椎间孔镜术后引流管的临床应用初步研究

目的:探究经皮椎间孔镜腰椎间盘切除(percutaneous endoscopic lumbar discectomy,PELD)术后放置引流管的临床意义及相关因素.方法:回顾性分析2019年1月至2019年9月接受PELD手术治疗的151例腰椎间盘突出症患者的临床资料,依据术后是否放置引流管,分为放置引流管组与未放置...     

Microcapsule-gel formulation of promethazine HCl for controlled nasal delivery: A motion sickness medication

The current method of choice for astronauts to treat space motion sickness is an intra-muscular injection of promethazine hydrochloride (PMZ HCl) which is invasive and causes considerable local irritation and discomfort at the site of injection. Intra-nasal delivery is considered a feasible alternative route for administration of medications to treat space motion sickness. The purpose of this research is to develop a PMZ HCl formulation that can be administered intra-nasally without irritation (i.e. leukocyte infiltration) in the nasal epithelium when dosed at PMZ HCl concentrations greater than the cytotoxic limit. The biocompatibility of PMZ HCl was tested in vitro and was shown to be cytotoxic at concentrations greater than 10^?5 molar regardless of pH. A controlled-release microencapsulated dosage formulation was developed using spinning disk atomization and release rates for the PMZ HCl microcapsules were determined in phosphate buffered saline. An animal study was conducted to determine the irritation response of rat nasal mucosa when dosed with encapsulated and non-encapsulated PMZ HCl.     

自拟“强筋健骨汤”治疗腰椎间盘突出症的临床疗效观察

目的：评价自拟“强筋健骨汤”治疗腰椎间盘突出症的疗效。方法本试验选择60例腰椎间盘突出症患者,分为观察组和对照组各30例,治疗4周通过有效率、疼痛评分来评价“强筋健骨汤”治疗腰椎间盘突出症的临床疗效。结果经过4周治疗后观察组VAS疼痛评分明显下降,与治疗前比较差异有统计学意义（P均＜0.01）,且与对照组相比,疼痛评分的差异有统计学意义（P＜0.05）,观察组总有效率为96.7%（29/30）,对照组总有效率为77.0%（23/30）,（P＜0.05）。结论自拟“强筋健骨汤”能有效治疗腰椎间盘突出症。     

经皮内镜椎板间入路微创治疗游离脱垂型L5～S1椎间盘突出症

目的：探讨经皮内镜椎板间入路微创治疗游离脱垂型L5～S1椎间盘突出症的手术技巧及临床疗效。方法2010年1月至2012年6月,我科采用经皮内镜椎板间入路椎间盘切除术（percutaneousendoscopicinterlaminardiscectomy,PEID）微创治疗游离脱垂型L5～S1椎间盘突出症94例。其中男53例,女41例,年龄13～56（平均29.69）岁。采用疼痛视觉模拟评分（visualanaloguescale,VAS）、Oswestry功能障碍指数（oswestrydisabilityindex,ODI）、改良MacNab评价临床疗效。结果平均随访26.5（12～37）个月。平均手术时间（66.4±8.4）min。每台手术术中平均透视时间（0.5±0.2）s。所有患者术后腰腿痛、感觉肌力减退均有不同程度的缓解。术前、术后1天、术后1、3、6、12个月腰痛VAS评分分别为：（5.40±1.12）分,（3.36±0.96）分,（1.86±0.99）分,（1.18±0.83）分,（0.78±0.62）分,（0.58±0.64）分;腿痛VAS评分分别为：（8.40±0.95）分,（2.66±1.53）分,（1.98±1.00）分,（1.20±0.81）分,（0.82±0.66）分,（0.68±0.62）分。术前、术后1、3、6、12个月ODI指数分别为：51.88±8.88,33.22±10.33,23.46±7.47,15.10±5.72,10.38±5.93。术前与术后各时段腰腿痛VAS评分及ODI指数差异有统计学意义（P＜0.01）。末次随访时改良MacNab评价疗效,优良率94.7%。结论经皮内镜椎板间入路椎间盘切除术微创治疗游离脱垂型L5～S1椎间盘突出症具有创伤小、出血少、术中透视少、术后恢复快等优点,其近期疗效确切,远期结果有待进一步随访。     

神经妥乐平治疗腰椎间盘突出症患者疼痛及麻木症状的临床效果研究

目的：观察神经妥乐平治疗腰椎间盘突出症疼痛及麻木症状的疗效。方法门诊纳入影像学及临床表现可确诊为腰椎间盘突出症及视觉模拟评分法（visualanaloguescale,VAS）在5分以上的患者56例,分为甲钴胺组及神经妥乐平＋甲钴胺组。不使用其它药物及按摩针灸等治疗,并要求患者卧床休息。观察两组患者的疼痛及麻木缓解情况。结果服药后第1周及第2周两组间疼痛VAS评分差异有统计学意义,神经妥乐平＋甲钴胺组和甲钴胺组对疼痛缓解的显效率于第2周时分别为：62.5％,8.3％,有效率分别为75.0％,41.6％。两组对麻木症状的缓解差异无统计学意义。结论神经妥乐平联合甲钴胺对腰椎间盘突出症疼痛的缓解优于单独应用甲钴胺,而对于麻木的缓解两组间差异无统计学意义。     

保留棘突双侧潜行扩大开窗减压术联合独活寄生汤加减治疗腰椎问盘突出合并椎管狭窄症76例临床观察

目的观察保留棘突双侧潜行扩大开窗减压术结合中药内服治疗腰椎间盘突出合并椎管狭窄症的临床疗效。方法将151例腰椎间盘突出合并椎管狭窄症患者随机分为2组。对照组75例予保留棘突双侧潜行扩大开窗减压术治疗,治疗组76例在对照组治疗基础上加用独活寄生汤加减治疗。采用日本骨科学会腰背痛手术评分标准（JOY评分）评价术后1个月末手术疗效和并发症发生情况。结果治疗组提高JOY评分幅度、JoY改善率高于对照组（P〈0．01）,且住院时间短于对照组（P〈0．01）。治疗组手术并发症发生率14．47％,对照组手术并发症发生率30．67％,治疗组低于对照组（P〈0．05）。结论保留棘突双侧潜行扩大开窗减压术联合独活寄生汤加减治疗腰椎间盘突出合并椎管狭窄症疗效确切。     

雀啄刺法配合温针治疗颈椎间盘膨出疗效观察

目的观察雀啄刺法配合温针治疗颈椎间盘膨出的临床疗效。方法将105例颈椎间盘膨出患者随机分为治疗组56例和对照组49例。治疗组采用雀啄刺法配合温针治疗,对照组采用常规针刺配合温针治疗。10 d为1个疗程,治疗2个疗程后比较两组临床疗效。结果治疗组总有效率和愈显率分别为100.0%和76.8%,对照组分别为87.8%和57.1%,两组比较差异均具有统计学意义(P0.05)。结论雀啄刺法配合温针是一种治疗颈椎间盘膨出的有效方法。     

Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation

We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o’clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.     

Corneal assessment technologies: Current status

There are now many devices that acquire data about the cornea: shape, power, pachymetry at any desired point of the cornea, corneal hysteresis, flap thickness (in LASIK procedures), endothelial cell count and morphology, and so forth. We review the literature on corneal assessment techniques and devices available in clinical practice. Specifically, we discuss slit lamp biomicroscopy, specular microscopy, ultrasound pachymetry, confocal microscopy, very-high-frequency digital ultrasound biomicroscopy, optical coherence tomography, Placido disk-based keratoscopy, slit-scanning elevation topography, Scheimpflug imaging, and dynamic applanation procedures—all of which can be used to assess the morphology of the cornea. In addition, we present a critical analysis of the instrumentation described and discuss the necessity of developing new technology for assessing both the morphology and the physiology of the cornea.     

2004-2011年甘肃省中医院采用非手术方法治疗的腰椎间盘突出症患者的临床特征分析

目的：分析甘肃省中医院近年来采用非手术方法治疗的腰椎间盘突出症患者的临床特征.方法：调查整理2004-2011年4 880例在甘肃省中医院采用非手术方法治疗的腰椎间盘突出症患者的病历资料,建立资料库,从性别、年龄、病因、突出节段、合并症、职业及医疗付款方式7各方面分析患者的临床特点.结果：①性别.纳入研究的4 880例患者中,男2 548例,女2 332例.②年龄.20岁以下患者38例,21 ～30岁患者332例,31 ～40岁患者996例,41～50岁患者1 392例,51～60岁患者1 152例,61～70岁患者672例,70岁以上患者298例.③病因.有慢性劳损史者1 598例,有明确外伤史者942例,有明确扭伤史者690例,无明显诱因者1 668例.④突出节段.L1～2突出82例,L2～3突出224例,L3～4突出1 194例,L4～5突出3 420例,L5S1突出2 560例;单节段突出2 996例,双节段突出1 182例,三节段突出702例.⑤合并症.合并高血压病684例,糖尿病537例,骨质疏松症402例,胆囊炎270例,膝骨关节炎204例.⑥职业.工人1 202例,农民1 084例,干部894例,学生86例,军人26例,会计38例,文员232例,教师212例,司机94例,其他职业者1 010例.⑦医疗付款方式.社会基本医疗保险2 550例,自费2 030例,商业保险26例,公费医疗26例,大病统筹8例.结论：2004-2011年甘肃省中医院采用非手术治疗的腰椎间盘突出症患者男性多于女性,以20～40岁的青壮年患者为主,慢性劳损、外伤和扭伤是发病的主要原因,突出节段以L4～5和L5S1多见,工人、农民和干部所占比例最高.