取髂骨植骨术中腰丛及主要分支神经的外科管理

目的 为取髂骨植骨术中腰丛及其主要分支神经的外科管理提供参考.方法 回顾性调查410例接受取髂骨植骨术患者的病历资料,记录取髂骨方式、大小、部位以及有无切断神经、术后神经损伤情况、治疗方法 、效果等,并加以统计分析.采用综合方法 对神经损伤进行诊断.结果 环锯法、常规法、开窗法导致的神经损伤发生率分别为8.0%、23....     

心理咨询技术对自杀未遂病人症状自评的影响

自杀是指故意伤害自己生命的行为。自杀未遂是指有意毁灭自我的行动,但并未导致死亡[1]。有资料显示,自杀病人中每出现一个自杀成功者,就有可能有10例~20例自杀未遂者,而[2]     

磁共振关节内增强扫描在膝关节损伤中的临床研究

目的探索进一步提高膝关节损伤诊断的方法,为临床诊断和治疗提供重要依据。方法对21例（22膝）膝关节损伤患者均先进行普通扫描,扫描完成后,如果关节内有积血、积液时,行关节穿刺,抽出积血、积液,同时向关节内注入增强剂,再进行扫描;无积血、积液患者,行关节穿刺直接注入增强剂。结果所有患者在平扫中均发现有不同程度的关节结构损伤,包括：骨质、半月板、韧带和软骨等。在放出积血、积液并注入关节内增强剂再次增强扫描中,这些损伤被进一步证实,并在损伤的程度和范围上更加明确。有4例患者在平扫中未被发现的软骨病变信号,在关节内增强扫描后发现软骨有裂缝。结论磁共振关节内增强扫描能提高诊断膝关节损伤的灵敏性和特异性,与普通磁共振扫描相比具有明显的优势。     

The effect of intrathecal administration of glial activation inhibitors on dorsal horn BDNF overexpression and hind paw mechanical allodynia in spinal nerve ligated rats

Recent studies have suggested that activated glia in the spinal cord may play a vital role at different times during spinal nerve ligation (SNL)-induced neuropathic pain; therefore, glial activation inhibitors have been used as effective painkillers. Brain-derived neurotrophic factor (BDNF) is also known to be a powerful pain modulator, but it remains unclear how it contributes to the glial activation inhibitor-based treatment. This study revealed the following results: (1) intrathecal administration of minocycline (a microglial activation inhibitor) could prevent mechanical allodynia during the initiation of SNL-induced neuropathic pain, and its action was associated with the elimination of BDNF overexpression in the dorsal horn; (2) the spinal injection of fluorocitrate (an astrocytic activation inhibitor) but not minocycline could reverse mechanical allodynia during the maintenance phase of SNL-induced pain, and its action was also related to a decrease in BDNF overexpression in the dorsal horn; and (3) treatment with TrkB/Fc (a BDNF-sequestering protein) had a similar effect during both the early development and maintenance periods. These results led to the following conclusions: (1) elevated BDNF expression in the dorsal horn was required to develop and maintain neuropathic pain; (2) minocycline could only prevent mechanical allodynia in the early stages, possibly by inhibiting BDNF release from microglia; and (3) fluorocitrate could reverse existing mechanical allodynia, and its action was associated with the inhibition of BDNF upregulation induced by astrocytic activation.     

Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis

Purpose

Laparoscopic herniorrhaphy (LH) has been evolved as a minimally invasive technique for pediatric inguinal hernias (PIHs). Considerable debate exists regarding the benefits of LH over conventional open herniorrhaphy (OH). The aim of this review was to critique the current literature to determine the efficacy of LH.

Methods

Published studies until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LH and OH were included. A systemic review and meta-analysis were performed using the odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables.

Results

Of 138 studies, 3 RCTs and 4 OCSs were eligible for inclusion criteria, comprising 1543 cases of LH and 657 cases of OH. Compared with OH, shorter operative time for bilateral hernias (WMD = −11.14; 95% confidence interval [CI], −20.61 to −1.68; P = .02) and lower rate of metachronic contralateral hernia (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were noted in LH. However, no significant difference was observed between LH and OH in patients' age, sex, affected side, operative time for unilateral hernias, duration of hospital stay, time to resume full activity, recurrence, and complications.

Conclusions

Laparoscopic herniorrhaphy is superior to OH in the repair of bilateral PIH and lower rate of metachronic contralateral hernia, with similar operative time for unilateral hernias, length of hospital stay, recurrence, and complication rates. Because of the publishing bias, a series of RCTs with standard report format and uniform unit are necessary to explore the efficiencies of LH in the management of PIH.