关节镜下胫骨端RigidFix、股骨端IntraFix固定技术重建后交叉韧带

目的探讨胫骨端RigidFix和股骨端IntraFix固定重建技术治疗后交叉韧带损伤的临床疗效。方法2007年3月-2010年3月,采用同种异体胫前肌腱为移植物重建后交叉韧带35例,男27例,女8例。年龄25—42岁,平均32．5岁。左膝12例,右膝23例。移植物胫骨端以RigidFix横穿钉固定,股骨端以Intra Fix挤压螺钉固定。术后通过体格检查、Lysholm评分及国际膝关节文献管理委员会（International Knee Documentation Committee,IKDC）评分来评价手术疗效。结果所有手术成功,无骨折或定位偏离等并发症。术后随访24～60个月,平均35．3月。末次随访时35例胫骨下陷征均为阴性;Lachman征阴性33例,I度阳性2例;后抽屉试验阴性31例,I度阳性3例,Ⅱ度阳性1例。Lysholm评分85．0±4．5（80～98）分,优9例,良25例,中1例。IKDC评分85．1±2．6（81～95）分,A级9例,B级26例。上述指标均较术前明显改善。结论胫骨端RigidFix和股骨端IntraFix固定重建后交叉韧带时不用顾忌移植物长度限制,操作简单;中心固定不会影响移植物的位置,可避免对移植物造成切割,避免干扰腱骨界面。此项技术切实可行、固定可靠,且不易发生并发症,疗效优良。     

基于临床随机对照试验的胰十二指肠切除术后消化道重建方式的系统评价

目的：系统评价胰十二指肠切除术（PD术）后不同的消化道吻合方式及相关辅助方法。方法检索万方数据库和PubMed、The Cochrane Library、Web of Science以及EMBASE等数据库中,关于PD手术后消化道吻合方式的临床随机对照试验（RCT）,采用Jadad量表对纳入文献进行质量分析,提取围手术期情况：包括手术时间、术中出血量、术后发生胰漏、胆漏、出血、胃排空延迟、死亡率、再次手术以及伤口愈合不良等并发症指标,采用RevMan 5．2软件进行Meta分析。结果17篇RCT研究共计2504例病例纳入分析,Meta分析结果显示,胰胃吻合组术后胰漏和胆漏的发生率明显低于胰肠吻合组（OR＝0．60,95％ CI：0．44～0．82,P＝0．00; OR＝0．33,95％ CI：0．13～0．82, P＝0．02）。胰肠吻合组中,胰管-黏膜吻合术与传统端端吻合术后总体并发症发生率以及术后胰漏、再次手术和围手术期死亡的发生率差异均无统计学意义（P＞0．05）。外支架管引流组的术后总体并发症发生率及胰漏、尤其是Ⅱ～Ⅲ级胰漏的发生率和住院时间均明显低于无支架管引流组（均P＜0．05）。结论 PD术后消化道重建方式,推荐采用胰胃吻合,辅以外支架管引流。     

带血管蒂骨瓣转移治疗双侧股骨头缺血性坏死的疗效分析

背景：非创伤性股骨头缺血性坏死（ONFH）常双侧发病,治疗更加困难,采用保留股骨头的治疗方法较为理想。目前,采用带血管蒂骨瓣转移治疗双侧ONFH疗效的报道甚少。 目的：探讨应用带血管蒂髂骨瓣转移治疗双侧ONFH的早中期临床疗效。 方法：2009年1月至2010年12月共收治双侧ONFH患者22例44髋,男10例,女12例;年龄22~41岁,平均32.6岁;体重指数（BMI）16.5~30,平均23.9。按ARCO分期标准分为：Ⅱb期9髋,Ⅱc期14髋,Ⅲa期8髋,Ⅲb期5髋,Ⅲc期8髋。术中所取血管蒂均为旋股外侧血管升支髂棘支骨瓣转移术。双髋分两次进行手术,手术间隔12~16个月,平均14个月。 结果：随访时间为36~47个月,平均40.3个月,单髋术中失血量200~500 ml,平均358 ml。双侧髋关节术后6个月、12个月的Harris髋关节评分（HHS）均较各自术前有明显提高;双侧髋关节术后相同时间点的HHS评分比较无统计学差异。初次手术侧1髋术后出现切口脂肪液化经换药痊愈,其余均无围手术期并发症。术后根据ARCO分期标准2髋由Ⅲb期病变进展至Ⅲc期;1髋由Ⅲc期进展至Ⅳ期,并于术后14个月进行人工关节置换手术。 结论：应用带血管蒂髂骨瓣转移分两次手术治疗双侧ONFH,合适的手术间隔对初次手术侧功能恢复影响较小,双侧髋关节术后早期临床功能评价较高,是治疗双侧ARCOⅡ~Ⅲ期ONFH的有效方法。     

Immediate birth – an analysis of women and their babies undergoing time critical birth in a tertiary referral obstetric hospital

BackgroundAt our institution, the emergency obstetric ‘code green’ activates the system for immediate birth, usually by caesarean section. This study aimed to determine the incidence of immediate birth, indications, modes of anaesthesia, and short-term neonatal and maternal outcomes.MethodA review was performed for all women at the Royal Women’s Hospital, Parkville, Australia who underwent immediate birth over a two-year period: January 1, 2013 to December 31, 2014.ResultsWithin the study period 14,115 women gave birth, of which 387 women underwent an immediate birth, the majority (83%) by caesarean section. The commonest indication for immediate birth was prolonged fetal bradycardia (53%), however cord prolapse (4%) produced the most rapid decision-to-delivery interval, with a median [IQR] time of 14 [13–16] min versus 18 [14–23] min for all immediate births (P < 0.01). Epidural top-up was the most common anaesthesia method. Conversion to general anaesthesia following inadequate neuraxial anaesthesia occurred in 6.2% of women. Among 103 general anaesthetics, there was one failed intubation (successful ventilation) and one dental injury. Nine women (2.3%) were admitted to the high dependency or intensive care units, and there were no maternal deaths. Babies born by caesarean section with a decision-to-delivery interval of less than 30 min were more likely to have longer times to establish respiration (22.6% vs 16.7%, P < 0.001).ConclusionRequest for immediate delivery is a common obstetric emergency. Epidural top-up has become the most common anaesthetic technique. Rapid delivery times can be achieved with an integrated emergency response system.     

股前外侧肌皮瓣修复小腿截肢残端软组织缺损

目的 探讨股前外侧肌皮瓣修复小腿截肢残端软组织缺损,保留小腿长度或膝关节以利于假肢装配.方法 2013年4月-2016年11月,应用股前外侧肌皮瓣对小腿截肢残端软组织缺损进行修复4例,其中游离肌皮瓣3例,带蒂肌皮瓣1例.患者均为男性,截肢肌创面位于小腿近端,年龄8~48岁,平均20岁,创面面积7.0 cm×6.0 cm^25.0 cm×10.0 cm.一期清创后二期修复,肌皮瓣面积13.0 cm×10.0 cm^28.0 cm×12.0 cm,保留胫骨长度5.2~9.4 cm.结果 肌皮瓣全部成活,1例肌皮瓣边缘出现浅表感染经换药处理后愈合,供区无并发症.所有患者随访12~37(平均19)个月,末次随访时皮瓣血运好、质地柔软、耐磨.皮瓣感觉恢复程度:S22例, S31例,S3+1例. 6 min步行测试:Ⅳ级2例,Ⅲ级2例;Stanmore运动分级:V级2例,Ⅳ级2例.结论 股前外侧肌皮瓣是修复小腿截肢残端软组织缺损的理想皮瓣.     

Factors impacting long-term pulmonary autograft durability after the Ross procedure

Objective

Although the Ross procedure provides excellent long-term survival and a high quality of life, its use has been limited to relatively few centers. In this study, we evaluated long-term Ross procedure results in adults to assess the predictors of pulmonary autograft durability.

Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction

BackgroundExtensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers.MethodsWe present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues.ResultsAt one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported.ConclusionsSecond EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible.Level of evidenceIV (Case Series).     

ADDIN CNKISM.UserStyle手术切除联合一期腹膜前间隙补片修补治疗腹壁韧带样纤维瘤的疗效

目的探讨手术切除联合腹膜前间隙补片修补治疗腹壁韧带样纤维瘤的临床疗效。 方法采用回顾性横断面研究方法,收集2005年4月至2018年7月四川大学华西医院收治的19例腹壁韧带样纤维瘤患者的临床资料,患者均行腹壁韧带样纤维瘤手术切除联合补片修补术。观察指标：（1）手术及术后情况：合并症、肿瘤大小、病理分型、住院时间、术后并发症情况;（2）随访情况：腹壁韧带样纤维瘤远期并发症情况及术后放化疗情况。采用电话、门诊或住院方式对患者进行为期12个月的随访,了解患者肿瘤复发及远期并发症发生的情况。随访时间截至2019年7月。 结果所有患者均行根治性肿块切除术和腹壁修补术,未进行术后放化疗。4例免疫组化结果显示肿瘤细胞均呈β-catenin表达,SMA（＋）3例,Desmin（灶性＋）1例。无术后并发症,随访期间内无肿瘤复发,也无远期并发症发生;住院时间9～22 d,平均14.8 d。 结论韧带样纤维瘤是一种交界性肿瘤,易复发,首选外科手术治疗,术中扩大切除,借助冰冻切片,保证切缘阴性。对于切除后造成的腹壁缺损,应对腹壁进行一期重建。