目的:探討醫(yī)源性隱睪的病因,預(yù)防和治療特點(diǎn)。方法:回顧分析我院治療的16 例醫(yī)源性隱睪患兒,其中睪丸鞘膜積液術(shù)后7 例,腹股溝斜疝術(shù)后8 例,尿道下裂術(shù)后1 例。結(jié)果:16 例均接受手術(shù)治療,10 例睪丸存在不同程度的萎縮,其中1 例睪丸完全萎縮,行睪丸切除。術(shù)后隨訪(fǎng)12 例,睪丸均在陰囊內(nèi),但發(fā)育較健側(cè)差。結(jié)論:降低醫(yī)源性隱睪發(fā)病率的根本措施是防止其發(fā)生,盡量減少不正確的醫(yī)療行為,并做到早期發(fā)現(xiàn),早期行手術(shù)治療。
目的 探討膝關(guān)節(jié)脫位多發(fā)韌帶損傷急性期原位縫合的修復(fù)方法及近期療效。 方法 2006 年2 月- 2007 年11 月,對(duì)9 例單膝關(guān)節(jié)脫位患者采用原位縫合方法修復(fù)多發(fā)韌帶損傷。男6 例,女3 例。年齡34 ~ 52 歲。左膝4 例,右膝5 例。交通傷8 例,重物砸傷1 例。EMRI 和關(guān)節(jié)鏡檢均證實(shí)前、后交叉韌帶為止點(diǎn)撕脫性損傷。傷后至手術(shù)時(shí)間為4 ~ 7 d,平均5.1 d。 結(jié)果 術(shù)后患者均未發(fā)生關(guān)節(jié)內(nèi)感染。7 例切口Ⅰ期愈合;2 例出現(xiàn)切口皮下脂肪液化,經(jīng)對(duì)癥處理后愈合?;颊咝g(shù)后均獲12 個(gè)月隨訪(fǎng)。2 例患膝較健側(cè)屈曲缺失10°,患膝主動(dòng)屈伸范圍0 ~ 125°;其他患者患膝關(guān)節(jié)活動(dòng)度恢復(fù)正常。膝關(guān)節(jié)功能Lysholm 評(píng)分為83 ~ 92 分,平均86.3 分;獲優(yōu)3 例,良6 例。前、后抽屜試驗(yàn)Ⅰ度陽(yáng)性各3 例,Lachman 試驗(yàn)Ⅰ度陽(yáng)性5 例,內(nèi)、外翻試驗(yàn)均為陰性。 結(jié)論 對(duì)外傷性膝關(guān)節(jié)脫位多發(fā)韌帶損傷于急性期原位縫合修復(fù),固定可靠,同期可處理膝關(guān)節(jié)合并傷,近期療效滿(mǎn)意。
【摘要】 目的 探討關(guān)節(jié)鏡治療膝關(guān)節(jié)滑膜軟骨瘤病的療效?!》椒ā?005年1月—2009年10月,對(duì)23例(28膝)滑膜軟骨瘤病患者入院行X線(xiàn)片、關(guān)節(jié)活動(dòng)度檢查、視覺(jué)模擬評(píng)分以及Lysholm膝關(guān)節(jié)功能評(píng)分。根據(jù)鏡下所見(jiàn)分為表淺型6例,游離體型17例。結(jié)合病理學(xué)檢查行Milgram 分期,Ⅱ期16例,Ⅲ期7例。所有患者均行關(guān)節(jié)鏡下病變滑膜切除及游離體取出治療。 結(jié)果 所有患者均隨訪(fǎng)13~57個(gè)月,平均(32.3±6.7)個(gè)月,術(shù)后傷口均甲級(jí)愈合。術(shù)后(5.05±2.43) d恢復(fù)正常生活或工作。癥狀明顯改善21例(91.30%),部分改善2例(8.70%),對(duì)療效滿(mǎn)意23例(100%)。膝關(guān)節(jié)關(guān)節(jié)活動(dòng)度由術(shù)前的伸膝(14.29±16.34)°以及屈膝(106.07±35.83)°提高到術(shù)后的伸膝(1.79±2.79)°及屈膝(132.64±35.64)°,差異具有統(tǒng)計(jì)學(xué)意義(Plt;0.05)。負(fù)重行走時(shí)疼痛視覺(jué)模擬評(píng)分由術(shù)前的(3.81±2.02)分降低到術(shù)后的(0.37±0.65)分(Plt;0.05)。Lysholm評(píng)分由術(shù)前的(43.20±8.24)分升至術(shù)后6個(gè)月的(86.72±5.40)分(Plt;0.05);術(shù)后1年復(fù)診并檢查膝關(guān)節(jié)正側(cè)位X線(xiàn)片,均未見(jiàn)滑膜軟骨瘤體,所有患者無(wú)復(fù)發(fā)?!〗Y(jié)論 關(guān)節(jié)鏡下游離體取出術(shù)聯(lián)合病變滑膜切除術(shù)療效滿(mǎn)意,關(guān)節(jié)疼痛明顯減輕,功能恢復(fù),是一種治療膝關(guān)節(jié)滑膜軟骨瘤病確切有效的方法?!続bstract】 Objective To investigate the therapeutic effect of arthroscopic treatment on synovial chondromatosis. Methods A total of 23 patients (28 knees) with synovial chondromatosis were diagnosed and treated in our hospital from January 2005 to October 2009. All of the patients underwent radiographic imaging examination, knee joint range of motion (ROM), visual analogue scale (VAS) and Lysholm score. According to distinct arthroscopic appearance, superficial pattern was found in 6 patients and loose body lesion pattern was in 17. Additionally, combined with pathological examination, according to the Milgram staging,Stage Ⅱ was in 6 patients and Stage Ⅲ was in 7. Arthroscopic limited synovectomy and removal of loose bodies were performed on all the patients. Results The patients were followed up for 13-57 months with the mean of (32.3±6.7) months. The wound of all patients healed up. The time of returning to normal work and life was (5.05±2.43) days for average. The postoperative symptom was markedly alleviated in 21 patietns and partly alleviated in 2. All patients were satisfied with the therapeutic effect. The mean activity of knee joint was significantly different befoe and after the surgery (Plt;0.05) preoperative extension and flexion degrees were (14.29±16.34) and (106.07±35.83) degrees, respectively; postoperative extension and flexion degrees were (1.79±2.79) and (132.64±35.64) degrees (flexion) , respectively. The mean VAS score of weight bearing walking was 0.37±0.65 after theoperation and 3.81±2.02 before the peration; the difference was significantly different (Plt;0.05). The preoperative Lysholm knee score was 34-67 with the mean of 43.20±8.24, and the post-operative score was 71-99 with the mean of 86.72±5.40. There were differences in preoperative and post-operative scores (Plt;0.05) . Radiographic imaging examination of knee joint was performed 1 year after the opertation, no loose bodies was seen and no patients recurred. Conclusion The therapeutic effect of arthroscopic limited synovectomy and removal of loose bodies is good on synovial chondromatosis.
目的 比較股骨近端防旋髓內(nèi)釘(proximal femoral nail anti-rotation,PFNA)和動(dòng)力髖螺釘(dynamic hip screw,DHS)治療老年骨質(zhì)疏松患者合并粗隆間骨折的臨床療效。 方法 選取 2011 年 12 月—2014 年 12 月患有骨質(zhì)疏松合并粗隆間骨折老年患者共 72 例,根據(jù)手術(shù)所選內(nèi)固定的不同分為 PFNA 組(38 例)和 DHS 組(34 例)。對(duì)手術(shù)時(shí)間、術(shù)中失血量、術(shù)后負(fù)重時(shí)間、術(shù)后髖關(guān)節(jié) Harris 評(píng)分等指標(biāo)進(jìn)行組間對(duì)比分析。 結(jié)果 所有患者均獲隨訪(fǎng),隨訪(fǎng)時(shí)間 5~24 個(gè)月(平均 13.5 個(gè)月)。PFNA 組手術(shù)時(shí)間 [(40.25±24.23)min] 短于 DHS 組 [(72.65±34.65)min],術(shù)中失血量 [(136±56)mL] 低于 DHS 組 [(256±102)mL],術(shù)后負(fù)重時(shí)間 [(5.24±4.52)d] 早于 DHS 組 [(15.69±6.78)d],術(shù)后髖關(guān)節(jié) Harris 評(píng)分 [(80.23±10.26 分)] 高于 DHS 組 [(54.75±12.37 分)],差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。 結(jié)論 對(duì)于老年骨質(zhì)疏松伴有粗隆間骨折患者,采用 PFNA 治療手術(shù)時(shí)間短,創(chuàng)傷小,髖關(guān)節(jié)功能恢復(fù)優(yōu)于 DHS 治療,術(shù)后可使患者早期負(fù)重,從而提高生活質(zhì)量。
傘形評(píng)價(jià)中的文獻(xiàn)重疊會(huì)影響研究結(jié)論的可靠性和準(zhǔn)確性,產(chǎn)生偏倚風(fēng)險(xiǎn)較大的結(jié)果,因此評(píng)估文獻(xiàn)重疊程度以及如何處理文獻(xiàn)重疊變得非常重要。為了避免重復(fù)計(jì)算和減少偏倚風(fēng)險(xiǎn),研究者需要量化文獻(xiàn)重疊程度并采取相應(yīng)的處理策略。本文詳細(xì)介紹了文獻(xiàn)重疊程度的計(jì)算方法以及處理重疊文獻(xiàn)的不同策略,以期為國(guó)內(nèi)學(xué)者對(duì)該方法的理解和應(yīng)用提供參考和借鑒。