不同手术方式治疗胫腓骨骨折的疗效比较

目的探讨不同手术方式治疗胫腓骨骨折的疗效及术后并发症情况。方法我院2008年1月～2010年6月手术治疗的100例胫腓骨骨折,根据入院随机数字表法将100例患者随机分为：A组（自锁髓内钉组）36例、B组（单臂外固定支架组）38例,C组（加压钢板组）26例,比较各组的手术疗效及并发症情况。结果 A组患者骨痂出现时间早、骨折愈合及住院时间短明显短于其他两组（P〈0.05）。A组总有效率明显高于B组、C组（P〈0.05）。且A组无一例发生再骨折,其术后并发症的发生率明显低于B组、C组,差异有统计学意义（P〈0.05）。结论交锁髓内钉内固定治疗胫腓骨骨折疗效优于外固定支架、加压钢板治疗,并发症少,住院时间短,临床医生根据患者的具体情况应优先选择。     

Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques

Purpose

An ideal anastomosis between hollow viscera should be easily performed, strong, and operator independent. We hypothesized that transluminal attraction between magnets in the intestine could be harnessed to create an intestinal compression anastomosis (magnamosis) with these characteristics. We further hypothesized that variation of attraction force and geometry of compression would affect the quality of the intestinal anastomosis.

Methods

We designed a self-orienting device composed of 2 neodymium-iron-boron magnets affixed to polytetrafluoroethylene moldings. Two topologies were evaluated: one designed with ‘uniform’ compression and the other with ‘gradient’ compression. Sixteen young adult pigs (Sus scrofa) underwent laparotomy with creation of a magnetic side-to-side anastomosis: 8 with the uniform device and 8 with the gradient device. Each also had a stapled anastomosis, and 5 had an additional hand-sutured anastomosis. Animals were euthanized at 1, 2, and 3 weeks after operation, then anastomoses were compared on the basis of gross appearance, histology, functional radiography, and mechanical integrity.

Results

All magnetic devices formed patent anastomoses without leak. One stapled anastomosis resulted in a contained leak. Mechanical integrity of magnetic anastomoses was not statistically significantly different from staple or suture counterparts, and there was a trend toward greater strength with magnetic anastomoses. Comparison between device types revealed the gradient device trended toward greater strength and earlier patency (67% vs 33% at 1 week). There was no evidence of stenosis, and histologic examination demonstrated tissue remodeling with mucosal and serosal apposition across the magnamoses.

Conclusions

The magnetic compression anastomosis (magnamosis) device is a safe and effective means of sutureless full-thickness intestinal anastomosis with serosal apposition in a pig model. Gradient compression is superior to uniform compression. This technique is compatible with endoscopic and natural orifice approaches.     

Eccentric Mastectomy and Zigzag Periareolar Incision for Gynecomastia

Background  Gynecomastia is enlargement of the male breast caused by gland proliferation. Surgery is performed for symptom relief or for cosmetic reasons. The authors used a modified operative procedure, then evaluated the results and safety. Methods  Between 2001 and 2005, 22 men (median age, 26 years; range, 13–63 years) with gynecomastia underwent surgery. The operative procedure included a zigzag periareolar skin incision, eccentric subcutaneous mastectomy, and liposuction, with postoperative compression. Results  All the patients were satisfied with the results of the surgery, which produced a chest contour resembling a normal male chest rather than simply a smaller breast. The only complication was a hematoma. One patient was found to have breast cancer. Conclusions  The normal male chest contour can be restored by the described method of eccentric subcutaneous mastectomy.     

经皮椎体成形术并发症的预防及处理

目的探讨预防和处理经皮椎体成形术常见并发症的经验。方法回顾性分析56例接受经皮椎体成形术治疗椎体压缩性骨折（共75个椎体）患者的资料。结果55例患者术后疼痛症状消失或缓解,优良率达98.22%。共21例出现术中及术后并发症,占37.50%;其中骨水泥向椎体外周软组织渗漏、椎旁静脉内渗漏、椎间盘内渗漏各4例,椎管内渗漏及肋骨骨折各1例,其他并发症7例。结论经皮椎体成形术治疗椎体压缩性骨折临床疗效好,同时要重视对并发症的预防和处理。     

Foley导尿管压迫止血治疗顽固性后鼻孔出血50例临床观察与护理

目的：观察应用Foley导尿管治疗顽固性后鼻孔出血的治疗效果,并总结护理经验。方法：50例顽固性后鼻孔出血患者均采用16号Foley气囊尿管进行压迫止血,并实施了各种护理措施。结果：48例有效,2例无效,后经鼻腔内窥镜下生物胶粘贴止血成功。50例患者在填塞期间未发生任何并发症,随访3～12个月,均无再次鼻出血。结论：应用Foley导尿管压迫止血法治疗顽固性鼻出血痛苦少,效果好;在治疗前、后采取相应的护理措施可促进患者早日康复。     

Hodgkin's disease presenting with spinal cord compression

INTRODUCTION: Hematological neoplasms may be complicated by signs of neurological compression. Most cases reported in the literature have described advanced-stage non-Hodgkin lymphomas. We report a case of spinal cord compression revealing an isolated vertebral localization of Hodgkin lymphoma. CASE REPORT: Magnetic resonance imaging of the thoracic spine in a 54-year-old man who presented with spastic paraplegia revealed a vertebral and extradural mass. After laminectomy, histology and immunohistochemistry showed Hodgkin's disease. Post-operative staging did not reveal any other localization. The patient responded favorably after decompressive surgery and ABVD regimen. CONCLUSION: Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5p.cent of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. Significant results may be obtained with decompressive surgery and chemotherapy when the disease is promptly diagnosed. Spinal cord compression by primary Hodgkin's disease is a very infrequent situation. We urge this diagnosis be considered in all patients presenting with spinal cord compression attributed to malignancy.     

Surgical anatomy of the radial nerve at the elbow

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (±11) and 157 (±11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (±4) and 6 (±1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (±13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (±13) and 121 (±13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (±6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (±14) and 110 (±23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.     

下肢间歇气压对糖尿病周围神经病变的作用

目的探讨下肢间歇气压疗法（IPC）对糖尿病周围神经病变的作用。方法选择2型糖尿病并发周围神经病变患者,分别给予弥可保、下肢IPC以及二者联合治疗。以尺神经、正中神经和腓总神经传导速度及＂神经病变主觉症状问卷＂（TSS）评分为观察指标进行相关分析研究。结果 IPC组治疗后运动神经传导速度（MNCV）和感觉神经传导速度（SNCV）均明显高于治疗前（P〈0.05）,且TSS各项评分较治疗前均改善（P〈0.05）,疗效与弥可保组相当,联合治疗组效果更为显著（P〈0.05）。治疗过程中未发现不良反应。结论下肢间歇气压治疗糖尿病周围神经病变具有疗效。＊     

Graft copolymers of ethyl methacrylate on waxy maize starch derivatives as novel excipients for matrix tablets: Physicochemical and technological characterisation

Nowadays, graft copolymers are being used as an interesting option when developing a direct compression excipient for controlled release matrix tablets. New graft copolymers of ethyl methacrylate (EMA) on waxy maize starch (MS) and hydroxypropylstarch (MHS) were synthesised by free radical polymerization and alternatively dried in a vacuum oven (OD) or freeze-dried (FD). This paper evaluates the performance of these new macromolecules and discusses the effect of the carbohydrate nature and drying process on their physicochemical and technological properties. Grafting of EMA on the carbohydrate backbone was confirmed by IR and NMR spectroscopy, and the grafting yields revealed that graft copolymers present mainly a hydrophobic character. The graft copolymerization also leads to more amorphous materials with larger particle size and lower apparent density and water content than carbohydrates (MS, MHS). All the products show a lack of flow, except MHSEMA derivatives. MSEMA copolymers underwent much plastic flow and less elastic recovery than MHSEMA copolymers. Concerning the effect of drying method, FD derivatives were characterised by higher plastic deformation and less elasticity than OD derivatives. Tablets obtained from graft copolymers showed higher crushing strength and disintegration time than tablets obtained from raw starches. This behaviour suggests that these copolymers could be used as excipients in matrix tablets obtained by direct compression and with a potential use in controlled release.