家庭赋权干预对永久性肠造口患者照顾者的影响

目的 探讨家庭赋权干预应用于永久性肠造口患者主要照顾者的效果。 方法 选择永久性肠造口患者及主要照顾者97对作为研究对象,按照患者住院时间分为对照组48对和观察组49对。对照组患者给予常规护理,观察组在对照组基础上实施家庭赋权干预方案。比较两组照顾者干预前后照顾准备程度、照顾负担及心理一致感评分。 结果 干预后,观察组照顾者照顾准备度评分及心理一致感评分显著高于对照组,照顾负担评分显著低于对照组（均P＜0.05）。 结论 家庭赋权干预有利于提高永久性肠造口患者主要照顾者的准备度及心理一致感,对缓解照顾者照顾负担具有积极意义。     

脊髓型颈椎病患者颈椎动态MRI检查价值与安全性分析

目的 探究脊髓型颈椎病（CSM）患者颈椎动态MRI（DMRI）检查的价值与安全性。方法 2019年1月—2021年9月,87例CSM患者于苏州大学附属第二医院行颈椎DMRI检查。在矢状面前屈、后伸和中立位MRI T2加权像上观察是否存在脊髓隐匿性压迫。记录患者在DMRI检查前后的症状及体征、疼痛视觉模拟量表（VAS）评分。以DMRI检查后原有症状或体征加重或出现新的症状与体征考虑为短期内脊髓损伤加重。结果 87例患者中17例（19.5%）存在脊髓隐匿性压迫,其中2例在前屈位MRI检查中发现,15例在后伸位MRI检查中发现。DMRI检查后73例患者无明显不适,出现颈肩部不适5例,轻度头晕4例,呼吸不畅、轻度胸闷3例,恶心2例,DMRI检查后VAS评分无下降。85例患者无脊髓神经损伤加重,2例脊髓钳夹伴MRI T2加权像高信号改变患者检查后症状、体征加重。结论 颈椎DMRI是一种相对安全的补充检查,19.5%（17/87）的CSM患者在屈、伸位MRI检查中可发现脊髓隐匿压迫,脊髓钳夹损伤伴MRI T2加权像高信号改变的CSM患者应慎行DMRI检查。     

变频式桡动脉穿刺示教器在急诊护理教学中的应用

目的探讨提升急诊科进修护士桡动脉穿刺技术水平的有效方法。方法将64名进修护士按照入科时间分为对照组34名,实验组33名。在统一理论教学后,对照组采用互动方式互相触摸桡动脉并讲解穿刺方法。实验组采用变频式桡动脉穿刺示教器进行穿刺练习。结果实验组进修护士动脉穿刺成功率显著高于对照组,穿刺并发症发生率及患者疼痛程度显著低于对照组(P0.05,P0.01)。结论采用变频式桡动脉穿刺示教器进行教学,可使进修护士多次进行模拟穿刺练习,提高其桡动脉穿刺水平。     

经皮椎间孔入路内镜下减压治疗老年腰椎侧隐窝狭窄症

目的 :探讨经皮椎间孔入路内镜下减压治疗老年腰椎侧隐窝狭窄症的手术策略、安全性及有效性。方法:2012年1月~2014年6月,采用经皮椎间孔入路内镜下减压治疗27例单节段老年腰椎侧隐窝狭窄症患者,其中男19例、女8例,平均年龄78.9±8.5岁(70~93岁)。均采用经皮椎间孔入路内镜下对侧隐窝进行减压及椎间孔成形治疗,术后第2天复查腰椎CT评估椎间孔成形及侧隐窝减压的情况。记录术前、术后1个月、术后3个月、术后6个月、术后12个月五个时间点的腿痛视觉模拟评分(visual analogue scale,VAS)及Oswsetry功能障碍指数(Oswestry disability index,ODI),统计分析比较术前及术后各时间点的差异。采用改良Mac Nab评价疗效。结果:本组中25例患者顺利完成手术,1例无法耐受疼痛转为开放手术,另1例有心肌缺血表现放弃手术。手术时间50~110min,平均75±28min。术后第2天复查CT显示椎间孔扩大明显,侧隐窝减压充分。24例患者获得随访,随访时间29±16个月(12~44个月),腿痛VAS评分术前为8.52±1.11,术后1个月为1.80±0.63,术后3个月为1.33±0.89,术后6个月为1.05±0.69,术后12个月为0.71±0.50;ODI术前为59.43±10.04,术后1个月为29.42±10.33,术后3个月为20.13±8.18,术后6个月为13.98±6.16,术后12个月为9.86±5.03。术后四个时间点随访VAS评分及ODI指数均较术前改善(P0.01)。改良Mac Nab疗效为优18例,良3例,可3例,优良率为87.5%。1例患者术后出现下肢感觉麻木,予以保守治疗,术后2周时恢复,无永久性神经损伤、感染等手术并发症发生。结论:经皮椎间孔入路内镜下减压术在确保良好侧隐窝减压的同时能够明显减少手术创伤,且能够在局麻下进行,对患者的全身影响小,是治疗老年腰椎侧隐窝狭窄症患者安全、有效、微创的手术方法。     

A review of the pelvic organ prolapse quantification system in China

Introduction and hypothesis

Unified staging systems for pelvic organ prolapse (POP) have been established. We examined the application of the POP quantification (POP-Q) system in China by examining its use in scientific journal articles.

Methods

Relevant articles were identified by searching the Sinomed database using the terms: uterus prolapse, cystocele, proctocele, prolapse, and pelvic floor; limited to Chinese core journals in obstetrics and gynecology, from January 2004 to December 2014. We analyzed systems for grading POP severity and the adoption of POP-Q in different article categories and hospitals of different levels. For the last decade, with two 5-year groups (2005–2009; 2010–2014), the χ² test was used to evaluate inter-group differences.

Results

In a total of 429 articles, 331 included a staging system, 70.7% of which used POP-Q. The POP-Q system first appeared in 2004 in China, was reported in 50% of articles in 2007, and its highest use occurred in 2012 (89.5%). In 234 POP-Q system-utilizing reports, operative treatment and basic research accounted for 73.1% and 14.0% respectively. POP-Q usage increased from 2005–2009 to 2010–2014 in surgery-related articles (54.2% vs 85.2%; P = 0.000). The proportion of reports using POP-Q in level I, II, and III hospitals was 20.0%, 35.4%, and 77.8% respectively.

Conclusions

The POP-Q system, first used in 2004 in China, is now the most commonly used grading system, with surgery reports and level III hospitals accounting for the largest proportion of POP-Q applications.

     

Subcutaneous dissection area contributes less to endoscopic thyroidectomy-related invasiveness

Objective

To clarify the contribution of the subcutaneous area during breast approach endoscopic thyroidectomy (BAET), with regard to invasiveness-related outcomes.

Methods

Seventy-two patients were randomly assigned to two groups: standard dissection and limited dissection. Postoperative pain and inflammatory response were compared between groups.

Results

The groups were well matched except for subcutaneous dissection area (137.11 ± 21.10 vs. 83.69 ± 12.10 cm², p < 0.0001). No significant difference was found with regard to VAS score and postoperative inflammatory response.

Conclusion

Our RCT indicated that the subcutaneous area plays a less important role with regard to BAET-related postoperative pain.

     

The comparison of adductor canal block with femoral nerve block following total knee arthroplasty: a systematic review with meta-analysis

Purpose

Although several studies have compared the clinical efficacy of an adductor canal block (ACB) to that of a femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA), disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. The aim of the present study was to compare, in a systematic review and meta-analysis, the clinical efficacy of ACB with that of FNB.

Methods

We systematically searched randomized controlled trials comparing FNB with ACB for analgesia after TKA in Pubmed and the Cochrane Library from inception to April 30th 2015. There was no limitation of publication language. Trial quality was assessed using the modified Jadad scale, and eligible data were pooled for meta-analysis.

Results

Five studies of 348 patients were included. Outcomes showed that patients who received ACB had similar or better recovery of quadriceps strength and mobilization ability than those that underwent FNB. Similar efficacy was found between the two strategies regarding adductor strength, pain scores [at rest (p = 0.86), at or after knee flexion (p = 0.31)], opioid consumption (p = 0.99), opioid-associated adverse effects (p = 0.60), length of hospital stay (p = 0.42), patient satisfaction (p = 0.57), and success rate of blockade (p = 0.20).

Conclusions

The present study suggests that TKA patients who receive ACB can achieve similar or even better recovery of quadriceps strength and mobilization ability than those treated with FNB. Taken as a whole, ACB may be a better analgesia strategy after TKA at present.

     

单纯膝关节镜手术与联合术后放疗治疗弥漫性色素沉着绒毛结节性滑膜炎的临床研究

目的 探讨单纯膝关节镜手术与联合术后放疗治疗膝关节弥漫性色素绒毛结节性滑膜炎(DPVNS)的临床疗效和安全性。方法 武汉市中心医院及北京军区总医院于2009年1月至2014年1月收治的30例膝关节DPVNS患者,平均病程为35.6个月(4~121个月)。按患者治疗意愿分为手术联合术后放射治疗(联合治疗)组16例,单纯手术组14例。联合治疗组行关节镜下滑膜切除联合术后局部放射治疗,总剂量40 Gy,每次2 Gy。所有患者治疗后平均随访时间38.7个月(12~72个月),比较两组术后复发率、KSS临床评分和功能评分。结果 联合治疗组优良率(14/16)明显高于单纯手术组(11/14)(χ²=9.87,P<0.05),且复发率(1/16)明显低于单纯手术组(3/14)(χ²=1.83,P<0.05),治疗后KSS临床评分和功能评分改善明显优于单纯手术组(χ²=15.00、15.78,P<0.05)。放疗的不良反应为白细胞下降、肢体浮肿、皮肤出现色素沉着,联合治疗组患者均能较好地耐受。结论 关节镜术后放疗治疗膝关节DPVNS是一种安全有效的治疗手段,值得临床推广应用。     

注射钆剂后弥散加权成像对乳腺肿瘤诊断的影响

目的：评估1.5 T MRI中乳腺肿瘤患者使用钆对比剂是否对弥散加权成像（DWI）有显著性影响。方法行乳腺MRI检查的女性患者40例（共计44个病灶）,分别测量增强前后DWI图像信噪比（SNR）和对比噪声比（CNR）、病灶增强前后的表观扩散系数（ADC）及指数表观扩散系数（eADC）。结果给药前后DWI图像的SNR及CNR差异无统计学意义。乳腺癌给药前后的ADC值（t=-4.023, P=0.001）及eADC值（t=4.082, P=0.001）差异有统计学意义,良性肿瘤给药前后的ADC值（t=-1.700, P=0.103）及eADC值（t=1.341, P=0.194）差异无统计学意义。结论增强后行DWI是可行的,并且有助于提高其鉴别乳腺良恶性肿瘤的能力。     

A Novel Free-hand Technique of Pedicle Screw Placement in the Lumbar Spine: Accuracy Evaluation and Preliminary Clinical Results

Objective

Pedicle screw implantation is the most common technique to achieve stability during spinal surgeries. Current methods for locating the entry point do not have a quantified criteria and highly rely on the surgeons' experience. Therefore, we aim to propose a quantified pedicle screw placement technique in the lumbar spine and to investigate its accuracy and safety in clinical practice.

Methods

We conducted a retrospective study involving 110 patients who received spinal surgery in our hospital from August 2018 to August 2021. All patients included had herniation of a single lumbar disc and were consistently treated with posterior discectomy, inter-body fusion, and transpedicular internal fixation. For 54 patients in the observation group, the pedicle screws were placed with our technique, which is located at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process. For 56 patients in the control group, pedicle screws were placed according to the traditional crista lambdoidalis method. Comparisons were made in terms of the operation time, blood loss, time for exposure, the accuracy of placement, and postoperative complications. Furthermore, we applied our method to 64 patients with indistinguishable crista lambdoidalis and evaluated the accuracy of screw placement and clinical outcomes according to the visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score.

Results

There was no significant difference in intraoperative bleeding, accuracy of placement, and postoperative complications between our technique and the traditional crista lambdoidalis method (P > 0.05). However, the exposure time before screw placement (12.8 ± 0.3 vs. 17.4 ± 0.3, P = 0.001) and the total surgery time (97.2 ± 1.9 vs 102.3 ± 0.9, P = 0.020) were significantly shortened with our method. Additionally, in cases with indistinguishable crista lambdoidalis, our technique showed satisfying accuracy, with 97.6% screws placed in appropriate trajectory on the first attempt and all screws eventually positioned in the safe zone according to the Gertzbein–Robbins grading. All patients experienced steady improvement after surgery.

Conclusion

Placing pedicle screws at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process is a viable pedicle screw placement method. With this method, we observed a higher success rate and shorter operation time. In addition, this method can be applied in cases with indistinguishable crista lambdoidalis, and have satisfied success rate and clinical outcome.