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视网膜色素变性合并不同并发症2例

Significance of Preoperative Nutritional Risk Screening in Perioperative Nutrition Support for Colon Cancer

ObjectiveTo investigate the guidance of preoperative nutritional risk screening in perioperative nutrition support for colon cancer, in order to provide evidence for the rationally clinical application of nutrition support. MethodsNutritional risk screening was carried out in 95 hospitalized patients with colon cancer who were treated in the Liao He Oil Center Hospital from Jul. 2012 to Jul. 2014, with the nutritional risk screening 2002 score summary table. Patients were divided into nutritional risk group and non-nutritional risk group according to the screening results, and postoperative bowel function recovery and nutritional indicators were compared between patients who received perioperative nutrition support according to the screening results and those who did not. ResultsThere were 29 patients received perioperative nutrition support among 53 patients at nutritional risk and 19 patients received perioperative nutrition support among 42 patients without nutritional risk. Among 53 patients at nutritional risk, the time to first flatus, time to first defecation, hospital stay, postoperative complications rate, and postoperative recurrence/metastasis rate of patients who received perioperative nutrition support were shorter or lower than those of patients who didn't receive perioperative nutrition support (P<0.05), but there was no significant difference in mortality (P≥0.05); in addition, the levels of albumin, prealbumin, and transferring on 7-day after surgery were all higher in patients received perioperative nutrition support (P<0.05). Among 42 patients without nutritional risk, there was no significant difference in time to first flatus, time to first defecation, hospital stay, postoperative complications rate, postoperative recurrence/metastasis rate, and levels of albumin, prealbumin, and transferring on 1- and 7-day after surgery between patients received perioperative nutrition support and those who did not (P>0.05). ConclusionsIt is important to evaluate the nutritional risk in hospitalized patients with colon cancer. Nutritional support is benefical to the patients with nutritional risk, but it isn't necessary to patients without nutritional risk.

指动脉皮支皮瓣修复手指皮肤缺损

目的总结应用指动脉皮支皮瓣修复手指软组织缺损的方法及效果。 方法2008年8月－2014年8月，以指动脉皮支供血设计切取皮瓣修复2～5指软组织缺损52例65指，其中男36例，女16例；年龄18～66岁，平均39.6岁。创面缺损范围10 mm×6 mm～26 mm×22 mm。受伤至手术时间2～10 h，平均6.5 h。皮瓣切取范围13 mm×10 mm～30 mm×25 mm。 结果4例皮瓣有水疱形成，1例皮瓣远端皮缘坏死，均经相应处理后愈合；其余皮瓣均成活，切口Ⅰ期愈合。供区创面植皮Ⅰ期愈合。47例58指获随访，随访时间6～25个月，平均14.3个月。术后皮瓣外观及感觉良好，皮瓣感觉恢复达S3；两点辨别觉6～10 mm，平均7.8 mm。手指功能恢复满意，按手指总主动活动度（TAM）法评定获优39指，良17指，可2指，优良率96.6%。供区无瘢痕挛缩、肌腱粘连等并发症发生。 结论指动脉皮支皮瓣不牺牲主要血管、血供可靠，操作简便、安全，术后效果满意，是修复手指皮肤软组织缺损较理想方法。

Effectiveness analysis of proximal humerus internal locking system plate combined with rotator cuff reinforcement suture in treatment of Neer type Ⅳ proximal humerus fracture

Objective To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture. MethodsThe clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up. Results The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation (P<0.05). ConclusionPHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.