以张力性气胸为主的严重多发伤急诊救治

目的：探讨以张力性气胸为主的严重多发伤的急诊救治。方法对46例以张力性气胸为主的严重多发伤患者的急诊救治进行回顾性分析。结果41例经急诊救治和病区综合治疗康复出院,其余5例患者由于存在严重颅脑损伤、腹腔脏器损伤及骨盆骨折导致多脏器功能衰竭,抢救无效死亡。结论床边B超结合诊断性的胸腔穿刺在张力性气胸的诊断上安全、省时;应用“腹腔镜穿刺鞘卡”穿刺置管行胸腔闭式引流术也因其操作简单、安全、快速、有效在治疗上取得满意的效果。     

负压封闭引流技术在软组织损伤修复中的临床应用

目的:探讨负压封闭引流(VSD)技术应用于软组织损伤创面早期修复的疗效;方法:对68例四肢软组织损伤患者将撕脱、离体及弃用肢体皮肤修剪成网状全厚皮片或含真皮下血管网皮瓣回植覆盖皮肤缺损创面,采用负压封闭引流技术促进创面肉芽组织及皮片生长修复创面。结果:68例愈合时间15~28 d,术后创面Ⅰ期愈合率为82.4%,Ⅱ期愈合率为100%;经3~24个月随访,患者皮肤弹性、感觉恢复满意。结论:该技术有效促进创面肉芽组织及皮片生长,缩小Ⅱ期植皮或皮瓣转移修复创面,是一种操作简便、疗效确切的治疗方法。     

Tension band wiring for olecranon fractures

Surgical Principles Anatomical reduction of fragments and internal fixation with 2 Kirschner wires and a tension band wire stable enough to allow early exercises. This technique permits dynamic compression of fragments and a speedy consolidation of the fractures.     

软组织张力测试对颈痛的诊断

目的：建立一种新的诊断颈痛痛点的生物力学测试方法及量化指标，即生物力学张力测试法(BMT)。方法：采用自制的局部软组织张力测试系统对颈痛患者局部痛点及正常人群无压痛点进行定量检测，用BMT作出诊断；并用目前颈痛痛点诊断方法(CDM)作为对照，进行临床诊断学试验。结果：软组织张力测试诊断颈痛痛点的灵敏度为70．0％，特异度为86．7％，Youden指数为56．7％，符合率为81．1％；阳性预测值为72．4％，阴性预测值为85．3％，阳性似然比为5．43，阴性似然比为0．32。结论：局部软组织张力测试诊断颈痛，能准确鉴别颈痛痛点与正常测试点，达到客观化诊断颈痛的基本要求。     

腹壁切口疝网片无张力修补术

目的 评估腹壁切口疝无张力修补术。方法 回顾分析15例腹壁切口疝用聚丙烯网片修补。网片用单丝不吸收缝线连续缝合固定在缺损边缘，网片必须超过缺损边缘2cm。常规术前预防性用单剂抗生素。结果 随访15－38个月无一例复发。结论 腹壁切口疝用聚丙烯网片无张力修补是一安全简单方法且术后疼痛轻微。     

Laparoscopic hernioplasty

This study compares the results of two laparoscopic hernioplasties: the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP). Over a 43-month period 1,115 laparoscopic hernioplasties, 733 TAPP and 382 TEP, were performed in 866 patients. There were 11 major complications in the TAPP group (2 recurrences, 6 trocar hernias, 1 small-bowel obstruction, 1 trocar, and 1 dissection injury of the small bowel) compared to 1 recurrence and no intraperitoneal complications in the TEP group. Five TEP procedures required conversion to the TAPP approach, resulting in one umbilical hernia. The median time to return to work did not vary with the approach, but was prolonged in patients compensated for time off, 16 vs 8 days for noncompensated patients.Results suggested that both techniques shortened recovery and eliminated most early failures, but the totally extraperitoneal approach reduced the potential for intraperitoneal complications and may be the procedure of choice in most situations.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

Soft tissue tension in extension in total knee arthroplasty affects postoperative knee extension and stability

The purpose of this study was to assess correlation of soft tissue tension in extension with postoperative extension deficit and valgus/varus instability. Sixty-four osteoarthritic knees that underwent primary total knee arthroplasty were investigated. Soft tissue tension in extension was measured during operation with a balancer/tensor device. Extension deficit was measured, and valgus/varus laxity was assessed by stress radiographs in extension and 30°-flexion 1 year after operation. The extension deficit became larger with an increase of soft tissue tension a year after operation. (P < 0.05) The varus laxity in extension and 30°-flexion and valgus laxity in 30°-flexion became smaller with an increase of soft tissue tension (P < 0.05). Our results demonstrated that soft tissue tension during operation affects postoperative knee extension and stability. An erratum to this article can be found at     

Relations between tensile impact properties and microstructure of compact bone

Summary Standardized human and beef femoral compact bone specimens were tested in tensile impact and the dynamic mechanical properties were determined. The microstructure of 45 beef and 47 human bone specimens were examined histologically to determine if there is a structural basis to account for strength differences in the bone samples. Strong negative correlations were obtained between the maximum stress and the percentage area of secondary osteons in each specimen. For human bone samples, the energy absorption capacity and the modulus of elasticity were also found to have strong negative correlations with the percentage area of secondary osteons present in each specimen. Linear regression equations were obtained describing the impact strength properties in terms of the percentage areas of secondary osteons and cavities in the samples.Fracture surfaces of the tested bone specimens were examined in a scanning electron microscope. Most surfaces exhibited a fairly rough texture indicating a quasi-cleavage type of failure. Fractographic analysis of bone fracture surface was helpful in understanding the micromechanics of bone fracture.Presented in part at the 21st Annual Meeting of Orthopaedic Research Society     

Tension pneumoperitoneum

A 26-year-old woman developed the adult respiratory distress syndrome after a post-partum haemorrhage. After mechanical ventilation was started the signs of a tense and distended acute abdomen developed. The aspiration and subsequent analysis of copious intra-peritoneal gas confirmed the diagnosis of a tension pneumoperitoneum secondary to pulmonary barotrauma.     

AO张力带钢丝与克氏针合用治疗髌骨骨折

本文报道了用ＡＯ张力带钢丝与克氏针合用治疗髌骨骨折９例，经临床观察，取得了良好的治疗效果。文中讨论了手术指征、手术技巧和介绍了术后功能恢复训练的方法。