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聚乙二醇干扰素挽救治疗慢性乙型肝炎双重耐药一例

Antivirus Therapy of Lamivudine Resistant Chronic Hepatitis B Patients

目的 采用干扰素和阿德福韦酯治疗慢性乙型肝炎患者经拉米夫定治疗后出现YMDD变异，比较两种治疗策略的临床疗效。 方法 选择2002年2月-年12月经100 mg拉米夫定治疗后出现YMDD变异的慢性乙型肝炎患者76例。其中，男52例，女24例；年龄18~55岁，平均年龄33岁。服用100 mg拉米夫定52～156周发生YMDD变异，HBV DNA低于治疗前水平，丙氨酸转移酶(alanine aminotransferase，ALT)lt;2×ULN/L患者分为A组(26例)，继续用100 mg拉米夫定治疗48周；服用100 mg拉米夫定52～156周发生YMDD变异，HBV DNA定量检测高于或等于治疗前水平，ALTgt;2×ULN/L，根据患者自愿分为B组(27例)和C组(23例)。B组用100 mg拉米夫定联合10 mg阿德福韦酯治疗48周；C组用干扰素治疗48周。分别观察3组ALT复常率及HBV DNA转阴率、HBeAg阳性患者血清学转换率。 结果 治疗48周时，B、C组患者ALT复常率分别是74.1%和78.3%，明显高于A组的34.6%，差异有统计学意义(Plt;0.05)；B、C组患者HBV DNA转阴率分别是77.7%和73.9%，明显高于A组的11.5%，差异有统计学意义(Plt;0.05)；3组HBeAg阳性患者血清学转换率比较，差异均无统计学意义(Pgt;0.05)。 结论 慢性乙型肝炎患者经拉米夫定治疗后出现YMDD变异，继续用拉米夫定治疗疗效不理想，改用干扰素或联合阿德福韦酯治疗更安全有效。

Impact of surgical timing on effectiveness of closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar humerus fractures

Objective To compare the effectiveness of early versus delayed closed reduction and percutaneous Kirschner wire fixation in the treatment of pediatric supracondylar humerus fractures. Methods A retrospective analysis was conducted on 468 children with supracondylar humerus fractures, who were admitted between January 2020 and December 2023 and met the inclusion criteria. Among them, 187 children were treated during 12 hours after injury (early operation group) and 281 were treated after 12 hours (delayed operation group). There was no significant difference between the two groups (P>0.05) in the gender, age, injury mechanism, fracture side and type, while there was significant difference in interval from injury to operation (P<0.05). The operative outcomes, including the operation time, intraoperative blood loss, hospital stay, fracture healing time, elbow function assessed by Flynn criteria at 3 months after operation, and complications, were compared. Results Compared to the delayed operation group, the early operation group demonstrated significantly shorter operation time and less intraoperative blood loss (P<0.05). There was no significant difference in the length of hospital stay between the two groups (P>0.05). All children were followed up 3-12 months. The follow-up time was (6.7±2.9) months in the early operation group and (6.9±2.8) months in the delayed operation group, showing no significant difference between the two groups (P>0.05). There was no significant difference in the fracture healing time between the two groups (P>0.05). At 3 months after operation, the early operation group exhibited superior Flynn elbow functional outcomes to the delayed operation group (P<0.05). In the early operation group, there was 1 case of fracture non-union and 3 cases of cubital varus deformity after operation. In the delayed operation group, there was 1 case of nerve injury, 7 cases of fracture non-union, and 12 cases of cubital varus deformity after operation. There was significant difference in the incidence of complications between the two groups (P<0.05). One case of the early operation group and 10 cases of the delayed operation group were undergone secondary operation, showing no significant difference in the incidence of secondary operation between the two groups (P>0.05). ConclusionFor pediatric supracondylar humerus fractures, early closed reduction and percutaneous Kirschner wire fixation can reduce operation time, minimize intraoperative blood loss and postoperative complications, and improve the functional recovery compared to delayed operation.

3-D 打印技术辅助人工全髋关节置换术治疗 Crowe Ⅳ 型髋关节发育不良合并股骨近段畸形一例

目的 介绍 3-D 打印技术辅助人工全髋关节置换术（total hip arthroplasty，THA）治疗 1 例 Crowe Ⅳ 型髋关节发育不良合并股骨近段畸形的临床经验。 方法 2017 年 2 月，收治 1 例 40 岁 Crowe Ⅳ 型髋关节发育不良合并股骨近段畸形的女性患者。术前采用 Mimics 软件建立患侧髋关节三维数字模型，3-D 打印患侧股骨模型，根据模型设计股骨假体截骨位置及截骨大小。采用 Magics 19.0 软件设计制作个性化股骨截骨导板三维模型，并 3-D 打印。THA 术中应用截骨导板进行股骨截骨矫形。 结果 手术时间 98 min。术后第 2 天髋关节正侧位 X 线片检查示，髋臼假体安放、螺钉植入角度及位置均理想，恢复髋臼正常旋转中心，股骨截骨两端对位良好，下肢力线恢复正常。患者获随访 6 个月，Harris 评分为 95 分，较术前（38 分）明显提高；疼痛视觉模拟评分（VAS）为 0 分，较术前（7 分）明显下降。随访期间未发生假体松动、感染、血栓形成等并发症。 结论 3-D 打印技术辅助 THA 治疗 Crowe Ⅳ 型髋关节发育不良合并股骨近段畸形，能简化手术操作、提高手术准确度、减少组织损伤、降低手术风险，取得满意临床疗效。