Barbed Versus Traditional Sutures: Closure Time,Cost, and Wound Related Outcomes in Total Joint Arthroplasty

The purpose of this study was to compare barbed sutures to traditional sutures in three domains: time, cost, and wound related outcomes in total knee arthroplasty (TKA) and total hip arthroplasty (THA). A total of 34 patients were enrolled in a prospective randomized controlled trial to assess time to wound closure and cost. In addition, a retrospective chart review of an additional 100 patients was conducted to further assess wound-related outcomes. On average, barbed sutures decreased time to wound closure by 9.72 min (P < 0.05) after controlling for length of incision, patient's BMI and number of physicians closing. Further, using barbed sutures saved an average of $549.59 per case. However, increased frequency and severity of wound complications were associated with barbed sutures.     

剖宫产术中B-Lynch缝合术后对月经及再次妊娠的影响

目的探讨剖宫产术中使用B-Lynch缝合术后对月经及再次妊娠等情况的影响。方法选择2007-2013年在安徽医科大学附属安庆医院剖宫产术中行B-Lynch缝合术患者78例,回顾性分析患者一般临床资料、术中出血量、术后恶露、月经恢复以及再次妊娠情况等各项指标。结果 2007-2013年该院行B-Lynch缝合术患者78例,随访76例（除2例切除子宫者）。随访患者中,术后恶露时间正常范围66例,异常10例;产后恢复正常月经70例,异常6例;产后共妊娠20次,均为自然受孕,其中足月手术分娩5例,1例处于妊娠期,6例生育患者中4例有生育要求,2例为意外怀孕,另外意外妊娠而行人工流产者14例。结论 B-Lynch缝合术治疗剖宫产术中产后出血简便易行,止血效果快速持久,对于剖宫产术后恶露、月经、生育功能等未发现明显影响。     

伸肌腱自发性断裂的诊断及治疗体会（附4例报告）

目的：探讨伸肌腱自发性断裂的诊断及治疗方法。方法对4例伸肌腱自发性断裂患者行手术治疗,观察并分析其效果。结果本组4例患者,术后随访1~5年,除1例伸直受限约20°外,其余3例功能基本正常。结论伸肌腱自发性断裂临床诊断误诊率高,行局部伸肌腱转位编织缝合手术治疗效果良好。     

鼻中隔矫正术后鼻黏膜缝合的临床应用研究

目的探讨鼻内镜下鼻中隔矫正术后行鼻中隔黏膜缝合的应用效果。方法将120例行鼻中隔偏曲矫正患者随机分为黏膜缝合组和鼻腔填塞组各60例,比较两组患者在术后鼻部疼痛、头痛、流泪、吞咽困难、睡眠障碍的视觉模拟评分（VAS）及并发症情况。结果在术后鼻部疼痛、头痛、流泪、吞咽困难、睡眠障碍这5个方面,黏膜缝合组的VAS评分均明显低于鼻腔填塞组,差异有统计学意义（P〈0.05）。结论鼻中隔偏曲矫正术后行鼻黏膜缝合术,不需要对鼻腔进行填塞,术后痛苦小,也避免了鼻中隔血肿等并发症的发生,具有更好的临床效果。     

丝裂霉素C联合巩膜瓣可移动缝线治疗原发性青光眼的临床效果

目的：探讨丝裂霉素C联合巩膜瓣可移动缝线治疗原发性青光眼的临床效果。方法按照手术方式不同将本院收治的120例原发性青光眼患者分为常规组40例、丝裂霉素C组40例和缝线组40例,常规组给予常规小梁切除术治疗,丝裂霉素C组术中应用丝裂霉素C的小梁切除术治疗,缝线组术中联合使用丝裂霉素C＋巩膜瓣可移动缝线小梁切除术治疗,比较3组患者术前、术后第3天、术后1周、术后1个月、术后3个月和术后6个月的眼压变化,术后半年滤过泡情况、术后早期前房深度以及并发症发生情况。结果3组患者术后眼压均显著下降,与术前比较,差异有统计学意义（P〈0.05）;丝裂霉素C组和缝线组患者术后不同时间眼压均显著低于常规组,差异有统计学意义（P〈0.05）;丝裂霉素C组和缝线组患者功能性滤泡形成率均显著高于常规组,差异有统计学意义（P〈0.05）;丝裂霉素C组患者术后早期Ⅰ、Ⅱ度浅前房发生率均显著高于常规组,差异有统计学意义（P〈0.05）;缝线组患者术后早期Ⅰ、Ⅱ度浅前房发生率均显著低于丝裂霉素C组,差异有统计学意义（P〈0.05）;3组均未出现角膜损伤、结膜瓣漏、黄斑水肿、眼内炎、恶性青光眼等并发症。丝裂霉素C组患者正常前房率显著低于常规组和缝线组,差异有统计学意义（P〈0.05）。结论原发性青光眼术中丝裂霉素C联合巩膜瓣可移动缝线能显著提高手术的成功率,改善眼压,合理控制缝线的拆除数目及时间,临床应用和推广价值较高。     

双J管远端栓线在输尿管中下段结石内镜术后的应用尝试

目的研究输尿管镜检和/或中下段结石内镜碎石术后留置双J管的时间,以及短期拔管方法的改进,尝试无创、快速、简单和经济的方式。方法选择2015年6月-2017年4月输尿管内镜手术患者71例,分为两组。实验组35例,为输尿管镜中下段结石患者,术毕留置双J管,双J管远端栓丝线,丝线另一端固定于体外;对照组36例,为输尿管全段结石患者,常规置入双J管。结果实验组35例术后第5天拔除双J管,2例拔除失败;对照组常规术后3或4周拔管。比较实验组留置双J管期间,两组在疼痛数字评分(NRS)、术后血尿时间和膀胱刺激征上,差异均无统计学意义(P0.05)。结论输尿管镜检和/或中下段结石内镜碎石术后,留置双J管的时间可以在5 d;双J管远端栓线不增加置管期间患者的不适症状,且拔管安全、简单、快速、无经济负担,可在此类术式中推行。     

Cardiocutaneous fistula

Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis.