两种牵引方式治疗腰椎间盘突出症的疗效评价

目的　观察间歇牵引和持续牵引治疗腰椎间盘突出症的疗效。方法　将 180例腰椎间盘突出症患者随机分为间歇牵引和持续牵引组 ,在温热和中频电治疗的同时分别给以间歇牵引和持续牵引 ,然后测定治疗前、后的下背痛评价表得分 ,并对其评测验结果进行比较分析。结果　治疗前 ,A组积分 10 .8±4.45 ,B组积分 11.2± 4.17;治疗 10次后 ,A组积分 2 0 .7± 5 .5 3 ,B组积分 18.8± 4.16;治疗 2 0次后 ,A组积分 2 7.1± 5 .75 ,B组积分 2 1.3± 5 .3 3。结论　两种治疗方法均有显著疗效 ,间歇牵引的疗效引优于持续牵引     

Experiences with pins and rubber band traction in the treatment of proximal interphalangeal joint contracture

BACKGROUND:

Proximal interphalangeal joint (PIPJ) contracture is a difficult problem to treat regardless of etiology. Although numerous interventions have been recommended, published results are mediocre at best.

OBJECTIVE:

The authors describe their experience and results of using a modification of pins and rubber band traction (PRBT) – applying a dynamic extension apparatus to a contracted PIPJ using the constant traction force in a stretched rubber (elastic) band.

METHOD:

A retrospective review of patients treated with this method was performed, and the results are presented. The technique itself is described, and clinical photographs illustrate the method.

RESULTS:

Mean PIPJ flexion contracture before PRBT was 82° (range 60° to 110°). The full correction of eight contracted PIPJs in seven patients was achieved, in a mean of 17.8 days (range 14 to 31 days). At one month postremoval of PRBT, the mean PIPJ flexion contracture was 22.8° (range 0° to 46°).

DISCUSSION:

The method is compared with previously described methods of PIPJ contracture correction, whether surgical or splinting; the latter may be static, dynamic or a combination of the two. The results of previously published studies are discussed and compared with the method described.

CONCLUSION:

The present method is a powerful and effective simplification of a previously described method of correcting PIPJ contractures. This technique is simple, ‘low-tech’ and can be applied under local anesthetic; the authors believe it offers a useful adjunct to surgical release.     

3D手术视频系统在PDR合并牵拉性视网膜脱离手术中的应用

目的：评价3D手术视频系统在增生性糖尿病视网膜病变(PDR)合并牵拉性视网膜脱离(TRD)玻璃体切除术中的应用效果。

方法：回顾性分析2018-08/2019-03于我院行25G微创玻璃体切除术的PDR合并局部TRD(无牵拉性视网膜裂孔)患者32例38眼的临床资料,根据术中采用的观察系统进行分组,试验组16例19眼采用3D手术视频系统手术,对照组16例19眼采用传统显微镜手术。记录两组患者手术时间、术中医源性视网膜裂孔和硅油注入情况。术后至少随访6mo,观察最佳矫正视力及术后并发症发生情况。

结果：试验组术中发生医源性视网膜裂孔1眼,硅油注入1眼; 术后视网膜均完全复位; 术后1d玻璃体出血4眼,2～4wk后自行吸收; 术后2wk内发生高眼压6眼,药物治疗均能控制; 术后6wk后玻璃体再出血2眼; 术后6mo最佳矫正视力0.3以上者15眼。对照组术中发生医源性视网膜裂孔4眼,硅油注入5眼; 术后视网膜均完全复位; 术后1d玻璃体出血6眼,2～4wk后自行吸收; 术后2wk内发生高眼压5眼,药物治疗均能控制; 术后6wk后玻璃体再出血3眼; 术后6mo最佳矫正视力0.3以上者14眼。所有患者手术均顺利完成,均无眼内炎等严重并发症发生,但试验组手术时间明显短于对照组(37.3±4.8min vs 41.2±5.1min,P=0.020)。

结论：3D手术视频系统在PDR合并TRD玻璃体切除术中的应用能够缩短手术时间,提高手术效率。     

脑电仿生电刺激配合牵引治疗椎基底动脉供血不足性眩晕效果的经颅多普勒超声和眩晕量表观察

目的观察脑电仿生电刺激配合牵引治疗椎基底动脉供血不足性眩晕（VBIV）的经颅多普勒超声（TCD）和眩晕量表评估的变化,探讨脑电仿生电刺激配合牵引治疗椎基底动脉供血不足性眩晕的作用机制。方法将44例VBIV患者,随机分为脑仿生电刺激配合牵引治疗组（综合组）和牵引对照组（牵引组）。治疗前及治疗2疗程后检查TCD并进行眩晕量表的评估,观察脑电仿生刺激配合牵引治疗对VBIV患者血流速度及患者症状与功能状况的影响。结果综合组显效率为63．3％,牵引组显效率为7．1％。2组显效率比较,差异有统计学意义（P〈0．01）;治疗后较治疗前,综合组与牵引组双侧椎动脉和基底动脉收缩期颅内血流峰速均有明显提高（P〈0．05）,综合组优于牵引组,差异有统计学意义（P〈0．05）。结论脑电仿生电刺激配合牵引治疗VBIV可改善该类型颈椎病的双侧椎动脉和基底动脉收缩期血流峰速度,临床疗效较显著。     

骨盆前、后环不稳定的治疗策略

目的探讨骨盆前后环不稳定的治疗策略。方法对22例Tile C型骨盆前、后环不稳定患者均急诊采用股骨髁上骨牵引结合外固定架固定,病情平稳后行前、后路重建钢板联合骶髂螺钉复位内固定术治疗。结果22例均获随访,时间6~31个月。疗效根据Matta评分标准评定:优21例,良1例。根据Majeed功能评分评定:优18例,良2例,差2例。结论先早期外固定架临时固定,二期行手术内固定,手术安全、固定可靠,可早期功能锻炼及负重,是治疗骨盆前后环不稳定的有效方法。     

谈颈椎病的牵引

从颈椎牵引的作用机理、牵引方法以及牵引器的选择要求方面阐述临床上应从颈椎病患者的自身情况出发,选择适合患者自身情况的牵引器械,并针对患者的具体情况设计合理、有效、规范的治疗方案。     

Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis

Purpose:Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony.Methods:This was a retrospective hospital-based interventional case-series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020.Results:Thirty-six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow-up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow-up.Conclusion:We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.     

综合疗法治疗腰椎间盘突出症106例

[目的]观察内服中药、骶管注射和三维牵引综合治疗腰椎间盘突出症的疗效。[方法]将205例患者随机分为治疗组(内服中药+骶管注射+三维牵引组)106例,对照组(西医常规治疗组)99例,两组对照观察。[结果]治疗组总有效率为97.17%,对照组总有效率为78.79%,两组比较差异有显著意义(P<0.05)。[结论]综合治疗腰椎间盘突出症有肯定疗效。