目的:探討醫源性隱睪的病因,預防和治療特點。方法:回顧分析我院治療的16 例醫源性隱睪患兒,其中睪丸鞘膜積液術后7 例,腹股溝斜疝術后8 例,尿道下裂術后1 例。結果:16 例均接受手術治療,10 例睪丸存在不同程度的萎縮,其中1 例睪丸完全萎縮,行睪丸切除。術后隨訪12 例,睪丸均在陰囊內,但發育較健側差。結論:降低醫源性隱睪發病率的根本措施是防止其發生,盡量減少不正確的醫療行為,并做到早期發現,早期行手術治療。
目的 探討膝關節脫位多發韌帶損傷急性期原位縫合的修復方法及近期療效。 方法 2006 年2 月－ 2007 年11 月，對9 例單膝關節脫位患者采用原位縫合方法修復多發韌帶損傷。男6 例，女3 例。年齡34 ～ 52 歲。左膝4 例，右膝5 例。交通傷8 例，重物砸傷1 例。EMRI 和關節鏡檢均證實前、后交叉韌帶為止點撕脫性損傷。傷后至手術時間為4 ～ 7 d，平均5.1 d。 結果 術后患者均未發生關節內感染。7 例切口Ⅰ期愈合；2 例出現切口皮下脂肪液化，經對癥處理后愈合。患者術后均獲12 個月隨訪。2 例患膝較健側屈曲缺失10°，患膝主動屈伸范圍0 ～ 125°；其他患者患膝關節活動度恢復正常。膝關節功能Lysholm 評分為83 ～ 92 分，平均86.3 分；獲優3 例，良6 例。前、后抽屜試驗Ⅰ度陽性各3 例，Lachman 試驗Ⅰ度陽性5 例，內、外翻試驗均為陰性。 結論 對外傷性膝關節脫位多發韌帶損傷于急性期原位縫合修復，固定可靠，同期可處理膝關節合并傷，近期療效滿意。
【摘要】 目的 探討關節鏡治療膝關節滑膜軟骨瘤病的療效。 方法 2005年1月—2009年10月，對23例（28膝）滑膜軟骨瘤病患者入院行X線片、關節活動度檢查、視覺模擬評分以及Lysholm膝關節功能評分。根據鏡下所見分為表淺型6例，游離體型17例。結合病理學檢查行Milgram 分期，Ⅱ期16例，Ⅲ期7例。所有患者均行關節鏡下病變滑膜切除及游離體取出治療。 結果 所有患者均隨訪13~57個月，平均（32.3±6.7）個月，術后傷口均甲級愈合。術后（5.05±2.43） d恢復正常生活或工作。癥狀明顯改善21例（91.30%），部分改善2例（8.70%），對療效滿意23例（100%）。膝關節關節活動度由術前的伸膝（14.29±16.34）°以及屈膝（106.07±35.83）°提高到術后的伸膝（1.79±2.79）°及屈膝（132.64±35.64）°，差異具有統計學意義（Plt;0.05）。負重行走時疼痛視覺模擬評分由術前的（3.81±2.02）分降低到術后的（0.37±0.65）分（Plt;0.05）。Lysholm評分由術前的（43.20±8.24）分升至術后6個月的（86.72±5.40）分（Plt;0.05）；術后1年復診并檢查膝關節正側位X線片，均未見滑膜軟骨瘤體，所有患者無復發。 結論 關節鏡下游離體取出術聯合病變滑膜切除術療效滿意，關節疼痛明顯減輕，功能恢復，是一種治療膝關節滑膜軟骨瘤病確切有效的方法。【Abstract】 Objective To investigate the therapeutic effect of arthroscopic treatment on synovial chondromatosis. Methods A total of 23 patients (28 knees) with synovial chondromatosis were diagnosed and treated in our hospital from January 2005 to October 2009. All of the patients underwent radiographic imaging examination, knee joint range of motion (ROM), visual analogue scale (VAS) and Lysholm score. According to distinct arthroscopic appearance, superficial pattern was found in 6 patients and loose body lesion pattern was in 17. Additionally, combined with pathological examination, according to the Milgram staging，Stage Ⅱ was in 6 patients and Stage Ⅲ was in 7. Arthroscopic limited synovectomy and removal of loose bodies were performed on all the patients. Results The patients were followed up for 13-57 months with the mean of (32.3±6.7) months. The wound of all patients healed up. The time of returning to normal work and life was (5.05±2.43) days for average. The postoperative symptom was markedly alleviated in 21 patietns and partly alleviated in 2. All patients were satisfied with the therapeutic effect. The mean activity of knee joint was significantly different befoe and after the surgery (Plt;0.05) preoperative extension and flexion degrees were (14.29±16.34) and (106.07±35.83) degrees, respectively; postoperative extension and flexion degrees were (1.79±2.79) and (132.64±35.64) degrees (flexion) , respectively. The mean VAS score of weight bearing walking was 0.37±0.65 after theoperation and 3.81±2.02 before the peration; the difference was significantly different (Plt;0.05). The preoperative Lysholm knee score was 34-67 with the mean of 43.20±8.24, and the post-operative score was 71-99 with the mean of 86.72±5.40. There were differences in preoperative and post-operative scores (Plt;0.05) . Radiographic imaging examination of knee joint was performed 1 year after the opertation, no loose bodies was seen and no patients recurred. Conclusion The therapeutic effect of arthroscopic limited synovectomy and removal of loose bodies is good on synovial chondromatosis.
目的 比較股骨近端防旋髓內釘（proximal femoral nail anti-rotation，PFNA）和動力髖螺釘（dynamic hip screw，DHS）治療老年骨質疏松患者合并粗隆間骨折的臨床療效。 方法 選取 2011 年 12 月—2014 年 12 月患有骨質疏松合并粗隆間骨折老年患者共 72 例，根據手術所選內固定的不同分為 PFNA 組（38 例）和 DHS 組（34 例）。對手術時間、術中失血量、術后負重時間、術后髖關節 Harris 評分等指標進行組間對比分析。 結果 所有患者均獲隨訪，隨訪時間 5～24 個月（平均 13.5 個月）。PFNA 組手術時間 [（40.25±24.23）min] 短于 DHS 組 [（72.65±34.65）min]，術中失血量 [（136±56）mL] 低于 DHS 組 [（256±102）mL]，術后負重時間 [（5.24±4.52）d] 早于 DHS 組 [（15.69±6.78）d]，術后髖關節 Harris 評分 [（80.23±10.26 分）] 高于 DHS 組 [（54.75±12.37 分）]，差異均有統計學意義（P<0.05）。 結論 對于老年骨質疏松伴有粗隆間骨折患者，采用 PFNA 治療手術時間短，創傷小，髖關節功能恢復優于 DHS 治療，術后可使患者早期負重，從而提高生活質量。