目的 总结腹部闭合性损伤的诊治体会。方法 回顾性分析我院78例腹部闭合性损伤患者的临床资料。结果 78例中67例手术治疗，4例行肾动脉栓塞术，7例保守治疗； 除1例死亡外，余均治愈。结论 及时诊断和治疗是救治腹部闭合性损伤患者的关键，腹腔穿刺、B超、CT及X线检查的合理应用对诊断有重要价值。
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
Objective To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma. Methods Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected. The injury causes, diagnostic methods, surgical treatment methods, curative effect, and complications of patients were analyzed. Results A total of 8 patients were included. Among them, there were 7 males and 1 female. The age ranged from 17 to 66 years old, with an average of (44.4±19.3) years old. There were 5 cases of traffic accident injury, 2 cases of crush injury, and 1 case of falling injury. There was 1 case of duodenal bulb injury, 3 cases of descending part injury, 3 cases of horizontal part injury and 1 case of both descending and horizontal injuries. According to the scale of American Association for the Surgery of Trauma for duodenal trauma, there were 5 cases of grade Ⅱ injury, 2 cases of grade Ⅲ injury, and 1 case of grade Ⅳ injury. All patients underwent CT scan, of which 2 cases were directly diagnosed with duodenal injuries by CT, and the remaining cases diagnosed by intraoperative exploration. All patients underwent surgical treatment, including 4 cases of pancreaticoduodenectomy, 2 cases of duodenal repair and gastrojejunostomy, 1 case of duodenal repair plus jejunostomy, and 1 case of superior mesenteric vein repair, pancreatic necrotic tissue removal, and abdominal catheterization for smooth drainage. One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery, 1 died of multiple organ failure during the resuscitation phase after damage control surgery, 3 developed intra-abdominal infection and cured by anti-infective treatment. Conclusions Early clinical manifestations of traumatic duodenal injuries are atypical, and imaging findings might not be clear. For trauma patients suspected of having duodenal injury, rigorous vital sign monitoring is necessary. Once vital signs stabilize, exploratory surgery should be actively considered to identify the location of the injury and perform appropriate surgical procedures. Adequate postoperative enteric decompression and drainage should be ensured.
Objective To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity (P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group (P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups (P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant (P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group (P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
目的 探讨腹腔镜技术在闭合性腹外伤病例中诊断、治疗的价值。方法 对1999年8月至2004年12月期间26例闭合性腹外伤患者应用腹腔镜进行探查及治疗。结果 26例中肝破裂3例，脾破裂6例，腹膜后血肿2例，肠系膜破裂3例，小肠破裂穿孔8例，结肠破裂穿孔1例，膀胱破裂1例，肠管挫伤2例。14例经腹腔镜顺利完成探查及治疗，另12例中转开腹手术。全部病例未发生术后并发症。结论 腹腔镜技术在闭合性腹外伤患者的探查及治疗过程中是一种有临床应用价值的有效方法。
Objective To investigate the reasons of misdiagnosis and missing diagnosis in blunt abdominal trauma (BAT), and to put forward effective preventive measures. Methods Literature on BAT diagnosis in recent years was reviewed. Results Misdiagnosis and missing diagnosis, which can take place in every segment of BAT patients, were still quite common nowadays. Conclusion Detailed case history collecting, faithful medical examination and making good use of assistant examinations can efficiently decrease the misdiagnosis and missing diagnosis rates of BAT patients.
目的探讨诊治闭合性肝外伤的有效方法。方法回顾分析了1990～2000年收治的168例闭合性肝外伤的临床资料。结果均行腹腔穿刺，阳性率为94.6%（159/168），B超检查92例，阳性率为95.7%（88/92），CT检查33例，阳性率为93.9%（31/33），术前确诊率为98.2%。168例中，行非手术治疗37例（22.0%），手术治疗131例（78.0%）。治愈161例（95.8%），其中非手术治疗37例均痊愈； 手术治疗131例中痊愈124例，死亡7例（4.2%）。结论外伤史、体征、腹腔穿刺、B超和CT检查是诊断肝外伤的重要依据，及时手术治疗是降低严重肝外伤病死率的关键。
Objective To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. Methods The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture(8 cases of complete rupture and 2 cases of incomplete rupture). Results The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5±2.5 cm. The width of origin tendon was 0.9±0.2 cm and the thickness was 0.3±0.1 cm; the width on apex of lateral malleolus was 0.7±0.1 cm and the thickness was 0.4±0.1 cm, the width on head of cuboid was 0.7±0.1 cm and the thickness was 0.3±0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2 292.4±617.3 Non tendon calcaneus, 1 020.4±175.4 N on long peroneal muscles tendon, 752.0±165.4 N on peroneus brevis tendon and 938.2±216.7 N on tibialis posteriortendon. Tencases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 1824 months. No Achilles tendon rerupture, necrosis of skin or other complications occurred. According to AmerLindholm criterion forcurative results, the results were excellent in 7 cases and good in 3 cases and the excellent and good rate was 100%. Conclusion The long peroneal muscles tendon transposition is a perfect and simple way to repair occlusive Achilles tendon rupture.