婴儿骨性纤维结构不良的影像表现

目的探讨婴儿骨性纤维结构不良（OFD）的影像学表现,为提高临床对婴儿OFD的诊断水平,为避免临床治疗失误及降低该病变复发率提供客观依据。方法回顾性分析自2009年1月至2013年9月经病理证实的3例OFD患者影像学检查图像,其中男性2例,女性1例,月龄1-5月,平均3月。3例患者均行X线检查,其中2例做行CT检查。结果 X线片显示3例患者病变均累及胫骨前缘,表现为胫骨局部膨大、胫骨弯曲变形及病变区骨皮质变薄,与正常骨组织分界清楚,其中1例合并病理性骨折。结论婴儿OFD有典型影像学表现,X线对婴儿骨性纤维结构不良的临床诊断有较强的指导价值。     

Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study.

BACKGROUND CONTEXT: In patients with spinal osteoporosis, the early achievement and maintenance of a biological bond between the pedicle screw and bone is important to avoid screw loosening complications. There are few reports of in vivo investigations involving biomechanical and histological evaluations in the osteoporotic spine. PURPOSE: To evaluate the effect of hydroxyapatite (HA)-coating on the pedicle screw in the osteoporotic lumbar spine and to investigate the relationship between resistance against the screw pull-out force and bone mineral density (BMD) of the vertebral body. STUDY DESIGN/SETTING: Mechanical and pathological investigations in the lumbar spine. METHODS: Two 24-month-old female beagle dogs were fed a calcium-free dog chow for 6 months after ovariectomy (OVX). BMD (in g/cm2) was measured by dual energy X-ray absorptiometry at pre-OVX and 6 months after OVX. Pedicle screws were placed from L1 to L6 at 6 months after OVX. Twenty-four pure titanium cortical screws (Synthes, #401-114) were used as pedicle screws (Ti-PS). Of these, 12 screws had HA-coating (HA-PS). The HA-PS screws were inserted into the right pedicles and the Ti-PS were inserted into the left pedicles. Ten days after this procedure, the lumbar spines were removed en bloc for screw pull-out testing and histological evaluation. RESULTS: The mean BMD value of the lumbar vertebrae 6 months after the OVX was 0.549+/-0.087 g/cm2, which was significantly less than the pre-OVX mean BMD of 0.603+/-0.092 g/cm2 (p < 0.001). The mean resistance against the pull-out force for the HA-PS was significantly greater at 165.6+/-26.5N than in the Ti-PS (103.1+/-30.2N, p < .001). The histological sections in the HA-PS clearly revealed new bone bonding with the apatite coating but only fibrous tissue bonding in the Ti-PS. CONCLUSIONS: The results of this study showed that the resistance to the pull-out force of HA-PS is 1.6 times that of Ti-PS. Furthermore, HA-PS has superior biological bonding to the surrounding bone, as early as 10 days after surgery in this osteoporotic spine model. Thus, in patients with osteoporosis, coating of the pedicle screw with HA may provide better stability and bonding between the pedicle screw and bone in the early postoperative period.     

Variations in the distance between the cricoid cartilage and targets of stellate ganglion block in neutral and extended supine positions: an ultrasonographic evaluation

Purpose

Anatomic variations complicate surface landmark-guided needle placement, thereby increasing nerve blockade failure rate. However, little is understood about how anatomic distances change under different clinical conditions. As the cricoid cartilage is an easy and accurate landmark, we investigated changes in distance between the sixth or seventh cervical transverse processes (C6TP or C7TP) and the cricoid cartilage in neutral and extended supine positions.

Methods

Forty-two patients (16 men, 26 women) were included in this study. Distances between the cricoid cartilage and C6TP/C7TP were measured using ultrasonography with the patient in neutral and extended supine positions.

Results

C6TP and C7TP were caudally located at 6.0 ± 8.1 and 15.1 ± 7.2 mm, respectively, from the cricoid cartilage in the neutral supine position, and at 15.2 ± 8.0 and 25.3 ± 8.0 mm, respectively, in the extended supine position. In the extended supine position, the cricoid cartilage was more cephalad than C6TP and C7TP in all patients. The distance from the cricoid cartilage to C6TP was 12.1 ± 7.6 mm in men and 17.2 ± 7.7 mm in women.

Conclusion

C6TP and C7TP are located approximately 15 and 25 mm, respectively, caudal to the cricoid cartilage in the extended supine position. Our results highlight the fact that there can be significant anatomic variation between the extended and neutral supine positions used in stellate ganglion block, which should be kept in mind when devising easily identifiable and palpable surface landmarks.

     

Predictors of Excess Weight Loss in Obese Patients After Gastric Bypass: a 60-Month Follow-up

Background

The objective of this study was to analyze the factors associated with change in body mass index (BMI) and with percentage of excess weight loss (%EWL) in patients undergoing Roux-en-Y gastric bypass (RYGB). The following factors were analyzed: sex, age, surgical access (laparotomy vs. laparoscopy), preoperative BMI, waist circumference (WC), type 2 diabetes mellitus (T2DM), high blood pressure, and dyslipidemia.

Methods

Retrospective cohort study using a convenience sample of 2070 patients of both sexes, aged 18 to 65 years, undergoing RYGB between 2000 and 2013. The outcomes of interest were BMI and %EWL at 0, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after RYGB.

Results

After 36, 48, and 60 months, approximately 50 % of patients had BMI >30 kg/m². As for %EWL, 60-month results were poor for 17 % of patients (%EWL <50 %), good for 40 % of patients (%EWL 50–75 %), very good for 24 % of patients (%EWL from >75–90 %), and excellent for 19 % of patients (%EWL >90 %). The four most significant predictors of BMI change 60 months after RYGB (in descending order of magnitude) were preoperative BMI, preoperative WC, surgical access, and age; and of %EWL, surgical access, preoperative BMI, preoperative WC, and age.

Conclusions

After 60 months of follow-up, the most relevant predictors of weight loss after RYGB were lower preoperative BMI and WC, videolaparoscopy as surgical access, and younger age. Further studies must be carried out to elucidate the impact of these factors on RYGB outcomes.

     

咽旁间隙病变55例的临床诊治分析

目的探讨咽旁间隙病变的临床特征、诊断方法及治疗。方法对我院1994年1月—2013年1月收治的55例咽旁间隙病变患者临床资料进行回顾性分析。结果本组病例咽旁间隙感染14例、原发性肿瘤32例(良性24例、恶性8例)、其他部位肿瘤累及咽旁间隙5例、异物4例;46例行手术治疗,7例行单纯放化疗,2例抗感染药物治疗。结论咽旁间隙病变以原发性良性肿瘤多见,其次为感染、恶性肿瘤,异物少见。     

Differences in activities of the lower extremity muscles with and without heel contact during stair ascent by young women wearing high-heeled shoes

Background  The purpose of this study was to identify any differences in the activity patterns of lower extremity muscles with and without heel contact during stair ascent by women in their twenties wearing high-heeled shoes. Methods  Twenty healthy female subjects wearing high-heeled shoes walked up a step with a height of 20 cm with and without heel contact, during which the activities of the vastus medialis oblique, vastus lateralis, and gastrocnemius were recorded using surface electromyography. Results  During stair ascent the activities of the vastus lateralis and vastus medialis oblique were significantly higher and that of the gastrocnemius significantly lower with high-heel contact than without high-heel contact. Conclusion  We suggest that young women wearing high-heeled shoes should step up with heel contact on the stair surface during stair ascent to activate the quadriceps muscle.     

Open vertebral cement augmentation combined with lumbar decompression for the operative management of thoracolumbar stenosis secondary to osteoporotic burst fractures

Osteoporotic burst fractures with neurologic symptoms are typically treated with neural decompression and multilevel instrumented fusion. These large surgical interventions are challenging because of patients' advanced ages, medical co-morbidities, and poor fixation secondary to osteoporosis. The purpose of this retrospective clinical study was to describe a novel technique for the treatment of osteoporotic burst fractures and symptomatic spinal stenosis via a limited thoracolumbar decompression with open cement augmentation [vertebroplasty (VP) or kyphoplasty (KP)]. Indications for decompression and cement augmentation were intractable pain at the level of a known osteoporotic burst fracture with symptoms of spinal stenosis. As such, 25 patients (mean age, 76.1 years) with low-energy, osteoporotic, thoracolumbar burst fractures (7 males, 18 females; 39 fractures) were included. In all cases, laminectomy of the stenotic level(s) was followed by vertebral cement augmentation (9 VP; 16 KP). When a spondylolisthesis at the decompressed level was present, instrumentation was applied across the listhetic level (n = 9). Clinical outcome (1 = poor to 4 = excellent) was assessed on last clinical follow-up (mean, 44.8 wks). In addition, a modified MacNab's grading criteria was used to objectively assess patient outcomes postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up. The average time from onset of symptoms to intervention was 19 weeks (range, 0.3-94 wks). A mean of 1.6 fractures/patient was augmented (range, 1-3 fractures) and 2.8 levels were decompressed (range, 1-6 levels). No statistical difference in anatomic distribution or number of fractures between the VP and KP groups or in the instrumented versus noninstrumented patients was noted (P > 0.05). An overall subjective outcome score of 3.4 was noted. Twenty of 25 patients were graded as excellent/good according to the modified MacNab's criteria. The choice of augmentation procedure or use of instrumentation did not predict outcome (P = 0.08). Overall, 1.7 degrees of sagittal correction was obtained at final follow-up. One patient was noted to have progressive kyphosis after KP. The use of a limited-posterior decompression and open cement augmentation via VP or KP is a safe treatment option for patients who have osteoporotic burst fractures and who are incapacitated from fracture pain and concomitant stenosis. After thoracolumbar decompression, open VP/KP provides direct visualization of the posterior vertebral body wall, allowing for safe cement augmentation of burst fractures, stabilizing the spine, and obviating the need for extensive spinal reconstruction. Although clinically successful, this technique warrants careful patient selection.     

结直肠良性疾病的选择性肠段切除治疗

目的探讨选择性肠段切除手术治疗结直肠良性疾病的临床疗效。方法根据结肠运输功能试验、结肠腔内测压、电子肠镜、钡剂造影、术中探查和病理检查结果综合分析作出选择性肠段的定位依据,并对57例患者进行了手术。结果选择性肠段切除手术治疗对本文所列述的结直肠良性疾病有较好的效果,达到治愈目的。结论选择性肠段切除对结直肠良性疾病,尤其是结肠慢运输型便秘、脾曲综合征、乙状结肠冗长症的手术治疗具有较好的指导意义。可较好的定位病变肠管,减少切除范围,降低并发症,同时又可避免遗漏病变。     

腹腔镜胆总管探查术中十二指肠镜下乳头切开术53例报告

目的探讨腹腔镜胆总管探查术中十二指肠镜下乳头切开术治疗十二指肠乳头狭窄的手术方法和适应证。方法腹腔镜下行胆囊切除、胆总管切开和胆管镜探查取石术,经胆总管切口插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀或弓式刀在输尿管导管或斑马导丝指引下对乳头施行切开术。结果施行术中十二指肠镜下乳头切开术53例,51例乳头狭窄切开成功,2例中转为其他术式。术后轻症胰腺炎1例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论只要选择合适的病例,腹腔镜胆总管探查术中十二指肠镜下乳头切开术是可行、有效和安全的。     

持续牵引在纠正桡骨远端不稳定骨折中桡骨短缩的作用机制探讨

目的：探讨持续牵引在桡骨远端不稳定骨折治疗中的力学机制。方法：采用复位外固定器治疗30例桡骨远端不稳定骨折,男4例,女26例;年龄18-85岁,平均61岁。按AO分型,其中A3型12例,B2型3例,C1型8例,C2型4例,C3型3例。分别测量患者术前与术后X线上的桡骨茎突与尺骨关节面之间的距离。结果：30例患者获得6-15个月的随访,平均11．2个月。测量X线结果为术前平均（0．55±0．22）cm,术后平均（1．07±0．23）cm,明显高于术前,差异有统计学意义（P〈0．01）。结论：复位外固定器提供的持续牵引其作用机制可以通过筋束骨理论、韧带整复原理及牵拉成骨理论解释。