[目的]比较股骨头-颈交界开窗减压打压植骨术与股骨头髓芯减压打压植骨重建棒置入术治疗中期股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析本院2014年6月—2022年4月收治的100例ONFH患者的临...[目的]比较股骨头-颈交界开窗减压打压植骨术与股骨头髓芯减压打压植骨重建棒置入术治疗中期股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的临床疗效。[方法]回顾性分析本院2014年6月—2022年4月收治的100例ONFH患者的临床资料,按照术前医患沟通结果,行开窗(开窗组)与髓芯(髓芯组)减压植骨治疗各50例。比较两组围手术期、随访及影像资料。[结果]开窗组手术时间[(54.4±7.2)min vs(46.3±6.8)min,P<0.001]、切口总长度[(4.2±0.8)cm vs(3.5±0.6)cm,P<0.001]、术中失血量[(100.5±12.0)ml vs(50.8±7.4)ml,P<0.001]均显著多于髓芯组,但前者的植骨量[(2.5±0.5)g vs(4.3±0.6)g,P<0.001]、下地行走时间[(96.0±5.2)d vs(106.3±10.6)d,P<0.001]、住院天数[(5.5±0.7)d vs(7.0±1.2)d,P<0.001]均显著少于髓芯组。随访时间平均(30.0±3.5)个月,开窗组完全负重活动时间显著早于髓芯组[(180.8±26.5)d vs(200.0±35.0)d,P=0.003]。随时间推移,两组术后VAS评分、HHS评分、iHOT-33评分及髋伸-屈、髋内-外旋ROM均显著改善(P<0.05)。开窗组术后3个月VAS评分[(2.8±0.6)vs(3.1±0.8),P=0.036]、HHS评分[(76.7±5.6)vs(72.4±6.5),P<0.001]、iHOT-33评分[(64.8±6.0)vs(60.5±5.6),P<0.001]均显著优于髓芯组。末次随访时开窗组股骨头生存率的差异无统计学意义[42/50(84.0%)vs 37/50(74.0%),P=0.220]。21例保髋失败患者中,行翻修髋关节置换术10例(47.6%)。影像方面,与术前相比,术后6个月及末次随访时,两组ARCO分级、T?nnis分期无显著变化(P>0.05),但是,两组病灶、关节积液征象显著改善(P<0.05)。相应时间点,两组上述指标比较的差异均无统计学意义(P>0.05)。[结论]开窗减压植骨治疗中期ONFH在完全负重活动时间及术后3个月髋关节功能改善上优于髓芯减压植骨。展开更多
AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone c...AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients' symptoms,characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate(TSR)was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate(CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery(regardless of number of SEMS deployed) to total number of patients. The surgical success rate(SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical,clinical,surgical success rates and complications after stenting were assessed.RESULTS: The median age of patients was 64(36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum,15 patients in the rectosigmoid region,10 patients in the sigmoid region,and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2(32.7%,16 patients) or stage 3(42.9%,21 patients) and 12 patients(24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery,and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo(P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies,especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical,clinical and surgical success rates were 95.9%,100% and 94.6%,respectively.CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition,results emphasize the importance of the skills of the endoscopist in colonic stenting.展开更多
文摘AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients' symptoms,characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate(TSR)was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate(CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery(regardless of number of SEMS deployed) to total number of patients. The surgical success rate(SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical,clinical,surgical success rates and complications after stenting were assessed.RESULTS: The median age of patients was 64(36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum,15 patients in the rectosigmoid region,10 patients in the sigmoid region,and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2(32.7%,16 patients) or stage 3(42.9%,21 patients) and 12 patients(24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery,and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo(P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies,especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical,clinical and surgical success rates were 95.9%,100% and 94.6%,respectively.CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition,results emphasize the importance of the skills of the endoscopist in colonic stenting.
