目的:评价经皮激光椎间盘减压术(Semiconductor Percutaneous Laser Disc Decompression,PLDD)治疗椎间盘源性腰痛的疗效。方法:对我院采用SPLDD治疗d的56例进行回顾性分析。经皮激光椎间盘减压术(PLDD)治疗椎间盘源性腰痛56例(70个椎间盘),每只椎间盘需激光能量如下:L3～4、L5～S1为:1 200～1 400J;L4～5为1300～1500J。比较手术前后疼痛强度数字等级 (pain intensity numerical rating scale, PINRS)评分,进行疗效观察和评定术后根据症状缓解程度。结果:随访3月为(2.1±0.4)分 (与术前比较,Plt;0.05);本组56例病例中,PINRS评分由术前平均(8.0±0.3)分改善到术后(2.0±0.2),共39例,占69.6%;(9.0±0.5)分改善到术后(4.0±0.6)共17例,占30.4%。未见椎间盘炎及其他并发症发生。手术时间15～60m in,平均30 m in。结论:SPLDD治疗椎间盘源性腰痛安全、有效、微创,值得推广。
Objective To investigate a new surgical approach for presacral lesion by double door via S3- 5. Methods From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feel ing in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormal ity in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size ofthe lesions was 4 cm × 3 cm × 3 cm - 20 cm × 15 cm × 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S3-5. Results The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occured during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occured. During the followed-up period of 6-13 months, no sacrum defect, pelvic instabil ity and sacroil iitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. Conclusion The approach of double door via S3-5 is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.
目的 研究组织工程骨结合带锁髓内钉修复成年山羊大段负重骨缺损的可行性，探索更可行的技术路径。 方法 将24只成年山羊，通过骨髓穿刺法获取山羊骨髓间充质干细胞（BMSC），将体外扩增及成骨定向诱导的第2代BMSC与同种异体脱钙骨基质（DBM）通过双相接种法构建组织工程骨。24只成年山羊，以带锁髓内钉构建股骨中段3 cm骨缺损模型。随机分为3组，每组8只。实验组以组织工程骨修复骨缺损，对照组单独使用DBM和空白组旷置。术后1、12、24周行X线片观察及评分，12、24周每组各处死4只动物行组织学观察和生物力学检测。 结果 标本大体观察示实验组和对照组术后12周骨缺损部位被骨痂连接，髓腔贯通，24周全部愈合；实验组24周恢复正常解剖形态，对照组外形仍然粗糙、不规则；空白组术后12周及24周缺损部位均为纤维组织充填。术后1周各组X线评分无明显差异（P＞0.05），实验组术后12周及24周X线评分均优于对照组和空白组，对照组优于空白组，各组24周X线评分均高于12周时，差异均有统计学意义（P＜0.05）。实验组术后12、24周的最大抗扭强度分别达正常侧的47.07% ± 5.05%和83.73% ± 2.33%，显著高于对照组和空白组（P＜0.05）；空白组2个时间点最大抗扭强度均不超过正常的15%，与骨不连时的纤维连接相符。组织学检查示术后12周实验组和对照组骨缺损区DBM支架材料基本被吸收，有典型的同心圆排列的哈弗系统形成，周围偶见淋巴细胞；术后24周，实验组和对照组股骨缺损均被修复，但实验组较对照组的新骨更多、骨塑形更好；空白组术后24周骨缺损区中央仍为纤维组织填充。 结论 组织工程骨结合带锁髓内钉能够更有效修复成年山羊负重骨大段骨缺损，满足负重骨的生物力学要求。
Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.
Objective To retrospectively analyze the long-term effectiveness of percutaneous laser disc decompression (PLDD) in treatment of cervical spondylosis. Methods Between March 2003 and June 2005, 156 patients with cervical spondylosis were treated with PLDD. There were 74 males and 82 females with an average age of 55.4 years (range, 31-74 years). The disease duration varied from 2 months to 15 years. Fifty-nine patients were classified as cervical spondyloticradiculopathy, 48 as vertebral-artery-type cervical spondylosis, 19 as cervical spondylotic myelopathy, and 30 as mixed type spondylosis. The lesions were located at the levels of C3,4 in 32 discs, C4,5 in 66 discs, C5,6 in 89 discs, and C6,7 in 69 discs, and including 71 one-leve lesion and 85 multi-level lesions. All cases were followed up to study the long-term effectiveness and correlative factors. Results A total of 117 (75%) patients’ symptoms were l ightened or eased up immediately after operation. Discitis occurred in 1 case at 3 days after operation and was cured after 3 weeks of antibiotic use. All patients were followed up 5 years to 7 years and 3 months (5 years and 6 months on average). According to Macnab criteria, the long-term effectiveness was excellent in 60 cases (38.46%), good in 65 cases (41.67%), fair in 19 cases (12.18%), and poor in 12 cases (7.69%); the excellent and good rate was 80.13%. No significant difference was observed in the wedge angels and displacements of the intervertebral discs between before and after operations (P gt; 0.05). Multiple-factors logistic regression showed that the disease duration and patient’s age had obvious relationship with the effectiveness of treatment (P lt; 0.05), while the type of cervical spondylosis, disc protrusion degree, mild cervical instabil ity, and lesion scope had no correlation with the effectiveness of treatment (P gt; 0.05). Conclusion PLDD is safe and effective in treatment of cervical spondylosis with less compl ication. There is no impact on the stabil ity in cervical spinal constructs. The disease duration and patient’s age have obvious impact on the long-term effectiveness of treatment. The type of cervical spondylosis, disc protrusion degree, cervical instabil ity, and lesion scope are not the correlative factors.
Objective To investigate the inpatient’s disease and cost constitution of the Third People’s Hospital of Chengdu in 2009, so as to provide baseline data for further research. Methods The case records of inpatients in the Third People’s Hospital of Chengdu in 2009 were collected, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis and hospitalization expense etc. were rearranged and analyzed using Excel software. Results a) The total number of inpatients was 1 220, and male was more than female. The disease spectrum included 12 categories. b) A total of 1 093 inpatients suffered from the top 3 systematic diseases as follows: trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. c) According to ICD-10, the top 9 diseases of trauma and toxicosis were injuries to the wrist and hand, injuries to the hip and thigh, injuries to the knee and lower leg, injuries to the shoulder and upper arm, injuries to the lower back, lumbar spine and pelvis, injuries to the elbow and forearm, injuries to the thorax, injuries to the neck and injuries to the ankle and foot; the top 4 diseases in musculoskeletal system and connective tissue disorders were dorsopathies, soft tissue disorders, arthrosis, and osteopathies and chondropathies; among the factors affecting health and resulting from contact with health care institutions, removal of fracture fixation device. d) According to ICD-10 (list of three-digit catalogue and four-digit sub-catalogue), the top 5 single diseases in trauma and toxicosis were muscle and tendon injuries of the wrist and hand, intertrochanteric frature, fracture of the femoral neck, fracture of the tibia and fibula, and fracture of the lumbar spine; the top 5 single diseases in musculoskeletal system and connective tissue disorders were lumbar disc herniation, spondylosis, arthrosis of the knee, osteoporosis with pathological fracture, and osteonecrosis. e) The average hospital stay were 23.55 days, and the average cost per capita were 13 073.73 yuan which were constituted by material cost, drug cost including western and Chinese medicines, treatment expenses including blood transfusion fee, operation expenses including anesthetic fee, examination expenses including radiation fee and laboratory fee, bed fee and others. The inpatient costs were mainly at patient’s own expense, nearly a half of those expenses were paid by social security, and public medical care only accounted for less than 3% of the total payment. Conclusion In 2009: a) The male inpatients were mainly the young and middle-aged, and the female were the elderly. The main 3 systematic diseases were trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. b) The top 3 single diseases were lumbar disc herniation, muscle and tendon injuries of the wrist and hand, and intertrochanteric fracture. Except lumbar disc herniation, the other 2 single diseases were mostly seen in male rather than in female. c) The average hospital stay was 23.55 days. The overall costs were mainly constituted by material and drug cost (59.25%), with rationality worthy of attention. d) Inpatient costs were mainly at patient’s own expense or paid by social security, and the proportion of public medical care was low in the payment.