持续闭式引流治疗下肢长骨骨折术后感染

感染是下肢长骨骨折钢板内固定术后常见并发症。由于内固定钢板螺钉的存在,常使感染迁延不愈,影响骨愈合。我科自1998年6月-2005年6月,采用加压接骨钢板内固定治疗下肢长骨骨折683例,其中34例术后发生感染,采用病灶清除,闭式滴注引流术,配合中药内服,感染得到控制,骨折愈合,取得满意的效果。1临床资料本组34例,男28例,女6例;年龄22~61岁,平均36岁。伤因:车祸伤16例,砸压伤7例,跌伤11例。开放性骨折23例,闭合性骨折11例;单纯股骨干骨折9例,股骨干合并同侧胫腓骨骨折2例,股骨干合并对侧胫腓骨骨折1例,单纯胫骨骨折5例,胫腓骨双骨折17例。病史2…     

Ascending cluster pinning of the humerus inserted through the deltoid tuberosity

Summary Goal of Surgery Stable internal fixation of extraarticular proximal humeral fractures. Indications Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision. Epiphysiolysis. Fracture-dislocation of the humeral head. Contraindications Pathological fractures. Four part fractures. Segmental fractures of the humerus. Positioning and Anaesthesia Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board. General or regional anaesthesia. Surgical Technique Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly at the metaphyseal level. Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which is controlled by image intensification. Postoperative Management Temporary immobilization in a sling. Passive and active assisted movements after a few days. Active movements after 2 weeks. Removal of wires after 3 months. Possible Complications Fracture of the humerus at the site of the cortical window. Injury to the radial nerve. Results 32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6, mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis nor infection. Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months. Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France.     

Dorsal Chopart’s fracture dislocation – A rare injury

A rare case of Dorsal Chopart’s fracture dislocation after a fall from height is presented. It combines the features of pure dorsal Chopart’s dislocation and the longitudinal swivel variant described by Main and Jowett presenting as dorsomedial fracture dislocation of the medial three fourths of the navicular, crushing the lateral one fourth. The possible mechanism of injury has been described. It has been successfully treated with closed reduction and percutaneous k-wire fixation. At two-year follow-up the patient was asymptomatic, back to his moderately active work.     

Achieve Closed Reduction of Irreducible,Unilateral Vertically Displaced Pelvic Ring Disruption with an Unlocking Closed Reduction Technique

ObjectiveTo be able to treat irreducible unilateral vertically displaced pelvic ring disruption (UVDPRD) using closed reduction, we introduced a technique named Unlocking Closed Reduction Technique (UCRT) and evaluated its effectiveness with improved pelvic closed reduction system (PCRS).MethodsA retrospective study was performed in our department. Between January 2014 and December 2017, 43 patients whose UVDPRD were not successfully reduced using transcondylar traction. Subsequently, they were treated with UCRT using improved PCRS. The study included 19 male and 24 female patients, with a mean age at the time of the operation of 46.2 years. During surgery, operation time and blood loss were recorded. Post‐surgical reduction quality was evaluated using Matta scoring criteria and patient lower‐extremity functional outcome was evaluated using Majeed functional scoring criteria.ResultsWhen used with improved PCRS, UCRT achieved pelvic reduction in all 43 cases of irreducible UVDPRD with postoperative pelvic reduction quality rated excellent and good for 42/43 (97.6%) patients according to the Matta scoring criteria (Matta Score < 10 mm). While no post‐surgical complications emerged as the direct result of UCRT in this cohort of patients, 8/37 patients who were treated with subcutaneous supra‐acetabular pedicle screw internal fixation (INFIX) for anterior ring fixation developed lateral femoral cutaneous nerve injury but recovered 6 months postoperatively. No revision surgery was performed on any of the recruited patients. All patients'' lower‐extremity functionality was rated excellent with an average Majeed function score of 94.3 during the last follow‐up at an average of 41.6 months postoperatively.ConclusionWith excellent surgical and functional outcomes in patients with irreducible UVDPRD, improved PCRS‐assisted UCRT proved to be a safe and effective method for the treatment of irreducible UVDPRD.     

Morel-Lavallée lesion diagnosed 25 years after blunt trauma

IntroductionMorel-Lavallée lesions are closed degloving injuries in which the skin and subcutaneous tissues separate from the underlying fascia secondary to a shearing force. These injuries are uncommon and can be misdiagnosed in acute settings. If treated incorrectly, they can recur, causing complications requiring multiple surgical interventions. Therefore, it is important to discuss the clinical presentation and imaging characteristics in order to improve their diagnosis and management.Presentation of caseThis is the case of a 44-year-old male patient with a Morel-Lavallée lesion of the left thigh that presented 25 years after trauma. He was successfully treated with open surgical excision. The patient underwent multiple surgical interventions before the lesion was accurately diagnosed and treated.DiscussionMorel-Lavallée injuries can lead to chronic symptoms, such as pain and swelling, affecting the patient’s quality of life. Treatment options include minimally invasive procedures, such as compression bandages or percutaneous drainage. However, if diagnosed late, a fibrotic capsule can form, which may require surgical excision. Our patient was diagnosed more than 20 years after the trauma. Earlier noninvasive treatment options were unsuccessful.ConclusionThe patient was treated with open surgical excision of the chronic lesion. There was no report of any recurrence up to 10 months after surgery. Such lesion treatments should be guided based on the chronicity of the injury and the patient’s symptoms. To the best of our knowledge, this is the first case with such delayed presentation.     

通脉络胶囊抗心肌缺血和耐常压缺氧作用的研究

目的：研究通脉络胶囊对实验动物的抗心肌缺血和耐常压缺氧作用,为临床用药提供依据。方法：给兔耳静脉注射脑垂体后叶素,造成急性心肌缺血状态,以心电图ＳＴ段及Ｔ波产生的变化为指标,来研究通脉络胶囊对抗垂体后叶素引起的兔心肌缺血作用;将小鼠放在密闭的容器中造成缺氧环境,以小鼠在常压缺氧条件下呼吸停止的时间为指标,来研究小鼠的耐常压缺氧作用。各实验均设四组动物：通脉络胶囊高、低剂量组、复方丹参片组、水对照组。结果：通脉络胶囊高剂量组与对照组比较有极显著性差异（Ｐ＜０．０１）;低剂量组有显著性差异（Ｐ＜０．０５）。与复方丹参片组比较,抗心肌缺血作用无显著性差异（Ｐ＞０．０５）;耐常压缺氧作用的高剂量组有极显著性差异（Ｐ＜０．０１）。结论：通脉络胶囊有显著的抗心肌缺血作用和耐常压缺氧作用,它的疗效与剂量有依赖关系;抗心肌缺血作用与复方丹参片近似,耐常压缺氧作用远较复方丹参片强。     

Maternal and perinatal outcome in rheumatic heart disease.

OBJECTIVES: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. METHODS: A retrospective study was carried out in the cardio-obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987-1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. RESULTS: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III-IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. CONCLUSIONS: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III-IV patients.     

COMPARATIVE OBSERVATION ON CURATIVE EFFECT OF POSTOPERATIVE SYMPTOMS OF THE CLOSED CRANIOCEREBRAL INJURY TREATED BY ACUPUNCTURE

Theincidenceofcraniocerebralinjuryisveryhighatpresent.Trafficaccident,violenceandindustrialinjuryarethemainreasonsofthedisease.Besidesthecorrespondingsymptomsofcontusionand1acerationofbrain,subduralhematoma,extraduralhematomaandintracere-bralhematomamayoccuratthesametime.Thepatientswilldieiftheyarenotoperatedintime.However,theexacerbationofcerebralfunctioncausedbyoperativemechanicalstimulationcannotbeavoided.Therefore,therehabilitationofcraniocerebralinjuryisverycomplicatedanddif-ficult,andne…