关节镜下后交叉韧带自体肌腱四隧道重建近期疗效观察

目的探讨关节镜下采用自体肌腱四隧道法后交叉韧带重建术的近期临床疗效。方法 2008年11月~2011年6月实施的双股双隧道PCL重建术43例。采用胫骨导向器,使胫骨隧道与胫骨的角度控制在50°~55°;胫骨侧的骨髓道入口位于胫骨前内侧取腱切口内,出口在胫骨平台后缘中心偏外侧,平台以下10mm的原PCL止点处。外上隧道出口为前外束,内下隧道为后内侧束,两隧道出口均在PCL止点范围内,其间约有3~5 mm的骨桥间隔。股骨骨道采用Inside-out技术:由外侧关节镜入口放入PCL上止点定位器;股骨隧道位于原PCL附着区,前外侧束隧道位于股骨髁间窝内髁外侧壁前上1∶30(右膝)或10∶30(左膝),距关节软骨边缘约7 mm位置;后内侧束隧道位于3∶30(右膝)或8∶30(左膝),距关节软骨10 mm位置。术中不保留后交叉韧带的残端,并同时治疗修复合并损伤。移植物采用自体半腱肌肌腱和股薄肌肌腱,使用可吸收螺钉固定。结果 43病例随访18~36个月,平均13个月。术后后抽屉试验:阴性39例,+阳性2例,++阳性2例。Lysholm评分:术前(48.4±6.8)分,术后(92.7±5.3)分,两者比较差异有显著性(t=32.85,P<0.05)。Tegner活动评分:术前(3.3±1.3)分,术后(6.7±0.9)分,两者差异有显著性(t=28.55,P<0.05)。结论采用自体半腱肌和股薄肌肌腱四隧道重建PCL术能达到解剖重建的目的,稳定性良好。     

Clinical application of a Kirschner wire assisted double - hook water - injection hernia needle in complicated pediatric oblique inguinal hernia北大核心CSCD

Objective To explore the clinical value of single -hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double - hook water - injection hernia needle in treating complicated pediatric oblique inguinal hernia. Methods The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children's Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed. According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group. Children treated by a single - port laparoscopic double hook water -injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group. Children treated by a single - port laparoscopic Kirschner wire assisted double hook water - injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group. The independent sample t - test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery [(2. 87 ± 1. 88) years vs. (4. 91 ±2. 39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm3 vs. 9 650.97(3 849.24, 17 539.51) mm3]. The differences in the age at surgery and hernia sac volume were statistically significant (t - 5. 407, Z - 4. 218;all P <0. 001). There was no significant difference in body mass index between the 2 groups (P > 0. 05). Taking hernias with sac volume > 10 000 mm as huge hernias, there were 70. 18% (40/57 cases) and 47. 25% (146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively. The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group [(20(15, 20) min vs. 15 (15, 20) min] (Z - 2. 842, P < 0. 05). However, the operation time for huge oblique hernias with sac volume > 10 000 mm was not statistically significant between the 2 groups (P >0. 05). No recurrence in both groups was found during 6-1 6 months of follow - up. Conclusions For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas deferens and spermatic cord vessels smoothly. As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar. With good feasibility and safety, it is applicable for clinical popularization. © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.     

医学本科高校外语学科现状调查及发展思考

为了解我国医学本科高校外语学科基本现状，选取45所独立建制西医类本科高校为研究样本，调查外语教学单位设置、外语专业及招生、外语师资力量等与学科发展相关数据并进行分析。研究发现，外语学科在医学本科高校学科体系中处于相对弱势地位。新医科、新文科背景下的医学本科高校需要推进外语学科建设，将外语学科与医学专业人才培养紧密结合，打造面向新时代的复合型医学人才。     

胃镜检查诱发心肌梗死二例

我们开展胃镜检查２０年来，共发现２例检查诱发心肌梗死意外。例１：男，６１岁，因上腹部不规律隐痛１年多，于１９８９年行胃镜检查。患者无高血压及心脏病史。胃镜检查前检测血压、心电图均正常。常规局麻，采用OlympusGIFK１０型胃镜，常规检查插镜顺利，当胃镜行将进入贲门区时，患者呈痛苦貌，大汗，面色苍白，呼吸急促。急速退镜，查心电图示：急性前间壁心肌梗死，经积极抢救治疗，患者于２０d后康复出院，至今健在。例２：女，７２岁，因间断性剑突下烧灼不适１月余于１９９９年行胃镜检查。患者有阵发性胸闷、心前区疼痛史１年…