【Abstract】 Objective To disscuss the therapeutic method of the postoperative infection after hip arthroplasty andcompare the results of one-stage revision and two-stage revision. Methods From January 1999 to December 2005, 15 casesof infection after hip arthroplasty were treated, including 10 males and 5 females, with a mean age of 63 years (54-71 years).The locations were left hip in 8 cases and right hip in 7 cases. The first operation was hip prosthesis replacement in 6 cases andtatol hip arthroplasty in 9 cases. Infection occurred after 1 month in 6 cases and after 6 months in 9 cases. The preoperativetemperature and ruting blood test were normal, the mean erythrocyte sedimentation rate(ESR) was 61 mm/h (34-80 mm/h),mean C-reactive protein(CRP) was 11.7 mg/L(5.4-21.0 mg/L). The mean Harris score was 33 (25 - 40). The X-ray films showedthat periosteal reaction, osteolysis and loosening of prosthesis occurred. The time from the first operation to revision operationwas 1-41 months (mean 7.3 months). The results of bacterial culture were positive in 11 cases. One-stage revision wasperformed in 10 ases, two-stage revision was performed in 5 cases. Results Of 15 cases, 6 were classified as early postoperativeinfection, 9 cases as late chonic infection. The microorganism cultures results of joint aspiration or pus in sinus werepositive in 11 cases and negative in 4 cases before operation and during operation; 8 had staphylococcus epidermids infection,2 escherichia col i infection and 1 staphylococcus aureus infection. Incision of revision operation healed by first ention. Nore-infection, swell ing and tenderness occurred after 19 months (12-37 months) of follow-up. Pain of hip joint disappeared in14 cases, and only 1 case had mild pain when walking. ESR and CRP after operation decreased to normal range. The mean Harrisscore increased significantly to 84.2(79-92) after revision, showing significant difference when compared with that beforeoperation (P ＜ 0.05). Conclusion For postoperative infection after total hip arthroplasty, it is still possible to have satisfactorycl inical outcome by one-stage or two-stage revision as long as clear diaglosis and correct treatment can made.【Key words】 Hip arthroplasty Postoperative compl ications Infection Revision operation
ObjectiveTo summarize the short-and medium-term effectivenesses of stemless hip arthroplasty for treating hip joint disease in young and middle-aged patients. MethodsBetween June 2005 and December 2010, 25 cases (27 hips) of hip joint disease were treated with stemless hip arthroplasty. There were 17 males (19 hips) and 8 females (8 hips) with an average age of 45.6 years (range, 30-57 years), including 13 left hips, 10 right hips, and 2 bilateral hips. The causes included avascular necrosis of the femoral head (ANFH) secondary to femoral neck fracture in 5 cases (5 hips), ANFH in 15 cases (16 hips), osteoarthritis of the hip joint caused by ankylosing spondylitis in 2 cases (3 hips), osteoarthritis of the hip joint caused by dysplasia of acetabular in 2 cases (2 hips), and rheumatoid arthritis in 1 case (1 hip). The disease duration was 1-17 years (mean, 6.1 years). Before operation, the Harris score was 47.6±14.2. ResultsThe incision healed by first intention in all patients, and no complications occurred, such as infection, periprosthetic fracture, and deep vein thrombosis of lower extremity. Twenty-five patients (27 hips) were followed up 36-96 months (mean, 51 months). One case (1 hip) had sciatic nerve injury after operation, which was relieved by symptomatic treatment. One case (1 hip) had prosthesis loosening, which was relieved after revision. The survival rate of prosthesis was 96.3% (26/27). At last follow-up, the Harris score was 92.1±3.6, which was significantly better than preoperative score (t=18.241, P=0.000). The excellent and good rate was 88.9% (excellent in 19 hips, good in 5 hips, fair in 2 hips, and poor in 1 hip). The X-ray films showed good location of prosthesis, and no evidence of dislocation, bone resorption, osteolysis, and heterotopic ossification. ConclusionBecause of reserving femoral neck, biomechanics conduction and distribute of the proximal femur achieve natural biomechanics state of the human body. The short-and medium-term effectivenesses of stemless hip arthroplasty for treating hip joint disease in young and middle-aged patients are satisfactory, but the long-term effectiveness need further observation.
ObjectiveTo explore the psychological process and needs of the second victims of medical adverse events after the occurrence of adverse events, so as to provide reference for the psychological intervention strategies of medical institutions for the second victims of medical adverse events.MethodsThe second victims of medical adverse events in the First People’s Hospital of Ziyang were selected from April to July 2019. Qualitative research method was used to conduct semi-structured in-depth interviews with the second victims. Colaizzi method was used to analyze the transcripts through reading and rereading, coding, and thematizing. ResultsA total of 22 second victims of medical adverse events were interviewed. The second victims of medical adverse events experienced negative emotional experience, and the desire to seek emotional support was urgent. The psychological process of the second victims of medical adverse events mainly involved five stages: fear, anxiety, depression, guilt and recovery. Emotional support hada positive effect on regression. Conversely, negative or lack of emotional support had a negative effect on regression. ConclusionsThe emotional experience of the second victims of medical adverse events is relatively staged, and the recovery and regression are greatly affected by internal and external factors. Hospital administrators should take active measures and establish an emotional support mechanism for adverse events in order to reduce psychosomatic injuries and improve medical quality and efficiency.
目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中不同CO2气腹压力对患者肝功能、动脉血气及对颈、肩痛的影响。方法 选择行择期LC术患者120例，采用随机数字表法，按住院先后顺序对应入组，随机均分为气腹压力10mmHg （1 mm Hg=0.133kPa）组、12mmHg组及14mmHg组3组；对比分析3组患者手术后肝功能、血气指标以及术后当天、第1和第2天恶心、呕吐及颈肩部疼痛的发生率。结果 3组患者术前各参数组间比较差异均无统计学意义（P＞0.05）。术后肝功能及血气分析指标的改变3组间的差异有统计学意义（P＜0.05），气腹压力越大，其术后AST、ALT及TBIL水平升高越明显，而pH及PO2的下降越明显，PCO2的升高也越明显；术后患者颈、肩痛及恶心呕吐发生率3组间比较差异也有统计学意义（P＜0.05），气腹压力越大，术后颈、肩痛及恶心呕吐发生率越高。结论 CO2气腹压力对术后肝功能及动脉血气指标的改变以及术后颈、肩痛和恶心呕吐发生率有明显影响。
目的总结困难腹腔镜胆囊切除术（LC）中造成操作困难的原因，探讨各种情况下的手术技巧。 方法回顾性分析2004年12月至2013年12月期间我院为128例LC术中遇有操作困难的患者施行手术的临床资料。 结果128例患者中113完成LC，住院时间为5～7 d（平均5.50 d）；15例中转开腹完成，住院时间为7～9 d（平均7.46 d）。术后发生胆汁漏1例，经保守治疗治愈，余术中、术后均未发生严重并发症。128例患者术后随访3个月～2年（平均19.4个月），无并发症发生。 结论术中仔细解剖，谨慎操作，采用适当的手术技巧，多数困难LC能顺利完成，遇复杂情况果断中转开腹是避免LC严重并发症的关键措施。