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藏线缝合修补术治疗中低位直肠阴道瘘

目的　总结藏线缝合修补术在治疗中低位直肠阴道瘘的可行性，并总结临床经验。 方法　回顾分析2007年10月－2011年6月采用藏线缝合修补术治疗12例中低位直肠阴道瘘患者的临床资料，观察术后创面愈合时间、肛门功能等情况，并对患者进行随访。 结果　12例患者经一次手术治愈，10例随访1年, 肛门功能无明显影响，无复发现象。 结论　藏线缝合修补术治疗中低位直肠阴道瘘是一种安全有效的手术方法。

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture

Objective To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity (P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group (P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups (P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant (P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group (P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.

帽状原位缝合结合筋膜瓣移位治疗无再植条件的指尖离断伤

目的总结帽状原位缝合结合筋膜瓣移位治疗无再植条件的指尖离断伤疗效。 方法2011年6 月－2012年1月，收治9例甲床中段平面以远的指尖离断伤患者。男6例，女3例；年龄12～60岁，平均42岁。致伤原因：机器绞伤3例，压砸伤6例。损伤指别：拇指3例，示指2例，中指3例，小指1例。受伤至入院时间为3～8 h，平均5 h。显微镜下探查明确无再植条件后，采用局部筋膜瓣移位结合帽状缝合治疗；对甲床缺损者同期行甲床扩大术。 结果术后回植指体均成活，创面Ⅰ期愈合。患者均获随访，随访时间6～15个月，平均8个月。患指指端无触痛，指腹饱满，指纹恢复。指端感觉恢复良好，末次随访时两点辨别觉为8～10 mm，远侧指间关节主动活动度0～60°。指甲生长良好，较正常略小。 结论对无再植条件的指尖离断伤，帽状原位缝合结合筋膜瓣移位治疗具有手术操作简便、回植指体成活率高、功能及外形可靠的优点。

小切口皮下缝合修复新鲜跟腱断裂

目的 总结小切口皮下缝合修复新鲜跟腱断裂的方法及临床疗效。 方法 2002 年10 月－ 2008 年4 月，采用小切口皮下缝合修复36 例新鲜闭合性跟腱断裂患者。其中男28 例，女8 例；年龄28 ～ 51 岁，平均37 岁。致伤原因：运动性损伤32 例，高处坠落伤2 例，交通伤2 例。受伤至手术时间为3 h ～ 7 d，平均28 h。 结果 术后切口均Ⅰ期愈合，无早期术后并发症发生。36 例均获随访，随访时间8 个月～ 4 年，平均18 个月。术后5 ～ 6 个月患者恢复正常活动，随访期内无跟腱再断裂。疗效根据Arner-Lindholm 标准评定，获优30 例，良6 例，优良率100%。 结论 小切口皮下缝合修复新鲜跟腱断裂操作简便、微创，临床疗效可靠。

改良背带缝合术防治难治性产后出血

Steel Wire Internal Fixing Sternal Fractures through Midsternal Incision Approach: A Clinical experience of 16 Patients

目的探讨钢丝缝合固定胸骨骨折的治疗效果。 方法回顾性分析2010年1月至2014年12月我院使用钢丝缝合固定胸骨骨折患者16例的临床资料，其中男15例、女1例，年龄30～74（46.3±7.1）岁，采用胸部正中切口达骨折处，上下骨折端适当游离后，用成人型带针钢丝从下骨折端缝入2针，翻转上下骨折端后从上骨折端对应部位出针，骨折复位后扭紧钢丝，14例单处骨折均用此法固定，2例2处骨折用8字缝合固定。 结果16例患者均治愈，术后骨折部疼痛明显减轻，切口愈合良好。单纯性胸骨骨折手术时间50～90（68.46±12.31）min，手术费4 414～6 765（5 495.77±786.36）元。骨折复查发现1例对位稍差，其余患者对位对线均良好，无钢丝断裂及钢丝割裂胸骨病例。 结论钢丝缝合固定能快速恢复胸廓的稳定性，方法简单、安全、费用低、效果好，值得在基层医院推广应用。

Laparoscopy Combined with Choledochoscopy for Common Bile Duct Stone (Report of 523 Cases)

Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.

Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture

ObjectiveTo investigate the effectiveness of modified suture technique in the treatment of acute closed Achilles tendon rupture.MethodsBetween December 2013 and December 2016, 29 cases with acute closed Achilles tendon rupture were treated with modified suture technique. There were 23 males and 6 females with an average age of 34 years (range, 22-45 years). All patients were sport injuries. The injury located at left side in 22 cases and right side in 7 cases. American Foot and Ankle Surgery Association (AOFAS) ankle and hind foot function score was 44.6±3.6. According to the Amer-Lindholm criteria, 29 cases were rated as poor. MRI showed the complete rupture of the Achilles tendon.ResultsThe operation time was 35-62 minutes (mean, 46 minutes). The intraoperative blood loss volume was 7-15 mL (mean, 10 mL). The incisions healed by first intention, and no sural nerve injury occured. All patients were followed up 5-38 months (mean, 18.4 months). AOFAS ankle and hind foot function score was 93.1±4.3 at 3 months after operation, showing significant difference when compared with the preoperative value (t=–49.581, P=0.000). According to the Amer-Lindholm criteria, the results were excellent in 24 cases and good in 5 cases, and the excellent and good rate was 100%; there was significant difference between pre- and post-operation (Z=–7.294, P=0.000). MRI showed the continuous and integrity of Achilles tendon. No Achilles tendon rupture recurred during the follow-up period.ConclusionModified suture technique in the treatment of acute closed Achilles tendon rupture owns the advantages of less trauma, lower recurrence rate of rupture, lower risk of the sural nerve injury, and satisfactory function recovery.

Effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy

Objective To investigate the effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy for temporomandibular joint anterior disc displacement (ADD). Methods A clinical data of 30 patients (45 sides) with temporomandibular joint ADD, who met selective criteria and were admitted between September 2022 and February 2024, was retrospectively analyzed. Among them, 15 patients (23 sides) were treated with temporomandibular joint disc reduction and suture via small incision (open operation group), and 15 patients (22 sides) with modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy (arthroscopy group). There was no significant difference in gender, age, disease duration, affected side, Wilkes-Bronstein stage, preoperative visual analogue scale (VAS) score, maximal interincisal opening (MIO), and temporomandibular joint dysfunction index (DI), craniomandibular index (CMI), palpation index (PI), and other baseline data between groups (P>0.05). VAS score, MIO, and temporomandibular joint function indicators (PI, DI, CMI) of patients were recorded at 3 months after operation, and the difference (change value) of the above indicators between pre- and post-operation was calculated. At 1 week after operation, MRI was performed to evaluate the reduction of the articular disc compared to the preoperative image. The results were classified as excellent, good, and poor, with excellent and good being considered effective reduction. The condition of condyle process repair was observed by cone beam CT (CBCT) at 3 months after operation. Results All incisions healed by first intention in the two groups. All patients were followed up 3-18 months (mean, 8.2 months). Facial nerve injury occurred in 3 cases in the open operation group and 1 case in the arthroscopy group, all of which returned to normal after physiotherapy and drug treatment. At 3 months after operation, MIO and VAS scores of both groups significantly improved when compared with those before operation (P<0.05), and temporomandibular joint function indicators (PI, DI, CMI) significantly decreased (P<0.05). The change values of MIO and temporomandibular joint function indicators in arthroscopy group were significantly higher than those in open operation group (P<0.05). There was no significant difference in the change value of VAS score between groups (P>0.05). There was no recurrence during follow-up. Postoperative MRI review showed that the effective reduction rate of joint disc was 95.65% (22/23) in the open operation group and 95.45% (21/22) in the arthroscopy group, with no significant difference between groups (P>0.05). Postoperative CBCT found that early and timely effective reduction of joint disc was conducive to condyle process repair and reconstruction. Conclusion Modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy has a clear effect in the treatment of ADD, with less trauma, fewer postoperative complications, and good early effectiveness.

Combined Double-Deck Continuous Stitch with Banding in End-to-End Invaginated Pancreaticoenterostomy

目的　改进胰肠吻合缝合技术，预防胰瘘发生。方法　24例胰十二指肠手术，采用2-0或3-0嶶乔吸收缝线行套入式双层连续缝合加捆绑胰肠吻合术。结果　吻合时间平均18 min，均未出现胰肠吻合口漏，无手术死亡病例。结论　双层连续缝合加捆绑胰肠套入式吻合，操作简便、省时、并发症少，是胰肠吻合术的一种有效改进。