常规开腹手术治疗卵巢囊肿的临床应用

目的探讨卵巢囊肿患者采取常规开腹手术治疗的临床效果。方法选取48例卵巢囊肿患者,均接受常规开腹手术治疗,统计分析患者的临床治疗效果、不良反应发生情况、治疗前后卵巢功能指标(雌二醇、促黄体生成激素、血清卵巢雌激素)。结果治疗后,患者中显效20例(41.67%),有效28例(58.33%),无效0例(0),临床治疗总有效率为100.00%。术后患者发生疼痛1例,发热2例,出血1例,未发生感染,不良反应发生例数为4例,不良反应发生率为8.33%。患者治疗前的雌二醇为(68.21±4.10)pg/ml,治疗后3个月为(55.25±3.84)pg/ml,患者治疗后3个月的雌二醇低于治疗前,差异具有统计学意义(t=15.984,P=0.000<0.05)。患者治疗前促黄体生成激素为(8.68±2.84)U/L,治疗后3个月为(10.18±3.10)U/L,患者治疗后3个月的促黄体生成激素高于治疗前,差异具有统计学意义(t=2.472,P=0.015<0.05)。患者治疗前血清卵巢雌激素为(6.54±1.26)U/L,治疗后3个月为(7.98±1.30)U/L,患者治疗后3个月的血清卵巢雌激素高于治疗前,差异具有统计学意义(t=5.511,P=0.000<0.05)。结论卵巢囊肿患者采取常规开腹手术治疗能有效改善卵巢功能,临床疗效较高,同时产生不良反应较少,安全性较高,具有一定临床推广和应用价值。     

Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures

BackgroundOpen pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.MethodsA query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher’s exact test and chi-square test for categorical variables, and Welch’s t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.ResultsA total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.ConclusionWe report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.Level of EvidenceLevel II, Retrospective study.     

Clinical outcomes of open treatment of old condylar head fractures in adults

The aim of this study was to classify the clinical feasibility and outcomes of open reduction treatment of old condylar head fractures (CHFs).This was a retrospective case series study of patients with old CHFs that were treated with open reduction and internal fixation, with anatomic reduction and sutured fixation of the articular disc. Preoperative and postoperative examinations were recorded and analyzed, including temporomandibular joint (TMJ) symptoms, occlusion, maximum interincisal opening (MIO), and mandibular deviation. Computed tomography (CT) was used to assess condylar morphology and position.Eleven patients with old CHFs were included (nine unilateral and two bilateral). The mean period from condylar fracture to operation was 8.9 months (ranging from 6 to 14 months). The mean follow-up period after surgery was 16.1 months (ranging from 12 to 22 months). At the end of follow-up period, no malocclusion was found, and the MIO had expanded considerably to 37.4 ± 3.8 mm. Postoperative CT showed that all fragments were properly reduced and the condyles were in the normal position. All patients showed apparently improved TMJ function, occlusion, and facial appearance.Our results showed that open reduction treatment could be an effective method for the treatment of old CHFs.     

Fixation of subcondylar fractures of the mandible: a randomized clinical trial comparing one trapezoidal plate with two miniplates

Subcondylar fracture of the mandible accounts for 25–35% of all mandibular fractures. In the past, most subcondylar fractures were managed non-surgically. The traditional method of fixation for subcondylar fractures uses two miniplates; however some bench studies have reported that trapezoidal plates are superior. The aim of this study was to compare the outcomes of subcondylar fractures fixed either with two non-parallel straight miniplates or with one trapezoidal plate. A randomized clinical trial was designed and implemented. Fifty-two consecutive patients with subcondylar fractures were recruited. All patients underwent surgery via a retromandibular approach. The time taken for fixation of the plate after fracture reduction and postoperative outcomes and complications were compared between the groups. The trapezoidal plates were superior in terms of ease of adaptation and time taken for fixation (P =  0.0001). Plate fracture was observed only in the two miniplates group, in four (16%) patients. Outcomes were similar in the two groups in terms of occlusion, mouth opening, protrusion, and lateral excursion. In conclusion, both systems – two miniplates and the trapezoidal plate – provide functionally stable fixation. The outcome was significantly better for the trapezoidal plate than for two miniplates regarding the time taken for insertion and ease of adaptation, but not for other parameters.     

Immediate weight bearing after plate fixation of fractures of the tibial plateau

BackgroundProximal articular fractures of the tibia are commonly stabilised with internal fixation using plates and screws. There is a lack of evidence and conflicting guidelines as to the most suitable post-operative rehabilitation regime including weight bearing status. There are numerous physiological and socioeconomic benefits of early weight bearing after orthopaedic surgery, but concerns remain around loss of fracture reduction. Therefore, the aim of this study is to investigate whether the weight bearing status after tibial plateau plate fixation is associated with any loss of reduction or articular collapse.MethodsWe retrospectively analysed data from our prospectively collected major trauma centre database. All tibial plateau fractures that required open reduction and internal fixation with plate and screws were included. The immediate post-operative weight bearing status of these patients was recorded. Group I consisted of those patients that were either non-weight bearing or touch weight bearing for the first six post-operative weeks. Group II consisted of patients who were instructed to weight bear fully (as tolerated) immediately after the operation. Radiographs were taken on day one post-operation, at six weeks and at three months and analysed for fracture displacement and joint depression or loss of fixation.ResultsA total of 90 patients were included in the study. Group I (non-weight bearing or touch weight bearing) consisted of 60 patients (67%). Group II (full weight bearing as tolerated) consisted of 30 patients (33%). The follow up radiographs demonstrated no failure of fixation in either study group. One patient from the weight bearing group had >1 mm joint depression (4 mm) identified at the first follow up, which did not progress.ConclusionsThis study shows immediate post-operative full weight bearing does not affect the fixation or cause articular collapse up to three months after surgery and thus we propose that patients should be allowed to weight bear immediately after surgical stabilisation of tibial plateau fractures. This will enable patients to benefit from the positive effects on fracture healing of early weight bearing post-surgery and avoid the complications of non-weight bearing without loss of fixation or articular collapse.     

Treatment and outcome of open dislocation of the ankle with complete talar extrusion: A case report

BackgroundOpen total talar extrusion is a severe, disabling ankle injuries. The most appropriate treatment (reimplantation versus talar body removal and tibiocalcaneal arthrodesis) is still a controversial challenge; outcomes and fearful potential complications are not predictable.ObjectiveTo report the case of an open ankle dislocation with talar extrusion, focusing on treatment modality and outcomes.MethodImmediate reduction, surgical debridement and external fixation were performed under antibiotic coverage. Wound closure was achieved with accurate debridement, postoperative strict clinical surveillance and meticulous handling of medications. The patient maintained external fixator for three weeks, then kept non-weight bearing with a cast for an additional four weeks.ResultsThe patient's wound healed with no complications. Full weight-bearing was gained at 12 weeks postoperation. At 18 months postoperatively, the patient did not develop any infection or avascularnecrosis, which are the major complications associated to talar extrusion.ConclusionsGood treatment procedure for a such severe open trauma, based on accurate debridement, wound care and stable temporary immobilization with external fixation allow reduction of infection risk and made preservation of extruded talus a successful option to preserve function and normal hindfoot anatomy at first instance. Talectomy should be considered as a salvage procedure.     

Colorectal cancer diagnosis: Pitfalls and opportunities

Colorectal cancer (CRC) is a major health problem in the Western world. The diagnostic process is a challenge in all health systems for many reasons: There are often no specific symptoms; lower abdominal symptoms are very common and mostly related to non-neoplastic diseases, not CRC; diagnosis of CRC is mainly based on colonoscopy, an invasive procedure; and the resource for diagnosis is usually scarce. Furthermore, the available predictive models for CRC are based on the evaluation of symptoms, and their diagnostic accuracy is limited. Moreover, diagnosis is a complex process involving a sequence of events related to the patient, the initial consulting physician and the health system. Understanding this process is the first step in identifying avoidable factors and reducing the effects of diagnostic delay on the prognosis of CRC. In this article, we describe the predictive value of symptoms for CRC detection. We summarize the available evidence concerning the diagnostic process, as well as the factors implicated in its delay and the methods proposed to reduce it. We describe the different prioritization criteria and predictive models for CRC detection, specifically addressing the two-week wait referral guideline from the National Institute of Clinical Excellence in terms of efficacy, efficiency and diagnostic accuracy. Finally, we collected information on the usefulness of biomarkers, specifically the faecal immunochemical test, as non-invasive diagnostic tests for CRC detection in symptomatic patients.     

开腹与后腹腔镜术式治疗肾上腺良性肿瘤的比较

目的 探讨开腹与后腹腔镜术式对肾上腺良性肿瘤患者围手术期临床指标、ICU转送率及并发症的影响。方法 选取120例肾上腺良性肿瘤患者为研究对象，以随机数字表法分为对照组和观察组，每组各60例；其中对照组患者采用开腹术式治疗，观察组患者则采用后腹腔镜术式治疗；比较两组患者的手术时间、术中失血量、肛门排气时间、术后引流量、术后拔管时间、住院时间、ICU转送率及并发症发生率。结果 观察组患者手术时间、肛门排气时间、术后拔管时间及住院时间均显著短于对照组（P＜0.05）；观察组患者术中失血量和术后引流量均显著少于对照组（P＜0.05）；两组患者ICU转送率比较差异无统计学意义（P＞0.05）；同时观察组患者术中和术后并发症发生率均显著低于对照组（P＜0.05）。结论 后腹腔镜术式治疗肾上腺良性肿瘤可有效减轻医源性损伤程度，促进术后早期康复，且有助于避免术中及术后出现并发症，其临床应用价值优于开腹术式。     

异位妊娠腹腔镜手术治疗与开腹手术治疗的疗效比较

目的：探讨腹腔镜手术治疗异位妊娠的疗效及临床价值。方法选取我院2010年11月-2012年10月收治的68例异位妊娠患者，按照手术方式不同，分为接受腹腔镜手术治疗的实验组和接受开腹手术治疗的对照组，实验组患者35例，实验组患者33例。通过观察实验组和对照组患者的手术时长、术中出血量、患者术后首次排气时间、首次下床活动时间和住院的时间来对比两种手术方案的疗效。结果通过观察和统计得出，两组患者手术均顺利完成并且没有中转开腹的患者。两组患者的手术时长差异无统计学意义（P＞0.05）；但是实验组患者在术中出血量、术后首次排气时间、首次下床活动时间和住院时间方面均优于对照组，差异有统计学意义（P＜0.05）。结论腹腔镜手术在治疗异位妊娠时，安全性高、创伤小、术后恢复快、患者满意度高，可在临床上推广使用。