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51.
目的 :探讨激素替代治疗对绝经后Ⅱ型糖尿病和高血压患者肾脏微血管病变的影响。方法 :36例患有Ⅱ型糖尿病和高血压的绝经后妇女随机分为治疗组和安慰剂组各 18例 ,采用双盲法予口服克龄蒙或安慰剂 1片 /日 ,共 4 5个周期 ,测量用药前后各参数值并进行比较及线性相关分析。结果 :治疗组用药前后 2 4小时尿蛋白定量由 ( 0 4 45± 0 0 36 )g降到 ( 0 36 1± 0 0 32 ) g(P <0 0 1) ,内生肌酐清除率由 ( 92 0± 5 2 )ml/min增到 ( 99 1± 4 8)ml/min (P <0 0 5) ,空腹血糖由 ( 7 0 2± 0 4 3)mmol/L降到 ( 6 55± 0 31)mmol/L(P <0 0 5) ,血清总胆固醇由 ( 6 6 6±0 2 8)mmol/L降到 ( 5 71± 0 71)mmol/L(P <0 0 1) ,血压无明显改变。 2 4小时尿蛋白定量和内生肌酐清除率与其他参数间无显著相关性。安慰剂组用药前后各项指标无明显改变。结论 :激素替代治疗对绝经后Ⅱ型糖尿病和高血压患者肾脏微血管病变有改善作用 相似文献
52.
目的 研究膝关节肿瘤保肢手术两种假体置换的术后效果及其比较.方法 随访我院1999年6月2006年3月治疗的72例膝关节肿瘤患者,失访9例,余63例中40例采用单纯铰链型假体置换(A组),23例采用旋转铰链型假体置换(B组)63例随访时间9月~8年平均3年9个月,按MSTS膝关节评分标准、ambulation scores、关节屈伸度及感染、复发、手术时间进行评估。结果:A组:手术时间2.6625±0.3362h,复发5例,转移死亡3例,感染2例; B组:手术时间2.5722±0.2878h,复发3例,转移死亡2例,感染2例 。B组1例术后发生旋转轴聚乙烯轴套断裂关节脱位,再次手术更换轴套后未再出现并发症,两组无假体松动病例。两组手术时间无统计学意义;去除复发及转移死亡病例后,剩50例, A组32例, MSTS评分平均23.0/30分。 B组18例,MSTS评分平均23.7/30分。两组MSTS评分p>0.05,无统计学意义;ambulation scores各分项总分均p<0.05,有统计学意义.两组关节伸直时为0°或接近0°,屈曲度A组119.3750±17.49°,B组125.0000±15.34°,无统计学意义(p>0.05)。结论: 1. 按ambulation scores标准,在步行舒适度和快速步行方面,旋转型铰链假体置换组与单纯铰链型假体置换比较有统计学意义;2.而MSTS标准则未能体现出两组术后功能方面的统计学意义,因此ambulation scores较MSTS评分更灵敏,更适合对膝关节保肢术后功能评价;3.两组在手术时间、术后临床屈伸功能及并发症方面,如复发、感染,未见显著差别,单纯铰链型不会出现脱位,而可旋转铰链型假体有脱位的可能。 相似文献
53.
54.
We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically. 相似文献
55.
George W. Boghdady Mohammed Shalaby 《Strategies in trauma and limb reconstruction (Online)》2007,2(2):83-89
Forty elderly patients with basicervical and pertrochanteric fractures were managed with uniplanar AO external fixator under regional anaesthetic block of the femoral nerve and lateral cutaneous nerve of the thigh from April 2003 to March 2006. The mean age of the patients was 67.9 ± 5.5 years. External fixator application was performed under radiological control after closed reduction had been obtained. Comorbid factors, duration of surgery, duration of hospitalisation, complications, walking ability, time to union and mortality rate were recorded. Patients were followed up for a mean period of 12 ± 4.5 months. Superficial pin tract infection occurred in 13 patients, healing in varus >10° and with shortening >2 cm occurred in six patients, and one patient suffered a spontaneous ipsilateral femoral neck fracture after removal of the fixator. The mean time for union was 10.4 ± 1.2 weeks. Rapid union rate and minor complications obtained in the present study are comparable to those obtained with standard internal fixation techniques. Minimal intraoperative blood loss, short operative time and early patient mobilisation are advantages signifying uniplanar external fixator application under regional anaesthetic block to be a viable option in treatment of basicervical and pertrochanteric fractures in high-risk elderly patients. 相似文献
56.
57.
Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine
U. Vieweg 《Journal of orthopaedics and traumatology》2007,8(2):64-70
A prospective longitudinal study was performed to evaluate the vertebral body replacement system Synex associated with posterior
fixation in unstable burst fractures of the lumbar and thoracic spine. Within 24 months, we treated 28 patients (average age,
41 years; range, 22–64 years; 14 women, 14 men) with acute unstable burst fractures without osteoporosis of the thoracolumbar
region (n=16) and the thoracic (n=3) as well as the lumbar (n=9) spine in two stages (primary dorsal transpedicular stabilization and secondary vertebral body replacement). The complications
were analyzed and the postoperative follow-up result was evaluated regarding stability, bone fusion, correction loss, pain
and neurological status. One patient showed a transient irritation of the lumbosacral plexus and one patient had a superficial
wound infection (complication rate, 7.1%). At the follow-up examination (mean follow-up, 13 months) only in two cases a minimal
loss of correction (<5°) was measured. Radiologically, 27 patients showed secure bone fusions and all patients had stability
of the osteosynthesis. Most of the patients stated no or just slight pain at follow-up. Only two patients with pain to a medium
degree had to take painkillers. The vertebral body replacement system Synex seems to be a good alternative for vertebral body
replacement in unstable burst fractures of the thoracic and lumbar spine since at present follow-up it shows a high rate of
bone fusion and minimal loss of correction. 相似文献
58.
F. Specchiulli R. Gabrieli D. Borsetti V. Di Carlo 《Journal of orthopaedics and traumatology》2007,8(3):123-127
We examined the clinical and radiographic results of 93 patients affected by knee arthritis or osteonecrosis subjected to
unilateral cementless mobile-bearing total knee arthroplasty with the LCS prothesis (Depuy/Johnson & Johnson). The mean follow-up
was 9.5 years (range, 7–12 years). Clinical evaluation was performed using the Knee Society rating system, while radiographic
evaluation was done according to the Knee Society roentgenographic system. At the latest follow-up, the mean knee score was
87 points: the functional score improved from 40 to 90. Radiolucent lines were small and not progressive. The implant survival
at 12 years was 88%. Six knees (7%) required revision for implant-related problems. We conclude that the mobile-bearing prosthesis
is a successful device even at long-term follow-up. 相似文献
59.
Javier Alegre-López José Cordero-Guevara José L. Alonso-Valdivielso Julia Fernández-Melón 《Osteoporosis international》2005,16(7):729-736
Hip fracture results in excess mortality and functional disability. This study sought to identify predictors of mortality and limited functional ability 1 year after hip fracture. We conducted a 1-year follow-up of a prospective population-based inception cohort of 218 hip fracture patients who had been consecutively admitted and discharged from hospital during the previous year. Mortality was observed to be independently associated with poor mental status (relative risk [RR]=6.96; 95% confidence interval [95% CI], 1.73–28.00), prefracture limited functional ability (RR=4.35; 95% CI, 1.32–14.36), institutionalized disposition at discharge (RR=2.92; 95% CI, 1.02–8.38), and male gender (RR=2.44; 95% CI, 1.01–5.93). Independent predictors of limited functional ability were prefracture functional disability (RR=34.14; 95% CI, 3.13–372.33), poor mental status (RR=9.71; 95% CI, 1.57–59.82), age >80 years (RR=4.03; 95% CI, 1.48–11.00), and female gender (RR=3.57; 95% CI, 0.08–0.98). On discharge, special attention and care should thus be given to all patients displaying any of the above predictive factors. 相似文献
60.
P. Rossi F. Castoldi R. Rossi F. Caranzano M. Baronetti F. Dettoni 《Journal of orthopaedics and traumatology》2007,8(3):157-163
Surgery passes through a continuous evolution, thanks to the introduction of new technologies and techniques. Tissue-sparing
surgery is a concept introduced in the last years to address prosthetic surgery to a more conservative fashion. We discuss
the TSS decalogue with a critical eye, pointing out how traditional surgery is evolving in accordance with TSS statements.
Proceedings of the Consensus Conference “TSS in hip and knee replacement”, Rapallo, Italy, 22–24 June 2006 相似文献