新型充气式康复靴治疗踝部骨折的疗效观察

目的 观察充气式康复靴治疗Danis-Weber A型踝部骨折患者的疗效.方法 将54例Danis-Weber A型急性外踝骨折患者随机分为治疗组及对照组.2组患者均经闭合复位处理后,治疗组给予充气康复靴治疗,对照组则采用传统石膏托固定治疗,治疗期间2组患者均避免患肢负重.分别于治疗前以及治疗第1,3及7天时采用排水法测量2组患者患肢肿胀体积,同时选用视觉模拟评分法(VAS)评估患者治疗前、治疗第12小时、第1及3天时患肢疼痛程度,治疗2周后复查踝关节正侧位X光片以了解2组患者骨折移位情况.结果 治疗组上述不同时间点患肢肿胀程度及VAS疼痛评分均显著优于对照组水平,组间差异均具有统计学意义(P＜0.05),治疗2周后复查发现治疗组骨折端移位情况亦明显优于对照组(P＜0.05).结论 充气式康复靴能显著改善踝部骨折患者患肢肿胀,缓解因创伤而引发的肢体疼痛,预防骨折移位,其疗效明显优于传统石膏托同定治疗.     

充气式保温机在婴儿先天性心脏病手术中的应用效果观察

目的 探讨充气式保温机在婴儿先天性心脏病(先心病)手术中的应用效果.方法 将同一外科组的71例心脏病患儿随机分为实验组(36例)和对照组(35例).患儿进人手术室即开始监测肛温,两组降温阶段均采用降低室温的方法.在保温和升温阶段,对照组采用调节室温、添加被服等常规保暖方式,而实验组则在调节室温、被服保暖方式的基础上使用充气式保温机.结果 围手术保温阶段,尤其是改良超滤阶段,对照组体温波动大,实验组体温保持平稳.实验组在苏醒、住ICU时间上少于对照组,术后1h胸腔-心包引流量少于对照组,差异有显著意义(P＜0.05).结论 充气式保温毯作用于体表,在围手术期可以保持患儿体温恒定,有效预防室颤、心跳停搏、出血等现象发生.     

Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

Background

Anatomic reduction of intra-articular fractures of the tibial plateau and distal radius can be difficult to achieve. Treatment goals are centered on restoring the native anatomy and articular congruency. Several surgeons in the USA have begun using an inflatable bone tamp to reduce these fracture patterns. The concept is built on the success of the tamp in kyphoplasty of the spine, but it has yet to be tested in the lab for use in the extremities. We performed an investigation into the safety and efficacy of using an inflatable bone tamp for intra-articular fracture reduction of the tibial plateau and distal radius.

Materials and methods

Paired cadaveric specimens were obtained for a total of six proximal tibias and six distal radii. Intra-articular depression-type fractures were created in all specimens. The inflatable bone tamp was then used to reduce the depression. For comparison, the tibias were fractured on the medial and lateral side and a conventional metal tamp was used on the contralateral side of the balloon. Fine-cut micro-computed tomography (CT) scans were performed on all intact specimens, which were then fractured, and again after fracture reduction. CT data was used to measure the amount of restoration of the normal anatomy and to compare the effectiveness of the balloon to conventional methods.

Results

The inflatable bone tamp was equivalent to conventional methods in large, minimally displaced fracture fragments and proved superior when comminution was present at the articular surface. No instances of overreduction or penetration into the joint were encountered with the balloon, whereas this was a common occurrence with conventional metal tamps. The inflatable tamp was successful in reducing all distal radius fractures without complication.

Conclusion

Anatomic reduction of impacted articular fractures should be the goal of any treating surgeon. In our cadaveric models, we have shown the inflatable bone tamp to be safe and effective in reducing depressed articular fractures around the tibial plateau and distal radius. The balloon offers the advantage of being minimally invasive and creating a symmetric, contained defect to hold bone filler for subchondral support.     

气垫床不同充气程度及不同翻身间隔时间预防压疮的效果观察

目的探讨气垫床不同充气程度配合不同翻身间隔时间预防压疮的效果。方法选择在本科住院的压疮高危患者160例随机分为A、B、C、D四组,各40例,A、B组患者应用充气程度为80%的气垫床,分别每2h、4h翻身1次,C、D组患者应用充气程度为100%的气垫床,分别每2h、4h翻身1次,观察、评估患者的皮肤变化及压疮发生情况。结果 A、B、C、D四组Ⅰ期压疮的发生数分别为1例、0例、6例、4例,A组和C组、B组和D组的压疮发生率比较,差异有统计学意义(P0.05);A组与B组、C组和D组的压疮发生率比较,差异无统计学意义(P0.05)。结论应用充气程度为80%的气垫床预防压疮的效果优于充气程度为100%的气垫床,且翻身间隔时间可延长至4h。     

Biomechanical Comparison of Inflatable Penile Implants: A Cadaveric Pilot Study

Background

Throughout the last decade there has been a growing interest in the biomechanical differences between inflatable penile prostheses (IPPs) and their significance with regard to the patient experience.

The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil

Background

Correction of residual curvature during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) by plaque incision and grafting is a common approach.

间歇式冲气压力抗栓泵在全麻术后预防下肢静脉血栓形成的护理

目的探讨间歇式冲气压力抗栓泵预防下肢静脉血栓形成的疗效。方法收集我科2010年2月～2012年12月使用间歇式冲气压力抗栓泵与常规患者的资料。对比分析行间歇式冲气压力抗栓泵对患者术后下肢静脉血栓形成的预防作用。结果干预组和常规组分别为600人。平均年龄分别为[（49．8±13．0）岁、（50．5±12．3）岁,P=0．34）],平均体重指数分别为[（29．1±3．5）、（28．6±6．3）,P=0．09）],平均手术时间分别为[（3．1±1．5）h、（3．2±1．3）h,P=0．22）],差异无显著意义。两组采用不同手术方式的患者人数差异无显著意义（P=0．19）。干预组与常规组相比,差异有显著意义（P=0．02）。结论间歇式冲气压力抗栓泵能够有效预防全麻术后患者下肢静脉血栓形成。     

体外充气复位结合PKP术治疗老年性胸腰椎压缩性骨折130例

目的:观察充气复位结合经皮球囊扩张椎体后凸成形术(PKP)对胸腰椎压缩性骨折的椎体形态改变。方法:对130例胸腰椎压缩性骨折患者采用体外复位后结合椎体后凸成形术(PKP)后观察手术前后对椎体前缘高度的恢复情况、cobb’s角的改变及术后并发症发生率。结果:体外充气整复后与后凸成形术后伤椎的前缘高度及cobb’s角及术后并发症发生率相应数据配对比较,差异有显著性(P<0.05)。结论:在充气复位结合PKP术对胸腰椎压缩性骨折的椎体形态有明显改变,能有效的恢复椎体前缘高度、减少后凸畸形、cobb’s角的改善及术后并发症发生率。     

Enhanced recovery strategies after penile implantation: a narrative review

Optimizing pain management strategies in penile implantation has historically been a challenge to urologists assuming care of patients post-operatively. In addition to the complex pathophysiology of male genital pain, the responsibility of opioid stewardship in the face of the ongoing narcotics epidemic presents its own set of challenges to experienced implanters. Recent innovations in pre- and intra-operative analgesia have provided some improvement in patient-reported pain outcomes. When used together in protocols spanning each phase of operative care, multimodal analgesia (MMA) regimens provide superior patient pain control and successfully decrease opioid usage compared to traditional opioid-based pain control. This review will systematically present literature that discusses interventions in the preoperative and intraoperative spaces aimed at optimally controlling pain. We will also highlight surgical techniques that have been demonstrated to help ameliorate post-operative pain in penile implant recipients. We will discuss the impact of MMA protocols across urology and further explore its larger impact on reducing opioid burden in the ongoing epidemic.