膝关节镜下修复重建手术后的康复

近年来国内外关节康复的基础与临床研究取得很大成果 ,膝关节镜手术后的康复训练成为保证手术成功的重要环节。治疗师应了解关节镜术后康复治疗的特点和基本方法 ,针对镜下修复重建手术的不同特点 ,制定个体化的康复计划。在康复进程中应注意术后制动所致并发症和CPM应用等问题     

盆底重建手术患者围手术期护理

目的探讨盆底重建手术患者围手术期规范化护理措施。方法对住院手术治疗的44例盆腔器官脱垂患者提供规范化护理措施,包括术前心理支持,术前肠道准备,盆底肌训练,预防继发感染,预防下肢静脉血栓,出院指导等。结果所有患者术后无严重并发症发生,均康复出院,经1~24月随访,44例患者均未出现器官脱垂、压力性尿失禁。结论对盆底重建手术患者提供围手术期规范化护理,可保证手术按时而顺利进行,缩短术后恢复时间,减少术后并发症的发生。     

Special issues in plastic and reconstructive surgery

Intensivists frequently collaborate with plastic and reconstructive surgeons in treating patients with major wounds, following significant reconstructive procedures, and following free-tissue transfers. Pressure ulcers are a significant source of morbidity and mortality in the intensive care unit; prevention, early recognition, and multidisciplinary treatment are critical components for successful management. Necrotizing fasciitis is an aggressive, soft-tissue infection that requires rapid diagnosis, early surgical intervention frequent operative debridements, and soft-tissue reconstruction Catastrophic abdominal injuries and infections can be treated with an open abdominal approach and require the expertise of a plastic surgeon to reconstruct the abdominal wall. The success of free-tissue transfers and complex reconstructive procedures requires a thorough understanding of the factors that improve flap survival.     

以问题为导向的护理对胃癌手术患者康复水平的影响

目的采用以问题为导向的护理促进胃癌患者术后康复。方法将60例胃癌患者随机分为观察组和对照组,对照组采用常规护理,观察组在对照组的基础上采用以问题为导向的护理,比较2组的自护能力及术后恢复情况。结果护理后观察组患者在自我概念、自我责任、自我护理技能等方面的评分均高于对照组,差异有统计学意义(P0.05)。观察组术后肛门排气时间、排便时间、卧床时间、住院时间均短于对照组,术后24 h疼痛评分低于对照组,精神状态评分高于对照组,差异均有统计学意义(P0.05)。结论以问题为导向的护理能够满足胃癌手术患者对康复知识的需求,可促进术后快速康复。     

Augmented autologous transfusions in major reconstructive spine surgery

Intraoperative autologous transfusion during major reconstructive spine surgery decreased allogeneic red blood cell transfusions, but patients were exposed to significant numbers of allogeneic blood products. This study reports a prospective study of 160 randomized patients undergoing major reconstructive spine surgery. Without delaying start of surgery, 80 patients underwent hemapheresis with coincidental normovolemic hemodilution in the operating room to sequester autologous blood components. A therapeutic dose plateletpheresis product and an average of 2 U each of freshly collected autologous red cells and fresh plasma were prepared prior to surgical incision. The same supplies and equipment were used subsequently to carry out intraoperative autologous transfusion (IAT). Autologous plasma and platelets were transfused to Sequestration patients, contributing to a significant decrease of total allogeneic donor exposures. One or more autologous red blood cell unit equivalents were cost effectively salvaged and retransfused to 78% of the Sequestration patients. Altogether, autologous red cells comprised 87% of the total red cells transfused. During the same time period, 80 age-, sex-, and weight-matched controls, who received IAT only, were accrued for comparison with Sequestration patients. Of all red cells transfused to control patients, autologous units comprised 47%. Both patient groups received the same total perioperative red blood cell support. The per patient cost for IAT, with or without sequestration, was competitive with supplying one unit of cross-matched allogeneic red cells. IAT only patients had greater allogeneic blood donor exposures than Sequestration patients, in whom the numbers of allogeneic red cells, plasma and platelet transfusions were decreased. Compared with IAT alone, the hospital post-operative stay of Sequestration patients was 23% less than IAT only patients. J. Clin. Apheresis 13:62–68, 1998. © 1998 Wiley-Liss, Inc.     

Tissue engineering in reconstructive surgery of bone and cartilage

Molecular research has Bern the subject of considerable interest in recent years. The same can also be said for tissue engineering, which has ushered us into a world previously accessible only in science fiction. The possibility of creating human tissue opens the road for reconstructive surgery using biologically matched grafts. Some of the tissue engineering methods that pertain to orthopedics have already found application in the clinic. Among these are operations to reconstruct defects of joint cartilage, based on the in vitro multiplication of chondrocytes isolated from cartilage fragments previously collected arthroscopically. By applying tissue engineering technology we will soon be able to culture the patient's own bone tissue needed to fill defects in the bone bed. At some point in the not too distant future we will be able to graft entire joint ends, instead of the joint endoprosthesoplastic procedures currently in use. Tissue engineering, like every new field of science, prompts emotional reactions not only in medical circles, but also in many social groups. Let us hoper for fulfillment of the anticipation that a way will be found to overcome disabilities involving the locomotor apparatus.
The authors, who come from varying theoretical and clinical settings, present a short history of tissue engineering, based on their own experience and the available literature, the current possibilities to use tissue engineering in the reconstruction of bone and cartilage, and the prospects for development in the field in the near future.