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TREATMENT OF HALLUX VALGUS BY REMODELING THE BONE AND ARTICULAR MORHP OLOGY OF THE FIRST METATARSOPHALANGEAL JOINT

Objective To evaluate the physiological function and the anatomic structure of the first metatarsophalangeal joint for the patient withhallux valgus after a remodeling operation with the Keller’s method. Methods From April 2004 to November 2006, the first metatarsophalangeal joints in 11 patients (22 feet) with hallux valgus were remodeled with the Keller’s operation. There were 3 males and 8 females, aged 5173 years. Accordingto the Piggot typing standard, there were 17 feet of type Ⅱ (deflexion) and 5 feet of type Ⅲ (semiluxation). The hallux valgus angles(HVAs) were 2449° (average, 37°). The intermetatarsal angles (IMAs) were 90135° (average, 115°). The curative effect and the anatomic structure were evaluated by the followup and the Xray examination. Results All the cases werefollowed up for 6 to 30 months after operation (average, 14 months). According to the standard of ZHU Li Hua, et al, the results were excellent in 18 feet,good in 3 feet, and poor in 1 foot. The Xray films showed that the first meta tarsophalangeal joint of 14 feet developed mortarlike false articulation, and 8 feet developed partial false articulation. HVAs were 716° (average, 11°).IMAs were 90135° (average, 11.5°). According to the Piggot typing standard, there were 12 feet of typeⅠ(fitter) and 10 feet of type Ⅱ (deflexion). Conclusion For the patients with hallux valgus, the remodeling ofthe first metatarsophalangeal joint by the Keller’s operation can rectify HVA, improve the stability of the joints, and prevent occurrence of the insufficient muscle strength after operation.

四川省腰椎间盘突出症诊治座谈会会议纪要

Retinal degeneration in transgenic mice induced by oncostatin M through gp130/OSMRβ receptor

ObjectiveTo determine the signal pathway of specifically expressed oncostatin M(OSM) in lens inducing retinal degeneration in transgenic mice.MethodsA sequence-truncated OSM cDNA (661 bp) of mice was linked to αA-crytallin promoter, and was micro-injected into unicellular embryo to set up the model of transgenic mice. Reversal transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA expression of gp130/OSMRβ receptor in the retinae of OSM transgenic and non-transgenic mice. Rabbit anti-phosphorylated STAT-3 antibody was used to detect the protein expression of phosphorylated STAT-3，and mouse anti-cytochrome C antibody was used to detect the distributing of cytochrome C in retinae. ResultsExpression of gp130/OSMRβmRNA was found in retina of non-transgenic mice. At the 17.5th day in the embryonic stage, significant accumulation of the phosphorylated STAT-3 was detected in the retinal nucleolus in OSM transgenic retina. At the first day after birth, intensive staining of cytochrome C in OSM transgenic retina was found. Conclusionsspecifically expressed OSM in lens may act on gp130/OSMRβ receptor in retinae, activate STAT-3, and cause the release of cytochrome C from mitochondria, which eventually induces widespread retinal degeneration.(Chin J Ocul Fundus Dis, 2005,21:167-169)

Treatment Of Osteoporotic Spinal Compression Fractures by Unipedicular Vertebroplasty

目的:探讨单侧经椎弓根基底部外侧穿刺进针的可行性和安全性。方法:14例椎体压缩性骨折经椎弓根基底外侧穿刺进针,球囊扩张,骨水泥注入治疗,使用VAS评分法评价患者疼痛变化,测定手术前后椎体前、中柱高度与Cobb角。结果:单侧经椎弓根基底外侧穿刺的手术均安全完成。VAS评分由术前平均(8.5±0.3)分改善到术后(2.2±0.2)分,随访三月为(2.1±0.4)分 (与术前比较,Plt;0.05); 椎体前缘高度由术前(13.6±2.3) mm到术后(24.5±2.2) mm,随访三月为(24.3±2.0) mm(与术前比较,Plt;0.05);锥体中部高度由术前(14.2±2.1) mm到术后(25.6±2.4) mm,随访三月为(25.4±2.2) mm(与术前比较,Plt;0.05); Cobb角由术前的(22.5±3.6)°到术后(10.5±3.0)°随访三月为(10.3±2.8)°(与术前比较,Plt;0.05)。结论:经椎弓根基底外侧的单侧穿刺锥体成形术可有效恢复骨质疏松性椎体压缩性骨折椎体高度、缓解疼痛,是一种安全、有效的治疗方法,值得推广。

Retrospective Analysis of Death Causes in Wenchuan Earthquake Victims

Objective　To retrospectively analyze the characteristics and death causes among the Wenchuan earthquake victims in The Third People’s Hospital of Chengdu so as to provide information for reducing mortality in future earthquake disasters. Methods　The analysis was based on the data provided by the Department of Information, the Medical Record Library, and the Emergency Room of the hospital through July 12. Microsoft EXCEL was used for data input and SPSS 13.0 was used for statistical analyses. Results　Through July 12, 9 (1.57%) out of the 575 wounded patients died, comprising 3 males and 6 females. Of those, 5 died in the outpatient department. The death causes were all related to severe cerebral injuries. The other 4 died in the inpatient department and the death causes were related to severe underlying illnesses and infection. Conclusion　Screening and early treatment for cerebral injuries is very important in the period directly following the earthquake. Later, more attention should be paid to the treatment of underlying illnesses as well as the prevention and control of infection.

循证护理在甘露醇输注疼痛中的应用

目的　探讨缓解甘露醇快速滴注引起的疼痛护理对策。 方法　对2010年1月－8月102例静脉滴注甘露醇治疗患者，随机分为两组，对照组50例给予常规护理措施，干预组52例采用循证护理方案，并用χ2检验比较两组患者疼痛的缓解效果。 结果　两组数据进行比较，干预组患者的疼痛明显低于对照组（P＜0.01）。 结论　循证护理可以缓解甘露醇快速滴注引起的肢体疼痛，提高患者舒适度，规避风险，提高护理质量。

运用“钻出”技术取出股骨头内断裂导针一例

RETROPERITONEAL LAPAROSCOPIC APPROACH COMBINED WITH ANTEROLATERAL MINI-INCISION FOR LUMBAR SPINE TUBERCULOSIS

ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.

“杠杆松解”技术在股骨近端防旋髓内钉螺旋刀片取出困难时的应用

目的 总结应用“杠杆松解”技术解决股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）螺旋刀片取出困难的效果。方法 2015年10月—2020年10月，9例股骨转子间和/或转子下骨折PFNA内固定后，二次手术取出内固定物时发生螺旋刀片取出困难。男8例，女1例；年龄48～68岁，平均58岁。PNFA内固定术至该次取出手术时间15～23个月，平均19个月。取出内固定物原因：螺旋刀片向内穿透股骨头2例、螺旋刀片退出激惹软组织1例、患者要求取出6例。术中采用“杠杆松解”技术，通过上、下敲击连接主钉的主钉打出器，使主钉上、下滑动带动螺旋刀片松解，顺利完整取出内固定物。结果 手术时间55～128 min，平均92 min；术中出血量70～150 mL，平均108 mL；术中无医源性骨折、血管及神经损伤发生。术后切口均Ⅰ期愈合。9例患者均获随访，随访时间4～9个月，平均6个月。X线片复查显示内固定物均完整取出。末次随访时，髋关节功能 Harris 评分为 95～100 分，均获优。未出现再骨折、创伤性关节炎、术区疼痛等并发症。结论 PFNA螺旋刀片取出困难时可选择“杠杆松解”技术，是一种简单、有效的取出方法。

股骨近端防旋髓内钉内固定术后尾帽退出并发症临床报道

目的总结股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）内固定术后尾帽退出患者资料，为临床医生认识该并发症提供参考。方法 回顾分析2018年1月—2020年5月6例股骨转子间或转子下骨折PFNA内固定术后发生尾帽退出患者临床资料。男2例，女4例；年龄32～82岁，平均55岁。股骨转子间骨折Evans-Jensen分型，ⅠB型1例，ⅡB型3例，股骨转子下骨折Seinshemer分型，ⅡA型1例，Ⅴ型 1例；术中透视及术后首次X线片证实尾帽与主钉均锁紧无间隙；尾帽与螺旋刀片静态锁定4例，动态锁定2例。使用广泛性焦虑量表（GAD-7）评分于内固定术后2周、初次发现尾帽退出后2周、末次随访时对患者焦虑程度进行评估。结果 6例患者均获随访，随访时间10～24个月。骨折均愈合，愈合时间3～5个月。内固定术后2周GAD-7评分2～7分，平均4.8分，正常2例、轻度焦虑4例；初次发现尾帽退出后2周GAD-7评分4～12分，平均8.2分，正常1例、轻度焦虑3例、中度焦虑2例；末次随访时GAD-7评分0～4分，平均2.0分，均为正常。末次随访时尾帽退出高度为3.6～10.0 mm，平均6.77 mm；尾帽均部分留存于主钉内，无完全脱出者；行内固定物保留4例，内固定物取出治疗2例。6例患者均未出现患髋部疼痛、髋关节功能障碍、内固定失效、骨折延迟愈合、再次骨折等并发症；末次随访时髋关节功能Harris评分94～98分，均获优。结论 尾帽退出是股骨转子间或转子下骨折PFNA内固定术后内固定物机械松动的罕见形式，当其发生时可加重患者焦虑程度，但不会造成严重危害，应根据具体情况选择适当处理方法。