目的:对前路病灶清除取髂骨植骨融合K型钢板内固定治疗胸腰段脊柱结核的临床疗效进行分析。方法:2003年1月至2007年1月,对我科22例患者进行随访。结果:20例患者腰痛完全消失,植骨块完全融合,内固定材料稳定牢固,无松动及断裂,脊柱后突有效纠正,仅2例患者结核复发。结论:前路病灶清除植骨融合K型钢板内固定术能有效治疗胸腰段脊柱结核,有效纠正脊柱后突畸形,恢复椎体的高度,建立脊柱的稳定性。
Mitral regurgitation (MR) is one of the most common valvular heart diseases, imposing a significant economic burden on society. Transcatheter mitral valve replacement (TMVR), as an emerging therapeutic strategy for MR, is expected to fill the gap in the treatment of transcatheter edge-to-edge repair in the future. This article reviews the progress of TMVR clinical research both domestically and internationally in the past two years and analyzes the current challenges faced by TMVR research, such as mitral valve anatomy, device access transition, valve design, and mitral valve calcification. Finally, the prospects of mitral valve product research are discussed.
Objective To discuss the concept of ulnar tunnel at thewrist, the types, causes, traits of compression, diagnosis, and clinical significance of ulnar tunnel syndrome(UTS). Methods Thirty-nine cases diagnosed as having UTS from 1986 were retrospectively reviewed combined with previous relevant literature. Results Ulnar tunnel included Guyon’s canal, pisohamate tunnel and hypothenar segment. There were 8 types andmany causes of UTS. Some patients had compression in more than one zones and might be associated with carpal tunnel syndrome or cubital tunnel syndrome. UTS could be diagnosed through clinical manifestations and electrophysiological examination. Conclusion Defining the concept of ulnar tunnel and the knowledge of the complexity and rarity of UTS can effectively guide diagnosis and treatment.
Objective To explore the effectiveness and appropriate energy parameters of high-intensity focused ultrasound (HIFU) in treating infant hemangiomas. Methods Between January 2009 and September 2010, 60 infants with hemangioma were treated. There were 23 boys and 37 girls, aged from 3 to 30 months with an average of 10 months. These hemangiomas were located at head and face (24 cases), trunk (15 cases), l imb (16 cases), buttocks (2 cases), perineum (1 case),and multiple lesions (cervix, abdomen, and upper l imbs, 2 cases). The size of hemangiomas ranged from 0.8 cm × 0.6 cm to 6.0 cm × 5.0 cm. The 60 infants were randomly divided into 3 groups: groups A, B, and C (n=20) based on different ultrasound energies used in treatment. The lesion surface was irradiated with 3-5 mm/second for 5 continuously by ultrasonic therapeutic apparatus at a frequency of 9 MHz, impulse of 1 000, and 10% of scanning overlap; the powers of 3.5, 4.0, and 4.5 W were used in groups A, B, and C, respectively, 3 times as a course of treatment with 1 month interval. The effect and ulcer and scar risk in irradiation region were observed after 6 months of treatment. Results All cases were treated for one course. After 6 months of treatment, no significant difference in the effect was found among 3 groups based on hemangioma treatment judging criterion (P gt; 0.05). Neither ulcer nor scar occurred in group A; ulcer occurred in 4 cases (20%) of group B with superficial scars, and in 7 cases (35%) of group C with obvious scars. The rates of ulcer and scar in groups B and C were significantly higher than that in group A (P lt; 0.05). Conclusion HIFU irradiating is one of effective methods for treating infant hemangioma, but the appropriate energy was below 3.5 W.
Objective To investigate the anatomical evidence of low end-to-side anastomosis of median nerve and ulnar nerve in repair of Dejerine Klumpke type paralysis or high ulnar nerve injury. Methods Twelve formaldehyde anticorrosion specimens (24 sides) and 3 fresh specimens (6 sides) were observed. There were 9 males (18 sides) and 6 females(12 sides). The specimen dissected under the microscope. S-shape incision was made at palmar thenar approaching ulnar side, the profundus nervi ulnaris and superficial branch of ulnar nerve were separated through near end of incision, and the recurrent branch of median nerve and comman digital nerve of the ring finger were separated through far end of incision. The distances from pisiform bone to the start point of the recurrent branch of median nerve, and to the start point of comman digital nerve of the ring finger were measured. The width and thickness of the profundus nervi ulnaris and superficial branch of ulnar nerve, and the recurrent branch of median nerve and comman digital nerve of the ring finger were measured, and the cross-sectional area was calculated. The number of nerve fiber was determined with HE staining and argentaffin staining. Results The crosssectional area and the number of nerve fiber were (2.46 ± 1.03) mm2 and 1 305 ± 239 for the profundus nervi ulnaris, (2.62 ± 1.75) mm2 and 1 634 ± 343 for the recurrent branch of median nerve, (1.60 ± 1.39) mm2 and 1 201 ± 235 for the superficial branch of ulnar nerve, and (2.19 ± 0.89) mm2 and 1 362 ± 162 for the comman digital nerve of the ring finger. There were no significant differences (P gt; 0.05) in the cross-sectional area and the number of nerve fiber between the profundus nervi ulnaris and the recurrent branch of median nerve, between the superficial branch of ulnar nerve and the comman digital nerve of the ring finger; and two factors had a l inear correlation (P lt; 0.05) with correlation coefficients of 0.68, 0.66 and 0.56, 0.36. The distances were (36.98 ± 4.93) mm from pisiform bone to the start point of the recurrent branch of median nerve, and (28.35 ± 6.63) mm to the start point of comman digital nerve of the ring finger. Conclusion Low end-to-side anastomosis of median nerve and ulnar nerve has perfect match in the cross-sectional area and the number of nerve fiber.
Objective To investage the relationship among the visual loss, the disease course, and retinal circulation time in patients with central retinal artery occlusion (CRAO)． Method The data about the central vision, disease course, and results of fundus fluorescein angiography (FFA) of 99 patients (99 eyes) with CRAO were statistically analyzed. Results Between 2 days and 21 days after the occurrence of CRAO, the disease course didnrsquo;t relate to the central visual loss (Pgt;0.05). In the retinal circulation, a correlation was found between the time of fluorescein perfusion and the central visual loss (Plt;0.05) but not between the time of arm-retina circulation and the central visual loss (Pgt;0.05). Conclusion In the duration of retinal circulation, the time of fluorescein perfusion in retinal artery relates to the central visual loss; the longer the duration is, the worse the vision is. (Chin J Ocul Fundus Dis, 2007, 23: 177-179)
Cardiac three-dimensional electrophysiological labeling technology is the prerequisite and foundation of atrial fibrillation (AF) ablation surgery, and invasive labeling is the current clinical method, but there are many shortcomings such as large trauma, long procedure duration, and low success rate. In recent years, because of its non-invasive and convenient characteristics, ex vivo labeling has become a new direction for the development of electrophysiological labeling technology. With the rapid development of computer hardware and software as well as the accumulation of clinical database, the application of deep learning technology in electrocardiogram (ECG) data is becoming more extensive and has made great progress, which provides new ideas for the research of ex vivo cardiac mapping and intelligent labeling of AF substrates. This paper reviewed the research progress in the fields of ECG forward problem, ECG inverse problem, and the application of deep learning in AF labeling, discussed the problems of ex vivo intelligent labeling of AF substrates and the possible approaches to solve them, prospected the challenges and future directions for ex vivo cardiac electrophysiology labeling.
Objective To review the mechanisms of cholesterol gallstones caused by female hormone so as to explore new treatments to prevent gallstones associated with estrogen and progesterone. Methods The literatures on gallstones related with female hormone were reviewed and the mechanisms of cholesterol gallstones were summarized. Results The cholesterol gallstones mechanisms was affected by estrogen through genomic effects，and the nucleation of cholesterol was promoted by estrogen through nongenomic，which resulted in the formation of cholesterol gallstones. And the bile empty dysfunction associated with estrogen through nongenomic effects was also the reason of cholesterol gallstone formation. The G proteins α subunit responsible for the motility of gallbladder were disrupted by progesterone through genomic effects，and the ionic channels and signal transduction were also interfered through nongenomic pathway，which impaired the contraction of gallbladder. However，the nongenomic effects might not play an important role in the gallstones formation caused by progesterone. Conclusions The mechanisms of cholesterol gallstones formation associated with female hormone are complicated，the understanding of chelesterol gallstones formation mechanisms might be helpful to prevent gallstones associated with estrogen and progesterone.
ObjectivesTo systematically review the efficacy and safety of new oral anticoagulants (Apixaban, Rivaroxaban, or Dabigatran) after joint replacement.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on new oral anticoagulants after joint replacement from inception to October, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 13 RCTs were included. The results of meta-analysis showed that compared to Enoxaparin, the new oral anticoagulant significantly reduced the incidence of asymptomatic deep vein thrombosis (DVT) (RR=0.60, 95%CI 0.46 to 0.78, P<0.000 1) and symptomatic DVT (RR=0.40, 95%CI 0.28 to 0.58, P<0.000 1), while the incidence of symptomatic pulmonary embolism (PE) during treatment (RR=0.91, 95%CI 0.59 to 1.39, P=0.65) and mortality (RR=1.00, 95%CI 0.40 to 1.76, P=0.99) were not reduced. Major bleeding (RR=1.05, 95%CI 0.81 to 1.35, P=0.72) and clinically relevant non-major bleeding events (RR=0.99, 95%CI 0.73 to 1.33, P=0.94) with new oral anticoagulants were not statistically different from Enoxaparin.ConclusionsCurrent evidence shows that new oral anticoagulants can effectively reduce the incidence of DVT in patients after joint replacement without increasing the risk of adverse events such as bleeding. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectiveTo explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook.MethodsFive patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness.ResultsAll the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] (t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] (t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case.ConclusionFor the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.