急性冠状动脉综合征患者经皮冠状动脉介入治疗的临床效果和2年随访结果

Background Increased thrombegenicity and smooth muscle cell proliferative response induced by the metal struts compromise the advantages of coronary stenting. Adnan Kastrati et al. reported in the ISAR-STEREO trial that a reduced strut thickness of coronary stent is associated with improved follow up angiographic and clincal results.

Objective To report outcomes of nonsurgical and surgical management of Menière's disease at Beijing Tiantan Hospital . Methods Patients with Menière's disease were categorized into groups based on hearing and quality of life. Individualized management was provided, including life style modification, drug therapies, endolymphatic sac decompression and labyrin-thectomy. Treatment outcomes were evaluated during up to 24 months follow up . Results Eighty seven patients under-went life style modification and drug therapies. The vertigo control rate of Grade A and B was 76.9% and 83.8% respec-tively. Six patients received surgical management, including endolymphatic sac decompression (n = 5) and labyrinthecto-my (n = 1) . For these patients, the vertigo control rate of Grade A and B was 80% and 100%, respectively. Conclu-Isions Management of Menière's disease depends on several factors, i.e. severities of vertigo and hearing loss, quality of life, surgical contraindications and patient subjective desire. The treatment is drug therapies for the majority of patients, as well as life style modification. Surgical indications are rare and the least invasive procedures should be considered first. The results of surgery are generally satisfying.

前十字韧带重建术后骨关节炎的研究进展

前十字韧带断裂是常见的膝关节运动损伤，断裂后可造成膝关节不稳，并导致创伤性骨关节炎。前十字韧带断裂后，临床上普遍采用前十字韧带重建术来恢复膝关节的前向稳定性，减少半月板和软骨继发损伤，改善膝关节的运动功能。长期的临床随访研究表明，重建前十字韧带后膝关节仍会发生退行性改变。传统的单束重建前十字韧带已经在临床应用多年，该方法可以有效恢复膝关节的前向稳定性，并已取得了较好的临床效果。但是，对于重建前十字韧带后能否减少骨关节炎的发生目前尚无一致性结论。采用骨-髌腱-骨重建前十字韧带20年后，61%的患者X线片示骨关节炎改变。近年来，随着对前十字韧带解剖和生物力学的进一步认识，重建前十字韧带的新术式不断涌现，包括双束重建、解剖重建和个体化重建，这些新术式能否更好地保护膝关节，减少前十字韧带重建术后骨关节炎的发生仍存争议。目前，各种手术技术均有其优势和局限性，尚无法准确评估哪种技术在重建前十字韧带后能在减少膝关节骨关节炎发生方面更具优势。未来对前十字韧带损伤的治疗，尤其是采用前十字韧带重建术后，不仅应注重恢复关节的前向和旋转稳定性，也应注重恢复膝关节关节软骨包括胫股关节和髌股关节的正常受力，尽可能避免和减少前十字韧带重建术后骨关节炎的发生。

腓肠肌内侧头肌瓣移植对保肢术后患者肢体功能的影响

Winberg once adopted muscle flap implantation for 26 patients after excision of peripheral giant malignant tumor of knee joint.After 3- 7 years of follow up survey,all muscle flap survived,function of limbs were good which indicated that implantation with pedunculated muscle flap or muscle skin flap had an important effect on improving success rate of limb salvage of malignant tumor.

腰骶段选择性脊神经后根切断术对痉挛型脑性瘫痪患者伴随症状的影响

Objective To investigate the effects of lumbar sacral selective posterior rhizotomy on spasticity of upper limbs,epilepsy, strabismus, sialorrhea and dysarthria of patients with spastic cerebral palsy.Methods 825 patients with cerebral palsy who had received SPR between 1990 and 1998 were followed up for two years at least.Results Of 328 cases with spasticity of upper limbs,67(20.4% ) had partial amelioration of spasticity of upper limbs.Of 35 cases with epilepsy, 31(88.6% ) had lower frequency of onset or needed to take lower dose drug to control than ever.Of 386 cases with strabismus,132(34.2% ) had improved.Of 73 cases with sialorrhea,49(67.1% ) had improved, 21(28.8% ) had found sialorrhea disappeararnce.Of 456 cases with dysarthria,72(15.8% ) had improved.Conclusion Selective posterior rhizotomy has curative effect on combined symptoms in some of patients with cerebral palsy.

胫腓骨骨折术后分期康复治疗效果分析

Background: Joint movement disorder and even stiff joint often occurs after external fixation for fracture of tibia and fibula, the reason of which is usually the intra joint adherence and the adherence and atrophy of the extra joint muscles. Objective: To discuss the treatment effects of post- operational staged rehabilitation for fracture of tibia and fibula. Unit: Second People Hospital of Ningxia. Subject: There were 65 cases including 45 male and 20 female ones. They were from 16～ 70 years with the average of 43 years. The fractures were all unstable, fragmental and open. Intervention: Three- staged rehabilitation was applied after external fixation: (1) Early rehabilitation treatment (3～ 6 weeks after operation): ① The fractured limb was elevated to diminish the swelling; ② To exercise the joints at the end of the limbs, as to exercise the toes for multiple times every day; ③ Fix the muscles of the limbs and contract them isometricly, do it for 15～ 20 minutes each time and for multiple times every day. (2) Middle rehabilitation treatment(8～ 10 weeks after operation ) muscle force exercises were increased gradually, the anti resistance exercises were added gradually after the muscle force got over degree III, the joint movement ranges were added gradually with the muscle under control. (3) Late rehabilitation treatment ( the fracture had healed).① Muscle force exercises: Anti resistance exercises such as sandbag kicking and pedaling. ② Joint movement exercises including active and passive exercises, such as extension and flexion of knee joint, dorsiextension and planter flexion of ankle joint, the exercises should be increased gradually to form some rhythm and speed. Also electric treatment, heat treatment, ultrasonic treatment and massage etc may be added in this period. Result: The follow up periods for the 65 cases were 3～ 12 months and the time for the fractures to heal completely was 8～ 16 weeks ( the average was 12 weeks). The function condition of the ankle and knee joints was as follows: knee flexion 150° , knee extension 0° ; ankle dorsiflexion 20° , ankle planter flexion 40° , ankle inversion 30° , ankle extroversion 20° . Conclusion: Manipulative reduction combined with rehabilitation exercises may have excellent effects on facture of tibia and fibula.

Objective To evaluate the mid- and long-term radiological outcomes of cerebral aneurysms with GDCs embolization.Methods One hundred and sixty-two patients with 173 aneurysms embolized with GDCs underwent angiographic follow-up from 1 to 54 months post-operatively and were retrospectively reviewed. Three neuro-radiologists reviewed each angiogram and made a comparison between initial and follow-up angiograms. Morphological outcomes were evaluated as follows: unchanged; progressive thrombosis; and re-opening or re-growth. Results Of 173 aneurysms with GDC embolization, 142 aneutysms had total or nearly total occlusion, 23 subtotal occlusion and 8 partial occlusion shown on initial angiograms. The incidence of re-opening was 17.1% (13/76) in less than 3 months, and 6.2% (6/97) between 3 and 6 months postoperatively. Four aneurysms showed recurrency(2.3%) on second follow-up angiography in one year after procedure and one-year cumulative recurrent rate was 13.3% of 56 aneurysms with the third follow-up angiography in the post-operation period of 12 to 54 months, four showed a little enlargement and the cmnulative recurrent rate so far was 20.2% (35/173). Conclusions The direct and main causes for aneurysmal recurrence are incomplete and loosening packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier after the procedure, especially in aneurysms with initial incomplete occlusion. Re-treatment with balloon- or stent-assisted coil embolization is recommended in re-opening aneurysms. (J Intervent Radiol,2005,14:472-479)

负压辅助闭合技术在修复隆突性皮肤纤维肉瘤扩大切除创面中的应用

目的 探讨修复隆突性皮肤纤维肉瘤扩大切除创面的新方法.方法 8例隆突性皮肤纤维肉瘤患者,肿瘤直径2.5～5.5 cm,切除后创面直径为12.5～17.5 cm.针对扩大切除后的巨大创面,利用筛状皮片及负压辅助闭合技术,修复创面.结果 8例患者筛状皮片均一期存活,无感染、无积液、无坏死.随访3 ～ 40个月,无1例复发,创面外形与功能均较满意,瘢痕平整,增生不明显.结论 负压辅助闭合技术在修复隆突性皮肤纤维肉瘤扩大切除创面中的应用,操作简单,并发症少.

骶尾部畸胎瘤预后因素探讨

101例骶尾部畸胎瘤良性75.2%、恶性24.8%.总随访率74.3%.恶性率1岁以内7.6%,1～2岁63.2%,2岁以后不随年龄上升.良性复发率12.3%,复发后71%为恶性.恶性病例中位生存期8个月,复发后生存期平均4个月.分析提示延迟诊断是导致恶性率上升的重要原因,手术切除的完整性是减少肿瘤复发和恶交的关键,联合辅助治疗能提高恶性病例的疗效.

髋骨切骨术治疗先天性髋关节脱位的长期随访和对手术的改进

作者报告23年来用髋骨切骨术治疗先天性髋关节脱位214例(264个髋关节).经长期随访,疗效满意,但也存在一些问题.分析再脱位原因,发现男性明显高于女性.提出了髋骨切骨术的改进措施与可行性.

小儿输尿管皮肤造口的远期随访

本文报道北京儿童医院对10例输尿管皮肤造口的患儿,年龄为10月～10.5岁(平均6.5岁)进行了21月～20年9月(平均7.8年)的随访.10例中神经性膀胱8例,膀胱横纹肌肉瘤1例,后尿道瓣膜1例.术前一般情况差,均有上尿路扩张及尿路感染.术后一般情况均有改善,2人已参加工作,1人做家务劳动,6人分别是中、小学生,1例后尿道瓣膜患儿于术后21月时已经尿道电灼瓣膜,并接受了尿路重建术.文中对适应证、手术方法及其疗效进行了讨论.

小儿泌尿生殖系及盆腔横纹肌肉瘤

横纹肌肉瘤是小儿软组织肉瘤中多见之一,除多位于头颈部外,也好发于泌尿生殖系.自1958年应用手术、放及化疗的综合措施后,该病的预后大为改观,故将我科收治的泌尿生殖系及其相邻近的盆腔及会阴部横纹肌肉瘤作一报道及讨论,以期总结,提高疗效.

电焊工肺部病变的高分辨 CT 短期随访分析

电焊工作业时吸入过量的电焊烟尘可导致电焊工尘肺，电焊工尘肺目前被我国确认为法定的尘肺病。早在1936年英国的 Doig 和 Melaughlin 首次通过胸片报道了电焊工肺部的异常表现以来，对于电焊烟尘致纤维化的作用有不同的看法，早期研究认为电焊烟尘是“惰性粉尘”，不引起纤维化，并通过胸片随访，观察到原有的病变变淡、消失[1]。近年来，多数学者认为由于电焊烟尘成分复杂，有多种致病因素，可引起不同程度的纤维化[2]。本研究采用高分辨 CT 技术，明显提高了对肺部细小病变的显示率，可显示电焊工早期肺部的异常，通过5年短期随访初步探讨电焊工早期肺部异常的动态变化，研究病变的转化规律。