Granular Cell Tumor of the Esophagus: A Patient Treated by Endoscopic Mucosal Resection with Long Term Follow-Up

Granular cell tumors (GCTs) of the esophagus are uncommon. We report a case of granular cell tumor of esophagus treated by endoscopic mucosal resection (EMR) with long term follow-up.

Long Term Follow-Up Results of a Fractional Radio Frequency Ablative Treatment of Acne Vulgaris and Related Acne Scars

Introduction: Acne vulgaris and acne scarring are prevalent conditions that can have a negative effect on a patient’s quality of life. Fractional radiofrequency technologies have been shown to be clinically safe and effective in managing acne scars through dermal remodeling without causing direct damage to the epidermis. In a recently published study, we presented our clinical and histological results in the treatment of patients with active acne and acne related scarring using a Fractional RF (FRF) device. In the current article we demonstrate long term follow-up results, up to two years post last fractional treatment. Methods: Four out of the eight patients who completed a four treatment regimen were invited for long term follow-up visit to document treatment results. In some cases, touch-up treatments were conducted to optimize clinical results. Results: Patients demonstrated significant improvement of acne lesions, acne scarring, pores and skin texture. Long term photos demonstrated that clinical improvement progressed with time. Conclusion: The current study further supports the previous findings that FRF is a safe and effective treatment modality for active acne and acne related scars. Treatment protocol can be customized according to patient needs and clinical results last for long term.

Long-term results of laparoscopic fenestration for patients with congenital liver cysts

BACKGROUND: The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results after laparoscopic fenestration. METHODS: A retrospective study was performed on 44 patients with congenital liver cysts who had undergone laparoscopic fenestration between June 1998 and December 2004. Among them, 30 were women and 14 men, aged 57 years on average (range 18-76 years). While 14 patients had solitary cysts, 20 had multiple cysts, and 10 had polycystic liver disease. The results of laparoscopic fenestration, including mortality, morbidity, mean postoperative hospital stay, and recurrences of cysts were evaluated. RESULTS: There was no perioperative death and the morbidity rate was 11% (5/44). All complications were treated conservatively. The mean postoperative hospital stay was 4 days. A mean follow-up of 57 months showed that the rates of cyst recurrence and symptom recurrence were 9% and 4.5%, respectively. CONCLUSION: Laparoscopic fenestration as a feasible and safe treatment procedure for patients with congenital liver cysts can yield very good long-term results.

Long-term results of Ahmed glaucoma valve implantation in Egyptian population

AIM： To evaluate the long-term results and complications of Ahmed glaucoma valve （AGV） implantation in a cohort of Egyptian patients. METHODS： A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure （lOP） measurement before surgery and at ld, weekly for the 1st month, 3, 6mo, and ly after surgery and yearly afterward for 5y. lOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as lOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS： Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery, lOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes （41.1%）, complicated cataract in 9 eyes （7.25%）, recessed tube in 8 eyes （6.45%）, tube exposure in 6 eyes （4.8%） and corneal touch in 6 eyes （4.8%）. Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes （1.6%）. ~ CONCLUSION： Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful lOP control after AGV implantation. However, effective complications management can improve the rate of success.

Long-term survival after enucleation of a giant esophagea gastrointestinal stromal tumor

Gastrointestinal stromal tumors(GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. Less than 1% occurs in the esophagus. Surgery is the primary treatment for patients with GISTs. We report a29-year-old male was admitted after the detection of a posterior mediastinal mass during work-up with routine examination. He did not have any disease-related symptoms. The physical examination was unremarkable. Chest computed tomographic scan, the barium esophagogram and endoscopic esophageal ultrasound showed benign neoplasm. The patient was performed an enucleation surgery through the right posterolateral thoracotomy. The pathology revealed a 13.0 cm × 12.0cm × 5.0 cm mass. The tumor was CD117(C-kit), PDGFRA and DOG1 positive. These findings were consistent with a GIST of the esophagus. So the diagnosis of GIST of esophagus was confirmed. The pathological diagnosis of low grade of GIST of esophagus was confirmed. The patient has no evidence of recurrence and is in good clinical conditions up-to date, five years after surgery.

A Long-Term Study of Efficacy of Patients with Macular Edema Secondary to BRVO Treated with Ranibizumab Combined with Compound Salvia

Purpose: To study the long-term efficacy of intravitreal ranibizumab injection combined with in-travenous compound salvia injection drip in the treatment of patients with macular edema sec-ondary to branch retinal vein occlusion(BRVO). Methods: Sixty-five patients of branch retinal vein occlusion with macular edema were analyzed retrospectively. Thirty-seven patients in the treat-ment group were treated with ranibizumab injection combined with intravenous compound salvia injection drip, twenty-eight patients in the control group were treated with ranibizumab injection only. All patients were recorded and analyzed changes of clinical efficacy after 3 months, 6 months after a course of treatment of 6 months. Results: During 3 months after 6 months’ treatment, there were 5 patients having recurrence in the treatment group, while there were 9 in control group, the rate of recurrence between the two groups had significant difference (P < 0.05);during 3 - 6 months after a course of treatment, there were 2 patients having recurrence in the treatment group, while there were 4 in control group, the rate of recurrence between the two groups had significant difference (P < 0.05);however, the treatment group’s BCVA was better than control group, and the difference between the two groups had significance (P < 0.05). Conclusion: Ranibizumab injection combined with intravenous compound salvia injection drip could effectively reduce the impossibility of recurrence, improve the visual activity and bring better therapeutic efficacy in patients with macular edema secondary to branch retinal vein occlusion. The treatment showed great potential in the clinical use.

Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy

Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.

Spouses Who Donate Seem to Be the Winners – A Questionnaire Study of Kidney Donors Long-Term

Background:Living donor kidney transplantations have been performed at Sahlgrenska University Hospital in Gothenburg, Sweden since 1965. In this study we wanted to explore the living kidney donor’s long-term experiences of the donation. Methods: Of 1110 consecutive living donors throughout 1965-2005, 823 were available for our questionnaire study. Results:Totally 692 replied to the questionnaire, 65% were females. The most common relation to the recipients was siblings (284), parents (262) and spouses (96). Time since donation was median 15 years (2 - 43). The initiative to donate came from the donors themselves in 69%. The dominating motives for donation were a wish to help, worries about the recipient not receiving a transplant and the knowledge that one could live a normal life with one kidney. The majority of the donors, felt well informed about potential risks both short-term and long-term. Depression post donation was reported by few donors, 2.3% and persisting pain by 4.3%. Comparisons between sibling donors and spouse donors show a significant difference (p Conclusions:Our study shows that the donor population is in good psychosocial health. It is a positive progress that spouses can be living kidney donors - they seem to be the winners.

Adult Congenital Lumbar Kyphosis Requiring Anteroposterior Correction and Fusion: A Case Report with 32-Year Follow-Up

Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.

Long-Term Follow-Up of Chinese Herbal Medicines Combined with Conventional Treatment in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Multicenter Randomized Controlled Trial

Objective： To evaluate the prognosis effect of Chinese herbal medicines（CHMs） for benefiting qi and activating blood circulation adjunctive to conventional treatment in patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods： A total of 702 patients with ACS who underwent PCI were enrolled and randomly assigned to receive conventional treatment plus CHMs for benefiting qi and activating blood circulation（treatment group, 351 cases） or conventional treatment alone（control group, 351 cases） for 6 months. Six months later, all patients received conventional treatment alone. Follow-ups were scheduled at 6th, 12 th, 18 th, 24 th month after enrollment in April 2008, and the final follow-up visit was during September 2011 and November 2011. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction or revascularization（PCI or coronary artery bypass grafting）; and the secondary endpoint was the composite of re-admission for ACS, congestive heart failure, nonfatal stroke or other thrombus events. Results： A total of 621（88.59%） patients completed 35.4±3.8 months follow-up, while 80（11.41%） patients withdrew from the trial（41 in the treatment group and 39 in the control group）. The incidence of primary endpoint was 5.7%（20 patients） in the treatment group versus 10.86%（38 patients） in the control group [relative risk（RR）： 0.53; 95% confidence interval（CI）： 0.30, 0.88; P=0.013; absolute risk reduction（ARR）： –0.052, 95% CI： –0.06, 0.01]. The incidence of secondary endpoint was 5.98%（21 patients） in the treatment group versus 10.28%（36 patients） in control group（RR： 0.58, 95% CI： 0.33, 0.97, P=0.037; ARR： –0.043, 95% CI： 0.06, 0.01）. Most of the primary and secondary endpoints were occurred in 18 months（84.50% in the treatment group versus 78.10% in the control group）. Conclusion： CHMs for benefiting qi and activating blood circulation adjunctive to conventional treatment improved clinical outcomes for patients with ACS after PCI in long-term follow-up.

耳穴压豆联合精细化随访管理对早期肺癌患者术后慢性疼痛的影响

目的观察耳穴压豆联合精细化随访管理对早期肺癌患者术后慢性疼痛心理灵活性、健康感知及睡眠质量的影响。方法选取2022年1月—2023年7月于南昌大学第一附属医院进行手术的80例早期肺癌术后长期慢性疼痛患者为研究对象,按照组间基本特征具有可比性的原则分为对照组与观察组,每组40例。对照组患者进行常规护理,观察组患者在对照组基础上进行耳穴压豆联合随访管理。两组患者采用视觉模拟评分法(VAS)于干预前及干预后1周、4周、12周评定疼痛度;于干预前后使用接纳与行动问卷第2版(AAQ-Ⅱ)及认知融合问卷(CFQ)进行联合评估心理灵活性;于干预前后使用健康感知量表(HPQ)评估健康感知;使用睡眠状况自评量表(SRSS)评估睡眠质量;于干预前后使用简明健康调查问卷(SF-36)评估生活质量。结果两组患者干预前、干预后1周、干预后4周、干预后12周VAS评分逐渐下降,时间比较差异有统计学意义(P_(时间)<0.05);干预后的1周、4周、12周观察组VAS评分低于对照组,组间比较差异有统计学意义(P_(组间)<0.05);随着观察时间延长,组间差距逐渐增大,差异有统计学意义(P_(交互)<0.05)。干预后,观察组AAQ-Ⅱ、CFQ评分低于对照组,差异有统计学意义(P<0.05)。干预后,观察组患者健康状况、健康史、健康展望、健康担忧、对疾病的态度及对疾病的抵御能力评分高于对照组,差异有统计学意义(P<0.05)。干预后,观察组患者SRSS评分低于对照组,差异有统计学意义(P<0.05)。干预后,两组患者社会功能及情感职能评分比较差异无统计学意义(P>0.05),但观察组患者生理机能、生理职能、躯体疼痛、一般健康状况、活力、精神健康维度评分高于对照组,比较差异有统计学意义(P<0.05)。结论耳穴压豆联合精细化随访管理干预运用于早期肺癌患者术后长期慢性疼痛中,可降低患者疼痛感,提高心理灵活性,调节健康感知水平,改善患者的生活质量及睡眠质量。

急性心肌梗死3526例的远期预后分析

目的探讨急性心肌梗死(AMI)患者远期死亡的影响因素。方法收集2007年1月至2018年12月于海军军医大学(第二军医大学)第一附属医院心血管内科住院治疗的AMI患者资料,并对院内生存的患者进行随访,通过Cox生存分析和ROC曲线探讨AMI患者远期死亡的影响因素及其预测价值。结果共纳入AMI患者4868例,其中院内死亡261例,失访1081例,共随访至3526例患者。高龄、糖尿病、吸烟及血肌酐、脂蛋白a、肌钙蛋白升高是AMI患者远期死亡的独立危险因素,其中发病年龄每增加1岁远期死亡风险增加7.5%(HR=1.075,95%CI 1.064~1.086,P<0.001),吸烟者发生AMI后的远期死亡风险是不吸烟者的1.261倍(HR=1.261,95%CI 1.023~1.555,P<0.05),糖尿病患者发生AMI后的远期死亡风险是无糖尿病患者的1.307倍(HR=1.307,95%CI 1.073~1.592,P<0.01)。院内行急诊或择期经皮冠状动脉介入术(PCI)、使用他汀类药物、使用β受体阻滞剂和血细胞比容升高是AMI患者远期死亡的保护因素,其中行急诊或择期PCI治疗者远期死亡风险分别降低46.9%和54.8%(HR=0.531,95%CI 0.398~0.707,P<0.001;HR=0.452,95%CI 0.353~0.580,P<0.001),使用他汀类药物的患者远期死亡风险降低39.2%(HR=0.608,95%CI 0.408~0.906,P<0.05),使用β受体阻滞剂的患者远期死亡风险降低17.7%(HR=0.823,95%CI 0.678~0.998,P<0.05)。ROC曲线分析显示,除年龄(AUC值为0.773)外,血肌酐、脂蛋白a、血细胞比容、肌钙蛋白对AMI患者远期死亡的预测价值均较低(AUC值分别为0.636、0.564、0.667、0.524)。结论急诊或择期行PCI治疗、使用他汀类药物、使用β受体阻滞剂能够改善AMI患者的远期预后,而高龄、糖尿病、吸烟则会增加远期死亡风险。

基于长期护理保险探讨社区健康随访管理与失能居民生活质量的关联性

目的探究社区健康随访管理与长期护理保险(简称长护险)居家照护居民生活质量的关系,为构建以失能居民为中心的整合式社区居家医疗护理服务模式提供依据。方法根据纳入排除标准,按照方便原则选取上海市闵行区梅陇社区2021年1月1日至12月31日参保长护险居家照护的居民。参保满1年以后,由培训合格的社区医师使用36条简明健康状况调查(the 36-item short form health survey,SF-36)量表面对面调查研究对象的生活质量,基于居民电子健康档案、社区慢性病管理系统、长护险管理系统,结合现场问卷调查,采集研究对象的基本人口学信息、生活方式、罹患疾病种类、慢性病共病状况及参加社区提供的健康随访管理情况等。采用横断面分析方法,评估社区健康随访管理与长护险居家照护参保居民生活质量之间的关系。结果230人(57.64%)实际接受社区卫生服务中心提供的健康随访管理,调查结果显示其SF-36量表的总体健康、生理职能、躯体疼痛、精神健康、活力、情感职能维度得分均高于未接受随访的人群,且组间差异具有统计学意义(P值均<0.05)。此外,接受社区健康随访管理者SF-36量表健康变化分数高于未接受随访者(P=0.003),提示健康状况较好。控制人口学及混杂因素后,进一步分析表明,社区卫生服务中心提供的健康随访管理与长护险居民SF-36量表的总体健康、生理职能、躯体疼痛、精神健康、活力维度有显著正相关(P值均<0.05)。结论社区卫生服务中心提供的健康随访管理对失能居民的生活质量有显著的正向影响。社区健康随访管理是提高长护险居家照护服务质量的有效途径。

基于人工智能的重型新型冠状病毒感染恢复期患者肺部CT影像变化分析

目的新型冠状病毒感染(coronavirus disease 19,COVID-19)对全球健康产生了重大影响,尤其是部分恢复期患者存在长新冠综合征(long-coronavirus disease,Long-COVID)症状及肺部影像学异常,然而肺部CT影像的长期动态变化特征尚未完全明确。本研究通过人工智能(artificial intelligence,AI)定量技术,动态分析重症COVID-19患者在1年内的肺部CT影像变化特征,为Long-COVID的管理和治疗提供参考。方法纳入干细胞治疗COVID-19队列中对照组(接受安慰剂及标准治疗方案)的58例受试者,收集基线及第1、3、6、9、12个月共6个时间点的临床及影像资料,应用AI定量技术测量病灶的质量、体积及密度值,分析病变的位置、范围及成分比例等,描绘重症COVID-19患者1年内的肺部影像学演变特征。结果绝大部分患者双肺受累,少数为单侧受累。不同肺叶受累程度不一,右肺下叶感染最严重,感染区域体积及体积比最大,随时间恢复正常的患者最少。基于CT密度值亨氏单位划分病灶成分,磨玻璃影较为常见,实变体积占全肺体积的比例较低。随时间推移,感染区域整体表现为密度下降、体积及体积比缩小的趋势,尤其在0~6个月期间逐渐减小,6个月后轻微回升。至第12个月时,所有患者的肺部CT影像仍残留异常表现。结论本研究利用AI定量技术发现,重症COVID-19患者肺部病变在恢复期逐渐吸收,但1年后仍未完全恢复正常。建议开展更长时间的随访研究,以监测COVID-19患者的肺部病变转归及特征,这对研究患者远期预后及Long-COVID相关机制具有重要意义。

电话及微信随访对首发脑梗死出院患者坚持二级预防依从性及远期预后的影响

目的探讨电话及微信随访对首发脑梗死出院患者坚持二级预防依从性及远期预后的影响。方法选取2019年1月至2020年12月接受治疗后出院的98例首发脑梗死患者为研究对象,采用单双号分组法将其分为对照组和研究组,各49例。对照组实施常规护理+电话随访,研究组在对照组基础上实施微信随访。比较两组的坚持二级预防依从性、神经功能恢复情况、生活自理能力、出院后脑梗死复发情况及健康状况。结果研究组的坚持二级预防总依从率高于对照组(P<0.05)。干预前,两组的改良Rankin量表(mRS)、Barthel指数(BI)评分比较,差异无统计学意义(P>0.05);干预后,研究组的mRS评分低于对照组,BI评分高于对照组(P<0.05)。研究组的出院后脑梗死复发率低于对照组(P<0.05)。研究组的健康调查简表(SF-36)各维度评分均高于对照组,差异具有统计学意义(P<0.05)。结论电话及微信随访可有效提高患者坚持二级预防依从性,提高其神经功能恢复效果、生活自理能力及健康状况,改善远期预后,值得推广及应用。

手术治疗腰椎间盘突出症的长期疗效及其影响因素

目的:评估腰椎间盘突出症手术治疗的长期疗效,探讨影响手术长期疗效的相关因素。方法:回顾性分析1996年2月～2002年12月在我院采用单纯开窗减压髓核摘除术治疗的125例单节段腰椎间盘突出症患者,记录患者性别、年龄、体重指数(body mass index,BMI)、病程、临床表现、体征、手术减压时椎间盘的突出类型和末次随访时复发性椎间盘突出症的例数。分别记录术前和末次随访时Oswestry伤残指数(Oswestry Disability Index,ODI)及腰痛/下肢根性痛的视觉模拟评分(visual analog scale,VAS)。根据Stauffer-Coventry′s(SC)疗效评定标准评价患者总体疗效。单因素分析患者术前与末次随访时的VAS以及ODI。患者总体疗效作为结果变量,单因素分析年龄、性别、BMI、吸烟、腰扭伤史、病程、术前腰痛VAS评分、术前下肢痛VAS评分、术前ODI、直腿抬高试验(straight-leg raise test,SLR)、肌力、感觉、椎间盘突出节段和类型等14项指标与疗效的关系。用非条件Logistic全回归分析和逐步回归分析来研究结果变量与术前各种指标的关系。结果:随访84～123个月,平均109个月,患者总体疗效优占32%,良占35.2%,可占23.2%,差占9.6%,复发率为8%。术前ODI为(72.23±25.72)%,末次随访时为(15.64±17.52)%,与术前比较有显著性差异(P<0.05)。腰痛VAS评分术前为5.44±3.43分,末次随访时为2.12±2.32分;下肢痛VAS评分术前为7.34±3.72分,末次随访时为1.42±2.74分;末次随访时与术前比较均有显著性差异(P<0.05)。全回归分析发现腰扭伤史、感觉减退是总体疗效不佳的相关因素,而非包含型突出类型是总体疗效佳的相关因素。逐步回归分析发现有4个有统计学意义的相关因素,其比值比(OR)及95%可信区间分别为:腰扭伤史(OR=6.50;95%CI 2.21-19.10)、吸烟(OR=4.48;95%CI 1.51-13.34)、感觉(OR=9.01;95%CI 1.75-46.46)、突出类型(OR=0.027;95%CI 0.005-0.145)。结论:手术治疗可以明显改善腰椎间盘突出症患者的腰痛、下肢痛和ODI。腰扭伤史、吸烟史、术前感觉和突出类型是影响腰椎间盘突出症手术长期疗效的相关因素。

单节段腰椎间盘突出症单纯髓核摘除术后10年以上随诊观察

目的:观察单纯髓核摘除术治疗单节段腰椎间盘突出症的远期疗效及影像学改变。方法:1990～1998年我院经单纯髓核摘除术治疗腰椎间盘突出症患者210例,对其中术后10年以上来门诊随访且资料完整的35例单节段腰椎间盘突出症患者进行回顾性分析,其中全椎板切除髓核摘除术10例,开窗减压髓核摘除术25例。随访内容包括:询问病史、骨科查体、摄腰椎正侧位及过伸过屈位X线片、行腰椎MRI检查及ODI评分,并对结果进行统计学分析。结果:随访时5例无腰腿疼痛症状,26例偶有腰痛及下肢酸痛,4例有明显腰腿痛。X线检查手术节段椎间隙变窄22例,占62.9%,手术节段残存活动度5.0°±3.2°,均未显示脊柱不稳定,依据U-CLA标准8例(22.9%)手术节段头侧相邻节段存在退变。MRI检查6例患者原手术节段可见椎间盘突出(占17.1%),其中4例有明显腰腿痛症状;依据改良Pfirrmann椎间盘退变分级,头侧椎间盘1～5级27例,6级及以上8例;12例手术节段存在终板信号改变,占34.3%,其中ModicⅠ型4例,Ⅱ型8例。随访时手术节段椎间隙狭窄与无狭窄患者的ODI评分有显著性差异(P<0.05)。两种术式患者ODI、相邻节段退变发生率和手术节段活动度均无统计学差异(P>0.05)。结论:单节段腰椎间盘突出症单纯髓核摘除术后10年以上手术节段能保留一定活动度,无脊柱不稳发生,但手术椎间隙变窄、相邻节段退变发生率较高,其与腰部功能障碍相关。

RF-Ⅱ系统治疗腰椎滑脱症的远期疗效

目的:总结RF-Ⅱ系统治疗腰椎滑脱症术后的远期疗效。方法:对接受RF-Ⅱ系统治疗腰椎滑脱症3年以上的患者进行问卷调查及影像学检查,并就患者的疼痛、功能状况以及影像学检查结果进行分析。结果:56例患者获得3～9年（平均5年8个月）随访,按疼痛、体征和功能状况评价,优良率为92.8％,患者满意率为 67.8％。9.4％的椎弓根螺钉弯曲或折断,6.2％的钉杆角度减小,但均未出现复位丢失现象,仅有椎间隙高度和角度的不同程度改变。结论:应用RF-Ⅱ治疗腰椎滑脱症长期疗效肯定,维持复位好;椎间植骨融合可能是进一步减少远期并发症的重要方法。

单纯减压治疗伴Ⅰ度退变滑脱的腰椎管狭窄症的中远期疗效分析

目的:探讨椎板节段开窗减压治疗伴Ⅰ度退变性滑脱的腰椎管狭窄症患者的中远期疗效及相关影响因素。方法:回顾分析28例采用单纯椎板减压术治疗的伴Ⅰ度退变性滑脱的腰椎管狭窄症患者,男10例,女18例,年龄45￣75岁,平均62岁,病程4个月￣14年,平均18个月;滑脱节段L425例,L32例,L51例。评估患者术后平均2年与6.8年时的临床疗效。结果:术后平均2年和6.8年的JOA评估优良率分别为89.8%和76%;术前腰痛VAS评分平均7.6分,术后2年及6.8年分别为3.8和5.6分(P<0.05),腿痛VAS评分分别由术前8.2分下降至2.4和2.7分(P<0.01)。影像学检查示滑脱节段椎间高度降低,滑脱轻度增加,椎体间活动度减少,但均无统计学差异。并发症3例,二次手术3例。结论:椎板节段开窗、椎管潜行扩大减压是治疗伴Ⅰ度退变性滑脱的腰椎管狭窄症的一种有效手术方法,远期疗效与手术方法、自然病程进展、相邻节段退变及腰椎不稳等多种因素有关。

38例先天性皮肤缺损创面不同治疗方法的疗效分析

目的探讨先天性皮肤缺损的创面处理方法。方法 38例先天性皮肤缺损创面,18例10%以下创面保守治疗(其中13例去膜,5例膜全)、1例7%的创面保守+大张刃厚植皮治疗、16例10%以上创面大张刃厚植皮治疗、3例伴骨缺损创面人工真皮+大张刃厚植皮治疗,总结不同缺损程度及不同处理方法的长期随访结果。结果本组38例均恢复良好。7例出院后失访。31例随访5个月至7年不等。14例(包括部分保守、部分手术病例)保守治疗创面,5例未去膜创面愈合较去膜创面快,且3例愈合后仅遗留色素减褪,2例遗留平、软、色素减褪浅表瘢痕,去膜的9例创面愈合后均遗留轻重不等瘢痕伴色素减褪。15例(包括部分保守、部分手术病例)刃厚植皮治疗创面愈合后5例无明显瘢痕,5例遗留平、软羊皮纸样瘢痕,5例遗留轻重不等增生性瘢痕;3例人工真皮+刃厚植皮的头皮缺损+颅骨缺损创面均遗留平、软、与皮肤同色瘢痕伴秃发,其深部颅骨缺损均已痊愈。结论先天性皮肤缺损创面覆盖膜为发育不良表皮,有促进创面愈合作用;10%以下创面保守治疗能达到理想创面愈合效果,但处理中需完整保留其表面覆盖的膜;10%以上创面由于愈合时间较长为避免并发症发生建议大张刃厚植皮封闭;伴颅骨缺损创面不需处理骨缺损。