ObjectiveTo evaluate long-term radiographic and clinical effectiveness of total cervical disc replacement (TDR) with Prodisc-C prosthesis at a minimum of 10 years follow-up.MethodsThe clinical data of 118 patients with cervical disc degeneration disease (CDDD) treated with TDR by using Prodisc-C prosthesis between December 2005 and April 2008 were retrospectively analyzed. There were 66 males and 52 females, with the age of 25-62 years (mean, 46.8 years). There were 38 cases of cervical spondylotic radiculopathy, 28 cases of cervical spondylotic myelopathy, and 52 cases of mixed cervical spondylotic myelopathy. The operative segments were C3-7, including 90 cases of single segment, 20 cases of continuous double segments, and 8 cases of continuous three segments. A total of 154 Prodisc-C prostheses were used during the operation. The clinical effectiveness was evaluated by pain visual analogue scale (VAS) score, neck disability index (NDI), Japanese Orthopaedic Association (JOA) score, and Odom grade before and after operation. Imaging evaluation indicators included range of motion (ROM), sagittal lordosis angle, intervertebral disc height (IDH), and prosthesis displacement, subsidence, loosening, locking, and heterotopic ossification (HO), adjacent segment degeneration (ASD), and other complications. Patients were grouped according to whether HO or ASD occurred or not, the ROM of surgical segment was compared.ResultsAll patients were followed up 121-150 months (mean, 135.8 months). No revision operation was performed during the follow-up period. The VAS, NDI, JOA scores and Odom grades were significantly improved at 1 week after operation and last follow-up when compared with preoperative ones (P<0.05); VAS and NDI scores were further improved at last follow-up than those at 1 week after operation (P<0.05); there was no significant difference in JOA scores and improvement rates between at 1 week after operation and at last follow-up (P>0.05). The ROM of the whole cervical spine and the operative segment decreased at 1 week and 10 years after operation when compared with preoperative ones (P<0.05), but there was no significant difference in the other time points (P>0.05); there was no significant difference in the ROM between the upper adjacent segment (UAS) and the lower adjacent segment (LAS) at each time point after operation (P>0.05). There was no significant difference in sagittal lordosis angle of cervical spine before and after operation (P>0.05); the sagittal lordosis angle of operative segment increased significantly at 1 week, 6 months, 1 year, and 2 years after operation (P<0.05). The IDH of operative segment was significantly improved at each time point after operation (P<0.05), but there was no significant difference in IDH between UAS and LAS at each time point after operation (P>0.05). No prosthesis displacement, subsidence, or loosening occurred at each time point after operation. There was no significant difference of the prosthetic displacement and subsidence distance between all time points after 6 months after operation (P>0.05). At last follow-up, the incidence of prosthetic locking/fusion was 10.4%, showing no significant difference when compared with 6 months (1.9%) (P<0.05). The incidence of upper ASD and lower ASD was 1.3% and 2.6% respectively at 1 week after operation. The incidence of upper ASD and lower ASD increased gradually with time prolonging, and there were significant differences between different time points (P<0.05). The ROM of operative segment in ASD group was lower than that in non-ASD group at each time point after operation, but there was no significant difference (P>0.05). HO appeared in 58.4% of the segments at 6 months after operation, and the incidence of HO increased significantly with time, which was significantly different from that at 6 months after operation (P<0.05). The ROM of operative segments in HO group was significantly lower than that in non-HO group at 6 months, 2 years, 5 years, and 10 years after operation (P<0.05).ConclusionTDR has little effect on adjacent segments, although there are some imaging complications, it has no significant effect on the improvement of overall clinical effectiveness. Prodisc-C prosthesis can provide long-term, safe, and definite clinical effectiveness in the treatment of CDDD.
OBJECTIVE To investigate the clinical result and influence factors of prognosis after repair of ruptured Achilles tendon with operative treatment. METHODS From 1961 to 1994, 62 cases with ruptured Achilles tendon were treated operatively. Among them, "8"-shaped suture was used in 8 cases, aponeurosis flap repair in 30 cases, transfer repair of tendon of peroneus longus muscle in 2 cases, reverse "V-Y" shaped tendon plastic operation in 10 cases, and mattress suture of opposite ends in 12 cases. RESULTS Followed up 3 to 33 years, there was excellent in 40 cases, better in 13 cases, moderate in 6 cases, poor in 3 cases, 85.5% in excellent rate. Postoperative infection and re-rupture were occurred in 6 cases respectively. CONCLUSION Different operative procedures are adopted to achieve better long-term clinical result according to the injury types.
【摘要】 目的 探讨椎管内囊肿的手术治疗疗效。 方法 2006年5月-2009年12月对30例患者的临床表现、影像学和治疗情况进行回顾性分析。 结果 30例均行手术治疗，3例为椎管内单侧硬膜下髓外囊肿，3例为脑脊膜囊肿，12例为髓外硬脊膜下囊肿，9例为神经根袖套部囊肿（Tarlov囊肿），3例为脊管内肠源性囊肿。术后21例症状消失；9例好转，其中3例术后发生脑脊液漏，伤口二次缝合未成功，后经内引流后切口愈合。 结论 椎管内囊肿的临床表现及体征复杂，不典型，与椎管内肿瘤及椎间盘突出症的临床表现和体征相似；对症状及体征明显者宜施行手术治疗，手术治疗效果较满意。【Abstract】 Objective To evaluate the therapeutic effect of the surgery on intraspinal cyst. Methods A total of 30 patients from May 2006 to December 2009 were collected, and the clinical manifestations, results of examinations and therapeutic effects were retrospectively analyzed. Results All the patients underwent the surgery, inluding 3 with unilateral intraspinal subdural extramedullary cyst, 3 with meningeal cyst, 12 with subdural extramedullary cyst, 3 with nerve-root oversleeve cyst (Tarlov cyst), and 3 with intra-spinal-canal enterogenous cyst. Afterh the surgery, the symptoms disappeared in 21 patients, alleviated in 9 including 3 with postoperative cerebrospinal-fluid leakage whose wound was not sutured successfully for the second time and healed up after drainage. Conclusions The clinical manifestations of intraspinal cyst are complicated and untypical, which is similar to that of intraspinal tumor and slipped disc. The surgeries should be performed on the patients with obvious symptoms and the therapeutic effect is good.
Objective To observe the efficacy and safety of sildenafil in one case of PoPH patients. Methods A case of PoPH patient who was successfully treated with sildenafil was retrospectively analyzed，and literatures related sildenafil and PoPH were reviewed. Results A case of PoPH patient admitted with dyspnea on extetion was diagnosed with echocardiography，gastroscrope and other examinations. She was treated with sildenafil and responded well by decreased pulmonary arterial pressure，improved exercise tolerance and life quality，without obvious side effects. Literatures review suggested that PoPH is an under-recognized but life-threatening complication of cirrhosis or noncirrhotic portal hypertension with poor prognosis which exists in decompensated chronic liver diseases patients. The most classic symptoms of PoPH is progressive dyspnea on extertion. PoPH patients may benefit from sildenafil therapy with decreased pulmonary arterial pressure and improved life quality. Conclusions Theawareness of PoPH should be increased and Sildenafil may be effective and safe for PoPH patients. However，more evidences from clinical trials are needed.
Objective To investigate the treatment and therapeutic efficacy of intra-articular meniscal cysts by arthroscopy. Methods From January 2005 to December 2009, 9 cases of intra-articular meniscal cysts were treated by arthroscopy, including 5 males and 4 females, with an average age of 33.8 years (range, 24-46 years). Six patients suffered in left knees, 3 in right ones. Just 1 case had trauma history, the others had no obvious predisposing causes. The average course of the disease was 24.2 months (range, 4-36 months). The Lysholm score was (74.2 ± 11.6) points. Arthroscopy showed that the locations of cysts were the anterior horn of lateral meniscus in 8 cases and the anterior horn of medial meniscus in 1 case; all being single cyst (of them, 3 being multilocular cyst). Results All incisions healed primarily with no compl ications of infection and joint effusion. All 9 patients were followed up from 3 to 48 months with an average of 12.7 months. Preoperative symptoms disappeared or reduced and the range of motion of the knee returned to normal. TheLysholm score was (95.1 ± 3.4) points after 3 months of operation, showing significant difference (P lt; 0.01) when compared with the socre before operation. According to assessment standard described by Choy, the treatment outcome was excellent in 6 cases, good in 2 cases, and general in 1 case; the excellent and good rate was 88.9%. No recurrence was found during follow-up. Conclusion Arthroscopic surgery shows the advantages to maintain good function of knee for the treatment of meniscal cyst, it is the best choice for intra-articular meniscal cysts because of its mini-trauma, rapid recovery, thorough treatment and less recurrence. Simultaneously, partial or tatol meniscectomy or menicus repairing under arthroscopy is performed.
ObjectiveTo investigate the predicting effect of PIK3CA mutations for the efficacy and prognosis of hepatocellular carcinoma (HCC) patients received surgical resection. MethodsPCR and DNA sequencing were used to detect the PIK3CA mutation status of 79 HCC tissues, its impact on the short and long term effects of the patients were analyzed. ResultsIn this group of patients, mutation rate of PIK3CA gene exon 9 was 39.24% (31/79), PIK3CA mutation rate correlated with lymph node status and tumor differentiation (P < 0.05). The therapeutic effect of patients with PIK3CA mutation was significantly poor than that of the non-mutated group (P < 0.05). The three-year cumulative survival of patients with PIK3CA mutation (33.33%) was significantly lower than non-mutated group's (60.00%) by Kaplan-Meier (P < 0.05). ConclusionPIK3CA gene mutation in exon 9 could impact the efficiency of surgical resection in patients with HCC and could predict a poor survival prognosis.
目的 总结分析急诊观察室患者流行病学特点及临床疗效，为临床急诊治疗提供指导。 方法 以2007年1月－2010年12月收治的247 312例急诊观察室患者为研究对象，按年龄、性别、地域分布、疾病种类、发病时间、好转率、收入院百分率、死亡率等因素进行流行病学分析。 结果 各年度患者人数呈增加趋势，2010年减缓；城镇患者占91.5%；20～40岁患者占45.9%，40～60岁患者占27.2%，＞60岁占21.3%；疾病种类分布中呼吸系统占42.4%，心血管疾病患者数量呈升高趋势，以老年人为主，中毒患者呈下降趋势。全年6、7、8月份因发热、上呼吸道感染患者较多，总数增加明显，其次11、12、1月份因慢性支气管炎急发患者较多，总数也有升高趋势；白天工作时间患者数量占66.2%；平均每天就诊人次为169.4人次，节假双休日平均每天就诊人次为191.1人次（P＜0.01）；各年度好转率呈升高趋势，收入院百分率无显著变化，死亡率无显著区别。 结论 近年急诊观察室患者以呼吸系统疾病为主，好转率呈升高趋势，但心血管疾病数量呈升高且有年轻化趋势，值得重视。
Objective To evaluate the efficacy and safety of the silicone stent for treatment of three common benign central airway stenosis. Methods We retrospectively reviewed 40 patients with benign airway stenosis who were treated with a Dumon silicone stent at Affiliated Hospital of Guizhou Medical University between November 2019 to October 2023, including 14 cases of tracheobronchial tuberculosis (TBTB) stenosis, 14 cases of stenosis after tracheal intubation,and 12 cases of stenosis after tracheotomy. The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed, for evaluating the short-term efficacy, long-term efficacy and stent-related complications. Results The 40 patients were successfully implanted of silicone stents for 48 times totally. The mMRC score, KPS score, blood oxygen saturation and the diameter of the narrowest airway were significantly improved (P<0.05) after the implantation of silicone stents in all patients. Patients in TBTB group achieved inferior efficacy than those in the other two groups (P<0.05), while there was no significant therapeutic effect between tracheal intubation and tracheotomy groups (P>0.05). The main complications after the implantation of silicone stents were granulation hyperplasia, sputum retention and stent displacement. There were higher incidence rates of granulation hyperplasia and sputum retention in the TBTB group compared with the tracheal intubation and tracheotomy groups (P<0.05 ), while there was no statistically significant difference in incidence rates of granulation hyperplasia and sputum retention between the last two groups. Meanwhile, there was no significant difference in the proportion of stent displacement among the three groups.Conclusions The efficacy and safety were satisfied in the treatment of the three common benign central airway stenosis,with a recommendation for the treatment of refractory benign airway stenosis. However, the treatment effect of the TBTB group is inferior to that of the tracheal intubation and tracheotomy groups, with higher rates of obvious granulation hyperplasia and sputum retention simultaneously. More detailed follow-up management was recommended for TBTB patients implanted with silicone stents to avoid the development of stent-related minor complications into serious complications with a worse prognosis.
ObjectiveTo analyze the curative effect and prognosis of drug resistant tuberculosis meningitis (TBM). MethodsRetrospective analysis was carried out on the clinical data of thirty-two cases of drug resistant tuberculous meningitis patients hospitalized from January 2010 to December 2015. And the prognosis of the patients was evaluated by meliorated Rankin Scale (mRS). ResultsThirty-one cases (96.9%) were improved in 32 patients with drug resistant TBM, and 1 case (3.1%) was ineffective. After treatment, one patient had hormone-related glaucoma and osteoporosis, and one patient had drug Cushing syndrome. Twenty-seven patients (84.4%) had an mRS score equal to or less than 2 points. ConclusionDrug resistant TBM is difficult to diagnose in the early stage, and the curative effect is satisfying with active anti-tuberculosis treatment.
ObjectiveTo summarize the current treatment status and progress of neoadjuvant chemotherapy for pancreatic cancer in order to improve the understanding of neoadjuvant chemotherapy and to guide clinical work.MethodThe relevant literatures at home and abroad on neoadjuvant chemotherapy for pancreatic cancer were readed and reviewed.ResultsNeoadjuvant chemotherapy could reduce tumor lesions, increase R0 resection rate, decrease postoperative complication rate, and improve patients’ survival, however, there was currently no high quality evidence-based medicine proof. At present, there was no unified neoadjuvant chemotherapy regimens for pancreatic cancer in the world. FOLFIRINOX, gemcitabine plus S-1, and gencitabine plus Nab-paclitaxel were the three common regimens we used. In addition, the neoadjuvant chemotherapy of pancreatic cancer had no uniform standard, and there were insufficient methods for evaluating therapeutic effects.ConclusionAlthough there are still some core problems need to be solved in neoadjuvant chemotherapy for pancreatic cancer, however, it’s curative effect is gradually recognized and widely used by clinicians, which is beneficial to provide a better prognosis for pancreatic cancer patients.