目的:探讨不同治疗方法对急性痛风性膝关节炎的治疗效果。方法:自2006年9月～2008年3月共收治42例急性痛风性膝关节炎患者。对21例急性痛风性膝关节炎患者采取药物保守治疗,21例行关节镜手术配合药物治疗。两组治疗前后采用WOMAC评分对膝关节功能进行评定,用student-t检验进行统计学分析。结果:保守组:随访发现关节症状好转不明显,复发率19.05％;WOMAC评分治疗前49～72分,治疗后69～85分。关节镜手术配合药物组:随访发现关节症状均明显缓解,关节功能恢复良好,伤口甲级愈合,无术后并发症,6个月无复发病例;WOMAC评分治疗前49～71分,治疗后75～96分。两组治疗前后及之间有显著性差异,保守组(t=-9.864,Plt;0.001);关节镜手术配合药物组(t=-11.267,Plt;0.001);两组之间(t=-2.366,Plt;0.023)。结论:比较以上2种治疗方法,关节镜手术治疗急性痛风性膝关节炎具有创伤小、起效快、效果明显、关节功能恢复满意等特有优势,结合药物治疗,能取得良好的治疗效果。
目的:探讨汶川地震伤中开放性骨折原因分析及治疗策略。方法:回顾性分析280例汶川地震中开放性骨折患者病例,总结骨折原因及治疗方法。结果:患者压砸伤266例,占95%,其他受伤方式约占5%。治疗上急诊行内固定手术者88例,占31%,行外支架固定者69例,占24%,单纯石膏外固定者60例,占21%,截肢患者63例,占22%,63例截肢患者中40例为肢端缺血坏死引起,占14%,15例为肢体毁损引起,占5%,8例为气性坏疽引起,占2%。结论:汶川地震伤中开放性骨折原因多为压砸伤,治疗首先考虑全身治疗,抢救生命,骨折治疗根据Gustilo分度及肢体有无气性坏疽或坏死而进行相应的治疗。又因为地震伤有受伤人群多,受伤时间长,感染严重及救治困难等特点,故应根据病情采取相应的特殊救治方法。
Mitral stenosis includes mitral stenosis due to rheumatic fever and non-rheumatic valve stenosis characterized by degenerative changes. Rheumatic mitral stenosis is common in developing countries and occurs in young adults, while degenerative mitral stenosis is common in developed countries and increases in incidence with aging. Mitral stenosis of different etiologies can lead to changes in heart structure and function, which affects the quality of life and prognosis of patients, so lifelong management of mitral stenosis is crucial. This article provides a comprehensive reference for clinicians in the management of mitral stenosis, with a detailed overview of the emerging prevalence features, imaging diagnosis, and treatment methods.
ObjectiveTo investigate the etiology, clinical features and treatment of familial exudative vitreoretinopathy (FEVR) secondary glaucoma. MethodsA retrospective clinical study. From January 1, 2016 to January 1, 2022, 15 patients (17 eyes) were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital, Capital Medical University were included in the study. All patients underwent systematic ophthalmological evaluation. According to the patient's age, visual acuity, intraocular pressure, anterior segment, vitreous body and retina condition, the choice of translimbal lensectomy combined with vitrectomy, goniectomy, cyclophotocoagulation, intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatment were chosen. The follow-up time was 3 to 37 months. The clinical characteristics of the affected eye, and the changes of intraocular pressure, anterior chamber depth and complications after surgery were observed. ResultsAmong the 15 patients, there were 11 males with 13 eyes, and 4 females with 4 eyes. Age was 6.14±7.37 years old. FEVR stages 2B, 3B, 4A, 4B, 5A, and 5B were 1, 1, 5, 6, 3, and 1 eye, respectively. The intraocular pressure of the affected eye was 42.74±9.06 mm Hg (1 mm Hg=0.133 kPa). All eyes had shallow anterior chamber and angle closure, anterior or posterior iris adhesions, lens opacity, retinal detachment, iris neovascularization in 4 eyes, and vitreous hemorrhage in 2 eyes. Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy, of which 8 eyes were treated with anti-VEGF treatment; 1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment. After operation, the intraocular pressure of 16 eyes returned to normal range, and the depth of anterior chamber of 16 eyes returned to normal, and no obvious complications occurred. ConclusionsThe main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle, which are found in the 2B and above stages of FEVR. The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber, with no serious complications.
Objective To study the cl inical features of infantile hemangioma and vascular malformation, to find out a proper strategy of deal ing with them. Methods From March 2000 to August 2007, 2 957 cases of infantile hemangioma and vascular malformation were treated, including 860 operative cases and 2 097 non-operative cases. There were 441 male and419 female patients in operation group, aging 6 months to 18 years (median 5 years). In 1 950 hemangioma patients of nonoperation group, there were 575 male and 1 375 female patients, aging 1 month to 14 years (median 6 months); in 147 vascular malformation patients of non-operation group, there 67 male and 80 female patients, aging 2 years to 17 years (median 7 years). In non-operative group, 147 vascular malformation patients and 1 525 infantile hemangioma patients were followed up without any medical intervention, while other 425 hemangioma patients recceived triamcinolone plus dexamethasone intralesional injection treatment. All the treatments and outcomes were recorded. Results Vascular malformation cases and infantile hemangioma cases presented totally different cl inical features. To the deadl ine of this study, 522 (34%) of 1 525 un-intervented hemangioma cases turned into involuted phase and 383 (90%) of 425 cases receiving triamcinolone plus dexamethasone intralesional injection treatment turned into involuted phase after injection treatment; no regression was noted in 147 cases of vascular malformation. The constituent ratio of infantile hemangioma in 860 operative cases was decreased gradually and the constituent ratio of vascular malformation was increased gradually as the age increasing. Conclusion Infantile hemangioma has a distinct l ife pattern. Except several specific cases need medical intervention for their special location or large ambit and unacceptable growth, most infantile hemangioma need no medical intervention. Most vascular malformations can not regress spontaneously, proper intervention is in need.
ObjectiveTo summarize the principle, classification, and treatment methods of knee extension device disruption after total knee arthroplasty (TKA).MethodsBy extensively consulted the relevant domestic and abroad literature, the principle, classification, and treatment methods of injury according to different parts of the knee extension device after TKA were summarized and analyzed.ResultsThe knee extension device disruption after TKA mainly occurs in the quadriceps tendon, patella tendon, and patella. Once the knee extension device is injured, it will seriously affect the functional recovery of the patient after surgery, resulting in delayed knee extension, limited range of motion, difficulty walking, and joint pain, etc. The current treatment methods are diverse, including conservative treatment and surgical treatment. Surgical treatment includes direct suture repair (traditional perosseous fixation and suture anchoring techniques), reconstruction and reinforcement repair (reconstruction using synthetic patches, autografts, and allografts). For the treatment of different parts, it is necessary to comprehensively consider the patient’s knee joint tissue condition, the presence or absence of underlying diseases, and the presence or absence of donors.ConclusionThere is no uniform conclusion on the treatment of knee extension device disruption after TKA. Different injury situations need to be considered comprehensively to choose the appropriate treatment method.
Objective To investigate the clinical features, diagnosis, and treatment of patients with localized epithelioid sarcoma (ES).Methods From January 2000 to September 2006, 11 patients with ES weretreated. There were 7 males and 4 females aged 14-41 years. The patients’ agesat the initial onset were 9-41 years, averaged 27.7 years. The ES was located in the upper extremity in 7 patients，lower extremity in 3, and abdomen in 1. Among the patients, 10 had a recurrence. Tumor lt; 2cm was seen in 7 patients, 2-5cm in 1, and gt;5 cm in 3. One patient underwent an operation of local resection at another hospital. Seven patients underwent an expanding resection surgery, and the tumors with the surrounding normal tissues 3 cm above were removed. Three patients underwent a radical surgery, including extremity amputation or finger amputation. All the patients underwent routine radiotherapy and chemotherapy after operation. Results All the wounds had a healing at the firstintention without complications. All the flaps survived and the grafted bone had a fusion. Among the 11 patients followed up for 5-54 months averaged 23.2 months, 8 had a recurrence 2-20 months (average, 8.9 months) after operation, witha recurrence rate of 73%. And among the patients, 3 had a further radical surgery of extremity amputation. Four patients had a metastasis in the axillary lymphnodes 6-24 months after operation, and 1 patient had a lung metastasis 10 months after operation. They did not have a further surgical treatment. Four patients died of systemic failure 6-14 months after operation. Conclusion An early expanding resection surgery combined with postoperative chemotherapy and radiotherapy is the therapy of choice for treating ES.
ObjectiveTo review the latest advances in diagnosis and treatment of gallbladder carcinoma.MethodsThe recent literatures on diagnosis and treatment of gallbladder carcinoma at home and abroad were reviewed, and the diagnosis, staging and treatment progress of gallbladder carcinoma were systematically reviewed.ResultsThere are many methods to diagnose gallbladder carcinoma, among which imaging methods are commonly used, as well as various tumor markers and gallbladder carcinoma-related genes. Surgical resection is still the only possible cure for gallbladder carcinoma, but the scope and timing of surgical resection are still controversial. Radiotherapy, chemotherapy and gene therapy also play an important role in the treatment of gallbladder carcinoma.ConclusionsImaging examination is still the first choice for the diagnosis of gallbladder carcinoma. The tumor markers and gene diagnosis has broad prospects. Gallbladder carcinoma is mainly treated by surgery. Gene intervention and precise targeted therapy are the future development direction.