125I粒子植入联合经皮椎体成形术治疗累及硬膜囊脊椎转移瘤

目的 探讨125I粒子植入联合经皮椎体成形术(PVP)治疗累及硬膜囊的脊椎转移瘤临床疗效.方法 回顾性分析2012年6月-2013年6月行125I粒子植入及PVP累及硬膜囊的脊椎转移瘤20例患者38节病变椎体.采用视觉模拟评分(VAS)、体力状况评分(KPS)和肿瘤病灶大小(mm3)3方面评价其疗效.分别记录术前VAS、KPS评分;术后24 h,1、3和6个月VAS及KPS评分;利用图像处理软件计算出术前肿瘤病灶大小、测量术后1、3和6个月残余肿瘤病灶大小,观察肿瘤有无增大.结果 20例患者手术均成功,每个椎体骨水泥平均注射量为(3.8±1.6)ml,每节椎体粒子平均植入量为(35±5)粒.随访6个月～1年,平均8个月.术前VAS平均得分为7.41±0.79;术后24 h,1、3和6个月VAS平均得分分别降为5.68±0.83、3.91±0.86、3.50±0.90和2.86±0.83;术前KPS平均得分为53.64±11.66;术后24 h,1、3和6个月KPS平均得分分别为59.32±7.19、80.33±4.32、84.55±5.09和82.05±6.06.术前肿瘤病灶平均大小为(650±10)mm3,术后1、3和6个月残余肿瘤病灶大小分别为(305±9)、(138±10)和(115±7)mm3,术后1、3和6个月肿瘤控制有效率达到70.0％ 、70.0％和88.9％.结论 125I粒子植入联合PVP治疗累及硬膜囊脊椎转移瘤在技术上可行,可有效控制病灶累及脊髓,保护脊髓神经功能健全.     

CT引导下125I粒子植入近距离治疗骨转移瘤(附24例报告)

目的:探讨CT引导下125I粒子植入对骨转移瘤进行近距离放疗的可行性、安全性及其疗效.方法:24例骨转移瘤患者(26个病灶),术前依据CT图像应用计算机治疗计划系统制定粒子植入计划,按治疗计划在CT引导下穿刺植入125I粒子,粒子植入数量6～40颗(中位数16颗).植入术后立即CT扫描及2～8个月CT扫描观察粒子在瘤体内的分布、有无并发症发生及疗效.结果:24例患者均成功植入,未见并发症和治疗相关的放射损伤.24h内100%疼痛完全减轻;随诊CT检查示24例的26个病灶中粒子植入后2个病灶消失,18个病灶明显缩小,4个病灶大小无明显变化,只有2个病灶增大.植入术前及植入术后随诊显示病灶平均直径分别为4.39cm和3.14cm(P=0.0059,P＜0.05).结论:CT引导下经皮穿刺125I粒子植入近距离放射治疗骨转移瘤具有微创、安全、高效等优点,可作为骨转移瘤的治疗方法.     

经皮椎体成形术联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤北大核心CSCD

目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤的安全性和有效性。方法回顾性分析2019年6月至2021年6月在河南科技大学第一附属医院介入科接受治疗的55例患者75节病变椎体。采用随机数字化法将患者分为两组,25例患者40节病变椎体接受PVP联合^(125)I粒子组织间置入术(联合组),30例患者35节病变椎体接受PVP(单一组)。使用视觉模拟量表(visual analogue scale,VAS)、卡氏评分(Karnofsky performance score,KPS)评估疼痛程度及体力状况。CT评估骨水泥分布及渗漏,MRI评估肿瘤控制情况,记录两组骨水泥数量及^(125)I粒子数目,Kaplan-Meier法分析两组患者生存情况。结果手术成功率是100%,联合组VAS评分由术前(8.25±0.31)分降至术后12个月(3.27±0.83)分,单一组VAS评分由术前(8.53±0.21)分降至术后12个月(3.98±0.69)分,联合组与单一组术后1、3、6、12个月VAS评分比较差异均有统计学意义(均P<0.05)。联合组KPS由(43.46±9.66)分升至术后12个月(90.05±2.06)分,单一组KPS由(41.15±8.36)分升至术后12个月(84.05±1.56)分。联合组与单一组术后1个月KPS差异无统计学意义(P=0.983),术后3、6、12个月KPS比较差异有统计学意义(均P<0.05)。联合组每个椎体骨水泥注射量为(2.8±0.6)mL,粒子植入量为(15±2)粒,单一组骨水泥注射量为(3.1±0.3)mL。联合组和单一组骨水泥渗漏发生率为42.5%和53.5%,单一组骨水泥漏入椎管1例,无相应症状发生。术后随访联合组肿瘤控制有效率与单一组比较差异有统计学意义(均P<0.05)。两组生存方面差异无统计学意义(P=0.324)。结论PVP联合^(125)I粒子组织间置入术治疗伴后缘破坏的椎体转移瘤安全可靠,较单纯PVP更能明显缓解疼痛、控制肿瘤生长。在延长生存时间方面无明显区别。     

125I粒子植入术治疗转移性骨痛的临床应用

目的 初步探讨放射性粒子植入术治疗骨转移瘤所致骨痛的疗效.方法 诊治52例骨转移瘤患者,在CT引导下行125I放射性粒子植入治疗.结果 125I放射性粒子植入后,第2天患者疼痛感明显减轻;第5～7天患者胀痛感加重;术后10～ 30 d患者疼痛逐渐缓解.术后1个月疗效评估:Ⅰ级疼痛缓解率100％,Ⅱ级疼痛缓解率88.9％,Ⅲ级疼痛缓解率92.3％,总有效率93.7％ (P＜0.05).对不同疼痛程度患者局部疼痛缓解有效率高,但Ⅱ、Ⅲ级疼痛缓解率无明显差异(P=0.369).结论 125I放射性粒子植入治疗骨转移瘤所致骨痛,治疗时间短、短期内缓解疼痛疗效明显且并发症少.特别对于溶骨型骨转移瘤,其治疗效果较好,在临床保守治疗疼痛控制不理想时,125I放射性粒子植入可作为一种有效的治疗方法.     

射频消融术联合经皮骨成形术治疗椎外转移性骨肿瘤的临床应用

目的 探讨DSA引导下射频消融术(radiofrequency ablation,RFA)联合经皮骨成形术(pecutaneous osteoplasty,POP)治疗椎体外转移性骨肿瘤的手术方法及临床疗效.方法 回顾性分析38例(54个病灶)行RFA联合POP治疗的椎外骨转移性肿瘤患者资料,年龄23 ～75岁,平均(52.6±12.2)岁.共54个转移灶得到治疗,其中髂骨24处、髋臼21处、股骨7处、坐骨1处、胫骨1处.所有患者至少随访3个月,通过术前、术后视觉模拟评分(visual analog scale,VAS)、止痛药服用剂量的变化以及运动功能的改善情况评价临床效果.结果 38例手术均获得成功.术后24 h VAS评分由术前平均(7.1±1.5)分降至术后(2.2±2.0)分,术后3个月降至(1.6±1.8)分,术后6个月降至(1.3±1.8)分.术后7例(18.4％)疼痛完全缓解,25例(65.8％)完全无需止痛药,10例(26.3％)止痛药用量减少或止痛药级别降级,2例(5.3％)维持原剂量,1例(2.6％)使用止痛药级别升级.33例行走困难者中20例(60.6％)术后行动功能改善,其中4例可正常行走;12例(36.4％)仍然行走困难;1例(3％)行动不便加重,稍微活动即疼痛难忍.术后患者中位生存时间为15个月,1年生存率为68.9％,2年生存率为27.3％.8例(21.1％)发生肿瘤周围软组织骨水泥渗漏,但无明显临床症状,1例(2.6％)发生皮肤灼伤.结论 DSA引导下行RFA联合POP治疗椎外转移性骨肿瘤临床效果良好、创伤小、并发症少,可以明显提高患者生存质量.     

125I粒子组织间置入治疗骨转移瘤

目的探讨^125I粒子组织间永久置入在骨转移瘤中的治疗价值。方法对22例不同来源骨转移瘤患者采取^125I粒子永久置入的方法进行治疗，观察治疗后骨痛缓解及术后病灶影像改变的情况。结果^125I粒子永久置入治疗骨转移瘤止痛有效率为91％（20／22），术后2个月粒子置入病灶的影像检查结果显示，32个骨转移灶中，完全缓解（CR）4个、部分缓解（PR）18个、稳定（NC）10个，总缓解率68．7％，所有患者均未出现严重不良反应。结论组织间永久置入^125I粒子治疗骨转移瘤止痛效果好，不良反应发生率低且程度轻，是一种疗效较好的治疗方法。     

CT导引125I粒子植入治疗肝门部胆管癌支架置入后的应用

目的 探讨CT导引经皮穿刺植入125I粒子治疗肝门部胆管癌支架置入术后的可行性、有效性及并发症.方法 17例肝门部胆管癌患者在胆管内支架置入缓解黄疸后,在CT引导下将125I粒子植入胆管癌病灶内.125I粒子活度2.59×107 Bq(0.7mCi),PD110Gy.术前通过放射性粒子治疗计划系统TPS(treatment planning system)布源,在CT导引下采取粒子间隔0.5～1.0cm,后退式平面植入.术后分别于3个月、6个月和12个月观察病人的客观疗效、胆管内支架通畅情况及手术并发症.结果 所有患者未出现严重并发症.17例患者术后3月,CR1例(5.9％),PR11例(64.7％),NC3例(17.6％),PD2例(11.8％).粒子植入术后3个月时未出现再梗阻;12个月存活的患者(10例)1例出现再梗阻.6个月和12个月生存率分别为82.3％和58.9％,中位生存时间为12个月.结论 CT导引经皮穿刺植入125I粒子治疗支架植入术后的肝门部胆管癌疗效确切,明显减少胆管内支架再梗阻的几率,且无明显副作用,值得进一步探讨.     

CT引导125I粒子植入术治疗胃癌术后区域淋巴结转移

目的 评价CT引导125I粒子植入术治疗胃癌术后区域淋巴结转移的安全性与近期疗效.方法 对23例胃癌术后局限性区域淋巴结转移并接受CT引导125I粒子植入治疗患者的临床病理特征与生存资料进行回顾性分析.所有患者术前经放射性粒子植入计划系统模拟布源,计算放射性粒子总活度与粒子数量.CT引导下经皮穿刺植入125I粒子.术后2个月参照实体瘤疗效评价标准(RECIST)评价近期疗效,采用寿命表法计算植入术后患者1、2和3年生存率;以单变量Cox模型检验相关因素对生存的影响;采用log-rank法比较组间(肿瘤最大径＞3 cm组和＜3 cm组)生存差异并绘制生存曲线.20例患者粒子植入术后接受了以氟尿嘧啶类药物为基础的全身化疗.结果 23例患者均未出现严重并发症.CR 14例(60.9％,14/23),PR 5例(21.7％,5/23),PD 4例(17.4％,4/23).患者粒子植入术后1、2和3年生存率分别为(87±7)％、(47±11)％与(13±9)％,中位生存时间为(22.1±5.1)个月.单变量Cox分析,肿瘤最大径是影响生存时间的因素(x2=9.752,P=0.002),＞3 cm组和＜3 cm组的中位生存时间分别为(17.0±5.0)和(30.0±5.1)个月,2组总生存时间差异具有统计学意义(x2=5.828,P=0.016).结论 CT引导1251粒子植入术治疗胃癌术后局限性区域淋巴结转移创伤小且并发症少,并能取得较高的局部控制率.     

经皮椎体成形术或椎体后凸成形术治疗多节段老年骨质疏松性脊柱骨折

目的 探讨经皮椎体成形术、椎体后凸成形术治疗多节段老年骨质疏松性脊柱压缩骨折的疗效.方法 根据影像学特点,对13例老年骨质疏松性多节段脊柱压缩骨折选择性进行单侧经皮椎体成形术或球囊扩张椎体后凸成形术.年龄54～83岁;其中2个椎体压缩8例,3个椎体压缩4例,4个椎体压缩1例.结果 13例在术后腰背部疼痛基本消失,24小时后均离床活动,患者的视觉模拟评分(VAS)由术前(8.3±1.5)分降至术后(2.5±1.2)分,手术前后差异有统计学意义(P<0.01),椎体高度恢复明显,Cobb角平均矫正10.17°.术后随访6～12个月,腰背痛无复发.结论 对多节段老年骨质疏松性脊柱骨折的患者,根据影像学特点选择经皮椎体成形术、球囊扩张椎体后凸成形术治疗能取得满意的疗效.     

CT引导下125I放射性粒子组织间植入治疗纵隔转移性淋巴结

目的 探讨CT引导下经皮穿刺125I放射性粒子植入治疗纵隔转移性淋巴结的技术方法、安全性及临床价值.方法 应用125I放射性粒子组织间种植治疗纵隔淋巴结转移患者8例,所有患者采用前路进针途径穿刺,按照病灶与体表穿刺点的位置设定CT机架的角度,采用多方位重组技术及平头针芯捻压分离主动脉、上腔静脉间隙进针法植入125I放射性粒子.疗效评价采用术后治疗计划系统(TPS),验证放射性粒子种植后剂量分布,观察治疗后患者局部压迫症状(气短、咳嗽、吞咽困难等)的改善情况及粒子植入术后2个月靶淋巴结的局部反应,并记录并发症情况.结果 植入术后粒子覆盖率为(93.5 ±1.5)％.术后2个月复查,其中完全缓解(CR)3例,部分缓解(PR)4例,病灶稳定(SD)1例.5例气短、4例咳嗽和吞咽困难等局部压迫症状均有不同程度减轻,未出现头颈部及上肢水肿.术后无严重并发症发生;无大血管、气管、食管损伤,1例出现少量气胸.结论 CT引导下经皮穿刺组织间放射性粒子植入治疗纵隔4R区肿瘤转移性淋巴结,疗效肯定、安全可靠,为常规治疗局部压迫症状较严重的复杂部位淋巴结转移,提供了一种新的微创治疗方法.     

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.     

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）     

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.