肱骨髁间骨折术后疗效影响因素的相关分析

目的探讨肱骨髁间骨折术后疗效的影响因素。方法对切开复位内固定治疗的66例肱骨髁间骨折患者临床资料进行分析,采用Cassebaum标准对术后肘关节功能评分,并选取临床可能影响手术疗效的因素,如年龄、切口的选择、手术时间、骨折类型、骨折复位质量以及术后功能锻炼的时间等作为指标进行分组、赋值及单因素筛选和多因素Logistic回归分析。结果66例随访5个月~4年,评分结果：优23例,良25例,可15例,差3例,优良率72.7%。钢板内固定组和克氏针固定组优良率分别为81.6%和53%;肱三头肌舌状瓣入路优良率70%,尺骨鹰嘴截骨入路优良率76.9%;术后50例解剖复位（优良率90%）,16例复位欠满意（优良率45.4%）;伤后24 h内手术优良率为73%,24h后为72.4%;年龄组：〈40岁与≥40岁的优良率分别为73.1%和72%;功能锻炼4周内与4周后组优良率分别为89.1%、65.6%。单因素和多因素Logistic回归分析显示不同手术方式（χ^2=7.606,P=0.006）、骨折复位质量情况（χ^2=31.023,P=0.000）以及术后功能锻炼的时间（χ^2=11.505,P=0.001）是影响肱骨髁间骨折术后疗效主要因素。结论影响肱骨髁间骨折手术疗效的因素有手术方式、骨折复位质量和术后功能锻炼的时间;根据骨折类型使用钢板坚强内固定、解剖复位骨折和早期渐进合理功能锻炼可获得较好疗效。     

复杂性严重胰腺外伤的外科综合治疗

目的 探讨复杂性严重胰腺外伤的抢救和治疗.方法 本组12例患者采取外科手术、胃造瘘和空肠造瘘、腹腔置管冲洗、深静脉高营养等综合治疗.结果 抢救成功10例,死亡2例.结论 复杂性重度胰腺外伤的患者,准确判断伤情,不断调整治疗方案;选择合理的手术方式和手术时机,胃造瘘和空肠造瘘,深静脉高营养是治疗的关键,胰周的通畅引流和灌洗是抢救治疗成功保证.     

直肠癌术中骶前大出血的防治

目的 探讨直肠癌根治术中骶前静脉丛大出血的预防和处理方法.方法 回顾性分析本院2001年1月至2007年12月收治的42例直肠癌术中骶前静脉丛大出血的临床资料.结果 42例骶前静脉丛大出血中40例止血成功,2例死亡,Miles术35例,Dixon术7例,30例出血量为900～8000 mL.结论 手术操作不当是导致骶前大出血的主要原因,按盆腔解剖结构正确操作是预防出血的关键,术中压迫法和术后纱布填塞法是处理骶前大出血最有效的方法.     

烧伤后早期心肌损害与防治

Isehemia/hypoxia is one of the key clinical issues following severe burns, and isehemic/hypoxic damage of tissues and organs is still hard to be prevented or minimized by various fluid resuscitation regimens . To those who suffered severe bums, even though fluid replacement therapy is delivered promptly, isehemic/hypoxie damage of organs is still inevitable. Previously, blood flow in vital organs such as heart was eonsidered not to be reduced because of blood redistribution under the circumstance of stress. The postbum cardiac dysfunction has been mainly attributed to the reduced blood flow returned to the heart due to decreased blood volume caused by increased capillary permeability. Therefore, postbum cardiac dysfunction has been considered to be the result of burn shock. During the past two decades, we have performed serial studies on severe burns, and found that isehemie/hypoxie myocardial damage and functional impairment of myocardium due to activation of reninangio tensin system existing in the heart itself occur immediately after severe bums even before significant reduction in blood volume secondary to an increase of capillary permeability . Such prompt myocardial damage leads to cardiac deficiency, and it is also a precipitating factor for bum shock and isehemic/hypoxie injury of systemic tissues and organs. Therefore, we called it " shock heart" in our reports. The cellular and molecular mechanisms leading to myocardial damage were systematically investigated. Strategies for prevention of early postburn myocardial damage and dysfunction, and a new effective burn shock resuscitation regimen "volume replacement" plus "dynamic support" (cardiac support and myocardial protection) have been proposed based on our previous studies.     

高能量脉冲CO2激光治疗眼睑部黑素痣

目的 评价脉冲CO2激光去除眼睑部先天性黑素痣的方法和美容效果.方法 用脉冲CO2激光气化去除眼睑部先天性黑素痣46例,共58块.病损最小面积0.3 cm×0.3 cm,最大面积3.0 cm×6.0 cm,平均面积1.3 cm×2.0 cm.尽可能保护正常的皮肤和睫毛毛囊组织,勿受损伤.术中没有焦痂产生及出血.结果 46例患者中44例对激光手术效果满意,仅2例对激光手术效果欠满意.58块黑素损害,50块愈后创面瘢痕平整.欠平整6块,外眦粘连1块,内眦瘢痕收缩1块.疗效优84.5%(49/58),良10.3%(6/58),有改善5.2%(3/58).总有效率94.8%(55/58),部分患者睑缘仍有睫毛生长.结论 高能量脉冲CO2激光是去除眼睑部先天性黑素痣的较好方法,具有去除彻底、创面愈后瘢痕平整、眼睑活动正常、外观影响小等优点.但对于面积较大的、侵犯多个解剖区域的病损,激光手术的选择仍需谨慎.     

激光多普勒血流仪测量股骨头坏死的血流改变

目的 应用激光多普勒血流仪(laser doppler flowmetry,LDF)检测临床确诊为股骨头坏死患者的坏死区和头颈交界正常区的血液灌注量.方法 2007年至2008年对50例股骨头坏死患者82侧行股骨头钻孔减压自体干细胞植入,按照ARCO分期Ⅱ期为A组,46髋(ⅡA 6髋、ⅡB 22髋、ⅡC 18髋);Ⅲ期为B组,36髋(ⅢA 20髋、ⅢB 10髋、ⅢC 6髋),术中用激光多普勒血流仪检测股骨头坏死区及头颈交接区的血流灌注情况,对数据进行统计学处理.结果 A组坏死区灌注量为(30.2±3.0)PU,头颈交界区灌注量为(103.4±4.4)PU,B组坏死区灌注量为(30.6±2.8)PU,头颈交界区灌注量为(103.4±3.9)PU,A组和B组坏死区灌注量均低于正常区,二者比较差异具有统计学意义(P<0.01).而A组和B组之间坏死区和头颈交界区的灌注量差别无统计学意义(P>0.01).结论 LDF可以有效地检测股骨头坏死区血流灌注量减少,为进一步研究股骨头坏死的发病机制提供了理论依据,在股骨头坏死的研究中有应用价值.     

山东省收治汶川地震伤员的损伤特点及诊治体会

目的 总结分析在山东省住院治疗的396例"5.12"汶川地震伤员的损伤特点及诊治经验.方法 汶川地震伤员396例,于2008年5月22日转至山东省住院治疗.山东省卫生厅及医学会成立了专家巡诊组,自5月22日至6月24日,对全部伤员逐个进行巡诊检查,统一阅读影像学资料,统一规范诊断,制定治疗方案.对伤员性别、年龄、损伤部位、骨折部位、手术情况、二次手术情况、截肢情况、伤口感染情况以及治疗结果进行调查分析.结果 本组病例在年龄分布、受伤部位、受伤特点等方面不同于交通伤.特点为多发伤常见,下肢截肢及伤口感染者较多,脊柱及骨盆骨折以稳定性骨折为主.手术治疗220例,其中转入前已经手术142例,转入后手术78例,有12例需要对转入前的手术进行二次手术调整内固定或治疗深部感染.至6月24日,已经治愈出院219例,无死亡病例,无医原性并发症出现.结论 按伤害控制理论,根据伤员的损伤特点、损伤程度制定转运及治疗方案,前线以抢救生命为主,早期清创.骨折的治疗原则是对不具备内固定条件者采用临时性外固定,复杂内固定手术留待转院后进行,可以提高救治效率,减少并发症,获得更好的综合疗效.     

Effect of paracetamol and coxib with or without dexamethasone after laparoscopic cholecystectomy

Background: Pain after laparoscopic cholecystectomy (LCC) is multifactorial. Effective post-operative pain control is necessary in LCC performed as day-case surgery. We studied the efficacy of paracetamol or valdecoxib with or without dexamethasone after LCC.
Methods: One hundred sixty patients were randomized to four groups of 40 patients. Groups 1 and 3 received parecoxib 40 mg intravenously (IV) during surgery and valdecoxib 40 mg × 1 per os (PO) for 7 post-operative days. Groups 2 and 4 received paracetamol 1 g × 4 IV during surgery and 1 g × 4 PO for 7 days. In addition, Groups 3 and 4 were given dexamethasone 10 mg IV intra-operatively. Propofol and remifentanil were used during surgery. The patients were given oxycodone 0.05 mg/kg IV in phase 1 post-anaesthesia care unit (PACU 1) or 0.15 mg/kg PO in phase 2 post-anaesthesia care unit (PACU 2) as needed to keep visual analogue scale <3/10. The patients were supplied with the study drugs for 7 post-operative days.
Results: Pain intensity, nausea and the need of oxycodone in phase 1 PACU were similar in all groups. Dexamethasone reduced the need of oral oxycodone in phase 2 PACU (7.0 ± 1.0 mg vs. 9.1 ± 1.0 mg, P <0.05). Pain intensity was similar in all groups at home. More patients in the parecoxib/valdecoxib groups needed rescue medication on the 1st post-operative day ( P <0.001) than paracetamol-treated patients.
Conclusion: Paracetamol was as effective as parecoxib/valdecoxib for pain after LCC. Dexamethasone decreased the need of oxycodone in phase 2 PACU. The effect of dexamethasone was similar in paracetamol and parecoxib/valdecoxib patients.     

Retinoids, 585-nm Laser,and Carbon Dioxide Laser: A Numeric Comparison of Neocollagen Formation in Photoaged Hairless Mouse Skin

Background  A variety of new methods for treating photoaging have been recently introduced. There has been increasing interest in comparing the relative efficacy of multiple methods for photoaging. However, the efficacy of a single method is difficult to assess from the data reported in the literature. Methods  Photoaged hairless mice were randomly divided into seven treatment groups: control, retinoids (tretinoin and adapalene), lasers (585 nm and CO₂), and combination groups (585 nm + adapalene and CO₂ + adapalene). Biopsies were taken from the treated regions, and the results were analyzed based on the repair zone. The repair zones of the various methods for photoaging were compared. Results  Retinoids produced a wider repair zone than the control condition. The 585-nm and CO₂ laser resurfacing produced a result equivalent to that of the control condition. A combination of these lasers with adapalene produced a wider repair zone than the lasers alone, but the combination produced a result equivalent to that of adapalene alone. Conclusion  Retinoids are potent stimuli for neocollagen formation. The 585-nm or CO₂ laser alone did not induce more neocollagen than the control condition. In addition, no synergistic effect was observed with the combination treatments. The repair zone of the combination treatment is mainly attributable to adapalene.     

医源性胆管损伤的治疗进展

胆管损伤一直是普外科倍受关注的问题.随着人们对胆管损伤后果严重性认识的提高,并采取了许多积极有效的预防措施,使胆管损伤的发病率有所下降,并随着医学技术的发展和大量的临床实践总结使已经造成胆管损伤的患者在治疗方法和临床疗效上都有了很大改善.同时又面临许多新的困难.本文概述了医源性胆管损伤的治疗现状.