DoppLer止血带的研制及103例骨科手术中临床应用

---------------------------------------------------------------最新资料推荐------------------------------------------------------骨科手术的麻醉胡崇辉骨科手术的麻醉金华中心医院麻醉科胡崇辉1/ 50病例资料? 患者王某某，女，97岁，40kg。

住院号：557779。

因“不慎摔伤致左下肢疼痛、不能站立行走3小时”于2015年10月10日入住我院骨二科。

? 拟完善相关准备后进一步行左股骨粗隆间骨折切复内固定术。

---------------------------------------------------------------最新资料推荐------------------------------------------------------ 骨科手术的麻醉特点手术体位手术部位病人情况仰卧位坐位侧卧位俯卧位手术出血骨盆手术肩部手术骶尾部手术股骨上段手术合并症年血贫脊龄气血柱外胸伤脊柱手术心肺功能3/ 50?麻醉前病情评估特点---------------------------------------------------------------最新资料推荐------------------------------------------------------ 心血管系统：高龄病人，常伴有高血压、冠心病、心律失常、心功能异常等。

创伤、恶性骨肿瘤病人常有低血压和贫血5/ 50心脏风险评估美国心脏病学会（ACC）制定的《非心脏手术围手术期心血管评估及治疗指南》该指南的术前评估分为三部分: ? ① 患者术前心血管危险程度分级? ② 手术危险程度分级? ③ 患者运动耐量评估评分---------------------------------------------------------------最新资料推荐------------------------------------------------------ 术前心血管危险程度分级7/ 50手术危险程度分级---------------------------------------------------------------最新资料推荐------------------------------------------------------ 患者运动耐量评估评分9/ 50呼吸系统：类风湿性关节炎、颈椎结核，常导致颈椎强直和活动受限，气管插管困难截瘫病人长期卧床常合并肺部感染老年病人常合并慢支炎、肺气肿、肺功能异常---------------------------------------------------------------最新资料推荐------------------------------------------------------ 1. 2.手术后的肺部并发症是术后并发症和死亡的主要原因严重肺部并发症的危险因素包括：上腹部手术和胸部手术、手术时间长＞3h、既往肺部疾病（慢性阻塞性肺病或慢性气管炎）、吸烟、术前营养不良3.4. 5.胸片或CT 检查，必要时行肺功能或血气检查吸烟者手术前应戒烟，有助于减少气管内分泌物哮喘或慢性阻塞性肺病，慢性阻塞性肺病病人急性气管炎发作，建议术前进行治疗11/ 50骨科手术的特殊问题---------------------------------------------------------------最新资料推荐------------------------------------------------------ 骨水泥反应综合征骨水泥反应综合征是指在骨水泥型假体置入过程中出现的急性低血压、低氧血症、心律失常、心跳骤停等并发症的总称13/ 50? 骨粘合剂为一种高分子聚合物，包括粉剂和液态单体，临用时将两者混合成团状，置入髓腔，自凝成固体而起作用。

中国组织工程研究与临床康复第15卷第25期 2011–06–18出版Journal of Clinical Rehabilitative Tissue Engineering Research June 18, 2011 Vol.15, No.25 ISSN 1673-8225 CN 21-1539/R CODEN: ZLKHAH4739 Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, ChinaWang Chun☆, Doctor, Attending physician, Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, Chinadoctorchun@ Correspondence to: Gu Tian-xiang, Doctor, Professor, Doctoral supervisor, Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, Chinacmugtx@Supported by: the Funding of Liaoning Educational Bureau, No. 2004C050*; Liaoning Science and Technology Plan, No. 2006401013-2* Received: 2011-03-29 Accepted: 2011-04-27再生氧化纤维素在严重骨质疏松体外循环手术胸骨止血中的作用**☆王春，谷天祥，喻磊，刘波，卢春茂Role of oxidized regenerated cellulose in the hemostasis of severe sternal osteoporosis during cardiopulmonary bypassWang Chun, Gu Tian-xiang, Yu Lei, Liu Bo, Lu Chun-maoAbstractBACKGROUND:Patients with serious osteoporosis have more bleeding volume than those without osteoporosis during cardiacsurgery with cardiopulmonary bypass.OBJECTIVE: To study the efficacy of oxidized regenerated cellulose on reducing post-cardiopulmonary bypass sternal bleedingand preventing sternal infection in patients with severe osteoporosis．METHODS: Eighty-four cases of severe osteoporosis undergoing open heart surgery were randomly divided into oxidizedregenerated cellulose group and control group. The sternal wound and bone marrow cavity of the oxidized regenerated cellulosegroup was filled with oxidized regenerated cellulose, and that of the control group was with medical bone wax. Drainage volumeat the first postoperative day, total drainage volume, time of draining tube, blood transfusion volume, suture removal time,duration of persistent fever, average hospital staying, postoperative sternal wound healing were recorded and observed, and allthe patients were follow-up for 6 months.RESULTS AND CONCLUSION: The comparison between two groups in the drainage volume at the first postoperative day, thetotal drainage volume, time of draining tube, the volume of blood transfusion and average hospital staying was significantlydifferent (P < 0.05). During the follow-up, there was no case of discharging the foreign body from sternal wound in the oxidizedregenerated cellulose group and 3 cases of discharging bone wax in the control group. Oxidized regenerated cellulose can beused in reducing bleeding and preventing sternal infection in patients with severe sternal osteoporosis after cardiopulmonarybypass. The short- and long-term efficacy is reliable.Wang C, Gu TX, Yu L, Liu B, Lu CM.Role of oxidized regenerated cellulose in the hemostasis of severe sternal osteoporosisduring cardiopulmonary bypass. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(25):4739-4742.[ ]摘要背景：严重骨质疏松患者正中开胸胸骨出血较多，尤其是体外循环下手术存在凝血功能障碍，更加重了术中及术后出血。

彩色多普勒超声联合D-二聚体检测对下肢骨折术后深静脉血栓【摘要】目的：分析下肢骨折术后深静脉血栓临床诊断中联合应用彩色多普勒超声、D-二聚体检测的价值。

方法：分析对象选择于2021.8~2022.8就诊于我院的下肢骨折患者90例，随机方式进行分组分析，45例联合应用彩色多普勒超声、D-二聚体检测进行诊断的患者分入试验组，45例应用彩色多普勒超声进行诊断的患者分入对照组，对比和观察诊断效果。

结果：与对照组对比，试验组诊断准确率明显较高，误诊率明显较低（P<0.05）；与其他部位骨折相比，髌骨骨折更易发生深静脉血栓（P<0.05）；与健侧相比，患侧静脉血管内径均明显较高（P<0.05）。

结论：下肢骨折术后深静脉血栓临床诊断中联合应用彩色多普勒超声、D-二聚体检测诊断价值较高，建议推广。

【关键词】下肢骨折；深静脉血栓；彩色多普勒超声；D-二聚体下肢骨折在临床上作为一种发病率较高的骨折类型，该病以手术治疗为主，但是手术呈较大创伤性，疼痛较大，术后需长期卧床，进而会减缓血液流动，同时骨折会使血管壁受损，深静脉血栓极易发生[1]。

为促进患者康复，需对深静脉血栓积极防治，否则会导致急性肺栓塞发生，对患者生命安全造成严重影响[2]。

因此，需对该并发症及时诊断，以便对其积极治疗，以保证患者生命安全和身心健康。

我院在临床诊断实践中发现联合应用彩色多普勒超声、D-二聚体检测价值较高，与彩色多普勒超声诊断相比，可促进诊断准确率提升，可减少误诊情况。

本研究选择于2021.8~2022.8就诊于我院的下肢骨折患者90例进行分组观察，对此诊断方式的价值进一步观察，结果如下。

1 资料与方法1.1一般资料分析对象选择于2021.8~2022.8就诊于我院的下肢骨折患者90例，随机方式进行分组分析，45例联合应用彩色多普勒超声、D-二聚体检测进行诊断的患者分入试验组，年龄情况：（53.15±15.45）岁（24~86岁），性别分布：25例男，20例女，骨折部位：23例足踝部骨折，4例髌骨骨折，8例胫骨骨折，10例股骨骨折，45例应彩色多普勒超声进行诊断的患者分入对照组，年龄情况：（54.05±15.38）岁（25~85岁），性别分布：27例男，18例女，骨折部位：24例足踝部骨折，5例髌骨骨折，6例胫骨骨折，10例股骨骨折。

2021年02月第18卷第1期生物骨科材料与临床研究O rthopaedic B iomechanics M aterials A nd C linical S tudy.39.doi:10.3969/j.issn.1672-5972.2021.01.010文章编号：swgk201头12-00271Allgower-Donati缝合法在跟骨骨折“L”形切口中的临床应用王小龙#景尚斐#郝增涛殷超王继宏樊东升温树正王永飞姜东孙韬张志勇韩超前*［摘要］目的探讨Allgower-Donati缝合法在跟骨骨折“L”形切口中的临床疗效。

方法选取内蒙古医科大学第二附属医院于2012年1月至2018年1月诊治的360例Sanders II>III型跟骨骨折切开复位钢板内固定的患者，以随机数字表法分为3组，分别采用不同的缝合方法：Allgower-Donati缝合组采用改良间断垂直褥式缝合法（Allgower-Donati缝合法，A组），Donati缝合组釆用间断垂直褥式缝合法（Donati缝合法，B组），单纯缝合组釆用间断单纯缝合法（C组），每组120例。

观察并对比3组患者的手术时间、伤口缝合时间、引流时间、术后VAS评分、临床疗效以及切口并发症的发生情况。

结果3组患者在手术时间、伤口缝合时间、引流时间及术后VAS评分方面比较，差异均无统计学意义Q0.05）；在临床疗效方面，A组患者的临床疗效优良率优于B组，而B组优于C组（92.5%vs.81.67%vs.73.33%）,差异均有统计学意义（P<0.05）；在术后伤口并发症方面，A组患者的伤口总体并发症发生率明显低于B组，而B组也显著低于C组，A组和C组的差异也有统计学意义（P<0.05）o结论Allgower-Donati缝合法在临床疗效和术后切口并发症方面均优于间断垂直褥式缝合法和单纯间断缝合法，不影响手术效果，值得临床推广运用。

［关键词］跟骨骨折；缝合方法；切口；并发症；Allgower-Donati缝合［中图分类号］R683.42［文献标识码］BClinical application of Allgower-Donati suture in L-shaped incision of calcaneal fractureWang Xiaolong,Jing Shangfei,Hao Zengtao,Yin Chao,Wang Jihong,Fan Dongsheng,Wen Shuzheng,WangYongfei,Jiang D ong,Sun Tao,Zhang Z hiyong,Han Chaoqian.Department of H and and F oot Svu^ery,The SecondAffiliated Hospital ofInner M ongolia Medical University,Hohhot Inner M ongolia,010030,China[Abstract]Objective To investigate the clinical effect of Allgower-Donati suture in the treatment of calcaneal fractureswith L-shaped incision.Methods We collected360patients who underwent open reduction and internal fixation of t hecalcaneal fracture(Sanders type II/HI)from January2012to January2018in the Second Affiliated Hospital of InnerMongolia Medical University the patients were randomly divided into three groups by random numbers and using dif­ferent sutures:Allgower-Donati suture group was treated with modified intermittent vertical suture(Allgower-Donatisuture,group A),Donati suture group was treated with intennittent vertical suture(Donati suture,group B),andsimple suture group was treated with simple suture(group C),120patients in each group.The operation time,woundsuture time,drainage time,and postoperative VAS score,clinical efficacy,and incidence of postoperative incisioncomplications such as incision skin margin necrosis,wound infection,incision dehiscence,plate exposure,osteomyelitisand other incision complications were observed and compared.Results There were no significant differences in the op­eration time,wound suture time,drainage time and postoperative VAS score among the three groups(P>0.05).Interms of clinical efficacy,the clinical efficacy of g roup A was better than that of g roup B,while group B was better thangroup C(92.5%vs.81.67%vs.73.33%),and the difference was statistically significant(P<0.05).In terms of p ost­wound complications,the overall complication rate of wounds in group A was significantly lower than that in group B,and group B was also significantly lower than group C,and there was significant difference between group A and groupC(P<0.05).Conclusion Allgower-Donati suture method is superior to intermittent vertical suture method and simpleintermittent suture method in clinical efficacy and postoperative incision complications,which does not affect the surgicaleffect and is worthy of clinical application.[Key words]Calcaneal fractures;Suture techniques;Incision;Complications;Allgower-Donati suture跟骨骨折当前公认的治疗方法是切开复位钢板内固定,跟骨外侧“L”形切口是治疗跟骨骨折应用最广泛、最经典作者单位:内蒙古医科大学第二附属医院手足显微外二科,内蒙古呼和浩特, 010030的手术入路，但跟骨局部软组织覆盖少、血供差，且周围结构解剖复杂，术后切口皮缘坏死、切口感染以及钢板外露、骨外露等切口并发症的发生率居高不下冋，成为困扰众多足踝外科医师的一个难题o跟骨骨折切口并发症的发生是多2021年 02月第18卷第1期生物骨科材料与临床研究O rthobabdic B iomechanics M aterials A nd C linical S tudy .40.因素共同作用的结果W1,目前已有相关文献报道采用不同的缝合方法可预防或减少跟骨骨折切口并发症的发生闕。