人工骨和自体骨在复杂跟骨骨折异形钢板内固定术中的病例对照研究

目的 :比较人工骨与自体骨在复杂跟骨骨折异形钢板内固定术中的临床疗效。方法:自2015年4月至2019年4月收治60例复杂跟骨骨折患者行切开复位异形钢板内固定术治疗,按照植骨材料不同分为试验组和对照组,每组30例。试验组男21例,女9例;年龄18～71(36.85±7.42)岁;SandersⅢ型19例,SandersⅣ型11例;采用人工骨植入。对照组男23例,女7例,年龄20～69(37.26±7.38)岁;SandersⅢ型18例,SandersⅣ型12例;采用自体骨植入。比较两组患者手术时间、术中出血量、术后切口干燥时间、愈合时间及并发症情况,比较术前及术后3个月B?hler角及Gissane角变化情况,采用Maryland评分评价患足功能恢复情况。结果:两组患者术后均获得随访,时间3～15(10.15±2.67)个月。试验组手术时间、术中出血量分别为(89.32±12.43) min、(101.64±5.13) ml,对照组分别为(112.45±13.82) min、(119.01±5.26) ml,两组比较差异有统计学意义(P0.05);两组术后切口干燥时间、愈合时间、并发症比较差异无统计学意义(P0.05)。试验组术前、术后3个月B?hler角分别为(14.19±2.47)°、(34.52±4.41)°,对照组分别为(14.08±2.35)°、(33.67±4.36)°;试验组术前及术后3个月Gissane角分别为(90.16±6.43)°、(131.45±9.83)°,对照组分别为(90.11±6.37)°、(130.87±9.24)°;两组术后3个月B?hler角、Gissane角与术前比较差异有统计学意义(P0.05);但两组术后3个月B?hler角、Gissane角比较差异无统计学意义(P0.05)。末次随访时,两组Maryland评分各项目评分、总分及优良率比较差异无统计学意义(P0.05)。结论:在复杂跟骨骨折异形钢板内固定术中,采用人工骨和自体骨在促进骨折恢复方面效果相当,且术后切口干燥时间、愈合时间及并发症发生情况相近,但使用人工骨可减少术中出血量,缩短手术时间。     

Panniculectomy at the time of bariatric surgery: a propensity score-matched analysis of outcomes in the MBSAQIP database

BackgroundBody contouring in the postbariatric surgery patient improves quality of life and daily function.ObjectivesTo determine the risk profile of panniculectomy when performed in select patients at the time of bariatric surgery.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating centers.MethodsWe examined the MBSAQIP database (2016-2017), in which data on 379,544 bariatric surgeries are reported. Concurrent panniculectomy procedures were identified by Current Procedural Technology (CPT) codes. Patient characteristics and in-hospital as well as 30-day complications were compared between the body contouring group and propensity score-matched bariatric surgery controls.ResultsOne hundred twenty-four patients met inclusion criteria and were matched to 248 controls. An infra-umbilical panniculectomy was performed in the majority of patients (n = 94, 75.8%). Most patients received an open rather than laparoscopic bariatric surgery (n = 87, 70.2%). There were no statistically significant differences between 30-day mortality (1.9%), wound complications (11.5%), readmission (12.5%) and reoperation (5.8%) between the 2 groups (P > .05). Wound complications occurred in 11.5% of patients and were associated with prolonged hospital stay (odds ratio 4.65, 95% confidence interval 1.99–10.86, P < .001) and a body mass index (BMI) > 50 (odds ratio 3.19, 95% confidence interval 1.02–9.96, P = .046).ConclusionIn select patients, panniculectomy at the time of bariatric surgery was not associated with increased in-hospital or 30-day adverse outcomes compared with matched bariatric surgery controls. This procedure may be performed in select patients, with awareness that revision surgery may be needed once weight loss stabilizes.     

Evaluation of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Disc Herniation: A Retrospective Study

ObjectiveThe objective of the present study was to evaluate the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and open fenestration discectomy (OFD) in the treatment of lumbar disc herniation (LDH).MethodsPatients in our hospital with LDH who received PTED (n = 71) and OFD (n = 39) from 2013 to 2014 were retrospectively studied. Patient information, including age, gender, visual analogue scale (VAS) score for low back pain and leg pain, body weight, height, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and recurrence, was collected. The patients in the two groups were followed up for an average of 63 months after surgery.ResultsA total of 136 patients completed the operation and 110 patients were followed up completely. There was no significant difference in baseline data between the two groups (P > 0.05). The postoperative low back pain, leg pain, ODI, and JOA of the two groups were better than those preoperatively (P < 0.05). One week after surgery, the recovery of PTED patients was better than that of OFD. The ODI score of the PTED group was lower than that of the OFD group (10 [8, 12] vs 14 [11, 16]; P < 0.05), the waist VAS score of the PTED group was lower than that of the OFD group (2 [2, 3] vs 3 [2, 4]; P < 0.05), the leg VAS score of the PTED group was lower than that of the OFD group (1 [0,1] vs 1 [1, 2]; P < 0.05), while the JOA score of the PTED group was higher than that of OFD group [19(16, 20) vs 12(10, 17); P < 0.05]. There were no significant differences in ODI, JOA, waist and leg VAS scores between the two groups at 1 month after surgery and at subsequent follow‐up (P > 0.05). At the end of the follow up, 89.7% (35/39) of patients in the OFD group had excellent improvement in the JOA score, and 88.7% (63/71) of patients in the PTED group had an excellent improvement. There was no significant difference between the two (P > 0.05). There was also no significant difference in the recurrence rate between the two groups [(5/71) vs (3/39); P > 0.05]. [Correction added on 05 March 2021, after first online publication: “3/29” was amended to “3/39” in the preceding sentence.]ConclusionBoth PTED and OFD can achieve good mid‐term efficacy in the treatment of LDH but PTED has certain advantages, including the small incision, a shorter hospital stay, and quicker, earlier recovery. However, prospective randomized controlled studies with a larger sample size are needed.     

严重开放性胫腓骨骨折两种固定法的比较与选择

目的：就钢板内固定与外固定架对严重开放性胫腓骨骨折的治疗结果进行比较分析。方法：２４１例病人,共２５６侧肢体,均为Ⅲ度胫腓骨骨折。用钢板内固定１７４侧,用外固定架６６例,一期截肢１６侧肢体。结果：钢板内固定组一期创面感染率１２．９％,二期创面感染率２１．０５;外固定架组一期创面感染率１３．６４％,二期创面感染率１８．１８％。两种固定法二期创面肉芽长满时间,钢板内固定组（ｎ＝１９）：３周以内６例,占     

颌骨骨折465例治疗体会

目的总结五年颌骨骨折治疗体会,探讨有关问题.方法选用1995年3月至2000年3月治疗的颌骨骨折465例,男348例、女117例.根据就诊时间早晚、致伤原因、骨折部位及分类,治疗方法选择进行总结.结果治疗有效率98.92%,行紧急气管切开术45例,抗体克12例,手术切开复位骨间固定284例,手法或牵引复位外固定181例,术后感染骨延迟愈合8例(1.7%)合并颅脑损伤死亡5例(1.08%).结论①排除颅脑及内脏损伤,保证无窒息、休克发生,通过临床表现确诊骨折类型.②要使骨折片尽早复位,应用坚固内固定技术保证骨块不再移位,恢复伤前咬合关系,软组织要严密缝合.③正确地运用正颌外科技术,使陈旧性骨折达到三维立体方向复位.     

Prevention of postoperative venous thromboembolism following laparoscopic cholecystectomy

Advantages of laparoscopic cholecystectomy are less patient discomfort and shorter hospital stay than with the traditional open approach. Nevertheless, this operation is performed under general anesthesia, using muscle relaxants and pneumoperitoneum, with most patients in the reverse Trendelenburg position. It has been shown that this procedure is associated with significant hypercoagulability and dilation of the veins of the leg. We review the role of these factors as potential risk factors for the development of postoperative venous thromboembolism and also report the rate of thromboembolic complications following laparoscopic cholecystectomy. Based on the available evidence, it is concluded that laparoscopic cholecystectomy, despite being a minimally invasive procedure, may be associated with a definite risk of developing postoperative venous thromboembolism that could extend beyond hospital discharge. Accordingly, thrombosis prophylaxis should be considered for these patients.     

胫骨外侧钢板治疗胫骨开放性骨折

目的:推荐使用胫骨外侧钢板。方法:将107例Ⅰ°、Ⅱ°开放性胫骨骨折随机分组,分别采用胫骨外侧钢板和普通加压钢板治疗,随诊1年～2.5年,比较两组术后功能和感染发生率。结果:发现两组功能评价无显著差异,但胫骨外侧钢板组感染发生率及骨髓炎发生率均明显低于普通加压钢板组(P<0.05)。结论:胫骨外侧钢板能明显降低开放性胫骨骨折的感染率和骨髓炎发生率,值得推荐。     

右前外胸部小切口行心脏不停跳心内直视手术

目的 介绍２７例右前外胸部小切口心脏不停跳体外循环心内直视手术的体会。方法：采用右前外胸部小切口２７例中,男１６例,女１１例,年龄１．８－４２岁,皮肤切口全长,儿童为８－１０ｃｍ,成人１０－１５ｃｍ,第四肋间入胸,在全麻浅低温心脏不停跳体外循环下进行,其中房缺３例,原发孔房缺（Ｐ－ＡＳＤ）１例,室缺（ＶＳＤ）１６例,室缺伴右室流出道狭窄（ＶＳＤ＋ＲＶＯＴ）１例,二尖瓣置换２例,主动脉瓣置换术３例。