骨质疏松性胸腰椎压缩性骨折经皮球囊后凸成形术的应用临床观察

目的探讨经皮球囊后凸成形术应用于骨质疏松性胸腰椎压缩性骨折的临床疗效。方法选取2012年~2013年治疗的11例骨质疏松性胸腰椎压缩性骨折患者,随访6个月至1年,观察患者的术后恢复情况。结果所有患者伤椎高度无丢失现象,疼痛感消失,脊柱活动度恢复伤前水平。结论应用经皮球囊后凸成形术治疗骨质疏松性胸腰椎压缩性骨折,不仅可解除或缓解疼痛症状,而且可以促使病人早下床活动,提高患者生活质量。     

高龄胸腰椎骨质疏松压缩性骨折经皮椎体成形术治疗效果分析

目的探讨经皮椎体成形术治疗高龄胸腰椎骨质疏松压缩性骨折的效果。方法选择65例胸腰椎骨质疏松压缩性骨折高龄患者,按手术编号随机分为观察组与对照组,观察组33例应用经皮椎体成形术治疗,对照组32例采用非手术疗法,治疗3个月后,比较两组患者疼痛视觉模拟VAS评分,伤椎前后缘高度恢复情况、Cobb’s角矫正情况,并发症发生情况。结果治疗后两组VAS评分均较前降低,且观察组较对照组更明显,两组比较有统计学差异(P<0.05);治疗后观察组伤椎前后缘高度、Cobb’s角改善情况明显优于对照组,两组比较有统计学差异(P<0.05);而并发症发生情况两组比较无统计学差异(P>0.05)。结论经皮椎体成形术治疗高龄胸腰椎骨质疏松压缩性骨折效果肯定。     

老年胸腰椎骨质疏松性椎体压缩性骨折经皮椎体成形术治疗效果不佳的影响因素分析

目的 探讨分析老年胸腰椎骨质疏松性椎体压缩性骨折(OVCF)经皮椎体成形术(PVP)治疗效果不佳的影响因素。方法 选取2021年1月至2022年1月安阳市第三人民医院收治的82例行PVP治疗的老年胸腰椎OVCF患者作为研究对象,收集患者性别、年龄、体重指数(BMI)、术前骨密度(BMD)、骨折椎体数、有无高血压、有无糖尿病、手术入路方式、单个椎体骨水泥注入量、有无骨水泥渗漏、术后是否规范行抗骨质疏松治疗等资料,并根据PVP术后1个月的治疗效果将其分为效果满意组和效果不佳组,多因素Logistic回归分析老年胸腰椎OVCF患者PVP治疗效果不佳的相关影响因素。结果 82例老年胸腰椎OVCF患者PVP术后1个月治疗效果满意67例(81.71%),设为效果满意组;治疗效果不佳15例(18.29%),设为效果不佳组。单因素分析结果显示,效果不佳组患者年龄明显大于效果满意组(t=3.745,P<0.001),术前BMD明显小于效果满意组(t=2.914,P=0.005),骨折椎体数≥2个、有骨水泥渗漏以及术后未规范行抗骨质疏松治疗者比例均明显高于效果满意组(χ²=9....     

经皮椎体成形术治疗胸腰椎骨质疏松性压缩骨折疗效及相关因素分析

目的探讨经皮椎体成形术(PVP)在治疗胸腰椎骨质疏松性压缩骨折的疗效。方法选择我院收治的骨质疏松性胸腰椎压缩骨折患者共176例,患者根据治疗方式不同分为PVP组及经皮椎体后凸成形术(PKP)组,PVP组102例,PKP组74例。比较两组患者手术时间、住院时间、骨水泥注射量、Cobb角及治疗有效率,VAS评分评估两组手术前后疼痛情况。结果 PVP组手术时间、住院时间均显著低于PKP组(P<0.05)。PVP组及PKP组术后24 h及术后1个月的VAS评分均显著低于术前(P<0.05)。PVP及PKP组术后Cobb角均较术前显著降低(P<0.05)。治疗有效率比较,PVP及PKP组差异无统计学意义(P>0.05)。PVP组病程<6个月的患者治疗有效率(98.4%)显著高于病程≥6个月的患者(73.6%)(P<0.05)。结论经皮椎体成形术是治疗胸腰椎骨质疏松性压缩骨折的有效、可行的方法,病程长短会影响椎体成形术的治疗有效率。     

经皮椎体成形术与非手术治疗对老年创伤性胸腰椎单椎体轻度压缩性骨折的疗效对比研究

目的比较经皮椎体成形术(PVP)与非手术治疗对老年创伤性胸腰椎单椎体轻度压缩性骨折的临床效果。方法回顾性分析2011年1月—2015年12月收治的因创伤所致的单个胸腰椎轻度压缩性骨折患者128例,男性46例,女性82例;年龄60～83岁,平均69.8岁。根据治疗方法不同分为PVP治疗组和非手术治疗组。比较两组伤后1年VAS评分、Oswestry功能障碍指数(ODI指数)及SF-12评分。结果 128例均获随访,随访时间12～34个月,平均16.8个月。两组的性别构成比、年龄、身体质量指数、骨折压缩程度及骨密度比较差异均无统计学意义(P0.05),具有可比性。伤后1年,PVP组的VAS评分、ODI指数、SF-12躯体评分及SF-12心理评分分别为(1.9±0.8)分、(35.7±4.4)%、(70.5±7.4)分和(75.1±5.4)分,非手术治疗组分别为(1.7±0.6)分、(31.5±3.3)%、(76.6±9.2)分和(79.0±6.7)分;两组VAS评分比较差异无统计学意义(P0.05),但非手术治疗组的ODI指数低于PVP治疗组,SF-12评分高于PVP治疗组(P0.05)。结论对创伤性老年胸腰椎单椎体轻度压缩性骨折而言,与非手术治疗相比,PVP对伤后1年后的腰痛缓解并无帮助,且可能会导致患者的腰椎功能及生活质量下降。     

经皮椎体成形术治疗重度骨质疏松性压缩骨折

重度骨质疏松性胸腰椎压缩性骨折(vertebral compression fracture,VCF),经皮椎体成形术(PVP)穿刺难度大,技术要求高,并发症多而被列为禁忌证[1].2001年8月至2008年8月,根据骨质疏松性VCF影像学改变及临床特点采取相应的治疗策略.     

特立帕肽在骨质疏松性胸腰椎压缩性骨折术后应用效果及对骨密度影响

目的探讨特立帕肽在骨质疏松性胸腰椎压缩性骨折术后的应用效果及对骨密度的影响。方法选取自2015年1月至2018年10月中日友好医院收治的70例骨质疏松性胸腰椎压缩性骨折患者为研究对象。采用随机数字表法将患者分为观察组与常规组,每组各35例。常规组在椎体成形术后给予唑来膦酸注射液等常规治疗,观察组在常规组治疗的基础上联合使用特立帕肽注射液。治疗3个月后,比较两组患者的临床疗效、骨密度、椎体高度、Cobb角、Oswestry功能障碍指数(ODI)评分、视觉模拟量表(VAS)评分。结果治疗后,观察组临床治疗有效率、骨密度、椎体前缘高度、椎体中线高度明显高于常规组,Cobb角、ODI评分、VAS评分明显低于常规组,组间比较,差异均有统计学意义(P<0.05)。结论骨质疏松性胸腰椎压缩性骨折术后应用特立帕肽临床疗效显著,可提高骨密度,促进关节功能恢复。     

经皮椎体成形术在胸腰椎压缩性骨折中的应用

目的探讨经皮椎体成形术（paructaneous vertebroplasty，PVP）在治疗胸腰椎压缩性骨折中的应用。方法采用PVP治疗腰椎压缩性骨折患者44例，其中单节段28例，双节段12例，3节段以上的4例，共67个椎体，进行临床和影像学评价。结果本组患者均获得4—23个月的随访（平均15个月）。40例患者术后背部疼痛得到改善；19例患者术后当天下床活动，25例患者术后次日下床，术后X线检查椎内骨水泥分布均匀，无外漏。结论PVP具有止痛和稳定椎体，微创、并发症少等优点，是治疗胸腰椎压缩性骨折安全有效的治疗方法。     

椎体成形术和传统法治疗骨质疏松性椎体压缩骨折疗效的对比研究

目的研究并比较椎体成形术(PVP)和保守疗法治疗骨质疏松性椎体压缩骨折的临床疗效。方法骨质疏松性椎体新鲜压缩骨折83例共104节,非随机分为2组,组1共44例58节用PVP治疗,组2共39例46节用保守治疗,比较两组治疗后随访期内疗效及椎体高度变化。结果组1患者44例PVP后1周疼痛均得到缓解,视觉疼痛评分(VAS)平均分值从术前8.5下降至2.6(平均下降5.9)。组2患者39例保守治疗后1周VAS分值无变化,在治疗后1周、1和3个月时。组1的VAS分值明显低于组2(P<0.01),6个月时两组差异无统计学意义(P>0.05)。平均随访8.9个月,组1有新发骨折3例3节,组2有2例2节,两组比较无显著差异无统计学意义(P>0.05)。PVP后1周椎体高度恢复平均为前缘2.2mm,中央2.3mm,后缘高度无变化,随访3、6个月椎体前缘、中央高度与PVP后1周时无差异(P<0.01)。保守治疗后1周椎体前缘、中央及后缘高度与治疗前比较无显著改变,3个月时椎体高度丢失平均为前缘1.9mm,中央2.1mm,6个月时与3个月无差异。在治疗3个月后,组1椎体高度明显高于组2(P<0.01)。结论PVP可迅速缓解疼痛,明显缩短病程,但6个月后两组疗效无显著差异;PVP可使新鲜压缩椎体的前缘和中央高度得到部分恢复,可显著预防椎体进一步塌陷;保守治疗在3个月内椎体高度可进一步丢失;PVP后新发骨折可能是骨质疏松症的自然发病过程。     

比较经皮椎体成形术与保守治疗对慢性疼痛性骨质疏松性椎体骨折患者疗效的非随机前瞻性试验

目的比较经皮椎体成形术(PVP)和保守治疗对慢性疼痛性骨质疏松性椎体骨折患者在疼痛缓解和功能恢复方面的疗效。方法 81例患者分成两组,分别施行PVP(n=41,A组)或保守治疗(n=40,B组)。患者均经MRI证实患有慢性压缩性骨折,且疼痛持续在3个月或以上。观察两组患者在治疗后1周,1、3、6个月和1年的疼痛缓解和功能恢复情况。结果共有71例(A组37例和B组34例)完成了1年随访评估。通过在1周,1、3、6个月和1年的视觉模拟评(VAS)评分、功能障碍指数评分、欧洲基金会关于骨质疏松症的生活品质问卷评分和罗兰莫里斯残疾评分显示,A组在疼痛缓解和功能恢复方面显著优于B组,各时间点两组差异均有统计学意义(P均<0.01)。最终的临床随访评估中A组有30例、B组13例患者疼痛达到完全缓解(P<0.01)。结论 PVP在治疗慢性压缩性骨折和持续性疼痛的缓解及功能恢复方面优于保守治疗。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.