补肾复活汤治疗48例老年股骨颈骨折的疗效观察

目的:探讨补肾复活汤对老年股骨骨颈骨折患者的治疗效果.方法:用补肾复活汤内服治疗老年股骨颈骨折48例,设对照组48例,通过1～6个月的治疗,观察治疗后骨折的愈合情况.结果:治疗组患者折愈合率达64.6%.结论:补肾复活汤有明显改善骨折端的血液循环,促进骨折愈合的作用.     

不同灸法治疗原发性痛经的临床研究进展

目的:通过对近十年不同灸法治疗原发性痛经的临床研究文献进行整理分析,了解各种灸法治疗原发性痛经的临床疗效,以期择优选择适宜灸法治疗原发性痛经。方法:以"灸""原发性痛经""功能性痛经"为主题词,在中英文数据库上检索近十年(2010年1月—2020年2月)灸法治疗原发性痛经临床研究文献。结果:临床上灸法治疗原发性痛经的方法众多,主要以温和灸、温针灸、热敏灸为主,应用灸法治疗原发性痛经最多的证型是寒凝血瘀型(或寒湿凝滞型),但大部分临床研究未进行辨证给予艾灸治疗痛经以及同种证型痛经应用不同灸法的疗效差异未进行比较。结论:各种灸法治疗原发性痛经的临床疗效均较显著,但疗效差异不详,故今后要开展更多高质量的临床研究不同灸法治疗痛经之间疗效差异,明确不同证型痛经所适宜的灸法以提高临床疗效。     

Long‐term Radiological and Clinical Outcome after Lumbar Spinal Fusion Surgery in Patients with Degenerative Spondylolisthesis: A Prospective 6‐Year Follow‐up Study

ObjectiveTo assess which radiological alignment parameters are associated with a satisfactory long‐term clinical outcome after performing lumbar spinal fusion for treating degenerative spondylolisthesis.MethodsThis single‐center prospective study assessed the relation between radiological alignment parameters measured on standing lateral lumbar spine radiographs and the patient‐reported outcome using four different questionnaires (COMI, EQ‐5D, ODI and VAS) as primary outcome measures (level of evidence: II). The following spinopelvic alignment parameters were used: gliding angle, sacral inclination, anterior displacement, sagittal rotation, lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Furthermore, the length of stay and perioperative complications were documented. Only cases from 2013 to 2015 of low‐grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) were considered. The patients underwent open posterior lumbar fusion surgery by pedicle screw instrumentation and cage insertion. The operative technique was either a posterior lumbar interbody fusion (PLIF) or a transforaminal lumbar interbody fusion (TLIF) performed by three different senior orthopedic surgeons. Exclusion criteria were spine fractures, minimally invasive techniques, underlying malignant diseases or acute infections, previous or multisegmental spine surgery as well as preoperative neurologic impairment. Of 89 initially contacted patients, 17 patients were included for data analysis (11 males, six females).ResultsThe data of 17 patients after mono‐ or bisegmental lumbar fusion surgery to treat low‐grade lumbar spondylolisthesis and with a follow‐up time of least 72 months were analyzed. The mean age was 66.7 ± 11.3 years. In terms of complications two dural tears and one intraoperative bleeding occurred. The average body mass index (BMI) was 27.6 ± 4.4 kg/m² and the average inpatient length of stay was 12.9 ± 3.8 days (range: 8–21). The long‐term clinical outcome correlated significantly with the change of the pelvic tilt (r _s = −0.515, P < 0.05) and the sagittal rotation (r _s = −0.545, P < 0.05). The sacral slope was significantly associated with the sacral inclination (r _s = 0.637, P < 0.01) and the pelvic incidence (r _s = 0.500, P < 0.05). In addition, the pelvic incidence showed a significant correlation with the pelvic tilt (r _s = 0.709, P < 0.01). The change of the different clinical scores over time also correlated significantly between the different questionnaires.ConclusionsThe surgical modification of the pelvic tilt and the sagittal rotation are the two radiological alignment parameters that can most accurately predict the long‐term clinical outcome after lumbar interbody fusion surgery.     

胸主动脉腔内修复术采用裙边型烟囱支架（Longuette™）的PATENCY临床试验研究结果

背景与目的 烟囱技术是胸主动脉腔内修复术（TEVAR）中重建左锁骨下动脉（LSA）的方法,Ⅰa型内漏是其主要并发症。裙边型烟囱支架（Longuette?）专为烟囱技术设计,用于重建LSA时降低Ⅰa型内漏。为评估Longuette?烟囱支架联合TEVAR治疗累及LSA的Stanford B型主动脉夹层（TBAD）的疗效,笔者开展了前瞻性、多中心临床试验（PATENCY临床试验）。本研究总结PATENCY临床试验的1年结果和经验。方法 2018年10月—2022年3月,全国26家血管外科中心参与PATENCY临床试验,共纳入150例符合标准的TBAD患者。所有患者均在TEVAR术中采用Longuette?烟囱支架重建LSA。评估患者围手术期和术后12个月的临床效果和不良事件,并分析患者术后1年累积生存率、LSA通畅率和无内漏率。结果 患者年龄30~77岁,平均（54.48±11.12）岁,138例（92.0%）患者合并高血压病;急性、亚急性和慢性TBAD分别占74.7%,17.3%和8.0%。124例（82.7%）患者采用全身麻醉。手术成功率为99.33%（149/150）,手术时间（91.67±41.47）min,X线暴露时间（31.36±16.71）min,手术出血量为（71.55±60.40）mL。围手术期内漏发生率为5.33%（8/150）,包括Ⅰ型6例、Ⅱ型1例、Ⅳ型1例;1例（0.67%）患者发生Longuette?烟囱支架急性闭塞,再次实施腔内手术后恢复通畅;1例（0.67%）患者术后发生急性脑梗死;2例（1.33%）患者术后发生逆撕的Stanford A型主动脉夹层,其中1例术后3周死亡。术后30 d死亡2例（1.33%）。142例患者进行了密切随访,随访时间为11.67（5~16）个月。无主动脉支架和Longuette?烟囱支架移位。2例Ⅰ型内漏患者分别于术后6个月和1年进行了再次介入栓塞手术治疗,术后1年随访仍有6例患者有轻微的内漏持续存在,患者TBAD假腔保持稳定,无明显症状,均予以保守治疗。Longuette?烟囱支架内狭窄和闭塞分别发生1例和2例,逆撕的Stanford A型主动脉夹层患者1例,假腔增大,患者均无明显症状,予以保守治疗。无发生脑卒中、截瘫、左上肢缺血等并发症。术后12个月累积生存率、LSA通畅率、无内漏率分别为97.96%、97.96%和91.91%。结论 采用Longuette?烟囱支架在TBAD腔内治疗中重建LSA简便、安全、有效,其能够有效降低围手术期Ⅰa型内漏的发生率,为微创治疗主动脉弓部病变提供新的治疗方式。     

多发性硬化168例临床分析

目的探讨多发性硬化（MS）的临床特点。方法综合分析168例多发性硬化患者的一般资料、病变部位、重要辅助检查及治疗方法。结果168例MS患者最常见的临床症状为肢体无力和感觉异常,其次为肌肉痉挛性疼痛、视力障碍、排便异常、共济失调,个别患者可有周围神经改变。实验室检查示：脑脊液蛋白水平和IgG指数增高最常见。磁共振（MRI）异常率高达90．98％。糖皮质激素治疗有效。结论MS是一种临床表现复杂、累及中枢神经系统白质多部位、病程表现多时相的自身免疫性疾病。根据临床特点,综合神经电生理、脑脊液免疫学及影像学检查能大大提高临床确诊率．茸中磁其据成像意义较大。     

废除胆道手术预防性腹腔引流的临床观察

目的探讨胆道手术不进行预防性腹腔引流的临床效果。方法将胆道手术患者随机分为观察组与对照组。观察组:不放引流管,针对导致术后出血、胆汁性腹膜炎、胆瘘等常见并发症的原因予以处理;对照组:术中安放引流管,其他处理同观察组。术后比较两组患者的临床疗效、引流副作用、住院时间、住院费用等。结果两组患者均痊愈出院。观察组平均住院时间及住院费用明显少于对照组(t=11.72,9.22;P<0.01);对照组的引流副作用发生率为31.03%,观察组则没有,二者比较有统计学意义(χ2=33.62,P<0.01)。结论胆道手术是否安放预防性腹腔引流应视术中对易致并发症部位的处理情况确定,绝大部分患者是可以不安放腹腔引流的。     

病毒性脑炎 217例症状性癫痫发生风险的预测研究

目的分析病毒性脑炎并发症状性癫痫的风险因素,据此构建列线图预测模型。方法回顾性分析 2018年 2月至 2022年 5月汕头市中心医院收治的 217例病毒性脑炎病人临床资料,抽取 70%为建模集(152例),30%为验证集(65例)。根据病人是否合并症状性癫痫,将建模集进一步分为发生组和未发生组,比较两组病人一般资料,选择差异有统计学意义的指标用逐步向前回归法进行非条件多因素 logistic分析病毒性脑炎病人症状性癫痫发生的影响因素,并采用 R3.4.3软件包绘制基于多因素分析结果的列线图模型。采用 Bootstrap法分别对建模集和验证集进行验证,并绘制受试者操作特征曲线(ROC曲线)和决策曲线(DCA)以评估列线图模型的预测效能和临床净获益率。结果 217例病毒性脑炎病人中,共 46例病人合并症状性癫痫(21.20%),其中建模集中有 32例合并症状性癫痫,验证集中有 14例合并症状性癫痫;发生组昏迷、大脑皮质损坏、脑电图重度异常、颅脑核磁共振成像(MRI)有责任病灶、累及颞叶或额叶、脑脊液单纯疱疹病毒(HSV)(+)占比及脑脊液压力均高于未发生组(P<0.05); logistic多元回归分析,昏迷、大脑皮质损坏、脑电图重度异常、颅脑 MRI有责任病灶、累及颞叶或额叶、脑脊液压力、脑脊液 HSV(+)均是病毒性脑炎合并症状性癫痫的影响因素(P<0.05);经 Bootsrap法进行验证,建模集其一致性指数( C-index)为 0.833,验证集的 Cindex则为 0.830,校正曲线和标准曲线拟合度较好。建模集 ROC曲线下面积(AUC)、灵敏度、特异度分别为 0.84［98%CI:(0.78,0.89)］、79.17%、84.04%,验证集则为 0.81［98%CI:(0.76,0.86)］,83.04%,73.64%,提示模型区分度良好。 DCA曲线显示病人根据列线图模型进行风险评估可获得满意的净收益。结论昏迷、大脑皮质损坏、脑电图重度异常、颅脑 MRI有责任病灶、累及颞叶或额叶、脑脊液压力、脑脊液 HSV(+)均是病毒性脑炎合并症状性癫痫的影响因素,综合上述因素针对病毒性脑炎病人构建的列线图预测模型可以较好地个体化预测症状性癫痫的发生,对临床防治症状性癫痫提供指导。     

鹦鹉热衣原体肺炎 28例临床特征分析

目的分析经宏基因组二代测序技术(metagenopmic next generation sequencing,mNGS)确诊的 28例鹦鹉热衣原体肺炎病人的临床特点。方法回顾性分析 2019年 10月 1日至 2022年 4月 1日长沙市第一医院采用 mNGS诊断的 28例鹦鹉热衣原体肺炎病人的诊治情况。结果 28例病人中 10例为女性, 18例为男性,中位年龄 60岁; 27例病人有明确禽类接触史, 1例无。重症病例占 32.1%,多为有慢性阻塞性肺疾病(COPD)糖尿病、高血压、冠心病或尿毒症等基础疾病病人。临床表现包括发热(100%)、畏寒(28.6%)、咳嗽、咳痰(71.4%)、气促(53.6%)。、外周血中白细胞总数多在正常范围, 96.4%的病人中性粒细胞比例增高、淋巴细胞比例降低; 96.4%病人 PCT升高,所检测病人中 ESR和 CRP升高者达 100%;分别有 71.4%和 50%病人乳酸脱氢酶和肌酸激酶增高;有 82.1%的病人谷草转氨酶增高,有 78.6%的病人白蛋白降低。胸部 CT表现单侧病变 25例、其中右肺病变 19例,常见影像改变是斑片状阴影(78.6%)、大片实变(21.4%),26例伴有胸腔积液。治疗情况:单用氟喹诺酮类(莫西沙星或者左氧氟沙星)治疗 9例,单用多西环素治疗 2例;联合用药 13例,其中青霉素类(哌拉西林他唑巴坦或头孢哌酮舒巴坦钠)联用喹诺酮类有 10例,青霉素类联合多西环素 3例。有 2例病人初始选择青霉素类加喹诺酮类药物治疗无效,改用多西环素或联用多西环素后症状缓解。 28例病人均预后良好,无死亡病例。结论鹦鹉热衣原体肺炎病人的职业史、临床表现、实验室检查结果及肺部 CT具有一定的特点;临床对可疑病例应尽早行 mNGS检测,快速过渡到精准治疗,能明显改善预后。     

Risk factors of young males with physically demanding occupations having accumulated damage of anterior cruciate ligament

ObjectiveTo present the clinical characteristics of accumulated anterior cruciate ligament (ACL) damage among young male patients undergoing routine exercise, and to evaluate the related risk factors.MethodsA retrospective study involving ACL‐accumulated damage from June 2015 to December 2019 was conducted. Baseline characteristics, such as age, body mass index (BMI), training parameters, and clinical signs, were recorded. The results of the radiologic examinations and related standardized tests were obtained to evaluate the research outcomes. These results were compared using Student''s t‐test or Chi‐square test, and the impact of risk factors on the patient''s injury were analyzed.ResultsA total of 86 men with accumulated ACL damage were included in this study. Exercise pain (86 [100%]), synovitis (80 [93.0%]), and intra‐articular effusion (79 [91.9%]) were the most common clinical symptoms. Loosening of ligaments, decreased tension, mild hyperplasia, and intercondylar fossa effusion were observed using radiography, magnetic resonance imaging, and arthroscopy. Age, BMI, training intensity, length of training, and knee hyperextension were identified as risk factors for accumulated ACL damage.ConclusionThis study suggests that accumulated ACL damage has differentiated clinical symptoms, imaging features, and risk factors compared to common ACL injuries.     

针灸治疗糖尿病性膀胱临床观察

目的:观察针灸对糖尿病性膀胱(DCP)的疗效。方法:100例DCP患者随机分为两组,治疗组53例予针灸治疗,1次/d,对照组47例予甲钴胺片500μg,口服,3次/d,共治疗3个月,分别于治疗前后观察临床表现、膀胱残余尿量。结果:治疗组疗效优于对照组(P<0.05)。结论:针灸对DCP治疗有效,疗效优于甲钴胺。