双线悬吊法经腹腔入路腹腔镜下肾盂成形术

目的探讨双线悬吊法经腹腔入路腹腔镜下肾盂成形术的临床价值。 方法2016年9月至2018年11月在连云港市第一人民医院采取双线悬吊法经腹腔入路腹腔镜下肾盂成形术患者22例，其中男19例，女3例。年龄4个月～14岁，平均年龄（5.3±2.7）岁。左侧20例，右侧1例，双侧1例，共23侧。右侧经结肠肝曲系膜缘打开侧腹膜入路，左侧经结肠系膜入路，在术中将输尿管和肾盂切口的两端用双线悬吊于腹壁，以便于缝合，用5-0可吸收线行Anderson-Hynes肾盂输尿管成形术，并从吻合口留置双J管，术后结合超声检查随访。 结果22例顺利完成手术，无中转开腹手术者。手术时间90～260 min，单侧平均（137±55）min。术中失血5～20 ml。平均住院时间7 d。术后1例因返流反复发热，在拔出双J管后症状消失，1例发生尿外渗，保留腹腔引流3 d后自愈。术后随访6～25个月，患儿临床症状消失，复查超声提示肾积水消失或减少，肾皮质逐渐增厚。 结论双线悬吊法经腹腹腔镜下肾盂成形术是一种安全、有效、容易学习的手术方法。     

胆道手术缝合技术与缝合材料选择中国专家共识（2018版）

正胆道缝合重建是肝胆胰外科手术的最基本操作之一,建立胆汁引流通畅、无张力、血供充足的黏膜对黏膜吻合是胆道重建的基本要求。目前,胆道重建方式繁多,但根据所须重建胆道的病理生理状况选择合适的胆道缝合方法及缝合材料是保障胆道重建成功的关键因素。随着手术技术的进步及各种缝合材料的发展,胆道缝合技术越来越精细,高质量的胆道缝合重建是病人顺利康复及减少多次手术的关键。基于此,中华医学会外科学分会组织国内部分专家结合最新文献及胆道外科的最新进     

甲状腺手术切口入路、缝合技术与缝合材料选择中国专家共识（2018版）

正随着外科手术技术的发展和人们对美学追求的不断提高,病人对甲状腺术后切口外观的重视程度也越来越高。如何在保证甲状腺手术质量的前提下,最大限度地降低手术对各解剖层次的损伤,减轻切口瘢痕,满足病人的美容要求,一直是外科医生追求的目标。目前,关于甲状腺手术切口入路、缝合技术及缝合材料选择方面的报道并不多,术者多以临床经验和个人习惯进行操作,存在的差异也较大。中华医学会外科学分会组织国内部分专家参考     

Gene-Loaded Nanoparticle-Coated Sutures Provide Effective Gene Delivery to Enhance Tendon Healing

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镍钛记忆合金皮内缝合对甲状腺手术切口愈合的影响

目的:探究甲状腺手术缝合时采用镍钛记忆合金皮内缝合对切口愈合的影响。方法:回顾性分析2018年1月-2019年1月125例在笔者医院行甲状腺手术患者相关资料,依据患者术后缝合方式分为合金皮内缝合组(n=60)与丝线间断缝合组(n=65),分别应用镍钛记忆合金皮内缝合与丝线间断缝合。比较两组患者术后恢复情况,切口愈合情况,切口瘢痕情况,切口美观优良率。结果:合金皮内缝合组患者术后疼痛持续时间、切口愈合时间以及住院时间均明显短于丝线间断缝合组患者,差异具有统计学意义(P<0.05);两组患者切口缝合时间比较差异没有统计学意义(P>0.05)。合金皮内缝合组患者切口愈合情况明显优于丝线间断缝合组,且切口瘢痕优良率明显高于丝线间断缝合组,差异具有统计学意义(P<0.05)。合金皮内缝合组与丝线间断缝合组切口美观优良率分别为95.00%与78.46%,差异有统计学意义(P<0.05)。结论:甲状腺手术切口缝合时应用镍钛记忆合金皮内缝合可以促进切口快速愈合,在保证切口美观优良率情况下促进患者快速康复,临床应用价值高。     

A comparison of double single suture-button fixation,suture-button fixation,and screw fixation for ankle syndesmosis injury: A retrospective cohort study

Different methods have been used throughout the years for syndesmotic injury but there is no consensus on the ideal treatment. Some methods are expensive and some have more complications. The aim of this study is to compare single suture endobutton with double suture endobutton and screw fixation for syndesmotic injury.Sixty nine patients with syndesmotic injury with fibular fractures whom were treated with a single interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet), a double interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet) and 1 syndesmotic screw (TST, Istanbul, Turkey) were included in this study. Functional and radiological results from patient records between 2015 and 2018 were retrospectively evaluated.Twenty patients were treated with the double interosseous suture endobutton, 23 were treated with the single interosseous suture endobutton, and 26 were treated with traditional AO screw fixation. Three patients from the screw fixation group (11.5%) required revision surgery (P < .05). All the radiologic and clinical outcomes were statistical similar in all 3 groups.Our findings showed that the interosseous suture endobutton system is at least as safe as the screw fixation technique for treatment of syndesmosis joint injuries and can be used as an alternative to the screw method. The interosseous suture endobutton system eliminates the need for a second surgery to remove the hardware, which minimizes the probability of re-diastasis. Since our results showed no statistical difference between single and double interosseous suture endobutton systems, the less costly single endobutton system may be the better alternative.     

A review of suture anchors

Suture anchors are designed to allow soft tissue to bone healing in cases where inadequate soft tissue stock on bone makes it impossible to perform a direct soft tissue-to-soft tissue repair. Suture anchor fixation is one of the most important innovations in arthroscopic glenohumeral shoulder surgery, optimizing the link between bone and soft tissue at the rotator cuff footprint. Newer developments and techniques have expanded the use of suture anchors to most other musculoskeletal tissues including the hip, elbow, hand, knee foot and ankle.Their success depends on having an understanding of the biology and biomechanics that affect their use and knowing the factors that may affect the clinical outcome. This review concentrates on the design, insertion technique, composition and evolution of suture anchors in orthopaedic surgery and the ways in which they are utilised in different tissues.