前外侧肌间隙入路术式微创全髋关节置换术的临床疗效评价

目的探计前外侧肌间隙入路术式对微创全髋关节置换术患者的临床疗效。方法选择该院2011年4月至2013年4月收治的需微创全髋关节置换术患者92例作为研究对象,随机分成观察组和对照组各46例。对照组进行传统手术治疗,观察组实行前外侧肌间隙入路术式进行治疗。对比两组切口长度、引流量、假体位置、髋臼假体前倾角大小及置换后Harris评分。结果治疗后,观察组平均出血量、置换1 d平均引流量及手术中切口长度均显著低于对照组;观察组置换后3、6、12个月Harris平均评分均显著高于对照组的,差异均有统计学意义(均P<0.05)。两组髋臼假体前倾角、髋臼杯外展角、股骨-假体3点固定率无统计学意义(均P>0.05)。结论前外侧肌间隙入路术式微创全髋关节置换术对患者创伤较小,且患者术后髋臼假体前倾角无明显改变,髋关节功能恢复较好。     

高龄人工股骨头置换OCM入路与后外侧入路短期疗效比较

Berlin等[1]在2004年介绍了OCM入路即德国慕尼黑骨科医院入路(Orthopaedische Chirurgie Munchen approach,OCM)行髋关节置换术式与传统后外侧(Moore)入路相比,OCM入路具有良好的早期康复效果,围手术期并发症的发生率更低[2]。本研究回顾性分析52例高龄股骨颈骨折行股骨头置换手术病人的临床资料,分析两种入路的短期疗效差异,总结手术技术和经验,现报道如下。     

多学科综合治疗模式下OCM入路和后外侧入路股骨头置换治疗高龄股骨颈骨折病人的临床疗效对比研究

目的对比多学科综合治疗(MDT)模式下慕尼黑骨科医院(OCM)入路和后外侧入路股骨头置换治疗高龄股骨颈骨折病人的临床疗效。方法42例在MDT模式下行股骨头置换的病人按手术入路分为试验组(n=20)和对照组(n=22)。试验组采用OCM入路,对照组采用后外侧入路,比较2组的手术时间、术中出血量、住院时间、术后3 d及术后3个月Harris评分。结果试验组的手术时间和对照组差异没有统计学意义(P>0.05),但试验组术中出血量少、住院时间短、术后3 d及术后3个月的Harris评分优良率高,差异均有统计学意义(P<0.05)。结论MDT模式下OCM入路股骨头置换治疗高龄股骨颈骨折病人的临床效果优于后外侧入路,值得推广。     

不同手术入路行髋关节置换术对患者髋关节功能恢复的影响

目的探讨和分析在不同手术入路下行髋关节置换术对患者髋关节功能恢复的临床效果及影响程度。方法选取我院近两年所收治行髋关节置换手术的患者80例,并根据当时采用不同手术入路方式来将其分为两组,分别为后外侧入路组(A组)40例和后外侧微创入路组(B组)40例。比较两组患者术后髋关节功能恢复效果程度。结果 A组数据与B组比较而言,在手术前差异无统计学意义,即P0.05,在手术治疗后,包括术后2周、术后6周、术后20周,B组均优于A组,效果显著,即P0.05。结论在髋关节置换手术治疗中,采用后外侧微创入路方式相对于传统的入路方式而言,能够大大提高手术疗效,以及加快患者髋关节功能恢复进度。     

前外侧小切口人工全髋关节置换术治疗成人髋臼发育不良的临床研究

目的探讨前外侧小切口(OCM)治疗成人髋臼发育不良的临床效果。方法回顾分析2009-06~2014-06在广西壮族自治区人民医院骨科采用前外侧小切口手术入路,进行了单侧全髋关节置换治疗的22例髋臼发育不良伴骨性关节炎成人患者的资料。对术口长度、术中出血量、手术时间、术后的引流量、手术前后血红蛋白值,以及术前、术后、术后6个月,末次髋关节Harris评分及术后X线片影像等进行统计分析及评估。结果术口长度为(7.5±1.0)cm、术中出血量为(260±92.8)ml、手术时间为(70.5±15.6)min、术后的引流量为(195±45)ml、手术前血红蛋白量为(121±16.8)g/L、手术后血红蛋白量为(95±12.6)g/L,术后髋关节功能Harris评分为良好。结论前外侧入路小切口人工全髋关节置换术治疗成人髋臼发育不良近期效果好,患者恢复快。     

直接前方入路全髋关节置换治疗老年股骨颈骨折的临床疗效

目的评价直接前方入路微创全髋关节置换治疗老年股骨颈骨折患者临床疗效。方法选择需全髋关节置换的老年股骨颈骨折患者59例为研究对象,随机分成观察组和对照组。观察组实行直接前方入路手术治疗,对照组实行标准外侧入路手术治疗。对比两组置换过程出血量、术后引流量、假体位置、术后疼痛评分、术前术后血清肌酸激酶、置换后Harris评分、相关不良反应等。结果治疗后,观察组平均出血量、术后引流量、术后疼痛数字评价分值、术后血清肌酸激酶均显著低于对照组(P<0.05);两组髋臼假体前倾角、外展角及股骨假体前倾角比较无统计学差异(P>0.05);观察组置换后3、6、12个月Harris平均评分均显著高于对照组(P<0.05)。结论直接前方入路术式微创全髋关节置换术对患者创伤比较小,且患者术后假体位置良好,髋关节功能恢复相对较好。     

不同手术入路在全髋关节置换中的疗效分析

目的分析比较前外侧入路和后外侧入路在人工全髋关节置换中的疗效,为临床手术入路的选择提供参考依据。方法对广西壮族自治区人民医院2006-08～2011-05全髋关节置换术患者进行回顾分析,选择符合条件的152例(161髋)纳入研究。其中髋关节传统后外侧入路手术79例(A组,82髋),髋关节改良前外侧入路手术73例(B组,79髋)。随访时间为15个月～5年,平均4.3年。统计分析患者的年龄、性别、诊断、身高、体重、体重指数、切口长度、术中失血量、手术时间、术后引流量、下床行走时间、住院日、术前后Harris评分、术后并发症等,应用SPSS16.0统计学软件对两组数据进行分析比较。结果 B组在手术时间、切口长度、术中失血量、术后引流量、住院日、术后下床行走时间等疗效指标均显著优于A组,差异有统计学意义(P0.01);而在术后假体脱位、神经麻痹、术后Harris评分及术中术后骨折、深静脉血栓形成、假体松动并发症发生率等方面两组差异无统计学意义(P0.05)。结论采用改良前外侧入路进行全髋关节置换术在早期减少术中术后出血量、缩短手术时间和住院日、降低术后并发症的发生率以及早期进行关节功能恢复锻炼等方面具有明显的优势。该手术方式降低了假体位置不当导致关节脱位的风险,减轻了患者的经济负担。在适应证相同的情况下,应优先考虑选择髋关节改良前外侧入路。     

头颈开窗带缝匠肌髂骨瓣移植治疗股骨头缺血性坏死33 例报告

１９９４年以来,我们采用股骨头颈部开窗、死骨刮除、带缝匠肌髂骨瓣移植,治疗股骨头缺血性坏死３３例４４个髋,疗效较好。现报告如下。临床资料：本组男２５例,女８例;年龄２０～４７岁,平均３１５岁。右侧３０髋,左侧１４髋。按Ｆｉｃａｔ分期,Ⅰ期１０髋,Ⅱａ期１２髋,Ⅱｂ期１４髋,Ⅲ期８髋。手术方法：取ＳＰ切口,逐层切开皮肤及皮下组织,游离股外侧皮神经,切开臀中肌及阔筋膜张肌在髂骨上的附着处,保留髂骨外板的骨膜。游离缝匠肌,凿取含缝匠肌髂骨瓣４ｃｍ×６ｃｍ,将股直肌牵向内侧,显露旋股外侧血管,尽量不…     

改良小切口髋关节前外侧入路用于全髋关节置换术的效果

目的比较改良小切口髋关节前外侧入路与常规后外侧入路于全髋关节置换术的临床疗效.方法选取2012年4月至2015年4月实施全髋关节置换术的患者76例,其中38例采用改良小切口髋关节前外侧入路(观察组),38例采用常规后外侧入路(对照组),记录并比较治疗一般资料.术后随访1年,比较两组术后1,3,6,12个月时疼痛视觉模拟评分(visual analogue score,VAS)和髋关节Harris功能评分.结果手术一般资料方面,观察组切口长度、术中出血量和手术时间均优于对照组(P0.05).术后资料方面,观察组术后引流量、下地负重时间和住院时间均小于对照组(P0.05).术后1个月时观察组VAS评分和髋关节Harris功能评分均优于对照组(P0.05).结论与常规后外侧入路相比,改良小切口髋关节前外侧入路用于全髋关节置换术具有手术时间短、患者术后恢复快等优点,符合现代外科微创理念,值得推广.     

带血管蒂髂骨瓣移植髋关节融合术25例报告

1986～1992年,我们对25例病人施行血管蒂髂骨瓣移植髋关节融合术,均获成功。病人年龄17～48岁,平均28岁。其中髋臼骨折6例,髋关节中心脱位并创伤性关节炎10例,髋臼粉碎性骨折关节后脱位9例。 手术方法:采用髋关节前方Smith-Pe-tersen切口,显露髋关节前外侧,在腹股沟韧带附着处切开腹内斜肌及腹横肌,于髂前上棘内侧找到股外侧皮神经,沿其神经走向向上纵行切开腹壁肌,即可发现旋髂深动、静脉和股外侧皮神经交叉横过神经前方。在     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.