Long-term outcome for surgically treated cervical spondylotic radiculopathy and myelopathy

Long-term follow-up results were examined to verify the efficacy of anterior osteophytectomy for cervical spondylotic myelopathy and radiculopathy, in particular the outcome for patients with developmentally narrow cervical canals and patients with associated ossification of the posterior longitudinal ligament (OPLL). One hundred thirty-nine patients who had undergone anterior osteophytectomy with interbody fusion between 1976 and 1990 were followed up for 1 to 22.5 years (mean 11.4 years). Overall results evaluated by the neurosurgical cervical spine scale scoring and grading showed significant improvement in both improvement score (2.7 +/- 2.3) and improvement rate (52.3 +/- 45.7%). Lower extremity motor function improved in 66.1% of patients, upper extremity motor function in 82.0%, and sensory/pain function in 70.5%. Improvement ranged from one to three grades. Severely affected patients showed good recovery. Outcome for patients with narrow cervical canals (41 patients, 29.5%) did not differ significantly from that for patients with normal canals (98, 70.5%). Patients with associated OPLL (32 patients, 23.0%) had approximately the same outcomes as those with only spondylosis (107, 77.0%). Fifteen patients (10.8%) underwent reoperation because of myelopathy due to disc degeneration adjacent to the fused level (11 patients) or OPLL (4 patients). Anterior osteophytectomy with interbody fusion can achieve good outcomes in patients with cervical spondylotic myelopathy and radiculopathy, regardless of the size of the spinal canal and association with OPLL.     

锁骨下血管合并臂丛损伤的处理

目的 探讨锁骨下动脉合并臂丛神经损伤的诊断和处理。方法 5例锁骨下动脉损伤合并臂丛损伤，其中锁骨下动脉第一段损伤1例，第三段损伤4例；2例合并动脉瘤，1例动脉瘤加动静脉瘘．2例血管纤维化自行闭塞。根据锁骨下动脉损伤性质，分别采用静脉移植、直接缝合、血管结扎处理，损伤臂丛神经采取直接缝合、神经松解。结果 3例开放性损伤患者早期手术修复动脉和神经，术后伤肢无疼痛，神经功能有不同程度恢复；2例闭合钝器伤晚期患者，1例行血管、神经松解术，仅疼痛减轻，1例血管臂丛神经广泛粘连，神经松解术后无任何恢复。结论 除原发性损伤外，进行性增大的血肿或假性动脉瘤压迫可加重臂丛神经损害．如能早期处理血肿或动脉瘤，解除压迫，可减轻神经损害，有利于臂丛神经功能恢复。     

Clinical significance of leukocyte infiltrative response in deep wound of patients with major burns

OBJECTIVE: To investigate the time course of infiltrated leukocytes and the subpopulations of infiltrated lymphocytes in deep wounds, and their relationship with injury severity in seriously burned patients. METHODS: Six patients with major burns were enrolled in the study. Specimens were taken from deep partial-thickness burn wounds of all patients at 3 days, 1 week, 2 weeks and 3 weeks after burn. The appearance time and cellular components of infiltrated leukocyte zone in the burn wound were evaluated by histological and immunohistochemistry examination with lymphocyte monoclonal antibodies. RESULTS: The infiltrated leukocyte zone of burn wound formed 1-2 weeks after burn. The more severe the degree of injury (including burn area, depth and combined injuries) was, the later the infiltrated leukocyte zone appeared. The infiltrated cells mainly consisted of polymorphonuclear leukocytes (PMN) during the early period after burn while macrophages and lymphocytes appeared later. There were some changes of the T lymphocyte subsets and their activation degree in the burn wound. CONCLUSION: The changes of infiltrated leukocyte zone of wound following burns were closely related to the injury severity, and represented alteration of the anti-infection ability and immune rejection of local wound. These results provide important evidence for appropriate wound treatment and prolonging the survival of skin allograft.     

Association between dysfunction of upper extremity and locomotive syndrome in general population

Objective

This study investigated the relation between self-assessment of upper extremity function and locomotive syndrome in a general population.

基质金属蛋白酶-13在骨性关节炎发病中的活性调控研究

目的 研究一氧化氮(NO)是否通过膜型基质金属蛋白酶-1(MT1-MMP)间接激活基质金属蛋白酶-13酶原(pro-MMP-13).方法 购买并传代人软骨肉瘤细胞(SW1353),用NO供体S-亚硝基-N-乙酰基青霉胺(SNAP),SNAP+NO清除荆氧合血红蛋白(OxyHb)和SNAP+组织金属蛋白酶抑制物-2(TI...     

严重多发伤并发急性肾损伤患者的肾功能监测及血必净注射液的干预作用

目的：对加强医疗病房（Intensive care unit,ICU）内严重多发伤并发急性肾损伤患者的肾功能进行监测并观察血必净的干预作用。方法：采用随南对照研究,将严重多发伤并发急性肾损伤的45例患者分为血必净组和对照组,对照组给予常规综合治疗,血必净组在常规综合治疗基础上加用血必净注射液100ml静脉滴注。2次/d,连用10d。动态观察两组患者的肾功能、炎症反应以及预后等指标变化。结果：与对照组比较,血必净组治疗后第3d、尿量、Uβ2-MG、UNAG差异无统计学意义（P〉0.05）,尿-ALB、血Scr和BUN差异有统计学意义（P〈0.05）,治疗结束后,两组肾功能指标以及中性粒细胞（N）、C-反应蛋白CRP、肿瘤坏死因子-α（TN F-α）、生存率差异有统计学意义（P〈0.05）。结论：血必净注射液具有遏制急性肾损伤患者肾功能的恶化及降低病死率的作用。     

经阴道与经腹子宫肌瘤剔除术的比较

目的探讨经阴道子宫肌瘤剔除术的可行性、安全性及临床疗效.方法对92例子宫肌瘤分别施行经阴道肌瘤剔除术(研究组,n=46)及开腹肌瘤剔除术(对照组,n=46),并对两种术式的临床疗效进行比较.结果经阴道与经腹肌瘤剔除术均获成功.手术时间研究组与对照组比较差异无显著性(t=-0.734, P=0.465);平均术中出血量、术后肛门排气时间、术后疼痛、术后病率、住院日期研究组与对照组比较差异均有显著性.结论经阴道子宫肌瘤剔除术具有创伤小、术中出血少、术后肛门排气早、疼痛轻、术后病率低及住院时间短的优点,是一种安全可行的微创手术方式.但须正确掌握适应证.     

闭孔动脉跨区供血的长型股薄肌肌皮瓣

目的 为解决由股深动脉分支供血的股薄肌肌皮瓣因血管蒂在股薄肌中上1／3处，致使向骨盆会阴带蒂转移时距离受限的问题，探索该肌皮瓣由闭孔起始部为旋转点向骨盆会阴区域转移的方法。方法 根据闭孔动脉-旋股内侧动脉-股深动脉分支之间存在良好吻合支，设计以闭孔动脉跨区供血的长型股薄肌肌皮瓣转移的方法。这种方法可以切断股深动脉分支，使股薄肌肌皮瓣能够更松弛地转移至骨盆、外阴、耻骨、联合、腹股沟等区域。结果修复骨盆会阴区的畸形和缺损9例，所有肌皮瓣均全部成活，经术后3个月至3年的随诊，效果均满意。结论 闭孔动脉跨区供血的长型股薄肌肌皮瓣，可以作为常规的肌皮瓣在临床应用。     

Wedge-Shaped Excision and Modified Vertical Mattress Suture Fully Buried in a Multilayered and Tensioned Wound Closure

Background  A successful deep multilayered wound suture should provide a firm tension-relieving closure, good wound-edge eversion, hemostasis, and minimal intradermal extraneous materials. However, this is not always achieved with a single standard technique. The authors describe their modification of a wound closure method that can rapidly and reliably achieve these results. Methods  A wedge-shaped excision was adopted to obtain a trapezoid pattern transect, after which a modified fully buried vertical mattress suture technique was used to close the wound. These techniques were compared with the standard excision and suture techniques used for the same patient at different times after surgery. Results  The wedge-shaped excision can facilitate good wound-edge eversion, and the modified fully buried vertical mattress suture can provide firm tension relief and optimal apposition. Compared with conventional excision and suture techniques, the described techniques brought about a better outcome in terms of hypertrophic scar prevention. Conclusion  The described modified technique seems to be more efficient than conventional procedures used to prevent hypertrophic scar formation.