目的:討論側后方減壓融合術治療胸腰椎骨折的優缺點及臨床應用。方法:對12例胸腰椎骨折采用側后方減壓植骨融合術,經一個手術入路完成減壓及脊椎的穩定重建。 結果:12例病例隨訪13～36個月,術后無一例神經癥狀加重;6例術后原有神經癥狀明顯改善,2例2個月后神經癥狀開始恢復,3例無改善;12例均獲得骨性融合。 結論:側后方減壓融合術是治療胸腰椎骨折的較好方法。但其技術要求高,視野顯露有限,操作范圍較窄,易出血增加了手術難度。
目的 總結頸動脈損傷患者救治的臨床經驗。 方法 2003年1月－2006年6月，搶救5例頸動脈損傷患者。男3例，女2例；年齡21～35歲。其中左右頸總動脈各1例，左鎖骨下動脈2例，左椎動脈1例。合并損傷：左頸內靜脈貫通傷1例，左胸導管及交感神經損傷1例，食道損傷1例，左鎖骨骨折1例。受傷至入院時間20 min～3個月。受傷原因：刀刺傷3例，誤食縫衣針伴感染1例，車禍傷1例。采用血管吻合修復頸總動脈及椎動脈3根、側壁修補修復左鎖骨下動脈1根、左頸內靜脈1根及自體血管移植術修復左鎖骨下動脈1根。術中輸血量1 000～11 000 mL,平均3 800 mL。 結果 所有患者均搶救成功，傷口Ⅰ期愈合，經1～3年隨訪，無神經功能障礙。 結論 頸動脈損傷救治成功的關鍵在于盡早做出診斷，快速有效的急救及選擇正確的治療方法。
Objective To summarize the cl inical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities. Methods From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsal is pedis in 5 cases, and planta pedis in 4 cases. The defect area ranged from 9 cm × 6 cm to 15 cm × 13 cm. Nine cases compl icated by bone defect and 1 case by radial nerve defect. The time from injury to hospital ization was 1 hourto 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterial ized small saphenous vein in 1 case, nd with fibular or il ium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm × 8 cm to 16 cm × 15 cm. Skin defects at donor site were repaired with spl it thickness skin graft or sutured directly. Results All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or il ium, the bony heal ing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site. Conclusion The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feel ing recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.
Objective To investigate the number, distribution and characteristics of the treatment of epilepsy by vagus nerve stimulation (VNS) under China's three-grade diagnosis and treatment system from 2022 to 2023. Methods Researchers from the China Association Against Epilepsy (CAAE) conducted investigations on the number and distribution of epilepsy centers, as well as the number and distribution of VNS treatments for epilepsy from 2022 to 2023 through online and telephone surveys. Results A total of 435 epilepsy centers in China participated in the treatment of epilepsy by VNS under the three-grade system, among which 191 (43.91%) were in the eastern region. From 2022 to 2023, a total of 1 888 VNS procedures were carried out. Among them, 1 255 procedures (66.47%) were carried out in the eastern region; 1 253 procedures (66.37%) were carried out in third-level epilepsy centers, and 635 procedures (33.63%) were carried out in second-level epilepsy centers. Conclusions The promotion and application of VNS for the treatment of epilepsy under China's three-grade diagnosis and treatment system have achieved preliminary outcomes. However, there are still a regional imbalance in the VNS treatment and a shortage of abilities in primary epilepsy c enters.
Objective To explore the relation between stigma and substance use of patients with substance use disorder and explore the impact of learning addiction medicine massive open online course (MOOC) on patients’ stigma, depression and anxiety. Methods Patients with substance use disorder in Meishan Detoxification Center from January 11 to 18, 2020 were selected. The patients were randomly divided into control group and teaching group. Both groups participated in regular labor reform while the teaching group attended extra MOOC course. The general demographic data and the duration and amount of substance use were collected before intervention. Before and after intervention, all the patients completed scales including Chinese Version of Substance Use Stigma Mechanisms Scale (SUSMS-C), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). The correlation between stigma and depression, anxiety, substance use characteristics were analyzed, as well as the changes of stigma, depression and anxiety before and after MOOC intervention.Results A total of 78 patients were included, including 41 in the control group and 37 in the teaching group. There was no correlation between the scores of SUSMS-C and the duration or amount of substances use (P>0.05). SAS score and SDS score were positively correlated with the total score of stigma, internalized stigma, enacted stigma (family) and enacted stigma (healthcare providers) (P<0.05). SDS scores and SAS scores had no correlation with the anticipated stigma (P>0.05). After intervention, the total score of stigma, anticipated stigma (family) and anticipated stigma (healthcare providers) in the teaching group decreased (P<0.05). In the control group, only anticipated stigma (family) decreased (P=0.047). There was no significant difference in other SUSMS-C items, SAS scores, or SDS scores between the two groups before and after intervention (P>0.05). Conclusions Stigma may not be able to protect patients with substance use disorder from using substances. Instead, stigma may potentially cause negative emotional consequences like depression and anxiety. The addiction medicine MOOC can be used as an intervention to reduce the stigma of patients with substance use disorder.