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31.
M. Innocenti R. Civinini M. Villano C. Carulli E. Pratelli 《Journal of orthopaedics and traumatology》2007,8(2):106-109
Unicompartmental knee arthroplasty (UKA) is considered the treatment of choice in patients with single compartment arthritis
of the knee at early stages or with osteonecrosis limited to one compartment. However, results in the literature are still
controversial and it is a technically difficult procedure. The main goal of UKA is to restore the articular space of the afflicted
compartment, without influencing the limb alignment. Selection of patients and pre-operative planning are crucial. The necessity
to improve functional results and to reduce immobilization of the patients has led to the development of minimally invasive
surgery. Applied to UKA, this approach reduces blood loss and surgical time, causes fewer symptomatic postoperative complications,
and permits earlier recovery compared to the traditional incision. The shorter incision makes careful pre-operative planning
essential. We briefly review the indications for UKA, the pre-operative clinical and radiological assessment, and the surgical
procedure.
Proocedings of the Consensus Conference “TSS in hip and knee replacement” (Rapallo, Italy 22–24 June 2006) 相似文献
32.
鼻胃管胃肠减压在择期腹部手术中的应用价值 总被引:6,自引:0,他引:6
鼻胃管胃肠减压曾被常规应用于择期和急诊的腹部手术后,目的是预防急性胃扩张的发生、治疗梗阻、降低吻合口压力等。但是,鼻胃管置入也会带来一些副作用,如呼吸道并发症、胃-食道反流、体液和电解质的丢失、声带的损伤,以及越来越被重视的患者的不适感。近年来的研究结果也对择期的腹部手术后常规应用鼻胃管胃肠减压提出不同的看法。现重新评价应用鼻胃管胃肠减压的理论基础及相关临床研究的结果,并对鼻胃管胃肠减压在择期腹部手术中的价值作一综述。 相似文献
33.
P. Rossi F. Castoldi R. Rossi F. Caranzano M. Baronetti F. Dettoni 《Journal of orthopaedics and traumatology》2007,8(3):157-163
Surgery passes through a continuous evolution, thanks to the introduction of new technologies and techniques. Tissue-sparing
surgery is a concept introduced in the last years to address prosthetic surgery to a more conservative fashion. We discuss
the TSS decalogue with a critical eye, pointing out how traditional surgery is evolving in accordance with TSS statements.
Proceedings of the Consensus Conference “TSS in hip and knee replacement”, Rapallo, Italy, 22–24 June 2006 相似文献
34.
经尿道电气化手术治疗112例膀胱肿瘤的临床分析 总被引:1,自引:0,他引:1
目的 :探讨经尿道电气化手术治疗病变局限于膀胱壁内肿瘤的治疗方法。方法:综合采用套切、勾切、气化、凝切及电凝、封闭闭孔神经等技术 ,经尿道根治性电气化手术切除膀胱肿瘤 112例。结果:2例因膀胱穿孔改行开放手术 ,7例需 2次手术完全切除肿瘤 ,全部病例均达到根治性切除目的 ,术后平均留置尿管 3~ 7d。结论 :经尿道电气化切除手术适宜病变局限于膀胱壁内肿瘤的根治性治疗。 相似文献
35.
后腹腔镜下肾肿瘤剜除术的临床疗效观察(附5例报告) 总被引:4,自引:0,他引:4
目的:探讨后腹腔镜下肾肿瘤剜除术的操作要点及临床价值。方法:采用后腹腔镜下肾肿瘤剜除术治疗肾肿瘤5例,其中肾癌3例,肾错钩瘤2例,瘤体直径1.5~4.0cm。具体方法是:①暴露瘤体和肾动脉;②采用硅胶管牵拉肾动脉,必要时可暂时阻断肾动脉;③于瘤体1cm正常肾组织处用电钩切除瘤体;④采用生物蛋白胶、止血纱布缝合加压处理创面出血。结果:手术均获成功。手术时间150~210min,术中出血80~350ml。术后1~2天肠道功能恢复并可床上活动,1~4天可下床活动。术后住院5~9天,平均7天。结论:后腹腔镜下肾肿瘤剜除术具有创伤小、康复快、安全、住院时间短等优点;对外生性生长、直径小于4cm瘤体,该法可作为首选手术方法。 相似文献
36.
37.
改良开放性手术治疗巨大良性前列腺增生症 总被引:2,自引:0,他引:2
目的探讨巨大良性前列腺增生症的开放性手术治疗方法及效果。方法回顾分析16例巨大良性前列腺增生症,年龄61~88岁,平均74岁。作耻骨上经膀胱前列腺切除术。结果手术均成功;手术时间35~65min,出血量100~200mL,术后前列腺重量为200~520g,平均215g;膀胱冲洗2~3d,拔导尿管5~7d;术后3d再出血1例,经DSA同侧髂内血管栓塞止血成功,排尿困难1例,短期尿失禁1例,其余患者术后均排尿通畅,控尿良好。结论开放性手术治疗巨大良性前列腺增生症,其梗阻解除彻底,是一种合理的治疗方法。恰当的手术方法是提高疗效及降低并发症的关键。 相似文献
38.
Michael D. Lara M.D. Matthew T. Baker M.D. Christopher J. Larson PA-C R.D. Michelle A. Mathiason M.S. Pamela J. Lambert R.N. Shanu N. Kothari M.D. 《Surgery for obesity and related diseases》2005,1(1):597-21
BACKGROUND: There is no consensus regarding the optimal rate of follow-up in the post-bariatric surgery patient population. METHODS: The records of all patients who underwent laparoscopic Roux-en-Y gastric bypass from 2001 to 2003 were reviewed. Using patient zip codes, travel distances were calculated between the patients' places of residence and our clinic. Patients were then assigned to 1 of 3 cohorts according to the following distances: (1) < 50 miles, (2) 50 to 100 miles, and (3) > 100 miles. Patient compliance with follow-up appointments at 3 weeks, 3 months, 6 months, 9 months, and 12 months was analyzed. Linear trends were identified using the Mantel-Haenszel test. Age and sex were analyzed as possible predictors of compliance using the chi(2) test. P values < .05 were considered statistically significant. RESULTS: The study group comprised 150 patients (127 females and 23 males). The 3 cohorts contained 115, 21, and 14 patients, respectively. All patients in each cohort were compliant with the 3-week follow-up appointment. Although there were differences in compliance between cohorts at each of the remaining appointments, only the 9-month (70.3% vs 61.9% vs 35.7%) visit showed statistical significance (P = .035). The 6-month visit trended toward significance (85.2% vs 76.2% vs 64.3%; P = .088). Males were more likely to be compliant with the 12-month follow-up (P = .040). When controlling for sex, travel distance was also a predictor of compliance at this follow-up visit (P = .024). Age was not predictive of compliance (P = .827). CONCLUSION: Based on our findings, we conclude that travel distance from the clinic does not significantly affect compliance at the initial follow-up, 3-month, and 12-month appointments. However, distance does tend to affect compliance at the 6-month appointment and significantly affects compliance at the 9-month appointment. Males are more likely to be compliant at the 12 month follow-up visit. We must continue to strive for 100% follow-up in our post-bariatric surgery patients. 相似文献
39.
Objective: The main aim of the present study was to examine the effectiveness and complication rate of the 1 cm right‐sided unilateral sublabial trans‐sphenoidal surgery for patients with pituitary adenoma equal to or greater than 5 mm in diameter. Method: A total of 350 patients were surgically treated for pituitary adenomas between December 1999 and December 2003 in an academic neurosurgical unit in China. Three hundred patients (86%) were treated with the 1‐cm right‐sided unilateral sublabial trans‐sphenoidal approach. The mean age of patients was 43 years (range 10–78 years) and female patients accounted for 59% of the total. One hundred and ninety‐six (64%) patients had functioning endocrine tumours and 104 (36%) patients had non‐functioning tumours or macroadenomas. Tumours which were outside this simple and basic classification were excluded from the study. Results: There were no operative mortalities. One patient developed hypopituitarism and 16 (5%) developed transient diabetes insipidus that required pituitrin treatment. The remission rate for macroadenoma was 85% and that for microadenoma was 98.5% during a medium term follow‐up of 1–5 years. One hundred and fifteen patients had prolactin secreting tumours and 90.4% achieved endocrine remission. Fifty‐six patients had growth hormone secreting tumours and 75.4% achieved endocrine remission. Preoperatively, one hundred and fifty‐one patients presented with visual impairment and 148 (98%) achieved a documented improvement in visual acuity. The mean duration of hospital stay was 4 days (range 3–7 days). Conclusion: This minimally invasive trans‐sphenoidal surgery for pituitary adenomas could be used as the primary treatment for small pituitary tumours. The effectiveness of the tumour removal and low morbidity rate compare favourably with the conventional sublabial approach as well as the more recently developed endoscopic endonasal approaches. 相似文献
40.
Autotransfusion after open heart surgery: the oxygen delivery capacity of shed mediastinal blood is maintained 总被引:1,自引:0,他引:1
H. Schmidt U. Kongsgaard J. Kofstad O. Geiran H. E. Refsum 《Acta anaesthesiologica Scandinavica》1995,39(6):754-758
Autotransfusion of mediastinal shed blood after open heart surgery has become a common and accepted procedure in reducing the need for homologous transfusion during the last 15 years. The objectives of the present study were to investigate the oxygen delivery capacity of autotransfused shed mediastinal blood, compared to patient-blood, during cardiopulmonary bypass and in the postoperative period.
Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration.
Autotransfusion volume ranged from 450–1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood.
The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion. 相似文献
Ten consecutive patients undergoing elective cardiac surgery were studied. Mediastinal shed blood was collected in the cardiotomy reservoir and retransfused during the first 18 postoperative hours. The oxygen delivery capacity of the blood to the tissues was calculated by use of the oxygen status algorithm (OSA 2.0) programme and measurement of the 2,3-diphosphoglycerate (2,3-DPG) concentration.
Autotransfusion volume ranged from 450–1530 ml per patient (median 824 ml). Shed blood had a mean haemoglobin level of 8.8 g/dl and 7.4 g/dl at 1 h and 6 h of autotransfusion, respectively. There were no significant changes of 2,3-DPG concentration in the patient-blood during cardiopulmonary bypass or after autotransfusion compared to preoperative values. P50 for oxygen (3.6 and 3.6 kPa) and 2,3-DPG concentrations (5.3 and 5.1 mikromol/ml erythrocyte) in shed mediastinal blood (1h and 6h postoperatively) were not significantly different compared to patient-blood.
The results demonstrate that the oxygen delivery capacity of shed mediastinal blood is maintained and that the oxygen affinity of patient-blood is not influenced by autotransfusion. 相似文献