全镜下单纯前入路与后内侧辅助入路治疗Meyers-McKeeverⅡ型后交叉韧带胫骨侧止点撕脱骨折的临床对比研究

目的 通过两种手术入路数据对比,探究全关节镜下单纯前入路和后内侧辅助入路弹性固定在治疗后交叉韧带胫骨侧止点撕脱骨折上是否存在差异。方法 通过回顾性分析2019年6月至2022年3月河北省保定市第一医院治疗的56例Meyers-MckeeverⅡ型后交叉胫骨侧止点撕脱骨折病例,分别采取全关节镜下单纯前入路(28例,单纯前入路组)和后内侧辅助入路(28例,后内侧辅助入路组),通过带袢钢板弹性固定治疗。对两组的手术时间,骨折愈合时间,术后2周、1个月、3个月、6个月膝关节Lysholm评分、数字分级量表(NRS)疼痛评分及日常生活能力(ADL)评分指标进行统计,比较两种手术入路的优良性。结果 两组均随访6个月,单纯前入路组的手术时间,术后2周、1个月、3个月的Lysholm评分、NRS疼痛评分及ADL评分优于后内侧辅助入路组,差异有统计学意义(P<0.05)。两组的骨折愈合时间和术后6个月的Lysholm评分、NRS疼痛评分、ADL评分比较,差异无统计学意义(P>0.05)。结论 全关节镜下单纯前入路弹性固定治疗Meyers-McKeeverⅡ型后交叉韧带胫骨侧止点撕脱骨折,具有手术操作简单、手术时间短、术后痛苦小的优点。

全镜下IB增强术与肌腱重建距腓前韧带术治疗慢性踝关节不稳的效果比较

目的:比较全镜下Internal Brace(IB)增强术与肌腱重建距腓前韧带(ATFL)术治疗慢性踝关节不稳(CAI)的效果。方法:选取2021年6月—2023年5月铜仁市中医医院收治的50例CAI患者,按随机数字表法分为对照组和观察组,各25例。对照组行肌腱重建ATFL术,观察组行全镜下IB增强术,术后均随访6个月。比较两组围手术期指标、疼痛程度、踝关节功能、前抽屉试验、生活质量及并发症发生情况。结果:观察组术中出血量少于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);观察组手术时间短于对照组,但差异无统计学意义(P>0.05)。术前、后,两组AOFAS评分比较,差异无统计学意义(P>0.05);术前,两组视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);术后,观察组VAS评分低于对照组,差异有统计学意义(P<0.05)。术前、后,两组生活质量综合评定问卷(GQOLI-74)内各维度评分比较,差异无统计学意义(P>0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:全镜下IB增强术与肌腱重建ATFL术均能够改善CAI患者的踝关节功能,改善患者的生活质量,且均无严重并发症,其中全镜下IB增强术创伤性更小,患者术后疼痛更轻,临床需根据患者自身的病情状况为患者施以针对性的术式,以保证患者预后。

全镜下修复治疗肩袖损伤的效果及对肩关节功能的影响

目的:分析全镜下修复在肩袖损伤患者治疗中的应用优势,为临床治疗提供数据参考。方法:选取2019年1月—2022年1月福建省立医院南院收治的62例肩袖损伤患者,随机分为微创组和常规组,各31例。微创组采用全镜下肩袖修复术治疗,常规组实施常规肩袖修复术治疗。比较两组围手术期指标、并发症发生率、美国加州大学(UCLA)肩关节评分、美国肩肘外科协会(ASES)评分、视觉模拟评分法(VAS)评分及肩关节功能优良率。结果:微创组手术时间、住院时间短于常规组,术中出血量少于常规组,差异有统计学意义(P<0.05)。微创组并发症发生率为6.45%,低于常规组的12.90%,但两组间比较差异无统计学意义(P>0.05)。术后6个月,微创组UCLA评分、ASES评分高于常规组,VAS评分低于常规组,差异有统计学意义(P<0.05)。随访6个月,微创组总有效率(100.00%)高于常规组(80.65%),差异有统计学意义(P<0.05)。结论:全镜下修复治疗肩袖损伤安全性高,有助于恢复肩关节功能,缓解术后疼痛,且能提高远期疗效。

观察全镜下“Brostrom-Gould”术治疗慢性踝关节外侧不稳定的临床效果

目的探究全镜下"Brostrom-Gould"术治疗慢性踝关节外侧不稳定的临床效果。方法回顾性分析我院2017年1月至2018年11月14例(14踝)慢性踝关节不稳患者资料。患者术前均接受规范非手术治疗大于6个月症状无缓解,均采用全镜下"Brostrom-Gould"术(距腓前韧带修复及下伸肌支持带加强)进行治疗,分析全镜下"Brostrom-Gould"术治疗效果。结果与治疗前相比,治疗后患者VAS评分明显降低,AOFAS评分显著升高,P<0.05,对比存在统计学意义。14例患者术后获12-24个月(平均14个月)随访。手术时间45-120min(平均67.5±16.2),术中镜下发现14例患者均存在滑膜炎性增生,其中12例患者有韧带周围瘢痕组织形成,均行清理;距骨软骨损伤5例,其中单纯行清理4例,清理加微骨折治疗1例;骨赘8例,予切除;游离体1例,予摘除。术后患者切口均I期愈合,无关节感染、腓浅和腓肠神经损伤症状或线结刺激等并发症,踝关节不稳、疼痛、肿胀等临床症状均明显好转。结论全镜下"Brostrom-Gould"术治疗CLAI是可重复实现的技术,具有微创性,可有效处理关节内病变,术后患者踝关节功能恢复快,其短期随访结果满意。

全镜下微创腓骨磨断术及膝关节清理术治疗老年膝关节骨性关节炎的疗效研究

目的评价全镜下微创腓骨磨断术及膝关节清理术治疗老年膝关节骨性关节炎的疗效。方法选取佛山市三水区人民医院创伤骨科2017年3月—2018年3月期间住院的老年膝关节骨性关节炎患者50例,采用抽签法随机分为对照组和治疗组,每组25例。对照组以关节镜行膝关节清理术,治疗组以关节镜行膝关节清理术同时行全镜下微创腓骨磨断术,对照两组患者术前、术后3天(此时切口疼痛基本消失)、术后2周(伤口拆线)、术后6个月(术后远期)的美国特种外科医院膝关节评分(HSS)、膝关节疼痛视觉模拟评分(VAS)、膝关节协会评分(KSS)。结果两组术后HSS评分均较术前上升,VAS评分较术前下降,KSS评分较术前上升,治疗组术后6个月的HSS评分较对照组上升,VAS评分下降,KSS评分上升两组差异具有统计学意义。结论全镜下微创腓骨磨断术及膝关节清理术,可以改善患肢功能,减少手术期间并发症,尤其适用于老年患者。

改良经椎间孔入路全镜下L_(5)S_(1)减压术

[目的]介绍改良经椎间孔入路全镜下椎间孔镜治疗L_(5)S_(1)椎间孔狭窄症的手术技术和初步临床效果。[方法]对12例L_(5)S_(1)椎间孔狭窄症患者,行经改良椎间孔入路全镜下椎间孔镜手术。透视下取经患侧L_(5)S_(1)椎间孔水平线为穿刺路径,水平线与髂骨嵴交点内侧作为穿刺进针点,穿刺至L_(5)峡部与S_(1)上关节突交界处外侧,置入套筒,全可视镜外环锯切除L_(5)部分峡部及S_(1)上关节突尖部少部分,去除压迫L_(5)神经根的突出髓核、肥厚黄韧带或钙化黄韧带,从而完成L_(5)神经根减压。[结果]所有患者均顺利完成手术,其中1例出现神经根外膜撕裂,另1例出现术后臀部疼痛,但都无严重不良后果。随访6个月~5年,平均(2.5±0.3)年,患者疼痛症状和功能均显著改善,无复发或症状加重。术后腰椎MRI显示所有患者L_(5)出口根均减压充分。[结论]改良经椎间孔入路全镜下椎间孔镜治疗L_(5)S_(1)椎间孔狭窄症具有可重复性强,不受高髂嵴限制,不影响脊柱稳定性等优点。

A holographic optical communication system based on RSA algorithm and quaternion function

A facile encryption way was successfully applied to the holographic optical encryption system with high speed,multidimensionality,and high capacity,which provided a better security solution for underwater communication.The reconstructed optical security system for information transmission was based on wavelengthλand focal length f that were keys to encryption and decryption.To finish the secure data transmission(λ,f)between sender and receiver,an extended Rivest-Shamir-Adleman(ERSA)algorithm for the encryption was achieved based on three-dimension quaternion function.Therein,the Pollard’s rho method was used for the evaluation and comparison of RSA and ERSA algorithms.The results demonstrate that the message encrypted by the ERSA algorithm has better security than that by RSA algorithm in the face of unpredictability and complexity of information transmission on the unsecure acoustic channel.

Analysis and Design of Broadband Stacked Microstrip Patch Antennas

A broadband microstrip patch antenna was analyzed and designed.Full wave analysis method(FWAM) was employed to show that a stacked microstrip dual patch antenna(SMDPA) might have a much wider bandwidth than that of the ordinanry uni patch one.By means of discrete complex image theory(DCIT),the Sommerfeld integrals (SI) involved were accurately calculated at a speed several hundred times faster than numerical integration method(NIM).The feeding structure of the SMDPA was then improved and the bandwidth was extended to about 22% or more for voltage standing wave ratio (VSWR)s≤2 Finally,a matching network was constructed to obtain a bandwidth of about 25% for s≤1.5.

Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts?

AIM:To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.METHODS: This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.RESULTS: Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P=1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.CONCLUSION: Complications following PEG placement in patients with VP shunts were infrequent in this study.

Holographic Goggles Optical System

Based on the holographic theory, a pair of reflective holographic lenses have been utilized with an aim to improve the optical properties of night vision goggles. The aberration distribution of the holographic lens has been confirmed by experiments and compensated by a conventional symmetrical spherical system. Resulting data of the whole optical system are given.

Laparoscopic distal pancreatectomy is as safe and feasible as open procedure:A meta-analysis

AIM:To evaluate the feasibility and safety of laparoscopic distal pancreatectomy(LDP) compared with open distal pancreatectomy(ODP).METHODS:Meta-analysis was performed using the databases,including PubMed,the Cochrane Central Register of Controlled Trials,Web of Science and BIOSIS Previews.Articles should contain quantitative data of the comparison of LDP and ODP.Each article was reviewed by two authors.Indices of operative time,spleen-preserving rate,time to fluid intake,ratio of malignant tumors,postoperative hospital stay,incidence rate of pancreatic fistula and overall morbidity rate were analyzed.RESULTS:Nine articles with 1341 patients who underwent pancreatectomy met the inclusion criteria.LDP was performed in 501(37.4%) patients,while ODP was performed in 840(62.6%) patients.There were significant differences in the operative time,time to fluid intake,postoperative hospital stay and spleen-preserving rate between LDP and ODP.There was no difference between the two groups in pancreatic fistula rate [random effects model,risk ratio(RR) 0.996(0.663,1.494),P = 0.983,I2 = 28.4%] and overall morbidity rate [random effects model,RR 0.81(0.596,1.101),P = 0.178,I2 = 55.6%].CONCLUSION:LDP has the advantages of shorter hospital stay and operative time,more rapid recovery and higher spleen-preserving rate as compared with ODP.

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise?

AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.

Safety and effectiveness of propofol sedation during and after outpatient colonoscopy

AIM:To study the safety and effectiveness of propofol sedation for outpatient colonoscopy.METHODS:Propofol was given by bolus injection with an age-adjusted standard protocol consisting of 60 mg for patients < 70 years old,40 mg for patients age 70-89 years,and 20 mg for those ≥ 90 years,and additional injections of 20 mg propofol were given up to a maximum of 200 mg.The principal parameters were the occurrence of adverse events within 24 h after colonoscopy and overall satisfaction for this procedure.Secondary parameters included successful procedure,respiratory depression,and other complications.RESULTS:Consecutive patients were entered prospectively and all 2101 entered successfully completed outpatient colonoscopy.The mean dose of propofol used was 96.4 mg(range 40-200 mg).Younger patients required higher doses of propofol than older patients(20-40 years vs ≥ 61 years:115.3 ± 32 mg vs 89.7 ± 21 mg,P < 0.001).Transient supplemental oxygen supply was needed by five patients(0.2%);no other complications occurred.The questionnaires were completed by 1820(87%) of 2101 patients and most rated their overall satisfaction as excellent(80%) or good(17%).The majority(65%) of patients drove home or to their office after their colonoscopy.Most(99%) were willing to repeat the same procedure.No incidents occurred within 24 h after colonoscopy.CONCLUSION:Propofol sedation using a dose < 200 mg proved both safe and practical for outpatient colonoscopy.

LAPAROSCOPIC SURGERY IN PATIENTS WITH HYPOVOLEMIC SHOCK DUE TO ECTOPIC PREGNANCY

Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.

Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

AIM:To determine the utility of endoscopic ultrasoundguided biliary drainage(EUS-BD)with a fully covered self-expandable metal stent for managing malignant biliary stricture. METHODS:We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography(ERCP)fails.EUS-guided choledochoduodenostomy(EUS-CD)and EUS-guided hepaticogastrostomy(EUS-HG)was performed in 9 patients and 4 patients,respectively. RESULTS:The technical and functional success rate was 92.3%(12/13)and 91.7%(11/12),respectively. Using an intrahepatic approach(EUS-HG,n=4),there was mild peritonitis(n=1)and migration of the metal stent to the stomach(n=1).With an extrahepatic approach(EUS-CD,n=10),there was pneumoperitoneum(n=2),migration(n=2),and mild peritonitis (n=1).All patients were managed conservatively with antibiotics.During follow-up(range,1-12 mo),there was re-intervention(4/13 cases,30.7%)necessitated by stent migration(n=2)and stent occlusion(n=2). CONCLUSION:EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.

Clinical utility,safety and tolerability of capsule endoscopy in urban Southeast Asian population

AIM:Capsule endoscopy has demonstrated its clinical utility in the evaluation of small bowel pathology in several Western studies.In this prospective study,we aimed to determine the clinical utility,safety and tolerability of capsule endoscopy in the evaluation of suspected small bowel disease in an urban Southeast Asian population. METHODS:We used the given (M2A) capsule endoscopy system in 16 consecutive patients with suspected small bowel pathology.In 9 patients the indication was obscure gastrointestinal bleeding,while in 6 patients it was to determine the extent of small bowel involvement in Crohn's disease.One patient underwent capsule endoscopy for evaluation of chronic abdominal pain.Patient's tolerability to the procedure was evaluated by standardized questionnaires and all patients were reviewed at one week to ensure that the capsule had been excreted without any adverse events. RESULTS:Abnormal findings were present in 8 patients (50%).The cause of obscure gastrointestinal bleeding was determined in 5 out of 9 patients.Findings included 2 cases of angiodysplasia,2 cases of jejunal ulcers and 1 case of both angiodysplasia and jejunal ulcer.One patient had small bowel erosions and loci of erythema of doubtful significance. Ileal lesions were diagnosed in 2 out of 6 patients with Crohn's disease.Capsule endoscopy was well tolerated by all patients.One patient with Crohn's disease had a complication of capsule retention due to terminal ileum stricture.The capsule eventually passed out spontaneously after i month. CONCLUSION:Our study,which represented the first Asian series,further confirms the diagnostic utility,safety and tolerability of wireless capsule endoscopy.

Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

AIM： To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy （SII_C） for acute inflamed gallbladder （AIG）.

Therapeutic approaches for portal biliopathy: A systematic review

Portal biliopathy(PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/nonneoplastic extrahepatic portal vein obstruction(EHPVO) and portal cavernoma(PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC(77%-100%), only a part of these(5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic(Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical(bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.

Obsevation for Epidermal Ultrastructure of Nostoc sphaeroides Kutzing under Scanning Electron Microscope

[Objective]The experiment aimed to explore a new way for observing surface structure of Nostoc sphaeroides Kutzing. [Method] The scanning electron microscope was used to observe the epidermal ultrastructure of wild and cultured Nostoc sphaeroides Kutzing. [ Result] The epidermis of wild and cultured Nostoc sphaeroides Kutzing showed mixture structure of fibril colloid which was reticular arranged. The difference between wild and cultured Nostoc sphaeroides Kutzing was that the outer epidermis of cultured Nostoc sphaeroides Kutzing had trichome distribution but the wild Nostoc sphaeroides Kutzing did not has such distribution. The obsevation results of under smaller than 10 μm by scanning electron microscope was touched thick and showed many folds and distortions. [ Conclusion] The scanning electron microscope was an effective way to study development of Nostoc sphaeroides Kutzing colony and it was worth popularizing.

Observation of Insulin Exocytosis by a Pancreatic β Cell Line with Total Internal Reflection Fluorescence Microscopy

INSULIN secretion was traditionally measured with biochemical and immunological methods such as enzyme linked immunosorbant assay and radioimmunoassay. However, these methods can only tell the amount of insulin secreted; they give no information about the secretion process or mechanism of exocytosis. In recent years, an imaging technique known as total internal reflection fluorescence （TIRF） microscopy has been employed to study insulin secretion.