封闭式负压引流装置在髋关节置换术后早期感染的应用研究

目的 观察封闭式负压引流装置在髋关节置换术后早期感染的临床疗效,为其治疗提供经验参考.方法 将医院骨科行髋关节置换术并发生术后早期感染的42例患者,随机分为观察组和对照组,在抗感染治疗基础上,观察组予80 kPa负压引流,对照组予20 kPa负压引流,观察两组患者的治疗效果.结果 观察组患者引流术第3天C反应蛋白(CRP)为(8.21±4.92) mg/L,明显低于对照组的(14.56±5.63) mg/L;观察组患者12 h内引流量为(371.42±51.32) ml,总引流量为(524.51±59.51) ml,引流持续时间为(3.32±1.02)d;观察组患者12h内引流量明显高于对照组,总引流量明显低于对照组,引流持续时间明显短于对照组;观察组平均感染控制时间为(5.63±2.96)d,明显短于对照组的(9.28±4.23)d,差异均有统计学意义(P＜0.05).结论 封闭式高负压引流术治疗髋关节置换术后早期感染时,引流第3天CRP及体温降低、12 h内引流量多、总引流量少、感染控制时间短,有利于患者感染的早日康复,可长时间的保留置换髋关节.     

负压封闭引流技术在骨科的临床应用进展

负压封闭引流(VSD)技术是临床上用来加速组织愈合、恢复外形及功能的重要治疗方法,最初应用于治疗软组织损伤和开放性骨折,在不断地优化后,现运用于各种类型疾病中,并取得了良好效果。随着对VSD技术在软组织损伤、创面感染和术后切口感染、骨筋膜室综合征、皮肤移植修复、骨髓炎的疗效及作用机制的深入研究,VSD技术已然变成近几年研究的热门之一。目前该技术已日臻完善,覆盖骨科疾病治疗的范围也逐年扩大,在临床疗效上获得了广泛认可,当然,这其中也存在美中不足的部分,需要各方人员不断推陈出新,共克难关。本文就负压封闭引流技术在骨科的临床应用进展作一综述,以利于VSD技术在临床中推广和进一步发展应用。     

Midline extraperitoneal approach for bilateral widespread retroperitoneal abscess originating from anorectal infection

IntroductionAnorectal abscess is one of the most common anorectal conditions encountered in practice. However, such abscesses may rarely extend upward and cause life-threatening medical conditions.Presentation of caseA 53-year-old woman presented with symptoms of anorectal abscess and evidence of severe inflammatory response and acute kidney injury. Computed tomography revealed a widespread abscess extending to the bilateral retroperitoneal spaces. Surgical drainage was performed via a totally extraperitoneal approach through a lower midline abdominal incision, and the patient had a rapid and uncomplicated recovery.DiscussionAlthough retroperitoneal abscesses originating from the anorectal region are rare, they are life-threating events that require immediate treatment. Percutaneous abscess drainage has been recently evolved; however, surgical drainage is required sometimes that may be challenging, particularly in the case of widespread abscesses, as in our case.ConclusionThe midline extraperitoneal approach reported here might be an effective surgical option for patients with bilateral widespread retroperitoneal abscesses.     

儿童踝关节背屈在步行中后期完成足廓清动作的作用分析

目的：探讨儿童踝关节背屈在步行中后期完成足廓清动作的重要性分析。方法将100例存在异常步态患儿随机分成两组，一组作为治疗组给予加强摆动相中后期踝关节背屈活动的康复训练，另一组作为对照组只给予常规康复训练。结果特别加强踝关节背屈训练组步行时足廓清动作显著改善，异常步态明显纠正。结论踝关节背屈对步行中后期完成足廓清动作进而纠正异常步行姿势有重要作用。     

带管病人病员服的研制与临床应用

引流管是手术后最常用的基本措施之一，常用的引流管一般有2～3根，多者为5～6根，如胸腔引管、T管、导尿引流管和负压引流。引流管的基本原理是消除积液，消除有害物质，解除管腔阻塞，以达到治疗疾病和伤口愈合的目的。     

Endoscopic ultrasound gallbladder drainage: Patient selection,preparation, and performance

Acute cholecystitis is a common cause of hospital admissions and can result in critically ill patients. For those patients not amenable to cholecystectomy, endoscopic drainage via transpapillary cystic duct stenting or transmural drainage offers a temporizing method for urgent gallbladder decompression. Endoscopic ultrasonography (EUS) and the development of novel lumen apposing metal stents can allow for more permanent drainage with comparable outcomes to percutaneous transhepatic catheters. The merits of this approach including the technical and clinical advantages of EUS-guided drainage are discussed further in this review article.     

LAPAROSCOPIC CHOLECYSTECTOMY WITH AND WITHOUT ABDOMINAL PROPHYLACTIC DRAINAGE

Aim: As techniques in laparoscopic cholecystectomy (LC) have improved, the role of routine prophylactic abdominal drainage may be limited. A retrospective review was carried out of patients undergoing elective LC to evaluate the benefit of routine drainage in simple uncomplicated procedures. Methods: This study of 295 patients with cholecystolithiasis or gallbladder polyp included 145 patients who underwent LC with drainage and 150 patients who underwent LC without drainage between 2003 and 2007. Allocation to drain or not to drain was non‐randomized and based on surgeon preference according to intraoperative findings. Patient characteristics, operative results, and postoperative outcomes were compared between the two groups with univariate analysis. Results: Time to first flatus and length of postoperative hospital stay in the LC without drainage group were shorter than in the LC with drainage group. There was no significant difference between the two groups with respect to postoperative complication rate. No complications were noted due to the lack of drain placement. Conclusion: The use of drain after simple elective uncomplicated LC could safely be limited to appropriate patients as judged by the operating surgeon.