Identifying potential prognostic factors of CSM patients could improve doctors’ clinical decision-making ability. The study retrospectively collected the baseline data of population characteristics, clinical symptoms, physical examination, neurological function and quality of life scores of patients with CSM based on the clinical big data research platform. The modified Japanese Orthopedic Association (mJOA) score and SF-36 score from the short-term follow-up data were entered into the cluster analysis to characterize postoperative residual symptoms and quality of life. Four clusters were yielded representing different patterns of residual symptoms and quality of patients’ life. Patients in cluster 2 (mJOA RR 55.8%) and cluster 4 (mJOA RR 55.8%) were substantially improved and had better quality of life. The influencing factors for the better prognosis of patients in cluster 2 were young age (50.1 ± 11.8), low incidence of disabling claudication (5.0%) and pathological signs (63.0%), and good preoperative SF36-physiological function score (73.1 ± 24.0) and mJOA socre (13.7 ± 2.8); and in cluster 4 the main influencing factor was low incidence of neck and shoulder pain (11.7%). We preliminarily verified the reliability of the clustering results with the long-term follow-up data and identified the preoperative features that were helpful to predict the prognosis of the patients. This study provided reference and research basis for further study with a larger sample data, extracting more patient features, selecting more follow-up nodes, and improving clustering algorithm.
一、髋关节软骨损伤成因及影响 关节软骨是关节表面上的透明软骨组织,具有超低摩擦系数并可以分散关节负荷.由于多种原因导致的关节软骨受损,可引起关节疼痛、畸形和功能障碍.导致股骨头骨软骨损伤的致病因素包括多种情况,如机械性损伤,包括造成股骨头软骨急性暴力损伤或长时间高负荷运动所致的慢性损伤.其次,风湿性疾病如强直性脊柱炎等会导致股骨头病理性骨软骨损伤.此外,股骨头坏死也是导致股骨头软骨损伤的一种重要因素.如果这些股骨头软骨损伤不得到及时治疗,关节间隙将逐渐变窄,最终导致骨关节炎的发展[1],给患者造成严重的残疾,并带来巨大的社会经济负担.由于关节软骨内部没有血管、神经和淋巴组织,其自我修复和再生能力非常有限.因此,对于软骨损伤的治疗非常具有挑战性和复杂性,特别是对于负重关节如髋关节的损伤更是如此.
目的 设计一种可注射用丝蛋白基水凝胶体系.方法 利用丝蛋白、羟丙基甲基纤维素和丙三醇的三元混合溶液,混合形成凝胶,通过流变学、分子结构、微观形貌和力学性能对三元体系进行表征.结果 本研究设计的丝蛋白基三元溶液/水凝胶体系(SF-HPMC-G溶液/水凝胶),其体系中丝蛋白浓度范围为2.1～6.4 wt%.该三元溶液具有剪切变稀的流动行为,剪切速率在10 s-1以上时体现低于1 Pa·s的粘度.当三种组分以相同比例混合时(SF12 wt%),在1 h 9 min实现凝胶化.所得三元水凝胶具有较为均匀的多孔网络微观形貌,β-折叠构象含量随丝蛋白浓度提高而增加,压缩力学性能由丝蛋白浓度和HPMC浓度共同决定,压缩模量随丝蛋白浓度增加而提高.羟丙基甲基纤维素能够强韧化丝蛋白基水凝胶,同时丙三醇能加速丝蛋白凝胶化,这种三元体系也有着一定的可注射性.结论 SF-HPMC-G三元水凝胶属于生物相容体系,初步验证了可注射性和快速凝胶化性质,为可注射丝蛋白基水凝胶的设计提供了一种新的应用思路.
患儿男,13岁.因远端关节挛缩影响手部功能就诊于北京积水潭医院手外科.出生后发现其颜面畸形,眉弓突出.患儿自幼跛行,7岁时父母发现其双肩关节上举受限. 10岁时患儿听力下降,听力筛查未通过,体格检查耳廓、外耳道无畸形,鼓膜完整.
患者男,72 岁,因摔伤致膝关节肿痛7 h,于2022 年12 月31 日就诊于北京积水潭医院新街口院区创伤骨科.患者于入院16 h前骑自行车时不慎摔倒,伤及左膝,伤后感左膝肿胀、疼痛、活动受限.于急诊行X线及 CT检查,提示左髌骨骨折.予以石膏固定后入院.患者既往患有高血压、糖尿病,口服药物治疗,血压及血糖控制良好.1 个月前因甲状腺癌行甲状腺切除手术.
Objective To investigate the factors of overgrowth of the injured bone in children with lateral humeral condyle fracture. Methods From January 2013 to December 2021, the clinical data of 144 children with lateral humeral condyle fractures treated in Department of Orthopedic Surgery, 96603 unit Hospital of PLA, were reviewed. The factors of overgrowth of the injured bone after lateral humeral fracture in children were analyzed statistically. The class variables were daeled with Chi-square test or Fisher exact test. Results A total of 81 patients（56.3%） had lateral humeral condyle overgrowth. Multivariate logistics regression showed that age was a protective factor for humeral overgrowth after lateral humeral condyle fracture in children, with OR values of 0.98（0.97-0.99）, P=0.019. Surgical treatment was a risk factor for overgrowth of the injured bone in children with lateral humeral condyle fracture with OR values 6.09（1.27-30.26）, P=0.027. Conclusion Age and surgical treatment are the factors of overgrowth of the injured bone in children with lateral humeral fracture.
双下肢不等长并不罕见.双下肢长度相差0. 5～1. 5 cm者约占全部人群的1/3;双下肢长度相差1. 5 cm以上的人群约占5％ [1].对于双下肢长度相差超过2 cm的患者,可考虑行骨延长手术予以矫正[2].目前Ilizarov牵张成骨原理仍然是肢体延长的金标准.然而,单纯通过外固定架技术实现牵张成骨时仍存在软组织栓系、关节僵硬、针道感染、舒适度和美观程度较差、长期佩戴影响患者心理和工作生活等问题[3-4].为减少外架肢体延长术的并发症,各种内外结合的新技术应运而生,如Paley等[5]在Ilizarov技术的基础上提出的单臂外固定架结合髓内钉的骨延长技术( lengthening over nail,LON).该技术可减少外固定架的佩戴时间和拆除外固定架后的骨折发生率,提高了舒适度,但存在患者术后深部感染的风险[6].因此,完全置入式髓内延长钉成为了肢体延长领域的研究重点.经过30余年的发展,髓内延长钉显示出了明显的优势,在世界范围内被广泛应用.
Objective To evaluate the short-term effect of posterior multi-rod internal fixation in correcting severe upper thoracic congenital scoliosis. Methods Clinical data of 20 cases of severe upper thoracic congenital scoliosis treated in the Department of Spine Surgery, the Third Xiangya Hospital of Central South University from January 2017 to June 2022 were retrospectively analyzed. All cases were divided into 2 groups according to the surgery operation. Ten patients treated with posterior multi-rod internal fixation and multi-segment Ponte osteotomy at the distal end of the rigid area were included in the multi-rod group; 10 patinets treated with traditional double-rod internal fixation and posterior vertebral column resection（PVCR）/pedicle subtraction osteotomy（PSO） were included in the double-rod group. The operation time, blood loss, fusion segment, multi-rod link position and postoperative complications of all patients were recorded. At the same time, the radiographic parameters including scoliosis Cobb’s angle, maximum kyphotic Cobb’s angle（global kyphosis, GK）, sagittal balance（sagittal vertical axis, SVA） and coronal balance[(distance from C 7 plumb line（C 7 PL） to center sacral vertical line（CSVL）, C 7 PL-CSVL] were measured preoperatively, postoperatively and at the last follow-up. All observations were compared within and between the 2 groups. Results The follow-up duration was（18.10±3.73）（13～23）months. The operation time and intraoperative blood loss in the multi-rod group were significantly less than those in the double-rod group（both P＜0.05）. The postoperative Cobb’s angle, GK, SVA and C 7 PL-CSVL were improved significantly in both groups. The correction rate of Cobb’s angle and GK of the multi-rod group [（64.62±7.43）% and（37.16±12.48）%] were slightly higher than that of the double-rod group[（62.84±6.35） % and（32.55±9.88） %], but the differences were not statistically significant（both P＞0.05）. No secondary scoliosis, kyphosis or imbalance in the upper and lower end of the correction area were found during the follow-up. The height of patients in the 2 groups increased by（8.60±1.10）（6.5-10.0）cm, and the appearance improvement was satisfactory. Eight cases of complications were found in the 2 groups including one case of epidermal wound infection and 2 cases of intermuscular vein thrombosis in the multi-rod group and 2 cases of epidermal wound infection, one case of cerebrospinal fluid leakage and 2 cases of muscular vein thrombosis in the double-rod group. No neurological complications were found. Conclusion Application of posterior multi-rod internal fixation and distal multi-segmental Ponte osteotomy can achieve satisfactory short-term results in treatment of patients with severe upper thoracic congenital scoliosis. This surgical method is especially suitable for patients with severe upper thoracic congenital scoliosis and mild kyphosis.
Objective To analyze the leg length discrepancy（LLD） in patients with Paprosky type Ⅰ, type Ⅱ and type ⅢA femur defect before surgery and after revisions by monobloc femoral stems. Methods From January 2009 to January 2016, 58 patients（58 hips） were followed up for 5 years or more in Department of Orthopedics, Wuhan Fourth Hospital, who underwent hip revisions with Wagner SL femoral stems. There were 15 males and 43 females. The age of the patients was 29-91（68.3±8.9）years. The classification of bone defects was determined according to the preoperative and intraoperative conditions. According to the defect of femoral side, the cases were divided into three groups: Paprosky Type Ⅰ, Paprosky Type Ⅱ, and Paprosky Type ⅢA. Clinical functions, images and Harris scores were recorded. By comparing with the patient’s postoperative imaging data, fixation of the prosthesis was evaluated and the length of both lower limbs was measured. Results The follow-up time was 5-10（7.6±1.6）years. The preoperative Harris score was 44.5±14.0, and the postoperative Harris score was 86.6±6.2, the difference was statistically significant（P＜0.05）. The patients were divided into three groups according to bone defect of femoral side: Paprosky type Ⅰ（17 cases）, Paprosky type Ⅱ（32 cases）, and Paprosky type ⅢA（9 cases）. There were no significant differences in age, BMI, preoperative Harris score and postoperative Haris score among the three groups. There were statistically significant differences in preoperative LLD among the three groups, as well as pairwise comparisons, which were（1.38±0.78）cm in group Ⅰ,（1.84±0.81）cm in group Ⅱ and（2.68±1.19）cm in group Ⅲ respectively. There was no significant difference in postoperative LLD between the three groups, nor was there any significant difference in pairwise comparison. Conclusion LLD increased gradually with the increase of Paprosky femoral bone defects. Revision with Wagner SL stem for Paprosky type Ⅰ, Ⅱ, and ⅢA bone defects can achieve good results and achieve great balance of limb length.
尺骨鹰嘴骨折发生率约占全身骨折的1. 17％ [1-2] ,为一种关节内损伤,因此常伴随关节内积血和组织液渗出.患者表现为肘关节疼痛、肿胀及活动受限,同时骨折端可触及凹陷.该骨折最重要的体征为抗重力伸肘丧失,表明伸肌装置连续性中断.该体征对治疗方案至关重要,在临床上往往需结合X线来明确诊断.此外,对于尺骨鹰嘴骨折患者,应详细检查其上肢神经功能,尤其需排除尺神经损伤.尺骨鹰嘴骨折伴随肘关节的屈伸,骨折端很容易分离移位,且鹰嘴半月切迹关节面的缺损或者不平整会引起后期肘关节僵硬或创伤性骨关节炎.术中对半月切迹良好的复位和固定是治疗尺骨鹰嘴骨折的基本原则.尺骨鹰嘴骨折无移位或者移位<2 mm的患者可以尝试非手术治疗.其主要适用于无移位且稳定的骨折,一般采用屈肘90°石膏或者支具固定.对于有移位的尺骨鹰嘴骨折,单纯手法复位不易成功,且多次手法复位后易造成骨化性肌炎等并发症,所以大多数学者都不主张采用单纯手法复位治疗尺骨鹰嘴骨折.此外,长时间固定可致肘关节僵硬,影响早期关节活动.因此,手法复位现已较少应用.目前报道采用非手术治疗尺骨鹰嘴骨折文献较少[3-4].石膏或支具等外固定对于较复杂或粉碎的尺骨鹰嘴骨折固定效果不佳,且严重影响正常生活,带来诸多不便,所以对尺骨鹰嘴骨折大多选择切开复位内固定手术治疗.
发育不良性腰椎滑脱是在儿童及青少年人群中最为常见的腰椎滑脱类型[1-2].该疾病常常起病隐匿,不易被早期发现及诊断.常常因患儿出现腰背痛、坐骨神经刺激症状或脊柱侧凸后才被发现.目前对发育不良性腰椎滑脱的治疗理念及方法存在差异,容易延误治疗而导致严重的继发性脊柱侧凸,或不恰当的手术方法给患者带来医源性损伤,甚至严重并发症.因此,急需重视儿童发育不良性腰椎滑脱的规范化治疗.
Objective To evaluate the clinical results of anterior column realignment（ACR） technique in the treatment of adult spinal deformities. Methods A retrospective study was conducted to compare the clinical data of adult patients with spinal deformities treated by ACR and pedicle subtraction osteotomy（PSO） in the Department of Spine Surgery, Beijing Jishuitan Hospital from January 2020 to August 2021. The ACR group included 11 patients, with 5 males and 6 females, aged（63.3±8.5）（43-71）years, and body mass index（BMI） and quantitative CT（QCT） bone mineral density（BMD） value were（26.1±3.5）kg/m~2 and（90.7±25.2）mg/cm~3, respectively; the PSO group included 6 patients, with one male and 5 females, aged（63.0±5.1）（55-70） years, and BMI and QCT value were（26.5±2.0）kg/m~2 and（82.7±10.4）mg/cm~3. The clinical and radiographic data before surgery, 3 d after surgery, one year after surgery and intraoperative and postoperative complications were recorded. The clinical parameters included visual analogue scale（VAS） and Oswestry Disability Index（ODI）. The radiographic parameters included lumbar lordosis（LL）, pelvic incidence minus lumbar lordosis（PI-LL）, pelvic tilt（PT）, sacral slope（SS）, sagittal vertical axis（SVA）, T 1 -pelvic angle（TPA） and segmental lordosis（SL）. These data were compared within and between the groups. Results There was no significant difference in baseline data between the 2 groups（all P＞0.05）. All patients received posterior pedicle screw fixation. In ACR group, ACR surgery was performed in 13 segments and 14 segments underwent standard oblique lateral interbody fusion（OLIF）. Six patients（8 segments） underwent ACR with posterior column osteotomy. An average of 3.9 vertebrae was fixed per case in ACR group. In PSO group, one patient underwent L 4 level osteotomy, 4 patients underwent L 3 level osteotomy, and one patient underwent L 2 level osteotomy. The average number of fixed vertebrae was 7.0. Compared with the values before surgery, LL, PI-LL, SVA and TPA were significantly improved in both groups at 3 d and one year after surgery（all P＜0.05）. The SL after ACR improved from 1.6° before surgery to 16.7° at 3 d after surgery（P＜0.001） and 15.6° at one-year follow-up（P＜0.001）. The average operation time in ACR group and PSO group was 331.8 min and 348.3 min, respectively, and the difference was not statistically significant（P＞0.05）; the average intraoperative blood loss was 247.3 ml and 966.7 ml, respectively, and the difference was statistically significant（P＜0.001）. At one-year follow-up, there was no statistical difference in radiographic parameters between the 2 groups（all P＞0.05） except PI-LL, which was significantly lower in ACR group than that in PSO group（7.9°±6.9° vs. 17.7°±3.2°,P＜0.01）. The change of SL after ACR was 2.7 times greater than that after OLIF alone（P＜0.001）. ACR combined with posterior column osteotomy showed 58.3% more changes in SL than that after ACR alone（P＜0.05）. At one-year follow-up, the VAS and ODI in both groups were significantly improved compared with those before surgery（both P＜0.05）, and there was no statistical difference of scores between the 2 groups. The postoperative complication rate was 36.4%（4/11） in ACR group and 50.0%（3/6） in PSO group, with no statistical difference（P＞0.05）. Conclusion ACR can effectively and safely restore LL in adult spinal deformity patients with sagittal imbalance. The clinical and radiographic outcomes are similar to those of PSO. Compared with OLIF alone, ACR technique has stronger segmental correction ability, and greater correction can be achieved when combined with posterior column osteotomy.
Objective To observe the mid-term outcome of treatment procedures for preventing periprosthetic joint infection（PJI） in conversion total hip arthroplasty（cTHA）. Methods Clinical data of 54 patients underwent cTHA managed with treatment procedures for preventing PJI and followed-up for at least 2 years in Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital between January 2018 and June 2020 were retrospectively analyzed. There were 29 males and 25 females with an age of（68.3±12.1）（43-82）years. Reason for cTHA included femoral head avascular necrosis after internal fixation with cannulated screws for femoral neck fracture in 31 cases and after intramedullary nail fixation of intertrochanteric fractures in 8 cases, non-union of femoral neck fracture in 4 cases and secondary osteoarthritis after internal fixation for acetabular fracture in 11 cases. The type of previous operation and preoperative erythrocyte sedimentation rate（ESR） and C-reactive protein（CRP） were compared between patients with and without positive finding in intraoperative tissue culture. Results The follow-up time was（35.0±8.7）（24-54）months. Bacteria was identified by culture of joint fliud in 2 patients before cTHA, while in 9 patients by intra-operative tissue biopsy. The ESR and CRP of the 11 patients were higher than that of patients with negative intra-operative tissue culture, although the difference was not statistically significant. PJI occurred in 3 patients（5.6%） after cTHA within 6 months, and treated with primary revision. The pre-operative CRP was elevated and more than 12 mg/L in all the 3 patients. Patients showed significantly higher Harris score at last follow-up（87.4±9.3） when compared to the pre-operative one（47.3±16.4）（P＜0.001）. Conclusion Patients underwent cTHA would confront higher risk of PJI. Our algorithm by optimizing the diagnosis of infection before and during operation, the usage of antibiotics and the nutrition support therapy could reduce the development of PJI.
Objective To investigate the safety and efficacy of no drainage after primary total hip arthroplasty（THA）. Methods Clinical data of 110 patients underwent primary unilateral THA in the Department of Orthopedics, Xiangya Hospital of Central South University from January 2019 to December 2021 were retrospectively analyzed.Thirty-eight males and 72 females aged（58.90±12.24）（19-84）years were included. All patients were divided into 2 groups（non-drainage group and drainage group） based on whether postoperative drainage was performed. Non-drainage group（n=46） included 15 males and 31 females, with an age of（61.26±12.86）（19-84）years and a body mass index（BMI） of（22.63±3.18）kg/m~2, and the combination included 6 cases of hypertension and 3 cases of diabetes. Drainage group（n=64） included 23 males and 41 females, with an aged of（57.20±11.59）（30-80）years and a BMI of（23.27±3.19）kg/m~2, and 6 patients were associated with hypertension and 4 patients were associated with diabetes. The changes of red blood cell count, hemoglobin（HB） and hematocrit（HCT） on the 3rd day after operation, the perioperative blood loss, operation time and hospitalization time, and the postoperative hematoma, incision complications and deep vein thrombosis（DVT） of lower extremity were recorded and compared between the 2 groups. Results The baseline data of the 2 groups met the requirement of balance and were comparable. The theoretical and the actual bleeding volume of the non-drainage group were lower than that of the drainage group significantly [（613.95±207.01）ml vs.（740.91±326.99）ml,（742.21±232.37）ml vs.（937.00±346.64）ml, P=0.014, 0.001,respectively]. The postoperative decrease of HCT and the number of red blood cells of the non-drainage group were lower than that of the drainage group significantly[（6.52±2.33）% vs.（7.68±3.20）%,（0.72±0.28）×10 12 /L vs.（0.85±0.37）×10 12 /L,P=0.030,0.033,respectively]. The length of hospital stay of the non-drainage group was shorter than that of the drainage group significantly[（7.89±2.49）d vs.（9.00±2.82）d, P=0.031]. No complications such as wound non-healing, subcutaneous hematoma, large subcutaneous ecchymosis and DVT of lower extremity were found in both groups. Conclusion Non-drainage in primary THA is safe and has no adverse effect on the outcome.
Objective To investigate the safety and efficacy of the three column osteotomy through previous spinal fusion site in the revision treatment for congenital scoliosis. Methods A retrospective analysis was performed on 38 patients undergoing revision surgery for congenital scoliosis fusion in Spinal Surgery Department, Chinese People’s Liberation Army Strategic Support Force Characteristic Medical Center, from January 2012 to January 2018. The age of primary surgery was（13.4±8.4）years old. The interval between revision surgery and primary surgery was 3-30（12.0±5.9）years. The reasons for revision: 29 cases（76.3%） of progressive scoliosis, 6 cases（15.8%） of nerve damage and 3 cases（7.9%） of internal fixation failure. Radiographs of the whole spine were measured before and after revision surgery and at the last follow-up. Cobb angle of scoliosis, Cobb angle of kyphosis, coronal plane balance（C7PL-CSVL） and sagittal plane balance（SVA） were measured. Results The operation time was 206-770（447.4±112.7）min. The intraoperative bleeding was 1 200-6 000（2 539.5±1 116.6）ml. The Cobb angle of the coronal main bend changed from（73.2±22.4） ° to（29.1±12.9） ° postoperatively. The Cobb angle of sagittal kyphosis changed from（83.9±26.6） ° to（35.0±13.4） ° postoperatively. Preoperative coronal balance（C7PL-CSVL） and sagittal balance（SVA） were（34.9±25.6）mm and（46.0±39.3）mm respectively, and were corrected to（18.5±10.4）mm and（17.2±10.5）mm postoperatively. Additionally, the differences were statistically significant（P＜0.05）. Six patients with preoperative neurological impairment had no worsening after revision surgery. At the last follow-up, 2 cases Frankel C and 3 Frankel D had recovered to Grade E, and 1 Frankel grade B had no significant improvement. There were 20 patients（52.6%） with different degrees of postoperative complications, and they all recovered completely at discharge. Conclusion Three-column osteotomy is safe and feasible in the revision surgery for congenital scoliosis, but revision surgery is risky, and perioperative complications should be focused carefully.
Objective To compare the spinal rotation measurement by EOS imaging and that by CT imaging, and to explore the influence of location on the apical vertebral rotation（AVR） measured by EOS imaging. Methods From March 2018 to June 2022, 87 patients with adolescent idiopathic scoliosis（AIS） who were indicated for surgery in Department of Spine Surgery, Beijing Jishuitan Hospital, were enrolled. Eighty-seven consecutive AIS patients with 112 curves were identified, with age of 11-18（14.7±2.3）years old. General information was collected and radiographic measurements were performed. Apical vertebral rotation（AVR） was measured by EOS imaging（Fast 3D reconstruction by SterEOS） and CT imaging（Aaro-Dahlborn method） respectively. Cobb angle was automatically generated by EOS imaging too. All curves were separated into thoracic group and lumbar group according to the curve location. Then subgroup analysis was performed. Results In the whole data, there was no significant difference of AVR between EOS and CT（P=0.096）. The high correlation was identified（r=0.771,P＜0.001）. In thoracic region significant difference was noted between them（P＜0.001）, and moderate correlation was identified（r=0.536,P＜0.001）. In lumbar region, no significant difference was noted between them（P=0.193）, and higher correlation was found between them（r=0.789, P＜0.001）, and this was higher than the general correlation coefficient. Conclusion A good correlation was identified in the AVR measured by EOS imaging and by CT imaging, while differences did exist which was more obvious in thoracic region. In lumbar region, they correlated better and showed no significant difference.
距骨骨软骨损伤( osteochondral lesion of talus,OLT)是指距骨关节面软骨和骨的局部损伤,主要发生在距骨穹顶的承重区域,并波及软骨下骨,是慢性踝关节疼痛的常见原因.早诊断和早治疗对改善和保留OLT患者踝关节功能有积极意义.对OLT的认知经历了漫长的过程,其间产生了许多学术观点.在此对OLT相关知识进行系统梳理和总结,以便于相关学术和经验交流,促进OLT的临床诊治.
儿童急性血源性骨髓炎( acute hematogenous osteomyelitis, AHO)是儿童最常见的骨骼感染.年幼儿童长骨干骺端的独特解剖特征和血液供应特点,使得AHO在临床上成为常见疾病.如果感染破坏了关节软骨和骺板,可导致关节功能受损或肢体不对称生长,出现严重的肢体功能障碍.有研究将急性感染定义为症状持续2周;亚急性感染定义为症状持续2 周至3 个月;慢性感染定义为症状持续3个月以上[1].北美儿科传染病学会和美国传染病学会指南小组使用了不同的分期[2] ,将急性骨髓炎定义为在以前未受感染的骨骼出现临床症状或体征后4周内的感染;慢性骨髓炎定义为一种更持久的、通常是间断的疾病过程.复发可表现为间歇性反复疼痛、肿胀、窦道.
目的 探讨采用骨膜牵张术治疗糖尿病足的临床效果.方法 对2021年1月至2022年1月山东省菏泽市单县中心医院骨科采用骨膜牵张技术治疗的糖尿病足患者20例的临床资料进行回顾性分析.其中男11例,女9例;年龄(68.26±3.74)(59～79)岁.患足溃疡面Wagner分级为2级2例,3级10例,4级8例;溃疡部位为足趾12例,足底5例,足背2例,踝及足跟部1例.记录患者术前与术后的患足足趾血氧饱和度、患足皮温、踝肱指数并进行比较,同时结合下肢CT血管成像(CTA)对治疗效果进行观察和评价.结果 患者术后足趾血氧饱和度、患足皮温和踝肱指数均优于术前,且术后7 d、1个月和3个月呈持续改善趋势,差异均有统计学意义(均P<0.05).术后3个月CTA显示患肢循环形成,下肢动脉较术前增多且增粗,并形成交织网.术后3个月1例患者病死,死因是基础病导致呼吸衰竭.其余19例患者患足溃疡面均愈合良好,坏死平面均未增加,患肢肤色均恢复正常.结论 采用骨膜牵张术治疗糖尿病足,可获得令人满意的近期疗效.
患者男,36 岁,因胸背部痛1 年余,加重伴左下肢痛4 d,于2019年04月23日入院.患者自诉1年前无明显诱因出现胸背部疼痛不适,无双下肢放射痛、麻木及无力,无间歇性跛行,无乏力,无潮热盗汗、咳嗽咳痰、心悸气紧等不适.
