尾骨痛10例临床分析

作者对收治１０５例尾骨痛进行分析，结果表明：（１）尾骨疼痛者女性比男性多。（３）与无尾骨痛者相比较，特发性尾骨痛者外偏角变大，骶尾间有和第１、２尾椎间角变小；而外伤性尾骨痛者我偏角不变，其它两角也变小。（３）保守治疗８７例，治愈率９２．９４％，好转率７．０６％，手术治疗１８例，治愈率１００％。总有效率１００％。     

100Hz电刺激肩胛间区对家兔胆囊痛及其脊髓后角磷酸化细胞外信号调节蛋白激酶表达的影响

目的 探讨100 Hz电刺激肩胛间区对家兔胆囊痛及脊髓后角磷酸化细胞外信号调节蛋白激酶(phosphorylate extracellular signal-regulated kinases,pERK1/2)表达的影响.方法 家兔采用随机数字表法随机分为5组:对照组、生理盐水组、甲醛溶液组、肩胛间区电刺激组和非肩胛间...     

输尿管下端狭窄诊治体会

目的:探讨输尿管下端狭窄的诊治方法.方法:回顾性分析13 例输尿管膀胱连接部狭窄的临床资料.男5例,女8例.平均年龄45 岁.左侧4 例,右侧7例,双侧2例.膀胱壁间段狭窄11例;膀胱前段狭窄2例,膀胱隧道式输尿管膀胱吻合术,术中留置双J 管10例,输尿管膀胱角吻合术2例,膀胱瓣输尿管下端成形术,术中留置双J 管1例.结果:13例术后随访2 个月～6 年,全组无输尿管狭窄,治愈率69%,无效率31%.其中膀胱隧道式输尿管膀胱吻合术70%(7/10),好转率30%(3/10);输尿管膀胱角吻合术50%(1/2),好转率50%(1/2);膀胱瓣输尿管下端成形术治愈率100%(1/1).膀胱造影无膀胱输尿管返流.结论 膀胱隧道式输尿管膀胱吻合术和输尿管膀胱角吻合术治疗输尿管膀胱连接部狭窄创伤小,疗效满意.     

臀大肌注射部位再探讨

为了减轻臀大肌肌内注射引起的疼痛 ,对 12 5例需臀大肌肌内注射治疗的患者行右侧髂前上棘与尾骨连线外上 1/ 3处 (对照组 )和左侧髂前上棘与尾骨连线外上 1/ 4处 (实验组 )肌内注射各 375例 ,并行自身对照。结果实验组疼痛显著低于对照组 (P<0 .0 1)。提示采用髂前上棘与尾骨连线外 1/ 4区域肌内注射 ,可减轻疼痛     

残角子宫35例临床分析

目的提高对残角子宫临床特点、诊断及处理的认识。方法对2004年1月至2014年1月北京协和医院收治的35例经手术确诊的残角子宫患者的临床资料进行回顾性分析。结果 (1)35例患者中IIa型3例(8.6%),IIb型22例(62.9%),IIc型8例(22.9%),无IId型,分型不详2例(5.7%);临床表现为痛经者24例(68.5%),不孕者6例(17.1%),12例合并子宫内膜异位症(34.3%),12例合并泌尿生殖系统畸形(34.3%)。(2)所有患者术前均行超声检查,提示为残角子宫12例,双子宫5例,畸形子宫3例,未见异常15例;其中13例患者术前同时行核磁共振检查,提示为残角子宫5例,双子宫4例,纵隔子宫1例,畸形子宫1例,未见异常2例,与超声诊断基本符合,超声及核磁共振与手术诊断符合率均为38.5%(5/13)(P0.05);7例术前行子宫输卵管造影,双侧输卵管未显影1例,单侧未显影4例,双侧正常2例。(3)非妊娠时诊断者23例,妊娠时诊断者12例(其中4例为残角子宫妊娠)。(4)手术切除残角子宫共25例,其中腹腔镜16例,开腹9例。结论残角子宫的诊断和分型是治疗的依据,超声及核磁共振检查有助于残角子宫的诊断,子宫输卵管碘油造影有助于判断其分型,宫腹腔镜联合手术诊治残角子宫具有良好效果。     

经髋臼基底三联截骨术治疗青少年髋臼发育不良

目的: 介绍经髋臼基底三联截骨术治疗青少年髋臼发育不良。方法: 2000年 3月~2004年 2月改进Tǒnnis术式, 设计经髋臼基底三联截骨治疗 22例患者。术前X线片显示:CE角为-25~15°, 平均 8. 4°; Sharp角为 45 ~70°, 平均 58. 6°: 臼头指数为 31% ~76%, 平均 61. 4%; ACP角为100~170°, 平均 139. 8°。CT片示: 髋臼前CE角大于正常, 髋臼前断面角和前倾角小于正常。CT三维重建示: 前、后外侧壁边缘角, 外侧髋臼倾斜角均大于正常, 水平面髋臼旋转角小于正常。结果: 16例 ( 16髋 ) 有 12 ~30个月(平均 20个月) 的随访结果。X线片示: CE角平均 32. 6°(15~52°), 比术前增大约 25°; Sharp角平均 41. 5°(38~46°), 减小约 18°; 臼头指数平均 81. 6% (69% ~89% ), 增大约 20%; ACP角平均 171. 1° ( 140 ~180°), 增大约31°。CT示: 髋臼前CE角和前倾角变小, 髋臼前断面变大。CT三维重建示: 髋臼前、后外侧壁边缘角变小, 外侧髋臼倾斜角变小, 水平面髋臼旋转角变大。结论: 经髋臼基底三联截骨术治疗青少年髋臼发育不良能够获得满意疗效。     

经皮微创经椎间孔腰椎体间融合术治疗腰椎退变性疾病的临床疗效分析

目的总结经皮微创经椎间孔腰椎椎体间融合术(MIS-TLIF)治疗腰椎退行性疾病的并发症,评估其临床疗效和安全性。方法自2010-05—2011-05采用MIS-TLIF治疗腰椎退行性疾病100例,记录手术时间、出血量、术后下床活动时间、住院时间和手术相关并发症;临床疗效评估采用VAS评分和腰椎JOA功能评分。结果随访时间18~36个月,平均23个月。手术时间95~195 min,平均125 min;出血量150~380 ml,平均210 ml;下床时间5~10 d,平均7 d,住院时间4~15 d,平均7 d;VAS评分由术前5~10分降低到末次随访时0~5分;JOA评分由术前的6~21分提高到术后23~29分;JOA评分改善率43%~92%,平均79%。2.5%(11/435)发生螺钉位置不良,1.7%(2/120)出现cage位置不良;0.8%(1/120)发生cage再移位;0.8%(1/120)的患者需要输血;2%(2/100)出现深静脉血栓;所有患者均未出现手术部位感染和脑脊液漏。结论采用MIS-TLIF治疗腰椎退行性疾病安全、可靠,并发症较低。     

风湿性多肌痛24例临床分析

目的 对2000-2004年间明确诊断的风湿性多肌痛(PMR)24例临床资料进行了回顾性分析.可根据下述6条临床特征:(1)发病年龄≥50岁.(2)颈部、肩胛部及骨盆部肌肉僵痛,至少两处,并伴晨僵,持续四周或四周以上.(3)血沉≥50mm/h(魏氏法).(4)抗核抗体及类风湿因子阴性.(5)小剂量糖皮质激素(泼尼松10～15 mg/d)治疗反应甚佳.(6)须除外继发性多肌痛症.拟诊为原发性PMR.治疗一般病例首选泼尼松10-15 mg/d口服,对使用糖皮质激素有禁忌证,或效果不佳,或减量困难,或不良反应严重者,可联合使用免疫抑制剂.若在数日内临床症状明显改善或缓解者,更有利于诊断.但需注意排除多发性肌炎、巨细胞动脉炎及肿瘤等所致的继发性PMR.     

第1、2跖骨间弹性固定术治疗轻中度外翻临床疗效分析

目的 探讨第1、2跖骨间弹性固定术治疗轻中度■外翻的临床疗效。方法 选取2018年8月至2021年2月间在我院行第1、 2跖骨间弹性固定术治疗的■外翻畸形患者34例(共52足),均为女性。其中,轻度18例(27足),中度16例(25足);双足手术者18例,单足手术者16例。记录并比较患者手术前后负重位IMA、 HVA及Maryland足功能评分,观察术后并发症发生情况。结果 本组34例(52足)患者均顺利完成手术,手术时间平均(68.6±14.3)min,术中出血量(19.4±4.2)mL。术后均获随访,平均(18.2±4.6)月。末次随访时HVA、IMA及Maryland评分均较术前明显改善,差异有统计学意义(P<0.001)。足功能评价：优29例(42足),良5例(10足),优良率100%。均未出现术后切口感染、第1跖骨头坏死及转移性跖痛等并发症。术后发生第2跖骨应力性骨折及第1跖趾关节内侧半脱位各1足,并发症发生率为3.8%(2/52)。结论 第1、2跖骨间弹性固定术可以有效矫正轻中度■外翻畸形,手术效果明确,并发症较低,安全性较高,且不需截骨,值得临床推广应用。     

尾骨骨折脱位外固定分析

尾骨骨折脱位较为常见 ,一般采用保守治疗 ,大多数效果满意 ,但约有 1/ 4或 1/ 5的病例由于愈合不良或移位较大 ,局部遗留瘢痕组织与纤维连接 ,在坐、行等活动时 ,瘢痕组织中神经末梢受到刺激而疼痛 ,甚至长期不能消失 ,一部分病人经封闭治疗疼痛缓解 ,一部分病人遗为顽固性尾骨痛 ,病人十分烦恼而需行尾骨切除术 ,所以初期的良好复位固定至关重要。但以往的外固定常采用胶布固定 ,效果不够确实可靠 ,为此我们自 1996年～2 0 0 0年对 12例尾骨骨折脱位患者 ,采用塑形板作外固定 ,并与同期未作固定治疗的 2 8例尾骨骨折脱位患者就远期疗效及…     

前部玻璃体切割联合房角分离术对白内障术后恶性青光眼的疗效观察

目的观察前部玻璃体切割联合房角分离术对白内障术后恶性青光眼的治疗效果。方法对2011年7月至2015年6月间因白内障摘除联合人工晶体植入术后继发恶性青光眼行药物和YAG激光治疗无效的20例(20只眼)患者,在安阳市眼科医院接受前部玻璃体切割联合房角分离手术治疗,随访3个月~1 a,观察记录20例患者手术后的最佳矫正视力、眼压、前房深度及视网膜、脉络膜状态等情况,并对数据进行统计学分析。结果术后3个月,20例(20只眼)患者最佳矫正视力、眼压、前房深度分别为(0.58±0.25)、(15.26±2.97)mm Hg、(3.28±0.42)mm,与术前比较差异均有统计学意义(P0.05)。术后第1天6只眼出现睫状体脱离,3只眼出现睫状体脱离合并脉络膜渗出性脱离。给予地塞米松针5 mg球旁注射,20%甘露醇注射液250 m L静滴,术后2周内9例患者睫状体及脉络膜脱离消失。结论前部玻璃体切割+后囊切开+房角分离术可有效解除白内障术后恶性青光眼患者的睫状环阻滞、房水流出道阻塞,促进患者前房形成和房水流出,明显改善患者症状和提高视功能。     

Operative treatment of fecal incontinence in coccyx agenesis in children after surgical correction of Hirschsprung's disease

The coccygeal agenesis is one of causes of the external anal sphincter functional insufficiency after performing operations for Hirschsprung's disease in children. The frequency of its diagnosis had constituted 6.2%, in 14.6% it was the causative factor of fecal incontinence after the operation. In coccygeal agenesis the normal anatomy of the pelvic floor muscles become disordered. It is convenient to perform the anomaly correction during the radical operation conduction for the main disease.     

Radiological study of 1500 coccyces

A radiological study of the coccyx and sacral vertebra was carried out in 1,000 healthy individuals, and in 500 individuals suffering from coccygeal pain. In terms of the age distribution of individuals suffering from coccygodynia, the peak of the distribution curve was found at fourth decade. Morphologically, the incidence of dislocation type was as follows: In the normal group, it was 2.6% in males, and 5.2% in females; in the traumatic group, the dislocation type was 5.1% in males, and 8.1% in females, in the idiopathic group, it was 4.8% in males, and 11.1% in females. The sacro-coccygeal angle was greater in the female than in the male. From these results it may be concluded that there is a greater occurrence of idiopathic coccygeal regional pain among females, owing to certain motor disadvantages affecting body movement, as well as possible hormonal imbalance and morphological abnormalities.     

Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma

STUDY DESIGN: A total of 208 consecutive coccydynia patients were examined with the same clinical and radiologic protocol. OBJECTIVES: To study radiographic coccygeal lesions in the sitting position, to elucidate the influence of body mass index on the different lesions, and to establish the effect of coccygeal trauma. SUMMARY OF BACKGROUND DATA: A protocol comparing standing radiographs and radiographs subsequently taken in the painful sitting position in coccydynia patients and in controls has shown two culprit lesions: posterior luxation and hypermobility. Obesity and a history of trauma have been identified as risk factors for luxation. METHODS: Dynamic radiographs were obtained. The body mass index was compared with the coccygeal angle of incidence, sagittal rotation of the pelvis when sitting down, and the presence and time of previous trauma. The patients with the newly described lesions were examined after an anesthetic block under fluoroscopic guidance. RESULTS: Two new coccygeal lesions are described (anterior luxation and spicules). Obesity was found to be a risk factor. The body mass index determines the way a subject sits down, and lesion patterns were different in obese, normal-weight, and thin patients (posterior luxation: 51%, 15.2%, 3.7%; hypermobility: 26.5%, 30.3%, 14.8%; spicules: 2%, 15.9%, 29.6%; normal: 16.3%, 32.6%, 48.1%, respectively; P < 0.0001). Trauma affected the type of lesion only if it was recent (<1 month before the onset of coccydynia), in which case the instability rate increased from 55.6% to 77.1%. Backward-moving coccyges were at greatest risk of trauma. CONCLUSIONS: This protocol allows identification of the culprit lesion in 69.2% of cases. The body mass index determines the causative lesion, as does trauma sustained within the month preceding the onset of the pain.     

头抬高后仰位联合60°气管拔管对患者拔管期应激反应的影响

目的观察头抬高后仰位联合60°气管拔管对患者拔管期应激反应的影响。方法选择全麻下行大隐静脉高位结扎手术的患者90例,男33例,女57例,年龄18~40岁,体重45~75kg,ASAⅠ或Ⅱ级。按照随机数字表法均分为三组,每组30例。A组患者平卧位,气管导管拔管角度为90°(拔管方向与地面夹角呈90°),B组患者平卧位,拔管角度为60°(拔管方向与地面夹角呈60°),C组患者头抬高后仰位,拔管角度为60°。记录手术结束时(T_0)、拔管前1 min(T_1)、拔管后1 min(T_2)、5min(T_3)的SBP、DBP及HR,记录拔管的力度,观察呛咳、咽痛、声音嘶哑发生情况。结果与T_0时比较,T_2时三组SBP、DBP明显升高,HR明显增快(P0.05),T_3时A、B组SBP、DBP明显升高,HR明显增快(P0.05);T_2、T_3时B、C组SBP、DBP明显低于,HR明显慢于,拔管力度明显小于A组(P0.05);T_2、T_3时C组SBP、DBP明显低于,HR明显慢于,拔管力度明显小于B组(P0.05)。B、C组呛咳发生率[3例(10.0%),2例(6.6%)]明显低于A组的[12例(40.0%)](P0.05)。结论头抬高后仰位联合60°拔除气管导管能明显减轻患者拔管期应激反应。     

Coccygectomy for coccygodynia: do we really have to wait?

AIM: To determine the results of 21 cases of persistent coccygodynia unresponsive to conservative management and treated with coccygectomy. METHODS: Of 81 patients with coccygodynia, 21 underwent surgical excision of the coccyx with a minimum 5 days of antibiotic prophylaxis. All 21 patients were followed for at least 2 years and questioned about their satisfaction with the operation and its timing. Pain levels were recorded preoperatively and during the postoperative period using the VAS scale. RESULTS: The mean VAS score was 51.88 (40-70), and this decreased to 3.17, 2.94 and 2.76 in the 6th, 12th and 24th months, respectively. This change was statistically significant. Of the 21 cases, 17 had an excellent result and 4 had a good result. None had a wound healing problem or infection. All were satisfied with the operation, and all stated that they would have liked to have undergone it sooner. CONCLUSION: For unstable coccygeal fracture and persistent coccygodynia, coccygectomy is a reliable method of treatment with a high satisfaction and a low complication rate.     

Vascularized autogenous canine coccygeal bone transfer.

Based on cadaver studies in dogs, the 8th, 9th, or 10th canine coccygeal vertebra with overlying skin was designed for free vascularized bone transfer. In six dogs the coccygeal osteocutaneous flap was transferred to fill a defect of the tibia, anastomosing the median caudal artery and one of the two caudal veins to the tibial vessels. The overlying skin provided a reliable monitoring system for the transferred tissue. The behavior of the vascularized coccygeal vertebrae was then evaluated with radiographic and histologic examination and compared with control vertebrae transferred without reconnection of the blood vessels. The results revealed that the canine coccygeal bone graft is a reliable vascularized osteocutaneous flap, which can be applied either in clinical veterinary surgery or in orthopedic microsurgical research.     

全膝置换术后髌骨髌腱角的变化

目的 研究全膝置换术后相同屈膝角度下矢状位髌骨和髌腱之间的角度变化,及其与术后活动度的关系.方法 材料为2002年5月～2003年12月期间做了初次全膝置换的33个关节(30例),诊断包括29个膝骨关节炎、4个类风湿性关节炎,其中20个关节置换了髌骨.男5例,女25例;年龄平均67.3岁.术前和术后1年摄0°、45°、90°侧位X线片,记录术后1年的活动度,测量术前术后不同屈膝度下的髌骨纵轴和髌韧带的夹角,并进行分析.结果 术后1年在屈膝90°时,髌骨与髌腱的角度较术前增大(P＜0.01).更换髌骨和保留髌骨组术后都发生了相似的角度变化(P＜0.01).术后屈膝90°的髌骨髌腱角和术后活动度呈负相关(r=-0.506,P=0.003).结论 全膝置换术后在屈膝活动时的髌骨髌腱角变化规律发生改变,与置换髌骨无关;术后屈膝90°时髌骨髌腱角的改变幅度与术后活动度限制有关.     

颈椎单开门椎管扩大成形术椎板开门角度对脊髓型颈椎病疗效的影响

目的:探讨椎板开门角度对颈椎单开门椎管扩大成形术(expansion of open-door laminoplasty)治疗脊髓型颈椎病疗效的影响。方法:选取我院2006年7月至2009年1月采用颈椎后路单开门椎管扩大成形术治疗并获得24个月以上随访的脊髓型颈椎病患者198例,男115例,女83例;年龄29～72岁,平均49±5岁。双节段39例(C3～C5 11例,C4～C6 28例);三个节段(C4～C7)97例,四个节段(C3～C7)62例。患者均有术前颈椎正侧位、双斜位和过度屈伸位X线平片和颈椎CT及MRI检查图片;术前JOA评分4～9分,平均6.3±2.9分。按照术后1周CT片上测量的椎板开门角度以30°为界限分为两组,统计两组手术时间、出血量、术后出现并发症病例、C2-C7 Cobb角度、颈椎前凸指数、颈椎活动度和脊髓后移数值,末次随访时评价患者神经功能情况,计算神经功能改善率。结果:开门角度>30°的患者共76例(A组);开门角度15°～30°的患者共122例(B组)。两组术前JOA评分、C2-C7 Cobb角度、颈椎前凸指数及颈椎活动度无显著性差异(P>0.05)。A组手术时间110±13min,出血量250±80ml;B组手术时间120±30min,出血量230±100ml,两组比较均无显著性差异(P>0.05)。术后A组51例(67.1%)出现轴性症状,8例(10.4%)发生C5神经根麻痹,1例(1.32%)颈椎轻度后凸畸形;B组37例(10.5%)出现轴性症状,3例(2.4%)发生C5神经根麻痹,4例(3.28%)发生关门,A组轴性症状和C5神经根麻痹的发生率高于B组,差异有显著性(P<0.05)。术后1个月脊髓后移值为0～7.95mm,平均2.41±0.46mm。末次随访时两组C2-C7 Cobb角度、颈椎前凸指数及颈椎活动度无显著性差异(P>0.05);JOA评分改善率A、B组分别为(72.1±11.7)%和(69.0±12.3)%,两组间比较无显著性差异(P>0.05)。结论:不同椎板开门角度术后神经功能改善率无显著性差异;将椎板开门角度控制在15°～30°轴性症状及C5神经根麻痹发生率较低,但应防止发生关门。     

髋关节旋转中心相关骨性参数的测量

目的 了解国人正常髋关节周围的骨性参数,探讨其对高位髋中心技术的影响. 方法 挑选CT表现完全正常且病例资料完整的男女各30例的影像资料,采用专用图像软件测量.测量参数:髋臼上方骨质的厚度、颈干角、偏心距、股骨头直径、骨盆高度及骨盆宽度.将年龄、体质量、性别和测量的各项参数值收集整理后进行统计分析. 结果 髋臼上方骨质形态在通过股骨头中心的冠状面上呈倒漏斗形,由远及近逐渐变薄,断面呈扇形,角度逐渐增大,半径逐渐变短.两性均在髋臼上方3 cm明显变薄,平均厚度男性为3.00 cm,女性为2.85 cm.男女两性之间的骨盆高度、骨盆宽度、颈干角、股骨头直径以及髋臼上方2 cm平面的骨质厚度等参数差异有统计学意义(P＜0.05),特别是颈干角,男性平均为121.42°,女性平均为135.42°,相差达14°,男女两性最小值与最大值相差达24.1°. 结论 髋臼上方骨质允许在全髋关节翻修术时垂直上方或上内方3 cm内放置高位髋中心.正常国人髋关节周围骨性参数男女差别较大,基于性别的差异,有必要在建立数据库时进行区别.