骨盆前环皮下内固定支架与微创经皮钢板内固定治疗骨盆前环骨折的疗效比较

目的 比较前环皮下内固定支架（INFIX）和微创经皮钢板内固定（MIPPO）治疗骨盆前环骨折的疗效。方法 回顾性分析2016年7月至2020年5月我院收治且符合标准的48例不稳定型骨盆骨折病人的临床资料,其中INFIX组22例,MIPPO组26例。INFIX组,男15例,女7例,年龄为（36.89±11.12）岁（21~58岁）。MIPPO组,男17例,女9例,年龄为（43.70±17.66）岁（21~71岁）。比较两组手术时间、术中出血量、骨折复位质量（Matta标准）、骨折愈合时间、骨折术后功能恢复情况（Majeed评分系统）,并记录并发症。结果 两组均获得随访,随访时间为5~17个月,平均为13个月。INFIX组手术时间[（75.41±15.25） min]低于MIPPO组[（85.62±17.92） min],差异无统计学意义（t=-5.154,P=0.101）;INFIX组术中出血量[（30.27±7.67） mL]明显低于MIPPO组[（111.15±24.30） mL],差异有统计学意义（t=-14.971,P=0.006）;两组负重时间[（16.00±2.06）周vs.（15.94±2.32）周]、Majeed评分[（81.90±7.73）分vs.（83.44±3.54）分]、骨折复位优良率[81.8% vs.84.6%]比较,差异均无统计学意义（P均＞0.05）,但MIPPO组能够达到更好的解剖复位。INFIX组1例病人出现股外侧皮神经损伤,两组病人未出现内固定失败情况。结论 治疗骨盆前环骨折,INFIX具有出血少、手术创伤小等优点,钢板能够达到更好的解剖复位,两组具有相似的术后功能恢复情况。可根据术者经验和病人具体情况选择适宜的固定方式。     

Achieve Closed Reduction of Irreducible,Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique

ObjectiveTo be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS).MethodsA retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post‐surgical reduction quality was evaluated using Matta scoring criteria and patient lower‐extremity functional outcome was evaluated using Majeed functional scoring criteria.ResultsWhen used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post‐surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra‐acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients'' lower‐extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow‐up at an average of 41.6 months postoperatively.ConclusionWith excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS‐assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.     

血清C—反应蛋白测定在女性盆腔包块鉴别诊断中的意义

目的;探讨C－反应蛋白（CRP）测定对女性盆腔包块鉴别诊断的临床价值。方法：分别测定盆腔炎性包块、良恶性肿瘤患者及无盆腔包块正常妇女血清C－反应蛋白。结果：炎性包块组、恶性肿瘤组血清CRP水平极显著地高于良性肿瘤组和正常对照组（P＜0．01）,且炎性包块组血清CRP水平升高的程度远大于恶性肿瘤组（P＜0．01）;而良性肿瘤组血清CRP与正常对照组无显著差异（P＞0．05）,两者均在正常范围。结论：血清CRP极显著升高者,首先应考虑炎性包块;较显著升高者,在排除感染,创伤及其他引起CRP升高者外要考虑盆腔恶性肿瘤的可能;CRP在正常范围者炎性包块的可能性极小。说明血清CRP测定是女性盆腔包块鉴别诊断的有用手段。     

Acute pouchitis and deficiencies of fuel

PURPOSE: Acute pouchitis is a troublesome complication after restorative proctocolectomy. Deficiency of fuel, especially short chain fatty acids (SCFA), produced by anaerobic bacterial fermentation of saccharides, is implicated in ulcerative and diversion colitis. Our hypothesis was that SCFA deficiency occurs in acute pouchitis, and correction of the deficiency is associated with resolution of pouchitis. METHODS: Thirty-two patients were studied, 10 with histologically confirmed acute pouchitis and 22 with healthy pouches. Stool concentrations of SCFA (acetic, propionic, butyric, and valeric acids) were determined by gas-liquid chromatography. Quantitative bacteriologic studies of stool were carried out, and four-quadrant pouch biopsies were assessed by a pathologist who was unaware of the clinical state. Patients with pouchitis were treated for six weeks with metronidazole and given dietary advice to increase their intake of fermentable saccharides. RESULTS: Stool concentrations of SCFA were significantly less in pouchitis patients compared with patients with healthy pouches (340 mol/g (range, 124–492) vs.93 (range, 44–136) P<0.01). No differences in anaerobic or aerobic counts were seen. Resolution of pouchitis was associated with a significant increase in SCFA, but anaerobic counts fell. CONCLUSION: Deficiency of SCFA is implicated in acute pouchitis Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.     

Pelvic floor exercise alone or with vaginal cones for the treatment of mild to moderate stress urinary incontinence in premenopausal women

The authors compared intensive pelvic floor exercise alone (A) with intensive pelvic floor exercise plus vaginal cones (B) in premenopausal women with mild to moderate stress urinary incontinence. Forty-six patients (mean 43±6 years) were randomized into two training groups and treated for 3 months. Pre- and post-therapy urethral pressure profiles at rest and under stress and subjective results were obtained from 29 patients. The subjective improvement rate of the compliant patients after 12 weeks was 85% in group A and 84% in group B. When the dropouts (9 in group A and 8 in group B) were included in the subjective results an overall improvement rate of 48% in group A and 52% in group B was obtained. In group A one pressure transmission ratio (PTR) improved significantly at 6 weeks and the position of maximum urethral closure pressure was shifted proximally at 12 weeks. In group B one PTR in the midurethra was improved significantly at 6 weeks. The other urodynamic parameters were unchanged. There were no differences between groups A and B in subjective results or urodynamic findings. These results suggest that intensive pelvic floor exercise with or without vaginal cones improves the symptoms of mild to moderate stress incontinence in about 85% of premenopausal women, but that it has little effect on urodynamic parameters. Vaginal cones provided no additional benefit but may be useful for women for whom closely supervised pelvic floor exercise is not available.Editorial Comment: It is becoming increasingly clear from the literature that pelvic floor muscle exercises are effective in improving continence in many women with straightforward stress incontinence. An appropriate quest continues to determine how the exercises can best be taught and done. This article demonstrates that with frequent supervision, similar continence status is achieved both with and without the use of vaginal cones. It would be interesting to compare outcomes with and without cones in women who saw a health care provider only once for their initial teaching. If cones were found to be more effective in this setting, that would be a great aid to primary care physicians.The authors state that there was no correlation between the cone weight and the degree of improvement of symptoms: however, only 2 of the subjects progressed to the next heaviest cone weight. My understanding of the principles of athletic muscles training is that as one increases the resistance the muscle fibers hypertrophy and strengthen. This is the principle behind building biceps. Body-builders or power-lifters continue to increase the amount of weight (resistance) they lift in order to increase bulk and strength. I wonder if this same principle is the reason for the differences in results between this study and the one by Peattie et al. quoted by the authors. My major concern is that people begin to devalue the amount of effort required to perform effective pelvic floor exercises and make assumptions that such exercises are not as good as a permanent surgical cure. I believe that we have not yet begun to develop really effective muscle strengthening regimens for the pelvic floor, and attitudes such as the above will only serve to inhibit our progress.     

Preliminary evaluation of pelvic vascular bed isolation chemotherapy in the treatment of advanced cervical carcinoma

ＰｒｅｌｉｍｉｎａｒｙｅｖａｌｕａｔｉｏｎｏｆｐｅｌｖｉｃｖａｓｃｕｌａｒｂｅｄｉｓｏｌａｔｉｏｎｃｈｅｍｏｔｈｅｒａｐｙｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆａｄｖａｎｃｅｄｃｅｒｖｉｃａｌｃａｒｃｉｎｏｍａＪｉａｎｇＳｅｎａｎｄＰｏｓｔｇｒａｄｕａｔｅ...     

盆腔囊性肿块超声手术对比及与中医辨证分型关系

本文对８３例患者盆腔囊性肿块超声诊断结果与手术及病理检查进行对比,提高了超声诊断的准确性。同时结合中医辨证分型拟找寻出中医分型与超声诊断的内在联系,以提高中医诊疗水平     

盆腔手术前后血清电解质变化的动态观察

为了解盆腔手术前后血清电解质变化及其规律,于盆腔手术前２４－４８ｈ及术后４８－７２ｈ分别抽取静脉血,用离子选择电极法测定血清钾,钠,氯的水平,用全自动生化分析仪检测血浆钙离子浓度。     

Interobserver variation in the assessment of pelvic organ prolapse

The aim of this study was to determine the interobserver agreement of two grading systems for pelvic organ prolapse: the vaginal profile and the International Continence Society (ICS) draft proposal. Forty-nine consecutive women referred for evaluation of urinary incontinence and/or pelvic organ prolapse were studied. Patients were first examined by a physician and a nurse clinician using the vaginal profile, followed by an examination according to the technique described in the ICS draft proposal for standardization of terminology (1994). statistic and Pearson's correlation coefficient were used to determine interobserver variability for the ICS system by overall stage, by stage-specific comparison, and by specific anatomic location. The vaginal profile was evaluated by obtaining a for overall degree of prolapse, stage-specific comparison and by anatomic area. The for the ICS stage was 0.79 (P<0.001), and the for the vaginal profile by area of greatest prolapse was 0.68 (P<0.001), indicating substantial interobserver agreement for both systems. The ICS system was noted to have substantial interobserver agreement by a stage-specific comparison. All anatomic locations of the ICS staging system were found to correlate significantly, and a high degree of interobserver precision was found. The vaginal profile also showed significant interobserver agreement by overall degree of prolapse, by specific degree of prolapse, and by anatomic area. It was concluded that both the proposed ICS staging system and the traditional vaginal profile show significant interobserver agreement both by overall stage, stage-specific analysis and specific location. The registered nurse examination correlated well with the physican examination, indicating that the most important factor in obtaining reproducible results may be definition and close attention to examination technique.EDITORIAL COMMENT: There has recently been a great deal of interest in the anatomy and physiology of the pelvic floor and the various investigative techniques to define its function. The lack of a standardized and reproducible system to describe pelvic organ prolapse through the hiatus of the pelvic floor has hampered research into its pathophysiology and treatment. The authors applied a validated statistic and Pearson's correlation coefficient to convincingly measure interobserver reliability for the ICS system and indicated an index of trend between points on the ICS scale as well.     

Dynamic assessment of pelvic floor function in women using the intravaginal device test

The aim of the study was to assess pelvic floor function and dysfunction using intravaginal devices (IVD test). One hundred and eighty-five patients were evaluated, 65 (35.1%) in the control group without genital prolapse and 120 (64.9%) in the study group, with prolapse. Anatomic changes were evaluated on a scale described by Halban, and functional classification based on palpation of the muscles of the pelvic floor during contraction. Additionally, weighted vaginal devices were used to assess pelvic floor function. Statistic analysis was performed with the Spearman-Pearson correlation coefficient, the ² test and the response/ operator characteristic curve. There was an acceptable correlation between the IVD test and the functional classification of 0.75. Using this classification, the IVD test showed 86.58% sensitivity, 75.72% specificity, and had a positive predictive value 73.95% and a negative predictive value of 87.64%. Significant differences between pelvic floor muscle activity in those patients with and without genital prolapse were observed (X²=58.28, P=<0.005). It was concluded that pelvic floor assessment can be done through the evaluation of active muscle strength or pelvic floor integrity using the functional classification and the IVD test.EDITORIAL COMMENT: In 1988, Peattie and Plevnick introduced the use of weighted vaginal cones to exercise the pelvic floor muscles and treat stress urinary incontinence [1]. Contreras-Ortiz and Nuñez build on this earlier work, using a similar technique to assess pelvic floor muscle function and integrity. Specifically, pelvic floor function is assessed by a combination of digital palpation of the pubococcygeus muscle at rest and during contraction; pelvic floor integrity is assessed by the patient's ability to retain a weighted cone vaginally for 1 minute. Scoring of these two parameters can then be objectively followed for therapeutic response to treatment for urinary incontinence or pelvic relaxation. Many of us forget to palpate the pubococcygeus muscle at rest and during an elicited contraction during baseline or follow-up examination. As this study indicates, simple assessment of pelvic floor function and integrity is possible, and should be used both clinically and in research.