医用钛缆在髌骨粉碎性骨折治疗中的应用

[目的]回顾性研究钛缆环扎固定法治疗髌骨粉碎性骨折的临床效果.[方法]2004年11月～2007年8月收治的髌骨粉碎性骨折57例,根据内固定方式分成3组:钛缆环扎固定组、AO改良张力带固定组、镍钛聚髌器固定组.探讨各组的手术时间、出血量、膝关节术后首次锻炼时间、住院时间、医疗费用、损耗工作日、并发症及远期膝关节功能情况,并进行统计学分析.[结果]57例患者均获得11～48个月的随访,平均22.4个月.钛缆环扎固定组患者术后开始伸屈膝关节锻炼时间最早,平均约5.6 d,但医疗费用较贵,约为0.95万元.应用改良的Bostman髌骨骨折临床疗效评分标准评估远期疗效,钛缆环扎固定组优良率为95.1%,明显高于其余2组.[结论]钛缆系统对髌骨粉碎性骨折固定牢靠,具有膝关节锻练时间早,并发症少等优点,是治疗髌骨粉碎性骨折的一种新的选择方法.     

锚钉技术治疗髌骨下极撕脱骨折的疗效分析

[目的]评价锚钉技术治疗髌骨下极撕脱粉碎性骨折的疗效。[方法]回顾性分析本院2008年3月~2014年3月收治的髌骨下极撕脱粉碎性骨折患者26例(男19例,女7例),平均年龄(39±11)岁(26~54岁),均采用锚钉技术治疗。术后定期随访,采用膝关节活动度(range of motion,ROM)和Bostman评分系统评价膝关节功能康复情况。[结果]26例中23例获得随访,术后平均随访(29±7)个月(19~46个月)。末次随访时,患侧膝关节ROM为(129.35±7.19)°,健侧膝关节ROM为(132.69±6.11)°,两组间差异无统计学意义(P>0.05),Bostman评分平均(28.41±2.13)分,优15例,良7例,差1例,优良率95.65%。[结论]锚钉技术结合张力带技术治疗髌骨下极撕脱粉碎性骨折操作简便,疗效确切,膝关节功能恢复好。     

可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折

背景：髌骨下极粉碎性骨折具有骨折块小、修复髌腱起点困难等特点,临床如何处理粉碎性骨折块及重建髌韧带功能是亟待解决的问题。目的：探讨可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折的方法和临床疗效。方法：2007年8月至2012年12月收治26例髌骨下极粉碎性骨折患者,男15例,女11例;年龄19~65岁,平均42.5岁。患侧髌骨下极粉碎性骨折严重,均无法用克氏针及拉力螺钉固定,术中切除粉碎性骨折块,两枚可吸收带线锚钉依次垂直于髌骨下极,沿骨横截面中轴三等分点拧入,Kessler法缝合髌腱起点,膝关节屈曲90°位8字钢丝减张带固定。结果：术后切口均Ⅰ期愈合,无一例发生并发症。26例中24例获得随访,随访时间为6个月~5年,平均15.6个月。末次随访时,患者疼痛视觉模拟评分（VAS）为（1.0±0.3）分,患侧膝关节活动度（ROM）与健侧比较无统计学差异（P〉0.05）,患侧Lysholm评分优18例、良4例、可1例、差1例,优良率为91.6%。结论：可吸收锚钉联合8字减张带是治疗髌骨下极粉碎性骨折的有效方法,具有并发症少、术后恢复快等优点。     

钢丝环扎治疗髌骨下极粉碎性骨折

目的 探讨间断垂直钢丝联合髌骨钢丝环扎治疗髌骨下极粉碎性骨折的疗效。方法 采用间断垂直钢丝联合髌骨钢丝环扎治疗27例髌骨下极粉碎性骨折患者。记录手术时间、术中出血量、膝关节活动度及并发症发生情况,采用Bostman评分评价髌骨骨折疗效。结果 手术均顺利完成。手术时间42～76(54.72±17.35)min,术中出血量40～120(74.68±18.20) ml。患者均获得随访,时间12～18个月。术后1、3、6个月及末次随访时,采用Bostman评分评价髌骨骨折疗效均为优良,膝关节屈伸活动恢复满意。结论 间断垂直钢丝联合髌骨钢丝环扎治疗髌骨下极粉碎性骨折手术简单,固定可靠,患者术后可早期功能锻炼,疗效满意。     

两种内固定方式治疗髌骨粉碎性骨折的临床疗效分析

目的探讨应用带孔金属骨针联合钛缆和髌骨环内固定治疗髌骨粉碎性骨折术后膝关节功能恢复疗效差异。方法我院骨科2016年1月～2018年1月收治髌骨粉碎性骨折病人52例,按治疗方式不同分成针缆组和髌骨环组,针缆组26例,给予带孔金属骨针联合钛缆内固定术;髌骨环组26例,给予髌骨环内固定术。比较两组内固定方式在术后膝关节功能恢复差异,随访3个月,比较两组病人术后膝关节有无僵硬、挛缩、屈伸功能废用性丧失及内固定装置有无松动等并发症。结果术后膝关节早期功能恢复均按照膝关节评分(hospital for special surgery knee score, HSS评分)进行评定,其中在针缆环组病人中,术后1周内直腿抬高训练、下肢肌力、膝关节屈曲及行走能力优良率情况,均高于髌骨环组,差异有统计学意义(P0.05);针缆组病人中,术后1个月内膝关节功能恢复优良率均显著高于髌骨环内固定组,差异有统计学意义(P0.05);术后随访3个月,髌骨环内固定组病人膝关节僵硬、挛缩、屈伸功能废用性丧失及内固定装置松动等并发症发生率高于针缆组,差异有统计学意义(P0.05)。结论针对髌骨粉碎性骨折行带孔金属骨针联合钛缆内固定的治疗,不仅充分予以骨折断端坚强内固定,同时有效提高病人术后膝关节早期功能恢复率,获得了满意的疗效。     

膝前正中直切口髌骨爪联合髌囊环扎治疗髌骨骨折

目的探讨膝前正中直切口髌骨爪联合髌囊环扎治疗髌骨粉碎性骨折及其疗效。方法采用膝前正中直切口髌骨爪联合髌囊环扎治疗髌骨骨折186例。结果 163例获得随访8～20个月,平均16个月,骨折均愈合。根据Bostman评分,优良率94.5%。结论膝前正中直切口髌骨爪联合髌囊环扎治疗髌骨粉碎性骨折具有损伤小、暴露充分、固定可靠,是治疗髌骨粉碎性骨折的一种有效方法。     

钢丝环扎联合镍钛聚髌器治疗髌骨粉碎性骨折30例

目的探讨采用钢丝环扎联合镍钛聚髌器治疗髌骨粉碎性骨折的方法及疗效。方法2003年8月至2005年7月,对30例髌骨粉碎性骨折患者进行钢丝环扎联合镍钛聚髌器治疗。结果30例患者均获得随访,均达骨性愈合,6～13个月后去除内固定物。膝关节功能按胥少汀评分法优23例,良7例。结论钢丝环扎联合镍钛聚髌器治疗髌骨粉碎性骨折可解剖复位,固定牢固,术后可以早期行功能锻炼,膝关节功能恢复满意。     

髌骨针结合钢(钛)缆内固定治疗髌骨粉碎性骨折

目的探讨髌骨针结合钢缆或钛缆内固定治疗髌骨粉碎性骨折的临床疗效。方法对62例髌骨粉碎性骨折患者行切开复位髌骨针结合钢缆或钛缆内固定治疗。结果患者均获得随访,时间8~24个月。骨折均在3~4个月愈合。术后8个月根据Bostman髌骨骨折评价标准评定疗效:优48例,良11例,差3例,优良率为95.2%。结论应用髌骨针结合钢缆或钛缆内固定治疗髌骨粉碎性骨折,术后无需外固定,可早期进行功能锻炼,是治疗髌骨粉碎性骨折较理想的手术方法。     

缝线与髌骨针钛缆张力带固定治疗粉碎性髌骨骨折的优、缺点比较

目的 比较缝线缝合法配合石膏外固定和髌骨针钛缆张力带固定治疗粉碎性髌骨骨折的优、缺点。方法 将80例粉碎性髌骨骨折患者根据固定方式不同分为A组(采用5号爱惜康2次环扎+8字张力带固定+石膏外固定，40例)和B组(采用髌骨针钛缆张力带内固定，40例)。记录两组手术情况、骨折复位及愈合情况、膝关节活动度、术后并发症发生情况。按照Bostman髌骨骨折疗效标准评定膝关节功能。结果 患者均获得随访，时间12～24个月。手术时间、住院天数、住院费用A组均短(少)于B组(P<0.05)。术后3个月两组骨折均愈合。术后12个月采用Bostman髌骨骨折疗效标准评定膝关节功能：优良率A组为38/40(95.0%),B组为39/40(97.5%),差异无统计学意义(P>0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论 粉碎性髌骨骨折的治疗中，缝线缝合法配合石膏外固定的优点是手术时间短、费用低、二期无需去除内固定，缺点是石膏固定时间长、康复时间长；髌骨针钛缆张力带固定的优点是术后患者可以早期功能锻炼、石膏固定时间短或无需石膏固定，缺点是手术时间长、费用高、需二期...     

髌骨环、髌骨爪与Pin-Cable内固定治疗髌骨骨折的疗效比较

目的比较髌骨环、髌骨爪与Pin-Cable内固定治疗髌骨骨折的疗效,探讨3种固定方法的适应证。方法髌骨骨折283例283膝。髌骨环组(A组)62例,横形骨折(A1组)35例,粉碎性骨折(A2组)27例;髌骨爪组(B组)131例,横形骨折(B1组)97例,粉碎性骨折(B2组)34例;Pin-Cable组(C组)90例,横形骨折(C1组)66例,粉碎性骨折(C2组)24例。比较各组膝关节功能评分(HSS)、膝关节活动度(ROM)、完全负重行走时间(LT)、骨折愈合时间(FT)。结果 A1、B1、C1小组之间各指标的差异无统计学意义(P0.05)。A2组的HSS优于B2和C2组(P0.05);A2和C2组之间的ROM差异无统计学意义(P0.05),但均优于B2(P0.05);A2组的LT短于B2和C2组(P0.05);A2和B2组的FT均比C2组短(P0.05)。结论 3种内固定器械对髌骨横形骨折均有较好的疗效,而在髌骨粉碎性骨折中,髌骨环是更好的选择。     

Amniotic Band Syndrome

Amniotic band syndrome is an uncommon congenital disorder without any genetic or hereditary disposition. It involves fetal entrapment in strands of amniotic tissue and causes an array of deletions and deformations. Primary treatment is plastic and reconstructive surgery after birth with in utero fetal surgery also coming in vogue.     

Band Occlusion of the Atrial Appendage

Abstract Objectives: A new device has been developed for occlusion of the left atrial appendage (LAA). Previous investigations have been in the canine model. The canine atrial appendage does not vary in size and shape as much as the human. The goal of this study was to investigate band occlusion of right atrial appendages in the pig model, which are more broad based. Methods: The right atrial appendages of six pigs were approached through a right thoracotomy. An expandable polyester fabric‐covered silicone band was placed on the appendage. The animals were evaluated at the time of band placement with fluoroscopy, contrast injection, and in three animals, echocardiography. After one week, the animals were again evaluated with fluoroscopy. The animals were sacrificed at 12 weeks. Results: Bands were placed without complication at the base of all six appendages. All appendages were effectively occluded and all bands remained at the appendage base. The healed atrial surface was consistently smooth and devoid of thrombus. Conclusions: Occlusion of a broad‐based appendage as seen with human LAA is feasible with this novel band technique. (J Card Surg 2010;25:156‐160)     

内镜下的内痔套扎(英文)

目前内痔的治疗趋势已经逐步从住院手术治疗转向门诊非手术治疗方式,而且都具有相当的效果。这其中包括套扎、注射、电灼、冷冻等技术都得到了发展和应用。在肠镜检查过程中,运用套扎技术是一种便捷有效的方式。本文对内镜下内痔套扎技术进行报道并作相关文献回顾。     

Endoscopic Treatment of Gastric Band Prolapse

Complications of laparoscopic adjustable gastric banding (LAGB) are well documented including migration, erosion, prolapse, infection, pouch dilatation, and gastric perforation. Band prolapse within the first 5 years after LAGB is observed in about 5 % of cases, requiring an operative procedure. Here we report our experience of endoscopic treatment of band prolapses. From December 2007 to December 2013, 1,347 consecutive patients (202 male, 1,145 female) underwent LAGB; 47 patients had band prolapses and 7 were treated by endoscopy. All patients were women (median age, 34 years). The mean preoperative body mass index was 38.3?±?2.9 kg/m². The mean duration to band prolapse after LAGB was 10.6?±?5.6 months. The mean duration of endoscopy was 12?±?3 min. One patient had recurrence of the prolapse 3 months after the first endoscopy and was treated by endoscopy again. There was no operative procedure required and no mortality. Endoscopic treatment of band prolapses is effective without the need for an operative procedure.     

Band Erosion with Gastric Cancer

Adjustable gastric banding is a well-established procedure for the treatment of morbid obesity. We present a 62-year-old female who experienced the rare complication of intragastric band perforation due to a gastric adenocarcinoma localized at the site of gastric banding, 10 years after insertion of the band.     

Gastroscopic Band Removal after Intragastric Migration of Adjustable Gastric Band: A New Minimal Invasive Technique

Background: Laparoscopic adjustable gastric banding (LAGB) is the most used procedure for bariatric surgery in Europe. Although a low complication rate is reported, band migration within the first 2 years after LAGB is still observed in nearly 5% of cases, requiring operative band removal.To avoid increased risk of complications due to laparotomy, we propose a minimally invasive technique for this purpose. Methods: We performed this operation in five patients who suffered from band migration after LAGB (1.9% in our series of 211 patients, one patient was operated elsewhere). The described method consists of gastroscopic band and tube removal, combined with removal of the port under local anesthesia. Results: The described procedure was developed in the endoscopy unit without additional equipment. The mean operating-time ranged from 65 to 180 minutes (mean 135 minutes). No perioperative complication were observed. In-patient treatment was necessary for 4 days. Conclusions: A novel technique for minimally invasive band removal after adjustable gastric band migration is described, offering the patient a low-risk procedure and a better chance for further laparoscopic approaches.     

Midterm Results of Sternal Band Closure in Open Heart Surgery and Risk Analysis of Sternal Band Removal

Sternal dehiscence, which is responsible for the development of mediastinitis, is a serious complication after cardiothoracic surgery. We retrospectively compared the results of two methods for sternal closure after cardiothoracic surgery performed during January 2009 to May 2012. The methods comprised closure with sternal bands and steel wires (group A, n = 92) versus conventional closure using steel wires alone (group B, n = 442). Although not significantly different between the two groups, no patients undergoing sternal band closure experienced dehiscence or mediastinitis. The incidence of having to remove materials used for sternal closure was significantly higher in group A than in group B. In each case of removal in group A, the materials removed were sternal bands whose tips had caused direct cutaneous irritation. Thus, although sternal bands may be effective for rigid sternal closure, they must sometimes be removed because of chest discomfort caused by the tip of the band.