目的:通过观察显微镜治疗精索静脉曲张术后睾丸追赶性生长的情况及术后并发症,探讨显微镜下精索静脉结扎的疗效.方法:回顾性分析2017年1月—2019年9月在我院及北京儿童医院住院并经手术治疗的青少年精索静脉曲张患者共33例.患者首次诊断年龄11岁10个月～16岁1个月,平均年龄(15.25±5.33)岁.所有患者均在术前接受彩超检查测量睾丸大小,并接受显微镜下精索静脉结扎术.手术时年龄12岁3个月～17岁9个月,平均年龄(15.63±6.07)岁.记录患者在显微镜下精索静脉曲张结扎术后伤口愈合、阴囊肿大、症状等发生情况,术后随访时鞘膜积液、睾丸萎缩和精索静脉曲张复发情况.结果:全组33例患者显微镜下精索静脉结扎术后均无伤口感染,术后约1周伤口即愈合,术后1周时阴囊水肿约占9.09％,2周阴囊水肿约占3.03％.随访时间6～13个月,平均随访(9.05±4.13)个月,无鞘膜积液及睾丸萎缩,无复发病例.术前存在坠胀及疼痛12例,完全缓解10例,明显改善2例.术前阴囊内精索静脉迂曲、"蚯蚓状"29例的阴囊内"蚯蚓状"团块已经消失.术前睾丸萎缩指数超过20％者均出现了恢复性生长,双侧睾丸大小差异<10％,睾丸韧性增强.结论:显微镜下精索静脉结扎能保留动脉和淋巴管,有效减少术后并发症,对于青少年精索静脉曲张患者是首选治疗方式之一.

目的 了解手术改善后尿道瓣膜症患儿膀胱功能的效果和手术前后膀胱功能的变化.方法 回顾性分析2014年1月 ～2016年12月在北京儿童医院及北京儿童医院顺义妇儿医院住院治疗并完成了手术前、后尿流动力学检查后尿道瓣膜症患者的临床资料.共7例患者,首诊年龄5个月 ～9岁2个月,平均年龄为4岁7个月,手术年龄5个月 ～9岁2个月,平均手术年龄4岁7个月.结果 7例患儿诊断为后尿道瓣膜症,随访时间3～96个月,平均随访时间32.7个月.术后复查尿流动力学时间为距术后3～21个月,平均6.9个月.手术前、后尿流动力学检查结果显示,最大膀胱测量容积138.86±116.13ml vs 174.71±100.20ml;残余尿量82.29±90.22ml vs 57.71±75.03ml;膀胱顺应性9.54±14.05ml/cmH2O vs 16.23±12.62ml/cmH2O;最大尿流率5.57±3.84ml/s vs 13.27±10.22ml/s.本组患儿最大膀胱容积、残余尿量、膀胱顺应性、最大尿流率在手术前、后两组数值变化比较,差异无统计学意义(P>0.05).结论 尿流动力学检查是监测后尿道瓣膜症病情变化的有效手段,瓣膜切开对改善最大膀胱容积、膀胱顺应性、残余尿量、最大尿流率并不理想.

目的:探究富血小板血浆对膝骨类关节炎的临床治疗效果;方法:选取了2017年3月到2017年12月在我院接受治疗的48例膝关节炎病患,分成治疗组和对照组,每组24例,对治疗组的病患给予富血小板血浆治疗,对照组病患注射25mg玻璃酸钠注射液.结果:相较于对照组68.75%的总有效率而言,治疗组能够达到87.50%,P>0.05,表明组间差距显著.从JOA评分上看,治疗之前两组之间差异显著,P>0.05;术后,治疗组优于对照组,P<0.05,说明差异显著.结论:膝关节炎使用富血小板血浆能够显著提升治疗的效果,对病患活动功能有所改善,可以缓解疼痛,有着较高的临床应用价值.

Background and Objective: The aim of this study was to compare the outcome of using tibial nails inserted by the suprapatellar approach with tibial nails inserted by the infrapatellar approach in a meta-analysis of randomized controlled trials (RCTs). Methods: The following electronic databases were searched: PubMed (1966 to January 2018), EMBASE (1974 to January 2018), Cochrane Library (January 2018), Web of Science (1990 to January 2018). We also used Google Search Engine to search more potentially eligible studies until January 2018. The methodological qualities of included studies were assessed in accordance with the guidelines provided by the Cochrane Collaboration for Systematic Reviews. The statistical analysis all of included studies were performed by STATA 13.0 software. The outcomes were total blood loss, postoperative pain, range of motion (ROM), Lysholm knee score, fluoroscopy time, operation time, and postoperative complications. Results: Four RCTs published between 2015 and 2017 were selected in the meta-analysis. There was a significant difference between suprapatellar and infrapatellar approach surgery in total blood loss, postoperative pain, ROM, Lysholm knee scores, and fluoroscopy times. Conclusions: The suprapatellar approach for intramedullary nailing appears superior to the infrapatellar approach, with a reduction in total blood loss, improved postoperative pain, shorter fluoroscopy time, and better knee functionality outcomes. There was no increased incidence of postoperative complications between the 2 groups. Further research remains necessary.

BackgroundandObjective:The aim of this study was to compare the outcome of using tibial nails inserted by the suprapatellar approach with tibial nails inserted by the infrapatellar approach in a meta-analysis of randomized controlled trials (RCTs). Methods: The following electronic databases were searched: PubMed (1966 to January 2018), EMBASE (1974 to January 2018), Cochrane Library (January 2018), Web of Science (1990 to January 2018). We also used Google Search Engine to search more potentially eligible studies until January 2018. The methodological qualities of included studies were assessed in accordance with the guidelines provided by the Cochrane Collaboration for Systematic Reviews. The statistical analysis all of included studies were performed by STATA 13.0 software. The outcomes were total blood loss, postoperative pain, range of motion (ROM), Lysholm knee score, fluoroscopy time, operation time, and postoperative complications. Results: Four RCTs published between 2015 and 2017 were selected in the meta-analysis. There was a significant difference between suprapatellar and infrapatellar approach surgery in total blood loss, postoperative pain, ROM, Lysholm knee scores, and fluoroscopy times. Conclusions:The suprapatellar approach for intramedullary nailing appears superior to the infrapatellar approach, with a reduction in total blood loss, improved postoperative pain, shorter fluoroscopy time, and better knee functionality outcomes. There was no increased incidence of postoperative complications between the 2 groups. Further research remains necessary. Abbreviations: CI = confidence interval, RCT = randomized controlled trials, ROM = range of motion.

目的 探究类风湿性关节炎中采用中西医结合治疗的临床效果;方法 选取了在2017年2月～12月,在我院接受治疗的92例类风湿性关节炎病患,随机分成治疗组与对照组,每组46例病患,治疗组主要使用中西医结合的治疗方法,对照组则采用西医治疗,将两组的治疗效果作为观察指标.结果 相较于对照组61％的有效率而言,治疗组的有效率更高,达到了96％,且P<0.05,组间差异显著.结论 中西医结合的方法能够治疗类风湿性关节炎,并且临床治疗效果比较高,可以提升预后质量,是一种指的推广的方法.

BackgroundandObjective: The aim of this study was to compare the outcome of using tibial nails inserted by the suprapatellar approach with tibial nails inserted by the infrapatellar approach in a meta-analysis of randomized controlled trials (RCTs). Methods: The following electronic databases were searched: PubMed (1966 to January 2018), EMBASE (1974 to January 2018), Cochrane Library (January 2018), Web of Science (1990 to January 2018). We also used Google Search Engine to search more potentially eligible studies until January 2018. The methodological qualities of included studies were assessed in accordance with the guidelines provided by the Cochrane Collaboration for Systematic Reviews. The statistical analysis all of included studies were performed by STATA 13.0 software. The outcomes were total blood loss, postoperative pain, range of motion (ROM), Lysholm knee score, fluoroscopy time, operation time, and postoperative complications. Results: Four RCTs published between 2015 and 2017 were selected in the meta-analysis. There was a significant difference between suprapatellar and infrapatellar approach surgery in total blood loss, postoperative pain, ROM, Lysholm knee scores, and fluoroscopy times. Conclusions: The suprapatellar approach for intramedullary nailing appears superior to the infrapatellar approach, with a reduction in total blood loss, improved postoperative pain, shorter fluoroscopy time, and better knee functionality outcomes. There was no increased incidence of postoperative complications between the 2 groups. Further research remains necessary.

BackgroundandObjective:The aim of this study was to compare the outcome of using tibial nails inserted by the suprapatellar approach with tibial nails inserted by the infrapatellar approach in a meta-analysis of randomized controlled trials (RCTs). Methods: The following electronic databases were searched: PubMed (1966 to January 2018), EMBASE (1974 to January 2018), Cochrane Library (January 2018), Web of Science (1990 to January 2018). We also used Google Search Engine to search more potentially eligible studies until January 2018. The methodological qualities of included studies were assessed in accordance with the guidelines provided by the Cochrane Collaboration for Systematic Reviews. The statistical analysis all of included studies were performed by STATA 13.0 software. The outcomes were total blood loss, postoperative pain, range of motion (ROM), Lysholm knee score, fluoroscopy time, operation time, and postoperative complications. Results: Four RCTs published between 2015 and 2017 were selected in the meta-analysis. There was a significant difference between suprapatellar and infrapatellar approach surgery in total blood loss, postoperative pain, ROM, Lysholm knee scores, and fluoroscopy times. Conclusions:The suprapatellar approach for intramedullary nailing appears superior to the infrapatellar approach, with a reduction in total blood loss, improved postoperative pain, shorter fluoroscopy time, and better knee functionality outcomes. There was no increased incidence of postoperative complications between the 2 groups. Further research remains necessary. Abbreviations: CI = confidence interval, RCT = randomized controlled trials, ROM = range of motion.

Objective To explore the indication method of nails in treatment of ipsilateral femoral shaft and neck fractures. Method Clinical data of 18 patients with ipsilateral femoral shaft and neck fractures during January 2008 and July 2012 in ours hospital was retrospectively analysis.18 nails were used.Among 15 antegrade nails,there were 6 cases with hollow screw.There were 3 cases with retrograde nails and hollow screw. Results All patients were followed with a mean of 22.4 months (8 to 60 months).The rate of missed diagnosis was 22.2%.All fractures healed without breakage of implants.2 femoral shaft fractures got delayed fracture healing in 18 months and 23 months.There were 2 cases with cystic change of femoral head without clinical symptoms.Conclusion The rate of missed diagnosis of ipsilateral femoral shaft and neck fractures was high.The clinical effect of ipsilateral femoral shaft and neck fractures was reliable,that we applied nailing combined with hollow nail appropriately.

目的:分析AO锁定钢板治疗老年肱骨近端骨折的疗效.方法:采用AO肱骨近端锁定钢板治疗57例,平均随访25个月.结果:术后无伤口感染、骨折不愈合及内固定松动发生,肩关节功能按Neer评分标准,功能优20例,良28例,可5例,差4例,优良率为84.21％.结论:肱骨近端锁定钢板对中老年肱骨近端骨折固定可靠,并发症少,骨折愈合良好,便于早期功能锻炼等优点.

Objective To discuss the operative technique and treatment effect of senile osteoporotic fracture of the proximal humerus with locking compression plate.Methods A group of 51 cases with senile osteoporotic fracture of the proximal humerus were treated with LCP or Hemi-arthroplasty.Among 51 patients,there were 22 males and 29 females,aged 55~74 years and a mean age of(63.6±7.4) years.Neer fracture classification and rating system were used to appraise the trauma and therapeutic effect.There were 21 patients had two parts fracture,18 patients had simple three parts fracture,3 patients had three parts fracture combined with shoulder dislocation and 9 patients had four parts fracture.All cases were followed up for 5 to 34 months,average(17.6±6.4)months.Results The clinical results were satisfied according to the Neer,Oxford evaluations and no obvious statistics differences were found between the two groups.Conclusion LCP would be an effective choice in the treatment of complex senile osteoporotic fracture of the proximal humerus,Hemi-arthroplasty is a good choice for Neer 4 complex senile osteoporotic fracture.

目的:观察应用外固定架结合克氏针治疗严重不稳定性桡骨远端骨折的疗效.方法 选取我院自2006年12月到2010年6月采用外固定架结合克氏针治疗中老年桡骨远端不稳定骨折38例.随访观察治疗效果.结果 所有患者随访12-43个月,平均20.2个月.骨折平均愈合时间约10.2周.根据Kienst功能评分标准评定:10例优.21例良,7例可,优良率81.6%.结论 外固定架结合克氏针治疗严重不稳定桡骨远端骨折可以获得较好的疗效,可根据骨折的具体情况及患者的年龄、需求及经济情况灵活应用.

Objective To evaluate the primary result and method of proximal femoral nail anti-rotation(PFNAR),to treat intertrochanteric fractures in the elders.Methods Between Jurnary 2006 and October 2007,63 cases were treated with PFNAR by manipulative traction and closed reduction,there were 26 men and 37 women with a mean age of 76.3 years,which of them was classified to Evans-Jensen classification,all of cases were followed-up regularly and placed on files according to Harris scores.Results 59 cases of 63 old patients were followed-up from 6 to 29 months(average 12.6 months),the operation time was 54 min(35～80 min).The blood loss was 140 mL(100～300 mL).Union occurred in all patients with a healing time of 13.2 weeks(10～17 weeks).According to Harris score,28 cases obtained excellent result,23 good result,6 fair result,and difference in 2,and the excellent and good rate was 86.4%.Conclusion PFNAR is a very good method to treat intertrochanteric fractures in the aged,and there are some advantages of small trauma,less complication,especially according to the function of vitodynamics of the bones.

目的 评价股骨近端防旋髓内钉治疗老年股骨转子间骨折的方法和初步疗效.方法 2006年1月至2007年10月,共对63 例老年病人(男26 例,女37 例,平均76.3 岁)采用闭合手法牵引复位,股骨近端防旋髓内钉治疗股骨转子间骨折,骨折采用Evans-Jensen分型,术后定期随访,根据Harris评分系统进行归档.结果 63 例老年病人,59 例病人获得了6～29个月(平均12.6个月)的随访,手术时间35～80 min,平均54 min.术中出血量为100～300 mL,平均140 mL.骨折全部愈合,愈合时间10～17周(平均13.2周).按Harris评分进行评价,优28 例,良23 例,可6 例,差2 例,优良率86.4%.结论 股骨近端防旋髓内钉治疗老年股骨转子间骨折,手术创伤小,并发症少,更加符合人体生物力学特征,是一种治疗老年股骨转子间骨折非常有效的方法.

Objective To evaluate the primary result and method of proximal femoral nail anti-rotation(PFNAR),to treat intertrochanteric fractures in the elders.Methods Between Jurnary 2006 and October 2007,63 cases were treated with PFNAR by manipulative traction and closed reduction,there were 26 men and 37 women with a mean age of 76.3 years,which of them was classified to Evans-Jensen classification,all of cases were followed-up regularly and placed on files according to Harris scores.Results 59 cases of 63 old patients were followed-up from 6 to 29 months(average 12.6 months),the operation time was 54 min(35～80 min).The blood loss was 140 mL(100～300 mL).Union occurred in all patients with a healing time of 13.2 weeks(10～17 weeks).According to Harris score,28 cases obtained excellent result,23 good result,6 fair result,and difference in 2,and the excellent and good rate was 86.4%.Conclusion PFNAR is a very good method to treat intertrochanteric fractures in the aged,and there are some advantages of small trauma,less complication,especially according to the function of vitodynamics of the bones.

目的:分析评价全髋关节置换与双动人工股骨头置换术后的临床疗效。方法:完全随访的人工髋关节置换手术患者485例(504髋),其中随访5年的全髋关节置换270例(285髋),双动人工股骨头置换215例(219髋);随访10年285例(305髋),其中全髋关节置换160例(169髋),双动人工股骨头置换125例(136髋)。根据Harris评分标准进行评分,并进行组间比较。结果:术后5年随访病例的Harris评分80分以上者,双动人工股骨头置换术为102髋(102/219,47%),全髋关节置换术为239髋(239/285,84%)。术后随访10年Harris评分在80分以上者,双动人工股骨头置换术为41髋(41/136,30%),全髋关节置换术为125髋(125/169,74%)。全髋关节置换术后5年和10年的Harris评分疗效80分以上者的比例明显高于双动人工股骨头置换术(P<0.05)。结论:全髋关节置换术中、远期疗效均优于人工股骨头置换,在患者身体情况允许情况下应该优先选择全髋关节置换术。