腹腔镜下超声刀小儿肾输尿管切除术

目的：探讨腹腔镜下超声刀小儿肾输尿管切除手术的操作特点及疗效。方法：对5例肾发育不全、多房性肾囊性变和重复肾合并输尿管异位开口的病孩，使用微型腹腔镜及超声刀技术施行肾输尿管切除术或部分肾及输尿管切除术。结果：5例手术均获成功。手术耗时105－268分钟，平均152分钟。术中出血不少15ml,术后无继发性出务、无手术合并症。结论：腹腔镜超声刀技术能安全、有效地应用于肾或部分肾输尿管切除术，有利于病孩术后的恢复。     

Patient-specific mechanical properties of a flexible multi-body model of the scoliotic spine

The flexibility of the scoliotic spine is an important biomechanical parameter to take into account in the planning of surgical instrumentation. The objective of the paper was to develop a method to characterisein vivo the mechanical properties of the scoliotic spine using a flexible multi-body model. Vertebrae were represented as rigid bodies, and intervertebral elements were defined at every level using a spherical joint and three torsion springs. The initial mechanical properties of motion segments were defined fromin vitro experimental data reported in the literature. They were adjusted using an optimisation algorithm to reduce the discrepancy between the simulated and the measured Ferguson angles in lateral bending of three spine segments (major or compensatory left thoracic, right thoracic and left lumbar scoliosis curves). The flexural rigidity of the spine segments was defined in three categories (flexible, nominal, rigid) according to the estimated mechanical factors (α). This approach was applied with ten scoliotic patients under-going spinal correction. Personalisation of the model resulted in an increase of the initial flexural rigidity for seven of the ten lumbar segments (1.38≤α≤10.0) and four of the ten right thoracic segments (1.74≤α≤5.18). The adjustment of the mechanical parameters based on the lateral bending tests improved the model's ability to predict the spine shape change described by the Ferguson angles by up to 50%. The largest differences after personalisation were for the left lumbar segments in left bending (4⁰±3⁰). Thein vivo identification of the mechanical properties of the scoliotic spine will improve the ability of biomechanical models adequately to predict the surgical correction, which should help clinicians in the planning of surgical instrumentation manoeuvres.     

鼻内镜手术后筛窦黏膜转归的病理组织形态学观察及临床意义

目的：了解鼻内镜手术后修复各阶段筛窦黏膜的组织学转归情况，探讨术后筛窦黏膜转归过程的组织形态学规律，为完善治疗、提高手术治愈率提供科学的依据。方法：采用Messerklinger术式治疗22例成年慢性鼻窦炎（CS）及慢性鼻窦炎鼻息肉（CSNP）患者，分别在术后恢复的3个阶段进行形态学观察和光镜、电镜检查。结果：（1）术腔清洁阶段术腔分泌物潴留，光镜下上皮缺失、黏膜缺损，水肿，炎性细胞浸润，黏膜下出血；（2）黏膜转归竞争阶段可有囊泡、小息肉和肉芽生长，光镜下上皮细胞增生，部分杯状细胞增生，黏膜下腺体增生或减少；（3）上皮化完成阶段见术腔清洁，镜下大部分黏膜基本恢复正常，部分固有层为致密结缔组织取代，可见不典型腺体。结论：鼻内镜术后筛窦黏膜可以再生，鼻内镜术中、术后筛窦黏膜的正确保护和处理对黏膜再生修复有重要作用。     

伴颈5/6椎间孔狭窄神经根型颈椎病影像学特点及临床意义

目的 观测伴C5/C6椎间孔狭窄神经根型颈椎病患者的颈椎间孔形态及三维空间下的各相关径值,分析并探讨其临床意义。方法 随机选取492例伴C5/C6椎间孔狭窄,在上海长征医院于2014年9月至2019年7月期间行手术治疗的神经根型颈椎病患者,行颈椎正侧位X线、颈椎CT、颈椎磁共振等检查,数字骨科系统重建后观测椎间孔形态并测量最佳投射角度下的纵径、上前后径、下前后径、横截面积、椎间隙高度等径值并对其进行统计学处理,比较病例组与正常成人组C5/C6椎间孔之间、病例组病变椎间孔与对侧椎间孔以及病例组中男女患者之间的差异。结果 病例组C5/C6椎间孔形态因骨赘增生等,以纺锤形、不规则形为主,病例组C5/C6椎间孔横径均值、纵径、横截面积、椎间隙平均高度分别为（5.81±1.40）mm、（10.45±1.70）mm、（50.02±15.46）mm2、（4.99±0.89）mm,均比正常成人组减小,且差异有统计学意义（P<0.01）;男女间比较差异无统计学意义（P>0.05）。结论 伴C5/C6椎间孔狭窄神经根型颈椎病患者的颈椎间孔的形态发生改变,导致椎间孔的横径均值及横截面积值均明显减小;椎间孔的横径在诊断颈椎间孔狭窄方面敏感性及特异性高;术中减压时应更加注重椎间孔横径的有效扩大,以提高手术效果。     

基于ERAS理念的HAPA模型健康教育在肝切除术中的应用效果

目的 探讨基于加速康复外科（ERAS）理念的健康行动过程取向（HAPA）模型健康教育在肝切除术中的应用效果。方法 选取2020年1月至2022年6月在湖北省荆州市第一人民医院行肝切除术的患者90例,按照随机数字表法,分为干预组和对照组,每组45例。对照组给予常规健康教育,干预组给予基于ERAS理念的HAPA模型健康教育,比较两组患者术后身体体征恢复情况、自我效能感、健康行为、自我管理能力差异。结果 干预组患者首次活动时间为（23.87±4.32）min、首次进食时间为（9.87±2.67）h、首次通气时间为（45.28±4.32）min、引流管拔管时间为（22.45±4.25）h、住院时间为（10.53±2.85）d,均短于对照组,差异均有统计学意义（P<0.05）;干预后,干预组患者自我效能感量表、健康促进生活方式量表Ⅱ、成年人健康自我管理能力测评量表评分均高于对照组,且干预前后各指标差值比较,差异均有统计学意义（P<0.05）。结论 肝切除术患者采用基于ERAS理念的HAPA模型健康教育干预,能够提高术后身体体征恢复效率,改善患者自我效能感、健康行为及自我管理能力。     

3D打印导板辅助上颈椎椎弓根置钉与徒手置钉的比较

目的 比较个体化3D打印导板辅助上颈椎椎弓根置钉与徒手置钉的精准性。方法 选择2019年6月至2022年6月在蚌埠医学院第二附属医院就诊的上颈椎疾患患者20例,获取每位患者颈椎三维CT数据,根据置钉方式不同分为导板组和对照组,分别制作20例等比例3D打印上颈椎模型,导板组使用3D打印导板辅助上颈椎模型椎弓根螺钉置入,对照组在透视辅助下徒手置钉。根据椎体是否存在骨折,将导板组内20例模型分为钉道损伤组10例（寰椎骨折与枢椎骨折病例）和钉道完整组10例（畸形与关节脱位病例）。比较导板组和对照组螺钉可接受率、单枚螺钉置入时间差异;比较导板组术前理想钉道与术后实际钉道内倾角差异,对比钉道损伤组和钉道完整组置钉结果差异。结果 导板组螺钉可接受率为93.55%,高于对照组的79.03%(P<0.05);导板组单枚螺钉置入时间短于对照组（P<0.05）;导板组术前理想螺钉内倾角与术后实际螺钉内倾角之间差异无统计学意义（P>0.05）;钉道损伤组螺钉突破椎弓根率26.7%高于钉道完整组3.1%(P<0.05)。结论 个体化3D打印导板辅助上颈椎椎弓根置钉在置钉精准度、安全性和置...     

New technique for posterior intra-articular arthrodesis using a single-block graft in cases of atlantoaxial instability

A new method of posterior C1-2 arthrodesis, derived from the W. V. Cone and G. Bertrand, technique (Montreal, 1970) is described with two modifications: (1) the exact measurements of the ideal graft are determined preoperatively, using CT and a sterilized pasteboard horseshoe-shaped model; (2) in the sitting postion, single occipital block graft was cut out microsurgically, using the preoperative model. After decortication of the graft, posterior arches of C1 and 2, and microsurgical excision of the cartilage of the C1-2 lateral joints, the graft was imbedded into the entire C1-2 space, fixed, and tightened using a braid of nylacap yarn. A case report of rotatory luxation and associated atlantoaxial instability in a 10-year-old girl illustrates the excellent functional results of this technique.Presented at the XVII Annual Meeting of the International Society for Pediatric Neurosurgery, Bombay 1989     

Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation

Summary Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6–132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a last resort.     

Impaired renal function due to raised intraabdominal pressure

A 19-year-old male developed renal failure after a laparotomy for liver trauma (urinary output of 30 ml/h, plasma creatinine 220 mol/l). Surgical decompression of the abdomen was performed without any attempt at correcting the underlying pathology. This reduced the intraabdominal pressure (IAP) from 40 to 24 cm H₂O and resulted in a massive diuresis (530 ml/h). Twenty-four hours later the plasma creatinine peaked at 280 mol/l and then returned to within the normal range. This case report confirms that there is a direct relationship between IAP and renal function.     

Fusarium endocarditis involving aortic valve following coronary artery surgery

This article describes a case of infective aortic valve endocarditisdue to Fusarium oxysporum occurring 4 years after coronary arterybypass grafting. It is the first reported case of endocarditiscaused by Fusarium.