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991.
992.
993.
Two cases are reported in which, after ACL reconstruction with autologous hamstring grafts, tibial polylactide interference
screws migrated into the knee joint. Clinically, both patients presented with recurrent locking of the joint. In one case,
a broken 15 mm-long tip of the screw was found intra-articularly. In the other case, the whole screw had migrated into the
joint cavity. The degradation process of polylactic acid, operative technique and bone quality are discussed as possible reasons
for these complications. 相似文献
994.
Benoit J. M. Pirotte Alphonse Lubansu Michael Bruneau Chakir Loqa Nathalie Van Cutsem Jacques Brotchi 《Child's nervous system》2007,23(11):1251-1261
Objective The objective of this study was to evaluate whether the rigid application of a sterile protocol for shunt placement was applicable
on a routine basis and allowed the reduction of shunt infections (SI) in children.
Materials and methods Since 2001, a rigid sterile protocol for shunt placement in children using neither antibiotic-impregnated catheters nor laminar
airflow was prospectively applied at Erasme Hospital, Brussels, Belgium. For assessing the protocol efficacy before continuation,
we preliminarily analyzed the results of the first 100 operated children (43 females, 57 males, 49 aged <12 months; 115 consecutive
shunt placement/revision procedures). All procedures were performed by the same senior surgeon, one assistant, one circulating
nurse, one anesthesiologist. The sterile protocol was rigidly imposed to these four staff members: uniformed surgical technique;
limited implant and skin edge manipulation; minimized human circulation in the room; scheduling surgery as first morning operation;
avoiding postoperative cerebrospinal fluid (CSF) leak; double gloving; procedures of less than 30-min duration; systemic antibiotics
prophylaxis. We analyzed separately: (1) children carrying an increased risk of SI (n = 38) due to preoperative external ventricular drainage, CSF leak, meningitis, glucocorticoids, chemotherapy; (2) children
aged <12 months; (3) procedures for shunt revision.
Results Errors in protocol application were recorded in 71/115 procedures. They were mainly done by non-surgical staff, decreased
with time and were medically justified in some young children. Surprisingly, no SI occurred (follow-up, 4 to 70 months). One
child developed an appendicitis with peritonitis (Streptococcus faecalis) after 6 months. No SI was found. After peritonitis was cured, shunt reinsertion was uneventful.
Conclusion These preliminary results suggest that a uniform and drastic sterile surgical technique for shunt placement: (1) can be rigidly
applied on a routine basis; (2) can lower the early SI rate below 1%; (3) might have a stronger impact to reduce SI than using
antibiotic-impregnated catheters and optimizing the operative environment such as using laminar airflow and reducing the non-surgical
staff. This last issue will be evaluated further in the present ongoing protocol. 相似文献
995.
996.
Seong-Woong Kim Kyu-Won Shim Nick Plesnila Yong-Oock Kim Joong-Uhn Choi Dong-Seok Kim 《Child's nervous system》2007,23(2):201-206
Objects We designed several distraction devices and applied these instruments in 14 patients with varying types of craniosynostosis.
The aim of this report is to clarify the advantages and disadvantages of these surgical methods and to discuss current concepts
for the surgical strategy in the treatment of craniosynostosis.
Methods From January 2000 to July 2005, 28 patients with craniosynostosis were retrospectively analyzed. Surgical treatment was performed
on 14 patients using the distraction method with internal distraction devices that we designed, in which 5 patients had plagiocephaly,
3 brachycephaly, and 6 scaphocephaly. All patients underwent preoperative and postoperative evaluations, which included the
patient’s neurological state, and three-dimensional CT.
Results With distraction devices, the time required for the surgery could be shortened almost 3 1/3 h; the bleeding during the surgery
was decreased with reduced requirement of more than 200 ml of blood transfusion as compared with remodeling surgery. Postoperatively
achieved distraction distances varied from 30.0 to 47.5 mm (mean, 42.99 mm). The average increased volume percent of cranium
in distraction surgery group was 20.9% (range, −11.5 to 58.9%) after full distraction.
Conclusion With distraction surgery, satisfactory cranial volume expansion and aesthetically pleasing morphological states were achieved
in all cases, and the efficacy was statistically significantly high as compared with remodeling method. 相似文献
997.
目的 探讨自发性颈动脉海绵窦瘘的诊治方法。方法 9例单纯颈内动脉供血,其中6例采取球囊瘘内闭塞术,3例采用瘘口一同闭塞的颈内动脉闭塞术。11例采用微导管超选择性插管,行瘘的供血动脉及瘘口栓塞。栓塞后7例仍有供血者3例经压颈1个月瘘口消失,2例疗效不满意,患者未再来治疗,2例采取经岩下窦途径和经眼静脉途径。1例单纯由颈内动脉脑膜支供血的行γ刀治疗。结果 13例栓塞后造影瘘口完全闭塞,7例栓塞后造影瘘口有显影,术后采取压迫患侧颈总动脉1个月,半年后3例造影瘘口消失,2例疗效不满意,失去随访,2例经眼静脉、岩下窦栓塞海绵窦取得成功。γ刀治疗1例,症状消失。19例随访6个月未见瘘口再通。结论 介入栓塞是治疗自发性颈动脉海绵窦瘘行之有效的方法。 相似文献
998.
为分析重症急性胰腺炎(SAP)合并深部真菌感染的临床特点、危险因素及预后,并探讨其防治的策略,回顾性分析85例SAP合并感染的临床资料,其中43例合并真菌感染,42例为单纯细菌感染。研究发现2组的年龄、性别、病因、ICU住院时间均无显著性差异;真菌感染组较细菌感染组APACHE Ⅱ评分及CT分级高,发生菌群紊乱、腹压增高及器官障碍的概率高、手术次数多,且均有显著性差异。真菌组的病死率约是细菌组的2倍多(44.19%比21.43%)。结果提示:合并真菌感染病死率明显增高;APACHE Ⅱ评分、CT分级、菌群紊乱、腹压增高、手术次数是真菌感染发生的危险因素;当发现不明原因的发热、意识改变及大出血时应怀疑合并真菌感染的可能;预防性抗真菌药物的应用可能有助于防治真菌感染。 相似文献
999.
1000.