目的:評價經皮激光椎間盤減壓術(Semiconductor Percutaneous Laser Disc Decompression,PLDD)治療椎間盤源性腰痛的療效。方法:對我院采用SPLDD治療d的56例進行回顧性分析。經皮激光椎間盤減壓術(PLDD)治療椎間盤源性腰痛56例(70個椎間盤),每只椎間盤需激光能量如下:L3～4、L5～S1為:1 200～1 400J;L4～5為1300～1500J。比較手術前后疼痛強度數字等級 (pain intensity numerical rating scale, PINRS)評分,進行療效觀察和評定術后根據癥狀緩解程度。結果:隨訪3月為(2.1±0.4)分 (與術前比較,Plt;0.05);本組56例病例中,PINRS評分由術前平均(8.0±0.3)分改善到術后(2.0±0.2),共39例,占69.6%;(9.0±0.5)分改善到術后(4.0±0.6)共17例,占30.4%。未見椎間盤炎及其他并發癥發生。手術時間15～60m in,平均30 m in。結論:SPLDD治療椎間盤源性腰痛安全、有效、微創,值得推廣。
目的 研究組織工程骨結合帶鎖髓內釘修復成年山羊大段負重骨缺損的可行性，探索更可行的技術路徑。 方法 將24只成年山羊，通過骨髓穿刺法獲取山羊骨髓間充質干細胞（BMSC），將體外擴增及成骨定向誘導的第2代BMSC與同種異體脫鈣骨基質（DBM）通過雙相接種法構建組織工程骨。24只成年山羊，以帶鎖髓內釘構建股骨中段3 cm骨缺損模型。隨機分為3組，每組8只。實驗組以組織工程骨修復骨缺損，對照組單獨使用DBM和空白組曠置。術后1、12、24周行X線片觀察及評分，12、24周每組各處死4只動物行組織學觀察和生物力學檢測。 結果 標本大體觀察示實驗組和對照組術后12周骨缺損部位被骨痂連接，髓腔貫通，24周全部愈合；實驗組24周恢復正常解剖形態，對照組外形仍然粗糙、不規則；空白組術后12周及24周缺損部位均為纖維組織充填。術后1周各組X線評分無明顯差異（P＞0.05），實驗組術后12周及24周X線評分均優于對照組和空白組，對照組優于空白組，各組24周X線評分均高于12周時，差異均有統計學意義（P＜0.05）。實驗組術后12、24周的最大抗扭強度分別達正常側的47.07% ± 5.05%和83.73% ± 2.33%，顯著高于對照組和空白組（P＜0.05）；空白組2個時間點最大抗扭強度均不超過正常的15%，與骨不連時的纖維連接相符。組織學檢查示術后12周實驗組和對照組骨缺損區DBM支架材料基本被吸收，有典型的同心圓排列的哈弗系統形成，周圍偶見淋巴細胞；術后24周，實驗組和對照組股骨缺損均被修復，但實驗組較對照組的新骨更多、骨塑形更好；空白組術后24周骨缺損區中央仍為纖維組織填充。 結論 組織工程骨結合帶鎖髓內釘能夠更有效修復成年山羊負重骨大段骨缺損，滿足負重骨的生物力學要求。
Objective To investigate a new surgical approach for presacral lesion by double door via S3- 5. Methods From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feel ing in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormal ity in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size ofthe lesions was 4 cm × 3 cm × 3 cm - 20 cm × 15 cm × 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S3-5. Results The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occured during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occured. During the followed-up period of 6-13 months, no sacrum defect, pelvic instabil ity and sacroil iitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. Conclusion The approach of double door via S3-5 is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.
Objective To investigate the inpatient’s disease and cost constitution of the Third People’s Hospital of Chengdu in 2009, so as to provide baseline data for further research. Methods The case records of inpatients in the Third People’s Hospital of Chengdu in 2009 were collected, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis and hospitalization expense etc. were rearranged and analyzed using Excel software. Results a) The total number of inpatients was 1 220, and male was more than female. The disease spectrum included 12 categories. b) A total of 1 093 inpatients suffered from the top 3 systematic diseases as follows: trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. c) According to ICD-10, the top 9 diseases of trauma and toxicosis were injuries to the wrist and hand, injuries to the hip and thigh, injuries to the knee and lower leg, injuries to the shoulder and upper arm, injuries to the lower back, lumbar spine and pelvis, injuries to the elbow and forearm, injuries to the thorax, injuries to the neck and injuries to the ankle and foot; the top 4 diseases in musculoskeletal system and connective tissue disorders were dorsopathies, soft tissue disorders, arthrosis, and osteopathies and chondropathies; among the factors affecting health and resulting from contact with health care institutions, removal of fracture fixation device. d) According to ICD-10 (list of three-digit catalogue and four-digit sub-catalogue), the top 5 single diseases in trauma and toxicosis were muscle and tendon injuries of the wrist and hand, intertrochanteric frature, fracture of the femoral neck, fracture of the tibia and fibula, and fracture of the lumbar spine; the top 5 single diseases in musculoskeletal system and connective tissue disorders were lumbar disc herniation, spondylosis, arthrosis of the knee, osteoporosis with pathological fracture, and osteonecrosis. e) The average hospital stay were 23.55 days, and the average cost per capita were 13 073.73 yuan which were constituted by material cost, drug cost including western and Chinese medicines, treatment expenses including blood transfusion fee, operation expenses including anesthetic fee, examination expenses including radiation fee and laboratory fee, bed fee and others. The inpatient costs were mainly at patient’s own expense, nearly a half of those expenses were paid by social security, and public medical care only accounted for less than 3% of the total payment. Conclusion In 2009: a) The male inpatients were mainly the young and middle-aged, and the female were the elderly. The main 3 systematic diseases were trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. b) The top 3 single diseases were lumbar disc herniation, muscle and tendon injuries of the wrist and hand, and intertrochanteric fracture. Except lumbar disc herniation, the other 2 single diseases were mostly seen in male rather than in female. c) The average hospital stay was 23.55 days. The overall costs were mainly constituted by material and drug cost (59.25%), with rationality worthy of attention. d) Inpatient costs were mainly at patient’s own expense or paid by social security, and the proportion of public medical care was low in the payment.
Objective To retrospectively analyze the long-term effectiveness of percutaneous laser disc decompression (PLDD) in treatment of cervical spondylosis. Methods Between March 2003 and June 2005, 156 patients with cervical spondylosis were treated with PLDD. There were 74 males and 82 females with an average age of 55.4 years (range, 31-74 years). The disease duration varied from 2 months to 15 years. Fifty-nine patients were classified as cervical spondyloticradiculopathy, 48 as vertebral-artery-type cervical spondylosis, 19 as cervical spondylotic myelopathy, and 30 as mixed type spondylosis. The lesions were located at the levels of C3,4 in 32 discs, C4,5 in 66 discs, C5,6 in 89 discs, and C6,7 in 69 discs, and including 71 one-leve lesion and 85 multi-level lesions. All cases were followed up to study the long-term effectiveness and correlative factors. Results A total of 117 (75%) patients’ symptoms were l ightened or eased up immediately after operation. Discitis occurred in 1 case at 3 days after operation and was cured after 3 weeks of antibiotic use. All patients were followed up 5 years to 7 years and 3 months (5 years and 6 months on average). According to Macnab criteria, the long-term effectiveness was excellent in 60 cases (38.46%), good in 65 cases (41.67%), fair in 19 cases (12.18%), and poor in 12 cases (7.69%); the excellent and good rate was 80.13%. No significant difference was observed in the wedge angels and displacements of the intervertebral discs between before and after operations (P gt; 0.05). Multiple-factors logistic regression showed that the disease duration and patient’s age had obvious relationship with the effectiveness of treatment (P lt; 0.05), while the type of cervical spondylosis, disc protrusion degree, mild cervical instabil ity, and lesion scope had no correlation with the effectiveness of treatment (P gt; 0.05). Conclusion PLDD is safe and effective in treatment of cervical spondylosis with less compl ication. There is no impact on the stabil ity in cervical spinal constructs. The disease duration and patient’s age have obvious impact on the long-term effectiveness of treatment. The type of cervical spondylosis, disc protrusion degree, cervical instabil ity, and lesion scope are not the correlative factors.
Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.