Search

Comparison between Butorphanol and Fentanyl Used for Patient-controlled Intravenous Analgesia after Abdominal Surgery

目的　通过对腹部手术后自控静脉镇痛（PCIA）不同药物配方的研究，探讨酒石酸布托啡诺与舒芬太尼用于术后PCIA临床效果。 方法　将2012年2月－8月收治的60例麻醉分级为Ⅰ～Ⅲ级需术后镇痛的腹部手术患者（均无心、肺、肝、肾、脑、内分泌疾病及过敏史）随机分成两组：酒石酸布托啡诺组（N组，n=30），舒芬太尼组（S组，n=30）。观察镇痛效果和不良反应发生率。 结果　两组镇痛效果差异无统计学意义（P＞0.05），不良反应（包括恶心、呕吐、头晕、嗜睡、皮肤瘙痒、呼吸抑制、尿潴留等），N组发生率均低于S组（P＜0.05）。 结论　酒石酸布托啡诺用于PCIA安全、有效，不良反应少。

Different Internal Fixation for Intertrochanteric Fractures in Elderly Patients

目的　回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效。 方法　1999年3月－2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者，根据内固定方式不同分为4组：动力髋螺钉（DHS；A组43例）、经皮加压钢板（PCCP；B组19例）、股骨近端髓内钉（PFN；C组27例）、Gamma钉（D组32例）。4组患者年龄、骨折类型（Tronzo-Evans分型）等一般资料比较差异无统计学意义（P＞0.05），具有可比性。记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度，比较评价各组临床疗效。 结果　术后各组患者切口均Ⅰ期愈合，无伤口感染等早期并发症发生。患者均获随访，随访时间18～108个月，平均56.4个月。与A组比较，B、C、D组手术时间明显缩短，术中出血量及术后引流量减少，骨折愈合时间缩短，差异均有统计学意义（P＜0.01），A组较差；B、C、D各组间两两比较差异无统计学意义（P＞0.05）。术后并发症发生率A组较高，与其余各组比较差异有统计学意义（P＜0.05）。末次随访时各组髋关节功能Harris评分比较差异无统计学意义（P＞0.05）。 结论　B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势，与A组法比较更有利于老年患者术后康复，但应注意骨折的良好复位及内固定物位置。

股四头肌瘫痪多肌联合的功能重建

CLINICAL FEATURES AND EARLY TREATMENT FOR 596 PATIENTS WITH FRACTURE IN WENCHUAN EARTHQUAKE

Objective To summarize the cl inical characteristics of 596 patients with fracture in Wenchuan earthquake and to investigate the therapeutic methods and effects of early treatment. Methods From May 12th 2008 to May 21st 2008, 596 patients with fracture caused by Wenchuan earthquake were treated, including 283 males and 313 females aged1.9-102 years (median 43 years). The time from injury to hospital ization varied from 12 minutes to 4 days. There were 132 cases of upper extremity fracture, 496 cases lower extremity fracture, 10 cases clavicular fracture, 16 cases scapular fracture, 23 cases pelvis fracture, and 59 cases spinal fracture. Among them, 183 cases were open fracture and 413 cases were closed fracture. And 214 cases had multiple fracture (35.9%) and 68 cases had crush injury in l imbs which scored (6.84 ± 2.48) points according to the mangled extremity severity score (MESS). Thirty-six cases were combined with neurovascular injury. The wound of the open fracture was contaminated at different degrees, but no gas gangrene was observed. Open fracture was treated with suturing or no suturing after debridement, open reduction and internal or external fixation. Closed fracture was fixed with spl ints, cast and traction. Forty-nine patients whom were highly suspected as osseous fascia compartment syndrome received incision decompression timely, and 34 patients whose MESS were above 7.0 points or suffering from crush injury of l ifethreatening systemic symptoms received amputation. Results Apart from 34 patients receiving amputation, 460 patients achieved functional reduction of fracture after manipulative reduction and 102 cases got satisfactory reduction after surgery. Postoperatively, 289 patients were transferred to other hospitals. Among the rest 307 patients, 34 with severe wound infection were healed after multiple debridement, anti-infection, and skin flap transplantation (16 cases healed by first intention and 18 cases healed by second intention), 42 cases with crush syndrome were treated with open decompression and amputation, and nodeep venous thrombosis of lower l imb, stress ulcer and death were observed after operation (29 cases healed by first intention and 13 cases healed by second intention). Conclusion By aiming at the features of fracture caused by earthquake, the prompt and professional treatment can achieve good therapeutic effects.

前后路联合复位固定术治疗严重下颈椎骨折脱位

目的 观察颈椎前后路联合手术复位固定治疗严重下颈椎骨折脱位的临床效果。方法 2003年4月～2006年8月，采用前后路联合手术复位减压固定治疗严重下颈椎骨折脱位合并不同程度脊髓损伤者7例。男5例,女2例；年龄27～42岁。致伤原因：车祸伤5例，高处坠落伤2例，受伤部位C4、54例，C5、63例。Allen分类：屈曲压缩型Ⅴ度4例，牵张屈曲型Ⅲ度3例。完全性瘫痪1例；不完全性瘫痪6例，其中上肢肌力1～2级3例，3～4级3例。脊髓损伤按Frankel分级：Ａ级1例,Ｂ级4例,D级2例。于伤后1～8 d手术。前路固定采用Orion带锁钢板（颈椎带锁钢板）7例，后路侧块钢板螺钉固定2例,后路钉棒系统固定5例。结果 本组术后伤口均Ⅰ期愈合，获随访4～24个月,平均6个月。X线片检查示损伤节段固定稳定,未见内植物松动、脱落及断裂。植骨于3～4个月内均融合。术后4个月脊髓功能按Frankel分级，术前1例A级，术后无恢复；术前4例B级，术后恢复至C级2例可行走，恢复至B级2例可扶拐行走，2例D级恢复至E级，能正常行走。术后4例行CT及MRI检查，颈椎序列均恢复，椎管矢状径达到正常，脊髓受压解除。结论 颈椎前后路联合手术复位固定严重下颈椎骨折脱位可使损伤节段获得早期稳定,方便术后护理和早期功能锻炼,有利于脊髓功能恢复。

一期前路病灶清除植骨后路内固定治疗下腰椎结核

目的 总结一期前后路联合手术治疗下腰椎结核的安全性和可行性。 方法 2001 年1 月－ 2005年12 月，采用一期后路经椎弓根器械内固定椎板植骨，前路病灶清除髂骨块植骨融合治疗L3 ～ 5 结核17 例。男6 例，女11 例；年龄38 ～ 74 岁。病程4 ～ 33 个月，平均8 个月。4 例有神经根性症状。受累节段：L1 及L3、4 1 例，L3、4 4 例，L4 ～ 5 9 例，L5、S3 3 例。Frankel 神经功能评价：D 级4 例，E 级13 例。合并糖尿病7 例，高血压病3 例。术前摄X 线片、CT 和/ 或MRI 影像学检查，诊断为腰椎结核，均有冷脓肿或死骨，15 例有不同程度椎管内侵犯占位。 结果 手术时间（180 ± 14）min，术中出血量（350 ± 20）mL，术后引流量（200 ± 20）mL。患者术后切口均Ⅰ期愈合，住院期间无死亡。17例均获随访，随访时间14 ～ 60 个月，平均34 个月。结核治愈无复发，神经根性症状消失。术后Frankel 分级均为E 级。根据Chen 等疗效评定标准，优11 例，良5 例，中1 例。X线片复查12 ～ 19 个月，所有患者椎间植骨均骨性融合。 结论 一期前后路联合手术治疗下腰椎脊柱结核安全可靠，疗效满意。