目的:探討單側經椎弓根基底部外側穿刺進針的可行性和安全性。方法:14例椎體壓縮性骨折經椎弓根基底外側穿刺進針,球囊擴張,骨水泥注入治療,使用VAS評分法評價患者疼痛變化,測定手術前后椎體前、中柱高度與Cobb角。結果:單側經椎弓根基底外側穿刺的手術均安全完成。VAS評分由術前平均(8.5±0.3)分改善到術后(2.2±0.2)分,隨訪三月為(2.1±0.4)分 (與術前比較,Plt;0.05); 椎體前緣高度由術前(13.6±2.3) mm到術后(24.5±2.2) mm,隨訪三月為(24.3±2.0) mm(與術前比較,Plt;0.05);錐體中部高度由術前(14.2±2.1) mm到術后(25.6±2.4) mm,隨訪三月為(25.4±2.2) mm(與術前比較,Plt;0.05); Cobb角由術前的(22.5±3.6)°到術后(10.5±3.0)°隨訪三月為(10.3±2.8)°(與術前比較,Plt;0.05)。結論:經椎弓根基底外側的單側穿刺錐體成形術可有效恢復骨質疏松性椎體壓縮性骨折椎體高度、緩解疼痛,是一種安全、有效的治療方法,值得推廣。
Objective To evaluate the physiological function and the anatomic structure of the first metatarsophalangeal joint for the patient withhallux valgus after a remodeling operation with the Keller’s method. Methods From April 2004 to November 2006, the first metatarsophalangeal joints in 11 patients (22 feet) with hallux valgus were remodeled with the Keller’s operation. There were 3 males and 8 females, aged 5173 years. Accordingto the Piggot typing standard, there were 17 feet of type Ⅱ (deflexion) and 5 feet of type Ⅲ (semiluxation). The hallux valgus angles(HVAs) were 2449° (average, 37°). The intermetatarsal angles (IMAs) were 90135° (average, 115°). The curative effect and the anatomic structure were evaluated by the followup and the Xray examination. Results All the cases werefollowed up for 6 to 30 months after operation (average, 14 months). According to the standard of ZHU Li Hua, et al, the results were excellent in 18 feet,good in 3 feet, and poor in 1 foot. The Xray films showed that the first meta tarsophalangeal joint of 14 feet developed mortarlike false articulation, and 8 feet developed partial false articulation. HVAs were 716° (average, 11°).IMAs were 90135° (average, 11.5°). According to the Piggot typing standard, there were 12 feet of typeⅠ(fitter) and 10 feet of type Ⅱ (deflexion). Conclusion For the patients with hallux valgus, the remodeling ofthe first metatarsophalangeal joint by the Keller’s operation can rectify HVA, improve the stability of the joints, and prevent occurrence of the insufficient muscle strength after operation.
Objective To retrospectively analyze the characteristics and death causes among the Wenchuan earthquake victims in The Third People’s Hospital of Chengdu so as to provide information for reducing mortality in future earthquake disasters. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, and the Emergency Room of the hospital through July 12. Microsoft EXCEL was used for data input and SPSS 13.0 was used for statistical analyses. Results Through July 12, 9 (1.57%) out of the 575 wounded patients died, comprising 3 males and 6 females. Of those, 5 died in the outpatient department. The death causes were all related to severe cerebral injuries. The other 4 died in the inpatient department and the death causes were related to severe underlying illnesses and infection. Conclusion Screening and early treatment for cerebral injuries is very important in the period directly following the earthquake. Later, more attention should be paid to the treatment of underlying illnesses as well as the prevention and control of infection.
Objective To analyze retrospectively the overall situation of medical rescue in the Third People’s Hospital of Chengdu after the Wenchuan earthquake, so as to provide references for the emergency preparedness for the disaster of earthquake. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the Hospital up to 8 a.m. of July 12. The software of Microsoft EXCEL was used for data input, and SPSS 11.5 was used for statistical analysis. Results Up to July 12, 563 cases from the disaster area had been treated in the hospital, of whom 249 were admitted into the outpatient department and 314 into the inpatient department, including 287 men and 276 women, with a median age of 42 years (28, 57) in the outpatient department and a median age of 46 years (33, 65) in the inpatient department. The inpatients’ age was older than the outpatients’s (P=0.003). Most outpatients were sent to the hospital within the first 3 days after the quake (73.50%), while less than half of the inpatients were sent to the hospital during this period of time. The wounded were mainly from Dujiangyan, Aba Prefecture and Pengzhou, which was correlated with the transportation distance, the casualty and the condition of the local hospitals. The wounded were mainly admitted into the Departments of Orthopaedics (69.3%), Neurosurgery (15.6%) and General Surgery (3.7%). The total cost in the Department of Orthopaedics was the highest, followed by the Intensive Care Unit (ICU) and the Department of Neurosurgery. However, the median cost in the ICU was the highest, followed by the Department of Neurosurgery and the Department of Nephrology. Only 9 out of the 563 patients died, including 5 outpatients and 4 inpatients, of whom 8 deaths were due to craniocerebral injury and 1 died of crush syndrome. Conclusion Based on the data, it is of vital importance to develop an emergent plan for the medical rescue after an earthquake disaster, and to strengthen the reserve of medical supplies, personnel training, scientific field triage as well as the construction of information platforms.
Objective To compare the effectiveness of three surgical methods in the treatment of Pauwels type Ⅲ femoral neck fracture in young and middle-aged patients, in order to provide reference for clinical selection of appropriate surgical methods. Methods The clinical data of 103 patients with Pauwels type Ⅲ femoral neck fracture who met the selection criteria between June 2018 and December 2021 were retrospectively analyzed. The fractures were fixed with hollow screws in an inverted triangular shape (37 cases, hollow screw group), hollow screws in an inverted triangular shape combined with eccentric shaft screw (34 cases, eccentric shaft screw group), and hollow screws in an inverted triangular shape combined with medial support plate (32 cases, support plate group). There was no significant difference in age, gender, cause of injury, body mass index, time from injury to operation, side of the fracture, and Garden classification, whether they were in traction preoperatively, and other baseline data between groups (P>0.05). The operation time, intraoperative blood loss, the number of fluoroscopy, the length of hospital stay, early postoperative complication and postoperative weight-bearing time of the three groups were recorded. Harris score was used to evaluate joint function at 6 and 12 months after operation, and the difference between the two time points (change value) was calculated for comparison between groups. X-ray films were reviewed to evaluate the quality of fracture reduction (Garden index) and healing, as well as the occurrence of internal fixation failure and femoral head necrosis. Results The patients of the three groups were successfully completed. Compared with the hollow screw group and the eccentric shaft screw group, the operation time and intraoperative blood loss of the support plate group significantly increased, the number of fluoroscopy reduced, and the quality of fracture reduction was better, the differences were significant (P<0.05 ). The operation time, intraoperative blood loss, and the number of fluoroscopy of the hollow screw group were less than those of the eccentric shaft screw group, the differences were significant (P<0.05). There was no significant difference in the length of hospital stay between groups (P>0.05). All patients in the three groups were followed up 21-52 months, with an average follow-up time of 36.0 months, and there was no significant difference between groups (P>0.05). The incisions of all patients healed by first intention. Imaging reexamination showed that there was no significant difference in the incidence of fracture nonunion between groups (P>0.05). The fracture healing, partial weight-bearing, and full weight-bearing were significantly earlier in the eccentric shaft screw group and the support plate group than in the hollow screw group (P<0.05). There was no significant difference in change value of Harris score, the incidence of postoperative deep venous thrombosis and femoral head necrosis between groups (P>0.05); however, the incidence of internal fixation failure in the support plate group and the eccentric shaft screw group was significantly lower than that in the hollow screw group (P<0.05). The incidence of postoperative lateral thigh irritation in the support plate group was significantly lower than that in the hollow screw group (P<0.05); there was no significant difference between the eccentric shaft screw group and the other two groups (P>0.05). The overall incidences of postoperative complications in the eccentric shaft screw group and the support plate group were significantly lower than that in the hollow screw group (P<0.05). Conclusion For young and middle-aged patients with Pauwels type Ⅲ femoral neck fracture, compared with simple hollow screw fixation in an inverted triangular shape, combined with medial support plate or eccentric shaft screw internal fixation can shorten the fracture healing time, reduce the incidences of postoperative complication, more conducive to early functional exercise of the affected limb; at the same time, the operation time and blood loss of combined eccentric shaft screw internal fixation are less than those of combined medial support plate internal fixation, so the hollow screw in an inverted triangular shape combined with eccentric shaft screw fixation may be a better choice.
目的 利用磁共振彌散張量成像技術(DTI)對右側難治性顳葉癲癇(TLE)患者術前及術后腦白質各向異性分數(FA)進行縱向隨訪研究,并對其與病程等臨床癥狀之間的相關性進行分析,探討右側TLE患者的腦白質FA變化模式。 方法 2008年7月-2009年8月納入10例右側難治性TLE患者。對每個受試者采用GE 3.0 T磁共振及8通道頭線圈掃描,所有DTI圖像通過單次回波平面成像序列采集。采用基于體素分析的SPM8軟件對受試患者術前術后FA圖進行配對t檢驗,觀察難治性TLE患者腦白質變化模式。采用Pearson相關計算FA變化幅度與病程等臨床癥狀之間的相關性,經比較校正后P值<0.05的區域為有統計學意義的區域。 結果 右側TLE患者FA值降低的區域包括左側顳下回、雙側額中回及左側殼核、右側楔葉。FA升高的區域包括左側海馬旁回、左側顳葉、右側額下回和左側中央旁小葉。相關分析發現,右側TLE患者右側額下回FA變化值與發病年齡呈負相關,左側顳下回FA變化值與術后隨訪間隔時間呈負相關。 結論 右側難治性TLE患者手術治療后大腦白質變化不僅局限于顳葉,還涉及顳葉外結構。