关节镜在胫骨平台骨折诊治中的应用

胫骨平台骨折是下肢负重关节的关节内骨折，约占全身骨折的1%[1]，其主要由交通事故或高处坠落伤等高能量所致，胫骨平台受到外力挤压或撞击时容易造成劈裂或塌陷，产生不同程度的膝内、外翻畸形，严重者还可合并半月板或韧带损伤等周围组织损伤[2]，处理不当常导致膝关节功能恢复不良[3]。传统的切开复位内固定术式严重破坏膝关节周围软组织环境并且不能对骨折伴随损伤妥善处理，由此导致的膝关节并发症经常被报道。近年来关节镜技术快速发展，且已广泛应用于胫骨平台骨折诊疗，关节镜微创技术在胫骨平台骨折治疗中的应用受到越来越多的关注[4]。现就近年来的研究进展综述如下。

医者学者师者--记本刊名誉总编辑侯树勋教授

侯树勋，《中国骨与关节杂志》名誉总编辑，我国著名骨科专家。1966年毕业于第四军医大学医疗系，作为我国第一批硕士研究生，师从著名骨科大师陆裕朴教授，1981年毕业后留校工作。1988年调入全军创伤中心解放军304医院骨科。1990年赴加拿大留学，回国后任304医院骨科主任。现任解放军总医院第一附属医院全军骨科研究所所长，主任医师，教授，博士生导师。

中央型巨大肝血管瘤的解剖学特点及手术方式选择:附10例

中央型巨大肝血管瘤是位于第一、二肝门及邻近下腔静脉的位于肝实质内直径≥10 cm的肝血管瘤,由于其位置特殊,此类手术方式有别于表浅肝血管瘤,潍坊市人民医院肝胆外科于2003年4月至2008年6月手术治疗10例中央型巨大肝血管瘤,报告如下.

老年人急性胆囊炎的手术适应证与术式的选择

随着老年人人数的增加,老年人急性胆囊炎发病率亦明显增加.老年人急性胆囊炎除具有急性胆囊炎的一般规律,还在病理改变与临床表现有不同的特点,特别是手术适应证与手术术式都具特点,讨论如下.

肺癌的淋巴结转移规律与肺癌系统纵隔淋巴结廊清术

淋巴结转移是肺癌转移的主要途径,也是影响肺癌手术根治性及预后的主要因素.研究肺癌淋巴结转移规律对指导肺癌淋巴结廓清、提高手术根治性及改善其预后具有现实的指导意义.

胰腺癌诊治中的几个问题胰十二指肠切除术的要点

胰十二指肠切除术是治疗胰腺及壶腹部周围肿瘤的主要手术方式,因其手术切除范围广泛,创伤较大和重建吻合口多,是腹部外科破坏较大、操作极为复杂、难度和风险均较高的手术之一.其手术病死率仍徘徊在3%～5%[1],术后并发症为25%～40%[2].进一步降低手术病死率和术后并发症是腹部外科医师的关注点,在加强围手术期处理的同时,亦应重视术中有关的一些注意点.

小切口脓胸廓清术

本文介绍小儿脓胸,脓气胸129例.早期开胸廓清术100例,治愈94.6%,好转4.4%,死亡1例,效果明显优于其它方法.近2年创用小切口脓胸廓清术24例均获满意效果,文中提出了本术式的优点,指征及手术操作注意事项.

先天性食管裂孔疝

Skinner DB(1)根据解剖缺陷及临床表现,将食管裂孔疝分为四型:Ⅰ型--滑动疝,食管裂孔轻度扩张,膈食管膜变薄,贲门及胃底上移,有不同程度的返流;Ⅰ型--食管旁疝,膈食管膜缺损,有腹膜形成的疝囊,贲门位置正常,无返流;Ⅲ型--混合型,食管旁疝与滑动疝同存,有返流;及Ⅳ型--多器官型(Multipleorgan Hiatal Hernia),部份结肠或小肠也进入食管旁疝囊内.以Ⅰ、Ⅱ型多,前者占95%,后者约3.5%(以下称Ⅰ、Ⅱ、Ⅲ型).

小儿阿米巴性腹膜炎(附12例报告)

小儿阿米巴性腹膜炎比较少见,诊断和治疗上易致延误,临床上病死率高.我院自1959～1981年共收治12例,现报告如下.

Objective:Lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), while necessity No.14v lymph node dissection for lower GC is still controversial.Methods: A total of 311 GC patients receiving D1+ (D1+7, 8a, 9) or D2 plus No.14v lymph node dissection in our center were enrolled. Patients were categorized into two groups based on No.14v lymph node status: positive group (PG) and negative group (NG).Results:Fifty patients (16.1%) had No.14v lymph node metastasis. Metastasis to No.4d, No.6 lymph node and distant metastasis were independent variables affecting No.14v lymph node metastasis. Patients with positive No.14v lymph node had a significant lower overall survival (OS) rate than those without (3-year OS, 34.0% vs. 67.0%,P<0.001).Conclusion:GC patients with positive No.4d and No.6 lymph node often metastasis to No.14v lymph node. Status of No.14v lymph node was an independent prognostic factor for GC staged TNM III. Patients with positive No.14v lymph node usually have a poor prognosis, while such patients without distant metastasis may beneift from a curative surgery.

Objective:D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), while necessity No.14v lymph node dissection for distal GC is still controversial. Methods: A total of 920 distal GC patients receiving at least D1+ (D1+7, 8a, 9) or D2 lymph node dissection in our center were enrolled in this study, of whom, 243 patients also had the No.14v lymph node dissected. Other 677 patients without No.14v lymph node dissection were used for comparison.Results:Forty-five (18.5%) patients had No.14v lymph node metastasis. There was no significant difference in overall survival (OS) rate between patients with and without No.14v lymph node dissection. Following stratiifed analysis, in TNM stages I, II, IIIa and IV, No.14v lymph node dissection did not affect OS. In multivariate analysis, No.14v lymph node dissection was found to be an independent prognostic factor in patients with TNM stage IIIb/IIIc GC (HR =0.670, 95% CI, 0.506~0.886, P=0.005).Conclusion:Adding No.14v lymph node to D2 lymphadenectomy may be associated improved OS for middle and lower GC staged TNM IIIb/IIIc.

Surgical site infection and clinical microbiology in orthopaedics surgeries in a rural hospital

Infection and Clinical Microbiology in Orthopaedics Surgeries in Wound infections resulting from contamination during major orthopaedics surgery continues to be a vital issue.In this study, specimens of pus,draining fluids or suspected pus from the wounds of surgical patients who had been undergone major orthopaedics surgical procedure were cultured.