并指畸形是常见的先天性上肢畸形之一,手术是主要的治疗方法,重建指蹼则是手术最为关键的部分,而指蹼爬移是并指分指术后最常见的晚期相关并发症.本文通过回顾相关文献阐述了指蹼爬移的定义、发生机制、影响因素、评估方法、预防和治疗措施.

目的 探讨阿司匹林联合硫酸氢氯吡格雷治疗伴H型高血压的急性脑梗死患者临床预后及安全性.方法 选取伴H型高血压的急性脑梗死患者92例,记录患者基线资料,包括性别、年龄、体重指数(BMI)、饮酒史、吸烟史、高血压病程、责任梗死灶最大面积长轴、入院急检血检测血小板(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、血浆纤维蛋白原(FIB)、C反应蛋白(CRP),入院当日或次日清晨抽取空腹静脉血检测尿酸、肾功、肝功、同型半胱氨酸(Hcy)、血糖、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),把患者分为观察组(46例)和对照组(46例),观察组给予阿司匹林100 mg联合硫酸氢氯吡格雷75 mg每日1次口服,对照组给予阿司匹林100 mg每日1次口服,2组均维持抗血小板治疗3个月,2组入院后未接受静脉溶栓或动脉取栓,均给予脑梗死急性期常规治疗,包括清除自由基、改善循环、强化降脂、稳定斑块、调整血糖血压、降同型半胱氨酸及对症治疗,同时指导早期良肢位规范摆放及康复治疗.记录入院时、治疗后1 w及3个月时美国国立卫生研究院脑卒中量表(NIHSS)评分,连续抗血小板治疗3个月时血小板参数(PLT、MPV、PDW)变化、缺血性脑卒中复发及药物引起不良反应情况.结果 治疗1 w后,与对照组比较,观察组进展性脑卒中发生率降低,神经功能缺损程度减轻,观察组NIHSS评分明显低于对照组,差异有统计学意义(P<0.05);治疗3个月时与对照组比较,观察组血小板参数(MPV、PDW)下降水平明显优于对照组,差异有统计学意义(P<0.05),神经功能恢复较好,且缺血性脑卒中复发率低,两组抗血小板药物引起不良反应情况无明显差异.结论 阿司匹林短期联合硫酸氢氯吡格雷治疗伴H型高血压的急性脑梗死患者临床预后明显优于单用阿司匹林,双重抗血小板可有效抑制血小板活化聚集,抑制病情进展,促进神经功能恢复,减少缺血性脑卒中复发风险,安全有效.

目的 探讨不同类型脑分水岭梗死危险因素及头颈部CT血管成像(CTA)的血管病变特点.方法 筛选急性脑分水岭梗死患者98例,包括皮质型分水岭梗死(CWI)49例、皮质下分水岭梗死即内分水岭梗死(IWI)49例.分析两组危险因素及头颈部CTA显示的血管病变特点.结果 两组性别、年龄、体重指数(BMI)、饮酒史、高血压史、冠心病史、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)、同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平及大脑前动脉(ACA)、大脑后动脉(PCA)狭窄例数均无统计学差异(均P>0.05).CWI组吸烟、低密度脂蛋白胆固醇(LDL-C)水平、颈动脉不稳定斑块及颈内动脉(ICA)狭窄例数均高于IWI组,差异有统计学意义(P<0.05);IWI组合并糖尿病例数、大脑中动脉(MCA)及椎基底动脉(VBA)狭窄例数均高于CWI组,有统计学差异(P<0.05).结论 脑分水岭梗死的发生与MCA、ICA狭窄或闭塞及VBA狭窄关系密切,吸烟、LDL-C水平升高、颈动脉不稳定斑块形成及ICA狭窄为CWI的重要危险因素,MCA狭窄或闭塞是IWI的主要血管病变特点,糖尿病对血管损害严重而广泛.

Congenital thumb duplication is the most common deformity of distal extremities. Surgical reconstruction of complex thumb duplication may include augmentation, correcting axial deviation, number reduction and length shortening. Correcting angular deformation of thumb has been one technical challenge. Angular deformation is one of the most common surgical complications in the literature. This review introduced the pathological factors of angular deformation in thumb duplication and summarized the improved methods of correcting deformations, including osteotomy, arthroplasty, ligament tightening, adductor pollicis brevis reattachment, tendon centralization and rebalance, etc.

Objective:To evaluate the clinical efficacy of trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty for the treatment of the first carpometacarpal joint osteoarthritis.Methods:From November 2017 to April 2020, 7 patients with the first carpometacarpal joint osteoarthritis underwent trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty. The thumb mobility, pain score, upper limb dysfunction score and the height of the first carpometacarpal joint were followed up at 1, 3 and 6 months after operation.Results:The patients were follow-up for 8 to 47 months, with an average of 28.6 months. The Kapandji score of thumb mobility was (4.67±2.40) before operation and (8.56±1.13) 3 months after operation. The VAS was (7.11±2.42) before operation and (1.44±0.88) at the last follow-up. The upper limb dysfunction score Quick-DASH score was (61.88±16.87) before operation and (24.49±14.08) at the last follow-up. The height of the first carpometacarpal joint was (8.66±0.70) mm before operation and (6.36±1.74) mm 3 months after operation. The level of proximal displacement of the first metacarpal bone at 3 months after operation was (27.19±17.40)%.Conclusion:The application of trapeziectomy combined with modified abductor pollicis longus suspension arthroplasty for the treatment of the first carpometacarpal joint osteoarthritis can alleviate thumb pain, improve thumb mobility and significantly improve upper limb function. It is an effective treatment method worthy of recommendation.

Objective:To investigate the clinical efficacy of TiRobot-assisted minimally invasive percutaneous screw fixation for pelvic fractures.Methods:The clinical data of 44 patients with pelvic fracture were retrospectively analyzed who had undergone TiRobot-assisted minimally invasive percutaneous screw fixation from May 2018 to April 2021 at Department of Orthopedic Traumatology, The First Hospital of Jilin University. There were 30 males and 14 females, aged from 11 to 78 years (average, 40.6 years). According to the Tile classification, there were 20 type C1 fractures, 23 type C2 fractures and one type C3 fracture. The time from injury to operation averaged 8.2 days (from 1 to 41 days). The minimally invasive percutaneous screw fixation was assisted by the orthopaedic TiRobot in all patients. Operation time, fluoroscopy time, reduction quality, complications and functional recovery at the final follow-up were recorded and analyzed.Results:A total of 96 screws were implanted in this cohort. The total fluoroscopy time ranged from 17 to 66 s, with an average of 17.8 s for each single screw. The operation time ranged from 50 to 355 min, averaging 179.7 min. According to the Matta criteria, the reduction quality was rated as excellent in 36 cases, as good in 5 and as fair in 3, yielding an excellent and good rate of 93.2%(41/44). All the 44 patients were followed up for 6 to 42 months (average, 20.4 months). The fracture healing time ranged from 2 to 6 months, averaging 3.3 months. The Majeed scores at the final follow-up ranged from 51 to 100 points (average, 83.7 points); there were 28 excellent, 8 good, 7 fair and one poor cases, giving an excellent to good rate of 81.8% (36/44). Follow-up found no such complications as iatrogenic neurovascular injury, incision infection, malunion, implant loosening or fracture re-displacement in all the 44 patients.Conclusion:TiRobot-assisted minimally invasive internal fixation can result in fine clinical efficacy for pelvic fractures, showing advantages of accuracy, minimal invasion and safety.

Polydactyly is a common congenital malformation of foot and postaxial polydactyly has been the most common type. The therapeutic goal is improving function and/or appearance. This review introduced clinical classifications of postaxial polydactyly, summarized the objective and timing of surgery and discussed the approaches of selecting row for resecting postaxial polydactyly, correcting axis deviation of toe, reconstructing toe web, correcting brachydactyly and reconstructing the stability of toe joint.

Objective:To introduce a new wound dressing method without regular dressing change after surgical treatment of hand or foot deformities for children, discuss the key points of application and advantages.Methods:The data of patients with hand and foot deformities who received surgical treatment in Children’s Hospital of Chongqing Medical University from January to December 2019 were retrospectively summarized. After the operation, mupirocin ointment was applied outside the incision, and the layered dressing was used with antiadhesion dressing, sterile gauze and bandage, and adhesive tape. The joint was fixed to the position required by the thickness of the dressing accumulation and the direction of bandage winding. If necessary, a small splint was added to the outer layer, and an observation port was reserved at the top of the finger(toe). Blood supply of fingers(toes) was observed after the operation, and the observation port was closed without abnormal condition 48 h later. If there was no exudation, odor or liquid contamination, the dressing should be changed for the first 2-4 weeks after surgery. The wound healing was observed and recorded during the outpatient visit.Results:A total of 436 patients were enrolled, including 256 males and 180 females. The operative age ranged from 5 months to 6 years old, with an average of 2.6 years. There were 166 cases of syndactyly, 213 cases of polydactyly, 22 cases of hand and foot scar contracture, and 35 cases of other hand and foot deformities. All the cases were aseptic operations on distal wrist and ankle joints. The first time to remove the dressing was 6-33 days after surgery, with an average of 21.3 days. Grade A healing was found in 431 cases (98.9%), grade B healing in 1 case (0.2%), and grade C healing in 4 cases (0.9%). All the incisions were healed by dressing change.Conclusions:With strict aseptic manipulation, it is safe and reliable for children with hand or foot deformities to apply this dressing method without regular change following surgery. The method can satisfy the need for bone and soft tissue healing and substitute for plaster immobilization in preschool patients.

竹叶石膏汤是中医治疗温热病后期余热不尽、气津两伤的常用方.高鹏翔教授常用该方治疗多种内科疾病,取得了较好的疗效.现列举高鹏翔教授运用竹叶石膏汤治疗脏腑病证及气血津液病证的验案,总结其应用竹叶石膏汤的经验.

高鹏翔教授认为异位妊娠起病多由郁热、痰湿、血瘀之浊互结于胞脉,冲任不畅,日久成癥而致,在治疗上常应用"通-消-和"三法,即通腑泄浊、化瘀消癥、调和冲任,选方以下瘀血汤为基础加味,使得浊降癥消,胞宫胞脉得通,邪去正安,病获痊愈.

目的 探讨密歇根大学手概况问卷调查表(Michigan Hand Outcomes Questionnaire,MHQ)在手外科的应用效果并,为临床上使用该患者主观自评量表提供参考.方法 查阅近年国内外MHQ应用的相关文献,总结分析MHQ在手外伤、周围神经卡压性疾病和关节炎等方面的应用.结果 文献显示MHQ具有较好的信度、效度及敏感度,不但可以对手功能进行整体评估,而且可以利用某一子量表对某一方面进行单独评估.结论 目前MHQ在国外已成为手外科常用的主观自评量表之一,但国内应用较少,相信随着对患者主观自评的重视,其研究和应用会越来越多.

目的 分析CT在肺部磨玻璃密度影(focal grground-glass opacity,fGGO)的诊断价值.方法 选取2017年5月—2019年5月fGGO患者300例,采用CT进行诊断,分析诊断价值.结果 肺泡细胞癌、腺癌、炎症、血管炎、腺瘤样增生分别为152例、59例、69例(曲菌感染24例)、10例、10例.300例患者中,左肺下叶、左肺上叶、右肺下叶、右肺中叶、右肺上叶分别为82例、47例、20例、69例、82例.圆形类圆形、不规则多边形分别为132例(其中恶性76例、良性56例)、168例(其中恶性137例、良性31例).两组在pGGO(pure groud-glass opacity)和mGGO(mixed ground-glass opacity)分布方面无统计学意义(P>0.05).两组除空泡征,其他方面CT征象表现对比有统计学意义(P<0.05).结论 CT在fGGO的形态、征象、鉴别良恶性中价值较高,对于提升检出率,改善患者的预后效果意义重大.

目的 探析老年急性脑出血患者诊断中64排螺旋CT的应用效果.方法 2017年8月—2019年8月,选取在我院接受治疗的急性脑出血老年患者350例,视为观察组,选取同期非脑出血老年患者350例,视为对照组,检查时两组均选择64排螺旋CT,对CT下患者表现加以统计并对比.结果 中线结构发生移位的几率对比,观察组(64.9％)较对照组(3.4％)高,P<0.05统计学存在显著差异.观察组患者CT下显示,基底节区为老年患者出血较多的部位;且患者出血量较30 mL少的较多.结论 针对急性脑出血老年患者诊断时选择64排螺旋CT,其准确性相对较高.

先天性多拇畸形是较常见的肢体先天畸形，其表型及分型多样，根据手术方案的不同多拇畸形被分为简单型和复杂型。从指甲发育情况、指体周径、指体长度及骨关节发育等方面重点讨论复杂型增容的指征，并从Bilhaut-Cloquet术及其改良术式、复合组织瓣及顶端移位术式方面重点介绍了复杂型增容的方法。

Hepatocellular carcinoma (HCC) is one of the most common human cancers, its prevalence and severity need us to discover novel early diagnostic biomarkers and new therapeutic strategies. MicroRNA-122 is the most abundant microRNA in the liver, and acts as a tumor suppressor and represses HCC development. In our study we showed that HNF-4α and MiR-122 were down-regulated significantly in hepatocellular carcinoma. Over-expression of HNF-4α inhibit hepatocellular carcinoma cells proliferation. And miR-122 is one of the downstream effector of HNF-4α. Up-regulated miR-122 inhibited hepatocellular carcinoma cells proliferation through regulating ADAM17. Collectively, our results suggested that HNF-4α could inhibit hepatocellular carcinoma proliferation with miR-122 being a downstream target of it. And miR-122 would inhibit hepatocellular carcinoma proliferation by regulating ADAM17 signal pathway.

1临床资料患者,女,37岁,入院2个月前铁签子扎伤左环指,当时由于开放性创口小,未处理。5天后出现创口疼痛,指体肿胀。在当地医院行X线检查后,行热水浴观察。11天后仍未好转,又遂行中药外敷、静脉用青霉素治疗,但环指肿胀、疼痛进行性加重,伴活动受限,来我院就诊。入院专科检查:左环指近节指体明显肿胀,指体尺侧偏斜,皮肤表面可见中药膏残留。肿胀部位皮色紫红,皮肤质硬,皮温略高,触痛剧烈;环指掌指关节、近指间关节主被动屈伸活动障碍,远指间关节活动尚可,中、小指掌指关节因疼痛主被动屈伸活动也受限。

Syndactyly is the second common congenital hand anomaly. Syndactyly release includes finger separation, web-space reconstruction and skin coverage. Among them, web-space reconstruction is the most important step. The authors reviewed the web-space anatomy, the principles and method of syndactyly release, as well as the designs and applications of Z-plasty, the double-triangle flap, the dorsal rectangular flap, the dorsal metacarpal perforator flaps for web-space reconstruction. The graft-free methods which were recently reported in China were also introduced.

Pain is one of the most common symptoms among cancer patients. About 60%-80% of patients with advanced cancer suffer from pain. Cancer pain can cause or aggravate physical symptoms, and can also cause psychological burden, which directly affects patients' quality of life. Cancer pain is a global public health problem. The World Health Organization (WHO) has set a strategic task to relief pain and its painful symptoms to overcome cancer. In 1986, the WHO proposed a three-step treatment regime for cancer pain, which made great progress in cancer pain control, but still about 20% of cancer patients suffer from pain. Poor pain management, which also poses new challenges for clinically effective treatment of cancer pain, especially for patients with advanced cancer. The United States National Cancer Network (NCCN) lists the cancer pain management as an important part of cancer control. Furthermore, cancer pain management is integrated into the comprehensive treatment of cancer in almost all countries worldwide. Paying attention to the influence of pain on cancer patients is important to oncologists. Knowing how to manage cancer pain effectively are essential skills for clinical stuff. In modern era, new progresses and new challenges have emerged in the diagnosis and treatment of cancer pain. This article will give a summary of the challenges and recent advances of cancer pain in recent years.