高频手术电极的研究进展

高频手术电极集切割、电凝和止血等作用于一体,能快速实现组织的离断、消融与闭合,在临床中的应用越来越广泛。高频手术电极按施加的电流频率范围可以分为普通高频电极和射频电极。该文主要介绍高频手术电极的工作原理与分类,并结合国内外高频手术电极的研究现状,对其在外科手术中的应用进行综述,并对其发展进行展望。     

外伤性嵌钝性天幕疝的发生及天幕切开疗效的初探

目的 :为了解外伤性嵌钝性脑疝的发生规律 ,认识天幕切开治疗嵌钝性脑疝的疗效 ,对术前确诊为脑疝的病例术中清除血肿后直接观察脑疝的嵌钝情况。方法 :对脑疝嵌钝者行天幕切开 ,观察其术后 GCS评分同时与既往临床资料上分析嵌钝性脑疝可能性较大、未切开天幕的病例进行对比。结果 :嵌钝性脑疝多发生在血肿量大 ,GCS评分低的病人。结论 :天幕切开可提高疗效。     

桔梗扦插繁殖试验

对桔梗进行扦插繁殖试验，结果看出：用茎基部作插条的成活率最高（５２．２３％），茎梢部作插条成活率很低（１．１１％）；用激素处理可大大提高插条的成活率，其中ＮＡＡ（萘乙酸）１００ｐｐｍ处理３ｈ最显著，比对照组提高２３．３３％；扦插基质湿度过大，会引起插条腐烂。     

纤维鼻咽镜联合切割吸引器对腺样体肥大患儿血清TNF-α、IL-4、LTB4水平的影响

目的探讨纤维鼻咽镜联合切割吸引器对腺样体肥大患儿血清肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白三烯B4(LTB4)水平的影响。方法选取2017年2月至2019年7月在本院进行治疗的腺样体肥大患儿80例,按照随机数字表法分为观察组与对照组,各40例。对照组行传统经口腺样体刮除术,观察组行纤维鼻咽镜联合切割吸引器切除术,比较两组患儿血清TNF-α、IL-4、LTB4水平。结果术后,两组血清TNF-α、IL-4、LTB4水平均降低,且观察组低于对照组,差异有统计学意义(P<0.05);观察组术中出血量少于对照组,鼻腔恢复通气与咽痛持续时间短于对照组,差异有统计学意义(P<0.05);观察组并发症发生率略低于对照组,差异无统计学意义。结论纤维鼻咽镜联合切割吸引器的应用可减少术中出血量,促进恢复,降低腺样体肥大患儿血清TNF-α、IL-4、LTB4水平,且安全性较高。     

Evaluation of a CT-based technique to measure the transfer accuracy of a virtually planned osteotomy

Accurate transfer of a preoperatively planned osteotomy plane to the bone is of significance for corrective surgery, tumor resection, implant positioning and evaluation of new osteotomy techniques. Methods for comparing a preoperatively planned osteotomy plane with a surgical cut exist but the accuracy of these techniques are either limited or unknown. This paper proposes and evaluates a CT-based technique that enables comparing virtual with actual osteotomy planes. The methodological accuracy and reproducibility of the technique is evaluated using CT-derived volume data of a cadaver limb, which serves to plan TKA osteotomies in 3-D space and to simulate perfect osteotomies not hampered by surgical errors. The methodological variability of the technique is further investigated with repeated CT scans after actual osteotomy surgery of the same cadaver specimen. Plane displacement (d_err) and angulation errors in the sagittal and coronal plane (β_err, γ_err) are measured with high accuracy and reproducibility (d_err = −0.11 ± 0.06 mm; β_err = 0.08 ± 0.04°, γ_err = −0.03 ± 0.03°). The proposed method for evaluating an osteotomy plane position and orientation has a high intrinsic accuracy and reproducibility. The method can be of great value for measuring the transfer accuracy of new techniques for positioning and orienting a surgical cut in 3-D space.     

冠状动脉僵硬性病变的切割球囊术后即刻结果

目的　研究新技术切割球囊对僵硬的冠状动脉狭窄病变的效果。方法　 33例病人经应用耐高压球囊高压扩张后 ,对不能扩张的僵硬病变换用切割球囊扩张后 ,对比其扩张结果。结果　切割球囊扩张僵硬性病变的总成功率达 87 9%。当耐高压球囊不能扩开病灶或效果不佳时 ,换用切割球囊 ,应用切割球囊取得了良好的效果 (最小血管内径 2 4 7± 0 5 4mm ,基线血管内径狭窄率 16 %± 15 % )。结论　切割球囊应用较低的压力和较小的扩张时间也可以用于硬性病变或某种程度的钙化病变 ,得到了较高的手术成功率且非常安全 (无心脏事件发生 )。     

Cut or burnt? – Categorizing morphological characteristics of heat-induced fractures and sharp force trauma

Distinguishing trauma from heat-induced fractures is a challenge faced by forensic anthropologists and pathologists during medicolegal investigations in which fire has been used by the perpetrators to destroy evidence. This paper aims to validate the provided identification features to distinguish between fire induced alterations and sharp force trauma.A total of 80 cremated adult individuals were used in this paper: 3 recently deceased embalmed cadavers from Cementerio Sur de Madrid for the sharp force trauma experiment in which 55 pre-burning injuries were inflicted using a machete and a serrated knife in different anatomical regions. And 77 cremated individuals from the Forensic Anthropology and Odontology Laboratory osteological collection. Five cremated long bones from this collection were selected, and 10 cuts were manually inflicted using a serrated knife to analyse post-burning trauma. Heat-induced changes and trauma morphologic characteristics were thus documented and analysed. The examination and documentation of morphological traits enabled the production of a heat-induced changes visual guide and a flow-chart. Two intraclass correlation tests were performed to validate the capacity of the observer to distinguish between fire related alterations and toolmarks.The results obtained in the statistical analysis indicate that, even if the toolmarks are visible and recognizable upon macroscopic observation by the observers, some features, such as the step and the transverse fractures can be mistaken with inflicted trauma. The use of the proposed features coupled with careful anthropological examination is recommended and has been found functional for participants with no prior knowledge in the analysis of cremated remains.     

Accuracy of position of cutting and drilling guide for sagittal split guided surgery: a proof of concept study

The benefits of three-dimensional planning and guided surgery have been realised over the last few years in maxillofacial surgery. Reproducing the exact positioning of the cutting and drilling guides on the flat mandibular angles defined by the engineer is a challenge for the surgeon and for the reliability of guided bilateral sagittal split osteotomy. Reference screws positioned on the skeleton before the acquisition of medical computed tomographic data can provide a fixed landmark that can be used during surgery and by the engineer during the design phase. The objective of this proof of concept in vitro study is to calculate the accuracy obtained for guides positioned by inserting a reference screw. The precision obtained for 30 guides following the insertion of 30 reference screws on 15 mandibular models was analysed. The models were scanned using an optical scanner and compared to CAD-CAM projects. The mean (SD) absolute position (in)-inaccuracy is 0.1616 (0.1141) mm for the entire guide surface and 0.13143 (0.0835) mm for the rim surface. The results indicate that the use of reference screws is efficient, and so they can be used to position guides accurately during guided bilateral sagittal split osteotomy.     

Use of a titanium cutting guide to assist with raising and inset of a DCIA free flap

Reconstructing maxillary defects can be challenging. In particular, Class 3 and 4 defects require careful planning.³ Bone for reconstruction must be placed in the correct three dimensional (3D) position in order to achieve a good cosmetic and functional result. Correct size and positioning of the harvested bone also enables placement of dental implants and allows rehabilitation.     

切割闭合器在胆道闭锁Kasai手术中的应用

目的探讨切割闭合器对胆道闭锁手术疗效、可行性及安全性的影响。方法将2012年5月至2014年12月本院收治的118例胆道闭锁患儿随机分为常规手术组和使用闭合器组,每组各59例。所有病例均行肝门空肠吻合术(Kasai手术),常规手术组行手工肠吻合术,闭合器组术中使用微型切割闭合器进行肠道重建。比较两组在手术时间、麻醉复苏时间、术后肠道功能恢复、吻合口瘘、狭窄、早期粘连性肠梗阻、肝功能损害程度以及术后黄疸清除率、早期胆管炎发生率、麻醉并发症及手术费用等方面的差异。结果两组在吻合口瘘、狭窄、体温变化,早期粘连性肠梗阻、术后呼吸道感染、黄疸清除率方面比较,差异无统计学意义(P0.05);在手术时间、麻醉复苏时间、肠道功能恢复时间等方面比较,差异有统计学意义(P0.05),闭合器组优于常规手术组,但前者住院费用明显升高(P0.05);两组术后转氨酶较术前均明显升高(P0.05),但升高差异,两组间比较,无统计学意义(P0.05)。结论使用切割闭合器进行Kasai手术,可缩短手术及麻醉时间,促进术后复苏及肠功能恢复,不增加手术、麻醉并发症、肝功能损害及术后早期胆管炎的发生率,但费用较高,在条件许可的情况下,可做临床推广应用。