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无脊髓损伤下颈椎骨折的手术疗效分析

目的　评价颈椎前路融合手术治疗无脊髓损伤下颈椎骨折的疗效。 方法　2009年10月－2010年6月，采用经前路颈椎单间隙或椎体次全切椎管减压椎间植骨融合治疗无脊髓损伤下颈椎骨折。共12例患者，男10例，女2例；年龄19～55岁，平均33.5岁。12例患者中术前神经功能均为脊髓损伤分级E级，以颈部疼痛、颈椎活动障碍等局部症状为主。所有患者术前常规行X线片及CT、MRI检查。并与正常人的数据进行比较。 结果　患者术前颈3-7骨性椎管矢状径及Pavlov比值均较正常值大。手术时间35～105 min，平均65 min；术中出血20～100 mL，平均30 mL。所有患者无术中相关并发症发生，12例患者均获得随访，术后颈椎椎间高度随访过程中未见明显丢失，植骨融合良好，未见颈椎不稳及脊髓神经损伤加重表现。 结论　颈椎前路融合手术治疗无脊髓损伤下颈椎骨折恢复快，疗效满意，手术相关并发症少。

外固定支架结合有限内固定治疗GustiloⅢ型胫腓骨骨折

【摘要】目的观察外固定支架结合有限内固定治疗GustiloⅢ型胫腓骨骨折的疗效。方法回顾性分析我院52例GustiloⅢ型胫腓骨骨折患者的治疗,其中男36例,女16例;平均年龄42岁;均急诊行清创、骨折复位外固定支架结合有限内固定固定术。结果本组52例患者均完成随访,随访时间7～18个月,平均14个月。随访结果显示优36例、良9例、可5例、差2例,优良率为865%。平均愈合时间7个月,拆除外固定支架时间6～14个月。结论外固定架结合有限内固定治疗GustiloⅢ型胫腓骨骨折,明显减少并发症发生率,降低创面感染率。

侧胸皮瓣游离移植修复重度颈颌胸瘢痕粘连唇外翻一例

Arthroscopic Reduction and Fixation of Comminuted Fracture of Posterior Cruciate Ligament from Tibia Using Suture Anchors through an Posterolateral Portal via Popliteal Fossa

【摘要】 目的 探讨关节镜辅助下经腘窝小切口应用锚钉固定治疗后交叉韧带胫骨止点粉碎骨折的临床效果。 方法 2007年2月-2008年12月对22例急性后交叉韧带胫骨止点骨折患者，采用关节镜辅助下经腘窝小切口切开复位，利用缝合锚钉重建止点，固定治疗后测试交叉韧带的张力和稳定，采用Lysholm膝关节功能评分评定膝关节功能。 结果 骨折平均愈合时间为6周，平均屈膝活动度（120±3）°。Lysholm膝关节功能评分为（92±2）分。 结论 关节镜辅助经腘窝小切口锚钉固定治疗后交叉韧带胫骨止点粉碎骨折，可协助诊断关节内韧带及骨折损伤情况，对韧带止点进行重建，操作简便，早期功能锻炼有助于关节功能恢复。【Abstract】 Objective To explore surgical technique and the results of arthroscopic reduction and fixation for the treatment of comminuted fracture of the posterior cruciate ligament (PCL) from the tibia using suture anchor through an posterolateral portal via popliteal fossa. Methods Twenty-two patients who were operated through an posterolateral portal via popliteal fossa, the fragment was fixed by using suture anchor to reestablish the insertion, test the tension and stabilization of PCL. Lysholm score was used to evaluate the knee function. Results The bone union was confirmed by X-ray films at the 6 weeks postoperatively. The ROM of knee joint relaxation was 120±3°. The Lysholm score was 92±2. Conclusion The displaced fragment of the comminuted fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the suture anchor arthroscopicly. Using suture anchors demonstrate a reliable and easy to use technique. Operation under arthroscopy helps diagnose and treat other complications inside knee joint. In addition, early functional exercise contributes torapid recovery of knee joint’s function.

Curative effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury

Objective To explore the short-term therapeutic effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury. Methods The data of 61 patients with thoracolumbar fractures without neurological injury treated with mini-incision common vertebral pedicle screw internal fixation (the mini-incision group, n=32) or percutaneous pedicle screw fixation (the percutaneous group, n=29) from February 2014 to January 2016 was retrospectively collected and analyzed. Total incision length, operation time, blood loss, fluoroscopy times, postoperative bed rest time, hospitalization costs, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI), vertebral Cobb angle of correction, and accuracy rate of screw placement were compared between the two groups. Results All the patients were followed up for 6 to 24 months with a mean of 13.4 months. There were no complications such as incision infection and neurovascular injury except for 2 screws breakage in one patient in the percutaneous group. In the mini-incision group, the average total incision length was longer than that in the percutaneous group [(7.33±0.53) vs. (6.38±0.44) cm], while the average operation time was shorter than that in the percutaneous group [(62.66±4.75) vs. (72.93±5.09) minutes]; the differences were statistically significant (P<0.001). In the mini-incision group, the average frequency of fluoroscopy was fewer [(5.63±0.61)vs. (19.07±1.60) times] and the average hospitalization costs was lower [(23.3±1.5) thousand yuan vs. (39.5±1.6) thousand yuan] than those in the than that in the percutaneous group; the differences were statistically significant (P<0.001). No significant difference was found in blood loss, postoperative bed rest time, VAS score, ODI, vertebral Cobb angle of correction, and accuracy rate of screw placement between the two groups (P>0.05). Conclusions Mini-incision common vertebral pedicle screw internal fixation for thoracoclumbar fractures without neurological injury has the advantages of short operation time, less fluoroscopy times, low hospitalization costs and high fixation strength. It may obtain a good short-term effectiveness.

原发软组织骨肉瘤二例

目的 报告2 例原发软组织骨肉瘤发病及治疗方法，并对其发病特点及治疗情况作初步总结。方法 2005 年12 月及2007 年6 月，分别收治2 例原发软组织骨肉瘤女性患者，年龄44 岁和65 岁。均因发现包块生长迅速入院。肿瘤分别位于左大腿外侧和左肘关节。病程分别为2 个月和6 个月。行广泛切除术后常规行放化疗。 结果 术后病理诊断为软组织骨肉瘤，1 例获随访16 个月未见复发；另1 例于术后10 个月因软组织骨肉瘤复发伴肺转移死亡。 结论 原发软组织骨肉瘤恶性度较高，对于化疗不敏感；保肢手术配合辅助性放疗是其治疗的发展方向。

Application of Capsule Endoscope in Diagnosing Small Bowel Diseases

【摘要】　目的　探讨胶囊内镜对小肠疾病的诊断价值及顺应性和安全性。　方法　分析2009年4月-2010年3月对35例疑有小肠疾病者行胶囊内镜检查的临床资料。　结果　35例中发现小肠病变26例 （74.3%），包括血管畸形9例，间质瘤1例，息肉2例，小溃疡 1例，非特异性炎症 11例，寄生虫2例，其中 4例患者同时存在两种病变。所获取的图像质量良好。胶囊胃内运行平均时间为 62 min（5～460 min），小肠运行时间为 347 min（103～538 min），平均到达盲肠时间为384 min （120～540 min），平均记录时间为547 min（299～605 min），平均获取照片数为54 766张，胶囊排出体外时间平均为33 h（10～120 h）。受检者顺应性良好，无任何并发症发生。　结论　胶囊内镜是一种对小肠疾病具有较高的检出能力；其安全性高、顺应性好 。【Abstract】　Objective　To investigate the diagnostic value of capsule endoscope for small intestine diseases, and to evaluate the compliance and security of capsule endoscopy.　Methods　The clinical data of 35 patients who underwent capsule endoscopy due to small bowel diseases between April 2009 and March 2010 were retrospectively analyzed.　Results　In the 35 patients, 26 (74.3%) had intestine diseases including vascular malformation in nine, interstitialoma in one, polyp in two, aphtha in one, non-specific inflammation in 11 and parasite in two; 4 patients had two lesions simultaneously. The quality of the obtained images was good. The average running time of the capsules in the stomach ranged from five to 460 minutes with an average time of 62 minutes. The running time of the capsules in the small intestine ranged from 103 to 538 minutes with an average of 347 minutes. The running time of the capsules arriving at the cecum ranged from 103 to 538 minutes with an average of 347 minutes. The time of the capsules egested out ranged from 10 to 120 hours with an average of 33 hours. The recording time ranged from 299 to 605 minuets with an average of 547 minutes. The mean acquired images were 54 766 pieces, The patients had good compliance, and none had any complications.　Conclusion　The capsule endoscopy had high security and good compliance. It has high detectivity in diagnosing small intestine diseases.

Short and Medium Term Results of Nitinol Self-Expending Stent (LifeStent) Implantation for Iliac Arteriosclerosis Obliteran

ObjectiveTo evaluate short and medium term results of nitinol self-expending stent (LifeStent) implantation for iliac arteriosclerosis obliteran. MethodsThe clinical data of 75 limbs iliac artery occlusions in 64 patients from June 2011 to June 2014 in this hospital were analyzed retrospectively. The postoperative ankle brachial index (ABI), limb salvage rate, primary and secondary patency rate, and postoperative complications were evaluated. ResultsThere were 75 limbs iliac artery occlusions in 64 patients (54 males and 10 females), 11 lesions were type A of TASCⅡ, 26 lesions were type B of TASCⅡ, 29 lesions were type C of TASCⅡ, 9 lesions were type D of TASCⅡ. The postoperative ABI was significantly higher than that preoperative ABI (0.94±0.16 versus 0.29±0.20, t=-24.7, P < 0.01). The following-up time was (22±10) months, 5 patients were lost to follow-up. In 12 and 24 months after surgery, the cumulative primary patency rates were 79% and 60%, respectively, the cumulative second patency rates were 91% and 84%, respectively, the limb salvage rates were 96% and 94%, respectively. Complications occurred in 5 patients (7.8%). There was no severe complications and inhospital mortality. ConclusionClinical efficacy of short and medium term is satisfactory by nitinol self-expending stents implantation (LifeStent) for iliac arteriosclerosis obliteran, but long term efficacy remains to be further studied.

改进关胸技术对开胸术后疼痛及血气分析的影响

目的探讨开胸手术患者的关胸技术改进对减轻术后早期疼痛的效果。 方法选取2010年11月至2012年7月湖南师范大学第二附属医院心胸外科连续住院开胸手术患者78例，男53例、女25例，年龄18～73（51.4±5.7）岁。根据电脑随机数字法将患者分为常规关胸组和改进关胸组，每组39例。胸内操作完成后，常规关胸组关胸时直接用7号丝线绕切口上一肋间及下一肋骨肋间缝合打结关闭胸腔；改进关胸组用7号丝线于切口两边肋间肌的中间（即原切除肋骨的上下肋间肌）行平行褥式缝合，收线打结关闭胸腔。 结果两组围术期均无死亡。根据疼痛视觉模拟评分（VAS），改进关胸组各时点的疼痛评分均明显低于常规关胸组（P<0.05）。常规关胸组动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）的变化均较改进关胸组显著（P<0.05）。 结论通过改进关胸技术，采用肋间肌平行褥式缝合法，可避免肋间神经损伤，有效减轻术后早期疼痛，减少对术后呼吸功能的影响。