目的 探讨CT引导下髂骨成形术在治疗恶性肿瘤晚期髂骨转移中的价值。 方法 对2009年3月－2011年8月收治的12例经病理活检证实为恶性肿瘤髂骨转移患者共，分别行CT引导下骨水泥注入髂骨成形术并观察该组患者治疗后的疼痛缓解、生活质量改善及生存期等。 结果 该组患者手术后24 h内，疼痛与术前相比差异无统计学意义（t=2.433，P＞0.05），手术后3 d和7 d进行再次评估，与治疗前相比差异有统计学意义（t=3.123，3.124；P＜0.05）；术后该组患者在躯体功能、心理功能、社会功能、物质生活状态方面的生活质量评分显著高于手术前（t=2.341，2.354，3.567，3.124；P＜0.05）。该组总有效率为82.5%。且治疗后癌胚抗原（CEA）含量为（2.9 ± 0.9）μg/L，显著低于治疗前的（15.5 ± 3.2）μg/L（P＜0.01）。所有患者随访1年，其6、10、12个月的总生存率分别为15.2%、32.8%、52.0%，平均生存时间10.4个月。该组患者治疗后并发症情况发生率58.3%，均为出现了无症状的骨水泥渗漏现象，注射治疗后持续时间为0.5～3 h，平均1.87 h。 结论 髂骨成形术短期内可明显减轻恶性肿瘤髂骨转移所致的疼痛症状。CT引导下髂骨成形术安全、可靠、近期疗效确切，是姑息性治疗恶性肿瘤髂骨转移的有效方法之一。
目的:探讨儿童颅骨生长性骨折(GSF)的形成机制,诊断和治疗。方法:对我院15例GSF患儿的临床资料进行回顾性分析。结果:15例患儿均有颅脑外伤史,致颅骨线性骨折,骨折线进行性增宽,颅骨缺损,术中均发现有硬脑膜破裂。15例患儿均行手术治疗,3例患儿手术后出现脑积水并予脑室-腹腔(V-P)分流术。结论:颅骨骨折和硬脑膜破裂是发生GSF最重要的因素;患儿发生颅骨线性骨折后应定期复查头部CT,一旦确诊为GSF须行颅骨成形手术治疗;儿童GSF手术后出现的脑积水行V-P分流术治疗效果较好。
Objective To analyze the effectiveness of endoscopic calcaneoplasty (ECP) for treating hindfoot pain in patients with Haglund’s deformity by comparing with conservative treatment. Methods According to the included standard, 64 hindfoot pain patients (77 feet) with Haglund’s deformity treated between January 2007 and October 2013 were enrolled. Based on the patient’s sports habit, 39 patients (49 feet) who had no requirement on sports were given conservative treatment (control group) and 25 patients (28 feet) who had stable sports habit were given ECP (ECP group). There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 2 groups (P > 0.05). Results The patients were followed up 16-44 months (mean, 33.7 months) in ECP group, and 12-40 months (mean, 37.5 months) in control group. In control group, the syndrome in 34 cases (43 feet) disappeared after 2 weeks; pain was improved in 5 cases (6 feet), and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases (30 feet) during following-up, 11 cases (13 feet) underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment (P < 0.05). With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment (P < 0.05). According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups (Z=-2.194, P=0.028). Conclusion Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund’s deformity.
As a worldwide challenge in the field of neurosurgery, there is no effective treatment method for pediatric skull defects repair in clinic. Currently clinical used cranioplasty materials couldn’t undergo adjustment in response to skull growth and deformation. An ideal material for pediatric cranioplasty should fulfill the requirements of achieving complete closure, good osseointegration, biodegradability and conformability, sufficient cerebral protection and optimal aesthetic, and functional restoration of calvaria. Biomimetic mineralized collagen-based bone material is a kind of material that simulates the microstructural unit of natural bone on the nanometer scale. Because of its high osteogenic activity, it is widely used in repair of all kinds of bone defects. Recently, the biomimetic mineralized collagen-based bone materials have successfully been applied for cranial regeneration and repair with satisfactory results. This review mainly introduces the characteristics of the biomimetic mineralized collagen-based bone materials, the advantages for the repair of pediatric skull defects, and the related progresses.