【摘要】 目的 探讨损伤控制理论（damage control theory，DCT）在脑动静脉畸形（arteriovenous malformations，AVM）诊断与治疗中的应用意义，以及指导治疗脑AVM的可行性。 方法 依据DCT原则，对2007年3月-2009年3月脑AVM患者进行积极治疗，并分析其治疗结果。 结果 根据DCT原则制订脑AVM患者的治疗方案，控制脑AVM的危险因素，降低其疾病发展风险，患者治疗结果比较满意。 结论 应用DCT原则指导脑AVM患者急性期处理及介入等治疗措施，可以提高患者的生存率，有效控制疾病的危险因素，提高治疗总有效率，具有临床指导意义。【Abstract】 Objective To investigate the significance and feasibility of damage control theory (DCT) in diagnosing and treating cerebral arteriovenous malformations (AVM). Methods According to the disease treatment principle of DCT, 76 patients with AVM diagnosed in our hospital from March 2007 to March 2009 were treated actively, and the treatment results were analyzed. Results The risk factors of AVM was controlled, the development risk of AVM slowed down, and the therapeutic effect was satisfactory. Conclusion According to the DCT principle, we could improve the survival rate of the patients, control the risk factors effectively, and improve the prognosis of the disease. DCT principle is clinically significant to guide the treatment of AVM.
ObjectiveTo compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall.MethodsThe clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups (P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated.ResultsThe wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B (P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups (P<0.05), and there was also no significant difference in TAD values between the postoperative time points (P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups (χ2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B (P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant (χ2=3.881, P=0.049).ConclusionFor the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.