Femoral hernia: a review of 83 cases

We evaluate the factors that affect morbidity and mortality in patients who underwent surgery due to femoral hernia. The medical records of 83 patients who underwent femoral hernia repair between January 1996 and June 2004 were retrospectively analyzed. The femoral hernias were repaired either with McVay or mesh plug hernioplasty. Sex, age, surgical repair technique, presence of incarceration/strangulation, incarcerated/strangulated organs, postoperative complications, duration of hospitalization, recurrence rate, and factors that affect mortality and morbidity were studied. There were 83 patients with femoral hernia in our study. Patients’ age ranged from 10 to 75 years (mean age was 46.84) with a predominance of female (71%). Thirty-six patients (40%) underwent emergency surgery with the diagnosis of strangulation or incarceration of femoral hernia. Seventeen patients had strangulation and underwent resection; eleven of these patients had omentum in the hernial sac, whereas six patients had intestines. Four of these patients underwent laparotomy. The remaining 19 patients had incarceration and underwent simple reduction of hernial sac content without resection. Forty-seven (60%) patients underwent elective surgery. McVay technique was used for 79 patients, while the other four patients were treated with mesh-plug. Twelve patients (15%) developed a variety of complications (nine patients (25%) in emergency, three patients (6%) in elective group). There was one mortality. Recurrences occurred in two patients. Femoral hernia is an important surgical pathology with high rates of incarceration/strangulation and intestinal resection. Emergency surgery can increase morbidity and mortality especially in the elderly. Early elective surgery may reduce complication.     

Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases)

Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.     

应用股骨近端髓内钉治疗股骨转子周围骨折

目的 评价股骨近端髓内钉(PFN)治疗股骨转子周围骨折的临床疗效.方法 对96例股骨转子周围骨折的治疗作回顾性总结分析.所有病例均通过闭合复位完成手术,年龄40～91岁,平均66.5岁.骨折按AO分型,31-A1型31例、31-A2型42例、31-A3型23例.结果 本组病例手术时间为35～90 min,平均为50 min;术中失血量为50～200 ml,平均为80ml,术中术后均未输血.本组病例均进行了6～24个月的随访,平均8.5个月.本组病例骨折全部愈合,平均愈合时间3.5个月,无髋内翻及头钉切割发生,无死亡病例.结论 对于股骨转子周围骨折,特别是不稳定型转子周围骨折,PFN具有微创操作,固定坚强,术后并发症少,系此类骨折内固定物的首选.     

Femoral vein occlusion and spontaneous collateral ectasia presenting as recurrent hernia of the groin: a case report

Femoral vein occlusion is not a common complication even after repeated hernia repair. We describe a case of a 14-year-old boy with a visible and soft, yet irreducible, mass below the inguinal ligament after 3 previous inguinal hernia repairs and heart catheterization in infancy. Further examination showed dilated venous collaterals, bypassing an occluded common femoral vein via the testicular sheaths and across the pelvic floor. We discuss etiology, diagnostic pitfalls, therapeutic options, and possible future complications, with a literature review.     

高位腹膜前股疝无张力修补(附28例报告)

目的探讨高位腹膜前股疝无张力修补的临床效果。方法1999年10月~2006年4月使用聚丙烯网塞及平片治疗股疝28例。术中旷置股环,游离疝囊,不做高位结扎,游离疝囊颈部以上平面的腹膜前间隙,疝囊推入腹腔,将聚丙烯网塞展平置入腹膜前间隙内,平片置入子宫圆韧带或精索后方。重点加强股环上方的腹壁缺损区。结果28例手术顺利,恢复良好,随访0.5~4年无复发。结论行疝修补术时应该重新正确认识股疝的解剖结构,最大限度地恢复局部正常解剖,避免压迫股血管。     

股骨近端髓内钉治疗高龄股骨转子间骨折

目的通过回顾性分析股骨近端髓内钉(PFN)治疗高龄股骨转子间骨折的手术效果,评价PFN的临床疗效。方法2003年1月~2004年12月对42例高龄股骨转子间骨折患者应用PFN治疗,对其骨折类型、合并症及临床疗效进行分析比较。结果随访3~15个月,骨折平均愈合时间为3·2个月,骨折全部愈合。髋关节功能优良39例,占92·86%。结论PFN治疗高龄股骨转子间骨折具有创伤小、固定牢靠、手术时间短的优点,是治疗高龄股骨转子间骨折的良好选择,适用于各种类型的股骨转子间骨折。     

改良充填式无张力股疝修补术20例报告

目的探讨改良充填式无张力股疝修补的效果。方法回顾性分析我院2002年1月至2008年6月使用网塞及平片行改良充填式无张力股疝修补术20例,均经腹股沟切口,高位游离疝囊,网塞充填于股环上方薄弱的腹膜前间隙内,常规使用平片并与陷窝韧带、耻骨梳韧带固定。结果20例手术顺利,恢复良好,随访6~36月均无复发。结论经改进的充填式无张力股疝修补术可有效避免压迫股静脉,防止股疝复发,预防直疝和斜疝新发,为股疝治疗合理手术方式之一。     

带旋股外侧血管大转子骨瓣移植治疗成年股骨颈骨折

目的：探讨带旋股外侧血管大转子骨瓣移植治疗成年股骨颈骨折的方法和疗效。方法：采用带旋股外侧血管横支为蒂大转子骨瓣加松质骨镙钉内固定,治疗成年股骨颈骨折8例。结果：术后随访10个月～3年,8例骨折均愈合,未发生骨折不愈和股骨头缺血性坏死,患者髋关节功能恢复良好。结论：该术式操作相对简便,可提高成年股骨颈骨折的愈合率,避免发生骨不连和股骨头缺血性坏死等严重并发症。     

防旋股骨近端髓内钉治疗老年股骨转子间骨折

目的介绍防旋股骨近端髓内钉(PFNA-R)治疗老年股骨转子间骨折的方法。方法2005年12月~2006年12月间,采用Synethes公司生产的PFNA-R治疗股骨转子间骨折27例,男12例,女15例;年龄63~90岁(平均78.5岁)。按股骨近端骨折AO分型:A2型20例,A3型7例,按Evans-Jensen分型:ⅡA型14例,ⅡB型7例,Ⅲ型6例,均为闭合性骨折。结果手术时间35~70 min,平均50.4 min。术中出血量为100~350 ml,平均180 ml。术后随访3~12个月,平均7.1个月。骨折全部愈合,未出现切割现象,骨折愈合时间为11~17周,平均14.6周,无髋内翻。结论PFNA-R具有操作简单、创伤小、失血少、内固定可靠、防旋转、骨量丢失少等优点,是一种理想的治疗股骨转子间骨折的内固定材料。     

Femoral hernia repair

Plug insertion for primary femoral hernia repair may cause p.o. discomfort. The Kugel technique may avoid this problem. Patients’ satisfaction to the Kugel and the plug techniques is compared in the present study. Demographics, surgical, outcome and analgesic consumption data of 26 patients treated for with the plug technique (P group) are compared with 24 operated with the Kugel patch (K group). Patients’ p.o. discomfort to the two procedures was measured with quantitative (VAS score) and a qualitative (the short form of McGill pain questionnaire, SF-MPQ) methods, and compared. P group presented higher early p.o. pain (P<0.001), higher analgesic consumption and a significative delay in the return to physical activity (P<0.001). SF-MPQ scores at p.o. day 8, day 30 and month 6 were significantly lower for K group (P<0.001, P<0.001, P<0.005). The Kugel technique for femoral hernia treatment seems to cause less p.o. discomfort to patients than the plug technique.     

Femoral herniation of transplanted ureter after deceased-donor kidney transplantation

IntroductionHerniation of the ureter after kidney transplant is a rare and under documented event. Many of these herniations are due to abdominal wall defects or ureteral redundancy. After an extensive review of available literature, there has not been a reported case of a femoral herniation of ureter after kidney transplant. We report a case of late allograft renal transplant failure due to ureteral obstruction secondary to femoral herniation of the ureter.Case presentationWe report a case of 64 year old male with a history of kidney transplant, who was found to have an inguinal bulge. He was diagnosed with a femoral hernia containing transplant ureter using transplant kidney ultrasound and CT of the abdomen and pelvis. Subsequently he developed transplant kidney failure due to obstructive uropathy from the femoral hernia. The patient underwent a femoral hernia repair with biologic mesh. Compromised ureter was excised and a neoureterocystostomy was created. Post operatively his creatinine returned to baseline.DiscussionIn our literature search there are two types of inguinal ureteral hernias described. Paraperitoneal, which makes up the majority of the cases, and extraperitoneal. There are no classifications for ureteral femoral hernias. We may extract these definitions to femoral hernias, as evidenced by our case where we encountered a paraperitoneal femoral hernia containing transplant kidney ureter.ConclusionTo the best of our knowledge this is the first reported case of a femoral ureter hernia. Due to its rarity in the literature, an understanding of management is critical to patient outcome.     

微创技术置入内锁股骨近端髓内钉治疗股骨粗隆间骨折的前瞻性研究

目的比较采用微创技术(MIS)置入内锁股骨近端髓内钉(ITST)与普通股骨近端髓内钉(PFN)内固定治疗股骨粗隆间骨折的临床疗效。方法采用前瞻性研究,将2007年1月～2008年1月收治的62例股骨粗隆间骨折患者随机分为微创ITST组和普通PFN组。其中微创ITST组在完成复位后经特殊器械导引置入ITST,普通组患者按常规方法置入PFN固定。记录两组的手术时间、术中失血量、切口长度、术后输血例数和骨折愈合时间并进行比较。结果1例患者死亡,4例失访。微创ITST组平均手术时间、失血量、切口长度及输血例数均明显低于普通PFN组,差异有显著性意义(P0.01),两组患者骨折临床愈合时间和平均住院时间无显著差异(P0.05)。两组所有骨折均愈合,无延迟愈合与不愈合。结论与普通PFN相比,微创置入ITST治疗股骨粗隆间骨折创伤小、失血量少、早期临床疗效更令人满意。     

加长柄人工双极股骨头置换治疗高龄股骨转子间骨折

目的探讨加长柄人工双极股骨头置换治疗高龄股骨转子间骨折的疗效。方法用标准人工骨水泥、加长柄人工双极股骨头治疗高龄股骨转子间骨折病人41例。结果41例平均手术时间65min,平均输血600ml。术后3d下地12例,7d下地21例,14d下地8例。术后并发肺部感染、菌群失调2例,电解质代谢紊乱6例,低蛋白血症9例。随访3～41个月,按Har-ris评分标准:优良率达85.4%。无人工关节脱位、松动及假体下沉,无晚期感染病例。结论用加长柄人工双极股骨头治疗高龄股骨转子间骨折,是一种较好的治疗方法,可早期下地锻炼,减少并发症,提高生活质量。     

Adult groin hernias

Inguinal hernias are common, affecting one in four men in their lifetime. They are much less common in women with a lifetime risk of about 3%. Consequently, inguinal hernia repair is one of the commonest operations with more than 20 million operations performed annually worldwide. Africans have a much higher incidence of hernias than Caucasians and this is thought to be because of the anatomical configuration of the African pelvis. Many hernias in poorer countries are not repaired, so that presentation as an emergency and indeed mortality due to complications are much more often seen than in more affluent societies.     

Antonio de gimbernat

Summary The Spanish anatomist and surgeon Antonio de Gimbernat y I Arbos can be considered the father of modern inguinal hernia surgery. Based J on his excellent studies of anatomy he went on to describe the most essential structures of the inguinal and femoral regions. Gimbernat's contribution became the groundwork for morphologic studies that govern modern techniques of hernia repair. Moreover, he is credited with themodus operandi involved in the repair of femoral hernia. Antonio de Gimbernat revolutionized hernia surgery. However, the contemporary social and political circumstances that isolated Spain from the rest of Europe were responsible for ignorance of his outstanding contributions. This paper is intended to put his aims in proper prospective.     

PFNA治疗老年不稳定型股骨粗隆间骨折疗效分析

目的 评价采用股骨近端抗螺旋髓内钉(PFNA)手术治疗老年不稳定型股骨粗隆间骨折的疗效.方法 自2008年8月至2009年7月,共治疗老年不稳定型股骨粗隆间骨折64例,均采用PFNA微创内固定.Hairs评分系统评价骨折复位质量.结果 所有病例术后随访6～18个月(平均12个月).术后X线片示骨折全部愈合.术后颈干角123.2°～132.8°,平均128°.Hairs评分:优34例,良24例,可3例,差3例.结论 采用PFNA治疗老年不稳定型股骨粗隆间骨折疗效肯定,值得临床推广应用.     

改良Kugel补片治疗再发股疝的价值探讨

目的探讨改良Kugel补片在无张力斜疝修补术后再发股疝中的应用价值。方法对21例无张力斜疝修补术后再发股疝患者采用改良Kugel补片修补,观察手术时间、术后并发症及复发情况。结果本组患者均治愈,平均手术时间69（60—120）min。术后疼痛轻,2例出现阴囊积液,经多次穿刺抽吸后缓解。术后无切口感染,平均随访18．6（2～24）个月,无疝复发。结论改良Kugel补片腹膜前修补术治疗无张力斜疝修补术后再发股疝是一种安全、有效的手术方式,值得推广。     

Femoral hernia in childhood: evaluation of sonography as a diagnostic aid

Summary Between 1986 and 1997, 1,970 children up to the age of 15 were operated for inguinal hernia at the University Surgical Clinic of the RWTH Aachen. During this period, we operated on 6 children for femoral hernia (0.3% of the total number of hernia operations). A preceding inguinal hernia appeared to favor femoral hernia in childhood. In our view, preoperative diagnostic examination of children using sonography is an absolute requirement. Our surgical method consisted of closing the hernial orifice using a continuous double-row suture. The success of our surgical approach has been confirmed by non-recurrence of the complaint.     

人工全髋关节置换中合并股骨近端畸形的股骨侧重建

目的探讨人工全髋关节置换中合并股骨近端畸形的股骨侧重建方法及疗效。方法 2004年3月-2009年6月,对25例26髋合并股骨近端畸形的髋关节疾病患者行人工全髋关节置换术,同时根据不同畸形部位重建股骨侧。其中男10例10髋,女15例16髋;年龄42～82岁,平均64岁。关节置换原因:原发性骨关节炎2髋,先天性髋关节脱位8髋,创伤性关节炎14髋,结核性关节炎2髋。病程10个月～25年,平均10.6年。术前Harris评分为(44.2±5.1)分,美国西部Ontario与McMaster大学骨关节炎指数(WOMAC)评分为(45.0±2.7)分。股骨近端畸形按照Berry分类系统,根据畸形原发病分类:先天性髋关节发育不良8髋,骨折畸形愈合7髋,陈旧性结核2髋,股骨头骨骺滑脱2髋,既往有粗隆下截骨手术史1髋,髋臼加盖术1髋,内固定术5髋;根据畸形部位分类:大粗隆5髋,股骨颈10髋,干骺端10髋,股骨干1髋。结果患者术后切口均Ⅰ期愈合;1周内3例发生下肢深静脉血栓形成,行制动及抗凝治疗后治愈;术后6周1例发生大转子滑囊炎,口服止痛药物缓解。25例均获随访,随访时间1年6个月～6年,平均3年3个月。末次随访Harris评分为(88.4±3.6)分,WOMAC评分改善至(82.0±5.2)分,与术前比较差异均有统计学意义(P<0.05)。X线片示1例术后8个月出现无菌性松动,行翻修术;其余患者假体无松动。结论对于伴有股骨近端畸形的患者,需要精确分类,有针对性地选择假体并设计个性化手术方案,才能获得良好的股骨侧重建,取得满意疗效。