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Objective:To evaluate the effects of peroneal osteotomy combined with arthroscopic knee debridement on perioperative indexes, X-ray indexes, Japanese Orthopaedic Association Assessment score (JOA score), American Hospital for Special Surgery knee score (HSS score) and complication rate of patients with knee osteoarthritis.Methods:A prospective research method was adopted. A total of 110 patients with knee osteoarthritis who were admitted to Chengde Central Hospital from April 2016 to April 2021 were selected as the research objects and divided into the control group (55 cases), the combined group (55 cases) by random number table method. The control group underwent arthroscopic debridement of the knee joint. On the basis of the control group, the combined group was combined with fibula osteotomy. The control group and the combined group were followed up for 6 months after operation. The perioperative indicators, score of JOA before and after 1 month of treatment, X-ray indicators, score of HSS before and after 6 months of treatment, and the incidence of complications during the follow-up period were compared between the control group and the combined group.Results:The operation time of the combined group was longer than that of the control group: (84.36 ± 14.64) min vs. (75.88 ± 12.86) min; compared with before operation, 1 month after operation, the scores of swelling, pain while up and down stairs, walking pain, joint range of motion were increased in the control group and the combined group, and the combined group was higher than the control group: (8.35 ± 0.73) points vs. (6.74 ± 0.67) points, (15.05 ± 1.74) points vs. (13.96±1.66) points, (21.75 ± 2.07) points vs. (18.58 ± 1.73) points, (27.59 ± 3.25) points vs. (25.74 ± 2.83) points; the femoral tibial angle and the range of motion of the knee joint in the control group and the combined group were increased, and the combined group was greater than the control group: (1.94 ± 0.60)° vs. (3.02 ± 0.67)°; the scores of stability, flexion deformity, muscle strength, range of motion, function, and pain in the control group and the combined group increased, and the combined group was higher than the control group: (8.62 ± 0.86) points vs. (6.89 ± 0.78) points, (7.86 ± 0.96) points vs. (6.27 ± 0.68) points, (7.79 ± 0.62) points vs. (6.95 ± 0.57) points, (14.95 ± 2.60) points vs. (12.48 ± 2.33) points, (17.46 ± 2.21) points vs. (14.59 ± 1.76) points, (24.83 ± 3.25) points vs. (18.59 ± 2.57) points, the difference was statistically significant ( P<0.05). During the following up period, there were no significant differences in the incidences of osteofascial compartment syndrome, neurovascular injury, intraarticular adhesion and incision infection between the two groups ( P>0.05). Conclusions:The operation time of fibular osteotomy combined with arthroscopic debridement of knee joint in patients with knee osteoarthritis was longer, but fibular osteotomy combined with arthroscopic debridement of the knee joint can reduce the valgus of the patient and improve the range of motion of the joint. It could effectively reduce the degree of pain and improve the function of knee joint, and the safety was good, with good therapeutic effect.
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Objective To evaluate the efficacy of chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency in treating upper limb postherpetic neuralgia ( PHN). Methods Forty-two patients of both sexes with upper limb PHN, aged 48-75 yr, were divided into 2 groups ( n=21 each) using a random number table method: chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency group ( TSNM+PR group) and pulsed radiofrequency group ( PR group) . TSNM+PR group was treated using chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequen-cy, and PR group received pulsed radiofrequency alone. The occurrence of treatment-related adverse reac-tions was recorded. Numeric rating scale scores were recorded preoperatively and at 1 day and 1 and 3 months after operation, and the efficacy was graded. The effective treatment and pain recurrence were re-corded 3 months after operation. Quantitative sensory nerve tests were performed to record the current per-ception threshold before operation and on 1 day, 1 month and 3 months after operation. Results Compared with PR group, numeric rating scale score was significantly decreased, the therapeutic effect was en-hanced, the rate of effective treatment was increased, the recurrence rate of pain was decreased at 1 and 3 months after surgery, the current perception threshold at 250 and 5 Hz on the ipsilateral side was increased at 1 and 3 months after surgery in TSNM+PR group ( P<0. 05) . No treatment-related adverse reactions were found in two groups. Conclusion Chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency provides reliable therapeutic effect and higher safety for upper limb PHN.
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PurposeAdrenal schwannoma is rare and quite difficult to diagnose before operation. This paper aims to analyze the CT findings of adrenal schwannoma to improve the recognition and diagnosis of this disease.Materials and Methods The CT findings of 6 patients with adrenal schwannomas proved by operation and pathology were retrospectively analyzed.Results Four schwannomas were located in the right adrenal and 2 in the left adrenal. The tumors, with diameters ranging from 3.0 cm to 6.4 cm, mean (4.5±1.3) cm, had well-defined margin. The densities of all the masses were close to or slightly lower than those of kidneys on plain scan images, with mean CT attenuation value of (32±7) HU. Three masses showed homogeneous density and the other 3 were mildly heterogeneous with patches of lower density. All the 6 schwannomas were enhanced mildly or moderately after intravenous administration of contrast material and showed gradual enhancement mode. They showed mild homogeneous or flocculent enhancement on arterial phase and had gradual progress on venous and delayed phases. The mean increase of CT attenuation value was (13±2) HU on arterial phase, (18±4) HU on venous phase and (23±4) HU on delayed phase. Only 1 mass showed some patches of cystic degeneration without enhancement inside.Conclusion Adrenal schwannoma should be included in the differential diagnosis of solid nonfunctioning adrenal tumors. Features such as relatively homogeneous mass, mild to moderate enhancement and gradual enhancement mode after contrast enhancement are possibly the unique CT manifestations of adrenal schwannoma.
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Objective To explore the application effect of sandwich teaching method in clini-cal teaching in the department of orthopedics. Methods Totally 150 clinical medicine students were divided into 2 groups: sandwich teaching group (n=75) and lecture-based learning group (n=75). Sandwich teaching method combined with bedside teaching method was used in sandwich teaching group while lecturing combined with bedside teaching method was used in control group. Theoretical examination, clinical operation skill test, clinical case analysis and questionnaire investigation were conducted after the course. Comparison between the two groups was made using independent sample t test and measurement data were expressed as x±s. P<0.05 signifies statistically significant differences. Results Theoretical examination score, clinical skill test score and clinical case analysis score were higher in sandwich teaching group than in control group. [(53.70±4.27) vs. (48.00±4.83);(15.70± 2.49) vs. (11.40±2.87);(17.10±1.52) vs. (13.80±1.32)]. Questionnaire showed that commutation and expression ability, cooperation ability and self thinking ability were better in sandwich teaching group than in control group , with statistical differences . Conclusions Sandwich teaching method achieves good teaching effect and it is worth recommending in clinical teaching.
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A total of 17 cases with pelvic limb hyperhidrosis were selected for lumbar sympathetic nerve modulation.The puncture of lumbar sympathetic nerve was guided by computed tomography (CT) through the gap of L2-3 until the needle tip reached the lateral of the second or third lumbar vertebra body and outside of psoas major.A mixture of 1％ lidocaine 3 ml and 30％ Iohexol injection 0.3 ml was injected.If the diffusion of lidocaine was observed between lumbar vertebra body and psoas major.After 15 min,5 ml of absolute alcohol was injected to modulate the lumbar sympathetic nerve.After 5 min,oximetry-derived perfusion index of toe and sole temperature increased (5.9 ± 1.4) folds and (4.16± 0.89) ℃ on average respectively.Pelvic limb hyperhidrosis was all cured within 6 months and one case recurred after a year.There were no occurrences of complications.Lumbar sympathetic nerve modulation guided by CT may be used for treating female pelvic limbs hyperhidrosis.
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Objective: To establish the optimum preparation process for Suxiaoxintong Dropping Pills (Cortex moutan, Rhizoma Chuanxiong, Borneolum Syntheticum). Methods: The preparation conditions, such as the different kinds of primary substance, cooling agent, the proportion between the extracts and primary substance etc. were studied with L 18 (3 7) orthogonal design. Results: Six batches of the products prepared with the process on the experimental result were conformed to the standard of the Chinese pharmacopoeia. Conclusion: It has been proved that the process is available.