下胫腓联合分离内固定术式的生物力学研究

目的　探讨下胫腓联合分离采用新型内固定术式———下胫腓钩板固定器 (Hook -platefixation ,HPF)的生物力学特性 ,与螺钉、钢板和带钩固定器三种内固定方式比较 ,为临床提供科学依据。方法　采用新鲜成人尸体足标本 6具 ,运用生物力学实验应力分析方法和压敏片技术 ,测量不同内固定术式的远端胫腓骨强度、应变、负重面积、接触应力和足弓承载能力及踝关节稳定性的变化。结果　新型下胫腓钩板固定器内固定术式无论在胫腓骨强度和刚度、负重面积、接触压力、足弓的变形、移位强度和刚度、承载能力以及踝关节的稳定性方面均优于其它三种内固定术式 ,具有显著性差异 (P <0 .0 1)。结论　实验结果表明 ,采用下胫腓钩板固定器 (HPF) ,既有利于提高生物力学性能 ,又有利于改善踝关节的稳定性 ,与传统手术方式相比可减少一次手术 ,避免了断钉等并发症 ,且能有效地提高足部承载能力 ,是下胫腓联合分离内固定的一种优良术式     

下胫腓关节弹性钩钢板内固定治疗下胫腓联合损伤

目的探讨下胫腓关节弹性钩钢板内固定治疗下胫腓联合损伤的临床疗效。方法采用下胫腓关节弹性钩钢板内固定治疗下胫腓联合损伤27例。结果 27例均获得随访6~18个月,疗效满意。末次随访时疗效按Baird-Jackson评分系统进行评定:优23例,良4例。结论下胫腓弹性钩钢板设计合理,符合下胫腓关节的解剖生理特点,固定可靠,可早期功能锻炼。     

胎盘早剥误诊及漏诊原因分析

目的：分析胎盘早剥的误诊及漏诊原因,提高不典型胎盘早剥的早期诊断率,改善母儿预后。方法2009年1月—2014年1月该院收治分娩孕产妇产前未明确诊断而产后确诊的胎盘早剥病例32例,误诊为先兆早产或临产16例、前置胎盘8例、胎儿窘迫6例、先兆子宫破裂2例,对临床资料进行回顾性分析。结果胎盘早剥误诊及漏诊率66.7%。发病诱因主要有妊娠期高血压疾病、胎膜早破、脐带过短或绕颈及不明原因;临床症状不典型、B超检查的阳性率低,胎心监护改变无特异性是其误诊及漏诊的主要原因。结论临床上只有重视诱因和不典型的临床症状,动态胎心监护,结合B超及实验室检查,综合分析,提高不典型胎盘早剥的早期诊断率并及时处理,才能改善母儿预后。     

胎盘早剥108例临床分析

目的探讨胎盘早剥病例的临床特点,提高诊断率,改善母儿预后。方法回顾性分析初诊时误、漏诊的80例(A组)和初诊时确诊的28例(B组)临床资料。结果胎盘早剥发生率为0.58%,误(漏)诊率为74.07%;妊高征、胎膜早破及催产素应用不当是胎盘早剥的主要发病诱因,妊高征与机械因素B组多于A组,两组差异均有统计学意义(P<0.01);阴道流血、腰背胀痛、腹胀痛和血性羊水,B组明显多于A组,差异有统计学意义(P<0.01)。新生儿窒息、婴儿死亡,B组明显多于A组,差异有统计学意义(P<0.01)。结论胎盘早剥误(漏)诊的主要因素是:病情隐匿,诱因不明,症状不典型,B超检出率低。因此,产科医务人员需高度重视主诉,详细询问患者病史,细仔检查盆腔体征,尤其要严密观察产程进展中的每个变化,并采用B超或彩超动态监测变化,力求尽早明确诊断,及时处理以降低母儿并发症和病死率。     

应用下胫腓钩板固定器治疗下胫腓联合分离伴腓骨骨折

目的 观察并总结采用自行研制的新型内固定器——下胫腓钩板固定器(Hook—plate fixation,HPF)治疗16例下胫腓联合分离伴腓骨骨折的初步临床疗效。方法 自2001年10月～2003年3月采用下胫腓钩板固定器治疗下胫腓联合分离伴腓骨骨折16例,根据应用改良Mazur评价标准对其术后疗效进行评定。结果 随访时间3～30个月,平均11个月。骨折愈合的时间为12～18周,16例中优良15例,可1例,优良率93％。结论 下胫腓钩板固定器生物力学性能最佳,也是治疗下胫腓联合分离伴腓骨下段骨折的最好内固定方式之一,但远期疗效有待于进一步观察。     

三踝骨折合并下胫腓联合分离治疗

目的 :探讨三踝骨折合并下胫腓联合分离的治疗。方法 :对 3 9例三踝骨折合并下胫腓联合分离内固定治疗患者进行回顾分析。结果 :本组 3 9例均获随访 ,随访时间 1～ 4年。优 2 0例 ,良 13例 ,可 6例。优良率 84.6%。结论 :三踝骨折合并下胫腓联合分离内固定治疗的关键是恢复并稳定踝穴和距骨的解剖关系 ,强调稳定内固定及早期功能锻炼     

Clinical features of abruptio placentae as a prominent cause of cerebral palsy

Background

Although abruptio placentae causes hypoxia in the infant and thus leading to cerebral palsy (CP), its incidence and clinical features at a nationwide level have not been demonstrated.

Aims

To determine the proportion of abruptio placentae among antenatal and intrapartum causative factors leading to cerebral palsy (CP) and clinical features of such abruptio placentae.

Study design

A review was conducted in 107 infants with CP in whom CP was determined to be due to antenatal and or intrapartum hypoxic conditions by the Japan Council for Quality Health Care until April 2012.

Results

Abruptio placenta was responsible for 28 (26%) of the 107 CP infants, and was the single leading causative factor of CP. Of these 28 women, 22 (79%) exhibited non-reassuring fetal status on admission to obstetric facilities at 36.2 ± 2.6 weeks of gestation and had neonates with umbilical cord arterial blood pH (base excess) of 6.728 ± 0.164 (− 25 ± 5.4 mmol/L). In these 22 women, strong abdominal pain and/or profuse vaginal bleeding occurred 159 ± 99 min prior to admission to an obstetric facility, and the interval until delivery after admission was 47 ± 31 min. Hypertension or isolated proteinuria preceded clinical events in one (4.5%) and five (23%) of these 22 women, respectively.

Conclusions

Abruptio placentae was responsible for CP in one quarter of all cases determined to be due to antenatal and/or intrapartum hypoxic conditions in Japan. New strategies to shorten the interval until admission to an obstetric facility after onset of symptoms are urgently needed.     

Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara,Turkey

Aim: To determine risk factors for severe complications during and after cesarean delivery (CD) in placenta previa (PP).

Methods: We reviewed retrospectively collected data from women with PP who underwent CD during a 6-year study period. We identified the complicated group based on the modified WHO near-miss criteria. Complicated and noncomplicated groups were compared considering clinical, laboratory, and sonographic features.

Results: Thirty-seven of 256 cases classified as near miss consisting of 14 peripartum hysterectomies, 12 uterine balloon placements, 10 great artery ligations, and four B-lynch suture placement procedures without maternal mortality. Perioperative complications included surgical wound infections (n?=?5), bladder injury (n?=?4), pelvic abscess (n?=?1), and uterine rupture (n?=?1). Logistic regression analyses demonstrated following features to be associated with maternal near miss in PP: (1) coexistent abruption (aOR 13.2, 95% CI 5.8–75.3), (2) morbidly adherent placenta (aOR 11.92, 95% CI 3.24–43.82), (3) number of hospitalizations for vaginal bleeding (≥3) (aOR 8.88, 95% CI 3.32–26.69), and (4) transvaginal cervical length (CL) measurement?<10th percentile (aOR 5.5, 95% CI 2.1–15.4).

Conclusion: Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe maternal morbidity in PP cases. Early identification of these risk factors during PP follow-up may improve maternal outcome.     

不同程度胎盘早剥产妇所生新生儿的临床特征

目的　探讨和强调不同程度胎盘早剥产妇所生新生儿的临床特征和危险性。　方法　回顾对照分析 1994年 7月～ 1998年 6月本科收治的 141例不同程度胎盘早剥产妇所生新生儿的临床资料。　结果　胎盘早剥产妇所生新生儿中早产儿为 94.3% ,低出生体重儿为 80 .9% ,窒息儿为79.4% ;入院时缺氧缺血性脑病 (HIE)为 6 3.1% ,心肌损害为 5 6 .0 % ,休克为 5 6 .7% ,贫血为 6 1.7% ,弥漫性血管内凝血 (DIC)为 83.0 % ,酸中毒为 6 6 .0 % ,呼吸窘迫综合征 (RDS)为 5 0 .4% ,呼吸暂停为5 1.1% ,均在 5 0 %以上。母胎盘早剥轻型组与重型组之间 ,入院日龄、性别、产式、胎龄、出生体重例数分布差异无显著意义 ,但各病症检出率均以重型组为高。其中窒息儿主要是重度窒息 ,检出率以重型组为高 ;DIC中 ,高凝期检出率以轻型组为高 ,低凝期检出率以重型组为高 ;轻型组新生儿中各相关危重症检出率虽然较重型组显著为低 ,但也分别达 43.4%～ 77.4%。　结论　印证了上述病症是胎盘早剥产妇所生新生儿的临床特征 ;表明了重型胎盘早剥产妇所生新生儿病情更复杂、更严重 ,但轻型产妇所生新生儿也具一定危险性 ,均应引起高度重视。