Is early hardware removal compulsory after retention of angled drill guides in palmar locking plates？ The role of pronator quadratus reconstruction

Palmar plate fixation is becoming a well recognized treatment for distal radial fracture. Tendon ruptures or irritations have been reported after this procedure. Inadvertent retention of angled drill guides useful for easy placement of locking screws in proper direction in volar plating can represent a high risk of secondary tendon rupture. In this case, we presented our experience in one patient in whom drill guides removal could be delayed for one year and summarized our techniques to prevent the aforementioned complications.     

ERCP治疗医源性胆道损伤应用价值（附27例分析）

目的 探讨ERCP对医源性胆道损伤的诊断与治疗。方法 回顾2009年1月至2011年1月收治的医源性胆道损伤27例,先行ERCP检查,明确损伤的部位、性质及程度,继而行内镜下乳头括约肌切开（EST）,胆道球囊扩张及鼻胆管引流（ENBD）或胆道内支架植入术（ERBD）。结果 27例胆道损伤病人,除1例恶性肿瘤病人死于肿瘤转移,其余26例病人临床症状完全缓解;10例胆瘘者内镜引流术,腹腔平均胆汁引流量由术前300mL/d减至50mL/d以下,两者比较有显著性减少（P<0.01）,窦道多在1~2周内自行愈合。发生黄疸者19例,治疗后第1天平均总胆红素由术前（65.2±11.6）μmol/L下降到（31.6±9.1）μmol/L,治疗前后相比有显著性降低（P<0.01）。3例患者术后出现一过性血淀粉酶增高,4～6d后恢复正常,1例出现胆道感染,无出血、穿孔和急性胰腺炎发生。结论 ERCP可作为处理胆道手术并发症如大流量胆瘘和或胆道狭窄的首选治疗。内镜下乳头括约肌切开鼻胆管引流能降低胆道内的压力,减少瘘口流量,促进瘘口闭合;大口径内支架植入能有效扩张狭窄胆管,有利于胆汁排泄通畅。