示指转位再造V°、VI°拇指缺损

由于显微外科的问世,足趾移植已成为拇指再造的常用方法,而传统的再造方法目前讨论很少。作者提出用示指残指转位再造V°、VI°拇指缺损。本术式的适应证是患者拒绝取足趾再造拇指,考虑到拇指的需要性,经患者同意可采用示指残指转位再造拇指V°、VI°缺损。这是一个老方法,但却是一个好方法。特别适用于基层医院和不愿担风险的患者群。     

子宫脱垂Ⅱ°～Ⅲ°修补应用局麻的体会

子宫脱垂Ⅱ°～Ⅲ°修补应用局麻的体会毛占军，陈杰我们对子宫脱垂Ⅱ°～Ⅲ°病人２０例采用１％利多卡因局部浸润麻醉，效果满意，操作方法如下：患者取截石位，消毒后在要剥离的部位上用亚甲蓝注射液定位，然后用１％利多卡因２０ｍｌ加肾上腺素１：２０万浓度，行子宫...     

Millagan-Morgan术联合消脱止-M治疗Ⅲ°Ⅳ°混合痔

目的 探讨Millagan-Morgan术（以下简称M-M术）联合消脱止-M治疗Ⅲ°Ⅳ°混合痔的临床疗效。方法 将180例Ⅲ°Ⅳ°混合痔患者随机分为两组，试验组90例采用M-M术联合消脱止-M，对照组90例只用M-M术。观察和比较两组患者手术时间、术后疼痛时间、应用镇痛药频率、术后出血、创面肿胀时间、并发症情况、住院时间、恢复正常工作生活时间、用药不良反应等指标。结果 试验组与对照组相比，术后疼痛时间、创面肿胀时间、住院时间、恢复正常工作和生活时间明显缩短（P＜0.05），术后出血量明显减少（P＜0.01），术后并发症发生率明显下降（P＜0.05），但手术时间、术后尿潴留差异无显著性意义（P＞0.05）。治疗组服用消脱止-M期间无不良反应。结论 M-M术联合消脱止-M是治疗Ⅲ°Ⅳ°混合痔的一种经济、安全、有效的治疗方法，尤适合基层医院应用。     

Screw-plate angulation of 130° or 135° and 120° in the stabilization of an unstable trochanteric femoral neck fracture

Correct positioning of the screw in the femoral head is the most important surgical challenge after the external reduction of an unstable femoral neck fracture. Rules of this challenge are very accurate, especially for osteoporotic elderly patients. We would like to point out the relationship between anatomy, mathematical pattern, and surgical procedure. Anatomically, the correct position for the screw must be in the lower half of the femoral head. From a mathematical point of view, in this position, the portion of a sphere's surface is higher and its volume is the highest. In some cases therefore, it is not technically possible to fix in good position the 130°or 135° screw. It could be of interest to provide surgeons with a 120° angulation screw-plate.     

微创腰椎360°固定术

目的评估微创腰椎360°固定术的疗效。方法从2002年5月至2005年5月,应用微创腰椎360°固定术治疗患者25例,其中男11例,女14例;年龄45~67岁,平均56岁。腰椎滑脱16例,其中Ⅰ度13例、Ⅱ度3例;腰椎不稳7例;椎间盘源性腰痛2例。行L4,5节段融合14例,L5~S111例。功能评估采用Oswestry D isab ility Index(OD I),统计患者术前、术后2周、3、6、12个月的OD I评分。术后即刻、3、6、12个月摄X线片,观察椎体的融合情况和融合器(cage)有无下沉。结果手术时间从110~180 m in。术中发生1例下腔静脉破裂出血。术后全部病例获得随访,随访时间12~35个月,平均22.3个月。OD I评分手术前为34.15±5.17,术后2周为43.27±10.43,术后3个月为46.14±6.85,术后6个月为44.97±3.65,术后12个月为46.38±4.48,与术前相比有显著差异(P<0.05)。25例植骨手术后3个月融合。1例患者术后3个月X线片显示相邻椎体滑移2 mm,6个月时融合。2例患者发生椎间高度丢失1 mm。无一例发生内置物松动、滑落及逆向射精等并发症。结论微创腰椎360°固定术适用于腰椎不稳、局限节段椎间盘变性及Ⅱ度以下腰椎滑脱伴神经根管狭窄患者。手术出血少、损伤小,但操作时应特别注意大血管的暴露和牵开。     

90°～90°牵引治疗儿童股骨干上1/3骨折

90°～90°牵引治疗儿童股骨干上1/3骨折@石青$天津市天津医院小儿骨科!天津市解放南路     

吻合器痔上粘膜环切术治疗Ⅲ°和Ⅳ°痔病

目的 评价治疗Ⅲ°和Ⅳ°痔病的吻合器痔上粘膜环切术。方法 回顾性分析了54例行吻合器痔上粘膜环切除术的病例资料。结果 平均手术时间18分钟,平均住院天数为4.5天,6例(11.1％)术后有疼痛而需要止痛治疗,1例(2.2％)有术后出血需要重新缝合。随访1～16个月,6例(11.1％)病人外观上仍有痔核萎缩后皮赘存在,无肛门狭窄、大便失禁及复发出现。满意度达98％。结论 吻合器痔上粘膜环切术操作简便,术后疼痛轻微,手术时间和住院时间短,恢复快,并发症少;但价格昂贵,少数病人外观改善不理想。此术式有望取代传统的痔手术方式。     

Tiefe Hypothermie unter 20° C

Ohne ZusammenfassungMit 28 Textabbildungen     

Precise Intraoperative 60° Skin Z-plasty

The primary objective of this tip is to assist foot and ankle surgeons in performing a precise 60° lengthening Z-plasty in the operating room without the use of a template or protractor. A ruler and basic trigonometric principles are applied to the line of contracture to obtain consistent and reliable results.     

吻合器痔上黏膜环切术治疗Ⅲ°～Ⅳ°痔病

目的探讨吻合器痔上黏膜环切术治疗痔病的临床应用价值.方法回顾总结了吻合器痔上黏膜环切术治疗96例Ⅲ°～Ⅳ°痔病的临床资料.结果平均手术时间为15min,术后平均住院时间2.3d.术后恢复正常生活的平均时间为6.8d.术后出血2例.术后6周随诊78例(81.25%),对术前症状控制满意程度满意者90例(93.75%),基本满意4例(4.17%),不满意2例(2.08%).无排便失禁、无肛门狭窄.结论吻合器痔上黏膜环切术具有安全、有效、手术时间短、住院时间少、恢复快等优点,是治疗重度痔病近期疗效优越的新技术.     

吻合器痔上黏膜环切术治疗III°～IV°痔病

目的探讨吻合器痔上黏膜环切术治疗痔病的临床应用价值。方法回顾总结了吻合器痔上黏膜环切术治疗96例III°～IV°痔病的临床资料。结果平均手术时间为15min,术后平均住院时间2.3d。术后恢复正常生活的平均时间为6.8d。术后出血2例。术后6周随诊78例(81.25%),对术前症状控制满意程度:满意者90例(93.75%),基本满意4例(4.17%),不满意2例(2.08%)。无排便失禁、无肛门狭窄。结论吻合器痔上黏膜环切术具有安全、有效、手术时间短、住院时间少、恢复快等优点,是治疗重度痔病近期疗效优越的新技术。     

180°-Talushalsluxationsfraktur,Hawkins-Typ III

Die Unfallchirurgie -     

Biobrane治疗Ⅱ°烧伤的临床经验

Biobrane是一种双层生物合成的皮肤代用品,一层是编织致密的尼龙网,另一层是超薄的多孔硅胶膜。两层通过猪真皮胶原中提取的多肽共价结合,以增强其与创面表面的粘合。Biobrane是富有弹性(最小延伸率350％)和柔软的材料,以不同大小规格密封在无菌     

Minimally invasive 360° instrumented lumbar fusion

A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach ¶anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral ¶fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflation and provides reliable access only to L5-S1 and in some cases L4-5. A gas-mediated approach yields many technical drawbacks to performing spinal surgery. A minimally invasive posterior approach involving suprafascial pedicle screw instrumentation has been developed, but without widespread use. Translaminar facet fixation may be a viable alternative to transpedicular fixation in a 360° instrumented fusion model. Past studies have shown open 360° instrumented lumbar fusion yields high arthrodesis rates. The study examined the cases of 46 patients who underwent successful 360° instrumented lumbar fusion using a combined minimally invasive approach. Anterior lumbar interbody fusion (ALIF) at one or two levels was performed through the BERG approach; a gasless retroperitoneal approach to the lumbar spine allowing the use ¶of standard anterior instrumentation. Posteriorly, all patients underwent successful decompression, translaminar fixation, and posterolateral fusion at one or two levels through ¶one small (2.5–5.0 cm) incision. Results showed mean hospital stay of 2.02 days; mean combined blood loss was 255 cc; and mean pain relief was 56%, with 75.5% of patients reporting good, excellent, or total pain relief. Forty-two of 46 patients (93.2%) achieved a solid fusion ¶24 months after surgery. A total of 47% of all patients working prior to surgery returned to work following surgery. The study showed that minimally invasive 360° instrumented lumbar fusion, when performed utilizing these approaches, yields a high rate of solid arthrodesis (93.3%), good pain relief, short hospital stays, low blood losses, accelerated rehabilitation, and a quick return to the workforce. The BERG approach offers technical advantages over the traditional gas-mediated laparoscopic approach to the anterior lumbar spine.     

Minimally invasive 360° instrumented lumbar fusion

A retrospective preliminary study was undertaken of combined minimally invasive instrumented lumbar fusion utilizing the BERG (balloon-assisted endoscopic retroperitoneal gasless) approach ¶anteriorly, and a posterior small-incision approach with translaminar screw fixation and posterolateral ¶fusion. The study aimed to quantify the clinical and radiological results using this combined technique. The traditional minimally invasive approach to the anterior lumbar spine involves gas insufflation and provides reliable access only to L5-S1 and in some cases L4-5. A gas-mediated approach yields many technical drawbacks to performing spinal surgery. A minimally invasive posterior approach involving suprafascial pedicle screw instrumentation has been developed, but without widespread use. Translaminar facet fixation may be a viable alternative to transpedicular fixation in a 360° instrumented fusion model. Past studies have shown open 360° instrumented lumbar fusion yields high arthrodesis rates. The study examined the cases of 46 patients who underwent successful 360° instrumented lumbar fusion using a combined minimally invasive approach. Anterior lumbar interbody fusion (ALIF) at one or two levels was performed through the BERG approach; a gasless retroperitoneal approach to the lumbar spine allowing the use ¶of standard anterior instrumentation. Posteriorly, all patients underwent successful decompression, translaminar fixation, and posterolateral fusion at one or two levels through ¶one small (2.5-5.0 cm) incision. Results showed mean hospital stay of 2.02 days; mean combined blood loss was 255 cc; and mean pain relief was 56%, with 75.5% of patients reporting good, excellent, or total pain relief. Forty-two of 46 patients (93.2%) achieved a solid fusion ¶24 months after surgery. A total of 47% of all patients working prior to surgery returned to work following surgery. The study showed that minimally invasive 360° instrumented lumbar fusion, when performed utilizing these approaches, yields a high rate of solid arthrodesis (93.3%), good pain relief, short hospital stays, low blood losses, accelerated rehabilitation, and a quick return to the workforce. The BERG approach offers technical advantages over the traditional gas-mediated laparoscopic approach to the anterior lumbar spine.     

Geometry and reproducibility in 360° fundoplication

Background: In this study, we set out to precisely define two symmetrical points—a on the anterior fundic wall and b on the posterior fundic wall. These points, when advanced around a 60-Fr bougie-filled esophagus, will meet on the right side, to the right of the anterior vagus nerve, to create a reliable, reproducible, loose (i.e., or ``floppy') 360° fundoplication (FP). Methods: For the terms of this study, circumference =c; diameter =d; c/d=π; π= 3.14; and d(cm) = Fr/30. Using a flexible plastic ruler, we measured, in cadavers (n= 5) and intraoperatively (n= 16), esophageal c at the gastroesophageal junction (GEJ) with a 60-Fr bougie in place; d was calculated from c. Results: The smallest measured value for c was 7.5 cm (d= 2.39 cm); the largest value for c was 10.0 cm (d= 3.18 cm). The mean value was 8.35 cm (d= 2.66 cm). Points a and b are established by measuring laterally from a point where the greater curve meets the GEJ in the bougie-filled esophagus. Point a is 6.0 cm laterally and 6.0 cm below the short gastric vessels on the anterior fundus; point b is 6.0 cm laterally in a symmetrical position on the posterior fundus. Connecting these three points as a line defines the inner c of the completed FP and measures 12.0 cm. This gives an internal d of 3.82 cm for the FP. This is >1 cm larger than d for the mean measured external esophageal c of 8.35 cm where d= 2.66 cm. This technique creates a correctly oriented, symmetrical, ``floppy,' true fundoplication. It avoids wrapping or twisting the fundus around the GEJ. The technique is easily taught and reproducible. Conclusions: Two points, measured a horizontal distance of 6.0 cm from the GEJ, symmetrically placed on the anterior (point a) and posterior (point b) fundus can be brought anterior (a) and posterior (b) to the esophagus and sutured to the right of the anterior vagus nerve to reliably and reproducibly create a ``floppy' 360° fundoplication. Received: 20 April 1999/Accepted: 15 February 2000/Online publication: 15 May 2000     

45°角侧入法腰椎穿刺术

<正>椎管内穿刺术(腰穿)在临床上广泛用于某些疾病的治疗和诊断,常用"直入法"和"75°侧入法"进行穿刺。当多种因素造成胸、腰椎棘突间隙狭窄者或者脊柱畸形时,往往因穿刺困难而失败,不能完成进一步的诊治措施。此时作者改用45°角侧入法做     

国产吻合器痔切闭术与Milligan-Morgan术治疗Ⅲ°-Ⅳ°痔的对比研究

目的:对国产吻合器痔切闭术与Milligan-Morgan手术的临床效果进行对比评估.方法:对60例Ⅲ°-Ⅳ°痔随机分为Ⅰ组(吻合器组)和Ⅱ组(Milligan-Morgan组).对其术后疼痛等7项指标进行比较研究.结果:手术平均时间分别为10.5min(Ⅰ组)与36.2min(Ⅱ组).术后疼痛评分于24h分别为3.2(Ⅰ组)与7.2(Ⅱ组),72h分别为1.3(Ⅰ组)与4.3(Ⅱ组).随访6个月,两组病人均无狭窄、失禁和复发等并发症.多项指标显示Ⅰ组明显优于Ⅱ组.结论:吻合器痔切闭术是一种简单、安全、可靠、微痛、恢复快的新术式,治疗Ⅲ°～Ⅳ°痔在近期疗效优于传统Milligan-Morgan术.     

AO锁骨钩钛板在ROCKWOODⅢ°～Ⅵ°肩锁关节损伤中的应用

目的总结AO锁骨钩钛板治疗RockwoodⅢ°～Ⅵ°肩锁关节损伤的临床疗效。方法采用AO锁骨钩钛板治疗RockwoodⅢ°～Ⅵ°肩锁关节损伤27例。术中,于肩锁关节复位后放置钛板,并修补关节囊及肩锁、喙锁韧带。结果患者术后切口均Ⅰ期愈合,肩锁关节脱位得到纠正,无血管、神经损伤等并发症发生。本组患者术后随访6～15个月。术后3～6个月取出锁骨钩钛板。术后6个月疗效评价,优23例,良3例,差1例,优良率为96.8%。结论 AO锁骨钩钛板治疗RockwoodⅢ°～Ⅵ°肩锁关节损伤具有创伤小,可早期锻炼等优点,值得临床推广。     

Ⅳ°～Ⅴ°严重脊椎滑脱的治疗(文献综述附7例报告)

目的:介绍Ⅳ°～Ⅴ°严重脊椎滑脱的各种治疗方法。方法:对常用方法如Harrington法,C-D法,Steffee法,Socon法以及前方L5滑椎切除加后路L4加压融合到S1二期手术法等进行了文献复习,并介绍了作者应用上述一些方法治疗7例严重脊椎滑脱的临床结果。结果:7例严重滑脱的治疗效果满意。结论:严重滑脱的治疗方法很多,术前对病例的正确评估及选择合适的手术方法是成功的关键。