Objective To evaluate the clinical effect of vacuum sealing drainage (VSD) technology in the treatment of high perianal abscess. Methods A total of 38 cases of high perianal abscess who underwent surgery in our hospital from May. 2014 to Feb. 2016 were randomly divided into 2 groups: the VSD group (n=19) and the control group (n=19). The cases of VSD group were performed with closure of internal orifice+VSD technique, and the cases of control group were treated with radical operation of perianal abscess (low incision combined with high thread operation). The following indexes of cases in 2 groups were compared and analyzed, including postoperative pain score, wound healing time, postoperative anal function score, and prognosis. Results There were significant differences in pain score (3.53±0.70vs. 5.11±0.74), postoperative anal function score (0vs. 1), and wound healing time〔(27.58±4.95) dvs. (44.68±6.53) d〕between VSD group and control group,P<0.05. Compared with the control group, the pain score and anal function score of the VSD group were both lower, and the wound healing time was shorter. However, there was no statistically significant difference in incidence of fistula between the two groups〔5.3% (1/19)vs. 15.8% (3/19),P=0.60〕. Conclusion In the treatment of high perianal abscess, VSD technology can relieve pain in patients, shorten the wound healing time, protect the anal function, and the prognosis is as well as low incision combined with high thread operation, so VSD is a better treatment method for high perianal abscess.
Objective To analyze the effect of stump-preserving repair on rotator cuff healing and shoulder function for degenerative total rotator cuff tears. Methods A clinical data of 152 patients with degenerative total rotator cuff tears, who underwent arthroscopic repair between April 2019 and May 2022, was retrospectively analyzed. There were 76 males and 76 females with an average age of 55.4 years (range, 24-78 years). MRI was performed at 6 months postoperatively to evaluate the rotator cuff healing according to the Sugaya classification. Pre- and intra-operative related factors were included for univariate analysis, including age (≥60 years/<60 years), gender (male/female), passive activity disorder (yes/no), disease duration (≤3 months/>3 months), stump-preserving repair (yes/no), use of suture bridge technique (yes/no), shoulder joint abduction angle at knotting (<45°/≥45°), acromioplasty (yes/no), glucocorticoid injection (yes/no), time for patients to start postoperative passive exercise (≤2 weeks/>2 weeks), and time for patients to start postoperative active exercise (≤3 months/>3 months). The influencing factors of tendon healing were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. Two sets of data were balanced by propensity score matching. The American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score of shoulder joint function at 6 and 12 months postoperatively, as well as rotator cuff healing rate at 6 months postoperatively, were compared between groups based on whether or not stump-preserving repair was used. Results All patients were followed up 12-33 months (mean, 23.8 months). MRI at 25-31 weeks postoperatively showed the 121 cases of rotator cuff healing and 31 cases of non healing. Univariate analysis showed that the disease duration, stump-preserving repair, shoulder joint abduction angle at knotting, and the time for patients to start postoperative active exercise were the influencing factors of rotator cuff healing (P<0.05). Multivariate analysis showed that non-stump-preserving repair, shoulder abduction angle more than 45° at knotting, and the time to start active exercise within 3 months postoperatively were risk factors affecting rotator cuff healing (P<0.05). A total of 51 pairs of cases were matched based on the grouping criteria of whether the disease duration exceeded 3 months, whether the shoulder abduction angle at knotting exceeded 45°, and whether the time to start postoperative active exercise exceeded 3 months. The rotator cuff healing rate, ASES score, and Constant-Murley score of the preserving repair group at 6 months postoperatively were superior to those of the non-preserving repair group, and the differences were significant (P<0.05). There was no significant difference in ASES score and Constant-Murley score between the two groups at 12 months postoperatively (P>0.05). Conclusion For degenerative total rotator cuff tears, the stump-preserving repair can shorten the healing time and promote the shoulder function recovery, but has no significant effect on shoulder function at 1 year postoperatively.
目的 探討魚膽汁對兔腎臟的影響及其機制。 方法 將實驗新西蘭大耳白兔隨機分為灌胃組（GP組，n=19）與靜脈注射組（VI組，n=15），根據體重分別按3 mL/kg、0.3 mL/kg的劑量通過灌胃或耳緣靜脈注射方式給予魚膽汁。采集魚膽汁處理前與處理后1～5 h的血標本，測定腎功能、酸堿平衡及電解質指標，記錄GP組每個采樣點前20 min尿量及魚膽汁處理前、處理后5 h的尿常規。魚膽汁處理后5 h處死動物取腎做病理學檢查。 結果 給予一定量魚膽汁后5 h內，兩組兔血肌酐（Scr）、尿素氮、K+呈升高趨勢（P均＜0.05），而血HCO3?濃度呈下降趨勢（P＜0.05），其中VI組兔Scr、血K+改變早于GP組。GP組記錄尿量明顯下降，尿pH值升高，蛋白定量試驗、隱血試驗結果均呈陽性。兩組兔腎組織病理檢查均顯示腎小球血管充盈，少量中性粒細胞浸潤；腎小管水腫及間質充血，部分有局灶性出血，腎間質損傷較腎小球更為嚴重。 結論 無論經由消化道還是血管給予實驗兔魚膽汁均可導致急性腎功能損傷，與魚膽汁造成急性腎實質損傷、特別是腎小管間質損傷有關。