目的 总结颈动脉损伤患者救治的临床经验。 方法 2003年1月－2006年6月，抢救5例颈动脉损伤患者。男3例，女2例；年龄21～35岁。其中左右颈总动脉各1例，左锁骨下动脉2例，左椎动脉1例。合并损伤：左颈内静脉贯通伤1例，左胸导管及交感神经损伤1例，食道损伤1例，左锁骨骨折1例。受伤至入院时间20 min～3个月。受伤原因：刀刺伤3例，误食缝衣针伴感染1例，车祸伤1例。采用血管吻合修复颈总动脉及椎动脉3根、侧壁修补修复左锁骨下动脉1根、左颈内静脉1根及自体血管移植术修复左锁骨下动脉1根。术中输血量1 000～11 000 mL,平均3 800 mL。 结果 所有患者均抢救成功，伤口Ⅰ期愈合，经1～3年随访，无神经功能障碍。 结论 颈动脉损伤救治成功的关键在于尽早做出诊断，快速有效的急救及选择正确的治疗方法。
目的:讨论侧后方减压融合术治疗胸腰椎骨折的优缺点及临床应用。方法:对12例胸腰椎骨折采用侧后方减压植骨融合术,经一个手术入路完成减压及脊椎的稳定重建。 结果:12例病例随访13～36个月,术后无一例神经症状加重;6例术后原有神经症状明显改善,2例2个月后神经症状开始恢复,3例无改善;12例均获得骨性融合。 结论:侧后方减压融合术是治疗胸腰椎骨折的较好方法。但其技术要求高,视野显露有限,操作范围较窄,易出血增加了手术难度。
Objective To summarize the cl inical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities. Methods From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsal is pedis in 5 cases, and planta pedis in 4 cases. The defect area ranged from 9 cm × 6 cm to 15 cm × 13 cm. Nine cases compl icated by bone defect and 1 case by radial nerve defect. The time from injury to hospital ization was 1 hourto 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterial ized small saphenous vein in 1 case, nd with fibular or il ium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm × 8 cm to 16 cm × 15 cm. Skin defects at donor site were repaired with spl it thickness skin graft or sutured directly. Results All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or il ium, the bony heal ing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site. Conclusion The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feel ing recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.
Objective To explore the relation between stigma and substance use of patients with substance use disorder and explore the impact of learning addiction medicine massive open online course (MOOC) on patients’ stigma, depression and anxiety. Methods Patients with substance use disorder in Meishan Detoxification Center from January 11 to 18, 2020 were selected. The patients were randomly divided into control group and teaching group. Both groups participated in regular labor reform while the teaching group attended extra MOOC course. The general demographic data and the duration and amount of substance use were collected before intervention. Before and after intervention, all the patients completed scales including Chinese Version of Substance Use Stigma Mechanisms Scale (SUSMS-C), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). The correlation between stigma and depression, anxiety, substance use characteristics were analyzed, as well as the changes of stigma, depression and anxiety before and after MOOC intervention.Results A total of 78 patients were included, including 41 in the control group and 37 in the teaching group. There was no correlation between the scores of SUSMS-C and the duration or amount of substances use (P>0.05). SAS score and SDS score were positively correlated with the total score of stigma, internalized stigma, enacted stigma (family) and enacted stigma (healthcare providers) (P<0.05). SDS scores and SAS scores had no correlation with the anticipated stigma (P>0.05). After intervention, the total score of stigma, anticipated stigma (family) and anticipated stigma (healthcare providers) in the teaching group decreased (P<0.05). In the control group, only anticipated stigma (family) decreased (P=0.047). There was no significant difference in other SUSMS-C items, SAS scores, or SDS scores between the two groups before and after intervention (P>0.05). Conclusions Stigma may not be able to protect patients with substance use disorder from using substances. Instead, stigma may potentially cause negative emotional consequences like depression and anxiety. The addiction medicine MOOC can be used as an intervention to reduce the stigma of patients with substance use disorder.