腹腔镜下子宫双侧动脉阻断术联合清宫术治疗剖宫产瘢痕妊娠疗效分析

目的 探讨腹腔镜下子宫双侧动脉阻断术联合清宫术治疗剖宫产瘢痕妊娠疗效及对内分泌的影响.方法 选择2011年1月至2015年12月剖宫产瘢痕妊娠患者57例,其中A组32例患者给予超声引导下清宫术治疗,B组25例患者给予腹腔镜下子宫双侧动脉阻断术联合清宫术治疗,比较两组患者出血量、住院时间、月经复潮时间、术后人绒毛膜促性腺激素(hCG)降至正常时间,并发症情况及术前(T0)、术后第1d(T1)、第3d(T2)神经内分泌激素水平.结果 ①B组患者出血量低于A组,住院时间、月经复潮时间短于A组,比较差异有统计学意义(t出血量=31.85,k院时间=9.36,t月经复t潮时间=16.37,均P＜0.05);②B组患者并发症发生率为8.00％,低于A组的15.63％,比较差异有统计学意义(x2=9.35,P＜0.05);③B组T1、T2血清COR、β-EP、GLU水平低于A组(CORF交互=17.67,β-EPF交互=132.36,6LUF交互=155.38,均P＜0.05).结论 腹腔镜下子宫双侧动脉阻断术联合清宫术治疗剖宫产瘢痕妊娠微创优势明显,安全性高,对内分泌影响较轻.     

The longitudinal validity,reproducibility and responsiveness of the Brisbane Burn Scar Impact Profile (caregiver report for young children version) for measuring health-related quality of life in children with burn scars

BackgroundThe measurement of health-related quality of life (HRQoL) provides information about the perceived burden of the health condition and treatments from a lived experience. The Brisbane Burn Scar Impact Profile (caregiver report for young children, BBSIP^0–8), developed in 2013, is a proxy-report measure of burn scar-specific HRQoL. The aim of this study was to report its psychometric properties in line with an evaluative purpose.MethodsCaregivers of children up to 8 years of age at risk of burn scarring were recruited into a prospective, longitudinal cohort study. Caregivers completed the BBSIP^0–8, Pediatric Quality of Life Inventory and Patient Observer Scar Assessment Scale at baseline (approximately ≥85% of the total body surface area re-epithelialised), 1–2 weeks after baseline and 1-month after baseline. Psychometric properties measured included internal consistency, test–retest reliability, validity and responsiveness.ResultsEighty-six caregivers of mostly male children (55%), of a median age (IQR) of 1 year, 10 months (2 years, 1 month) and total body surface area burn of 1.5% (3.0%) were recruited. Over one third of participants were grafted and 15% had contractures or skin tightness at baseline. Internal consistency of ten item groups ranged from 0.73 to 0.96. Hypothesised correlations of changes in the BBSIP^0–8 items with changes in criterion measures supported longitudinal validity (ρ ranging from ?0.73 to 0.68). The majority of item groups had acceptable reproducibility (ICC = 0.65–0.83). The responsiveness of five item groups was supported (AUC = 0.71–0.90).ConclusionThe psychometric properties tested support the use of the BBSIP^0–8 as an evaluative measure of burn scar-related health-related quality of life for children aged below eight years in the early post-acute period of rehabilitation. Further investigation at longer time period after burn injury is indicated.     

The epiphyseal scar joint line distance and age are important factors in determining the optimal screw length for medial malleoli fractures

AimThe screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw length.Material method368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance. The mean screw length for each decade was calculated. The correlations of screw length with age, screw length with distance of epiphyseal scar to joint line, and screw length with distance of joint line to medullary space were evaluated.ResultsThe optimal screw length was obviously decreased in patients in 61–70 and >70 years old group (p = 0.002). As the distance of epiphyseal scar from joint line was increased, the optimal length of screw was also increased (p = 0.001). The distance of epiphyseal scar from joint line was decreased by age (p = 0.011).ConclusionThe optimal screw length was decreased by age and the epiphyseal scar to joint line distance could be a clue for optimal screw length in medial malleoli fractures.     

超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕疗效分析

目的:探究超脉冲CO2点阵激光联合富血小板血浆(PRP)治疗面部痤疮凹陷性瘢痕的疗效。方法:72例面部痤疮凹陷性瘢痕患者,随机分为观察组(36例)和对照组(36例)。对照组采用超脉冲CO2点阵激光治疗,观察组采用超脉冲CO2点阵激光联合PRP治疗。比较两组患者的灰度差异、时间指标、瘢痕程度、疼痛、不良反应及视觉评估。结果:观察组的并发症发生率为11.11%,低于对照组的36.11%,差异具有统计学意义(P<0.05)。治疗后,两组患者的灰度差异率均减小,且观察组患者的灰度差异率显著低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的炎性渗出时间、红肿时间、愈合时间、停工时间及瘢痕程度评分均低于对照组,差异均具有统计学意义(P<0.05);但疼痛度评分组间比较,差异无统计学意义(P>0.05)。结论:超脉冲CO2点阵激光联合PRP治疗面部痤疮凹陷性瘢痕效果较好,可有效降低瘢痕程度,减少治疗时间及并发症的发生,帮助患者迅速回归正常工作与生活,值得临床推广使用。     

颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

经桡动脉行冠状动脉造影术的安全性观察

目的探讨经桡动脉行冠状动脉(冠脉)造影术的特点及安全性。方法200例患者接受经桡动脉径路行冠脉造影术。结果196例成功,4例失败,其中3例桡动脉迂曲畸形导丝不能通过,1例为锁骨下动脉闭塞。所有患者无严重的并发症出现。结论桡动脉径路行冠状动脉造影具有止血容易,患者卧床时间短和并发症少的优点,是一种安全、有效的介入途径。     

磷酸钙水泥填充固定桡骨远端骨折的抗旋转生物力学研究

目的对磷酸钙水泥(CPC)填充固定桡骨远端骨折的抗旋转应力进行评价,并与传统的克氏针固定方法进行比较。方法18根人桡骨标本制备桡骨远端骨折伴骨缺损模型,随机分为三组:克氏针固定组、CPC固定组和CPC 克氏针联合固定组。设定扭转速度为5°／min,最大扭转角度为10°时停止。记录扭转刚度、10°内的最大扭矩及所对应的最大扭角。结果在10°的扭转范围内,CPC固定组、CPC 克氏针联合固定组的扭转刚度、最大扭矩均比克氏针固定组大,差异有统计学意义(P< 0．01);最大扭转角度分别为4．3°和5．0°,均比克氏针组(9．6°)小,差异有统计学意义(P<0．01)。CPC固定组与CPC 克氏针联合固定组之间的扭转刚度、最大扭矩及最大扭角差异无统计学意义(P> 0．05)。结论在旋转角度小于4°范围内,CPC的抗旋转固定强度要比克氏针大,超过这个范围,骨水泥就会发生断裂,CPC的有效固定范围比克氏针要小。     

The radial forearm flap

Described in 1981 by the Chinese authors Yang Kuofan et al. [1] as a free flap, then in 1982 by Lu et al. [2] as a retrograde flow pedicle flap, this fasciocutaneous flap is designed at the level of the anterior and external faces of the forearm, and vascularized by the radial artery via a network of septal arteries. Prior to utilization it must be reversed on its distal pedicle. This flap allows repairing cutaneous substance loss of the whole hand and fingers. The emergence of the Chinese flap in the 1980’s resulted in a regression of the Mac Gregor groin flap that was widely used at this time [3,4]. Nevertheless, other forearm flaps, less “expensive” in terms of vascular involvement [5–9] have reduced its indications. The Chinese flap however keeps two essential indications: the multi-finger important defect that no other forearmflapmay cover; and composite substance loss of the thumb (despite the fact that the Chinese flap shares these indications with interosseous artery composite flaps).     

Mammaplasty: Shape,volume, and scar size

Recently many mammaplasty techniques have been presented with special attention paid to the resulting scar's size and its position. The surgeon should try to hid the scar, and if the inverted T incision is used, its horizontal branch should be as short as possible and kept in the breast area. Neverthelss, excessive concern about the final scar size should not interfere with the final results of the mammaplasty as far as shape, volume and lasting results are concerned. The author presents his experience in mammaplasty with respect to the volume, the shape, and the scar size interrelationships.