A surgical treatment for frank rupture of acute type a small intramural hematoma

A 71‐year‐old woman was admitted to the hospital due to cardiac tamponade. Computed tomography revealed that the diameter and wall thickness of the ascending aorta were 36 and 9 mm, respectively. An emergent ascending aortic replacement was performed uneventfully. The pathological findings indicated frank rupture of intramural hematoma.     

帕瑞昔布钠超前镇痛对髋关节置换术患者IL-6和TNF-α的影响

目的：探讨帕瑞昔布钠超前镇痛对髋关节置换术后患者炎症细胞因子的影响,并进一步观察术后镇痛效果。方法本组患者60例,年龄40~65岁,ASAⅠ-Ⅱ级,择期在全麻下行髋关节置换术。随机分成观察组和对照组,每组30例。麻醉前20 min观察组静脉注射帕瑞昔布钠40 mg（用生理盐水稀释成4 mL）,对照组静脉注射生理盐水4 mL。分别于静推帕瑞昔布钠或生理盐水前10 min（T1）、术毕（T2）、术后6 h（T3）、术后12 h（T4）、术后24 h（T5）采上肢静脉血样,测定IL-6、TNF-α的血浆浓度。采用视觉模拟评分法（VAS）评价术毕即刻、术后2 h、6 h、12 h、24 h镇痛效果。结果患者血浆IL-6浓度于T3、T4、T5时点较术前显著升高,差异有统计学意义（P〈0.05）;观察组血浆IL-6浓度于T3、T4、T5时点比对照组显著降低,差异有统计学意义（P〈0.05）。患者血浆TNF-α浓度于T4、T5时点较术前显著升高,差异有统计学意义（P〈0.05）;观察组血浆TNF-α浓度在T4、T5时间点比对照组显著降低,差异有统计学意义（P〈0.05）。观察组患者在术毕即刻、术后2 h、6 h、12 h VAS评分均显著低于对照组,差异有统计学意义（P〈0.05）。结论帕瑞昔布钠超前镇痛可有效缓解全髋关节置换术患者术后疼痛,抑制炎性介质释放,降低神经系统敏感性,利于患者术后康复。     

人工肱骨头置换治疗老年肱骨近端复杂骨折

目的 探讨应用人工肱骨头置换治疗老年肱骨近端复杂骨折的手术适应证、手术时机、操作要点及术后康复等.方法 选取我院2009年1月至2012年3月收治的老年肱骨近端Neer三、四部分骨折行人工肱骨头置换术患者25例,男15例,女10例;年龄64.0～89.0岁,平均73.6岁.手术中均假体植入得当,准确复位固定大小结节,修复肩袖,术后早期分阶段功能康复锻炼.随访应用Neer肩关节功能评分标准评估疗效.结果 手术时间60～110 min,平均80 min;术后随访9～24个月,平均14个月.所有患者均无感染、假体周围骨折、假体松动等并发症.Neer评分显示优良率84％,患者均能完成日常活动,患者主观满意度为76％.结论 通过严格把握手术适应证,掌握手术时机及操作要点,配合术后积极的功能康复训练,人工肱骨头置换术是治疗老年肱骨近端复杂骨折较满意的方法.     

经股动脉与经心尖主动脉瓣置换术患者CT影像差异及分析

目的 探讨经股动脉主动脉瓣置换手术（TF-TAVR）和经心尖主动脉瓣置换手术（TA-TAVR）患者的CT影像学表现及差异。方法 选取我院经导管主动脉瓣置换手术（TAVR）共198例患者的临床资料,依据手术方式分成TFTAVR组100例和TA-TAVR组98例,术后经CT检查评定有无并发症发生,对比TF-TAVR组、TA-TAVR组患者的CT影像学参数和术后并发症出现情况。结果 两组（左冠状动脉,LM）至主动脉瓣环距离、窦直径、窦管交界直径、左心房大小及升主动脉钙化比例相比差异无统计学意义（P> 0.05）,TF-TAVR组的右冠状动脉（RCA）至主动脉瓣环距离及左心室大小均大于TA-TAVR组（P<0.05）。TF-TAVR组的瓣周漏出现比例为63.00%高于TA-TAVR组42.86%(P<0.05);TF-TAVR组的心包积液出现比例为18.00%高于TA-TAVR组7.14%(P<0.05);TF-TAVR组的肺膨胀不全出现比例为3.00%低于TA-TAVR组11.22%(P<0.05);TF-TAVR组的胸腔积液出现比例为43.00%和TA-TAV...     

老年难治性心力衰竭患者连续性肾脏替代治疗的效果及对血清因子水平的影响

目的 探讨老年难治性心力衰竭患者连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的效果及对血清C反应蛋白(Creactive protein,CRP)、半乳糖凝集素-3 (galectin-3,Gal-3)、氨基末端脑钠肽前体(N-terminal pro-bra...     

Total arch replacement using frozen elephant trunk technique with Frozenix for distal aortic arch aneurysms

Open in a separate window OBJECTIVESTotal arch replacement (TAR) using an endovascular approach has been initially introduced as the frozen elephant trunk technique (FET). In our institute, TAR using the FET with Frozenix has been used as the first-line treatment for distal aortic arch aneurysms since 2014. This study aimed to evaluate the early and long-term outcomes and demonstrate the efficacy of this procedure.METHODSBetween 2014 and 2021, 121 consecutive patients were treated with TAR using the FET with Frozenix for distal aortic arch aneurysms. Early and long-term outcomes were retrospectively analysed.RESULTSThe 30-day mortality rate was 2.5% (3/121). Of postoperative complications, paraplegia due to spinal cord injury occurred in 2 (1.7%) patients, stroke in 12 (9.9%) and acute renal failure in 10 (8.3%). At follow-up, 23 secondary aortic interventions were required and 8 (6.6%) patients underwent intended secondary thoracic endovascular aortic repair for residual descending aortic aneurysm. Late and aortic-related deaths occurred in 16 (13.2%) and 4 (3.3%) patients, respectively. The overall long-term survival rates at 1, 3 and 5 years were 87.6%, 83.1% and 65.4%, respectively, while the rates of freedom from aortic-related death at 1, 3 and 5 years were 95.7%, 95.7% and 84.8%, respectively.CONCLUSIONSTAR using the FET with Frozenix for distal aortic arch aneurysms has acceptable early mortality and morbidity. Spinal cord injury and paraplegia occur less frequently than previously reported. The technique has satisfactory long-term survival and freedom from aortic-related death.     

Single-stage repair for ascending aortic aneurysm,artery stenosis and occlusion of neck vessels caused by Takayasu arteritis

Takayasu arteritis results in a variety of vascular symptoms, and there are some cases in which progressive vascular lesions require surgical intervention. We present a case with ascending aortic aneurysm, right common carotid artery stenosis, left common carotid artery occlusion and left subclavian artery stenosis caused by Takayasu arteritis that was successfully treated with total arch replacement and ascending aorta to right internal carotid artery bypass.     

后路小切口人工全髋关节置换术

目的 观察后路小切口人工全髋关节置换术（total hip arthroplasty，THA）的临床效果。方法 将70例患者按年龄、性别、体重指数、病种、髋关节功能配对分为两组进行前瞻性研究。35例小切口组，术前Harris评分52．21（24～76），35例标准后路手术组（简称标准组），术前Harris评分51．6（33～68）。分析手术时间、术中出血＋术后12h引流量、并发症、切口长度、疼痛评分、Harris评分等。结果 平均随访11.5个月（6～14个月）。两组手术时间相近。小切口组平均切口长9．0cm（7．0～12cm），标准组16cm（12—20cm），两组差异有统计学意义（P〈0．01）；小切口组平均出血500ml（270～700m1），29％（10／35）需输血，输血量约400ml，而标准组平均出血约950ml（600～1200m1），100％需输血，平均输血650ml，小切口组明显比标准组具有优势（P〈0．05）；小切口组疼痛评分平均为4．8分，标准组为6．8分（P〈0.01）。术后6个月，小切口组Harris评分94．0（84～100），标准组Harris评分90．5（82～94）。结论 后路小切口微创技术具有创伤小、出血少、疼痛小、恢复快的特点，可获得与常规后路手术相同的冶疗效果。     

胫骨结节撕脱性骨折的治疗

1997年8月～2010年9月,我科手术治疗32例胫骨结节撕脱性骨折患者,效果良好,报道如下。1材料与方法1.1病例资料本组32例,男27例,女5例,年龄14～19岁31例,52岁1例。左侧19例,右侧13例。骨折按Watson-Jones分型[1]:Ⅰ型4例,Ⅱ型19例,Ⅲ型9例。伤后至就诊时间50min～2 d。