隧道刀制作双层巩膜瓣的青光眼小梁切除术后疗效观察

目的：：探讨隧道刀制作双层巩膜瓣并切除层间巩膜瓣的青光眼小梁切除术的临床疗效。方法：采用随机分组方法,将46例60眼青光眼患者分为治疗组24例32眼和对照组22例28眼。前者用隧道刀制作双层巩膜瓣,浅层巩膜瓣大小约为5mm×5.5mm,1/3巩膜厚度,瓣下再做一大小约3.5mm×4mm的巩膜瓣,1/3巩膜厚度,切除中间层的巩膜瓣,切除2mm×2mm小梁组织,常规行虹膜周边切除,可调节缝线缝合浅层巩膜瓣,缝合球筋膜、球结膜;后者行常规青光眼小梁切除术。结果：术后随访1a,治疗组视力明显优于对照组,两组比较差异有统计学意义(P<0.05)。两组患者术后眼压均明显低于术前眼压。术后1,3 mo时,两组患者的眼压比较差异无统计学意义(P>0.05),但术后6,12mo检查发现,治疗组患者的眼压明显低于对照组,差异有统计学意义(P<0.05)。术后1a治疗组和对照组的累积完全成功率分别为90.63％和75％,两组的累积条件成功率分别为96.88％和89.29％,两组比较差异有统计学意义(均P<0.05)。结论：隧道刀制作双层巩膜瓣并切除层间巩膜瓣的小梁切除术降眼压效果好,巩膜瓣厚薄均匀、表面光滑,滤过泡功能维持时间长,术后并发症少,适用于多种类型的青光眼,值得临床推广。     

Collagen gel contraction as a measure of fibroblast function in an animal model of subsynovial connective tissue fibrosis

Carpal tunnel syndrome (CTS) is a peripheral neuropathy characterized by non‐inflammatory fibrosis of the subsynovial connective tissues (SSCT). A rabbit model of CTS was developed to test the hypothesis that SSCT fibrosis causes the neuropathy. We used a cell‐seeded collagen‐gel contraction model to characterize the fibrosis in this model in terms of cellular mechanics, specifically to compare the ability of SSCT cells from the rabbit model and normal rabbits to contract the gel, and to assess the effect of transforming growth factor‐β1,which is upregulated in CTS, on these cells. SSCT fibrosis was induced in six retired breeder female rabbits which were sacrificed at 6 weeks (N = 3) and 12 weeks (n = 3). An additional two rabbits served as controls. SSCT was harvested according to a standard protocol. Gels seeded with SSCT cells from rabbits sacrificed at 6 weeks had significantly higher tensile strength (p < 0.001) and Young's modulus (p < 0.001) than gels seeded with cells from rabbits sacrificed at 12 weeks or control animals. TGF‐β1 significantly increased the decay time constant (p < 0.001), tensile strength (p < 0.001), and Young's modulus (p < 0.001) regardless of the cell source. This model may be useful in screening therapeutic agents that may block SSCT fibrosis, identifying possible candidates for CTS treatment. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:668–674, 2015.     

Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome

Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross‐sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70–71% and specificity of 80–84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1332–1340, 2015.     

低强度激光治疗轻中度腕管综合征有效性的Meta分析

目的应用Meta分析方法定量评价低强度激光治疗轻中度腕管综合征的有效性。方法计算机检索Pub Med、Embase、The Cochrane Library、Web of Science、中国期刊全文数据库、万方数据库和维普数据库,筛选与低强度激光治疗轻中度腕管综合征相关的随机对照研究,检索时限均为建库起至2014年1月。由两位评价员按照预先制定的纳入排除标准独立筛选文献,提取数据和评价纳入文献质量。用Rev Man 5.2软件对符合质量标准的随机对照研究进行Meta分析。结果最终纳入9个随机对照研究,共518例患者。Meta分析结果显示:低强度激光组治疗后0周(治疗刚结束时)在缓解疼痛,改善手握力、指捏力和临床症状方面疗效优于对照组,而在改善手功能状态方面两组疗效差异无统计学意义(P0.05);指捏力在治疗后2周恢复好于对照组;随访12周后在缓解疼痛方面疗效优于对照组,而在改善手握力、临床症状和手功能状态方面两组疗效差异无统计学意义(P0.05)。结论根据目前研究结果,低强度激光治疗轻中度腕管综合征可以缓解疼痛、改善手无力和临床症状,但在改善手功能状态方面疗效不明显。受纳入研究数量和质量的限制,该研究结论仍需高质量大样本随机对照试验进一步证实。     

Immediate and durable clinical improvement in the non-operated hand after contralateral surgery for patients with bilateral Carpal Tunnel Syndrome

Background

Little is known about clinical improvement in the non-operated hand after unilateral surgery for patients who present with bilateral carpal tunnel syndrome (CTS). In this prospective study of patients with bilateral CTS, we evaluated the clinical effects on the non-operated hand following unilateral contralateral carpal tunnel surgical release.

Material and Methods

During a consecutive period of 22 months, 69 patients with bilateral CTS underwent unilateral open carpal tunnel release. Bilateral subjective and objective evaluations were performed pre-operatively, at days 2, 15 and 180 after surgery. Subjective evaluations, analysed with Student t test, included the Boston-Levine symptom severity score and a visual analogue scale including pain, nocturnal symptoms and numbness. A telephone survey was conducted 12 months after surgery.

Results

The Boston-Levine severity score of the contralateral non-operated hand decreased from 2.70 pre-operatively to 1.70 at 2 days (p < 0.001). The visual analogue pain score decreased at 2 days for 61 patients (88 %), whereas the nocturnal symptoms decreased or disappeared in 63 cases (91 %) and the paresthesia in 52 cases (75 %) (ps < 0.001). These beneficial effects were stable in time with no statistically significant change at 180 days. Overall, 58 patients (84 %) observed a total resolution or a significant improvement in their symptoms at 6 months. At 12 months, 100 % of patients responded to a telephone survey. Fifty one of them (74 %) reported minimal or no symptoms on the non-operated hand. Linear regression (analysis of variance [ANOVA]) showed that gender, age, professional status, duration of pre-operative symptoms and severity of electrophysiological disturbances were not predictive of post-operative evolution in the non-operated hand after unilateral surgery for CTS.     

肥厚梗阻型心肌病介入治疗方法的新改进

目的 探讨经皮“室间隔心肌隧道化学消融术（percutaneous transluminal septal tunnel myocardial ablation,PTSTMA）”治疗传统技术不适合的肥厚梗阻型心肌病（hypertrophic obstructive cardiomyopathy,HOCM）的方法及疗效.方法 选择2005年6月至2011年6月期间住院的HOCM患者中的26例为研究对象.观察经PTSTMA治疗的26例HOCM患者术后即刻左心室流出道压力阶差（left ventricular outflow tract pressure gradient,LVOTPG）变化,术后24 h磷酸肌酸激酶同工酶、心电学改变,术后3个月心脏超声指标变化以及随访临床症状的转归.结果 3例通过单支血管消融,17例通过2支血管消融,6例通过3支血管消融.LVOTG由术前（75.6±22.4）mm Hg（1 mm Hg=0.133 kPa）降至（21.4±5.84）mm Hg,差异有统计学意义（P＜0.01）.术后24 h磷酸肌酸激酶同工酶为（1 86±84）μ/L,2例发生Ⅲ＆#176;房-室传导阻滞,均于1周后恢复正常传导,10例发生室性心律失常,12例发生右束支传导阻滞.消融后室间隔厚度减少[（16.8±4.2）mm vs.（22.8±5.8）mm,P＜0.01]、左心房内径减少[（42.0±8.6）mmvs.（48.0±7.0）mm,P＜0.05],差异均有统计学意义.随访时间为（39.8±8.6）个月.与消融前比较,随访中胸痛、呼吸困难症状明显减少,纽约心脏协会心功能分级明显改善,室性心律失常明显减少,黑蒙症状也有一定改善.结论 冠状动脉造影证实冠状动脉室间隔支解剖形态不适合做传统室间隔心肌化学消融术的HOCM患者,PTSTMA能显著降低LVOTPG,改善临床症状.PTSTMA可作为HOCM心肌化学消融术的一种补充方法,其近、中期安全有效.     

Comparison of Long-Term Strength Development of Steel Fiber Shotcrete with Cast Concrete Based on Accelerator Type

This study analyzed the effect of accelerating agents, such as aluminate, cement mineral, and alkali-free accelerators, on the long-term performance of steel-fiber-reinforced shotcrete. The shotcrete performance was studied based on the type and amount of steel fiber added. Performance tests were performed to identify the accelerator providing better long-term performance to the steel-fiber-reinforced shotcrete. Changes in strength and flexural performance over time were investigated. The compressive strength and flexural strength tests on 1-, 3-, 6-, 12-, and 24-month-old test specimens were performed, wherein 37 kg of steel fiber was added to the cement mineral and aluminate mixes, and 40 kg of steel fiber was added to the alkali-free mix. The 1-month compressive strength result of all the test variables satisfied the Korea Expressway Corporation standard. The compressive strength of the cast concrete and shotcrete specimens increased with age, demonstrating a strength reduction, particularly in the 24-month-old shotcrete specimens. Thus, the shotcrete performance may deteriorate in the long-term. In the 24-month-old specimen, substantial flexural strength reduction was observed, particularly in the aluminate and alkali-free specimens. The relative strength of the specimens was compared with that of the cast concrete mold specimens. The results suggest the use of alkali-free accelerators, considering the long-term performance of tunnels and safety of workers. Moreover, increasing the steel fiber performance rather than the amount of low-performance steel fiber must be considered.     

Peripheral nerve entrapment syndromes of the upper limb

Peripheral nerve entrapment syndrome is a condition caused by the persistent application of pressure to a nerve. Symptoms include pain, numbness and tingling, and muscle weakness. The distribution of symptoms depends upon the nerve affected. This article discusses the aetiology, epidemiology and pathogenesis of peripheral nerve entrapment in the upper limb, and the principles of diagnosis and management. Common examples of nerve entrapment are described in greater depth.     

自体骨—髌腱—骨前交叉韧带重建术后胫骨隧道的变化

目的观察电子计算机X射线断层扫描技术(CT)测量下自体骨—髌腱—骨(BPTB)前交叉韧带(ACL)重建术后胫骨隧道直径的变化。方法对52例(52膝)ACL损伤患者行自体BPTB ACL重建术。分别于术后1、10周、12个月用64层螺旋CT对患膝进行扫描,同时进行三维重建。测量胫骨骨隧道关节面下方1 cm、隧道外口上方1 cm及隧道中点的直径,计算骨隧道扩大百分比。结果 52例患者术后1周胫骨隧道扩大11.18%±3.39%,术后10周胫骨隧道扩大25.98%±4.36%,术后12个月为26.24%±4.44%。术后1、10周胫骨隧道扩大百分比相比,P<0.05,术后10周、12个月相比,P>0.05。结论 BPTB ACL重建术后胫骨隧道发生扩大,明显扩大发生在术后10周内,术后10周～12个月骨隧道直径比较稳定。