目的：探讨电击伤的临床特征，手术治疗及疗效。方法：对78例电击伤患者的临床资料进行分析。结果：电击伤多为工伤，病情重，常常多次手术，住院时间长，致残率高。结论：早期积极、延迟的手术，功能可得到最大的恢复，截肢率降低，预后较好；电击伤创面修复以皮瓣、肌皮瓣转移的手术方式效果为佳。
Objective To retrospectively analyze the clinical and imaging features of multi-segmental lumbar intervertebral disc protrusion and its treatment with the limited recessive decompression operation. Methods Twenty two patients (14 males and 8 females, aged 49-68 years) were admitted to hospital from March 1999 to March 2004. They suffered from multisegmental lumbar intervertebral disc protrusion that involved L1S1 and were treated with the limited recessive decompression operation. Results The follow-up for 4-21 months showed that 16 of the patients had an excellent outcome, 5 had a good outcome, and 1 had fair outcome. There were nosuch operative complications as nerve root lesions and putamen lesions. Conclusion The limited recessive decompression operation is one of the available good treatments for multi-segmental lumbar intervertebral disc protrusion. It solves problems of herniation and stenosis and maintains stability ofthe spine.
Objective To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. Methods Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpio posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirtythree patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8°(range, 5-140°).According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexioncontracture less than 20° (range, 0-15°), and group B consisted of the patients with flexion-contracture not less than 20° (range, 20-60°). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7±8.0°, 104.6±20.0°, 29.1±18.0, and 32.6±20.7, respectively. But the corresponding data were much worse ingroup B than in group A, which were 28.2±7.8°, 60.8±26.6°, 12.1±13.2, and 26.8±18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee.Results The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4±2.1°, 108.6±19.0°, 82.1±13.8, and 72.3±29.1, respectively; and the corresponding data in group B were 1.3±3.2°, 986±16.4°, 75.9±8.2, and 81.4±26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. Conclusion The curative effect is mainly determined by the surgeon’s good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexioncontracture deformity. The knee ROM after TKA, which has a “toward middle ROM”phenomenon, is influenced by many clinical factors. It is very important for the patientto perform a functional exercise of the knee as early as possible after operation.
Objective To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prosthesis implanted in the total knee arthroplasty (TKA). Methods Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prosthesis from September 2003 to March 2004. Preoperative KSS knee scores were 16.08±11.58, function scores 13.75±19.79, and the range of motion (ROM) of the knee 75.00±26.46°. Meanwhile, 50 knees of 30 patients (the Scorpio group) werefollowed up, who had undergone TKA with the Scorpio posterior stabilized prosthesis.Preoperative KSS knee scores were 19.48±967, function scores 3.16±19.82,andthe ROM of the knee 80.80±22.82°. The anteroposterior and lateral X-ray filmsof each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. Results The average of the 130 days’ follow-up revealed that the patients implanted with the TC-Dynamic prosthesis had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83±4.04 with improved scores of 72.75±14.47 compared with those before operation; function scores were 79.17±5.15 with improved scores of 65.42±19.47; the ROM of the knee was 107.92±11.57° with increased degrees of 32.92±32.22°.Meanwhile, in the Scorpio group, the KSS knee scores were 85.68±7.36 with improved scores of 66.20±10.44 compared with those before operation; function scores were 71.40±12.70 with improved scores of 68.24±25.35; the ROM of the knee was 109.20±11.13° withincreaseddegrees of 28.40±26.41°.There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups （Pgt;0.01）. All the X-ray films of the knees implanted with both the Scorpio prosthesis and the TC-Dynamic prosthesis were analyzed.No malalignment or lucent line with the prosthesis was seen in all these X-ray films. Conclusion The short-term follow-up indicates that the patients implanted with the TC-Dynamic prosthesis have an excellent result. The TC-Dynamic prosthesis with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prosthesis should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of thebone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the longterm high survivalrate of the knee prosthesis.
目的:观察乙酰半胱氨酸注射液(NAC)治疗慢性重型乙型肝炎的疗效。方法:收治的慢性重型肝炎早、中期分为对照组(57例),治疗组(58例),对照组给予一般支持治疗、门冬氨酸钾镁,血浆或白蛋白等基础治疗及促肝细胞生长素100mg/d。治疗组在对照组的基础上加用乙酰半胱氨酸注射液8g/d静脉滴注,疗程30d,并于用药前,用药后15d,30d分别抽血查肝功,凝血酶原活动度。结果:治疗组血清总胆红素(TBil),凝血酶原活动度(PTA)的改善程度明显优于对照组,差异有统计学意义。结论:乙酰半胱氨酸注射液能明显降低患者血清TBil,提高PTA,对重型肝炎的治疗有较好的帮助。
目的:比较低位直肠癌几种术式的复发率及5年生存率的差异,探讨术式的选择。方法:收集我院2001～2008年收治268例低位直肠癌病例资料,按局部切除,TME+DIXON、TME+MILES分成三组,对术后复发率及5年生存率进行回顾分析。结果:局部切除组12例,2年局部复发2例,复发率16.%,TME+DIXON组192例,总保肛率84.%,2年复发45例,复发率16.%,5年生存率61.%,TME+MILES术64例,2年复发11例,复发率17%,5年生存率59%,三组病例2年复发率相近,统计学数据显示无显著性差异(Pgt;0.5)。结论:对低位直肠癌,可根据病灶大小,病理学类型,Dukes分期等把握术式选择的适应症:保肛术式为首选, Miles术为最后的选择。