采用整群随机抽样方法,对兰州市18家公立医院2 989名医护人员进行职业紧张因素及其工作相关肌肉骨骼疾患(WMSDs)发生情况调查,采用x2检验、Mantel-Haenszel趋势检验、Pearson相关及Logistic回归进行统计分析.结果显示,医护人员WMSDs发生率为37.04％,患有≥2种WMSDs疾病的569人(19.04％),发生率最高的是颈椎病(22.68％),其次是腰肌劳损(13.35％)和颈肩肌肉酸痛(12.71％).WMSDs患病情况与年龄、文化程度、工龄、职称、岗位、月收入、每周工作时间、过度承诺及付出-回报失衡情况成正相关;与户籍和所在科室成负相关.工龄＜15年、每周工作时间＞40 h、付出-回报失衡及高水平过度承诺状态是发生WMSDs的危险因素(P＜0.01).

目的 探讨上睑下垂患者提上睑肌组织病理学评价和临床病情的相关性.方法 前瞻性病例研究.纳入2014年1月至2020年6月于我院就诊的125例(125只眼)上睑下垂患者为研究对象;根据病程严重程度分为重度组(50例)和中度组(75例).在手术过程中获得了125例上睑肌腱膜病标本并进行苏木精-伊红染色、Van Gieson染色、Masson染色、免疫组织化学和透射电镜观察,以观察提上睑肌肌腱膜的病理学特征;使用曼恩·惠特尼(Mann-Whitney)的U检验和多元线性回归进行统计分析,探讨上睑下垂患者提上睑肌组织病理学特征与临床病情的相关性.结果 透射电子显微镜两组患者均存在胶原纤维增生和细胞变性,包括线粒体肿胀和增生,液泡,脂质滴,脓疱核,染色体凝集,细胞器分解,髓样体和自噬体.两组患者提上睑肌腱膜病理学特征脂肪浸润、横纹肌肌纤维丢失、胶原纤维增生、肌红蛋白分布、提上睑肌厚度组间比较存在差异(P＜0.05)o Logistics回归表明脂肪浸润(OR=1.816)、横纹肌肌纤维丢失(OR=2.856)、胶原纤维增生(OR=0.301)是影响上睑下垂患者临床病情的影响因子.结论 上睑下垂患者提上睑肌肌腱膜存在肌纤维变性,胶原纤维增生和细胞变性有关,其中脂肪浸润、横纹肌肌纤维丢失、胶原纤维增生与患者临床病情的严重程度呈正相关.

BackgroundBecause of high working intensity, high responsibility, and unexpected situations, health care workers may suffer great work pressure, which may lead to health damage. ObjectiveTo explore the self-rated health status and its influencing factors such as demographic and occupational-related factors of medical staff in Lanzhou. MethodsIn-service medical staff were selected by using cluster random sampling method from 18 public hospitals in Lanzhou City and were investigated with a self-made questionnaire and the Self-rated Health Measurement Scale (SRHMS). SRHMS includes 48 items in 10 dimensions, which are divided into three sub-scales of physical health, mental health, and social health, and another independent dimension is overall health. The scores were converted into a percentage scale and expressed as the percentage of measured score to full score; a higher score indicated better health, and >70% was considered good health status. t test, Kruskal-Wallis H test, and Spearman correlation were used to analyze the scores of SRHMS and the demographic and occupational-related factors affecting the scores of physical, mental, and social health sub-scales. ResultsA total of 2989 valid questionnaires were recovered. There were statistically significant differences in total score and the scores of physical, mental, and social health among medical staff of different age, educational background, length of service, and weekly working hours groups (P < 0.05). The percentage of total score to full score in the medical staff was 71.41%, but the scores of physical, mental, and social health sub-scales and total scale of selected participants were all lower than the corresponding domestic norms (t=−3.323, −12.283, −7.157, −9.659, P < 0.05); the percentage of psychological symptoms and negative emotions in mental health scale to full score was the lowest, only 58.39%. Educational background, length of service, and weekly working hours were negatively correlated with physical health score (r=−0.061, −0.060, −0.165, P < 0.05); professional title was positively correlated with mental health score (r=0.045, P < 0.05), while educational background and weekly working hours were negatively correlated with it (r=−0.051, −0.172, P < 0.05). Monthly income, professional title, and length of service were positively correlated with social health score (r=0.040, 0.049, 0.071, P < 0.05), while educational background and weekly working hours were negatively correlated with it (r=−0.038, −0.110, P < 0.05). ConclusionThe self-rated health status of selected medical staff in Lanzhou is generally good, but lower than that of the norm, especially the mental health score is the lowest. The self-rated health score of total scale is correlated with education, length of service, professional title, and working time per week.

目的:探讨睑黄瘤切除术后采用眼轮匝肌风筝皮瓣联合重睑术修复的临床价值.方法:将2016年1月-2020年1月兰州市第一人民医院眼科接收的80例睑黄瘤患者作为研究对象,随机设为研究组与对照组(n=40).对照组采取眼轮匝肌皮瓣修复术,研究组采用眼轮匝肌风筝皮瓣与重睑术联合修复.比较两组临床疗效、美观情况、手术指标以及治疗满意度.结果:研究组有效率高于对照组(P<0.05);研究组内眦部平整及双眼对称率较对照组高,而上睑臃肿率较对照组低(P<0.05);研究组手术时间及术中出血量均较对照组少,而满意度较对照组高(P<0.05).结论:对睑黄瘤患者采取眼轮匝肌风筝皮瓣与重脸术联合修复,其效果较好,有助于改善患者眼部美观度,其治疗满意度较高,利于临床推广应用.

目的 探讨先天性上睑下垂患者提上睑肌腱膜纤维特征及其与病情的相关性.方法 前瞻性病例研究.纳入2016年1月至2020年1月我院收治的50例(76只眼)先天性上睑下垂患者为研究对象;入院后根据患者病情的严重程度分为轻度组17例(25只眼)、中度组20例(31只眼)和重度组13例(20只眼),比较3组患者提上睑肌腱膜纤维特征,并分析其与病情的相关性.结果 Ⅰ型胶原分布、Ⅲ型胶原分布、肌球蛋白分均随着患者病情的严重程度增加而增加(P<0.05),其余比较差异无统计意义(P>0.05);肌球蛋白分布、肌红蛋白分布评分轻度组低于中度组,中度组低于重度组,差异均有统计学意义(P<0.05),提上睑肌厚度轻度组高于中度组,中度组高于重度组差异均有统计学意义(P<0.05);logistics回归分析显示Ⅰ型胶原分布、Ⅲ型胶原分布、肌球蛋白分布是影响先天性上睑下垂患者的影响因子.结论 Ⅰ型胶原分布、Ⅲ型胶原分布、肌球蛋白分均随着患者病情的严重程度增加而增加,且Ⅰ型胶原分布、Ⅲ型胶原分布、肌球蛋白是先天性上睑下垂患者病情的影响因素.

目的:分析眼睑恶性肿瘤切除术后眼险缺损行局部皮瓣联合异体巩膜移植修复的临床效果.方法:选取2016年1月～2019年8月收治的眼睑恶性肿瘤切除术后眼睑缺损患者80例为研究对象,随机分为控制组和实验组,各40例.控制组采用邻近皮瓣转移及自体唇黏膜修复治疗,实验组采用局部皮瓣联合异体巩膜移植修复治疗.比较两组修复前后睑裂高度、长度差值,修复效果,并发症发生情况.结果:两组修复前睑裂高度、长度差值比较无显著性差异(P＞0.05);修复后实验组睑裂高度、长度差值明显小于控制组,差异有统计学意义(P＜0.05).实验组修复总有效率95.0％高于控制组的75.0％,差异有统计学意义(P＜0.05).实验组并发症发生率10.0％低于控制组的27.5％,差异有统计学意义(P＜0.05).结论:眼睑恶性肿瘤切除术后眼睑缺损行局部皮瓣联合异体现膜移植修复的效果显著,可有效修复眼睑功能和外形,并发症发生率较低.

目的 比较额肌瓣腱膜悬吊术与上睑提肌缩短术在中重度先天性上睑下垂治疗中的效果.方法 回顾性分析2017年1月~2019年12月本院收治的54例中重度先天性上睑下垂患者(82只患眼)根据手术治疗方法分为观察组(n=27例,39眼)和对照组(n=27例,43眼),观察组以额肌瓣腱膜悬吊术矫正治疗,对照组患者采用上睑提肌缩短术矫正治疗,比较两组患者矫正效果与并发症发生率.结果 观察组矫正有效率(94.87%)显著高于对照组(76.74%)(P＜0.05);观察组并发症发生率(25.64%)显著高于对照组(6.98%)(P＜0.05).结论 与上睑提肌缩短术比较,额肌瓣腱膜悬吊术治疗中重度先天性上睑下垂疗效更显著,但并发症相对较多,临床可结合患者情况与实际需求选择相应治疗方式.

目的:分析眼压值对POAG选择临床治疗方案的价值.方法:选取2017年1月-2019年1月,到我院治疗的68例POAG患者,将其分为药物组46例及手术组22例,分别采取β-受体阻滞剂或前列腺素衍生物等药物治疗及青光眼阀植入术治疗.结果:治疗前,手术组患者的眼压值明显高于药物组(P＜0.05);治疗后,两组患者的眼压值均显著降低(p＜0.05),组间对比无明显差异(P＞0.05);随访期间,两组患者视力恶化率、并发症率无明显差异(P＞0.05).结论:药物及手术治疗均可有效降低POAG患者眼压值,且安全性良好,其中,药物治疗更适合眼压较低的患者,手术治疗更适合眼压较高的患者.

目的 探讨不同的上斜肌减弱手术方式在A型斜视治疗中的作用.方法 本研究采用回顾性分析收集自2013年1月～2016年12月在我院手术的A型斜视患者68例,其中A型内斜视30例,A型外斜视38例,所有患者依据上斜肌亢进程度、原位水平斜视度及双眼视觉功能情况行手术治疗.术后随访时间6月～18月.平均12月.结果 A型-内斜视30例,上斜肌中度亢进,21例一期行上斜肌部分肌腱切除术,术后上斜肌功能强消失17例(80.9％17/21),4例上斜肌功能亢进+1,水平斜视度平均增大4.9△;9例一期行上斜肌断腱术,术后上斜肌亢进均消失,水平斜视度增大6.11△;A型-外斜视38例,伴上斜肌中重度亢进,16例一期行上斜肌部分肌腱切除术,术后上斜肌功能亢进消失13例(81.2％13/16),3例上斜肌功能亢进+1～+2,水平斜视度平均减小12.50△;22例一期行上斜肌断腱术,术后上斜肌功能强消失20例,2例上斜肌仍亢进+1,水平斜视度平均减小14.54△.结论 两种上斜肌减弱术对伴有上斜肌功能亢进的A型斜视治疗均有效,上斜肌断腱术对水平斜视度影响更大.

目的:探讨影响间歇性外斜视手术治疗效果及远期正位率的相关因素.方法:回顾性分析我院2011年1月至2015年6月手术治疗间歇性外斜视患者的临床资料,共计178例,对患者的屈光状态、术后第一天眼位、手术年龄、手术前后双眼视功能、斜视度以及远期眼位进行观察和分析.结果:178例间歇性外斜视手术患者术后远期正位者162例,占91.01%,无明显过矫,轻度过矫2例占1.12%,轻度欠矫9例占5.06%,明显欠矫5例占2.81%.其中患者4~8岁54例,远期眼位正位48例占88.89%,术前无同视功能23例,术后远期恢复双眼单视功能22例,其中重建立体视18例;8~12岁64例,远期眼位正位60例占93.75%,术前无同视功能32例,术后远期恢复双眼单视功能24例,其中重建立体视19例;>12岁60例,远期眼位正位54例占90%,术前无同视功能33例,术后远期恢复双眼单视功能12例,其中重建立体视11例.结论:手术前后有无双眼视功能是影响间歇性外斜视手术效果的重要影响因素之一,手术后第一天眼位轻度过矫有利于远期正位率.

目的 探讨眼睑恶性肿瘤切除术后重建方法.方法 对该院从2009年3月—2014年5月收治的57例眼睑恶性肿瘤患者行手术切除肿瘤,并通过鼻中隔软骨黏膜瓣修补眼睑缺损,行眼睑重建术.结果 57例患者,治愈38例,有效19例,总有效57例,总有效率为100.00％.术后随访6个月～4年,肿瘤无复发.术后发生并发症8例,其中上睑下垂、睑缘切迹各3例、肉芽增生2例.结论 鼻中隔软骨黏膜瓣移植重建眼睑对眼睑恶性肿瘤切除术后患者的眼睑形态和功能均有良好的恢复作用.

目的 探讨健眼手术治疗知觉性外斜视的矫正效果.方法 随机选取60例患者分两组行健眼(外直肌后徙术和/或内直肌缩短术)及斜视眼手术(外直肌超常量后徙联合内直肌缩短术)矫正斜视.比较术前术后眼位矫正效果.健眼手术组平均手术量11.39 mm,手术均为1次完成.斜位眼手术组平均手术量19.17 mm.结果 该组采用两种手术方法 分别对60例知觉性外斜视患者进行治疗,健眼手术组根据三井幸彦对主眼的手术量按(斜角÷3)mm计算,斜角>15°分二份,健眼手术矫正知觉性外斜视,手术量明显低于仅斜眼手术组,疗效优于斜视眼手术组.结论 健眼手术是矫正知觉性外斜视的有效手术方式.

原发性开角型青光眼是导致视网膜中央静脉阻塞，严重影响患者视力的高危因素之一。本文介绍1例由原发性开角型青光眼并发的视网膜中央静脉阻塞病例，通过介绍其发病及治疗过程，分析其发病原因，探讨如何有效防止类似病例再次发生及有效治疗方法。

Objective To investigate the features and treatment of A-V pattern strabismus Methods Pre-and post-operative deviation and oblique muscle action as well as binocular visual function were evaluated in fifty-two A-V pattern patients.The difference between up gaze and down gaze of deviation was recorded before and after operation.Results 54 patients with binocular or unilateral inferior oblique over action +2 to +3 were treated with inferior or superior oblique weakening procedure and horizontal rectus recession-resection procedure.The A-V pattern of 50 patients were cured.9 patients with ocular Torricelli's were ameliorated.37 patients obtained steroidal function.4 patients were treated second horizontal rectus recession or resection procedure.Conclusions A-V patterns always had inferior or superior oblique over action and could be treated with the inferior or superior oblique weakening procedure.The primary position deviation should be treated by traditional horizontal rectus recession-resection procedure.The stereoscopic function has a good progress with surgery.

Objective:To investigate the time,methods and results of the surgery of congenital esotropia.Methods:Retrospective analysis was made of surgical treatment of 36 cases of congenital esotropia.For 20△ monocular esotropia,the inner rectus was resettled backward for 5 mm;for +40△ ~ 60△the inner rectus of both eyes were resettled backward for 4 ~ 6 mm;a small number of older children with greater squinting were treated with the inner rectus resettled backward in both their eyes plus the treatment of cutting the external rectus away directly.After treatment,three-level-function training was carried out on synoptophore.Results:28 patients' eye positions were corrected after orthotopic,7 cases undercorrection,and 1 case overcorrection.For those with preoperative oblique angle at +30△ ~ +50△,the orthotopic rate of the eye position was 91.67%(33/36);for those with preoperative squinting angle greater than +50△,the orthotopic rate of the eye position was 61.11%(22/36).Conclusion:The surgery of children with congenital esotropia should be done early,with the downward rectus resettlement within eyes as the preferred surgical technique.The postoperative follow-up is very important for the long term eye position correction.