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find Author "张智" 10 results
  • PROGRESS IN THE TREATMENT OF CHRONIC ACHILLES TENDON RUPTURE

    To review the progress in the treatment of chronic Achilles tendon rupture. Methods Recent l iterature on the treatment of chronic Achilles tendon rupture was reviewed. Results The choice of operative method for the repair of chronic Achilles tendon rupture depended primarily on the length of tendon defect, the atrophic condition of triceps surae muscle, and the age and the sportive level of patient. Conclusion Most chronic Achilles tendon ruptures should be treated operatively to reach good functional recovery, and tissue engineering provides a promising future for tendon defect repair.

    Release date:2016-09-01 09:07 Export PDF Favorites Scan
  • 可疑肾上腺内异位甲状腺1例报道并文献复习

    目的总结肾上腺内异位甲状腺的影像学表现、病理特征、临床诊断、鉴别诊断以及治疗方法和预后。方法回顾性分析2023年3月广东医科大学附属医院收治的1例可疑肾上腺内异位甲状腺的临床表现、病理特征、治疗及预后情况,并结合国内外相关文献报道的26例肾上腺内异位甲状腺的病例资料进行分析。结果本例66岁女性患者,术前检查提示左侧肾上腺占位(考虑嗜铬细胞瘤)并行手术完整切除,术后根据病理学检查和免疫组织化学检查最终考虑诊断为肾上腺内异位甲状腺并腺瘤样增生,术后随访6个月未见复发。复习国内外文献报道的26例肾上腺内异位甲状腺患者资料,亚洲中老年女性多见(22例),左侧多发(17例),大部分(19例)由体检发现,通常表现为无痛性囊性肿块,大体呈类圆形,镜下可见甲状腺样组织,并见甲状腺样滤泡,滤泡腔内见嗜酸性胶质样物,部分区域可见滤泡与肾上腺皮质混杂,通常无肾上腺髓质成分,囊壁被覆扁平上皮细胞或甲状腺滤泡样细胞、可见核重叠,偶见核沟和包涵体,类似甲状腺乳头状癌细胞核,但未见砂粒体。免疫组织化学表现为PCK、EMA、TTF-1、Tg、Vimentin阳性,提示甲状腺分化,BRAFV600E、KRAS基因突变阴性。治疗以完整切除肿瘤为主,预后良好。结论肾上腺内异位甲状腺罕见,确切发生机制有待研究,临床术前不易辨识,应与肾上腺肿瘤、转移性甲状腺滤泡癌、乳头状癌等鉴别,免疫组织化学染色及基因检测有助于明确诊断,治疗以完整切除肿瘤为主,预后良好。

    Release date:2024-05-28 01:54 Export PDF Favorites Scan
  • Surgical Resection and Reconstruction for Metastatic Spinal Tumors

    目的:探讨脊柱转移瘤患者的手术切除与脊柱稳定性重建的适应证与效果。方法:2003年4月至2008年4月,收治了脊柱转移癌患者32例。肿瘤转移部位:胸椎转移22例,腰椎转移7例,颈椎转移3例。男性13例,女性19例。出现神经系统受损者27例,其中完全瘫痪者7例,不完全瘫痪者20例。全组患者均做了椎体切除、内固定术或后路椎板切除、椎管减压内固定术或前后路联合行360°脊椎切除固定一期重建脊柱稳定性。观察术后局部疼痛缓解,神经功能恢复及脊柱稳定性情况。结果:随访时间为6~60个月,32例患者中,30例术后痛疼得到缓解。27例有神经功能损害的患者中,25例术后麻痹症状改善。3例完全瘫痪的患者中,2例在减压术后ASIA分级提高了1~2个等级。术后影像学提示脊柱序列和椎间高度恢复。术后存活1年以上的患者22例,约占患者总数的69%。结论:外科切除与重建治疗转移癌所致椎体塌陷或不稳定造成严重的神经损害或机械性脊柱痛疼的外科疗效肯定,能够增加脊椎稳定性,提高生存质量。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • PALMARIS LONGUS TENDON GRAFT FOR TREATMENT OF OLD MALLET FINGER DEFORMITY

    Objective To investigate the effectiveness of the terminal extensor tendon reconstrution by palmaris longus tendon graft for the treatment of old mallet finger deformity. Methods Between February 2009 and February 2011, 32 patients with old mallet finger deformity were treated with palmaris longus tendon graft. There were 28 males and 4 females with an average age of 32.5 years (range, 22-58 years). The injury causes included sports injury in 26 cases and punctured injury in 6 cases. The index finger was involved in 8 cases, the middle finger in 3 cases, the ring finger in 16 cases, and the little finger in 5 cases. According to the Rockwell’s classification, all patients were classified as type I. The time from injury to operation was 4-16 weeks (mean, 6 weeks). Results Primary healing was obtained in all incisions; no necrosis, infection, or nail bed injury occurred. All patients were followed up 12-20 months (mean, 14 months). The patients had no pain or paresthesia of volar finger. According to Patel’s functional assessment system, the results were excellent in 8 cases, good in 21 cases, fair in 2 cases, and poor in 1 case at last follow-up, with an excellent and good rate of 90.6%. Conclusion Reconstruction of the terminal extensor tendon by palmaris longus tendon graft is a reliable method to treat old mallet finger deformity.

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • Association of metabolic syndrome components with knee osteoarthritis: a Mendelian randomization study

    ObjectiveTo investigate the causal association between metabolic syndrome (MetS) components and osteoarthritis of the knee (KOA) by using Mendelian randomization analysis. MethodsThe genome-wide association study database (GWAS) was mined, in which the exposure factors were MetS components, namely waist circumference (WC) level, triglyceride (TG) level, high-density lipoprotein cholesterol (HDL-C) level, hypertension (HBP), and type 2 diabetes (T2DM), and the outcome factor was KOA. Mendelian randomization analysis was performed using regression models of inverse-variance weighted (IVW), MR-Egger, Simple Mode, Weighted Median, and Weighted Mode methods. ResultsIVW showed a causal relationship between WC level and KOA with a positive correlation (OR=3.088, 95%CI 2.574 to 3.704, P<0.01), and HDL-C level had a causal relationship with KOA with a negative correlation (OR=0.877, 95%CI 0.779 to 0.989, P<0.05). IVW did not show a causal relationship between TG levels, HBP, and T2DM with KOA (P>0.05). The results of the ME-Egger intercept test were not multiplicative (P>0.05), indicating that Mendelian randomization was a valid method for causal inference in this study. ConclusionCentral obesity and low HDL-C disorder are independent risk factors for KOA. The causal relationship between TG level, HBP, and T2DM with KOA is still uncertain.

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  • 带神经邻指近节指背逆行岛状皮瓣修复指腹缺损

    目的 总结应用以指背动脉为蒂带神经的邻指近节指背逆行岛状皮瓣修复指腹缺损的方法及疗效。 方法 2005 年7 月- 2007 年1 月,应用带神经的邻指近节指背逆行岛状皮瓣修复12 例12 指指腹缺损。男10 例,女2 例;年龄19 ~ 52 岁,平均34 岁。机器挤伤6 例,电锯伤4 例,绞伤2 例。损伤指别:示指7 指,中指2 指,环指3 指。缺损范围1.6 cm × 1.0 cm ~ 3.0 cm × 2.0 cm。受伤至入院时间为2 ~ 9 h。术中切取皮瓣范围2.0 cm × 1.2 cm ~ 3.5 cm ×2.3 cm。供区游离植皮修复。 结果 4 例术后1 ~ 2 d 出现皮瓣肿胀并伴张力性水疱,经对症治疗后5 ~ 7 d 肿胀消退;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区植皮全部成活,指蹼处遗留瘢痕。患者均获随访,随访时间8 ~ 20 个月,平均13 个月。手指外形良好,皮瓣质地软,无触痛,能耐受寒冷刺激。静止两点辨别觉为4 ~ 7 mm,平均5.2 mm。供指无明显畸形,指间关节活动正常。 结论 带感觉神经的邻指近节指背逆行岛状皮瓣修复指腹缺损不损伤手指重要血管及神经,切取皮瓣适中,手术操作简便,术后无指间关节僵硬,重建指腹感觉恢复满意。

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • Preliminary study on the clinicopathological features and clinical subtypes of Peutz-Jeghers syndrome: a report of 295 Chinese cases

    Objective To investigate the clinicopathological features and clinical subtypes of Peutz-Jeghers syndrome (PJS) in Chinese cases. Methods The clinical and pathological data of 295 patients with PJS who were treated in Air Force General Hospital from Nov. 1994 to Aug. 2017 were retrospectively analyzed and a multifactor statistical study was carried out on. Results Two hundreds and ninety-five patients with PJS belonged to 7 nationalities and came from 26 provinces and urban areas. 99.0% (292/295) of the patients had black spots on the lip and buccal mucosa, and the median occurrence time was 2 years old (0–33 years). The median age of inital diagnosis and treatment was 15 years old (1–45 years). The median interval time between the occurrence of black spots and abdominal symptoms was about 10 years (0–45 years). PJS hamartoma polyps were found in alimentary canals of 293 patients (99.3%), and 96.9% distributed in the duodenum and small intestine (n=284), 90.4% distributed in the colorectal (n=265), 79.9% distributed in the stomach (n=234). Patients of black spot appearing at age <3 years and (or) initial treatment at age <14 years were classified as early-onset subtype, otherwise they could be included in delayed-onset subtype. Conclusions The clinical features of PJS are prominent and the harm of PJS hamartoma polyps is serious. The black spots on the lip and buccal mucosa can be used as an early warning signal to divide the PJS patients into 2 clinical subtypes, which should be differentiated in clinical therapy and follow-up strategy.

    Release date:2018-07-18 01:46 Export PDF Favorites Scan
  • A Study on Catheter Related Infection in Cancer Patient Treated with Central Venous Catheterization

    Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.

    Release date:2016-09-07 11:00 Export PDF Favorites Scan
  • 甲状旁腺全切除+前臂自体移植术对肾功能衰竭继发甲状旁腺功能亢进合并关节周围软组织钙化患者的疗效分析

    目的 探讨甲状旁腺全切除+前臂自体移植术(TPT+AG)对肾脏功能衰竭(简称肾衰)继发甲状旁腺功能亢进(简称甲旁亢)患者关节周围软组织钙化的疗效。 方法 回顾性分析 广东医科大学附属医院 2015 年 4 月至 2017 年 4 月期间收治的 11 例肾衰继发甲旁亢合并关节周围软组织钙化患者的临床资料,均采用 TPT+AG 治疗,比较手术前后血清甲状旁腺激素(PTH)、钙、磷水平、钙磷乘积变化情况,并观察术后关节周围软组织钙化改善的情况。 结果 11 例患者术后第 6 个月时血磷、钙磷乘积均在正常范围内,有 10 例患者在术后 6 个月于体表均未及原有肿物,临床观察肿物消失最短时间为 2 个月,其原有的活动障碍、局部麻木、疼痛等不适症状完全消失,仅 1 例患者术后肘关节肿物缩小不明显。 结论 本研究有限病例的初步研究结果提示,对于肾衰继发甲旁亢合并关节周围软组织钙化的患者,TPT+AG 是有效的治疗方法,患者可能仅通过 TPT 就可使关节周围软组织钙化明显缩小或者完全消除。

    Release date:2018-02-05 01:53 Export PDF Favorites Scan
  • ANTERIOR APPROACH DEBRIDEMENT AND BONE GRAFTING WITH SELF-LOCKED TITANIUM PLATE INTERNAL FIXATION FOR TREATING LUMBOSACRAL TUBERCULOSIS

    ObjectiveTo explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis. MethodsSeven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L5, S1 lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy. ResultsAll patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt. ConclusionStage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.

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