目的 探讨非手术治疗外伤性脾破裂的可行性及适应证。 方法 回顾分析1998年以来山东省聊城市第二人民医院非手术治疗88例外伤性脾破裂的临床资料及其治疗效果。结果 88例均经B超检查确诊脾破裂，Ⅰ级损伤19例，Ⅱ级损伤57例，Ⅲ级损伤12例，其中16例患者合并肋骨骨折，11例合并肝外伤，9例合并肾挫伤，4例合并颅脑损伤，3例中转手术。结论 有选择地采用非手术治疗外伤性脾破裂安全、有效，轻度的肝肾损伤、腹腔外器官合并伤及患者的年龄并不影响非手术治疗的疗效。
Lumbar disc herniation is one of the most common causes of low back and leg pain in clinic. There are a lot of non-surgical therapeutic methods widely used in clinic for treating lumbar disc herniation. The author assessed the available systematic reviews of non-surgical methods in treating lumbar disc herniation which had been published in these years, and finally a total of 13 systematic reviews were retrieved including 1 about conservative treatments, 8 Chinese medicine treatments, and 4 percutaneous treatments, such as chemonucleolysis and epidural steroid injection. The results showed that the conservative treatments included injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture. But no evidence was found to show that any of the above treatments was clearly superior to others including no treatment for patients with lumbar disc herniation. The outcomes from some reviews showed that Chinese medicine treatments were safer and comprehensive treatment of traditional Chinese medicine was relatively effective compared with single treatment. Electro-acupuncture, compared with conventional therapy (bed rest, waist protection, pelvic traction, manual or physical therapy) and oral medications as well, was safe and effective in alleviating pain and improving overall function. Chinese medicinal fumigation combined with traction was more effective than single treatment. Percutaneous treatment of chemonucleolysis had much better short-term effectiveness. Percutaneous epidural steroid injection also had certain effects. To summarize, Chinese medicine and percutaneous treatments may be effective in treating lumbar disc herniation. However, more clinical trials are needed, since current evidence is of low quality.
目的 观察内给氧治疗重症急性胰腺炎的临床效果。方法 对2005年2月至2009年3月期间收治的55例重症急性胰腺炎患者采用非手术治疗，在给予奥曲肽或施他宁、抗生素及基础性支持治疗的基础上，按入院时间先后分为2组，试验组(n=28)给予注射用内给氧治疗1周，对照组(n=27)未用内给氧。结果 试验组动脉血氧分压在应用内给氧治疗前为(53.8±8.1) mm Hg，治疗后为(87.9±9.5) mm Hg； 血氧饱和度治疗前为（81.1±7.4）%，治疗后为（93.2±6.7）%； 治愈病例中血淀粉酶降至正常的时间，试验组平均为(29.4±7.2) h，对照组平均为(162.1±46.8) h； 死于急性呼吸窘迫综合征者试验组为0（0/28），对照组为14.8%（4/27）; 上述指标差异均有统计学意义（P＜0.05）。结论 内给氧配合基础性治疗对重症急性胰腺炎有较好疗效，实用性较强。
Objective To analyze the clinical effect of TINAVI robotic system-assisted pedicle screw internal fixation for thoracolumbar fracture with a Thoracolumbar Injury Classification and Severity Score (TLICS) of 4. Methods A total of 38 patients with TLICS 4 thoracolumbar fracture treated between January 2019 and January 2021 who met the selection criteria of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. According to the results of doctor-patient communication, 18 cases were treated with robot-assisted minimally invasive surgery (robot group), and 20 cases were treated with traditional conservative treatment (non-surgical group). Complications during hospitalization were observed. After discharge, the patients in the two groups were followed up by telephone and outpatient clinic. The Visual Analogue Scale (VAS) score at admission, at discharge, and 3 and 6 months after discharge, and the Oswestry Disability Index (ODI) score 3 and 6 months after discharge were compared between the two groups. Results There were no statistically significant difference in age, sex, body mass index or distribution of injured vertebrae segment between the two groups (P>0.05). No serious complication occurred in any group during hospitalization. The difference in the length of hospital stay between the two groups was not statistically significant (P>0.05). The bed rest in the robot group was shorter than that in the non-surgical group [(4.83±0.92) vs. (43.05±2.70) d, P<0.05]. The VAS scores at discharge (2.50±0.51 vs. 5.05±1.00), 3 months after discharge (1.83±0.71 vs. 3.10±0.72) and 6 months after discharge (1.50±0.51 vs. 1.90±0.79) in the robot group were lower than those in the non-surgical group (P<0.05). The ODI scores 3 months after discharge (21.89±1.41 vs. 30.40±3.00) and 6 months after discharge (10.72±2.37 vs. 12.10±2.29) in the robot group were significantly lower than those in the non-surgical group (P<0.05). Conclusion For patients with TLICS 4 thoracolumbar fracture, the early clinical effect of robot-assisted surgical treatment is better than that of non-surgical treatment.
目的 探讨外伤性脾破裂非手术治疗的可行性、适应证及其治疗效果。 方法 回顾性分析我院1990年1月至2005年1月收治的外伤性脾破裂非手术治疗46例临床资料。结果 非手术治愈43例，3例因提前下床活动致大出血而中转手术，其中1例并发膈下脓肿，仍经保守治疗痊愈。无死亡病例。结论 在严格掌握适应证前提下非手术治疗外伤性脾破裂安全可行，年龄及腹腔外合并伤不是影响非手术治疗的主要因素。
目的观察普鲁卡因对重症急性胰腺炎（SAP）患者的治疗效果。方法将我院1993年3月至2001年4月收治行非手术治疗的SAP患者40例，分为普鲁卡因治疗组23例，非普鲁卡因治疗组17例。结果普鲁卡因治疗组治愈20例，死亡3例，死亡率为13.0%； 非普鲁卡因治疗组治愈9例，死亡8例，死亡率为47.1%，普鲁卡因治疗组死亡率明显低于非普鲁卡因治疗组（P＜0.05）。结论SAP的普鲁卡因治疗组效果优于非普鲁卡因治疗组，且患者痛苦小、并发症少、费用低，值得推广使用。
Objective To evaluate the effectiveness of arthroscopic treatment and nonsurgical treatment on ankle degenerative osteoarthropathy. Methods Between July 2009 and June 2011, 58 patients (58 ankles) suffering from ankle degenerative osteoarthropathy underwent arthroscopic treatment (arthroscopic group, n=28) and routine treatment (control group, n=30). There was no significant difference in gender, age, body mass index, disease duration, and degree of ankle degenerative osteoarthropathy between 2 groups (P gt; 0.05). Mazur score, visual analogue scale (VAS), and Tegner activity scale were used to evaluate the effectiveness. Results Incision healed primarily in arthroscopic group. The patients of 2 groups were followed up 1-2 years, averaged 1.5 years in arthroscopic group and 1.6 years in control group. At last follow-up, Mazur, VAS, and Tegner scores were significantly improved when compared with the preoperative scores in 2 groups (P lt; 0.05), but no significant difference was found at last follow-up between 2 groups (P gt; 0.05). According to Mazur scoring, the results were excellent in 8 cases, good in 14 cases, fair in 5 cases, and poor in 1 case, with an excellent and good rate of 79% in arthroscopic group; the results were excellent in 6 cases, good in 15 cases, fair in 6 cases, and poor in 3 cases, with an excellent and good rate of 70% in control group; and no significant difference was observed between 2 groups (u=0.98, P=0.77). Moreover, there was no correlation between Outerbridge classification and Mazur score in patients undergoing arthroscopic treatment (r=0.18, P=0.34). Conclusion Arthroscopic and nonsurgical treatments of ankle degenerative osteoarthropathy can both achieve good effectiveness.
ObjectiveTo summarize the progress in treatment of unstable atlas fracture, the existing problems, and the research direction.MethodsRelated literature at home and abroad was reviewed. The stability evaluation of atlas fracture and treatment methods were introduced, and the selection of surgical approach and fixation instruments in treatment of unstable atlas fracture were summarized and analyzed.ResultsAt present, atlas fractures are considered as unstable fractures except single anterior arch fractures with complete transverse ligament or simple posterior arch fractures. The treatment of unstable atlas fracture has been developed from nonsurgical treatment and traditional fusion surgery to single-segment fixation. Nonsurgical treatment is less effective, while traditional fusion surgery has a disadvantage of limited the motion of the upper cervical spine. Single-segment fixation can not only restore and fix the fracture, but also preserve the upper cervical motion function. Single-segment fixation approaches include posterior and transoral approaches, and the fixation instruments are being constantly improved, mainly including screw-rod system, screw-plate system, and plate system.ConclusionFor unstable atlas fracture, single-segment fixation is an ideal surgical method, and has more advantages when compared with nonsurgical treatment and traditional fusion surgery. Single-segment fixation via transoral approach is more direct for atlas anterior arch fracture reduction, but there is a high risk of infection; and single-segment fixation via posterior approach is less effective for the reduction of atlas anterior arch fracture. Therefore, a better reduction method should be explored.