Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma

OBJECTIVES: The continued advances in imaging and stent/stent-graft technology have considerably expanded the indications for endovascular approach also in vascular trauma. We report our institutional experience with endovascular treatment of peripheral arterial injuries after blunt trauma. METHODS: Between January 2000 and June 2006 out of a series of 81 patients, 10 male patients (mean age of 50+/-14 years) with peripheral arterial injuries were managed endovascularly. At admission, haemorrhagic shock was present in three patients. Artery location involved common femoral (n=2), subclavian (n=2), axillary (n=2), external iliac (n=2), superficial femoral (n=1), and popliteal (n=1). Type of lesion was as follows: pseudoaneurysm (n=4), dissection (n=4), expanding haematoma (n=1), and arterio-venous fistula (n=1). Follow-up program included visit and duplex-ultrasonography, X-rays and/or spiral-computed tomography at 6-month interval during the first year, and yearly thereafter. RESULTS: The lesion was excluded in all cases. All patients survived. Major complications did not occur. Mean hospitalisation was 13 days. Limb-salvage was 100%. Follow-up ranged from 3 to 60 months (mean 16); a late occlusion of a popliteal stent-graft was managed with another endovascular procedure. CONCLUSION: In our experience, endovascular treatment of vascular injuries after blunt trauma was feasible and effective.     

Interventional treatment of bleeding complications due to percutaneous cannulation for peripheral extracorporeal membrane oxygenation

PurposeThis study aimed to evaluate the safety and effectiveness of interventional techniques as a treatment for bleeding complications secondary to percutaneous cannulation for peripheral extracorporeal membrane oxygenation (PECMO).Materials and methodsOut of 1264 patients who underwent PECMO at our hospital between January 2009 and September 2018, we reviewed the clinical characteristics and outcomes of eight patients (4 men, 4 women; mean age, 54.9 years [range, 31–77 years]) who underwent percutaneous interventional treatment for bleeding complications secondary to percutaneous cannulation for PECMO.ResultsBoth hemodynamic instability and coagulopathy were present in 7 patients who had direct injury during PECMO insertion and absent in one patient with pseudoaneurysm at the PECMO removal site. Percutaneous ultrasound-guided thrombin injection was performed in three patients with pseudoaneurysm of the common or superficial femoral artery, and adjunctive embolization was combined with microcoils or n-butyl 2-cyanoacrylate in two of them. Stent graft was inserted in four patients with contrast extravasation (n = 3) from external iliac artery (n = 1) or common femoral or iliac veins (n = 2) ruptures or the fistula between the superficial femoral artery and vein (n = 1). N-butyl 2-cyanoacrylate and coil embolization was performed for pseudoaneurysm from the internal pudendal artery branch in the remaining one patient. Technical success was achieved in all eight patients. There were no procedure-related complications. There was no rebleeding during the follow-up.ConclusionInterventional treatment is a safe, technically feasible and therapeutically effective modality for treating bleeding complications secondary to a percutaneous cannulation for PECMO.     

开放与通道下二种不同手术方式对腰椎管狭窄的治疗效果比较

目的：比较开放与通道下二种不同手术方式对腰椎管狭窄患者的治疗效果。方法：选择我院于2021年1月—2022年6月收治的腰椎管狭窄患者95例,依据手术方法分为开放组46例与通道组49例。开放组采用传统椎板切除减压内固定术,通道组采用固定通道技术治疗。两组患者均完成6个月随访。比较两组手术指标,术后并发症情况;术前和术后3 d患者疼痛介质和应激反应指标变化;术前、术后1个月和术后6个月腰痛和腿痛及腰椎功能变化。结果：通道组腰椎管狭窄患者术中出血量少于开放组,手术时间长于开放组,住院时间短于开放组（P <0.05）。通道组腰椎管狭窄患者术后并发症发生率小于开放组（P <0.05）。两组术后3 d腰椎管狭窄患者皮质醇（Cor）和去甲肾上腺素（NE）水平高于术前（P <0.05）;而通道组术后3 d Cor和NE水平低于开放组（P <0.05）。两组术后3 d神经肽Y(NPY)和P物质（SP）水平高于术前,而β-内啡肽（β-EP）水平低于术前（P <0.05）;而通道组术后3 d NPY和SP水平低于开放组,而β-EP水平高于开放组（P <0.05）。两组术后...     

Different association between renal dysfunction and clinical outcomes according to the presence of diabetes in patients undergoing endovascular treatment for peripheral artery disease

ObjectiveAlthough chronic kidney disease (CKD) and diabetes are important prognostic factors in patients with peripheral artery disease, there are limited data regarding the outcomes of endovascular treatment (EVT) according to the severity of CKD, especially in the presence of diabetes. This study sought to compare clinical outcomes of lower limb EVT between patients with and patients without CKD according to the presence of diabetes.MethodsPatients were enrolled from the Korean multicenter EVT registry and were divided according to the presence of diabetes, then further stratified by CKD (estimated glomerular filtration rate <60 mL/min/1.73 m²). The primary outcome was major adverse limb events (MALEs; a composite of reintervention for target limb, reintervention for target vessel, and unplanned major amputation) at 2 years.ResultsA total of 3045 patients were eligible for analysis: 1277 nondiabetic patients (944 without CKD, 333 with CKD) and 1768 diabetic patients (951 without CKD, 817 with CKD). CKD was associated with a significantly increased risk of MALEs after EVT in diabetic patients (14.4% vs 9.9%; adjusted hazard ratio, 1.60; 95% confidence interval, 1.28-2.01; P < .001) but not in nondiabetic patients (7.6% vs 9.7%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.53-1.14; P = .203; interaction P = .018). In analysis stratified by the severity of CKD among diabetic patients, end-stage renal disease was significantly associated with an increased risk of MALE.ConclusionsCKD was associated with a significantly higher risk of MALEs after EVT in diabetic patients but not in nondiabetic patients. The increased risk of MALEs was mainly driven by patients with end-stage renal disease.     

超声定位与盲法用于创伤后循环不稳患者桡动脉穿刺的比较

目的比较超声定位法与旨法用于创伤后循环不稳患者桡动脉穿刺的效果。方法采用前瞻性随机分组设计,纳入标准为外伤后拟行急诊手术,因循环不稳（定义为人手术室时平均动脉压〈60mmHg或休克指数〉1）需动脉穿刺测压患者,纳入患者40例随机分为超声定位组和盲法组行桡动脉穿刺。考察指标包括首次穿刺成功率、总成功率、总操作时间和总穿刺次数。结果两组间一般资料差异无统计学意义;与盲法组相比,虽然两组总穿刺成功率差异无统计学意义,但超声定位组首次穿刺成功率高（19例比13例,P〈0．05）,总操作时间短[（1．2±0．5）min比（2．8±2．5）min,P〈0．01],总穿刺7欠数少[（1．2±0．4）次比（2．1±1．5）次,P〈0．01]。结论对于创伤后循环不稳需行桡动脉穿刺患者,超声定位法桡动脉穿刺效果优于传统盲法。     

腹主动脉瘤腔内修复与开腹切除术的麻醉管理比较

目的比较腹主动脉瘤腔内修复与开腹切除术的麻醉管理特点。方法 2010年2月~2011年1月,70例ASAⅡ~Ⅳ级,肾下型腹主动脉瘤行腔内修复术52例（腔内修复组）,开腹切除术18例（开腹切除组）。开腹切除组采用气管内插管全身麻醉。腔内修复组采用的麻醉方法包括气管内插管全身麻酔、全凭静脉麻醉（喉罩通气）和监护麻醉。气管内插管全身麻醉采用快速顺序静脉诱导,气管插管后机械控制呼吸,静吸复合方式维持麻醉;全凭静脉麻醉（喉罩通气）采用丙泊酚靶控静脉输注,经喉罩行机械通气控制呼吸;监护麻醉保留自主呼吸,适当镇静镇痛。结果开腹切除组在气管内插管全身麻醉下完成手术,术中均需要使用血管活性药物控制血压。腔内修复组有57.7%（30/52）的患者采用气管内插管全身麻醉、34.6%（18/52）的患者采用全凭静脉麻醉（喉罩通气）和7.7%（4/52）的患者在监护麻醉下完成手术。与开腹切除组相比,腔内治疗组术中血压较平稳,麻醉时间[（90±27）min vs.（210±44）min,t=13.668,P=0.000]、手术时间[（45±22）min vs.（187±36）min,t=-19.811,P=0.000]、术中输注晶体液[（750±178）ml vs.（1896±367）ml,t=17.486,P=0.000]、胶体液[（349±147）ml vs.（1257±266）ml,t=18.034,P=0.000]、异体血[（50±34）ml vs.（898±154）ml,t=-37.615,P=0.000]、术后返ICU患者比例（15.4%vs.66.7%,χ2=17.231,P=0.000）及术后住院时间[（8.5±2.1）d vs.（15.2±4.3）d,t=8.700,P=0.000]均明显降低。结论腹主动脉瘤腔内修复术的麻醉手术时间、液体出入量及血管活性药物应用水平远低于腹主动脉瘤开腹切除术,且监护麻醉、全凭静脉麻醉适用于该术式。     

探讨腋臭治疗三种方法效果比较

目的 评价小切口切除术、肿胀麻醉下吸刮术与肉毒毒素注射治疗腋臭的临床效果.方法 2006年9月至2009年4月收治的腋臭患者350例,其中180例采用小切口切除治疗,120例肿胀麻醉下吸刮术治疗,50例行肉毒毒素注射治疗;对3组手术治疗的效果与并发症情况进行回顾性分析并做比较.结果 经术后3～24个月的随访,3组治愈率分别为90.6%、84.8%和84.2%,有效率均达到100%.结论 小切口切除术、吸刮术、肉毒毒素注射均为治疗腋臭的有效方法,但小切口切除对异味的祛除能更彻底.如考虑到术后的并发症,术后美观及恢复期短的等原因,对局部异味轻中度的患者,肉毒毒素注射治疗更适合;对中、重度的局部异味患者,可采用吸刮术.     

腔内双向开通慢性髂动脉闭塞的长期结果分析

目的分析腔内治疗时经双向开通的复杂髂动脉闭塞患者的长期通畅率。方法回顾性分析首都医科大学附属北京世纪坛医院2012年8月至2018年8月因慢性髂动脉闭塞尝试双向开通并且最终成功完成腔内手术的58例患者(66条肢体)资料,统计长期通畅率。结果技术成功率96.6%。1年的一期通畅率96.6%(56/58),5年一期通畅率82.6%(19/23),二期通畅率91.3%(21/23),主要不良事件率为8.7%(2/23)。结论腔内双向开通复杂髂动脉闭塞性病变,有创伤小、恢复快等优点,而且其长期通畅率并不劣于开放手术。     

三种方法治疗锁骨重度粉碎骨折的比较

目的　比较 3种方法治疗锁骨重度粉碎骨折的疗效。方法　对 95例锁骨重度粉碎骨折患者应用 3种方法治疗 :重建钢板加钢丝捆绑 (Ⅰ组 ) 2 6例、改良张力带加钢丝捆绑 (Ⅱ组 ) 32例、带锁边张力带 (Ⅲ组 ) 37例。结果　 95例均获随访 1～ 2年 ,骨折愈合率 :Ⅰ组 5 7 7% ,Ⅱ组 6 8 8% ,Ⅲ组97 3%。Ⅲ组愈合率与Ⅰ、Ⅱ组分别比较 ,差异均有显著性 (P <0 0 1)。结论　带锁边张力带内固定是一种轴性及弹性整体内固定 ,较重建钢板加钢丝捆绑和改良张力带加钢丝捆绑效果好。     

锁骨粉碎性骨折的治疗方法与疗效分析

目的比较3种方法治疗锁骨骨折的疗效，探讨治疗锁骨骨折的最佳方法。方法采用3种方法治疗102例锁骨骨折，其中克氏针（Ⅰ组）35例、钢板（Ⅱ组）37例、外固定支架（Ⅲ组）30例。结果随访时间8～18个月，骨折愈合优良率：Ⅰ组60．00％，Ⅱ组64．86％，Ⅲ组93．33％。Ⅲ组愈合率与Ⅰ、Ⅱ组分别比较，差异均有显著性（P〈0．01）。结论针对不同的骨折选择不同的治疗方法可取的满意的效果，外固定支架治疗粉碎性锁骨骨折是一种较好的方法。     

粗隆间骨折三种治疗方法的比较

经总结1996—2002年采用卧床牵引、动力髋螺钉(DHS)钢板内固定及股骨近端短重建髓钉固定3种方法治疗股骨粗隆间骨折53例，探讨如何界定和选择适应证，并研究骨折类型、股骨近端机械强度与治疗方法的关系。     

Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture

Objective:The main treatment method used for thoracolumbar fractures is open reduction and internal fixation.Commonly there are three surgical approaches:anterior,posterior and paraspinal.We attempt to...     

3种不同方式治疗老年股骨转子间骨折的病例对照试验

目的:通过比较分析3种不同方式治疗老年股骨转子间骨折的临床资料及其随访结果,为临床选择合适的治疗方法提供依据。方法:自2004年6月至2010年6月治疗老年股骨转子间骨折131例,其中动力髋螺钉(dy-namichipscrew,DHS)内固定组72例,男20例,女52例,年龄(72.5±5.5)岁;PFNA(proximalfemoralnailantirotation,PFNA)组43例,男12例,女31例,年龄(72.8±4.9)岁;人工股骨头置换组16例,男4例,女12例,年龄(76.0±5.0)岁。分别对3组患者手术创伤(手术时间、切口长度、X线透视次数、术中失血量),术后恢复(非负重行走时间、住院时间、临床愈合时间、术后12周Harris髋关节评分)及并发症等进行统计学分析。结果:所有患者获随访,时间6～36个月,平均18.2个月。手术创伤:手术切口长度、手术时间及术中失血量方面,DHS组>人工股骨头置换组>PFNA组;X线透视次数PFNA组最多,人工股骨头置换组最少。术后恢复:非负重行走时间、住院时间、临床愈合时间方面,DHS组>PFNA组>中人工股骨头置换组。术后12周Harris评分,人工股骨头置换组明显高于DHS组和PFNA组;DHS组与PFNA组相比差异无统计学意义。术后并发症发生情况:DHS组比PFNA组发生率高,3组总体比较差异无统计学意义。结论:PFNA可以作为老年性股骨转子间骨折优先考虑的疗法。DHS较为适合于基层医院、AI型骨折及骨折部位在PFNA入点附近;而人工股骨头置换术是治疗粉碎性不稳定型并(或)高龄严重骨质疏松性转子间骨折的理想方法之一,但不优先考虑。     

不同固定方法治疗青少年胫骨骨折的比较

目的：通过对3种固定方法的疗效及并发症比较并研究其有关影响因素,探讨治疗青少年胫骨骨折固定方式的选择.方法：2007年1月至2012年1月收治青少年胫骨骨折患者79例（83处骨折）,男55例,女24例;年龄11～17.6岁,平均13.9岁.分别采用弹性髓内钉、钢板及外固定支架进行固定治疗,并行回顾性分析.观察比较各组住院时间、骨折愈合时间以及并发症发生率和再手术发生率等.结果：所有患者得到随访,平均随访时间为15.8个月.骨折愈合时间与固定方式、高能量损伤、多发骨折、开放性骨折因素显著相关.且外固定支架组愈合时间明显长于弹性髓内钉组和钢板组.外固定支架组并发症发生率明显高于弹性髓内钉组和钢板组.4例弹性髓内钉固定患者需再手术（复位丢失2例、延迟愈合和畸形愈合各1例）.6例外固定支架患者需再手术（复位丢失3例,畸形愈合2例,钉道感染1例）.2例钢板固定患者因不愈合、成角畸形行二次手术.通过统计学分析：外固定支架与弹性髓内钉固定术比较有7.56倍（95％可信区间=3.74～29.87）的复位丢失和（或）畸形愈合风险.未次随访时,3组疗效结果差异无统计学意义（P＞0.05）.结论：不同方法治疗青少年胫骨干骨折中,外固定支架固定术并发症发生率最高,弹性髓内钉可以达到其他固定系统效果并可避免大部分并发症,手术方式选择取决于医生的经验以及患者基本情况和骨折类型.     

The impact of surgical site infection on hospitalisation,treatment costs,and health‐related quality of life after vascular surgery

Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. The objective of this study was to assess the cost and health‐related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Data were available for 144 participants undergoing clean or clean‐contaminated vascular surgery. SSI development, length of hospital stay, readmission, and antibiotic use were recorded over a 30‐day period. Patient‐reported EQ‐5D scores were obtained at baseline, day 7 and day 30. Linear regressions were used to control for confounding variables. A mean SSI‐associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532). Adjusting for age, smoking status, and procedure type, SSI was associated with a 92% increase in length of stay (P < 0.001). The adjusted episode cost was £3040. SSI reduced patient utility between baseline and day 30 by 0.156 (P = 0.236). Readmission rates were higher with SSI (P = 0.017), and the rate to return to work within 90 days was lower. Therefore, strategies to reduce the risk of surgical site infection for high‐risk vascular patients should be investigated.     

Difference in Therapeutic Strategies for Joint‐Preserving Surgery for Non‐Traumatic Osteonecrosis of the Femoral Head between the United States and Japan: A Review of the Literature

For patients with non‐traumatic osteonecrosis of the femoral head (ONFH), core decompression (CD) and bone grafts (BG) are mainly performed in the West, while osteotomy is found to be predominant in Japan. It is not well recognized how the surgical procedures for joint preservation in patients with ONFH are completely different between the United States and Japan. This paper identifies the contexts and the differences in treatment strategies for ONFH between the two countries. We compared the surgical trends of the two countries over three periods, 1997–2001, 2002–2006, and 2007–2011 (the US data for the third period was 2007–2008), based on a 2014 US paper and a 2013 national publication in Japan. We compared the details of surgery for non‐traumatic ONFH under the same conditions in the two reports. For the period 1997–2001, the rates of surgeries for ONFH in the US were as follows: total hip arthroplasty (THA), 86%; CD, 10%; and osteotomy, 0.4%. In Japan, THA was 61%, osteotomy 38%, and CD 0%. For the recent period, 2007–2011 (US 2007–2008), the rate of THA was 91%, CD 6%, and osteotomy 0.1%, in the US, compared to a THA rate of 73%, CD 0%, and osteotomy 26% in Japan. The results for the interim period (2002–2006) were between the old and new data. The use of joint‐preserving surgery for ONFH differs greatly between the US and Japan. The first‐line joint‐preserving surgery was CD in the US and osteotomy in Japan. Each procedure was rarely done in the other country. From about 2000 to 2010, the percentage of THA increased in both countries. The proportion of joint‐preserving surgery (CD in the US and osteotomy in Japan) declined. The decrease in joint‐preserving procedures may be largely attributed to improved long‐term outcomes of THA due to technological advances. There is also a reluctance for young ONFH patients to undergo joint‐preserving procedures, such as osteotomy, that require long‐term hospitalization.     

重症急性胰腺炎合并胰腺周围大量积液的不同处理

目的:探讨重症急性胰腺炎(SAP)合并胰腺周围大量积液不同处理方式的疗效。方法:回顾性分析2008年10月—2016年5月收治的162例SAP合并胰腺周围大量积液患者的临床资料,其中68例行保守治疗(保守治疗组),67例行超声或CT引导下经皮穿刺置管引流治疗(穿刺引流组),13例行腹腔镜手术治疗(腹腔镜组),14例行开腹手术治疗(开腹组),比较各组的相关临床指标。结果:各组一般资料具有可比性;穿刺引流组与腹腔镜组症状体征消失时间、血淀粉酶恢复正常时间均明显短于保守治疗组,保守治疗组腹腔内积液大体吸收时间、膀胱压下降时间明显晚于其余各组(均P0.05);穿刺引流组与腹腔镜组住院时间明显短于保守治疗组与开腹组,并发症发生率也明显低于保守治疗组与开腹组(均P0.05);保守治疗组的治疗有效率明显低于其余各组,再手术率明显高于其余各组(均P0.05);保守治疗组与开腹组病死率明显高于穿刺引流组与腹腔镜组(均P0.05)。结论:B超或CT引导下穿刺及腹腔镜后入路置管引流对治疗SAP合并胰腺周围大量积液疗效较好,且并发症发生率与病死率较低。     

胆总管囊肿切除术治疗先天性胆总管囊肿的术式比较

目的 评价腹腔镜胆总管囊肿切除术治疗先天性胆总管囊肿患者的疗效.方法 40例先天性胆总管囊肿患者随机分为开腹手术组和腹腔镜手术组,开腹组行开腹胆总管囊肿切除术,腹腔镜组在腹腔镜下采用胆总管囊肿切除术.结果 两组40例手术均顺利完成.腹腔镜组手术时间较开腹组长(P＜0.01);但腹腔镜组术中出血量、肛门排气时间、术后进食时间、术后住院时间以及切口大小等均明显优于开腹组(均P＜0.001);治疗和随访(随访1年)过程中两组未见与手术直接相关的严重并发症.结论 腹腔镜胆总管囊肿切除术治疗先天性胆总管囊肿患者虽然手术时间较开腹组长、费用可能要比开腹组高,但疗效佳、安全.     

Comparison of the Clinical Outcomes of Full‐Endoscopic Visualized Foraminoplasty and Discectomy Versus Microdiscectomy for Lumbar Disc Herniation

ObjectiveThis retrospective case‐control study aimed to evaluate and compare the clinical outcomes of full‐endoscopic visualized foraminoplasty and discectomy (FEVFD) with microdiscectomy (MD) for lumbar disc herniation (LDH).MethodsData from 198 patients who presented with LDH between January 2016 and December 2017 treated by either FEVFD or MD were retrospectively analyzed. The inclusion criteria were single‐level LDH, unilateral radiating leg pain with or without positive Lasegue''s sign, and failure of standard conservative treatment for at least 12 weeks. The patients were categorized into an FEVFD group (n = 102) or an MD group (n = 96), according to the surgical procedure performed. Operative time, time in bed after surgery, postoperative hospitalization time, complications, and reoperations were recorded. Visual analog scales (VAS) for leg and back pain, Oswestry Disability index (ODI), 36‐Item Short‐Form Health Survey physical function (SF36‐PF), and bodily pain (SF36‐BP) scores were assessed and compared between the two groups.ResultsThe demographic data and baseline characteristics of the two groups were not significantly different. Operative time for the FEVFD group (73.82 ± 20.73 min) was longer than that for the MD group (64.74 ± 17.37 min) (P = 0.003), and fluoroscopy time for the FEVFD group (1.71 ± 0.58s) was longer than that for the MD group (1.30 ± 0.33s) (P < 0.001). However, time in bed experienced in the FEVFD group (8.51 ± 2.10 h) was less than that in the MD group (9.24 ± 2.01 h) (P = 0.014), and postoperative hospitalization time experienced in the FEVFD group (2.89 ± 0.83d) was also shorter than that in the MD group (4.94 ± 1.35d) (P < 0.001). All patients completed 24 months of follow‐up. Postoperative scores at each follow‐up for the VAS for leg and back pain, ODI, SF36‐PF, and SF36‐BP all improved significantly for both groups, as compared to the preoperative data (P < 0.05). The mean preoperative and postoperative scores for the VAS for leg and back pain, ODI, SF36‐PF, and SF36‐BP were not significantly different between the two groups. According to the modified MacNab criteria, the outcomes of the procedures were rated as excellent or good by 92.16% and 93.75% of the patients in the FEVFD and MD groups, respectively. One patient suffered a nerve root injury during the discectomy, one patient suffered from a dural tear, and two patients suffered from a residual herniation in the FEVFD group. One patient in the MD group suffered from poor wound healing. Moreover, recurrence happened in two cases in the FEVFD group, and in one case in the MD group.ConclusionFEVFD and MD are both reliable techniques for the treatment of symptomatic LDH. FEVFD resulted in a more rapid recovery and equivalent clinical outcomes after 24 months of follow‐up.