有限元分析冠状动脉新型刻痕球囊的安全性及有效性

背景:目前临床上使用的冠状动脉介入预扩张球囊主要是传统的高压球囊、乳突球囊等,它们在病变血管中可能会出现滑脱进而擦伤血管的情况。目的:评估新型旋刻球囊在血管扩张中的安全性及有效性。方法:(1)有限元分析:通过采集相关人体组织数据建立血管三维有限元模型,随后建立乳突球囊植入血管三维有限元模型与旋刻球囊植入血管三维有限元模型,分析不同充气压下球囊扩张时的血管应力、血管位移、球囊应力、球囊位移。(2)动物实验:将8只新西兰大耳兔随机分成2组,在髂动脉中分别植入乳突球囊与旋刻球囊进行扩张,每组4只。球囊撤出后取材,苏木精-伊红染色与透射电镜观察血管损伤情况。结果与结论:(1)有限元分析:两种球囊的弹力性质无明显差异,在相同充气压下,乳突球囊组血管应力、血管位移、球囊应力、球囊位移均远远大于旋刻球囊组,并且各指标的均匀性优于旋刻球囊组;随着充气压的增加,乳突球囊组血管应力、血管位移、球囊应力、球囊位移增加幅度远远大于旋刻球囊组。(2)动物实验:苏木精-伊红染色与透射电镜观察显示,旋刻球囊扩张造成的血管损伤只局限在内膜,而乳突球囊扩张造成的血管损伤比较严重,内膜、中膜损伤严重,部分节段可以看到血肿形成,血管周围的炎性细胞较多,局部可见有巨噬细胞堆积。(3)结果表明:相较于乳突球囊扩张,旋刻球囊扩张造成血管闭塞以及夹层的风险较小,但有一定出现球囊弯曲的概率。

宽体液腔Janus-Helmholtz换能器

该文使用有限元方法对宽体液腔Janus-Helmholtz(JH)换能器进行了仿真分析,得出了壳体宽度拓展增量对JH换能器工作性能的影响规律。使用三维建模的方式,分析了连接部分对换能器性能的影响及宽体壳体的模态,证明了三维建模的必要性。依据仿真优化结构设计了一款宽体液腔JH换能器并进行了湖上测试。最终测试结果与仿真结果有很好的一致性,相较直筒JH换能器其谐振频率降低300 Hz,发射电压响应最高可达144 dB。

久坐间断对成年人血管功能的急性影响与调节因素:荟萃分析

目的:持续性地久坐行为会急性降低外周与中枢血管功能,进而加剧罹患心血管疾病风险。久坐间断可能是预防持续久坐对血管功能危害的潜在实用策略,但目前关于其急性功效的已有研究结论并不一致,也尚未得出具体的应用建议。文章旨在对久坐间断对成人外周与中枢血管功能的急性影响进行荟萃分析,并探究其调节因素。方法:基于PRISMA报告规范,以“interrupting”“sedentary”与“vascular function”等为文献检索特征词,于2024年3月检索Web of Science核心合集、PubMed和中国知网数据库。纳入久坐间断对成人外周与中枢血管功能的急性影响的急性随机交叉试验文献。基于Cochrane开发的Risk of Bias 2评估偏倚风险,并基于GRADE系统评价证据等级。使用R语言(版本4.2.0)中的“meta”与“metafor”包进行主效应合并(Hedge’s g作为效应量指标)、发表偏倚检验、亚组与回归分析。结果:纳入22篇随机交叉试验,共364例受试者(年龄21-70岁)。相比于持续不间断久坐,久坐间断急性提升外周血管血流量(Hedge’s g=0.48,95%CI:0.14-0.82,P<0.01,I2=63%,低证据等级)、剪切应力(Hedge’s g=0.65,95%CI:0.37-0.93,P<0.01,I^(2)=54%,中等证据等级)与血流介导的血管舒张功能(Hedge’s g=0.43,95%CI:0.15-0.72,P<0.01,I2=61%,中等证据等级)。疾病(亚组间P=0.01)与性别(亚组间P=0.01)对血流量的主效应合并有显著调节作用(亚组间P=0.01),间断方式(亚组间P=0.01)与频率(亚组间P=0.02)对剪切应力的主效应合并有显著调节作用。久坐间断改善外周血管剪切应力受年龄(β=-0.02,95%CI:-0.03-0.01,P=0.09)与体质量指数(β=-0.10,95%CI:-0.18至-0.02,P<0.01)影响。久坐间断改善血流介导的血管舒张功能受总间断次数(β=-0.09,95%CI:-0.17至-0.01,P=0.03)与试验期间久坐控制时长影响(β=-0.21,-0.34至-0.09,P<0.01);每增加1 h久坐时长与久坐间断对血流介导的血管舒张功能的急性提升效果降低0.67%相关(P<0.01),当久坐控制时间>6 h时,久坐间断的急性收益消失。定性系统综述发现,久坐间断对各类人群血管脉搏波速度无显著影响,但可能预防老年人因持续久坐引起的中枢血管功能下降。结论:久坐间断急性提升成人外周血管血流量(低证据强度)、剪切应力(中证据强度)与血流介导的血管舒张功能(中证据强度),并可能预防、保护老年人因持续久坐引起的中枢血管功能下降(非常低证据等级)。受试者特征(疾病因素、性别、年龄与体质量指数)、间断干预方案(方式、频率、总间断次数)与久坐控制时长均会影响久坐间断对血管功能的急性改善效果。建议各类成人通过爬楼等大肌肉群参与的运动方式,以较高频率(如,每40 min进行1次)进行单次至少5 min的中低强度运动间断久坐,且每日持续久坐的累积时长不要超过6 h。

毒素清对肺炎痰热证大鼠肺组织Janus激酶/信号转导和转录激活因子信号通路的影响

目的 观察肺炎痰热证大鼠肺组织Janus激酶/信号转导和转录激活因子(JAK/STAT)转导通路,探讨毒素清治疗肺炎痰热证的作用机制.方法 将Wistar大鼠按随机数字表法分为正常组、肺炎组、肺炎痰热证组、阳性对照组、毒素清组,每组12只.制备细菌性肺炎痰热证大鼠模型,采用免疫组化法测定肺组织p-JAK2、p-STAT1、p-STAT3、细胞信号转导抑制蛋白3(SOCS3)表达,采用逆转录-聚合酶链反应(RT-PCR)测定肺组织SOCS3 mRNA表达.结果 与正常组比较,肺炎组、肺炎痰热证组肺组织p-JAK2、p-STAT1、p-STAT3、SOCS3蛋白及SOCS3 mRNA表达均显著升高(均P【0.01),且肺炎痰热证组较肺炎组升高明显(均P【0.05).与肺炎痰热证组相比,毒素清组、阳性对照组肺组织p-JAK2、p-STAT1、p-STAT3蛋白表达明显减弱(均P【0.01),SOCS3蛋白及mRNA表达明显增强(均P【0.01),其中,毒素清组肺组织p-JAK2、p-STAT1、p-STAT3蛋白表达较阳性对照组减弱尤为明显(均P【0.05).结论 JAK/STAT信号转导通路参与了肺炎痰热证肺组织的病理损伤过程;毒素清治疗肺炎痰热证的作用机制可能与上调SOCS3,阻断JAK/STAT信号通路,继而减少炎症因子的释放有关.

Education of Parents When a Child Born with an Imperforate Anus;Does It Improve the Health of the Child?

Objectives: To describe and investigate the value of an education program for parents of children born with an imperforate anus in order to help them cope with the new situation of having a stoma. A comparison is made with a group of parents following routine hospital. A secondary aim was to illuminate the parents’ feelings and concerns in the first month after the birth of the child. Subjects and methods: The program was tested in 20 Vietnamese mothers of babies born with an imperforate anus;10 followed an intervention comprising an education program and 10 the ordinary routine hospital. The study design is both qualitative and quantitative. The mothers were interviewed, using open-ended questions, within a week of their child’s birth and then repeatedly for up to one month. Finally, the conditions of children were accessed on their return to the hospital for the second operation after one month of care at home. The qualitative data were subjected to content analysis. Results: All mothers felt sad and worried in the beginning, but this quickly changed to confidence, particularly among mothers in the intervention group who received education. While at home, mothers in both groups had financial concerns, as they were unable to work as much as expected and also had to buy equipment for colostomy care. The mothers in the control group complained about a lack of knowledge and how it affected the care of their child. The mothers in the intervention group, however, felt confident in their caring even at home. When the families returned for the second operation, the children in the intervention group were significantly healthier, had increased more in weight, and had fewer complications and emergency return visits to hospital compared to the control group. In the control group skin problems around the stoma, diarrhea, bleeding or constipation while at home were reported (p < 0.01). Conclusion: The education improved the care at home resulting in healthier children and more confident parents.

Obstructive ileus due to a giant fibroepithelial polyp of the anus

Fibroepithelial polyps or hypertrophied anal papillae are essentially skin tags that project up from the dentate line and the junction between the skin and the epithelial lining of the anus. They are usually small in size, but sometimes they become enlarged, causing unexpected medical conditions. An extremely rare case of a giant hypertrophied anal papilla complicated by obstructive ileus is reported. Fibroepithelial anal polyp, despite its size, should be included in the differential diagnosis of a smooth mass located near the anal verge, especially in a patient with a history of chronic anal irritation or infection.

OBSERVATION ON THERAPEUTIC EFFECTS OF ACUPUNCTURE IN 206 CASES WITH POSTOPERATIVE COMPLICATION OF ANUS AND INTESTINE

The authors have treated postoperative complication of anus and intestine by usingacupuncture at main point Chengshan(BL 57) with cool-producing needling manipulation. Therapeuticeffects of the treatment on postoperative severe pain, retention of urine, constipation, and bleedingwere observed clinically. Results indicated that the cure rate was 97. 6 % and the total effective ratewas 100%. Strong stimulation of Chengshan(BL 57) point improved mainly postoperative edema,spasm, local edema. The improvement of hyperemia and spasm is a ma jor factor of curing various postoperative complication of the anus and intestine. The therapeutic method has advantages of using lesspoints, rapidly producing effects, shorter therapeutic course, suffering little for patients, and no sideeffect.

Neurostimulation for fecal incontinence after correction of repair of imperforate anus

We are reporting the case of a 32-year-old female who had suffered from fecal incontinence(FI). She was born with an imperforate anus and a recto-vaginal fistula; she underwent repair at 6 mo of age. At 29 years of age, she was still fecally incontinent despite extensive pelvic floor reeducation. A magnetic resonance imaging and an anal electromyography were performed. Because her symptoms were considered to be probably due to extra-sphincteric implantation of the neo-anus, a redo was performed of the recto-neo-anal intra-sphincteric anastomosis. A neurostimulator device was subsequently implanted for persistent incontinence. Solid and liquid FI resolved, and her quality of life improved markedly. Combining surgery to correct the position of the neo-anus within the anal sphincter complex and neurostimulation could thus become a new approach in cases of refractory FI for patients with imperforate anus as a newborn. Follow-up into adulthood after pediatric imperforate anus surgery should be recommended for adult patients with persistent FI.

The Causes of Distress in Paediatric Outpatients Receiving Dilating Drops

Background/aims: Paediatric outpatients are often dilated with cyclopentolate drops. These cause discomfort and distress, which may impede subsequent examination. We aimed to determine the distress caused by cyclopentolate drops, and other factors in the clinic environment. Methods: Over an 8 week period, questionnaires were issued to guardians of all paediatric outpatients aged under 10 years receiving cyclopentolate. The childrens’distress was graded on a scale of 1 - 10 (1 = no distress, 10 = severe distress). Waiting time and ease of examination were recorded. Data was analysed using Stata statistics, and significant differences were reported at the P < 0.05 level. Results: The 72 children were grouped as under 4 years (n = 43, Group A), aged 4 - 7 years (n = 19, Group B), and aged 7-10 years (n = 10, Group C). Median distress levels at home (baseline), on arrival, on dilation, and on examination were as follows: Group A;1, 2, 7, 6 respectively;Group B;1, 1, 6, 2 and Group C;1, 1, 4.5, 1. All age groups were significantly more distressed on examination compared to baseline. Distress scores on examination were significantly greater for Group A, in keeping with the greatest number of suboptimal examinations. Guardians reported that a prolonged waiting time and bright examination lights also contributed to distress. Conclusions: This study confirms that cyclopentolate causes significant distress in young children, and in 45% of very young children, the examination is difficult. Proxymetacaine prior to cyclopentolate is a possible solution, but other distressing factors should also be addressed for optimal outcomes.

THE FACTORS AND TREATMENT OF LOCAL RECURRENCE AFTER RADICAL RESECTION RESERVING THE ANUS IN THE PATIENTS WITH RECTAL CANCER

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.

52例症状性颅内动脉粥样硬化性狭窄患者个体化血管内治疗的回顾性分析

目的评估症状性颅内动脉粥样硬化性狭窄(sICAS)患者个体化血管内治疗的安全性和有效性。方法回顾性收集2019年1月至2022年12月在我院接受个体化血管内治疗的sICAS患者的临床资料,分析血管重建成功率、围手术期并发症发生率和死亡情况,以及随访期间复发性缺血性脑卒中(IS)、短暂性脑缺血发作、死亡和血管再狭窄的发生率。结果52例sICAS患者共有55处病变,均接受血管内治疗。患者平均年龄为(62.94±9.04)岁。术前病变血管狭窄程度为90%(80%,99%),狭窄长度为8(5,11)mm。采用的手术方式分别为球囊扩张式支架植入术(25例,27个病变)、自膨式支架植入术(19例,20个病变)、单纯球囊扩张血管成形术(8例,8个病变)。术后残余狭窄程度为10%(0,20%),较术前降低且差异有统计学意义(P<0.001)。血管重建成功率为94.23%(49/52),围手术期并发症发生率为3.85%(2/52)。临床随访12(12,18)个月,影像学随访10(6,12)个月,血管再狭窄发生率为7.69%(4/52),复发性IS发生率为1.92%(1/52),无患者死亡。结论个体化血管内治疗对sICAS安全、有效,其可提高血管重建成功率,降低围手术期并发症、远期IS复发和再狭窄风险。

Non-Operative Management of Pilonidal Sinuses Located Around Anus

Aim: Pilonidal disease is generally located at sacrococcygeal region whereas it is rarely located near anus. The aim of this study is to discuss the results of crystallized phenol application that we performed for patients with sinus pilonidalis located near anus with 95% success rate. Patients and Methods: Patients admitted between 2005 to 2011 with sinuses located in 2 cm range of anus or were primarily located up to 2 cm to the anal verge were enrolled in the study. Patients’ demographic features, Body Mass Index (BMI), family history, skin color, hair thickness, number of sinus openings, and the status of the sinus (acute vs. chronic) were recorded. Crystallized phenol was applied into the sinus. The pa tients were followed-up after recovery during the first 6 months and annually afterwards. Results: A total of 25 sinus pilonidalis cases located near anus were encountered. All patients were male;crystallized phenol application was per formed on all patients a total of 115 times. The mean number of applications was 5.6 (between 4 and 8 times). The mean recovery period was 74.5 days (range: 31 - 154) and the mean follow-up period was 36.16 months (range: 18 - 48). No surgical intervention was required. Conclusion: Sinus pilonidalis cases located in perianal region can be successfully treated with the crystallized phenol application which is a simple and inexpensive method, that can easily be performed in an outpatient setting.

LOOSENING AND LENGTHENING OF INTESTINAL TRACT AFTER RECTAL ISOLATION IN ANUS－SAVING RESECTION FOR RECTAL CARCINOMA

In low rectal cancer surgery,the section of rectum destal to the lower tumor maigin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving operation.Before and after fully isolation of the rectum in low ratal cancer surgery, the distance between the lower tumor margin and the anorectal line was measured by the same rectuscope introduced through the anus.The two results were compared .The average lengthening was less than 1 cm if the lower tumor marginanorectal line distance was 5 cm.It was 1─2 cm if the lower tumor margin-anorectal distance was 6 cm.It was more than 2 cm if the distance was 7─9 cm.The loosening and lengthening of the rectal canal was related to the presence of lymphnode metastasis and the skill of the operator.The lengthening was also influenced by the body build of the patient,involvement of the rectal circumference and the Dukes stage. Modified Park's operation,trans abdominosacral resection with anastormosis of rectum,and anterior resection on transpubic approach are indicated for those in whom the lower tumor margin-anorectal line distance was 5 cm The rectectomy-anastomosis in the abdominal cavity(Dixon's operation)is indicated for those in whom the lower tumor margin-anorectal line was 6 cm.If manual anastomosis is difficult,stapling device may be used. The anus saving resection is easy if the distance was 7─9 cm.

SAFETY MARGIN IN ANUS-SAVING RESECTION FOR LOW RECTAL CANCER

The length and method of measurement of the safety-margin below the rectal cancer, being of the utmost importance for its prognosis, is still under debate.The following study was designed and done for its solution.Light microscopic examination was done on 83 resected rectal cancer specimens to assess the extent of intramural invasion towards the anus.By use of a ruler,the distance between the lower tumour margin and the resection line or the dentate line was measured when the specimen was:l. freshly resected,2.after fixing in 10% formalin, and 3.after being mounted in sections. The measurements were compared. By the same method,the distance between the lower tumor margin and the intended resectyion line was measured immediately before resection.It was compared with the measurement immediately after the resection.In 83 rectal cancer specimens, the extent of intramural infiltration toward the anus was:≤0.5 cm in 75 cases (90.4%).≥l cm in 2 cases which showed highly malignant carcinomas.These 2 cases, however,should not have been indicated for anus-saving resection.In 46 fresh specimens,the tumor-resection line distances gave an average of 2.7 cm.After fixing in 10% formalin, they became shortened by 0.7 cm. And, mouting in sections further shortened them by another 0.5 cm,giving a total shortening of l.2 cm.The tumor-resection line distance in 7 of the 11 fresh specimens resected by the Dixon's operation was shortened,though never more than o.5 cm immediately the operation.In performin ganus-saving resection for the low rectal cancer, after full isolation the rectum and stretching it slightly,≥3 cm of the rectum distal to the lower tumor margin should be resected.A safety margin of more than 2.5 cm is necessary in the fresh specimen.If formalin fixed specimen is measured, the safety margin should be ≥2 cm.

Extramammary Paget’s Disease Manifested by Intraepithelial Adenocarcinoma of the Vulva and Anus Combined with Invasive Adenocarcinoma of the Ampullary Part of the Rectum

The Object of the Study: The author of the given paper describes an unusual combination of two diseases: extramammary Paget’s disease manifested by intraepithelial adenocarcinoma of the vulva and anus combined with invasive adenocarcinoma of the ampullary part of the rectum and describes the atypical manifestations of these diseases. The Content: The content of this research paper includes a description of the patient, an analysis of the clinical picture, diagnostic methods and therapeutic interventions used, a report of the following disease, and the result of the presented case. The Result of the Research Work: The result of the research work is the analysis of a clinical case with two different tumors, where such a combination of tumors is rarely described in the literature. Moreover, no large specific sample with this combination of diseases is available. Patient Characteristics: The given case report describes a patient of the Palliative Care Unit of the Gerontology Clinic with a primary diagnosis of C20-rectal adenocarcinoma in the background of the anal canal, perineal skin Paget’s disease, stage IV. The presented complications of the patient’s primary diagnosis are multiple metastases in the liver;status post palliative chemotherapy;hepatomegaly;metastases to abdominal lymph nodes, inguinal lymph nodes;metastases at Th12, L4 level;pain syndrome. The presented above combination of diagnosed diseases is very rare. Applied Diagnostics: In October 2021, it was performed diagnostic manipulation: biopsy and the pathologist have provided a microscopic description. The first tissue fragment had a pronounced electrothermal lesion and the epithelial structures were not valuable. The second skin tissue fragment was covered with hyperplastic and acanthotic epithelium;its basal and middle layers contained multiple large cells proliferates extending into the medial epidermis, and the cytoplasm of these cells reacted positively with PAS (Periodic Acid Schiff reaction). It needs to be noted that the patient had previously had several years of biopsies from the perineal and anal epidermis, where Paget’s disease had also been diagnosed. The performed immunohistochemistry showed these cells to be CK20 positive, CK7 rare positive and p16 negative. The following pathohistological findings were made: morphological and immunohistochemical picture is consistent with Paget’s disease. According to the ICD-10, the patient was diagnosed with C51 malignant neoplasm of the female external genitalia. Using imaging diagnostics, it became clear that the patient’s rectal adenocarcinoma had progressed to metastatic stage with distant liver metastases in the background of anal canal, perineal skin Paget’s disease. Therapeutic Plan of the Patient: Based on the patient’s main diagnoses, the complications of the principal diagnosis, the patient’s overall severe condition, pain syndrome, age and comorbidities, palliative chemotherapy was approved as a therapeutic option in council of doctors. Monitoring and Outcome of the Patient: The patient’s general condition was becoming worse over time, and she was diagnosed with exitus latalis in December 2022. At that time, the patient was discharged from hospital and was on palliative care at home under the control of her family physician.

先天性巨结肠肠道微生态平衡维持措施的研究进展

先天性巨结肠是肠神经系统发育障碍、肠神经节细胞缺如引起功能性肠动力紊乱的疾病,是小儿外科常见的先天性消化道畸形疾病,其主要特征是病变肠管肌间和黏膜下神经丛内神经节细胞的缺乏引起病变肠管的痉挛。主要治疗方式为手术切除无神经节细胞肠管。针对先天性巨结肠患儿存在肠道免疫功能缺陷,容易引起细菌易位导致感染的特点,本文就营养状态、微生态制剂、扩肛、结肠灌洗、手术方式等方面对先天性巨结肠患儿肠道菌群的影响进行阐述,以加强临床医师对先天性巨结肠的认识,提高治疗效果。

考虑孔隙比影响的堆石料湿化试验及湿化模型

对某堆石坝的坝壳料进行了不同密实状态下的单线法三轴湿化试验,分析了湿化变形随围压、应力水平以及初始孔隙比的变化规律。结果表明:在围压和应力水平相同条件下,随着初始孔隙比的减小,堆石料湿化轴向应变和体积应变均明显降低;初始孔隙比对湿化应力剪胀规律影响不大,采用对数形式的湿化剪胀方程可对不同初始孔隙比条件下的湿化应力剪胀关系进行统一描述。对指数形式的湿化轴向应变经验模型进行修正,构建了考虑初始孔隙比及应力状态影响的湿化轴向应变计算模型,并联立湿化剪胀方程推导了湿化体积应变的计算公式,通过对三轴湿化试验结果进行模拟验证了该公式的合理性。

复杂应力条件下粗粒料的剪胀性研究进展

粗粒料的剪胀性是其强度和变形研究的重要问题之一,它取决于颗粒排列、粒间压力等细微观作用;在宏观层面,受相对密度与应力状态的影响。围绕复杂应力条件下粗粒料的剪胀问题,从粗粒料力学特性的试验研究、粗粒料的剪胀性强度准则以及临界状态与剪胀性方面,对国内外的研究进展进行了系统论述。在此基础上,提出该领域呈现如下发展态势:①通过大型真三轴试验开展粗粒料剪胀率的试验研究与理论分析,能够促进粗粒料本构理论的发展进步;②结合应力路径试验中的应力变形规律研究,可实现从常规三轴条件下向复杂应力条件下的剪胀方程的进一步发展,从而体现强度与变形问题的统一;③采用状态参量去评价土体的松密状态与剪胀性,能够耦合应力状态与孔隙比,尽量避免“一种材料,多组参数”。研究结果表明状态参量和应力路径相结合的方法,使得粗粒料的力学特性研究更加具有科学性和系统性。

考虑软化和扩容的圆形巷道围岩Z-P准则弹塑性解

巷道围岩受应力作用表现出的软化、扩容行为对巷道的变形和破环有重大影响。为了研究软化、扩容特性对巷道围岩稳定性的影响,根据岩体的软化特性,建立理想的弹性软化模型,将围岩分为弹性区、塑性软化区和破裂区;基于Zienkiewicz-Pande准则和非关联流动法则,考虑围岩的软化、扩容特性,推导出含中间主应力的圆形巷道弹塑性解析解;将Z-P准则与M-C、D-P等准则进行比较,分析了软化模量、扩容等因素对巷道围岩的影响。结果表明:Z-P准则可良好地适用于发生软化、扩容的巷道;中间主应力系数为0.4时,围岩塑性区范围最小,围岩位移最小,塑性区内应力最大;软化模量越大,围岩破裂区半径越大;剪胀角越大,塑性区位移越大,破裂区半径越大;支护阻力越大,巷道塑性区范围越小,且提高支护阻力能有效控制巷道围岩的变形。

老年胸腰椎压缩性骨折治疗方案及可行性分析

目的探讨不同治疗方案对老年胸腰椎压缩性骨折患者腰椎功能、疼痛程度、椎体前缘高度的影响。方法回顾性分析完成1年随访的102例老年胸腰椎压缩性骨折患者的临床资料,依据治疗方案的不同分为保守组(32例)、经皮球囊扩张椎体后凸成形术(PKP)组(35例)、经皮椎体成形术(PVP)组(35例),治疗1年后评估3组临床疗效和并发症发生情况,比较3组治疗前和治疗1年后视觉模拟评分法(VAS)评分、日本骨科学会(JOA)评分、Cobb角、椎体前缘高度。结果PKP组、PVP组治疗优良率高于保守组,差异有统计学意义(P<0.05);PKP组与PVP组治疗优良率比较,差异无统计学意义(P>0.05)。3组并发症发生率比较,差异无统计学意义(P>0.05)。治疗1年,3组VAS评分低于治疗前,JOA评分高于治疗前,且PKP组、PVP组VAS评分低于保守组,JOA评分高于保守组,差异有统计学意义(P<0.05);PKP组VAS评分低于PVP组,JOA评分高于PVP组,差异有统计学意义(P<0.05)。治疗1年,3组Cobb角小于治疗前,椎体前缘高度高于治疗前,其中PKP组、PVP组Cobb角小于保守组,椎体前缘高度高于保守组,差异有统计学意义(P<0.05);PKP组Cobb角小于PVP组,椎体前缘高度高于PVP组,椎体前缘高度差值大于PVP组,差异有统计学意义(P<0.05)。结论与保守治疗相比,手术可提高老年胸腰椎压缩性骨折患者的临床疗效。PKP在减轻患者疼痛程度、提高腰椎功能、改善Cobb角、椎体前缘高度方面优于PVP,且安全性较好。