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钩钢板治疗锁骨外侧端骨折伴肩锁关节脱位

REPAIR OF COLLATERAL LIGAMENT RUPTURE IN THE INTERPHALANGEAL JOINT USING SUPERFICIAL FLEXOR TENDON OF FINGER

OBJECTIVE To introduce the surgical procedure and clinical result of microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger. METHODS From 1987, 23 cases with collateral ligament rupture in the interphalangeal joint were repaired by part of superficial flexor tendon of finger. The initial point of collateral ligament was drilled two holes, 2 to 3 mm in distance, and crossed by steel wire. Then the superficial flexor tendon of finger was crossed under the steel wire and sutured to the terminal point of superficial flexor tendon of finger by 5/0 to 7/0 nontraumatic suture thread to maintain suitable tension, and sutured to collateral ligament by 8/0 nontraumatic suture thread. Extension splint fixation was performed 4 to 6 weeks postoperatively. RESULTS Followed up 3 to 6 months, 15 cases were excellent, 6 cases were better, 2 cases were moderate, and the excellent rate was 91.34% according to Saetta standard. CONCLUSION Microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger is a convenient and effective surgical method.

低位进钉法动力髋螺钉治疗高龄股骨粗隆间骨折

【摘 要】 目的 总结利用低位进钉法动力髋螺钉（dynamic hip screw，DHS）治疗高龄股骨粗隆间骨折的临床经验。 方法 2000 年1 月－ 2006 年12 月，利用低位进钉法DHS 治疗高龄骨质疏松股骨粗隆间骨折25 例。男11 例，女14 例；年龄70 ～ 92 岁，平均81 岁。致伤原因：撞摔伤6 例，跌倒伤19 例。病程1 ～ 7 d。骨折类型按Evan’s 分型，Ⅰ型3 例，Ⅱ型10 例，Ⅲ型8 例，Ⅳ型4 例。伴其他部位骨折4 例，颅脑损伤1 例。合并高血压病12 例，冠心病3 例，糖尿病1 例，脑血管病1 例，慢性支气管炎和肺气肿1 例。 结果 术中出现低血压4 例，静脉输血和应用升压药物后好转。术后1 个月内发生并发症13 例，其中肺部感染4 例，精神障碍3 例，深静脉血栓、肠道感染、心律失常、心肌梗死各1 例，经抗感染、抗精神药物、溶栓等内科治疗后无死亡患者。全部患者均获随访，随访时间6 个月～ 3 年，平均21 个月。骨折平均愈合时间为14 周。参照Harris 评分标准，优9 例，良12 例，可3 例，差1 例，优良率84%。无螺钉松动、移位、滑出等内固定失败发生。 结论 低位进钉法DHS 是治疗高龄股骨粗隆间骨折较好的方法，选择恰当的手术时机、采用正确的手术方法、术后适当的功能锻炼是取得满意疗效的关 键。

有创-无创序贯机械通气治疗COPD急性加重

目的 评价有创-无创序贯机械通气治疗COPD 急性加重( AECOPD) 的临床疗效。方法 选择ICU 收治的AECOPD 患者13 例为序贯组, 同样病情患者12 例为对照组。临床出现“肺部感染控制窗”后, 序贯组拔除气管插管, 应用口鼻面罩双水平正压通气直至脱机; 对照组继续有创机械通气, 以压力支持方式脱机。比较两组患者机械通气时间、住院时间、呼吸机相关性肺炎( VAP)患病率和患者转归。结果 与对照组比较, 序贯组有创机械通气时间显著缩短[ ( 4. 33 ±1. 05) d 比( 10. 13 ±2. 06) d, P lt; 0. 001] , ICU 住院时间显著缩短[ ( 8. 79 ±2. 07) d 比( 11. 96 ±2. 11) d, P lt;0. 005] , VAP 发生数显著减少[ 0 比6 例, P lt;0. 01] 。总机械通气时间、总住院时间、再插管率和病死率均无显著性差异( P gt; 0. 05) 。结论 对需要机械通气的AECOPD 患者, 采用有创-无创序贯机械通气治疗, 可以缩短有创机械通气时间和ICU住院时间, 降低VAP 患病率。

Effect of Early Enteral Nutrition in Severe Thoracic Trauma Patients Requiring Mechanical Ventilation: A Randomized Controlled Trial

ObjectiveTo investigate the clinical effects of early enteral nutrition in severe thoracic trauma patients requiring mechanical ventilation. MethodsWe randomly allocated 60 patients with thoracic trauma requiring mechanical ventilation into two groups by drawing lots including an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group in our hospital between January 2013 and September 2014 year. There were 30 patients in each group. We compared the recovery results of the patients between the two groups. ResultsAfter the treatment of 7 and 14 days, indicators in the EEN group were better than before significantly and better than those in the PN group; diarrhea rate average days of ICU and the average days of hospital decreased significantly with statistical differences (P<0.05). There was no statistical difference in ventilator-associated pneumonia or the incidence of stress ulcer between the two groups (P>0.05). ConclusionEarly enteral nutrition in severe chest trauma patients requiring mechanical ventilation may promote protein synthesis, improve the nutritional status of patients, correct negative nitrogen balance, reduce inflammation response, reduce the complications.

Prophylactic Measures for Non Traumatic Complications of Laparoscopic Cholecystectomy

【Abstract】Objective To investigate prophylactic measures for nontraumatic complications of laparoscopic cholecystectomy (LC).Methods The data of 13 000 patients who underwent LC in Kunming general hospital of PLA over 13 years(1991-2004) were retrospectively reviewed. Results Nine malignant tumors and 47 common bile duct stones were missed at LC. The 9 malignant tumors included hepatic cancer (n=1), gastric cancer (n=1), gallbladder cancer (n=2), pancreatic cancer (n=2) and right colon cancer (n=3). Of all the carcinomas, 3 patients with right colon cancer underwent colectomy, the other 6 patients couldn’t be cured radically. All the 47 patients with choledocholithiasis were cured successfully, among them 31 patients were performed with ERCP and 16 were reoperated on with cholangiotomy. Conclusion This study emphasizes the necessity to analyze carefully patients’ symptoms before operation and pay attention to pathological changes of gallbladder and intraabdominal situation intraoperatively. If necessary, laparoscopic ultrosonography can be used to avoid missing malignant tumors and biliary stones.