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STUDY OF THE MAGNETIC PIECE DRESSINGS OF DIFFERENT INTENSITIES ON THE EFFECT OF SURVIVAL OF SKIN FLAPS AND HEALING OF INCISIONAL WOUNDS

The comparative study of local application of magnetic piece dressings of different intensities (Gs) on the effect of survival of 48 skin flaps (2×5cm in size) and the healing of the incisional wornds was reported. Twelve Japanese long ear white rabbits were used for this study. It was noted that the magnetic field intensity of 200or 400 Gs showed remarkable increase of the area of survival of the skin flaps and enhancement of the healing of the incisional wounds.

小切口松解治疗伸直型膝关节僵直

【摘 要】 目的 总结小切口松解治疗伸直型膝关节僵直的临床效果。 方法 2004 年3 月－ 2007 年1 月，采用小切口松解治疗伸直型膝关节僵直34 例。男26 例，女8 例；年龄18 ～ 58 岁。病程8 ～ 36 个月。病因：骨折30 例，交叉韧带损伤3 例，滑膜损伤1 例。术前膝关节平均屈曲35°。患者均采用膝关节外侧弧形小切口松解粘连，术后24 h 即进行CPM 机锻炼。 结果 患者切口均Ⅰ期愈合。34 例获6 个月～ 2 年随访。膝关节屈曲均达90° 以上，股四头肌肌力正常，无髌前皮肤坏死发生。按刘国辉等疗效评定标准，优25 例，良8 例，中1 例，优良率97%。 结论 小切口松解治疗伸直型膝关节僵直创伤小，可早期行膝关节功能锻炼，术后并发症少，关节功能恢复好，是治疗伸直型膝关节僵直的一种较好方法。

小切口重睑成形术的临床体会

目的　探讨小切口重睑成形术的临床效果。 方法　2011年9月－2012年6月，按三点切开法设计重睑线，在内中外重睑线上各作约5 mm长的小切口，掏剪睑扳前眼轮匝肌及外侧切口部分臃肿的脂肪组织，按切开重睑的方法，用6-0尼龙线带提上睑肌腱膜将伤口缝1～2针。 结果　对13例行小切口重睑成形术的患者， 随访3～6个月，重睑外形均自然，无严重并发症。 结论　本术式创伤小、恢复快、效果稳定，是一种值得推广的手术。

跟骨骨折切开复位内固定术后切口并发症分析

目的 总结预防跟骨骨折切开复位内固定术后切口并发症的方法。 方法 回顾分析2004 年8 月－2008 年4 月收治的56 例64 侧跟骨关节内骨折患者临床资料。其中男41 例，女15 例；年龄21 ～ 62 岁，平均36 岁。单侧48 例，双侧8 例。按Sanders 分型：Ⅱ型18 侧，Ⅲ型43 侧，Ⅳ型3 侧。受伤至手术时间3 h ～ 14 d，平均7.5 d。行跟骨骨折切开复位钢板内固定术，观察术后切口并发症发生情况。 结果 术后8 例11 侧发生局部切口并发症，发生率为17.2%，其中伤口乙级愈合9 侧，丙级愈合2 侧。11 侧中切口裂开6 侧，局部皮肤坏死3 侧，发生感染2 侧。分析原因发现4 侧为未待水肿明显消退即进行手术；3 侧为手术时间gt;2 h；2 侧为医生对手术入路解剖不完全熟悉、术中对皮瓣保护意识不强所致；2 侧原因不明，可能与术后过早拔除引流有关。余53 侧切口均甲级愈合。 结论 骨折后待皮肤皱褶征阳性再行手术、缩短手术时间及止血带使用时间、熟悉手术入路的解剖特点、熟练掌握全层切开皮肤和“不接触”皮肤保护技术、锐性分离皮瓣方法及术后恰当处理是预防切口并发症的有效途径。

Peutz-Jeghers综合征肠套叠术后肠梗阻并发肠瘘妊娠患者护理一例

Effect of Povidone Iodine for Preventing The Surgical Site Infections in Class Ⅲ Appendectomy Incision

目的探讨碘伏原液浸泡对于预防阑尾Ⅲ类手术切口手术部位感染（SSI）的疗效。 方法回顾性分析笔者所在医院2012年5月至2013年5月期间施行阑尾切除术者中切口类型为Ⅲ类的92例患者的临床资料，比较以碘伏原液浸泡切口（浸泡组）和冲洗切口（常规组）处理后患者的切口愈合情况。 结果术后常规组57例患者中，有43例切口愈合等级为甲级，5例为乙级，9例为丙级，SSI发生率为24.56%（14/57）。浸泡组35例患者的切口愈合均良好，均为甲级愈合，SSI发生率为0，低于常规组（P<0.05）。 结论采用碘伏原液浸泡切口5 min能有效预防阑尾炎Ⅲ类切口SSI的发生，值得临床推广应用。

Surgical Treatment of Thoracic Outlet Tumors Via Posterior Thoracotomy

Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely. 

Choice of Surgical Pathway and Incision for Multiple Fractured Ribs

目的探讨多发性肋骨骨折切口及手术入路选择 方法回顾性分析赤峰学院附属医院2000年6至2013年12月手术治疗58例多发性肋骨骨折患者的临床资料，其中开胸组46例，胸腔镜组12例，男43例、女15例，年龄36（15～61）岁。 结果开胸手术组平均手术时间152 min，平均住院时间16 d；腔镜镜手术组平均手术时间125 min，平均住院时间12.5 d。46例开胸手术患者中44例术后胸壁稳定，自主呼吸排痰良好，16例肺挫伤较重有呼吸综合征（ARDS）倾向，术后经12～148 h呼吸机支持后恢复，1例死于合并食管下段破裂，术后第3 d突发腹腔大出血，分析为外伤性腹主动脉瘤破裂。3例患者切口部分裂开，均为环抱器骨板，1例胸骨骨折胸大肌皮瓣拉拢缝合治愈，另2例中1例取出裸露骨板，1例换药及二期缝合治愈。45例患者返院及电话随访6个月至3年，开胸组39例胸壁稳定，胸部X线片固定处均有骨伽形成，全组无难以耐受的肋间神经痛，腔镜手术组切口及固定肋骨处愈合良好。 结论实际操作中可根据骨折形态特点以后外侧“～”切口及垂直切口为基础做多种变形。胸腔镜下手术切口设计时要根据骨折断端位置，可能出现的胸内脏器血管损伤，综合考虑切口布局；最好操作孔及进镜孔处有骨折断端，方便内外结合固定，节省手术时间；同时要考虑出血脏器损伤的部位，方便止血修补或中转开胸；操作孔可以3～5个。

Efficacy of Triclosan-Coated Polyglactin 910 Suture in Reducing Surgical Wound Infection for Patients Undergoing Gastrointestinal Emergency Operation

ObjectiveTo evaluate the role of triclosan-coated polyglactin 910 suture in reducing wound infections of emergency gastrointestinal surgeries. MethodsThis was a prospective, randomized, controlled, single center study. From May 2009 to August 2010, 412 patients underwent emergency gastrointestinal operations in our department, 198 of them were chose randomly as experimental group using triclosancoated polyglactin 910 suture for abdominal wall closure， 214 using traditional braiding suture were taken as control. The risk factors for wound healing were analyzed, and wound infection rate was compared between two groups. ResultsThere were no significant differences of gender, age, body mass index, combined diabetes, use of immunosuppressant, and glucocorticoid steroid, type of incision, intraoperative bleeding volume, and operation time between two groups (Pgt;0.05). Wound infection rate of experimental group 〔3.0% (6/198）〕 was significantly lower than that of control group 〔11.7% (25/214), Plt;0.001〕. Especially in subgroup of type Ⅲ incision and operative time more than 120 min, wound infection rate was significantly different between experimental group and control group 〔3.5%(5/141) versus 14.3%(22/154); 3.3%(2/60) versus 21.2%(11/52) respectively, Plt;0.001〕. ConclusionTriclosancoated polyglactin 910 suture can reduce wound infection rate of gastrointestinal emergency operations, especially with type Ⅲ incision and operation time ≥120 min.

COMPARATIVE STUDY OF POSTEROLATERAL CONVENTIONAL AND MINIMALLY INVASIVE TOTAL HIP ARTHROPLASTY

To compare the cl inical effect of total hi p arthroplasty (THA) using posterolateral conventional or minimally invasive incision. Methods From January 2007 to November 2007, 38 patients (41 hi ps) were treated with minimally invasive THA (mini-incision group), and 15 patients (15 hi ps) underwent conventional THA (conventional incision group). Mini-incision group: 23 males (25 hi ps) and 15 females (16 hi ps) aged (53.2 ± 15.5) years old; body mass index (BMI) was 23.4 ± 3.3; there were 20 cases (20 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 14 cases (16 hips) of stage III or IV aseptic necrosis of the femoral head, 2 cases (3 hips) of ankylosing spondyl itis involving hip joint; Harris hip score was 47.7 ± 5.5 and the course of disease was (4.5 ± 4.3) years. Conventional incision group: 7 males (7 hips) and 8 females (8 hips) aged (54.8 ± 10.8) years old; BMI was 26.1 ± 5.1; there were 8 cases (8 hips) of femoralneck fracture, 1 case (1 hip) of primary osteoarthritis, 5 cases (5 hips) of stage III or IV aseptic necrosis of the femoral head, 1 case (1 hip) of ankylosing spondyl itis involving hip joint; Harris hip score was 51.2 ± 4.3 and the course of disease was (3.8 ± 3.7) years. There were no statistically significant differences between two groups in the general information (P gt; 0.05). Results There were statistical differences between two groups in terms of incision length, perioperative blood loss, drainage volume and blood transfusion volume (P lt; 0.05), and no statistical differences were evident in operative time, abduction angle and the anteversion angle of acetabular cup (P gt; 0.05). All incisions healed by first intention and no early postoperative compl ications occurred. Two groups were followed for 12-22 months (average 18.3 months). All patients walked without the crutch at 2-3 months after operation. The Harris score of the mini-incision group and the conventional incision group 6 months after operation was 88.6 ± 3.6 and 85.8 ± 3.3, respectively, indicating there was no significant difference between two groups (P gt; 0.05), but there was significant difference between before and after operation (P lt; 0.05). Conclusion Compared with conventional THA, the minimaly incisive using posteroplateral approach THA has the merits of mini invasion, sl ight hemorrage, short hospital stay, minor compl ication, convenient management of femoral head and accurate prosthesis location. However, strict attention should be paid to operative indications.