【摘要】 目的 對比玻璃體手術和鞏膜環扎術對治療非復雜性孔源性視網膜剝離（rhegmotogenous retinal detachment，RRD）的療效。 方法 檢索Pubmed、Embase、Cochrane對照試驗中心注冊數據庫，對相關的隨機對照臨床試驗（randomized controlled trialc，RCT）按Cochrane協作網推薦的方法進行Meta分析。 結果 有晶狀體組包括3篇RCT共523例，人工晶狀體/無狀晶體組包括4篇RCT共690例。有晶狀體組玻璃體手術（pars plana vitrectomy，PPV）術后白內障的發生率更高[OR=4.18，95%CI（2.75，6.35），Plt;0.000 01]。人工晶狀體/無晶狀體組PPV術后最終解剖復位率更高[OR=1.97，95%CI（1.04，3.73），P=0.04]。 結論 鞏膜環扎術通過降低術后白內障的發生率在治療非復雜性有晶狀體眼RRD中占有優勢；PPV可提高最終解剖復位率，更適合人工晶狀體/無晶狀體眼RRD。【Abstract】 Objective To compare the efficacy of pars plana vitrectomy (PPV) and scleral buckling (SB) in treating uncomplicated rhegmatogenous retinal detachment (RRD). Methods Randomized controlled trials (RCTs) were searched from Pubmed, Embase and the Cochrane Central Register. Meta-analysis was conducted using the methods recommended by the Cochrane Collaboration. Results Three RCTs with 523 phakic eyes and four RCTs with 690 pseudophakic/aphakic eyes were included. In the phakic group, the rate of postopertative cataract was higher with PPV [OR=4.18, 95% CI (2.75,6.35), Plt;0.000 01]. In the pseudophakic/aphakic group, final anatomic success outcome was in favor of PPV [OR=1.97, 95% CI (1.04,3.73), P=0.04]. Conclusions SB results better in terms of postoperative cataract in phakic RRDs. PPV is more likely to achieve a favorable final reattachment in pseudophakic/aphakic RRDs.
Objective To investigate the radiological features of degenerative cervical kyphosis (DCK) and the relationship between cervical sagittal parameters. Methods The quality of life scores and imaging data of 89 patients with DCK treated between February 2019 and February 2022 were retrospectively analysed. There were 47 males and 42 females, with an average age of 48.4 years (range, 25-81 years). Quality of life scores included visual analogue scale (VAS) score and neck disability index (NDI). The imaging data included C0-C2 angle, C2-C7 angle, C3-C7 inclination of zygapophyseal joints, C7 slope (C7S), cervical sagittal vertical axis (cSVA), kyphosis range, and kyphosis focal. The patients were grouped by gender, and the differences of the above parameters between the two groups were compared. Pearson correlation was used to analyze the relationship between age, quality of life scores, and cervical sagittal parameters, and the relationship between cervical sagittal parameters. Results The preoperative VAS score was 0-9 (mean, 4.3); NDI was 16%-44% (mean, 30.0%). There was no significant difference in VAS score and NDI between male and female groups (P>0.05). The kyphosis range of cervical spines was C3-5 in 3 cases, C3-6 in 41 cases, C3-7 in 30 cases, C4-6 in 4 cases, C4-7 in 10 cases, C5-7 in 1 case, and the kyphosis focal was mostly located between C4-C5 (78/89, 87.64%). The C3-C7 inclination of zygapophyseal joints were (60.25±5.56)°, (55.42±5.77)°, (53.03±6.33)°, (58.39±7.27)°, and (64.70±6.40)°, respectively. The C0-C2 angle, C2-C7 angle, C7S, and cSVA were (–23.81±6.74)°, (10.15±2.94)°, (15.31±4.59)°, and (2.37±1.19) mm, respectively. The C7S and cSVA of males were significantly larger than females (P<0.05), with no significant difference in other parameters between male and female groups (P>0.05). VAS score and NDI were negatively correlated with C0-C2 angle (P<0.05), and positively correlated with C2-C7 angle and cSVA (P<0.05); VAS score was negatively correlated with C7S (P<0.05). Except VAS, NDI and all cervical sagittal parameters were affected by age. Age was positively correlated with NDI, C7S, and cSVA (P<0.05), and negatively correlated with C0-C2 angle and C2-C7 angle (P<0.05). The correlation analysis of cervical sagittal parameters showed that C0-C2 angle was negatively correlated with C2-C7 angle and cSVA (P<0.05); C7S was negatively correlated with C2-C7 angle (P<0.05) and positively correlated with cSVA (P<0.05). There was no correlation among other parameters (P>0.05). ConclusionThe inclination of zygapophyseal joints of cervical spines of DCK patients is U-shaped in the kyphosis range, and the inclination at the kyphosis focal is the smallest. When cervical degenerative kyphosis occurs, in addition to the interaction of sagittal parameters, age, gender, neck pain, and dysfunction will also affect the cervical sagittal balance. Furthermore, cervical curvature and morphological changes are not purely local problems.