[目的]比较髓外DHS(dynamic hip screw)与髓内PFNA(proximal femoral nail anti-rotation)治疗外侧壁危险型股骨粗隆间骨折的临床效果,并探讨术中或术后外侧壁破裂对功能恢复的影响。[方法]回顾性分析2007～2008年采用PFNA和2005～2006...[目的]比较髓外DHS(dynamic hip screw)与髓内PFNA(proximal femoral nail anti-rotation)治疗外侧壁危险型股骨粗隆间骨折的临床效果,并探讨术中或术后外侧壁破裂对功能恢复的影响。[方法]回顾性分析2007～2008年采用PFNA和2005～2006年采用DHS治疗的不稳定型顺向股骨粗隆间骨折,PFNA组71例(男19例,女52例,平均年龄77岁),DHS组62例(男24例,女38例,平均年龄75.5岁)。比较两组患者的基线状况,外侧壁骨折的发生率、术后康复进程和功能恢复情况,并对比DHS组外侧壁破裂对康复过程和功能效果的影响。[结果]两组患者在年龄、性别比、骨折前的基本日常生活能力(BADL)、步行活动能力、手术危险度分级、内科合并症数目、骨质疏松Sigh指数、术中骨折复位质量以及拉力螺钉的置放(TAD)等方面,均无明显统计学差别。PFNA组能早期下地负重行走(平均4.4周),较DHS组(平均10.6周)康复进程显著为快。但PFNA组的髋股部疼痛不适发生率(25%)较DHS组(11%)显著为高。DHS组有5例发生外侧壁破裂(占8%),虽经延长卧床时间(达3个月以上)等措施骨折均获得愈合,但其功能效果较无外侧壁破裂者显著为差。[结论]DHS治疗不稳定型顺向股骨粗隆间骨折有发生外侧壁破裂而导致失败的危险,建议采用头髓钉系统(如PFNA)固定。展开更多
Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity...Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.展开更多
目的探讨液体衰减反转恢复(FLAIR)序列血管高信号(FVH)与侧支循环、血管再通治疗后功能预后的相关性。方法前瞻性纳入2017年1月至2018年3月南京市第一医院急性缺血性脑卒中并接受血管再通治疗患者37例。所有患者均于治疗前接受MRI检查,...目的探讨液体衰减反转恢复(FLAIR)序列血管高信号(FVH)与侧支循环、血管再通治疗后功能预后的相关性。方法前瞻性纳入2017年1月至2018年3月南京市第一医院急性缺血性脑卒中并接受血管再通治疗患者37例。所有患者均于治疗前接受MRI检查,大部分患者于治疗后24 h内复查MRI。FVH根据改良后Alberta卒中项目早期CT评分(ASPECTS)系统进行评分,采用美国介入和治疗神经放射学会(ASITN)分级系统评估侧支循环。3个月后的功能预后情况根据改良Rankin量表(mRS)评估,mRS 0~2分为预后良好组,mRS 3~6分为预后不良组。统计分析预后良好组与不良组之间各参数的差异,采用Spearman等级相关分析预测FVH与卒中预后的相关性。结果37例中,预后良好组16例,预后不良组21例。预后良好组较不良组治疗前FVH(FVH1)评分更高(4.63±1.20 vs 3.14±1.15;P=0.001),ASITN等级更高(3.31±0.48 vs 2.00±1.22;P=0.000)。与FVH1相反,预后良好组治疗后FVH(FVH2)评分低于预后不良组(0.125±0.50 vs 1.44±2.16;P=0.030)。Spearman等级相关分析显示FVH1评分(r=-0.525,P=0.001)、ASITN分级(r=-0.478,P=0.003)与预后呈负相关,而FVH2与预后呈正相关(r=0.376,P=0.034)。此外,FVH1评分与ASITN分级之间呈正相关(r=0.704,P=0.000)。结论治疗前FVH的存在可预测卒中良好的功能预后,而治疗后FVH则与预后不良有关。综合评估治疗前、后FVH的评分可以有效地判断卒中的功能预后、指导治疗。展开更多
Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current rev...Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.展开更多
目的:探讨烟雾病性脑出血与高血压性脑出血患者的临床及影像学特征,以及预后和影响因素。方法:回顾性连续纳入2017年1月至2019年1月在神经内科、神经外科住院治疗的烟雾病性脑出血和高血压性脑出血患者。收集患者的人口学资料、临床特...目的:探讨烟雾病性脑出血与高血压性脑出血患者的临床及影像学特征,以及预后和影响因素。方法:回顾性连续纳入2017年1月至2019年1月在神经内科、神经外科住院治疗的烟雾病性脑出血和高血压性脑出血患者。收集患者的人口学资料、临床特征和影像学特征等资料,随访发病后3个月死亡及神经功能结局。将影响脑出血预后的因素作为自变量,3个月不良神经功能结局作为应变量进行logistic回归分析。结果:共纳入30例烟雾病性脑出血患者,同时期按照1:3的比例纳入90例高血压性脑出血患者。烟雾病性脑出血与高血压性脑出血患者相比,年龄较轻、男性及高血压病史比例更低,入院时收缩压、舒张压、美国国立卫生研究院中风量表(National Institutes of Health Stroke Scale,NIHSS)评分及血红蛋白更低、血肿体积更小,发生脑叶及侧脑室出血比例更高(P<0.05)。烟雾病性脑出血患者3个月时不良神经功能结局比例为20.00%,明显低于高血压性脑出血患者(47.78%)。病因(OR=0.27;95%CI:0.10~0.73)、发病年龄(OR=1.05;95%CI:1.02~1.09)、GCS评分(OR=0.76;95%CI:0.67~0.86)、NIHSS评分(OR=1.21;95%CI:1.13~1.32)、呼吸道感染(OR=8.36;95%CI:2.85~24.51)、血肿体积(OR=1.05;95%CI:1.02~1.07)等因素与脑出血3个月不良神经功能相关。结论:烟雾病性脑出血临床特征、影像学特征和预后与高血压性脑出血患者存在显著地差异。在临床工作需完善MRI血管造影、CT血管成像、数字减影血管造影等检查明确脑出血的病因,根据其病因给予特异性的治疗。展开更多
文摘[目的]比较髓外DHS(dynamic hip screw)与髓内PFNA(proximal femoral nail anti-rotation)治疗外侧壁危险型股骨粗隆间骨折的临床效果,并探讨术中或术后外侧壁破裂对功能恢复的影响。[方法]回顾性分析2007～2008年采用PFNA和2005～2006年采用DHS治疗的不稳定型顺向股骨粗隆间骨折,PFNA组71例(男19例,女52例,平均年龄77岁),DHS组62例(男24例,女38例,平均年龄75.5岁)。比较两组患者的基线状况,外侧壁骨折的发生率、术后康复进程和功能恢复情况,并对比DHS组外侧壁破裂对康复过程和功能效果的影响。[结果]两组患者在年龄、性别比、骨折前的基本日常生活能力(BADL)、步行活动能力、手术危险度分级、内科合并症数目、骨质疏松Sigh指数、术中骨折复位质量以及拉力螺钉的置放(TAD)等方面,均无明显统计学差别。PFNA组能早期下地负重行走(平均4.4周),较DHS组(平均10.6周)康复进程显著为快。但PFNA组的髋股部疼痛不适发生率(25%)较DHS组(11%)显著为高。DHS组有5例发生外侧壁破裂(占8%),虽经延长卧床时间(达3个月以上)等措施骨折均获得愈合,但其功能效果较无外侧壁破裂者显著为差。[结论]DHS治疗不稳定型顺向股骨粗隆间骨折有发生外侧壁破裂而导致失败的危险,建议采用头髓钉系统(如PFNA)固定。
文摘Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.
文摘目的探讨液体衰减反转恢复(FLAIR)序列血管高信号(FVH)与侧支循环、血管再通治疗后功能预后的相关性。方法前瞻性纳入2017年1月至2018年3月南京市第一医院急性缺血性脑卒中并接受血管再通治疗患者37例。所有患者均于治疗前接受MRI检查,大部分患者于治疗后24 h内复查MRI。FVH根据改良后Alberta卒中项目早期CT评分(ASPECTS)系统进行评分,采用美国介入和治疗神经放射学会(ASITN)分级系统评估侧支循环。3个月后的功能预后情况根据改良Rankin量表(mRS)评估,mRS 0~2分为预后良好组,mRS 3~6分为预后不良组。统计分析预后良好组与不良组之间各参数的差异,采用Spearman等级相关分析预测FVH与卒中预后的相关性。结果37例中,预后良好组16例,预后不良组21例。预后良好组较不良组治疗前FVH(FVH1)评分更高(4.63±1.20 vs 3.14±1.15;P=0.001),ASITN等级更高(3.31±0.48 vs 2.00±1.22;P=0.000)。与FVH1相反,预后良好组治疗后FVH(FVH2)评分低于预后不良组(0.125±0.50 vs 1.44±2.16;P=0.030)。Spearman等级相关分析显示FVH1评分(r=-0.525,P=0.001)、ASITN分级(r=-0.478,P=0.003)与预后呈负相关,而FVH2与预后呈正相关(r=0.376,P=0.034)。此外,FVH1评分与ASITN分级之间呈正相关(r=0.704,P=0.000)。结论治疗前FVH的存在可预测卒中良好的功能预后,而治疗后FVH则与预后不良有关。综合评估治疗前、后FVH的评分可以有效地判断卒中的功能预后、指导治疗。
文摘Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.
文摘目的:探讨烟雾病性脑出血与高血压性脑出血患者的临床及影像学特征,以及预后和影响因素。方法:回顾性连续纳入2017年1月至2019年1月在神经内科、神经外科住院治疗的烟雾病性脑出血和高血压性脑出血患者。收集患者的人口学资料、临床特征和影像学特征等资料,随访发病后3个月死亡及神经功能结局。将影响脑出血预后的因素作为自变量,3个月不良神经功能结局作为应变量进行logistic回归分析。结果:共纳入30例烟雾病性脑出血患者,同时期按照1:3的比例纳入90例高血压性脑出血患者。烟雾病性脑出血与高血压性脑出血患者相比,年龄较轻、男性及高血压病史比例更低,入院时收缩压、舒张压、美国国立卫生研究院中风量表(National Institutes of Health Stroke Scale,NIHSS)评分及血红蛋白更低、血肿体积更小,发生脑叶及侧脑室出血比例更高(P<0.05)。烟雾病性脑出血患者3个月时不良神经功能结局比例为20.00%,明显低于高血压性脑出血患者(47.78%)。病因(OR=0.27;95%CI:0.10~0.73)、发病年龄(OR=1.05;95%CI:1.02~1.09)、GCS评分(OR=0.76;95%CI:0.67~0.86)、NIHSS评分(OR=1.21;95%CI:1.13~1.32)、呼吸道感染(OR=8.36;95%CI:2.85~24.51)、血肿体积(OR=1.05;95%CI:1.02~1.07)等因素与脑出血3个月不良神经功能相关。结论:烟雾病性脑出血临床特征、影像学特征和预后与高血压性脑出血患者存在显著地差异。在临床工作需完善MRI血管造影、CT血管成像、数字减影血管造影等检查明确脑出血的病因,根据其病因给予特异性的治疗。
