关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折

目的：分析关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折的价值。方法以68例患者为对象,比较患者术前、后Lysholm膝关节功能评分和Lachman试验阴性率。结果：所有患者骨折均愈合良好。术后Lysholm评分为（92.84±1.65）分,显著高于术前（28.46±1.37）的评分（t=33.486,P=0.000）。术后Lachman阴性率为0.00%,显著低于术前100.00%的阳性率（χ2=36.942,P=0.000)。结论关节镜下缝线“8”字打结空心钉固定治疗前交叉韧带胫骨止点撕脱性骨折具有较好的近期疗效。     

剖宫产术子宫切口连续单层缝合与传统双层缝合的比较研究

目的 探讨子宫下段横切口剖宫产术子宫切口连续单层缝合与传统双层缝合的优缺点.方法 将620例行子宫下段横切口剖宫产术的孕妇 ,根据子宫下段切口缝合方式的不同分为A组(连续单层缝合法)及B组(传统双层缝合法) ,比较两组的手术时间、术中出血量及术后切口假腔发生情况,以及部分患者再次妊娠剖宫产术时的子宫下段厚度、盆腹腔粘连和子宫切口愈合情况.结果 两组患者在术中出血量、产后出血发生率比较 ,差异均无统计学意义(P >0.05) ,而A组手术时间(50.24 ± 8.16)min显著低于B组(54.36 ± 9.12)min( P <0.05);术后2年内随访 ,A组子宫切口憩室发生率(3.16%)低于B组(4.57%).两组患者再次行剖宫产术中比较子宫下段厚度、腹腔粘连及子宫切口愈合情况差异有统计学意义( P <0.05).结论 单层缝合法缝合子宫切口在一些方面优于传统双层缝合法 ,可在临床推广.     

电视胸腔镜手术下应用切割缝合器和缝扎术治疗自发性气胸患者的疗效分析

目的比较观察电视胸腔镜手术(VATS)下应用切割缝合器和缝扎术治疗自发性气胸(SP)患者的临床疗效。方法选取该院2016年1月-2016年12月SP患者58例为研究对象,按随机数字表法分为观察组(n=29)和对照组(n=29),观察组采用VATS下切割缝合器治疗,对照组则采用VATS下缝扎术治疗。对两组患者的手术治疗效果进行综合评价。结果 (1)观察组患者的手术时间和术中出血量低于对照组患者(P0.05),手术费用高于对照组患者(P0.05),术后置管时间和住院时间比较无差异(P0.05);(2)两组患者术后并发症发生率无明显差异(P0.05);(3)两组患者术后疼痛评分和止疼药服用时间差异无统计学意义(P0.05);(4)观察组术后复发率明显低于对照组(P0.05)。结论两种手术方法治疗SP均安全、有效,并且预后良好,但VATS下缝合器术中出血量和手术时间优于VATS下缝扎术,且术后复发率更低,而VATS下缝扎术手术费用低,在临床上可根据实际病情需要合理选择手术方法。     

关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜的研究（附17例报告）

目的探讨关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜的临床疗效。方法通过对17例符合跟骨骨刺的病例行关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜进行疗效观察。结果所有病例均得到有效随访,所有患者疼痛均得到有效缓解,X片显示骨刺消除未再生。无切口感染病例,其中5例患者伤口延迟愈合,2例患者切口愈合后负重行走再裂开,细菌培养均阴性。总有效率100.00%,切口正常愈合率70.58%。结论关节镜下跟骨骨刺去除联合带线锚钉固定跖筋膜:(1)创伤小,切口小,2.0 cm左右,出血少;(2)关节镜视野清晰,有效彻底清除病灶,缩短手术时间;(3)缝合跖筋膜,维持、修复了足弓的稳定性;(4)术后恢复快,切口美观,住院时间短。     

关节镜下两种固定方式治疗前交叉韧带胫骨止点撕脱骨折的临床研究

目的探讨关节镜下螺钉与缝线固定治疗前交叉韧带(ACL)胫骨止点撕脱骨折临床疗效差异。方法研究对象选取ACL胫骨止点撕脱骨折患者共80例,以随机数字表法分为A组(40例)和B组(40例),分别在关节镜下行缝线与螺钉固定治疗;比较两组患者手术时间、随访Lysholm膝关节评分、国际膝关节评分委员会(IKDC)膝关节功能主观量表评分、患健侧位移差值及屈曲挛缩发生率。结果 B组患者手术时间明显短于A组(P0.05);两组患者随访Lysholm评分、IKDC评分及患健侧位移差值比较差异无统计学意义(P0.05);两组患者随访屈曲挛缩发生率比较差异无统计学意义(P0.05)。结论关节镜下螺钉与缝线固定治疗ACL胫骨止点撕脱骨折在提高复位稳定性和改善关节活动功能方面效果接近,但关节镜下螺钉固定方案应用可有效缩短手术时间,降低操作难度。     

Self-retaining barbed suture reduces warm ischemia time during laparoscopic partial nephrectomy

Objective: To evaluate the efficacy and safety of self-retaining barbed suture in renorrhaphy during laparoscopic partial nephrectomy by comparing surgical outcomes in a prospective randomized manner.

Material and methods: From July 2014 to July 2015, a total of 60 patients with T1 renal tumor were randomized into two equal groups: self-retaining barbed suture (SRBS) and conventional absorbable polyglactin suture (non-SRBS group). All patients were treated by retroperitoneal laparoscopic partial nephrectomy. One surgeon with high volume experience performed all procedures. The patient demographics and perioperative outcomes were compared.

Results: The patient demographics and tumor characteristics were comparable. The mean tumor size and R.E.N.A.L. scores were comparable between the two groups. LPN was successfully accomplished in all patients without open conversion. The warm ischemia and renorrhaphy times were significantly shorter in the SRBS group (18.8?±?8.2 vs. 22.9?±?7.3?min, P?=?.04; 10.4?±?3.7 vs. 13.8?±?5.6?min, P?=?.01). The minor complication rate was 13.3% vs. 10.0%, which was comparable. No major complication occurred.

Conclusions: The randomized controlled trial demonstrates that SRBS for renorrhaphy during retroperitoneal laparoscopic partial nephrectomy is safe and efficient. Application of barbed suture simplifies the parenchymal repair procedure and reduces warm ischemia time in comparison with conventional suture.     

B-Lynch缝合术治疗妊娠合并主动脉夹层1例报告

正妊娠合并主动脉夹层是一类临床极为罕见的疾病,其发病率低、病死率高,对母婴生命安全造成了严重威胁。有研究~([1-2])表明,妊娠期妇女主动脉夹层发病率为0.6%。妊娠期心源性死亡率为3/100 000,而其中一半孕产妇死亡原因为主动脉夹层所致~([3])。子宫捆绑缝合术(B-Lynch缝合术)由BLynch等~([4])在1997年发明和报道,主要用于控制产后出血。现将我院应用B-Lynch缝合术救治妊娠     

Suture pull-through insertion of graft donor in Descemet stripping automated endothelial keratoplasty: Results of 4-year follow-up

Purpose:

To report our clinical experience and 4-year follow-up results of Descemet stripping automated endothelial keratoplasty (DSAEK) with the suture pull-through insertion technique.

Methods:

This is a retrospective study of 195 eyes in which a posterior lamellar keratoplasty was performed between 2007 and 2011. The insertion of a folded donor lenticule was performed with a double-armed 10-0 suture using a straight transchamber needle and half-circle needle. Endothelial cell density was measured annually up to 4 years after the surgery, and cell loss was calculated based on the median preoperative donor endothelial cell density. Postoperative complications, primary graft failure, pupillary block, and dislocation of the donor tissue were assessed.

Results:

All patients underwent uncomplicated DSAEK. Data were available for 195 eyes (100%) at 1 year, 186 eyes (95.3%) at 2 years, 176 eyes (90.2%) at 3 years, and 160 eyes (82%) at 4 years. Median preop-erative donor endothelial cell density was 2688 cells/mm² [interquartile range (IQR) 207.5 cells/mm²], which decreased by 27% at 1 year (1956 cells/mm², IQR 264.8 cells/mm²), 31% at 2 years (1855 cells/mm², IQR 320.5 cells/mm²), 35% at 3 years (1756.5 cells/mm², IQR 306.5 cells/mm²), and 36% at 4 years (1709.5 cells/mm², IQR 288,0 cells/mm²). Nine patients (4.6%) had a dislocation of donor tissue; all were successfully reattached with a second air injection. Only three eyes (1.5%) developed graft failure. Pupillary block was present in 15 eyes (7.7%).

Conclusion:

DSAEK with suture pull-through insertion of donor graft represents a simplified and safe technique that has endothelial cell loss comparable with other techniques and low rates of intraoperative and postoperative complications.     

深部埋置环形褥式缝合联合浅层X射线放射治疗胸背部瘢痕疙瘩的疗效分析

目的探讨深部埋置环形褥式缝合联合浅层X射线放射治疗胸背部瘢痕疙瘩的临床疗效。方法选取102例胸背部瘢痕疙瘩患者,采用深部埋置环形褥式缝合技术进行治疗,术后进行病理HE染色分析,于术后24 h内行第1次浅层X射线放射治疗,每隔5 d 1次,共4次。于术后1个月、3个月、6个月及1年观察患者的临床疗效,记录患者术后并发症发生率及满意率。结果瘢痕组织HE染色可见表皮萎缩变薄,真皮中上部成纤维细胞及胶原增生,增生的毛细血管周围可见稀疏的炎细胞浸润。术后1个月、3个月、6个月及1年,患者治疗有效率分别为100%、99.02%、96.08%及89.22%;术后总体并发症发生率为16.67%,总体满意率为97.06%。结论胸背部瘢痕疙瘩手术切除后采取深部埋置环形褥式缝合技术联合浅层X射线放射治疗,患者可取得较好的临床疗效,且具有复发率低、无严重并发症等优点。