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距骨体与距骨颈骨折手术疗效分析 总被引：4，自引：1，他引：4
目的探讨距骨体与距骨颈骨折患者采用切开复位内固定术在治疗和预后上的差异。方法通过对1996年4月～2003年9月间17例SneppenⅡ型距骨体骨折患者与19例HawkinsⅠ、Ⅱ型距骨颈骨折患者均采用切开复位内固定,将Hawkins评分优良率、距骨缺血坏死率、胫距关节创伤性关节炎发生率和距下关节创伤性关节炎发生率进行对比,使用χ2检验确切概率法分析。结果SneppenⅡ型距骨体骨折患者Hawkins评分优良率为64.7%(11/17),距骨缺血坏死率17.6%(3/17),胫距关节创伤性关节炎发生率41.2%(7/17),距下关节创伤性关节炎发生率64.7%(11/17)。HawkinsⅠ、Ⅱ型距骨颈骨折患者Hawkins评分优良率为73.7%(14/19),距骨缺血坏死率15.8%(3/19),胫距关节创伤性关节炎发生率15.8%(3/19),距下关节创伤性关节炎发生率36.8%(7/19)。四种评价指标两组之间比较,差异无显著性意义(P>0.05)。结论距骨体和距骨颈骨折仅是解剖学上的概念,目前对于两种骨折的预后没有区分意义。对有移位(≥2mm)的距骨体或距骨颈骨折患者均应视软组织条件行切开复位内固定,保护残存血运,解剖复位,减少创伤性关节炎和距骨缺血坏死的发生。 相似文献
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Kerri A. Ohman Jingxia Liu David C. Linehan Marcus C. Tan Benjamin R. Tan Ryan C. Fields Steven M. Strasberg William G. Hawkins 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):449-457
To report long-term follow up of a phase II, single-arm trial of resectable pancreatic ductal adenocarcinoma (PDAC) treated with adjuvant interferon-based chemoradiation followed by gemcitabine to determine survival, recurrence, and complications.
Methods
From 2002 to 2005, 53 patients with PDAC underwent pancreaticoduodenectomy and received adjuvant interferon-based chemoradiation consisting of external-beam irradiation and simultaneous 3-drug chemotherapy of continuous daily 5-fluorouracil infusion, weekly intravenous bolus cisplatin, and subcutaneous interferon-α, followed by two months of weekly intravenous gemcitabine.Results
Actual overall survival for the 5- and 10-year periods were 26% and 10%, respectively, with a median overall survival of 25 months (95% CI: 16.4–38.5). Adverse prognostic factors on multivariate analysis were positive tumor margin (p < 0.035), lymphovascular invasion (p < 0.015), and perineural invasion (p < 0.026). Median time to recurrence was 11 months. Positive tumor margin was associated with lymph node involvement (p < 0.005), portal vein resection (p < 0.038), and metastases (p < 0.018). Late complications were frequent and predominated by gastrointestinal and infectious complications.Conclusions
Adjuvant interferon-based chemoradiation for PDAC improves long-term survival compared to standard therapy. However, recurrence rates and long-term complications remain high, thus further studies are indicated to assess patient characteristics that indicate a favorable treatment profile. 相似文献43.
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Jacob A. Evans Thomas J.E. Clark Kai Wang Erin M. Shriver 《Canadian journal of ophthalmology. Journal canadien d'ophtalmologie》2018,53(5):462-465
Objective
To introduce “iris show,” the amount of visible iris tissue between the superior pupil border and the upper eyelid margin, to evaluate the effect of iris show on perceived upper eyelid height, and to discuss potential nonsurgical treatment options for mild blepharoptosis.Methods
Participants completed a survey containing 4 subject photographs. These photographs depicted images of varying iris colouration (blue, green, light brown, and dark brown) with identical upper eyelid marginal reflex distance (MRD1) values, but asymmetric pupil size/amount of visible iris show. Study participants were asked to select the eyelid that appeared “droopier,” or choose “same height.” Statistical analyses used 1-tailed and 2-tailed t tests.Results
390 participants completed the survey. In photographs of blue and green irides, both eyelids had equal MRD1s, but the eyelid with less iris show was perceived as more ptotic (p = 0.002 and 0.03, respectively). In patients with dark brown irides, eyelid heights were perceived as identical despite differences in iris show (p = 0.002).Conclusions
Decreased iris show corresponds to perceived lowering of the upper eyelid in light-coloured irides (e.g., blue and green), but may be less impactful in brown and/or dark brown irides where the iris tissue is less distinguishable from the pupil. Topical instillation of apraclonidine may represent a nonsurgical option for treatment of mild blepharoptosis in patients with light irides as it both elevates the upper eyelid margin and induces miosis, resulting in an increase in iris show and corresponding enhanced perception of upper eyelid elevation. 相似文献45.
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Kripa Guram Mark Smith Timothy Ginader Kellie Bodeker Darrin Pelland Edward Pennington John M. Buatti 《Practical radiation oncology》2019,9(1):16-23
Purpose
The number of studies that evaluate treatment margins for high grade gliomas (HGG) are limited. We hypothesize that patients with HGG who are treated with a gross tumor volume (GTV) to planning tumor volume (PTV) expansion of ≤1 cm will have progression-free survival (PFS) and overall survival (OS) rates similar to those treated in accordance with standard protocols by the Radiation Therapy Oncology Group or European Organisation for Research and Treatment of Cancer. Furthermore, the PFS and OS of subgroups within the study population will have equivalent survival outcomes with GTV1-to-PTV1 margins of 1.0 cm and 0.4 cm.Methods and materials
Treatment plans and outcomes for patients with pathologically confirmed HGG were analyzed (n = 267). Survival (PFS and OS) was calculated from the time of the first radiation treatment and a χ2 test or Fisher exact test was used to calculate the associations between margin size and patient characteristics. Survival was estimated using Kaplan-Meier and compared using the log-rank test. All analyses were performed on the univariate level.Results
The median PFS and OS times were 10.6 and 19.1 months, respectively. By disease, the median PFS and OS times were 8.6 and 16.1 months for glioblastoma and 26.7 and 52.5 months for anaplastic glioma. The median follow-up time was 18.3 months. The treatment margin had no effect on outcome and the 1.0 cm GTV1-PTV1 margin subgroup (n = 212) showed median PFS and OS times of 10.7 and 19.1 months, respectively, and the 0.4 cm margin subgroup (n = 55) 10.2 and 19.3 months, respectively. In comparison with the standard treatment with 2 cm to 3 cm margins, there was not a significant difference in outcomes.Conclusions
There is no apparent difference in survival when utilizing smaller versus larger margins as defined by the guidelines of the Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer. Although there remains no class I evidence that outcomes after treatment with smaller margins are identical to those after treatment with larger margins, this large series with long-term follow up suggests that a reduction of the margins is safe and further investigation is warranted. 相似文献47.
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Fractures of the talus are challenging to manage, with historically poor outcomes and a high rate of complications. The rare nature of this injury limits the number of studies available to guide treatment. Fortunately, a number of advancements have been made in the last decade. There is increased recognition regarding the importance of anatomic reconstruction of the osseous injury. Advanced imaging is used to assess the subtalar joint, where even slight displacement may predispose to arthritis. Increasing use of dual anteromedial and anterolateral approaches, along with plate fixation, has improved our ability to accurately restore the anatomy of the talus. Modification of the original Hawkins classification can both guide treatment and allow us to better predict which patients will develop avascular necrosis. Lastly, improved reconstructive techniques help address the most common complications after talus fracture, including arthritis, avascular necrosis, and malunion. 相似文献