改良的三层缝合法处女膜修补术

目的探讨一种修补3、9点处女膜破裂的简单有效的手术方法。方法回顾性分析65例处女膜3点和／或9点破裂的患者,采用改良的三层缝合法处女膜修补术,术后达到处女膜孔径恢复至容一眼科镊柄大小（5～6mm）;术后1个月复诊。结果本组共65例患者,其中41例（63．1％）患者于术后1个月复诊,38例完全愈合,愈合率为92．7％,3例均有一处裂口裂开,但未至基底部,不影响效果。有效率为100％。结论应用改良的三层缝合法修复处女膜3、9点破裂的患者,切口愈合率较高,有微型紧缩阴道的作用,能模拟处女的正常生理状态。其方法简单有效,值得临床推广。     

A comparison of three methods of skin closure following repair of Achilles tendon rupture

Meticulous skin closure is required to avoid wound problems after Achilles tendon surgery. The purpose of our study was to compare postoperative complication rate, operation time, clinical outcome and patient satisfaction with the wound among two topical skin adhesives (2-octyl cyanoacrylate and n-butyl cyanoacrylate) and conventional nylon skin sutures in Achilles tendon repair surgery. We retrospectively reviewed the records 122 consecutive patients (40 patient in nylon skin suture, 43 patients in 2-octyl cyanoacrylate and 39 patients in n-butyl cyanoacrylate) who underwent surgical repair for acute Achilles tendon rupture between 2012 and 2016. The primary outcome measure was the development of complications in the wound. Secondary outcome measures included the operative time, the Achilles Tendon Total Rupture Score (ATRS) and patient satisfaction with the wound. There was no difference in complication rate in the wound (p = 0.694) and in ATRS (p = 0.824) among patients in the three groups. Mean operative time in nylon skin suture group was significantly longer than in the 2-octyl cyanoacrylate group and n-butyl cyanoacrylate group (p = 0.018 and p = 0.002, respectively). Patient satisfaction in the 2-octyl cyanoacrylate and n-butyl cyanoacrylate groups was significantly higher than in the nylon skin suture group (p = 0.015 and 0.018, respectively). The use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives for skin closure following repair of Achilles tendon rupture has equivalent effectiveness and safety compared to conventional nylon skin suture, but higher patient satisfaction. Despite its higher cost, these topical skin adhesives are viable alternatives for wound closure in patients who regard cosmetic outcomes as important.     

轮匝肌切除术联合睫毛外翻褥式缝合对先天性下睑内翻的矫治效果

目的 探究轮匝肌切除术联合睫毛外翻褥式缝合对先天性下睑内翻的矫治效果。方法 选取2019年1月—2022年1月南通大学附属医院眼科收治的82例先天性下睑内翻患儿,采用随机数字表法分为切除术组和缝线组,每组41例,切除术组采用轮匝肌切除术联合睫毛外翻褥式缝合治疗,缝线组采用传统缝线法治疗。术后2个月,比较两组的临床疗效、角膜散光值、最佳矫正视力及泪膜破裂时间。结果 切除术组治疗有效率为98.75%,高于缝线组90.00%(P <0.05)。切除术组治疗前后柱镜度数、泪膜破裂时间的差值均高于缝线组（P <0.05）;两组治疗前后轴位、最佳矫正视力的差值比较,差异无统计学意义（P>0.05）。结论 轮匝肌切除术联合睫毛外翻褥式缝合应用于先天性下睑内翻患儿的治疗中,更有助于提升临床疗效,保护视力且安全性良好。     

应用皮肤皱缩缝合技术行垂直切口乳房缩小整形术

目的　减少乳房缩小整形术所导致的切口瘢痕。方法　在做乳房缩小整形术时 ,在乳房下皱襞处不做切口 ,仅保留乳晕周围和乳晕下垂直切口 ,对乳房进行悬吊和塑形 ,而对乳晕下多余的皮肤和较长的皮肤切口 ,应用皮肤皱缩缝合技术进行缝合 ,利用组织的弹性 ,使其在手术后自动逐渐展平。结果　共为 13例患者实施了垂直切口的乳房缩小整形术 ,术后切口皆一期愈合 ,无血肿、感染、皮肤或乳头坏死等并发症发生 ,除 3例巨乳合并乳房严重松垂者半年后需再次对下皱襞处多余皮肤进行小的修整外 ,其余患者术后乳房和垂直切口形态满意。结论　垂直切口乳房缩小整形术设计、操作简单 ,容易掌握 ,效果恒定 ,在保证乳房缩小整形良好的乳房形态的同时 ,避免了在乳房下皱襞处的切口 ,是一种较好的乳房缩小整形术式。     

关节镜下double-needle缝线修复混合型半月板撕裂

目的探讨关节镜下采用double-needle缝线修复混合型半月板撕裂的疗效。方法 2006年4月-2011年1月,关节镜下采用double-needle缝线修复22例单膝混合型半月板撕裂。男14例,女8例;年龄18～41岁,平均31.3岁。均为运动损伤。受伤至入院时间为2 d～4年,中位时间11个月。膝关节功能根据国际膝关节文献委员会(IKDC)评分标准为(42.5±15.2)分,Lysholm评分为(45.5±13.5)分,Tegner评分为(2.9±1.6)分。17例合并前交叉韧带损伤。结果术后切口均Ⅰ期愈合,无神经、血管损伤。患者均获随访,随访时间12～48个月,平均27.6个月。按照Barrett等的评定标准,19例半月板临床愈合,临床愈合率86%。末次随访时,患者膝关节活动度均恢复正常,IKDC评分为(77.1±8.9)分,Lysholm评分为(79.8±9.9)分,Tegner评分为(6.8±1.6)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下使用double-needle缝线由内向外修复混合型半月板撕裂固定牢固、疗效肯定。     

Symptomatic chronic long head of biceps rupture: Surgical results

Purpose:

Chronic rupture of the long head of biceps (LHB) tendon is usually asymptomatic. However, some active patients suffer with long-term cramping pain associated with repetitive biceps use. The aim of this study is to review the outcomes of biceps tenodesis performed for chronic LHB ruptures.

Materials and Methods:

We performed a retrospective review of 11 consecutive patients who underwent biceps tenodesis for symptomatic chronic LHB ruptures over a 4-year period.

Results:

There were 10 men and one woman with an average age at surgery of 41 years (range 23-65). The mean follow-up was 29 months (range 6-60). In five cases a tendon was still identifiable and suitable for repair with an ‘in-bone’ interference screw. However, in six cases the tendon was not possible to tenodese with an interference screw. In these cases we used an ‘on-bone’ technique with suture anchors. All, except one, patients reported improvement in their arm pain (78%), strength (74%) and appearance. All, except one, were glad to have had the surgery.

Conclusions:

Symptomatic chronic LHB ruptures improve with a biceps tenodesis procedure. Due to the chronicity of the injury and possible degeneration of the tendon, a suitable tendon for ‘in-bone’ tenodesis may not be possible. In these cases an ‘on-bone’ footprint repair with suture anchors achieves good results.

Level of Evidence:

IV (retrospective case series).     

外痔切除缝合内痔结扎术治疗混合痔100例临床观察

目的 提高混合痔手术疗效,缩短愈合时间,减轻患者痛苦.方法 随机将200例混合痔患者分为两组,试验组100例采用外痔切除缝合内痔结扎术,即将内痔结扎,外痔剥离切除后一期缝合切口.对照组100例采用传统Milligan-Morgan术.观察两组切口愈合时间,术后疼痛、水肿、出血等情况.结果 两组病例治愈率均达90%以上,差异无统计学意义.但两组在切口愈合时间、痛苦程度、并发症等方面差异有统计学意义(P<0.05),试验组明显优于对照组.结论 与传统Milligan-Morgan术相比,外痔切除缝合内痔结扎术疗效肯定,愈合时间短,疼痛轻,术后并发症少.     

Transosseous arthroscopic repair of partial articular-surface supraspinatus tendon tears

Partial articular-surface tendon avulsion (PASTA) lesions of the supraspinatus muscle represent a common cause for shoulder impairment and a preceding pathology for full-thickness tendon tears. Arthroscopic tendon repair is a possible surgical method of treatment. The purposes of cuff repair are anatomical tendon healing, prevention of tear size progression to completion and reduction of shoulder pain. In this report, we describe a transtendon arthroscopic technique of transosseous refixation of articular-side partial tears leaving the bursal layer of the supraspinatus tendon intact. A curved hollow needle is used to perform an all arthroscopic transosseous mattress suture. Thus, anatomical tendon-to-bone contact of the rotator cuff to the footprint is restored. Preliminary clinical results of 16 patients are convincing with significant pain relief and functional improvement.     

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material

The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason–Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P < 0.001). The ultimate tensile strength in double-row specimens was significantly higher than in others (P < 0.001). There was no significant variation in using different suture material (P > 0.05). Double-row suture anchor repair with arthroscopic Mason–Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason–Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason–Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.     

胰岛素生长因子1在颅缝闭合中调节作用的实验研究

目的：研究胰岛素生长因子1对大鼠颅缝细胞的骨诱导作用和体外调节小鼠矢状缝闭合的作用。方法：获取新出生的SD大鼠的矢状缝细胞进行培养和出生8d的CD1小鼠矢状缝进行体外无血清器官培养基培养，加入胰岛素生长因子1（insulin lilce growth factor 1 IGF1），浓度分别为10ng/ml和40ng/ml，并设立不加IGF1者为对照组，应用RT－PCR检测颅缝细胞的成骨细胞表型碱性磷酸酶、骨钙素和骨桥蛋白mRNA表达，ELISA法检测培养液I型胶原的分泌，光镜观察小鼠矢状缝闭合的情况。结果：加入IGF1的矢状缝细胞的成骨细胞表型碱性磷酸酶、骨钙素和骨桥蛋白mRNA表达以及培养液I型胶原分泌量较对照组明显增高。有IGF1干预的矢状缝移植体培养8d时，颅缝内侧面骨板开始接近，培养20d时，颅缝小部分闭合，培养30d时颅缝大部分闭合，无IGF1干预的对照组培养30d，颅缝未发生闭合。结论：胰岛素生长因子1通过增强颅缝细胞的骨诱导促进颅缝的闭合。