电动外伤科换药装置的设计

针对医院换药室的现状,构思并设计出一款电动升降的换药装置。同时简单介绍这种装置的结构组成,解析其控制系统及传动机构。

危亦林及《世医得效方》

危亦林,字达斋,元代医学家,江西南丰人,大约生于公元1277年,卒于公元1347年,世以医为业,官本州医学教授。根据家传数代的医疗经验以及古代名医方药,危亦林用了十余年的时间编成《世医得效方》二十卷,是书积其高祖以下五世所集医方,

《金匮要略》临床治疗学成就

《金匮要略》是《伤寒杂病论》中的杂病部分,是我国现存最早的临床杂病治疗学专著,主要对中医内科、外科、妇科、急症等提供了辨病辨证及治疗方法,奠定了中医临床治疗学的基础。

颅脑损伤患者治疗及预后临床分析

目的探讨不同方法治疗颅脑损伤的适应证和注意事项,为临床提供科学的诊疗证据。方法选取诊治的急性颅脑损伤患者86例,所有患者根据治疗方法不同分为开颅组(28例)、微创组(30例)和保守组(28例),分别采用开颅血肿清除去骨瓣减压术、颅内血肿微创清除术及保守治疗,观察患者的预后情况。结果开颅组、微创组和保守组总有效率为89.29%、93.33%、92.86%,3组比较差异无统计学意义(P>0.05);3组并发症发生例数以及复发例数比较差异无统计学意义(P>0.05);3组患者治疗后1、3、7 d的颅内压均明显下降,其中微创组的下降程度明显优于开颅组和保守组,差异有统计学意义(P<0.05);微创组治疗后1、3、7 d的Glasgow昏迷评分均低于开颅组和保守组,差异有统计学意义(P<0.05);治疗后,开颅组和微创组的对侧血肿厚度及中线移位情况有明显变化,开颅组和微创组与保守组的血肿厚度及中线移位情况比较,差异有统计学意义(P<0.05);且微创组变化情况要大于开颅组(P<0.05)。保守组患者住院时间长于开颅组和微创组,差异有统计学意义(P<0.05)。结论抢救生命是实施手术治疗的基本原则,通过治疗,阻止患者脑疝发生与恶化,缓解颅高压症状,清除颅内血肿。症状较轻患者进行脑膜修补,临床上需要依据患者病情的具体情况针对性的选择治疗方法,从而为患者制定合理的治疗方案。

包扎绷带的改进和应用

绷带是外伤科常用的包扎材料.过去用于烧伤、创伤以及术后的包扎等均使用单层窄小绷带,既费时又费事,且不能回收,尤其烧伤病人用量多,由于不能回收造成很大浪费.我科自1988年以来,在不断研究、实践的基础上,自制了一种改进的绷带。

New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy

AIM： To investigate the anatomic variations in the cystic artery by laparoscopy, and to provide a new classification system for the guidance of laparoscopic surgeons.METHODS： Six hundred patients treated with laparoscopic cholecystectomy from June 2005 to May 2006 were studied retrospectively, The laparoscope of 30° （Stryker, American） was applied, Anatomic structures of cystic artery and conditions of Calot＇s triangle under laparoscope were recorded respectively,RESULTS： Laparoscopy has revealed there are many anatomic variations of the cystic artery that occur frequently. Based on our experience with 600 laparoscopic cholecystectomies, we present a new classification of anatomic variations of the cystic artery, which can be divided into three groups： （1） Calot＇s triangle type, found in 513 patients （85.5%）; （2） outside Calot＇s triangle, found in 78 patients （13%）; （3） compound type, observed in 9 patients （1.5%）.CONCLUSION： Our classification of the anatomic variations of the cystic artery uncontrollable cystic artery extrahepatic bile duct injury. will be useful for decreasing hemorrhage, and avoiding extrahepatic bile duct injury.

Effects of Wy14643 on hepatic ischemia reperfusion injury in rats

AIM: To investigate the effects and possible mechanisms of Wy14643 on hepatic ischemia-reperfusion (I/R) injury in rats.METHODS: Thirty male Sprague-Dawley rats weighing 220-280 g were randomly divided into five experimental groups: sham group (G1, n = 6): a sham operation was performed (except for liver I/R); I/R-untreated group (G2, n = 6): rats underwent liver ischemia for 90 min followed by reperfusion for 4 h; and I/R + Wy14643 groups (G3, G4, G5; n = 6): after the same surgical procedure as in group 2, animals were pretreated with Wy14643 at the dose of 1, 5 and 10 mg/kg 1 h before ischemia, respectively. Hepatic ischemia-reperfusion (I/R) was induced by clamping blood supply to the left lateral and median lobes of the liver for 90 min, and atraumatic clamp was removed for 4 h reperfusion. Blood samples and liver tissues were obtained at the end of reperfusion to assess serum and hepatic tissue homogenate aminotransferase (ALT), aspartate aminotransferase (AST), myeloperoxidase (MPO), serum interleukin-1β (IL-1β) and tumor necrosis factor alpha (TNF-α), as well as activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) in the hepatic tissue homogenate. RESULTS: Hepatic I/R induced a significant increase in the serum levels of ALT, AST, TNF-α, IL-1β and MPO, as well as the levels of ALT, AST and MDA in the liver tissue homogenate, which were reduced bypretreatment with Wy14643 at the dose of 1, 5 and 10 mg/kg, respectively. The activity of SOD in the liver tissue homogenate was decreased after hepatic I/R, which was enhanced by Wy14643 pretreatment. In addition, serum and liver tissue homogenate ALT and AST in the Wy14643 10 mg/kg group were lower than in the Wy14643 1 mg/kg and 5 mg/kg groups, respectively.CONCLUSION: Wy14643 pretreatment exerts significant protection against hepatic I/R injury in rats. The protective effects are possibly associated with enhancement of anti-oxidant and inhibition inflammation response.

Effect of Dermabrasion and ReCell on Large Superficial Facial Scars Caused by Burn, Trauma and Acnes

Objective To explore the effects of dermabrasion combined with ReCell on large superficial facial scars caused by burn, trauma and acnes. Methods Nineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell？. According to the etiology, patients were classified into post-burning group （n=5）, post-traumatic group （n=7） and post-acne group （n=7）. Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score （PSS）, Vancouver Scar Scale （VSS）, and Patient and Observer Scar Assessment Scale （POSAS） of each group were analyzed to compare the effect of the combined therapy on outcomes.Results The healing time of post-burning group （19.6±4.0 days）, post-traumatic group （15.8±2.6 days）, and post-acne group （11.4±3.1 days） varied remarkably （F=7.701, P=0.007）. The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups （P〈0.05）, where the most significant improvement was shown in the post-acne group （P〈0.05）. The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group （all P〈0.05）, where the more significant improvement was also shown in the post-acne group （P〈0.05）. Conclusions The combined treatment of dermabrasion and ReCell has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.

THE DEVELOPMENT OF BURN SURGERYIN CHINA —A RETROSPECTIVE OVERVIEW

Sheng Zhiyong Burns Institute, 304th Hospital, Beijing 100037

Novel biomarkers of acute kidney injury: Evaluation and evidence in urologic surgery

atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.

WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Effect of preoperative limited fluid resuscitation to the patients with traumatic shock

Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.

Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma

The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.

THORACIC SPINE FRACTURES

Objective. To investigate the unique characteristics and treatment of thoracic spine fractures. Methods. Seventy seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 compression fractures, 34 fracture dislocations, 3 burst fractures and 3 burst dislocations. Twenty six patients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 were neurologically intact. Fifty three patients were treated nonoperatively and 24 treated operatively. Results. All patients were followed up for 2～15 years. None of the 26 patients with a complete lesion recovered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them remained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some function and 5 did not recovered. Conclusions. Because of the unique anatomy and biomechanics of the thoracic spine, the classification commonly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicated when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidates for supplemented decompression.

SELECTION OF SURGICAL APPROACH TO TREAT TRAUMATIC INSTABILITY OF SUBAXIAL CERVICAL SPINE

Objective To evaluate the clinical outcomes of surgical therapy in treating traumatic instability of subaxial cervical spine through either anterior or posterior approach. Methods According to the Allen-Fergurson's classification, we retrospectively studied 42 cases of traumatic instability of subaxial cervical spine through either anterior or posterior surgical reconstruction. Patients requiring approach for either reduction or decompression were not included. Results The average follow-up interval was 3 years and 2 months. The anterior and posterior reconstructions were 24 and 18 cases, respectively. Before operation, the average scores of JOA and VAS were: 12.1 and 6.9 for anterior group, and 12.3 and 7.2 for posterior group. At the final assement, the scores of JOA and VAS improved to 16.0 and 2.2 for anterior group, and 15.7 and 2.6 for posterior group. The average ASIA motor scores of anterior and posterior group improved to 68.2 and 65.5 at the final follow-up from 58.4 and 59.7 before operation, respectively. The ASIA grade (A-E) was converted to a numeric score. The average scores before operation in the anterior and posterior group were 3.3 and 3.4, and increased to 3.8 and 3.7 at the final follow-up. After operation, there were different extent improvements of average radiological parameter, such as Cobb angle, vertebral body translation and disc height ratio. The average operation time and blood losing were 122 min and 125 mL for anterior group, and 153 min and 287 mL for posterior group. Fusion was achieved in all patients and 4 and 2 complications occurred at the anterior or posterior group. Conclusion The results showed that there were no obvious difference in parameters, such as neurological assements, functional grades, fusion rate, operation time and blood losing, between anterior and posterior group, except the virtues of anterior group in reconstruction and maintaining physiologic cervical lordosis and intervertrbal disc height occurred.

THE EFFECTS OF INJURIES IN THE EXTREMITIES ON HUMAN COAGULATION STATUS

Objective To investigate the changes of blood coagulation status and the safety of emergency microsurgery in patients with acute trauma to their extremities. Methods Forty seven patients with open injuries to the extremities were divided into 3 groups: in Group Ia (n=20), the patients presented with open injury to a single limb without traumatic shock and chest or head injuries, and they did not undergo microsurgery; while in Group Ib (n=13), an emergency microsurgery was done. In Group Ⅱ , the patients suffered from multiple compound fractures of the extremities with traumatic shock and chest or head injuries. The blood coagulation status of all the patients was evaluated by testing platelet count (PLC), platelet adhesiveness (PadT), serum antithrombin Ⅲ (AT- Ⅲ ), and D-dimer (D-Di) level. Results In Groups Ia and Ib, only PadT was increased and AT- Ⅲ declined preoperatively, then they returned to normal 24h postoperatively. In Group Ⅱ, at different periods after trauma, there was significant evidence of Pg and AT-Ⅲ decline accompanied by high increase of PadT and D-Di level; at 24h postoperatively, the mean values were 49.3% (PadT), 2.7mg/L (D-Di), 1..1g/L (Pg), and 69.1% (AT-Ⅲ), respectively. All these changes got significant difference (P<0.05) when compared with the normal value and those of Groups Ia and Ib, and did not completely return to normal even 72h after operation. Conclusion An emergency microsurgery could be safely performed in patients with ordinary open injuries to their limbs without traumatic shock, however it should be done with caution in cases of severe injuries with traumatic shock, because hypercoagulation status would follow in several hours after injuries. D-Di measurement may be used as a screening test to predict and assess hypercoagulation status more early after trauma.

SURGICAL TREATMENT OF BLUNT CARDIAC TRAUMA IN CHILDREN: REPORT OF 2 CASES AND REVIEW OF LITERATURES

Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiactrauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricularseptal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect re-pair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture ofposterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association (NYHA) class echocardiographyshowed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second pa-tient is in NYHA class echocardiography showed mild mitral regurgitation. Conclusion Blunt traumaticheart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is ad-vocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up isnecessary.

古代战争与中医学的关系初探

医学的目的是维护人类的健康,只有在稳定的社会环境下,人类的健康才能得到最基本的保障。战争摧毁了文明,也在客观上推动了历史车轮的前进。战争导致了医书的亡佚,使许多宝贵的医学经验不能流传,阻碍了人类文明发展,但同时对中医外伤科发展有促进作用,特别是与战争相关的金创外科、正骨科。战争中的兵法理论对中医学理论也有借鉴意义,它们同源异流、兵药同理,兵法思想、战争语言也是中医学进行类比援引的对象。拟从战争对中医学的负面影响、战争促进了中医外伤科的发展及兵法医理相互渗透三个方面探讨古代战争和中医学的关系。

Application of damage control orthopedics in 41 patients with severe multiple injuries

Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males and 10 females, aged 18-71 years, mean： 36.4） with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005. Results： As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% （5/41） with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured. Conclusions： Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.