关节镜辅助下微创经皮螺钉内固定治疗胫骨平台骨折

目的:探讨关节镜辅助下微创经皮螺钉内固定治疗胫骨平台骨折的可行性及疗效。方法:自2001年1月-2005年1月,应用膝关节镜检查及监测下经皮螺钉内固定治疗胫骨平台骨折27例,按照Schatzker分类法:Ⅰ型9例,Ⅱ型8例,Ⅲ型5例,Ⅳ型5例。所有病例均行经皮骨折有限显露复位,适当植骨,应用1~3枚松质骨拉力螺钉内固定,术后配合CPM功能锻炼。结果:本组随访6~24个月,平均15个月。骨折临床愈合时间3~4个月,平均3·5个月。无畸形愈合、感染、螺钉断裂。按Sanders膝关节功能评分法评定结果:优12例,良11例,中3例,差1例,优良率85·2%。结论:关节镜辅助经皮螺钉内固定是治疗胫骨平台骨折的有效方法之一,其对膝关节创伤小,可达解剖复位,固定可靠,患肢功能恢复好,并发症少。     

腹腔镜与开放性肾囊肿去顶术的临床对照分析

目的评价腹腔镜与开放性肾囊肿去顶术的临床疗效。方法回顾性分析采用经后腹腔镜和经腹腔镜行肾囊肿去顶术21例，其中经腹腔5例，经后腹腔16例，与开放性手术16例比较。结果手术时间，术中平均出血量，术后下床活动时间，术后住院天数，术后并发症腹腔镜组均优于开放手术组，住院费用腹腔镜组略高于开放性手术组。结论腹腔镜肾囊肿去顶术治疗单纯性肾囊肿安全、有效。应成为治疗单纯性肾囊肿的首选方法。     

A literature review of autograft and allograft anterior cruciate ligament reconstruction

Knee anterior cruciate ligament reconstructive surgery has significantly evolved and now includes the option of using an allograft. This has resulted in numerous studies evaluating the advantages and disadvantages of allografts. The purpose of this literature review is to evaluate this research and present important findings to allow the selection of the most appropriate graft source when considering allograft versus autograft reconstruction.     

The current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery

Objective: We assessed the current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery. Methods: Group 1 consisted of 51 patients between 5 and 10 years old who underwent preoperative autologous blood donation. Group 2 consisted of 50 age-matched patients without preoperative donation as controls. Intraoperative donation was conducted in both groups prior to cardiopulmonary bypass. We evaluated perioperative blood cell count, blood loss, and the need for homologous blood products. Results: No serious complications occurred in preoperative or intraoperative donation. Total preoperative donation storage was 17.5±3.4 mL/kg. Intraoperative donation was 21.7 ±6.1 mL/kg in Group 1 and 12.8±4.0 mL/kg in Group 2 (p<0.001). On admission, serum hemoglobin was lower in Group 1 (12.2±1.0 g/dL versus 13.6±1.6 g/dL, p<0.001) but returned postoperatively to the preoperative value. It hovered at a depressed level in Group 2 (12.2±1.4 versus 10.2±1.1 g/dL, p<0.001). The homologous blood requirement was significantly less in Group 1 than in Group 2 (0% versus 10%, p<0.05). Postoperative platelet counts showed similar curves, and blood loss was not statistically significantly different between groups. Conclusion: Preoperative and intraoperative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.     

白内障手术结膜囊及房水细菌培养的临床观察

目的　探讨白内障术中结膜囊、房水污染与眼内炎的关系。方法　对 74例 80眼白内障囊外摘除术中结膜囊及房水进行细菌培养。结果　 16 0份细菌培养标本中 ,细菌培养阳性者 18株 ,平均培养阳性率为 11.3%。房水为 8株 ,检出率为 10 .0 % ;结膜囊为 10株 ,检出率为 12 .5 %。以表皮葡萄球菌为主 (11 18) ,其中 3眼结膜囊及房水检出同一菌株。检出阳性的 15眼无 1例发展成眼内炎。结论　白内障摘除术后前房有少量细菌 ,虽不致发生眼内炎 ,但不可掉以轻心。     

Laparoscopic choledochotomy with primary closure

Background: Thirty-three patients were candidates for laparoscopic choledochotomy. The indications for this operation are described. Methods: The procedure was completed 32 times (97%). We had 29 successful common bile duct (CBD) clearances, three negative explorations, and one failed clearance which needed to be converted to laparotomy. All the completed procedures ended with primary closure of the main duct. Median duration of surgery was 180 min (range 100–300), including three associated laparoscopic procedures. Results: There were three postoperative complications (9.4%), none major. Average postoperative hospital stay was 7.1 days (range 4–14). In May–June 1995 we controlled 31 out of the 32 consecutive patients (one patient was lost to follow-up) who had a successful laparoscopic choledochotomy from October 1991 to December 1994. Median follow-up was 22 months (range 5–44). Besides clinical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography. Two patients died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically. None had signs of postoperative CBD stricture. At US, CBD was ≤7 mm in 15 patients, 8–10 mm in four patients, and 10–12 mm in three patients. The last group had preoperative CBD dilation, too. We could compare preoperative and postoperative CBD diameters in 22 patients: 11 had no change; in nine it decreased; and two had a slight increase (8–10 mm). Conclusions: We conclude that laparoscopic choledochotomy with primary closure is a very good operation: It has a high success rate and low morbidity. Mortality is nil so far. Medium-term results are very positive: We had no CBD stricture and only one case of asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless, and its specific complications are well known. Received: 20 October 1995/Accepted: 28 February 1996     

Referral pattern of patients with oral mucosal lesions in The Netherlands

The referral pattern of 140 Dutch patients with oral mucosal lesions, who had been referred to a Department of Oral & Maxillofacial Surgery and Oral Pathology, shows that patients with oral mucosal lesions consult the dentist as often as the family doctor as the first source of help or information. Furthermore, family doctors were much more used to refer patients with oral mucosal disease to medical specialists rather than to the dentist or the oral and maxillofacial surgeon.     

Laparoscopic-assisted bowel surgery

The use of laparoscopic surgical techniques is now being applied to a variety of operations traditionally performed in an open fashion. Twenty patients underwent laparoscopic-guided large and small bowel surgery at our institution from March 1991 to April 1992. The indications for surgery included polyps, obstruction, bleeding, and perforation, and pathologic diagnoses included benign polyps, lipomas, inflammatory bowel disease, perforation of a jejunal diverticulum, colonic arteriovenous malformations, and adenocarcinoma. Mobilization of the colon, ligation of the mesentery, and closure of the mesenteric defect were performed using the laparoscopic equipment. One trocar site was enlarged to 3 cm to deliver the bowel through the abdominal wall. All anastomoses were hand-sewn. Postoperative hospitalization ranged from 2 to 31 days (median, five days). No mortality was noted, and morbidity was 20 percent. We conclude that laparoscopic-guided bowel surgery is technically feasible and should translate into shorter hospitalization and less patient discomfort.     

Effects of STA-MCA anastomosis for ischaemic oculopathy due to occlusion of the internal carotid artery

Summary Effects of STA-MCA anastomosis on two patients with neovascular glaucoma due to occlusion of the internal carotid artery are presented. Both patients improved in visual acuity and central retinal artery pressure as well as in signs of transient ischaemic attack. Postoperative angiography showed a marked decrease in collateral flow through the ophthalmic artery, which is reversed from the normal direction, with the development of blood flow through the anastomosis. Discussion is offered indicating that the lack of collateral flow through both the anterior and posterior communicating arteries is important in addition to occlusion of the internal carotid artery in order to produce full-blown ischaemic oculopathy such as venous stasis retinopathy, neovascular glaucoma or rubeosis iridis. It is stressed that EC-IC bypass surgery should be performed soon after the appearance of ischaemia and before the development of neovascular glaucoma or rubeosis iridis in order to obtain normal vision. In ischaemic oculopathy the results of EC-IC bypass can be evaluated objectively and quantitatively by many noninvasive neuro-ophthalmological tests which are important in discussing the efficacy of the bypass surgery.