<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare, and serious bec...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. </span><b><span style="font-family:Verdana;">Observation:</span></b><span style="font-family:Verdana;"> We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. </span><a name="_Hlk80358912"></a><span style="font-family:Verdana;">The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>展开更多
Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain. In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association (NAS...Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain. In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association (NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult (hereinafter referred to as the guideline). Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.展开更多
Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisth...Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were展开更多
目的 :探讨应用Smiley face rod固定系统治疗L5椎弓峡部裂的临床疗效。方法:2016年1月~2017年6月,我科采用Smiley face rod固定系统节段内固定植骨融合治疗腰椎峡部裂患者18例,男13例,女5例,年龄28.2±3.2岁(25~32岁),术前平均病程...目的 :探讨应用Smiley face rod固定系统治疗L5椎弓峡部裂的临床疗效。方法:2016年1月~2017年6月,我科采用Smiley face rod固定系统节段内固定植骨融合治疗腰椎峡部裂患者18例,男13例,女5例,年龄28.2±3.2岁(25~32岁),术前平均病程为16.3±5.7个月(7~24个月)。峡部裂节段均位于L5。术后3个月、1年时进行随访,对患者进行疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评定,评价其临床治疗效果。行X线、CT等检查,分析术前和术后L5/S1椎间活动度变化及椎间不稳发生率变化情况,并评价患者术后植骨融合情况。结果:手术时间平均90.0±24.1min,术中出血量平均140±15ml。平均随访18.5±5.0个月(12~24个月)。术前VAS评分为7.3±2.5分,ODI为(67.0±15.1)%;术后3个月时分别为3.0±1.2分和(17.2±4.5)%,较术前明显改善(P<0.05);术后1年时分别为1.0±0.6分和(9.1±5.3)%,较术后3个月时进一步改善(P<0.05)。术前L5/S1间隙活动度为13.1°±2.1°,存在腰椎不稳或小于Ⅰ度滑脱者共15例(83.3%,15/18);术后1年时分别为9.3°±1.6°和2例(11.1%,2/18),两者之间存在统计学差异(P<0.05)。术后1年时随访患者峡部裂均获得骨性愈合。结论 :应用Smiley face rod固定系统治疗L5椎弓峡部裂具有创伤小、对神经干扰少、恢复正常的解剖结构、提高椎间稳定性的优点。展开更多
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. </span><b><span style="font-family:Verdana;">Observation:</span></b><span style="font-family:Verdana;"> We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. </span><a name="_Hlk80358912"></a><span style="font-family:Verdana;">The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>
文摘Isthmic spondylolisthesis in adults is a common clinical disease that causes lower back pain. In order to provide the best and effective diagnosis and treatment plan, in 2014, the North American Spine Association (NASS) formulated the guidelines for the diagnosis and treatment of isthmic spondylolisthesis in adult (hereinafter referred to as the guideline). Through the systematic review of literature, evidence-based medical evidence analysis was conducted to identify different recommended intensities, to discuss the clinical diagnosis and treatment plan mainly from two aspects of diagnosis and treatment. This article gives a brief explanation of the guidelines and discusses them in combination with the clinical practice in China, so as to provide a reference for clinicians.
文摘Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were
文摘甲状腺乳头状癌(papillary thyroid carcinoma,PTC)是甲状腺癌中最常见的病理类型,绝大多数位于两侧腺叶,但仍有小部分起源于峡部。相比腺叶癌,峡部PTC表现出更具侵袭性的临床病理特征。基于峡部PTC解剖学和生物学行为的特殊性,目前国内外指南针对临床淋巴结阴性(cN_(0))峡部PTC缺乏明确的治疗细则,临床医生最常用的治疗方案为甲状腺全部切除术+预防性中央区淋巴结清扫(preventive central region lymph node dissection,pCLND)。但在倡导对肿瘤风险分层、实施个性化精准治疗的背景下,学者们对于cN_(0)峡部PTC的手术切除及预防性中央区淋巴结清扫的范围存在很大争议。同时,热消融技术在甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)治疗中的不断推进,也可能为cN_(0)峡部PTMC的治疗带来了新思路。本文就cN_(0)峡部PTC的临床病理特征及治疗进展进行系统的综述,为外科医生选择最佳治疗方案提供参考。
文摘目的 :探讨应用Smiley face rod固定系统治疗L5椎弓峡部裂的临床疗效。方法:2016年1月~2017年6月,我科采用Smiley face rod固定系统节段内固定植骨融合治疗腰椎峡部裂患者18例,男13例,女5例,年龄28.2±3.2岁(25~32岁),术前平均病程为16.3±5.7个月(7~24个月)。峡部裂节段均位于L5。术后3个月、1年时进行随访,对患者进行疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评定,评价其临床治疗效果。行X线、CT等检查,分析术前和术后L5/S1椎间活动度变化及椎间不稳发生率变化情况,并评价患者术后植骨融合情况。结果:手术时间平均90.0±24.1min,术中出血量平均140±15ml。平均随访18.5±5.0个月(12~24个月)。术前VAS评分为7.3±2.5分,ODI为(67.0±15.1)%;术后3个月时分别为3.0±1.2分和(17.2±4.5)%,较术前明显改善(P<0.05);术后1年时分别为1.0±0.6分和(9.1±5.3)%,较术后3个月时进一步改善(P<0.05)。术前L5/S1间隙活动度为13.1°±2.1°,存在腰椎不稳或小于Ⅰ度滑脱者共15例(83.3%,15/18);术后1年时分别为9.3°±1.6°和2例(11.1%,2/18),两者之间存在统计学差异(P<0.05)。术后1年时随访患者峡部裂均获得骨性愈合。结论 :应用Smiley face rod固定系统治疗L5椎弓峡部裂具有创伤小、对神经干扰少、恢复正常的解剖结构、提高椎间稳定性的优点。
