Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely...Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3-36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types: tight ilium terminale (53 cases), lipomyelome- ningocele (55 cases), lipomatous malformation (124 cases), postoperative adhesions (56 cases), and split cord malformation (38 cases). All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight ilium terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord mal- formation. Binary logistic regression analysis revealed that types of tethered cord syndrome (lipoma-type or not) and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800016464).展开更多
To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 wer...To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score(CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score.展开更多
[目的]分析不同手术方法治疗不同类型外翻的疗效。[方法]自2003年4月~2006年4月本院手术治疗外翻165例(210足)。根据外翻畸形程度不同分为3组。A组:共96例(128足),男21例,女75例;年龄20~65岁,平均42.5岁。外翻角(hallux valgu...[目的]分析不同手术方法治疗不同类型外翻的疗效。[方法]自2003年4月~2006年4月本院手术治疗外翻165例(210足)。根据外翻畸形程度不同分为3组。A组:共96例(128足),男21例,女75例;年龄20~65岁,平均42.5岁。外翻角(hallux valgus angle,HVA)25°~35°,平均30°,第1、2跖骨夹角(inter-metatarsalangle,IMA)12°~16°,平均14°。手术方法采用McBride加第1跖骨基底楔形截骨术。B组:共55例(61足),男11例,女34例;年龄38~62岁,平均50岁。HVA28°~44°,平均36°,IMA14°~18°,平均16°。手术方法与A组相同,另加第2跖趾关节成形术。C组:共15例(21足),男10例,女5例;年龄64~82岁,平均73岁。HVA45°~75°,平均60°,IMA18°~20°,平均19°。手术方法采用Kell手术。[结果]参照美国足踝外科学会Mary-land评分系统。随访6~24个月,平均15个月。A组,优98足,良24足,可6足,优良率95.3%。平均HVA矫正18°,平均IMA矫正7°。B组,优46足,良12足,可3足,优良率95.1%。平均HVA矫正21°,平均IMA矫正8°。C组,优11足,良8足,可3足,优良率90.5%。平均HVA矫正42°,IMA无矫正。[结论]外翻的病理基础主要为第1跖骨内翻的骨性畸形与收肌高度紧张挛缩的软组织畸形。手术应针对有明显临床症状的病人。手术的设计应重点解除骨性与软组织的畸形。只要注意手术操作与手术方法,手术并发证是可以避免的。展开更多
Objective: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the ...Objective: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources: We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: &quot;minimally invasive,&quot; &quot;spine,&quot; &quot;surgery,&quot; and &quot;scoliosis.&quot;Study Selection: The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results: The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. Conclusions: MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.展开更多
目的探讨食管癌患者胸、腹腔淋巴结的转移规律及其对生存预后的影响。方法选取经微创食管癌切除术(minimally invasive esophagectomy,MIE)治疗的食管鳞癌患者103例,按照日本食管肿瘤研究会(Japan Esophageal Cancer Research Associati...目的探讨食管癌患者胸、腹腔淋巴结的转移规律及其对生存预后的影响。方法选取经微创食管癌切除术(minimally invasive esophagectomy,MIE)治疗的食管鳞癌患者103例,按照日本食管肿瘤研究会(Japan Esophageal Cancer Research Association,JEOG)淋巴结分区的标准进行淋巴结清扫,统计淋巴结的转移情况,分析淋巴结转移情况对3年总生存率的影响。结果胸上段食管癌主要向左、右喉返神经旁淋巴结转移。胸中段食管癌呈现双向淋巴结转移。胸下段食管癌主要向胃左动脉旁和肝总动脉旁淋巴结转移。食管癌患者3年总生存率在病变长度、分化程度、浸润深度、肿瘤位置和淋巴结转移方面比较,差异均具有统计学意义(均P<0.05)。结论淋巴结转移是影响胸段食管癌患者术后效果的重要影响因素,结合病变位置情况,重点清扫相应部位的淋巴结,并可依据病变长度、分化程度、浸润深度、肿瘤位置及淋巴结转移判定远期预后。展开更多
BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be ...BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be either symptomatic or asymptomatic,and relies on image tools for diagnosis and preoperative planning.Indications for surgery are dependent on the complications from the diverticulum.Metaplasia is about 10%among those with hutch diverticulum,and it still has chances turning into malignancy,especially urothelial cell carcinoma.CASE SUMMARY A 27-year-old man was presented with frequently recurrent urinary tract infection for one year,and had suffered from intermittent right flank pain for 3 mo.No past medical histories were recorded before.No obvious abnormalities on laboratory data and urine examination were found.Under ultrasound,right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography.Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice.Cystoscopy was done and biopsy results showed focal metaplasia.After discussing with him,roboticassisted diverticulectomy with reconstruction was performed.Right hydronephrosis was greatly improved after surgery.He has completed his 1.5-year follow-ups,and no malignancies were seen from urine cytology and image of intravenous pyelography.CONCLUSION Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation,providing several advantages over open and laparoscopic ones.展开更多
基金supported by the Science Foundation of Military Medical Research and Clinical Research Foundation of PLA General Hospital in China,No.2016FC-CXYY-1006(to AJS)a grant from the Application of Clinical Features of Capital City of Science and Technology Commission in China,No.Z171100001017140(to AJS)
文摘Tethered cord syndrome is a progressive disease with a typically insidious onset in infants and children, and which can lead to persistent progress of neurological deficits and a high rate of disability without timely intervention. The purpose of this study was to investigate the curative effect of microsurgery in children with different types of tethered cord syndrome. In this study, we analyzed 326 patients with tethered cord syndrome, aged from 2 months to 14 years old, who were followed for 3-36 months after microscopic surgery. Based on clinical manifestations and imaging findings, these patients were classified into five types: tight ilium terminale (53 cases), lipomyelome- ningocele (55 cases), lipomatous malformation (124 cases), postoperative adhesions (56 cases), and split cord malformation (38 cases). All patients underwent microsurgery. Curative effects were measured before and 3 months after surgery by Spina Bifida Neurological Scale based on sensory and motor functions, reflexes, and bladder and bowel function. The results showed that Spina Bifida Neurological Scale scores improved in all five types after surgery. Overall effective rates in these patients were 75%. Effective rates were 91% in tight ilium terminale, 84% in lipomyelomeningocele, 65% in lipomatous malformation, 75% in postoperative adhesion, and 79% in split cord mal- formation. Binary logistic regression analysis revealed that types of tethered cord syndrome (lipoma-type or not) and symptom duration before surgery were independent influencing factors of surgical outcome. These results show that therapeutic effect is markedly different in patients with different types of tethered cord syndrome. Suitable clinical classification for tethered cord syndrome will be helpful in predicting prognosis and guiding treatment. This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800016464).
文摘To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score(CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score.
文摘[目的]分析不同手术方法治疗不同类型外翻的疗效。[方法]自2003年4月~2006年4月本院手术治疗外翻165例(210足)。根据外翻畸形程度不同分为3组。A组:共96例(128足),男21例,女75例;年龄20~65岁,平均42.5岁。外翻角(hallux valgus angle,HVA)25°~35°,平均30°,第1、2跖骨夹角(inter-metatarsalangle,IMA)12°~16°,平均14°。手术方法采用McBride加第1跖骨基底楔形截骨术。B组:共55例(61足),男11例,女34例;年龄38~62岁,平均50岁。HVA28°~44°,平均36°,IMA14°~18°,平均16°。手术方法与A组相同,另加第2跖趾关节成形术。C组:共15例(21足),男10例,女5例;年龄64~82岁,平均73岁。HVA45°~75°,平均60°,IMA18°~20°,平均19°。手术方法采用Kell手术。[结果]参照美国足踝外科学会Mary-land评分系统。随访6~24个月,平均15个月。A组,优98足,良24足,可6足,优良率95.3%。平均HVA矫正18°,平均IMA矫正7°。B组,优46足,良12足,可3足,优良率95.1%。平均HVA矫正21°,平均IMA矫正8°。C组,优11足,良8足,可3足,优良率90.5%。平均HVA矫正42°,IMA无矫正。[结论]外翻的病理基础主要为第1跖骨内翻的骨性畸形与收肌高度紧张挛缩的软组织畸形。手术应针对有明显临床症状的病人。手术的设计应重点解除骨性与软组织的畸形。只要注意手术操作与手术方法,手术并发证是可以避免的。
文摘Objective: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources: We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: &quot;minimally invasive,&quot; &quot;spine,&quot; &quot;surgery,&quot; and &quot;scoliosis.&quot;Study Selection: The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results: The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. Conclusions: MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.
文摘目的探讨食管癌患者胸、腹腔淋巴结的转移规律及其对生存预后的影响。方法选取经微创食管癌切除术(minimally invasive esophagectomy,MIE)治疗的食管鳞癌患者103例,按照日本食管肿瘤研究会(Japan Esophageal Cancer Research Association,JEOG)淋巴结分区的标准进行淋巴结清扫,统计淋巴结的转移情况,分析淋巴结转移情况对3年总生存率的影响。结果胸上段食管癌主要向左、右喉返神经旁淋巴结转移。胸中段食管癌呈现双向淋巴结转移。胸下段食管癌主要向胃左动脉旁和肝总动脉旁淋巴结转移。食管癌患者3年总生存率在病变长度、分化程度、浸润深度、肿瘤位置和淋巴结转移方面比较,差异均具有统计学意义(均P<0.05)。结论淋巴结转移是影响胸段食管癌患者术后效果的重要影响因素,结合病变位置情况,重点清扫相应部位的淋巴结,并可依据病变长度、分化程度、浸润深度、肿瘤位置及淋巴结转移判定远期预后。
文摘BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be either symptomatic or asymptomatic,and relies on image tools for diagnosis and preoperative planning.Indications for surgery are dependent on the complications from the diverticulum.Metaplasia is about 10%among those with hutch diverticulum,and it still has chances turning into malignancy,especially urothelial cell carcinoma.CASE SUMMARY A 27-year-old man was presented with frequently recurrent urinary tract infection for one year,and had suffered from intermittent right flank pain for 3 mo.No past medical histories were recorded before.No obvious abnormalities on laboratory data and urine examination were found.Under ultrasound,right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography.Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice.Cystoscopy was done and biopsy results showed focal metaplasia.After discussing with him,roboticassisted diverticulectomy with reconstruction was performed.Right hydronephrosis was greatly improved after surgery.He has completed his 1.5-year follow-ups,and no malignancies were seen from urine cytology and image of intravenous pyelography.CONCLUSION Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation,providing several advantages over open and laparoscopic ones.