关节镜下两种方法治疗胫骨髁间嵴骨折的疗效对比

目的比较关节镜下缝线套扎方法和可吸收带线锚钉方法治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。 方法选取2012年6月至2018年2月解放军总医院第一医学中心骨科收治的62例损伤3周以内、伤前患肢功能正常的前交叉韧带胫骨止点撕脱骨折患者为研究对象,同时排除伴有开放性骨折、多发骨折或胫骨平台、半月板及韧带损伤的患者。根据手术方法不同将其分为两组,其中关节镜下应用缝线套扎方法治疗30例患者,关节镜下应用可吸收锚钉方法治疗32例患者。比较两组患者的手术时间、术中出血量;通过前抽屉试验、Lachman试验(屈膝30°前抽屉试验)、轴移试验检查比较两组患者膝关节稳定性;通过Lysholm评分、国际膝关节文献委员会(IKDC)2000膝关节功能主观评分比较两组患者膝关节功能情况。计量资料组间比较采用独立样本t检验,组内比较采用配对t检验,计数资料组间比较采用卡方检验。 结果两组患者手术切口均一期愈合,术后3个月X线检查示髁间嵴撕脱骨折均愈合。缝线套扎组随访13～42个月,平均(22±8)个月;可吸收锚钉组随访12～39个月,平均(19±7)个月。可吸收锚组手术时间低于缝线套扎组,差异有统计学意义(t＝2.491,P <0.05),两组术中出血量差异无统计学意义(t＝1.506,P>0.05)。两组患者术后6个月Lysholm评分较术前提高,差异有统计学意义(缝线套扎组：t＝26.265,P<0.05;可吸收锚钉组：t＝29.857,P<0.05),两组患者术后IKDC 2000膝关节功能主观评分较术前提高,差异有统计学意义(缝线套扎组：t＝35.619,P <0.05;可吸收锚钉组：t＝37.004,P<0.05),术后6个月两组患者膝关节前抽屉试验、Lachman试验、轴移试验及Lysholm评分、IKDC 2000评分差别无统计学意义(P>0.05)。 结论关节镜下缝线套扎方法与可吸收锚钉方法治疗胫骨髁间嵴撕脱性骨折各有其特点,但临床治疗效果相同,均能够实现骨折块有效复位、牢固固定以及骨折愈合,有效恢复患肢功能,获得良好疗效。     

单向倒刺线与传统缝线在腹腔镜胆总管一期缝合术中应用比较的Meta分析

目的:比较腹腔镜胆道探查术后胆总管一期缝合术中采用单向倒刺线(UBS)与传统缝线(TS)的临床效果。方法:检索中英文数据库中比较UBS与TS在腹腔镜胆道探查胆总管一期缝合术中应用的临床研究,检索时间最后为2018年9月。在对纳入研究进行方法学质量评价和数据提取后,采用RevMan5.1和STATA12.0软件行Meta分析。结果:最终纳入10个研究,包括3个随机对照研究(RCT)和7个观察性研究,共848例患者。整体分析显示,与TS组比较,UBS组胆管缝合时间(WMD=-11.38,95%CI=-14.81～-7.94,P0.001),手术时间(WMD=-20.55,95%CI=-30.63～-10.46,P0.001)和住院时间(WMD=-0.78,95%CI=-1.47～-0.09,P0.05)均明显缩短,术后胆汁漏发生率明显降低(RR=0.23,95%CI=0.10～0.55,P0.001)。基于研究设计的亚组分析结果显示,两组除住院时间在RCT研究中无统计学差异(WMD=-0.06,95%CI=-0.61～0.49,P=0.83),其余均与整体分析结果一致。结论:UBS不仅为腹腔镜胆总管一期缝合提供了一个新途径,且安全可行。未来还需要更多的多中心大样本随机对照试验来予以验证。     

多针头手术缝线中垫片的设计与观察

目的:对多针头手术缝线中垫片的使用进行设计并观察在心室切口中的缝合效果。方法:在5个游离猪心上模拟左心室壁切口,对多针头手术缝线中各种垫片的使用情况进行设计,并在左心室壁切口中使用带垫片的多针头手术缝线进行缝合,对心室壁切口缝合的效果、针孔处组织的撕裂程度以及垫片对手术操作的影响等方面进行观察。结果:根据置放垫片的先后顺序不同,可以设计出两类置放垫片的方式,在术中临时置放垫片的设计有利于防止针孔处组织的撕裂和出血的发生。结论:在使用多针头手术缝线时合理置放垫片,可以防止撕裂针孔处心脏组织,使多针头手术缝线的优点充分得到发挥。     

ACL femoral avulsion repair using suture pull-out technique: A case series ofthirteen patients

Purpose

Anterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort.

Tie Hard 2- An in-Vitro Comparison of First Throw Tension Holding In Twisted v Straight-First Throws; Using Polyglycolic acid (Dexon S), Polyglactin 910 (Coated Vicryl)

Objective: To compare the first throw tension holding properties of twisted versus straight first throws in two commonly used Oculoplastic braided absorbable sutures.

Design: An in-vitro experimental model.

Methods: Variable loads were applied to the first double throw of a surgical knot – either in straight-line configuration or twisting the knot using both 6/0 Polyglycolic acid (Dexon S) and 6/0 Polyglactin 910 (Coated Vicryl). Each suture was tested to the point of knot slipping and the critical tension recorded. Two variations of the experiment were undertaken: Experiment 1 – two metal loops were brought together by the test suture, experiment 2 – two strips of tissue (Permacol - cross-linked porcine dermal collagen) were brought together by the test suture.

Results: Experiment 1 straight: Polyglycolic acid 12.2g (11-13.5), Polyglactin-910 2.5?g (2.5- no range). Experiment 1 twisted: Polyglycolic acid 13.33?g (10–15), Polyglactin 910 3?g (2–5). Experiment 2 straight: Polyglycolic acid 33g (30-35), Polyglactin 910 25g (25 – no range). Experiment 2 twisted: Polyglycolic acid 35 (30-40), Polyglactin 910 25g (20–30).

Conclusions: Twisting the suture adds only a modest increase in first throw knot security. Polyglycolic acid (Dexon S) braided absorbable suture has significantly better first throw knot security when compared with Polyglactin-910 (coated Vicryl). This is an important property when suturing tissues under tension as it minimises slippage before the locking throw is tied.     

肠吻合采用不同缝线对克罗恩病术后复发的影响

目的探讨克罗恩病（CD）患者在肠切除吻合时使用不同缝线对CD术后复发的影响．方法回顾性分析2002年1月至2010年1月在南京军区南京总医院行肠切除肠吻合术的102例CD患者的临床资料,比较采用可吸收线（可吸收线组,48例）与丝线（丝线组,54例）进行缝合的患者术后内镜复发和临床复发情况。结果可吸收线组和丝线组术后1、2、3年累计临床复发率分别为6．3％、14．6％、22．9％和18．5％、27．8％、35．2％。差异无统计学意义（P=0．213）;两组术后1年和2年累计内镜复发率分别为14．7％、38．2％和22．9％、62．9％,差异有统计学意义（P=0．034）。结论CD患者在实施肠切除吻合术时采用可吸收线进行缝合相对于丝线能够显著降低CD术后内镜复发率;可吸收线可考虑作为CD肠吻合的首选缝合材料。     

Long term outcome of patella fractures:open reduction and internal fixation with stainless steel wire vs.non-absorbable braided polyester suture

目的 比较不锈钢钢丝与不可吸收涤纶编织线治疗髌骨骨折的长期疗效.设计 前瞻性对照研究.从2000年至2005年,通过随机抽取密封号码,一组连续的患者被安排收入2组,分别行不锈钢钢丝环扎和不可吸收涤纶编织线缝合治疗髌骨骨折,每组采用相同的手术技术和术后治疗策略.对象 年龄＞ 16岁,有移位的髌骨骨折并适合内固定治疗的患者.同时患者依从性较好,能提供知情同意,可以配合医生行术后康复治疗.干预方法 两组均采用标准的切开复位内固定方法,使用2枚纵形克氏针,“8”字形张力带,18G不锈钢钢丝或者2股5号涤纶编织线环扎固定.结果 评估 主要结果评估为再手术率.次要结果评估包括手术时间、临床和影像学愈合以及末次随访收集的患者膝关节功能评分(膝关节问卷,Euroqol EQ-5D,SF-36).结果 22例患者中有20例达到临床和影像学愈合.不锈钢钢丝环扎组和涤纶编织线缝合组平均随访时间分别为4年和2.3年,再手术例数分别为4例(共11例)和5例(共11例).大多数再手术患者是由于纵向克氏针的疼痛刺激(6/9).不锈钢钢丝环扎组手术时间(44 min)较涤纶编织线缝合组(33 min)少,但差异无统计学意义.长期功能评分显示患者有残留的功能障碍,但并不影响膝关节的总功能.结论 我们认为纵形克氏针过长是髌骨骨折采用张力带固定后发生再手术的一个主要原因.涤纶编织线缝合与不锈钢钢丝环扎均可达到临床和影像学愈合.髌骨骨折患者可以得到较为理想的功能恢复,但康复过程中再手术的几率会较高.     

可吸收线连续缝合在无张力腹外疝修补术中的应用

目的探讨可吸收线连续缝合在腹外疝无张力修补术中应用的安全性及效果。方法使用可吸收线连续缝合无张力疝修补术治疗腹股沟疝79例、切口疝4例,观察术后疼痛、切口感染、慢性疼痛及复发等并发症。结果83例术后随访6个月～5年,1例右下肢高位截肢后同侧巨大斜疝病人发生术后疝囊残腔积液,无复发;其余病例无因局部疼痛用止痛剂者,无切口感染、浆液肿、阴囊血肿、疝复发、睾丸萎缩等并发症。结论可吸收线连续缝合在腹外疝无张力修补术中的使用可减少复发、疼痛、感染等并发症,安全有效。     

Long-term quality of life after endoscopic dilation of strictured colorectal or colocolonic anastomoses

BACKGROUND: Endoscopic balloon dilation is the first-line treatment for benign colorectal anastomotic strictures. We aimed to objectively assess its long-term results. METHODS: Gastrointestinal symptoms and health-related quality of life (HRQoL) were assessed at long-term after balloon dilation of anastomotic strictures in 31 consecutive patients (excluding those with inflammatory bowel disease) as well as and controls, using the validated Gastrointestinal Quality of Life Index (GIQLI). Most colectomies had been performed for benign diseases, with anastomoses located at the colorectal junction. RESULTS: Completed surveys were collected from 81 subjects, including 27 study patients (response rate 87%), 27 surgical controls matched for age, gender, and indication of colectomy, and 27 healthy subjects. At a mean of 3.9 +/- 2.3 years after the first endoscopic balloon-dilation, study patients self-reported significantly more gastrointestinal symptoms than controls; these included frequent and urgent bowel movements, bloating, food restriction (p < or = 0.001, all comparisons), diarrhea, excessive passage of gas through the anus (p < 0.01, all comparisons), constipation, and abdominal pain (p < 0.05, all comparisons). Health-related quality of life was significantly impaired in study patients versus surgical controls and healthy subjects (GIQLI scores, 104 +/- 20, 119 +/- 24, and 121 +/- 16, respectively; p = 0.005). Impaired HRQoL subdimensions included gastrointestinal symptoms (p < 0.001), stress by treatment (p < 0.05), and emotional status (p = 0.08). HRQoL was independent of the delay between stricture dilation and the survey. Follow-up endoscopy (performed in 21/27 [78%] study patients, including the 7 patients with the lowest HRQoL, and 19 [70%] surgical controls) disclosed anastomoses larger than 13 mm in all cases. CONCLUSIONS: Health-related quality of life is significantly impaired at long-term after standard balloon-dilation of benign anastomotic colorectal strictures as a result of gastrointestinal symptoms and stress by treatment. This impairment might be related to the fact that an anastomotic diameter > or = 13 mm, although commonly used to define successful endoscopic treatment, is insufficient to provide long-term symptom relief in some patients, or to other, yet to be identified, factors.     

针刺颅骨缝治疗脑血管疾病的应用解剖

目的：为针刺颅骨缝治疗脑血管疾　病提供临床实用表面解剖数据。方法：用等分规、量角规、卷尺、卡尺　等测量器对２９颗成年正常完整干燥颅骨标本的矢状缝（Ｌ１）、冠状缝（Ｌ２）、人字缝（Ｌ３）　、翼颞部骨缝（Ｌ４～Ｌ６）骨性固定标志间距离、夹角（峤恰⑩角）进行观测。　结果：Ｌ１为１０．４６±０．９０ｃｍ，Ｌ２为１２．０３±０．９１ｃｍ　，Ｌ３为６．７３±０．７２ｃｍ，Ｌ４为２．７１±０．４１　ｃｍ，Ｌ５为６．０９±０　．４２　ｃｍ，Ｌ６为９．６６±０．９９　ｃｍ，峤亲１８．９３±４．０２度，右１７．４１±４．０６度；　饨１１１．１０±９．９２度。结论：观测颅骨缝所得数据的同身寸简化法，　准确、实用，可供临床头针治疗参考。