ObjectiveTo evaluate the surgical techniques, perioperative complications, clinical outcomes of the modified Stoppa approach in the treatment of acetabular anterior and posterior column fractures. MethodsBetween March 2008 and October 2014, 42 cases of acetabular anterior and posterior column fractures were treated by modified Stoppa approach or modified Stoppa approach combined with iliac fossa approach, and the clinical data were retrospectively analyzed. There were 20 females and 22 males with an average age of 43.2 years (range, 19-68 years). Fractures were caused by traffic accident in 21 cases, by falling from height in 16 cases, and by heavy pound in 5 cases. The time from injury to operation was 3-15 days (mean, 6 days). According to fracture classification of Letournel-Judet, there were 20 cases of both column fractures, 15 cases of anterior and posterior hemi-transverse fractures and 7 cases of T-shaped fractures. The intraoperative blood loss, the amount of blood transfusion, the operation time, the volumn of drainage, and complication were recorded. Matta radiological standard was used to evaluate the reduction quality of fracture, and Merled'Aubigné-Postel system to evaluate hip function. ResultsThe average intraoperative blood loss was 900 mL; the average amount of blood transfusion was 400 mL; the average volume of drainage was 110 mL; and the average operation time was 165 minutes. Intraoperative complications included 4 cases of tractive injury of obturator nerve and 2 cases of the external iliac vein injury, and postoperative complications included 2 cases of lateral femoral cutaneous nerve palsies and 1 case of deep vein embolism of lower extremity, which were improved after treatment. The patients were followed up 36 months on average (range, 12-48 months). There was no infection or heterotopic ossification. According to Matta radiological evaluation system, the reduction quality of fractures was rated as excellent in 21 cases, good in 16 cases, and poor in 5 cases, with an excellent and good rate of 88.1%. The healing time of fracture was 3.5-8.0 months (mean, 5.1 months). According to Merled'Aubigné-Postel system for hip function, 20 cases were graded as excellent, 15 cases as good, 4 cases as fair, and 3 cases as poor, with an excellent and good rate of 83.3% at last follow-up. ConclusionModified Stoppa approach or with iliac fossa approach can get full exposure of quadrilateral area, good reduction, and firm internal fixation in the treatment of acetabular fractures associated with T-shaped fractures, both column fractures, anterior and posterior hemi-transverse fractures.
目的 探讨预防慢性肛裂手术并发症的技巧。方法 回顾性分析近3年笔者所在单位收治的63例慢性肛裂患者的临床资料，男21例，女42例，年龄（34±12）岁（17～51岁），均行肛裂切除术，并在处理内括约肌时采用橡皮筋结扎法，观察术后并发症的发生情况。 结果 所有患者术后恢复良好，无一例出现术后大出血、肛裂复发、肛门失禁等并发症。 结论 通过采用橡皮筋结扎法处理内括约肌，避免了术后并发症的发生，该方法值得推广。
目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。
OBJECTIVE: To discuss the method to repair the defects of palm with the improved flaps pedicled with the dorsal carpal branch of ulnar artery. METHODS: The improved flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery and the medial antebrechial cutaneous nerve, the ulnar artery was ligated and cut at the beginning of its dorsal carpal branch. The flap pedicled with dorsal carpal branch including the distal ulnar artery was achieved and applied clinically to repair 15 cases of the skin and soft tissue defects of palm from August 1997 to November 2001. The size of flaps ranged from 7 cm x 5 cm to 12 cm x 8 cm. RESULTS: All of the cases were followed up 3 weeks to 6 months, and the flaps completely survived. There was no ischemia and necrosis at the distal part of flaps and the appearance and function was satisfactory. CONCLUSION: The improved flap has long vascular pedicle, abundant blood supply and sensitive sensation, so it can be used to repair defect of palm.
To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.
目的 探讨应用改良Kugel补片后入路腹膜前修补腹股沟斜疝的优点、手术效果及其体会。方法 回顾性分析2006年12月至2007年6月期间我院采用改良Kugel补片施行腹股沟斜疝无张力修补术15例患者的临床资料。观察手术时间、伤口疼痛、术后恢复情况、并发症和复发率。结果 手术时间35～90 min，平均（50±10） min； 术后1 d能下床活动，术后均未使用止痛剂，术后住院时间3～5 d。全组切口一期愈合，无感染发生，1例切口周围有青紫，微波治疗1周后青紫消失。随访半年无不适和复发。结论 改良Kugel补片后入路腹膜前疝修补术具有微创、无张力、免缝合、疼痛轻、恢复快、并发症少等特点
ObjectiveTo evaluate the feasibility and safety of modified Yacoub technique with aortic annuloplasty in the patients with aortic root aneurysm and dilatation of aortic annular base.MethodsWe performed a retrospective review of 6 patients with aortic root aneurysm undergoing modified Yacoub technique with aortic annuloplasty from November 2017 to January 2019. There were 5 males and 1 female, with a mean age of 54.1±12.3 years. The preoperative cardiac function of 3 patients was in New York Heart Association (NYHA) classⅡand the other 3 patients were in class Ⅲ. There were two patients with bicuspid aortic valve, and no Marfan syndrome. There was aortic regurgitation in the patients measured by the echocardiogram, 1 in mild aortic regurgitation, 1 in moderate aortic regurgitation, and 4 in severe aortic regurgitation. The diameter of aortic annular base was 27.8±1.9 mm, and the largest diameter of aortic root was 49.8±3.7 mm. Six patients underwent modified Yacoub technique with aortic annuloplasty, including 5 patients who underwent aortic cusp repair at the same time.ResultsAll 6 identified patients survived. There was no severe complication (bleeding, stroke, or acute renal failure). The cardiopulmonary bypass time was 204.6±13.5 min, aortic cross-clamping time 168.0±17.1 min, mechanical ventilation time 21.3±19.5 h, ICU stay time 67.8±62.2 h. The follow-up time ranged from 4 to 18 months with an average time of 12.8±4.7 months. Patients' cardiac function improved postoperatively with four patients in NYHA classⅠand two patients with classⅡ. Two patients had no aortic valve regurgitation, four patients had mild regurgitation. Left ventricular end diastolic volume decreased significantly (118.6±20.4 mL vs. 169.1±58.4 mL, P<0.05).ConclusionThe modified Yacoub technique with aortic annuloplasty is effective and safe for the patients with aortic root aneurysm and dilatation of aortic annular base, and the early- and mid-term outcomes are satisfactory.
Objective To explore the effectiveness of the improved pedicled superficial iliac circumflex artery flap for repairing serious wound of the hand and forearm. Methods Between June 2008 and June 2011, 13 cases of serious wound of the hand and forearm were treated. There were 9 males and 4 females with a mean age of 41 years (range, 23-64 years). The disease causes included twist injury by machine in 2 cases, wire rope squeezed injury in 4 cases, traffic accident injury in 3 cases, crushing injury in 2 cases, high voltage electrical injury in 1 case, and snake bites in 1 case. There were 10 cases of fresh wounds and 3 cases of infection and necrosis wounds, and all had bone and tendon exposure. The skin and soft tissue defects ranged from 7 cm × 3 cm to 22 cm × 6 cm. The pedicled iliac artery flap was used in 8 cases, and pedicled iliac artery composite flap in 5 cases. The flap size ranged from 12 cm × 4 cm to 27 cm × 8 cm, with the flap pedicle of 2-4 cm wide strip and 3-5 cm wide fascia. Results The pedicle of flap was cut at 3 weeks in 12 patients, and at 4 weeks in 1 patient who had partial avulsion and hemorrhage at 1 week after operation. All flaps survived and incisions at donors and wounds healed by first intention. Eleven patients were followed up 6-36 months (mean, 20 months). The flap color and texture were good; 3 bulky flaps were observed, and satisfactory appearance was achieved after skin flap thinning. After 6 months, the protective sensation recovered in all cases; according to the Hand Surgery Society of Chinese Medical Association evaluation of upper extremity function trial standard for total active motion of the fingers, the results were excellent in 9 cases, good in 1 case, and poor in 1 case. Conclusion Improved fascia pedicled superficial iliac circumflex artery skin flap can repair serious hand and forearm injury, which is easy-to-operate and less injury at donor site.