外伤性肝破裂的救治

目的 分析创伤性肝破裂外科多种干预治疗的效果。方法 总结分析1982-2002年我院收治创伤性肝破裂76例的救治方法和病死率。其中Ⅲ级以上的严重肝破裂46例(60．53％)。手术治疗56例，手术方式包括单纯修补、清创性肝切除、规则性肝切除、肝周填塞止血；非手术治疗20例。结果 手术组：治愈44例，术后并发症17例均经保守治疗治愈，死亡12例，其中术中死亡2例；非手术组：治愈12例，好转6例，2例失访。全组治愈64例，死亡12例，病死率15．8％。结论 Ⅰ-Ⅱ级单纯性外伤性肝破裂可保守治疗；手术是治疗创伤性肝破裂的主要措施，正确的手术方式，积极处理合并伤，重视综合治疗可提高救治成功率。     

钝性腹部创伤致内出血的非手术治疗

目的：探讨非手术治疗在钝性腹部损伤并仙出血的地位和作用。方法：回顾性分析1992－1999年我院收治的32例经选择的钝性腹部创伤致内出血病人行非手术治疗的疗效。结果：30例经保守治疗痊愈,2例需中转手术,没有发生严重的迟发性并发症。结论：经选择的钝性腹部创伤致内出血病人行非手术治疗是安全有效的,对血流动力学稳定的患者可作为首选。     

Ankle Fractures: Supination-Eversion Fractures Stage II Primary and Late Results of Operative and Non-Operative Treatment

Sixty-nine patients with stage II supination-eversion fractures of the ankle, 34 treated by operation and 35 treated conservatively, were seen at follow-up after 3–10 years. There was no statistically significant difference between the results of the two methods. However, larger series and perhaps a longer observation time are probably needed to decide whether the displacement of the lateral malleolus as a result of non-operative treatment affords the same possibility of unhindered ankle function as union of the lateral malleolus in the anatomical position obtained by operation.     

Clinical outcomes of primary arterial embolization in severe hepatic trauma: A systematic review

Purpose

This purpose of this systematic review was to determine the safety and efficacy of arterial embolization as the primary treatment for grade III-V liver trauma, excluding the postoperative use of arterial embolization.

Operating theatre etiquette,sterile technique and surgical site preparation

The operating theatre is an unusual environment and understanding the systems in place there is an important part of surgical training. ‘Non-technical skills’ is a term used to describe everything a surgeon does in the operating theatre, other than the technical aspects of the procedure itself. This includes communication, decision making and leadership. Non-technical skills have become a vital aspect of the development of a surgeon and should form part of training programmes. A fundamental responsibility of the surgeon is the maintenance of sterility. The techniques of the surgical scrub and preparing and draping a patient only become second nature after good teaching and reflection by the surgeon. The purpose of this article is firstly to describe how a surgical trainee can get the most out of an operating session. We will describe what non-technical surgical skills are and why they are important. We will focus on safety in the operating theatre and discuss worldwide strategies such as the ‘Surgical Safety Checklist’ that aims to improve this. Finally we will present data on measures to reduce surgical site infection, such as which surgical scrub solution to use and whether drapes or wound protectors work.     

Calcaneonavicular coalition: a case study of non-operative management in an adult patient

ObjectiveThis study describes the radiographic diagnosis and nonoperative chiropractic management for a case of a chronic calcaneonavicular coalition in an adult patient.BackgroundCalcaneonavicular coalition is a congenital/acquired condition of the tarsal bones often diagnosed in individuals 8–12 years old. Considering its rare presentation (less than 1% of the population), there remains little literature on the conservative management of this condition.Case presentationChronic calcaneonavicular coalition in a 35-year-old recreational athlete is presented.Management/outcomeFollowing radiographic diagnosis, the patient was placed in a walking boot for four-weeks. After removal of the boot, the patient was managed nonoperatively. They reported a full resolution of symptoms with noted return to all pre-injury activities.SummaryPresentation of calcaneonavicular coalition may be dependent on many factors, including age, medical history, and chronicity of the condition. Previous medical background may include recurrent inversion ankle sprains, aggravated with activity, and alleviated with rest. Nonoperative management of calcaneonavicular coalition may be considered as a viable intervention.     

不稳定性骨盆骨折内固定治疗及非手术治疗近期疗效

目的比较分析不稳定性骨盆骨折内固定治疗及非手术治疗疗效。方法对84例不稳定性骨盆骨折患者,38例采用内固定手术治疗,46例采用非手术治疗。结果死亡5例,79例随访6个月～3年(21.4个月),根据Majeed骨盆骨折的结果分级评定标准,内固定组优良率91.7%,非手术组优良率62.8%。结论内固定组患者术后疗效满意率明显高于非手术组,对于不稳定性骨盆骨折患者应积极开展手术治疗。     

跟骨关节内骨折手术与非手术治疗疗效比较

为比较跟骨关节内骨折手术与非手术治疗的疗效差异。选择SandersⅡ-Ⅲ型跟骨关节内骨折24例，随机均分为两组。非手术组行手法复位石膏固定，手术组采用延长的外侧途径应用钢板松质骨螺丝钉联合固定。随访时间手术组平均30个月，非手术组平均26个月。按Maryland足部评分，手术组优良率83．3％，非手术组优良率41．7％；非手术组治疗后并发症发生率明显高于手术组；Bohler’s角与Gissane角手术组治疗前后比较有显著统计学差异，而非手术组治疗前后元显著统计学差异。表明对于SandersⅡ型或Ⅲ型的跟骨关节内骨折，手术治疗疗效明显优于非手术治疗。     

Conservative physiotherapeutic management of chronic haematomata and haemophilic pseudotumours: case study and comparison to historical management

Summary.  A conservative, non-operative physiotherapeutic regime for the management of chronic haematomata and pseudotumours in patients suffering from haemophilia is described in this article. Two cases are described where physiotherapy treatment is applied to large masses at the shoulder and femur respectively, where therapy commenced within the first 6 months following onset. These are presented relative to a case that was managed over a much longer period without early physiotherapy input, and the relative outcomes are examined. While both the early physiotherapy-managed cases showed a complete resolution at follow-up examination, the more established chronic pseudotumour required surgical excision, with significant residual muscle contractility, length and strength issues noted on clinical and magnetic resonance imaging reviews. No adverse symptoms or haemostatic issues were reported in response to this less invasive treatment regime by either patient in the two conservative physiotherapy cases.     

闭合性肝外伤的非手术治疗

目的：观察闭合性肝外伤的非手术治疗效果。方法：回顾性分析1999年1月至2002年12月本院收治的25例肝外伤病人的临床资料。其中闭合性伤21例。对Ⅰ-Ⅲ级肝损伤的13例先予非手术治疗。结果：入院时决定非手术治疗的13例中。2例观察48小时后因循环不稳定而中转手术，11例非手术治疗痊愈；Ⅰ-Ⅲ级闭合性肝损伤非手术治疗成功率为84．64％(11/13)。结论：闭合性肝外伤病人如入院时循环稳定，行B超及CT检查诊断为Ⅰ-Ⅲ级肝外伤。无合并需行手术处理的其它腹部损伤时，可首先考虑予非手术治疗。