切开与闭合复位空心钉内固定治疗移位股骨颈骨折的疗效比较

目的比较切开复位与闭合复位3枚空心钉内固定术治疗移位股骨颈骨折的效果。方法回顾性分析自2006-01—2013-01诊治的移位股骨颈骨折51例,32例采用闭合复位3枚空心钉内固定(闭合复位组),19例采用切开复位3枚空心钉内固定(切开复位组)。比较2组手术时间、术中出血量、术中透视时间、末次随访时髋关节功能Harris评分、并发症情况(骨折不愈合、股骨头坏死)。结果 51例均获得随访12~90个月,平均39个月。闭合复位组手术时间、术中出血量均少于切开复位组,差异有统计学意义(P0.05);而2组术中透视时间、骨折不愈合发生率差异无统计学意义(P0.05)。切开复位组股骨头坏死发生率低于闭合复位组,差异有统计学意义(P0.05)。切开复位组末次随访时髋关节功能Harris评分优良率高于闭合复位组,差异有统计学意义(P0.05)。结论对于移位股骨颈骨折,切开复位内固定术后股骨头缺血坏死的发生率低于闭合复位内固定术。     

Simplified negative pressure wound therapy: clinical evaluation of an ultraportable,no‐canister system

The aim of this study was to evaluate a prototype negative pressure wound therapy (NPWT) system that has been developed to simplify NPWT for wounds at the lower end of the acuity scale. The new device has a single preset pressure of ?80 mmHg, is single use and operates without an exudate canister. The disposable NPWT system (PICO?) was tested in a prospective, non‐comparative, multicentre clinical trial to assess device functionality and clinical acceptance. Twenty patients were recruited for a maximum treatment period of 14 days. The NPWT devices were fitted with data log chips to enable longitudinal assessment of negative pressure and leak rates during therapy. Sixteen (80%) patients had closed surgical wounds, two (10%) patients had traumatic wounds and two (10%) patients received meshed split thickness skin grafts. The mean study duration was 10·7 days (range: 5–14 days) and the mean dressing wear time per individual patient was 4·6 days (range: 2–11). Fifty‐five percent of wounds had closed by the end of the 14‐day study or earlier, with a further 40% of wounds progressing to closure. Real‐time pressure monitoring showed continuous delivery of NPWT. Three cases are discussed representing different wound locations and different patient factors that can increase the risk of post‐surgical complications. Clinical studies of the disposable NPWT system confirmed the ability of the simplified single‐use device to function consistently over the expected wear time. The anticipated reduced costs, ease of use and increased mobility of patients using this system may enable NPWT benefits to be available to a greater proportion of patients.     

Closed loop obstruction: Pictorial essay

Closed loop obstruction occurs when a segment of bowel is incarcerated at two contiguous points. The diagnosis is based on multiple transitional zones. The incarcerated loops appear in U or C form or present a radial layout around the location of the obstruction. It's very important to specify the type of obstruction because, in patients with simple bowel obstruction, a conservative approach is often advised. On the other hand, a closed loop obstruction immediately requires a surgical approach because of its high morbidity and the risk of death in case of a late diagnosis.     

封闭式负压引流治疗难愈性创面临床应用研究

目的:分析对比封闭式负压引流(VSD)与传统换药方法在治疗难愈性创面中的应用效果。方法:选择2012年1月至2014年6月期间烧伤整形科收治的难愈性创面患者60例,随机分为研究组与对照组,每组各30例。对照组患者应用常规清创、换药方法治疗;研究组在常规清创的基础上应用VSD治疗,比较两组创面愈合时间、创面愈合率、换药次数及住院时间。结果:研究组创面愈合时间、换药次数及住院时间显著低于对照组(P<0.05);创面愈合率显著高于对照组(P<0.05)。结论:VSD治疗难愈性创面疗效显著,可以有效减少患者的换药次数,加快创面的愈合时间,操作简便,值得临床推广。     

切开复位与闭合复位交锁髓内钉内固定治疗股骨干骨折效果观察

目的 对比分析切开复位交锁髓内钉内固定与闭合复位交锁髓内钉内固定治疗股骨干骨折的效果。方法 选取2015年1月至2018年6月收治的78例股骨干骨折患者随机分为观察组和对照组,观察组给予闭合复位交锁髓内钉内固定治疗,对照组给予切开复位交锁髓内钉内固定治疗,比较手术情况、骨折愈合时间、术前及术后6个月HSS评分、术后12个月膝关节功能评价、并发症发生情况、术后12个月综合疗效。结果 观察组术中出血量(165.78±29.34)mL较对照组(451.26±30.02)mL显著减少,骨折愈合时间为(19.36±5.24)周较对照组(31.33±4.48)周显著缩短,差异具有统计学意义(P＜0.05),两组手术时间无统计学差异(P＞0.05),术前两组HSS评分无统计学差异(P＞0.05),术后两组HSS评分均显著提高,且观察组HSS评分提高更显著(P＜0.05),观察组并发症发生率为5.13%较对照组23.08%显著降低,差异具有统计学意义(P＜0.05),术后12个月观察组、对照组综合疗效、膝关节功能优良率分别为94.87%vs87.18%、94.87%vs89.74%,差异无统计学意义(P＞0.05)。结论 切开复位交锁髓内钉内固定与闭合复位交锁髓内钉内固定治疗股骨干骨折疗效相当,但是闭合复位可减轻对患者创伤,缩短骨折愈合时间,降低术后并发症的发生率,促进膝关节功能的恢复,值得在临床上推广。     

Narcissism,a Relational Aspect of Dissociation

ABSTRACT

Pathological narcissism is an inevitable result of trauma-generated dissociation. It is also a relational aspect of dissociation, for in dissociative psychopathology the mutuality of relationships, both interpersonal and intrapsychic, has collapsed in significant ways. Dissociation of both aggression and dependency characterizes the “closed system.” While an open system allows interaction with the outside and transformation of the individual through interactive interchange with another, a closed system precludes transformation and intersubjectivity. Grandiose, domineering self-states may be understood as procedural, somatoform, dyadic enactments. These working models of attachment are at the core of much of the narcissistic entitlement, grandiosity, domination, and self-sufficiency that are so often found in dissociative disorders and in narcissism. It is possible to have a real impact on the closed system of narcissistic psychopathology by providing a safe attachment within the therapeutic relationship, and empathizing with the expression of self-protective aggression while containing its destructiveness. As a safe attachment figure with expertise, the therapist has the opportunity to facilitate positive transformation.     

Efficacy of closed reduction for nasal fractures in children

The aim of this study was to evaluate the efficacy of closed reduction and the effects of the time of intervention on young patients’ satisfaction. Patients older than 16 years and those with additional maxillofacial fractures were excluded. All patients were treated by closed reduction and external fixation. The patients and parents were asked about their satisfaction in a survey 6 months’ postoperatively. They were divided into groups according to the time of intervention, and the results. Twenty-four patients, age range 4–16 years, with isolated nasal fractures were included in the study. The mean (SD) time before intervention was 5.5 (1.8) days. The first group comprised 16 patients whose fractures were reduced between days 1 and 5 after the injury, and the second the 8 whose fractures were reduced between days 6 and 10. At 6 months 15 of the 24 were satisfied with the result, and 9 were not. In the group treated between days 1–5, 12/16 were happy with the result, and in the group treated between days 6–10, 3/8 were satisfied. Closed reduction gives good results in the treatment of nasal fractures in children. Early intervention increases the rate of satisfaction.     

游离腓骨瓣楔形截骨术在下颌骨重建中的应用

目的:探讨游离腓骨瓣同期修复下颌骨缺损过程中应用楔形截骨塑形与小型钛板分段固定的方法.方法:16例下颌骨病变患者均按改良方法制备腓骨瓣,断蒂前在所需修复下颌骨的角部及颏部的相应位置上,直接由腓骨外侧面楔形截骨塑形,精细磨削截骨面,调整至所需的弧度及角度,采用2块小型钛板在腓骨的不同骨面固定.结果:16例患者的骨瓣及骨皮瓣均存活,出院时下颌骨颏部及下颌角外形良好,咬合关系、语音功能恢复正常或基本正常.术后15例随访3～18个月,下颌骨全景片示移植骨段均一期愈合.结论:应用楔形截骨法塑形结合小型钛板分段固定重建下颌骨,可灵活调整骨瓣所需的弧度和角度,使每个骨段得到充足的血供,有利于截骨段的愈合,安全可靠,制备简便,易于操作和掌握.     

Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute

Purpose:To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma.Methods:In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019).Results:Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 ± 17.3 and 34.1 ± 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034).Conclusion:During the COVID-19 period, there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.     

闭合性心脏及主动脉损伤的救治策略

国内外缺乏胸部闭合性创伤对心脏及生动脉损伤的损伤机制、诊断标准．且缺乏成熟的处置原刺。因此外伤尤其伴稍胸部钝挫伤的患者,早期应通过病史特点、实验室检查及辅助检查（心肌酶学、心电圈和超声心动）进行快速识别,救治策略上尽快对患者进行分类管理．早期判断及救治时效对预后结果至美重要。现就胸部闭合性刨伤对心脏及主动脉损伤的救治策略作一综述。