AO张力带治疗完全性肩锁关节脱位

目的 探讨肩锁关节脱位的手术治疗方法，特别是AO张力带的原理、手术方法及并发症。方法 AO张力带治疗完全性肩锁关节脱位17例，其中4例进行喙锁韧带重建，6例切除半月板。结果 随访17例，平均随访时间2．7年，全部疗效满意，无再脱位发生。结论 AO张力带是治疗完全性肩锁关节脱位较好的方法之一，伴脱位出现的喙锁韧带损伤不必强求修复，损伤的肩锁关节半月板亦可不必切除。     

喙锁韧带修复结合可吸收螺钉治疗Ⅲ度肩锁关节脱位

目的探讨喙锁韧带修复结合可吸收螺钉治疗Ⅲ度肩锁关节脱位的疗效。方法回顾性分析应用喙锁韧带修复及可吸收螺钉治疗Ⅲ度肩锁关节脱位56例。结果获随访48例，其中2例术后出现可吸收螺钉折断，按Karlesson疗效评价标准，优良率达95．8％。结论应用喙锁韧带修复结合可吸收螺钉治疗Ⅲ度肩锁关节脱位是较理想方法之一，并且无须二次手术取出内固定物的优点。     

应用锚钉治疗RockwoodⅢ型肩锁关节脱位临床疗效观察

目的探讨应用锚钉治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法应用Arthrex锚钉治疗RockwoodⅢ型肩锁关节脱位19例。结果本组获随访1~2年,患者肩锁关节脱位均获矫正,术后疗效评定结果:优15例,良4例。结论应用锚钉治疗肩锁关节脱位具有复位良好、固定可靠且符合生物力学要求、手术创伤小、术后并发症少且无需取出等优点。     

肩锁钩钢板联合带线锚钉重建喙锁韧带治疗肩锁关节脱位

目的探讨肩锁钩钢板联合带线锚钉重建喙锁韧带治疗肩锁关节脱位的临床疗效。方法对17例肩锁关节脱位进行肩锁钩钢板内固定（钩钢板组）,12例进行肩锁钩钢板联合带线锚钉重建喙锁韧带治疗（联合锚钉组）。结果 29例均得到随访8-24个月,平均16个月。钩钢板组术后肩锁关节间隙增宽1例、术后4个月肩峰切割并取出内固定后轻度脱位1例、术后1年取出内固定后轻度脱位1例。联合锚钉组术后至取出内固定后未见不良并发症出现。结论肩锁钩钢板联合带线锚钉治疗肩锁关节脱位能有效避免肩峰切割、取出内固定后再脱位等并发症,是肩锁关节脱位的有效治疗方法。     

双Endobutton带袢钛板与锁骨钩钛板内固定治疗RockwoodⅢ型肩锁关节脱位的疗效比较

目的比较双Endobutton带袢钛板与锁骨钩钛板内固定治疗RockwoodⅢ型肩锁关节脱位的临床疗效。方法回顾性分析自2015-12—2017-12诊治的62例RockwoodⅢ型肩锁关节脱位,其中29例采用双Endobutton带袢钛板系统内固定治疗(观察组),33例采用锁骨钩钛板内固定治疗(对照组)。比较2组手术时间、术中出血量、住院时间、肩锁关节功能恢复及术后并发症情况。结果 62例均获得随访,观察组的手术时间、术中出血量、住院时间以及末次随访肩关节功能Constant-Murley评分均优于对照组,差异有统计学意义(P 0.05)。观察组术后3例出现肩峰下骨侵蚀,4例出现肩周疼痛,2例出现复位丢失;对照组8例出现肩峰下骨侵蚀,16例出现术后肩周疼痛,2例出现肩锁关节半脱位。以上并发症经对症治疗后症状均改善。观察组术后并发症整体发生率(31.0%)明显低于对照组(78.8%),差异有统计学意义(P 0.05)。结论双Endobutton带袢钛板系统内固定治疗RockwoodⅢ型肩锁关节脱位操作简单、创伤小、恢复快、术后并发症少,值得临床推广。     

重建喙锁韧带治疗急性肩锁关节脱位的疗效观察

目的探讨重建喙锁韧带治疗急性肩锁关节脱位的手术方法及临床疗效。方法自2010—09--2012—02对28例急性肩锁关节脱位行同种异体肌腱移植结合双带袢钢板重建喙锁韧带术治疗。结果本组获12～29个月。平均17．2个月的随访,肩外形正常,X线复查肩锁关节解剖关系正常。参照Karlsson标准行肩关节功能评定：优25例。良3例。结论应用同种异体肌腱移植结合双带袢钢板重建喙锁韧带治疗肩锁关节脱位,可长期恢复肩锁关节的解剖关系、维持喙锁间隙、术后并发症少,术后配合个性化的康复计划,肩关节功能恢复满意。     

急性肩锁关节脱位手术治疗体会

目的探讨急性肩锁关节脱位的治疗方法及临床效果。方法2003-2006年，应用三种不同术式治疗急性肩锁关节脱位89例，其中钩钢板29例，Dewar改良术治疗33例，Dewar改进术治疗27例。结果85例获得随访，随访时间6～12个月，平均10．5个月。采用VAS视觉模拟疼痛评分评定主观疼痛；UCLA评分和美国肩肘协会肩关节评分（ASES评分）进行关节功能评定，并测量肩关节活动范围，钩钢板与Dewar的术后效果有显著差异（P〈0．05），Dewar改良与改进型之间无显著性差异（P〉0．05），但改进Dewar的手术病例肩锁关节复位可靠。结论对于急性肩锁关节脱位的手术治疗，各种方法均有优缺点，但改进Dewar的手术方式具有手术简单、有效、恢复快、费用低、痛苦小及肩锁关节完全复位等优点，是疗效可靠的治疗方法。     

Retrobutton技术治疗RockwoodⅢ型肩锁关节脱位的体会

目的探讨Retrobutton技术重建喙锁韧带治疗RockwoodⅢ型肩锁关节脱位的新技术方法及疗效。方法采用Retrobuuon技术重建喙锁韧带治疗36例RockwoodⅢ型肩锁关节脱位。结果36例术后获6～15（8．8±2．3）个月的随访。术后疗效采用Constant和Murley肩关节评分标准评定为（94.2±6.3）分。结论Retrobatton技术具有微创、解剖复位、持续稳定的固定、符合生物力学要求,术后无医源性骨折等并发症少及无需二次手术取出内植物等优点,应用其重建喙锁韧带治疗Rockwoodm型肩锁关节脱位疗效满意,值得推广。     

双尾TightRope系统与锁骨钩钢板内固定治疗Rockwood Ⅳ、Ⅴ型肩锁关节脱位的疗效比较

目的比较分析双尾TightRope系统与锁骨钩钢板内固定治疗RockwoodⅣ、Ⅴ型急性肩锁关节脱位的临床疗效。方法纳入自2013-06—2015-06诊治的35例新鲜RockwoodⅣ、Ⅴ型肩锁关节脱位,15例采用双尾TightRope系统内固定治疗(TightRope组),20例采用锁骨钩钢板内固定治疗(锁骨钩钢板组)。结果 35例均获得12个月以上随访,随访时间平均20.9(13~31)个月。术后即刻X线片显示肩锁关节解剖关系恢复正常,内固定在位。TightRope组在切口长度、手术时间、术中出血量、并发症发生率以及术后1年肩关节功能Constant-Murley评分方面均优于锁骨钩钢板组,差异有统计学意义(P 0.05)。TightRope组出现1例(6.7%)轻度复位丢失,但未见肩峰下撞击、肩关节疼痛、内固定松动断裂等并发症。锁骨钩钢板组出现8例(40.0%)并发症,4例存在肩关节疼痛,3例取出内固定后出现肩锁关节半脱位,1例内固定松动。结论双尾TightRope系统重建喙锁韧带治疗RockwoodⅣ、Ⅴ型肩锁关节脱位能维持肩锁关节微动特性,符合生物学固定理念,而且手术操作简单、创伤小,可明显降低术后并发症发生率,疗效满意。     

带钢丝克氏针固定治疗肩锁关节脱位

为了探讨外伤性肩锁关节脱位的治疗方法，作者１９８５年４月～１９９３年５月应用带钢丝克氏针行肩锁关节固定治疗肩锁关节脱位２７例，术后随访１年１０个月～９年。随访结果显示：无痛、无畸形，肩关节功能完全恢复者２５例（９２．６％）；无痛、无畸形，肩外展正常，上举受限＜２０°者２例（７．４％）；无１例出现合并症。作者认为，带钢丝克氏针固定治疗肩锁关节脱位，明显优于传统的二根交叉克氏针内固定术，与其他手术方法比较也有操作简单，关节面损伤小，固定牢固，副作用少等优点。     

胫骨平台骨折手术治疗的治疗体会

胫骨平台骨折又称胫骨近端关节内骨折,是膝关节创伤中最常见的骨折之一.在临床中较常见,约占全身各种骨折的4%.胫骨平台骨折大多是由于高能量损伤导致的,骨折类型复杂,并伴有严重软组织、侧刮韧带、膝关节韧带、交叉韧带半月板等损伤,治疗难度大.我科2007年10月至2010年3月,共手术治疗胫骨平台骨折21例,取得较为满意的效果.     

颈椎过伸性脊髓损伤保守和手术治疗疗效分析

目的回顾性分析比较颈椎过伸性损伤患者行早期（小于24h）和晚期（大于24h）手术以及非手术治疗的疗效。方法自1995年1月～2005年6月间收治并获得随访的132例过伸性脊髓损伤患者中，31例行保守治疗，27例24h内行手术治疗，74例24h后行手术治疗，观察各组治疗前、后及随访时的AISA评分以及相关并发症。结果早期和晚期手术组术后随访临床疗效好于保守治疗组，差异有统计学意义（P〈0．01），早期和晚期手术组间差异无统计学意义（P〉0．05）；保守治疗、早期和晚期手术组肺炎的并发症的发生率分别是2／31（6．5％）、1／27（3．6％）和9／74（12．2％）。结论颈椎过伸性损伤患者手术治疗疗效好于保守治疗，晚期和早期手术对神经功能改善无明显差异，但晚期手术并发症相对增多。     

Surgical treatment of peritoneal carcinomatosis: current treatment modalities

Background

Selected patients with peritoneal surface malignancies (PSM) have been treated effectively by the combination of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Purpose

The purpose of this study is to summarize the treatment outcomes and general considerations regarding definitions and staging systems of current CRS and HIPEC modalities in malignant peritoneal mesothelioma and in secondary peritoneal malignancies such as peritoneal metastasis from appendiceal, colorectal, gastric, and epithelial ovarian cancers.

Conclusion

Disease progression within the peritoneal cavity has in the past been regarded as a terminal event. Accumulating evidence underlines the therapeutic potential and the acceptable morbidity and mortality rates of CRS and HIPEC in selected patients.     

Pain treatment today--current standing of pain treatment in Germany

Beyond doubt the provision of pain therapy for patients with acute and chronic pain in Germany has improved over the last 30 years. This positive development comprises i. e. the growing impact of acute pain services on the treatment of patients with postoperative pain and the implementation of new developments in research into the clinical setting of obstetric pain therapy. Nevertheless, the provision of pain therapy for patients with chronic pain syndromes, for children, and in the fields of cancer pain and palliative medicine is neither qualitatively nor quantitatively sufficient.     

Results of treatment

Overall results of management in patients admitted to the 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery were rather unsatisfactory, with good recovery in only 42% of patients, and death in 45% of patients. As compared to the other centers included in the Study, Italian centers exhibited a significantly lower recovery rate and a significantly higher mortality rate. There were significant differences also between the individual Italian centers; independently of admission neurological status and timing of surgery, the outcome was better in centers 2 and 6 (a mortality rate under 20%) and worse in centers 1 and 8 (a mortality rate around 60%). Using prognostic factor models, higher than expected mortality rates were observed in 4 centers, and lower than expected good recovery rates in 3 centers. In Italian centers vasospasm accounted for the highest morbidity and mortality rate; the difference in mortality rate from vasospasm between Italian and other centers was very significant. Other important causes of death and disability were constituted by direct effect of the initial bleed and by recurrent hemorrhage. Patients operated on in Italian centers exhibited a good recovery in 57% of cases; the mortality was 27%. Differences from the other centers were less marked than for the overall management results. Mortality rates from vasospasm and from surgical complications were significantly higher in Italian than in the other study centers. Between the individual Italian centers, vasospasm accounted for the highest mortality rate in centers 7 and 8 (17% and 28% respectively). Postoperative pneumonia was significantly more frequent in Italian than in the other centers. In regard to timing of surgery, the differences in results between Italian and other centers were less marked when surgery was performed after 10 days from hemorrhage. In Italian centers as a whole, a delayed operation was linked with a better outcome than an early or subacute operation. The lowest recovery rate was observed in drowsy patients operated on between 4 and 10 days from the hemorrhage. Focal ischemic deficits and pneumonia were prevalent after an operation within 3 days of hemorrhage, while postoperative brain swelling was most frequent in patients operated on between 4 and 10 days from hemorrhage. The differences in results between Italian and other centers and among the individual Italian centers are widely discussed; possible explanations include inadequate modalities of treatment (especially inadequate management of vasospasm) and structural deficiencies of intensive care management in seriously ill patients.     

Immunotropic treatment of patients with surgical treatment of the gastrointestinal tract

Results of examination of systemic immunity state, microbiocenosis and immunohistological changes of tissues of the esophagus and stomach in 37 adult patients and 69 children with erosive-ulcerous diseases of the gastrointestinal tract were analyzed. Based on these examinations, up-to-date immunomodulator tamerit inhibiting pathologic activity of monocytes/macrophage system with simultaneous activation of neutrophil granulocytes was used in 154 adult patients and 69 children. Positive result was achieved in all the cases when tamerit was used.