半月板大桶柄样撕裂的关节镜下联合修补技术

目的:介绍关节镜下自内向外缝合技术联合全内缝合技术修补半月板的手术方式(联合修补技术),探讨修补半月板大桶柄样撕裂的安全、可靠方法。方法:2002年5月~2006年1月,采用关节镜下联合修补技术修补93例患者的96个半月板大桶柄样撕裂,均累及半月板后角至前角与体部交界处(前体部)区域。手术适应症:红-红区及红-白区损伤、具备可复位性、半月板组织无复合撕裂及明显变性、前十字韧带(ACL)完整或同时重建。手术技术:撕裂的后角与体部交界处(后体部)至中、前1/3区域采用标准的自内向外缝合技术:在半月板上、下表面交错进行垂直褥式缝合,膝后内侧或后外侧作辅助安全切口保护血管神经,伸膝位将缝线在关节囊浅层打结固定;撕裂的后部区域采用全关节内缝合技术:经两个后内侧或后外侧入路在关节内完成垂直褥式缝合、打结及剪线。单纯的红-白区撕裂修补后局部植入血凝块促进愈合,合并前十字韧带损伤者同时行韧带重建手术。术后对93例患者中的49例共51个半月板进行了平均20·1个月(9·2个月~54·2个月)的随访。随访时均进行了临床评估,包括交锁、积液、关节间隙压痛、McMurray试验。随访结果显示:49例患者中,无症状者46例(93·9%),关节间隙压痛者2例(4·1%),交锁复发1例(2%)。51个半月板中的44个(86·3%)经MRI复查,结果为:30个(68·2%)完全愈合,13个(29·5%)部分愈合,1个(2·3%)不愈合。38例患者共40个半月板(78·4%)经过二次手术探查,完全愈合者36个(90%),部分愈合者2个(5%),不愈合行半月板切除者2个(5%)。膝关节活动度检查显示3例伸膝受限>10°。结论:对于发生在红-红区或红-白区的大型半月板撕裂,采用自内向外与全关节内两种缝合技术可以保证撕裂的全长区域获得有效、稳定的修补,并且与ACL重建同期进行,可以获得很好的主、客观临床疗效。联合修补技术是安全、可靠的半月板大桶柄样撕裂的修补方法。     

Focus on research: Which disc is a candidate for biological repair?

Low back pain affects the majority of population at some point in their lives.Disc degeneration of lumbar spine has been considered as a main contributor to low back pain.Considering the high prevalence of low back pain in the population, treatment that aims to repair or regenerate the disc degeneration biologically appears promising as a future treatment option in humans.……     

吻合血管的胸脐皮瓣移植修复足踝部大面积软组织缺损

目的 探讨吻合血管的胸脐皮瓣移植修复足踝部大面积软组织缺损的临床效果.方法 对18例足踝部大面积软组织缺损(其中11例伴胫前或胫后血管节段损害)采用胸脐皮瓣游离移植修复创面.创面面积12cm×6cm～32cm×12cm.结果 移植皮瓣全部成活,3例足跟部缺损的病人术后因长期磨擦形成足跟部慢性溃疡;3例皮瓣臃肿,需再次手术整形.其余病例外观和足踝部功能恢复满意.结论 胸脐皮瓣为腹壁下动脉供血,血运丰富,血管解剖恒定,血管蒂长,可切取面积大且易于切取,适宜修复足踝部软组织缺损,尤其适用于缺损面积大、胫前或胫后血管之一长节段损害者.     

A randomized comparison between lateral ligaments augmentation using suture-tape and modified Broström repair in young female patients with chronic ankle instability

Background

Although various minimally invasive procedures for chronic ankle instability are increasingly being used, a question regarding whether these procedures can be a viable alternative of the modified Broström procedure remains controversial. This study was conducted to compare the intermediate-term clinical outcomes between lateral ligaments augmentation using suture-tape and modified Broström repair in a selected cohort of patients.

Repair of bone defect in femoral condyle using microencapsulated chitosan, nanohydroxyapatite/collagen and poly(L-lactide)-based microsphere-scaffold delivery system

Bone repair ability of microencapsulated chitosan, nanohydroxyapatite/collagen (nHAC), and poly(L-lactide) (PLLA)-based microsphere-scaffold delivery system was investigated in present research, with nHAC/PLLA composite scaffold as a control. Chitosan microspheres (CMs) encapsulated with bone morphogenetic protein-2-derived synthetic peptide were incorporated into nHAC and PLLA-based matrix via a thermally induced phase separation method, in which dioxane was used as the solvent for PLLA. Compared with the rapid release from CMs, the synthetic peptide was delivered from CMs/nHAC/PLLA microsphere-scaffold composite in a temporally controlled manner, depending on the degradation of both incorporated CMs and PLLA matrix. MC3T3-E1 osteoblastic cells were seeded into nHAC/PLLA and CMs/nHAC/PLLA scaffolds, respectively, and in vitro cytocompatibility was tested by scanning electron microscopy and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The results indicated that, with the appearance of CMs in microsphere-scaffold composite, the osteoblasts exhibit better morphology and proliferation ability. In vivo tissue compatibility was evaluated by transplanting the scaffolds into rabbit femoral condyles with a defect 6 mm in diameter. After implanting for 4, 8, and 12 weeks, respectively, radiographic and histological observation revealed that the CMs/nHAC/PLLA composite can accelerate the regeneration of cancellous bone defect as compared with the nHAC/PLLA scaffold. The results demonstrated that the CMs/nHAC/PLLA possesses better biocompatibility, which should be attributed to both the incorporated chitosan component and the encapsulated bioactive synthetic peptide. The promising CMs/nHAC/PLLA microsphere-scaffold composite can be used as delivery system for multiple bioactive factors or as inductive implant scaffold for bone regeneration.     

腔镜手术治疗儿童食管裂孔疝的临床体会(附104例报告)

目的:探讨腹腔镜下儿童食管裂孔疝的治疗经验与体会。方法:回顾分析2002年6月至2016年12月为104例食管裂孔疝患儿行腹腔镜手术的临床资料。患儿50 d~10岁,平均(4.0±1.5)岁。按美国消化内镜学会分类:滑动性疝25例、混合性疝42例、食管旁疝37例,术前均通过上消化道造影明确食管裂孔疝。采用5孔法施术,行Nissen-Rossetti、改良Thal法修补食管裂孔并进行胃底折叠。结果:腹腔镜手术均顺利完成,无一例中转开腹。疝孔直径3~5 cm,手术时间90~150 min,平均(110±20)min;术后5例复发。其中4例再次通过腹腔镜进行修补。改良Thal法术后发生胃食管反流4例,术后1例发生裂孔关闭过紧,再次腔镜下松解裂孔。本组术后24~48 h正常进食,平均(28±4)h;术后5~7 d出院。随访3个月~13年,患儿均生长发育良好。结论:腹腔镜下治疗儿童食管裂孔疝具有良好的手术效果,术者必须具备较高的腔镜技术,术前患儿的评估对手术方法的选择与预后具有重要作用。     

股疝患者急诊手术的危险因素分析

目的探讨股疝患者急诊手术的相关危险因素。 方法回顾性分析2013年1月至2018年1月,中信惠州医院行股疝手术病程超过1个月103例患者的临床资料。根据手术时机分为急诊手术组（53例）和择期手术组（50例）。对2组患者的临床指标进行单因素分析,将单因素分析中具有统计学意义的因素纳入多因素Logistics回归分析,以确定其是否为股疝急诊手术的独立危险因素。 结果单因素分析结果显示,2组间年龄、病程、肝硬化、高血压和慢性阻塞性肺疾病比较,差异均有统计学意义（P<0.001、0.004、0.002、0.036、0.001）。Logistic多因素回归分析显示,年龄、病程、肝硬化和慢性阻塞性肺疾病是急诊手术的独立危险因素（OR=1.062、1.099、11.408、5.558,P=0.026、0.016、0.034、0.042）。 结论高龄、病程较长、合并肝硬化和合并慢性阻塞性肺疾病对病程超过1个月的股疝患者的手术时机选择的影响不容忽视。     

桡动脉掌浅支腕横纹Flow-through皮瓣修复手指皮肤软组织缺损

目的应用桡动脉掌浅支腕横纹Flow-through皮瓣修复手指皮肤软组织缺损伴指动脉缺损创面,更好恢复手指生理供血,提高临床疗效。方法2008年8月-2018年10月,对收治的48例手指皮肤软组织缺损伴指动脉缺损患者,切取桡动脉掌浅支腕横纹Flow-through皮瓣覆盖手指缺损创面,让创伤缺损动脉恢复再通血;供区直接缝合。结果术后皮瓣全部成活,创面Ⅰ期愈合,48例均获得随访,随访时间32~48周,平均40周,末次随访时皮瓣质地柔软,指体外观无臃肿,颜色与患指周围皮肤相似,皮瓣两点辨别觉6~12 mm,手指功能根据总主动活动度(TAM)法评定,优45例,良2例,可1例,优良率97.9%。结论手指皮肤软组织缺损伴动脉缺损,影响指端供血,应用桡动脉掌浅支腕横纹Floe-through皮瓣修复,巧妙桥接指动脉缺损,更好地恢复手指生理血供。     

全程护理对腹股沟疝修补术患者心理状态与生活质量的影响

目的研究全程护理对腹股沟疝修补术患者心理状态与生活质量的影响。 方法选择2015年6月至2017年6月,湖北文理学院附属医院收治的腹腔镜腹股沟疝修补术患者64例,以随机数字表法分为观察组及对照组,每组32例。对照组给予常规护理,观察组给予全程护理。比较2组患者护理前后的心理状态与生活质量情况。 结果护理前2组SAS评分与SDS评分比较,差异无统计学意义（P>0.05）;护理后2组SAS评分与SDS评分均有所下降,虽然观察组下降程度较对照组明显,但差异均有统计学意义（P均<0.05）。护理前2组生活质量评分比较,差异无统计学意义（P>0.05）;术后首次随访时2组生活质量评分较前均升高,但观察组改善程度优于对照组,差异有统计学意义（P<0.05）。 结论在腹股沟疝修补术的患者应用全程护理可显著改善患者心理状态,并提高生活质量,值得借鉴。