Search

双侧肩关节脱位一例

STUDY ON REPAIR APPROACH OF BILATERAL CLEFT LIPS AND NOSE DEFORMITY

Objective To detect the operative technique and aesthetic problem of reconstruction to deformity of bilateral cleft lip． Methods From March 2003 to December 2004, 26 patients with bilateral cleft lip were treated, aged 10 months to 11 years. Of 26 patients, there were 13 bilateral complete cleft lip and palate, 9 bilateral incomplete cleft lip and 4 mixed cleft lip with unilateral complete cleft palate. The chief design principle was keeping the length of prolabium. During operation, sufficient dissociation was made in the base of the ala base and orbicularis oris muscle to reconstruct these structures．The circle suture was made for the bilateral orbicularis oris muscle. The shape of vermilion was achieved by lateral red lip muscle flap and simultaneous simple rhinoplasty was performed. Results Primary healing of the incisions was achieved in all cases. After the 10 days-3 months follow-up, the results were satisfactory in thewidth and chubbiness of the nose bottom,the shapes of nostril and Cupid’s bow were good without whistle deformity. Theapperance of upper lip was good in either dynamic or static state． Conclusion Excellent shapes and function of the nose and lip， and opportunity for twostage repair could be obtained with this method，which being believed important methods for the primary repair of bilateral cleft lip．

Effects of different puncture levels in bilateral percutaneous vertebroplasty on distribution of bone cement and effectiveness of osteoporotic thoracolumbar compression fractures

Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.

Optimized arterial perfusion strategy in total arch replacement for acute type A aortic dissection with malperfusion syndrome

ObjectiveTo investigate the effect of optimized arterial perfusion strategy on total arch replacement for acute type A aortic dissection (AAAD) with malperfusion syndrome (MPS).MethodsFrom 2017 to 2019, 51 patients with AAAD and MPS who had received total arch replacement with optimized arterial perfusion strategy in our hospital were included in the optimized perfusion group, including 40 males and 11 females, with an average age of 47.43±13.39 years. A total of 40 patients with AAAD and MPS who had been treated with traditional Sun's surgery were taken as the traditional control group, including 31 males and 9 females, with an average age of 50.66±12.05 years. The perioperative clinical data of the two groups were compared.ResultsThe preoperative baseline data of the two groups were basically consistent (P>0.05). The comparison of operative data between the optimized perfusion group and the traditional control group showed that in the optimized perfusion group, the extracorporeal circulation time, aortic occlusion time, and circulation-out cerebral perfusion time were significantly less than those in the traditional control group (223.64±65.13 min vs. 266.77±87.04 min, 114.48±27.28 min vs. 138.20±39.89 min, 8.28±3.81 min vs. 50.53±23.60 min, all P≤0.05). The lowest intraoperative nasopharyngeal temperature in the optimized perfusion group was significantly higher than that in the traditional control group (27.10±1.18℃ vs. 23.6±3.30℃, P=0.000). Postoperative wakefulness time of the optimized perfusion group was earlier than that of the traditional control group (4.50±1.35 h vs. 5.27±1.15 h, P=0.019). The volume of blood transfusions in the optimized perfusion group was significantly less than that in the traditional control group (13.25±9.06 U vs. 16.95±7.53 U, P=0.046). There was no significant difference in ICU time and invasive ventilation time between the two groups (P>0.05). Postoperative complications of the two groups showed that the incidence of postoperative continuous renal replacement therapy in the optimized perfusion group was significantly lower than that in the traditional control group, with a statistically significant difference (21.6% vs. 42.5% P=0.003). The incidence of postoperative delirium, coma, low cardiac row syndrome and limb ischemia in the optimized perfusion group was lower than that in the traditional control group, but the difference was not statistically significant (P>0.05). The incidence of postoperative hemiplegia, sepsis, and secondary thoracotomy in the optimized perfusion group was higher than that in the traditional control group, and the difference was not statistically significant (P>0.05). Postoperative mortality in the optimized perfusion group was significantly lower than that in the traditional control group (13.7% vs. 27.5%), but the difference was not statistically significant (P=0.102).ConclusionOptimized arterial perfusion strategy and its related comprehensive surgical technique reduce surgical trauma, shorten the operation time, reduce perioperative consumption of blood products. Postoperative wakefulness is rapid and the incidence of complications of nervous system, kidney and limb ischemia is low. Optimized arterial perfusion strategy is suitable for operation of AAAD with MPS by inhibiting the related potential death risk factors to reduce operation mortality.

电视胸腔镜双侧肺减容术21例

目的　总结电视胸腔镜双侧肺减容术（BLVRS）治疗慢性阻塞性肺气肿（COPE）的临床经验，并观察其疗效。　方法　2009年9月至2010年9月，南京医科大学附属南京医院对21例COPE患者行电视胸腔镜 BLVRS，均为男性，年龄（65.71±9.05）岁。采用电视胸腔镜专用切缝器（Endo-GIA）切除过度充气的肺大泡组织，常规用4-0 Prolene线连续往返缝合。术后观察患者的肺功能、血气分析指标和6 min步行距离（6-MWD）的变化，并与术前进行比较，评价手术疗效。　结果　无围术期死亡，术后住院时间（13.20±4.60） d，胸腔引流时间（5.33±3.67） d。术后持续肺漏气 （5.91±3.52） d 12例，出现急性呼吸衰竭1例，广泛皮下气肿2例，合并肺部感染5例，均经相应的处理治愈。随访21例，随访时间6个月，术后6个月第1秒用力呼气容积［（1.63±0.23） L vs. （1.21±0.17） L］、动脉血氧分压［（77.62±6.98） mm Hg vs. （67.54±8.12） mm Hg］和6-MWD ［（430.55±80.49） m vs. （283.48±108.12） m］较术前增加，动脉血二氧化碳分压（PaCO2）、、残气量（RV） 较术前降低（P＜0.05）。　结论　电视胸腔镜BLVRS安全、有效，特别对非均质性肺气肿，可明显改善患者的生活质量，近期效果显著。

SIMULTANEOUS BILATERAL TOTAL HIP ARTHROPLASTY IN A SINGLE PROCEDURE

Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made. 

双侧颞叶癫痫的外科治疗策略

单侧颞叶癫痫(Unilateral temporal lobe epilepsy，UTLE)是最适合外科手术的对象之一，手术疗效已得到肯定。但是仍有部分颞叶癫痫患者术后发作控制不理想，可能与致痫灶为双侧颞叶起源或颞叶附加癫痫综合征等因素相关。其中双侧颞叶癫痫(Bilateral temporal lobe epilepsy，BTLE)是临床治疗的难题，常常药物疗效差，而又不被建议外科治疗。然而，目前BTLE的诊断标准、发病率、以及外科治疗策略等方面仍不明确。文章对BTLE的临床概念、发生率、形成机制、临床特点、诊断依据、神经心理学检查及外科手术策略进行分析、探讨。结果显示，基于头皮发作间期、发作期脑电图(EEG)判定BTLE并不可靠，经过颅内电极发作期EEG记录后，部分患者可以诊断为UTLE，接受手术切除后，效果满意；部分患者的颅内EEG记录显示癫痫发作具有明显的偏侧倾向，也可以考虑切除性手术。高频(EEG)监测、神经影像学检查及神经心理学检查对BTLE的诊断和治疗策略也有重要意义。

Robot-assisted bilateral internal mammary arteries harvesting for off-pump coronary artery bypass grafting with 5 grafts by minimally invasive small incision: A case report

ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.

改良双侧Glenn手术后早期处理

目的 总结功能性单心室患者行改良双侧Glenn 术后早期处理经验，为临床提供借鉴。 方法 回顾性分析2009 年1 月至2010 年6 月济南军区总医院共19 例功能性单心室患者行改良双侧Glenn 术的临床资料，其中男10 例，女9 例；年龄3.5 ～ 18.0（7.4±3.3）岁，体重11.5 ～ 70.0（ 21.5±12.3） kg；术前经超声心动图和心血管造影检查诊断为功能性单心室19 例，其中合并三尖瓣闭锁4 例，二尖瓣闭锁1 例。术后患者均取半卧位，留置桡动脉、上腔静脉测压管，常规建立下腔静脉输液通路。给予多巴胺、米力农等正性肌力药物，依据上腔静脉压力情况予以吸入伊洛前列环素，后续口服西地那非，并强调联合序贯治疗。控制红细胞积压（HCT）在0.40 左右，血浆白蛋白＞ 30 g/L。撤离呼吸机后予以抗凝治疗。 结果 全组无死亡，无严重并发症。手术时间（119.0±41.8） min，机械通气时间（6.5±1.9） h，监护室滞留时间（ 3.6 ±1.5） d，纵隔心包引流量（13.9±4.2） ml/kg。全组患者动脉血氧饱和度（SaO2）较术前上升28.3%（t=5.13，P=0.000），术后平均肺动脉压（13.6±3.6） mm Hg。 结论 改良双侧Glenn 术对于难以解剖根治及不能Ⅰ期生理矫治的紫绀型复杂先天性心脏病患者效果良好。术后应结合新的手术方式及病理生理特点采取有针对性处理。

尘肺并发双侧自发性气胸21例临床分析

目的　探讨尘肺并发双侧自发性气胸的诱发因素、临床特点和急救处理方法，以减少误诊和降低死亡率。方法　回顾性分析2006年3月至2012年1月重庆市职业病防治院21例尘肺并发双侧自发性气胸患者的临床资料，男20例，女1例；平均年龄62 （46～65） 岁。发病缓慢者4例，突发起病17例。术前肺压缩程度＜30% 6例，30%～50% 10例，＞50% 5例。二期尘肺7例，三期14例。所有患者均采用双侧胸腔闭式引流术治疗。 结果　气胸治愈13例，好转5例；1例因持续漏气转外院行电视胸腔镜手术治疗好转出院；2例因早期患者不愿意采用手术治疗，而采用内科保守治疗延误手术时机，致急性呼吸循环衰竭死亡。胸腔引流管平均引流时间10.4 （4～24） d。随访17例，随访时间5～12个月，16例气胸无复发，1例并发右侧少量气胸经保守治疗痊愈，2例失访。 结论　尘肺并发双侧气胸患者多数突然发病，临床症状有时不典型，易误诊，发生严重的缺氧和急性呼吸功能衰竭，从而危及患者生命；对明确诊断者及时行双侧胸腔闭式引流术治疗是救治成功的关键。