,时间3～24个月.按照ASES肩关节评分:疼痛4.8分±0.2分;肌力4.5分±0.4分;稳定性4.5分±0.3分.至末次随访时,患者患肩均无明显疼痛;无感染、假体松动等并发症.患者主观满意度均满意.结论 人工肱骨头置换术已成为治疗老年肱骨近端粉碎性骨折的有效措施,严谨的术中操作、重建假体的解剖学关系、肩袖的良好重建及术后积极的康复锻炼都是提高手术效果的有效方式.     

人工肱骨头置换治疗老年肱骨近端陈旧性骨折的疗效分析

目的探讨人工肱骨头置换治疗老年肱骨近端陈旧性骨折的手术特点及疗效。方法回顾性分析成都大学附属医院2009年1月至2013年12月采取人工肱骨头置换治疗22例肱骨近端粉碎陈旧性骨折患者(陈旧性骨折组),同期治疗68例新鲜肱骨近端粉碎性骨折患者(新鲜骨折组),两组患者进行对比。陈旧性骨折组:Neer三部份骨折6例,四部分骨折16例;骨折时间3~6个月12例,6~9个月8例,9~12个月2例。新鲜骨折组:Neer三部分骨折23例,四部分骨折45例,其中28例患者伴有肱骨头脱位。两组患者均采用同一品牌的骨水泥型人工肱骨头假体。采用Neer及UCLA肩关节功能评分标准对两组患者手术前、后随访进行评价对比。结果两组患者均获得随访,随访时间2~6年,平均3.87年。陈旧性骨折组:术后Neer评分平均82.4分,优良率77.27%;UCLA评分平均28.9分,优良率72.73%。新鲜骨折组:术后Neer评分平均84.7分,优良率80.88%;UCLA评分平均30.8分,优良率77.94%。所有患者术后肩关节功能明显改善,陈旧性骨折组与新鲜骨折组功能评分相比,差异无统计学意义(P0.05),但陈旧性骨折组患者满意度比新鲜骨折组高,陈旧性骨折组骨折时间越久,术后肩关节功能越差。结论人工肱骨头置换治疗老年肱骨近端粉碎陈旧性骨折可取得较好的疗效,认真清理肩袖内骨折块、仔细松解关节囊、精确重建肩袖对肩关节功能的恢复十分重要。     

人工肱骨头置换治疗肱骨近端粉碎性骨折

[目的]探讨人工肱骨头置换治疗肱骨近端粉碎性骨折的临床效果.[方法] 2005年4月～2009年4月29例新鲜肱骨近端粉碎性骨折患者行人工肱骨头置换并关节功能锻炼,术后随访时间平均50个月.对所有患者进行主观评价,同时对活动度进行评估,采用Neer评分标准评估患者疗效.[结果]22例无疼痛,5例偶感疼痛,2例时有疼痛.29例患者肩关节活动范围:前屈上举108.7°:后伸40°;外展82.3°;内收35°;外旋34°;内旋50°.Neer评分平均85.7分;优11例,良14例,可4例,优良率86％.[结论]人工肱骨头置换是一种治疗肱骨粉碎性骨折的有效方法,但手术适应证、假体安置、软组织重建、术后长期康复锻炼对于手术效果具有重要意义.     

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。