中国脆性骨折术后规范化抗骨质疏松治疗指南(2021)

骨质疏松症是一种全身性的骨骼系统疾病,其特征是骨量减少和骨组织显微结构退化,导致骨骼脆性增加,骨折风险增高。根据其发病原因可分为原发性骨质疏松和继发性骨质疏松两大类。本指南仅针对原发性骨质疏松症引起的脆性骨折所制定。脆性骨折亦称为骨质疏松性骨折,是骨质疏松症的最严重后果.     

双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎的临床疗效

目的探讨双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎(INP)的临床疗效。方法采用回顾性描述性研究方法。收集2016年4月至2019年7月陆军军医大学大坪医院收治的20例INP病人的临床资料;男11例,女9例;年龄为(42±9)岁。20例病人均行双入路小切口坏死组织清除术,联合术后脓腔持续灌注引流。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊及电话方式进行随访,了解病人发热、腹痛、腹胀、腹泻等临床表现及胰腺周围残余组织感染和生存情况。随访时间截至2020年1月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术情况:20例病人均顺利完成手术,其中14例手术入路为腹上区+左侧腹膜后入路,1例为腹上区+右侧腹膜后入路,5例为腹上区+双侧腹膜后入路。20例病人中,14例行附加手术,其中10例行空肠造瘘术、2例行胃造瘘及空肠造瘘术、1例行腹腔镜胆囊切除及空肠造瘘术、1例行胆囊造瘘术。20例病人手术时间为(228±41)min,术中出血量为100 mL(50~700 mL)。(2)术后情况:20例病人术后开始行0.9%氯化钠溶液脓腔持续灌注引流时间为2 d(1~14 d)。20例病人中,6例发生术后并发症,其中1例为术后胃瘘合并腹腔出血(于术后13 d行剖腹探查止血+胃造瘘术)、1例为术后十二指肠瘘(于术后111 d行胃肠吻合+空肠造瘘术)、1例为术后腹膜后残余组织坏死感染(于术后11 d再次行胰腺周围坏死组织清除引流术)、1例为术后胆囊瘘(于术后71 d行胆囊切除术)、2例为术后胰瘘(经保守治疗后痊愈)。20例病人第1次手术后住院时间为42 d(20~178 d)。(3)随访情况:20例病人均获得术后随访,随访时间为6.0~45.0个月,中位随访时间为14.5个月。随访期间,1例病人继发糖尿病;无病人出现发热、腹痛、腹胀、腹泻等临床表现。20例病人胰腺周围残余组织吸收良好,无病人死亡。结论双入路小切口坏死组织清除术联合持续灌注引流治疗INP安全、可行。     

2018年中国15岁及以上人群吸烟现况及变化趋势研究

目的描述中国≥15岁人群的吸烟现况, 并与既往调查比较, 分析其发展变化趋势。方法本次调查采用全球成人烟草调查的多阶段分层整群随机抽样, 覆盖全国31个省(自治区/直辖市)的200个区/县。于2018年7-12月收集个人问卷19 376份, 应答率为91.50%。数据采用SAS 9.4软件进行复杂抽样加权分析。结果 2018年我国≥15岁人群吸烟率为26.59%, 男性(50.47%)高于女性(2.07%), 农村(28.87%)高于城市(25.05%)。吸烟者戒烟率为20.10%, 女性(30.22%)高于男性(19.64%), 城乡差异无统计学意义(P=0.864)。与既往调查结果相比, 吸烟率呈现下降趋势, 其中, 25～44岁和45～64岁人群吸烟率下降明显, 大专及以上文化程度人群的吸烟率下降幅度最大。此外, 2018年我国≥15岁吸烟者平均每日吸烟量为16.00支, 现在每日吸烟者开始每日吸烟的平均年龄为20.95岁。结论我国≥15岁人群吸烟率下降速度不足以保证《健康中国行动(2019-2030年)》既定控烟目标的顺利实现, 需加大控烟工作力度。     

内蒙古自治区不同生态系鼠疫自然疫源地动物鼠疫流行现状及流行风险简析

内蒙古面临着多种类型疫源地鼠疫流行和复燃的风险。蒙古旱獭疫源地虽然暂未在国内发现动物间鼠疫流行,但过去检出过阳性血清,同时蒙古旱獭种群数量持续增加且分布范围不断扩大,毗邻的蒙古国和俄罗斯联邦的蒙古旱獭疫源地动物间鼠疫持续流行;达乌尔黄鼠疫源地动物间鼠疫时隐时现;长爪沙鼠疫源地动物间鼠疫流行猛烈,并频频波及人间。由于蒙古旱獭和达乌尔黄鼠鼠疫耶尔森菌菌株毒力明显高于长爪沙鼠鼠疫耶尔森菌菌株,且在历史上曾给当地带来深重灾难,因此内蒙古自治区鼠疫防控重点应在常规鼠疫监测的基础上,进一步加强蒙古旱獭和达乌尔黄鼠疫源地流行动态的监测,警惕该两个疫源地复燃并波及人间。     

中国9个省（自治区、直辖市）小学生户外时间对近视发生影响的队列研究

目的 探索户外时间对小学生近视发生的影响,并评估其在不同年级学生中的差异,为预防近视相关政策制定提供依据。方法 本研究基于队列研究设计,在2019年调查了江苏、上海、福建、山西、河南、湖南、甘肃、重庆、广西9个省（自治区、直辖市）6 046名1~5年级小学生,现场对其近视情况进行检查,并在2020年对该群体再次进行随访,现场检测近视发生情况,并在2020年视力测量后一周内对近视相关行为进行问卷调查。采用χ²检验、Cochran-Armitage趋势检验比较组间差异,采用Cox比例风险回归模型检验户外时间与近视发生的关系。结果 在2020年,基线时为1~5年级的小学生近视发生率为27.5%,其中,1~2年级小学生近视发生率为23.0%,3~5年级小学生近视发生率为31.7%。控制协变量后,在1~2年级小学生中,平均每天户外时间≥1 h学生近视发生风险是平均每天户外时间<1 h学生的0.76倍（95%CI：0.62~0.93,P=0.008）;而对于3~5年级小学生,平均每天户外时间≥3 h才对近视发生有显著保护作用,其近视发生风险是平均每天户外时间<3 h学生的0.75倍（95%CI：0.61~0.93,P=0.007）。结论 1~2年级小学生平均每天达到1 h户外时间可以降低近视发生率,而3~5年级小学生平均每天需达到3 h户外时间可能才会有效降低近视发生率。因此,针对不同年级小学生预防近视的户外时间推荐应有差异,年级越高,户外时间相应增加,降低其近视发生率。但同时,还要关注其他因素对近视的作用,采用综合手段防控近视的发生。     

内镜下全腹膜外Sublay修补在腹壁疝中的应用

目的评价腹壁疝内镜下全腹膜外Sublay(TES)手术的效果并总结经验。方法回顾性总结国内10所医院自2016年3月至2019年7月115例腹壁疝内镜下TES手术的患者资料。分析患者情况、疝的特点、手术经过和结果。结果115例计划实施TES的患者中,因严重腹膜破损中转为IPOM修补患者1例,其余均成功手术。可以缝合缺损患者108例(94.74%),需要永久补片固定患者15例(13.16%)。放置引流患者76例(66.67%),中位手术时间为144 min,术中无严重并发症发生。随访时间3~45个月,总并发症发生率为20例(17.54%),其中出现血清肿患者5例(4.38%)。绝大多数患者术后仅出现轻微疼痛,未出现慢性疼痛。结论在腹壁疝的治疗中,对熟悉腹壁解剖的外科医师而言,TES是一种有效、安全的修复手段。在熟悉手术的基础上适应症可逐步拓展。     

Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases

ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions.     

Crowdfunding in urology: Canadian perspective

IntroductionCrowdfunding is becoming an increasingly used resource for patients to cover costs related to medical care. These costs can be related directly to treatments or indirectly to loss of income or travel-related costs. Little is known as to the extent of which crowdfunding is used for urological disease here in Canada. This study offers a first look at the prevalence of crowdfunding for urological disease and the factors surrounding its use.MethodsIn January 2020, we queried the GoFundMe internal search engine for fundraising campaigns regarding urological ailments. Results were categorized according to the major organs of urological disease.ResultsCrowdfunding campaigns are very prevalent within several areas of urology. Prostate cancer and chronic kidney disease represent the most frequent reason for campaigns. Fundraising goals and actual funds raised for malignant disease were significantly more than for benign disease. Interestingly, there was a significant portion of crowdfunding campaigns to cover costs for non-conventional treatments and transplant tourism.ConclusionCrowdfunding use to help cover direct and indirect costs of medical care is becoming increasingly apparent through several facets of medicine. This study shows that this statement holds true when looking at patients with urological disease in Canada. As urologists, we need to be aware of this trend, as it highlights the often-unforeseen financial burdens experienced by our patients.     

Achieve Closed Reduction of Irreducible,Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique

ObjectiveTo be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS).MethodsA retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post‐surgical reduction quality was evaluated using Matta scoring criteria and patient lower‐extremity functional outcome was evaluated using Majeed functional scoring criteria.ResultsWhen used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post‐surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra‐acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients'' lower‐extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow‐up at an average of 41.6 months postoperatively.ConclusionWith excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS‐assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.