目的 分析總結嚴重擠壓傷導致四肢創傷性截肢各種生化指標的動態變化及對臨床中治療的指導意義。 方法 2000年3月－2011年3月對23例由于嚴重擠壓導致創傷性截肢的患者各項生化指標檢測結果進行實時監控，根據監控結果及時調整治療方案。 結果 傷后患者電解質，血、尿肌紅蛋白，尿比重，尿pH值，血肌酸激酶、肌酸激酶同工酶、羥丁酸脫氫酶、白蛋白、血紅蛋白、血小板等指標均有明顯改變，據此作為救治的依據進行精細化治療。術后隨訪7個月～10年，23例患者均得到康復，腎功能良好。 結論 對于嚴重擠壓傷導致四肢創傷性截肢的各種生化指標實時監控并同步制定精細化治療，才能確保患者成功救治并得以康復。
目的探討復雜膽管疾病膽囊切除術的處理方法，減少醫源性膽管損傷的發生率。方法回顧性分析2000年1月至2005年1月收治的160例困難膽囊切除術患者的資料，對其處理方法進行總結。結果結合術中B超和膽管造影檢查，順逆結合，解剖、明確三管關系后切除膽囊132例，取出結石行膽囊部分切除術26例，行肝葉楔形切除2例，其中行膽總管修補、T管引流7例，膽腸RouxenY吻合5例，結扎副肝管4例。結論仔細解剖、辨清三管關系是預防困難膽囊切除術并發癥的主要措施。
Objective To evaluate the coronary artery ostium obstruction caused by the commissure of transcatheter heart valve (THV) with the markers on THV under X-ray, which was identified by observing the position relationship between the commissure of THV and the coronary artery ostium from analyzing aortic root computed tomographic angiography (CTA) images after transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was performed on 25 patients undergoing TAVR who were checked with electrocardiographically gated CTA for the aortic root after the TAVR procedure between January 2020 and December 2021 in General Hospital of Northern Theater Command. The images of THV with the lowest position of non-coronary sinus and the right anterior oblique and caudal in most cases were observed when the THVs were deployed. The position relationships of the three markers on the THV after valve release were recorded, which were divided into three conditions, namely the three markers being averagely distributed, the middle marker being close to left, and the middle marker being close to right. Postoperative CTA images of the patients were analyzed. The angle between the commissure of THV and the coronary artery ostium was measured, and the angles in each group were presented as medium (lower quartile, upper quartile). Results A total of 17 patients were finally included. The angles between the commissure of THV and the left coronary artery ostium were 19.0 (16.0, 31.0)°, 36.0 (15.0, 44.0)°, and 3.0 (3.0, 5.0)° in the markers averagely distributed group (n=7), the middle marker close to left group (n=6), and the middle marker close to right group (n=4), respectively, which were significantly different (P=0.033). The angles between the commissure of THV and the right coronary artery ostium were 43.0 (25.0, 51.0)°, 47.0 (41.0, 57.0)°, and 13.0 (7.5, 21.0)° in the markers averagely distributed group, the middle marker close to left group, and the middle marker close to right group, respectively, which were significantly different (P=0.017). There was significant difference in the obstruction degrees of left coronary artery ostium by the commissure of THV (P=0.008), and no significant difference in the obstruction degrees of right coronary artery ostium (P=0.062). When the middle marker was close to right, there was no more than moderately obstruction on the right coronary artery ostium and no any obstruction on the left coronary artery ostium. When the middle marker was close to left, the obstruction rate of the left coronary artery ostium with more than moderate degree was 4/6 (66.7%) and it was 6/6 (100.0%) for the right coronary artery ostium. Conclusions The degree of coronary artery ostium obstruction by the commissure of THV can be accurately evaluated by using markers on THV. Among them, when the middle marker is close to right, the commissures of THV are least likely to block the coronary artery ostium.
Lumbar disc herniation (LDH) is one of the most important causes of back and leg pain, which seriously affects the quality of life of patients. As the first-line treatment for LDH, non-operative treatment can relieve 80% to 90% of symptoms among the patients with LDH. This guideline followed Guidelines for the Formulation/Revision of Clinical Treatment Guidelines in China (2022 edition) and WHO handbook for guideline development (2014 edition) to set up guideline working group. This guideline identified fourteen clinical questions through the literature review and clinical experts’ consensus. We drafted the recommendations after systematically searching and evaluating the evidence; delphi method was adopted for expert consensus on the preliminary recommendations, finally, 19 recommendations were made to guide non-operative treatments for LDH. This guideline can provide guidance for the clinical practice of Chinese and western orthopedics practitioners.