FP-7型与S-2型Ahmed青光眼引流阀在难治性青光眼中的短期疗效

Background  Ahmed glaucoma valves (AGV) has been used for decades, but there is no detailed report about the efficacy of AGV in Chinese glaucoma patients. This study aimed to compare the intraocular pressure (IOP) lowering efficacy and side effects of S-2 polypropylene and PF-7 silicone AGV implantation in Chinese refractory glaucoma patients.

Methods  Patients were divided into S-2 model AGV group and FP-7 model AGV group. The complete and qualified surgical success rate, change of IOP, number of anti-glaucoma medications used and postoperative complications were recorded and analyzed.

Results  Average follow-up time was comparable between two groups. IOP was reduced from (37.9±12.7) mmHg preoperatively to (17.3±5.3) mmHg at the last follow-up in S-2 group and reduced from (39.9±14.4) mmHg to (17.7±4.9) mmHg in FP-7 group. Anti-glaucoma medications were reduced from 3.8±0.2 to 1.5±0.2 in S-2 group, and 3.5±0.2 to 0.7±0.2 in FP-7 groups. The cumulative success rates were comparable in two groups, which were 61.2% and 72.1% in S-2 group and FP-7 group respectively. When IOP reduction criteria was used, complete success rates were 30.6% and 51.2% for S-2 and FP-7 groups, and qualified success rates were 86.1% and 92.7% separately. In both groups, the major complication was hypotony, and the previous trabeculectomy of patients was the major risk factor for surgery failure.

Conclusions  In this short-term retrospective study, S-2 AGV is showed at least as effective as FP-7 AGV in IOP reduction, but associated with higher rate of complications. Previous trabeculectomy is a principle risk factor for AGV implantation failure. These clinical outcomes are important for converting use of the FP-7 silicon AGV in Chinese refractory glaucoma patients.

     

成年Tillaux骨折1例报道

<正>Tillaux骨折是由下胫腓前韧带牵拉引起的胫骨前结节撕脱性骨折,属关节内骨折,最初由Pual Jules Tillaux描述其机制,后经Chaput更加详细地分析,故也称为Tillaux-Chaput骨折。Tillaux骨折发生于青少年骨骺未闭合者中亦属于Salter-HarrisⅢ型,该骨折类型临床较少见,发生于成年患者中更罕见。     

原发性急性闭角型青光眼铜蓝蛋白变化和氧化损伤的初步观察

目的探讨原发性急性闭角型青光眼患者血浆铜蓝蛋白和氧化损伤的变化。设计实验研究。研究对象50例年龄45~70岁原发性急性闭角型青光眼患者及20例年龄和性别相匹配的健康成年人对照者。方法采用总抗氧化能力和铜蓝蛋白含量试剂盒,测定血浆总抗氧化能力和铜蓝蛋白含量的变化及丙二醛(MDA)含量和超氧化物歧化酶(SOD)活性。主要指标总抗氧化能力、铜蓝蛋白含量、MDA含量和SOD活性。结果原发性急性闭角型青光眼患者总抗氧化能力、SOD活性较正常对照组明显下降,分别为(5.37±1.29)、(9.28±0.98)kU/L;(58.45±20.21)、(79.26±18.02)U/ml;P均<0.05;而铜蓝蛋白含量、MDA含量较对照组明显增加,分别为(76.72±19.32)、(52.38±13.53)mg/dl;(689.76±189.34)、(472.21±181.72)nmol/ml;P均<0.05。结论原发性急性闭角型青光眼患者存在氧化损伤、铜蓝蛋白增加与抗氧化能力下降,可能与青光眼的视功能损害有关。     

复杂性肩关节脱位术后功能分析

目的 探讨复杂性肩关节脱位术后不同类型的合并损伤对肩关节功能的影响.方法 回顾性收集2015年1月至2017年12月北京大学人民医院收治的32例复杂性肩关节脱位患者的病例资料.分析因素包括年龄、性别、受伤方式、合并损伤类型及手术方式.结果 肩关节脱位合并单纯肱骨大结节骨折行手术治疗组(n=8)末次随访时视觉模拟评分(v...     

肩袖损伤程度和肱骨头上移距离间的相关性分析

目的: 评估肩袖组织损伤程度与肱骨头上移距离之间的关系。方法: 选取2015年9月至2016年5月北京大学人民医院创伤骨科收治的肩袖损伤患者30例,均已行患侧肩关节磁共振及X线检查。将患者根据X线正位片测量所得的肱骨头上移系数(upward migration index,UMI),即肱骨头中心至肩峰距离与肱骨头半径的比值分为3个小组,每组10人,组1:1.2≥UMI >1,组2:1.4≥UMI >1.2,组3:UMI >1.4,进行Spearman等级相关分析,判定不同的UMI值与肩袖组织脂肪变程度、肩袖撕裂范围、撕裂处冈上肌厚度之间的关系。结果: 在X线正位片上,平均UMI值为1.33(范围1.02~1.51,标准差为±0.22),UMI值与肩袖组织撕裂的大小呈负相关(R=-0.584,P<0.01),与冈上肌脂肪变程度呈负相关(R=-0.312,P=0.033),而与磁共振上撕裂处冈上肌厚度并无相关性(R=0.127,P=0.071)。结论: UMI与肩袖撕裂及肩袖脂肪变程度存在相关性,UMI值与肩袖组织撕裂大小和冈上肌脂肪化程度呈负相关,其数值减小是肩袖撕裂及脂肪化退变的可靠标志。当患者因急性肩痛就诊时,门诊医师可结合临床表现、体格检查及X线影像学检查结果作出初步判断,对初步筛查肩袖损伤及指导进一步治疗具有重要意义。     

肩关节镜检查对人体电解质影响的临床观察

目的观察肩关节镜下肩袖修补手术对血浆钾、钠、氯的影响。 方法收集22例肩关节镜下行肩袖修补术患者,观察术前术后血清钾、钠、氯含量的变化。 结果肩关节术后测定血中钾、钠、氯浓度,发现与术前相比均有不同程度的变化,均在正常范围。但手术前后钾和氯变化差异具有统计学意义（P<0.05）,其中钾降低,氯升高。 结论应用肩关节修补肩袖撕裂,术后钠、钾、氯均有不同程度变化,其中有部分患者出现低钾血症或高氯血症,应引起重视。