关节镜下规避骺板“8”字法缝线固定治疗急性儿童前交叉韧带胫骨止点撕脱性骨折

目的：选取该院探讨关节镜下实施规避骺板“8”字法缝线固定术治疗急性儿童前交叉韧带胫骨止点撕脱性骨折的临床疗效。方法2011年3月-2015年3月收治的关节镜下膝关节前内、外侧及辅助正中入路,采用“8”字法缝线固定治疗急性儿童膝关节前交叉韧带胫骨止点撕脱性骨折的22例患者进行回顾性分析,术后随访2年(14~32个月,平均26个月),对其进行临床评价,包括前抽屉试验、Lachman试验评价膝关节稳定性,根据Lysholm评分、IKDC评分及Tegner评分来术后评价膝关节功能,术后骨折部位X线及CT评价骨折复位愈合情况。结果术后3个月 X线及CT片示骨折均为解剖复位或近解剖复位,均达到骨性愈合。患者前抽屉试验Lachman试验及均为阴性,术后膝关节Lysholm评分(86~96分)(94.7±3.3)分、IKDC评分为(72.2~94.1分)(84.6±3.2)分,Tegner评分7~9分(8.35±1.4)分,较术前差异有统计学意义(P<0.01)。体检步态均正常,测量双小腿长度差异无统计学意义。结论关节镜下规避骺板“8”字法缝线固定术治疗急性儿童前交叉韧带胫骨止点撕脱性骨折疗效确切、创伤小、固定可靠、膝关节活动度及功能好,不影响儿童生长发育。     

巩膜瓣不同缝合法在小梁切除术中的应用分析

目的探讨巩膜瓣不同缝合法在小梁切除术中的应用效果。方法选择114例于2011年5月~2012年5月来笔者医院治疗的青光眼患者作为本研究的研究对象,患者年龄36~72岁。将114例患者随机分为观察组和对照组。观察组采取L形单针缝合法对本组所有患者巩膜瓣进行缝合;对照组采取矩形两针缝合法对58例患者巩膜瓣进行缝合。结果术后1个月,观察组患者术后眼压和对照组相比差异有统计学意义(P<0.05);患者术后前两周,观察组前房情况差于对照组,但差异无统计学意义(P>0.05);术后6个月时观察组患者滤过泡形成明显优于对照组(P<0.01)。观察组患者术后1天眼压要明显低于对照组(P<0.01),观察组患者术后2周眼压要明显低于对照组(P<0.01),观察组患者术后1个月眼压要明显低于对照组(P<0.01);观察组患者术后3个月眼压要低于对照组(P<0.05)。结论 L形巩膜瓣单针缝合术在眼压水平控制和滤过泡形成方面显著优于两针缝合方法。     

医用生物蛋白胶与缝线在翼状胬肉切除中应用的Meta分析

背景：目前在翼状胬肉切除联合角膜缘上皮移植中,对于医用生物蛋白胶能否代替缝线固定自体球结膜植片还存在一定争议。 目的：采用Meta分析比较医用生物蛋白胶与缝线在翼状胬肉切除联合角膜缘上皮移植中应用的效果。 方法：查阅PubMed数据库、CNKI全文数据库、中国生物医学文献数据库、维普数据库和万方数据库,从建库初始至2015年6月比较医用生物蛋白胶与缝线在翼状胬肉切除联合角膜缘上皮移植中应用效果的随机对照试验,采用Meta分析两组手术时间、术后并发症发生率及复发率。 结果与结论：共纳入14篇随机对照试验,879例患者。Meta分析结果显示,纤维蛋白胶组手术时间、术后并发症发生率、术后6个月及1年的复发率均低于缝线组[MD=-15.58,95%CI(-18.96,-12.21),P < 0.000 01;OR= 0.39,95%CI(0.19,0.68),P=0.02;OR=0.28,95%CI(0.12,0.65),P=0.003];OR=0.23,95%CI(0.07,0.76),P=0.02]。表明翼状胬肉切除联合自体角膜缘干细胞移植中应用生物蛋白胶促进植片贴附,可缩短手术时间、降低术后并发症、减少翼状胬肉术后复发。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

The Efficacy of Suture Fixation of the Greater Trochanter in Unstable Intertrochanteric Fractures

BackgroudIntertrochanteric fractures are one of the most common fractures in the elderly, especially those having osteoporosis. Stable intertrochanteric fractures may be fixed with implants including the dynamic hip screw and proximal femoral nail antirotation; however, this method is difficult to apply to unstable fractures. Bipolar hemiarthroplasty can be applied to unstable fractures and it prevents complications by facilitating early ambulation in the elderly. Many studies reported on how to fix the greater trochanter in unstable fractures during arthroplasty. We suggest that suture fixation alone can be a useful, effective, and affordable method.MethodsWe retrospectively enrolled 294 patients who underwent hemiarthroplasty for an unstable intertrochanteric fracture, and 225 patients were included in this study after excluding 69 patients who had not been available for follow-up until 1 year after surgery or died. The patients were divided into suture fixation and wiring fixation groups. Relationships of operation time, estimated blood loss, tip-to-stem distance, union rate, and physical performance in the groups of suture fixation and wiring were analyzed respectively.ResultsChanges in the tip-to-stem distance between the initial assessment at 1 year after surgery were statistically significantly different between the suture fixation group and wiring group (p < 0.001). There was no significant difference in change of the Koval score between the suture fixation and wiring groups (p = 0.362). The operation time and estimated intraoperative blood loss were statistically significantly lower in the suture group than in the wiring group (p < 0.001). There was no significant difference in the union rate between the groups (p = 0.470).ConclusionsCompared to tension-band wiring, the suture fixation technique demonstrated an effective fixing force. In addition to the clinical results, it had an advantage of preventing complications due to shortening of the operation time and estimated intraoperative blood loss. Suture fixation of the greater trochanter is recommended for elderly patients with unstable intertrochanteric fractures.     

Meniscal sutures: biomechanical study of “mulberry” and horizontal loop techniques

Background  

This in vitro biomechanical study tested the pullout strength of meniscal repair in human menisci using two different biodegradable suture techniques: the “mulberry” and the horizontal loop.     

Appréciation de la place de l’anesthésie locorégionale pour la prise en charge des plaies de la face aux urgences

Objective

Defining the place of regional anaesthesia (RA) for facial wounds in an emergency department.

Study Design

Prospective observational study conducted in the emergency department of a regional hospital.

Patients and methods

Two hundred and forty-six successive patients with one or more facial wounds were included from 1st august 2004 to 31st december 2004. Data on patient, operator, wound (measured by the number of stitches), anaesthetic method (RA, local anaesthesia [LA], or no anaesthesia), method of repairing skin, duration of intervention, operator comfort (verbal numeric scale [VNS] from 0 to 10) and pain feeled by the patient (visual analogic scale [VAS] from 0 to 10) in the different stages of care were collected.

Results

Compared to the LA, the RA of the face decreased the number of punctures (1.36 vs 4.38 punctures, p < 0.001) and the quantity of local anaesthetic injected (2.8 ml vs 5.3 ml, p < 0.01) for wounds requiring more than 10 stitches. It has improved operator comfort (VNS = 10 [8–10] vs 8 [6.75–10] (p < 0.01)). Its effectiveness during skin repair was equivalent to that of the LA by infiltration (VAS 0 [0–1] vs 0 [0–1]).

Conclusion

When practicable, the RA of the face is a better technique than the LA for facial wounds treatment.     

外固定器结合可吸收缝线治疗桡骨远端骨折

目的探讨外固定架结合可吸收缝线治疗桡骨远端粉碎性骨折的临床疗效。方法 2006年9月至2008年5月,运用万向式骨外固定器结合可吸收线治疗桡骨远端不稳定骨折42例,男性26例,女性16例,并对关节功能按Dienst标准进行评定。结果 42例均获随访,时间6~18个月（平均10个月）,骨折均骨性愈合,愈合时间6~8周。关节功能评定：优23例,良14例,可5例。结论万向式外固定架结合可吸收线治疗桡骨远端粉碎性骨折操作简单、固定可靠、疗效满意。     

Penetration of Staphylococcus aureus into sutured wounds

An animal model was developed to study whether Staphylococcus aureus could penetrate a sutured wound. Six days after bacteria were applied to sutured incisions, viable organisms could be recovered from the depths of the wounds in the majority of cases. Specifically, bacteria could be recovered in 23 of 24 wounds when they were applied 1 day after suturing, in 17 of 24 wounds when they were applied 4 days after suturing, and in 13 of 24 when applied 7 days after suturing. When Steri-strips were used to close the wounds, bacteria could not be recovered from any of 24 wounds when bacteria were applied 4 or 7 days after wound closure. When bacteria were applied 5 min after sutures had been placed but without incision, bacteria could be recovered in three of 12 cases and in two of 12 cases when they were applied 7 days after suturing. These results demonstrate that bacteria can penetrate sutured wounds. The sutures themselves probably contributed to this phenomenon.     

Study of two simplified microsurgical techniques for uterine horn anastomosis in rat

Summary This study compares two simplified techniques, which use only 2 and 4 sutures respectively, with a conventional technique with 8 sutures for fallopian tube anastomosis. Experimentally these techniques were performed on the uterine horns of fifteen female rats. A 100% patency rate was obtained with all three techniques. No difference in the mucosal, muscular and serosal regeneration was observed in the three groups at 10, 20 and 60 days. Two months after surgery, the serosa, muscularis and mucosal layers were completely continuous in all groups. The operating with 2 sutures (5′ 30″±1′ 10″) was significantly less than with 4 (9′09″±0′55″,P<0.05 ANOVA) and 8 sutures (15′12″ ± 1′41″,P<0.05 ANOVA). A minimum inflammatory reaction to sutures was observed in all three groups at 60 days after surgery. The results suggest that with 2 sutures are all that is needed for tissue repair.     

可吸收缝合线在移植韧带中降解性能的实验研究

目的 探讨可吸收缝合线在移植肌腱内的降解吸收机制及移植腱束之间的愈合情况。方法 15只成年新西兰大白兔,切取半腱肌,折叠成双股后,采用3个0快薇乔可吸收缝合线编织缝合,建立采用可吸收缝线编织缝合的前交叉韧带自体肌腱移植重建模型。术后观察实验动物一般情况,术后2、4、8周取材行大体及组织学观察。结果 术后动物肢体活动情况良好,大体观察实验动物前交叉韧带连续性完整,张力适中。组织学观察术后2周位于移植肌腱内部的缝合线无降解,少量炎性细胞浸润,而位于移植肌腱边缘的缝合线开始出现降解,移植腱束间通过纤维组织连接;术后4周移植肌腱内部缝合线部分降解,降解区未见新生组织长入;术后8周移植肌腱内部缝合线完全降解,形成一不规则无染色区。结论 可吸收缝合线在移植肌腱内部降解速度不变,但吸收周期明显延长。