When the gap between the posterior medial tibia and the tibia exceeds the sputum, it should be given high priority. If necessary, the autologous bone graft should be taken to eliminate the defect. Only when the fracture sections are closely aligned, the stress at the fracture end can be evenly distributed, in order to effectively prevent the deformation and fracture of the internal fixation equipment, and promote the soft tissue injury of the fracture site of the bone. 2.3 The soft tissue injury of the fracture site is severe, and the incision skin is postoperative. Necrosis liquefaction, fracture and internal fixation equipment exposed to surgery failed a total of 12 cases, about 20 of the total number of missed sputum, of which 8 cases were tibiofibular fractures. Mostly direct impact and heavy weight injury, local skin and soft tissue contusion severe bone exposure, requiring emergency treatment. The operator was underestimated for soft tissue injury due to lack of experience. The skin tension increased due to soft tissue edema after internal fixation, and the suture was difficult to suture. In addition, the incision was not sufficient. The postoperative wound 1 skin necrotic liquefaction fracture was exposed. In addition, soft tissue damage destroys local blood circulation, directly affects the growth of the epiphysis, and makes the fracture heal slowly. If the weight is walking before the fracture is healed, the internal fixation equipment will bear the stress for a long time, and it is easy to see fatigue and fracture, and then the abnormal activity occurs at the broken end, which makes the operation fail. Therefore, the tibiofibular fracture with severe soft tissue injury should be fixed with an external fixator with less local circulatory disturbance. For open fractures with soft tissue contusion and skin defects after debridement, local rotation flaps should be used as much as possible. The free flaps can also be used to close the wounds. Improving the surgeon's wound handling ability and improving local blood circulation is the fundamental way to prevent such surgery failure. 2.4 Infection factors In this group, 9 cases of chronic osteomyelitis were caused by surgical infection.
About the total number of failures, including one case of the femoral bone, one case of the ulna, the ulna and the phalanx. With the rapid development of antibiotics, people's fear of orthopedic surgery infection has gradually faded, and preoperative preparation for orthopedics tends to be simple and quick. Although orthopedic surgery is the most serious complication of internal fixation surgery. When the infection occurs, it will bring great pain and trouble to the patient, and the treatment is quite tricky. The infection course of this group is the shortest one year, the longest is 8 years, the average is 3 years, and the joint dysfunction of the affected limbs is left to varying degrees, which brings great harm to the patient's body and mind. Therefore, measures to prevent infection must be implemented. The surgeon should select appropriate fixation methods according to the age of the patient's injury, minimize the operation time, and wash and drain the wound after surgery. According to the patient's condition, the effective amount of 2.5 other factors were selected. In this group, there were 2 cases of stress shielding by the compression plate, bone absorption at the fracture end, and re-operation of bone grafting was needed. Two other cases were incorrectly moved too early and the bones were not connected. There are also 2 cases because the quality of the internal fixation material is inferior, resulting in fracture of the intramedullary needle splitting plate. Prevention is to correctly grasp the indications of compression plate, advocate elastic fixation; guide postoperative rehabilitation training, and strive to achieve step-by-step functional recovery; use internal fixators produced by regular manufacturers with quality assurance to prevent unqualified internal fixators In the clinic.
1 Xu Yuxiang, Liu, Li Changsheng and so on. The current basic treatment of the internal fixation of the internal fixation 4. Chinese Journal of Orthopaedics, 1996, 4204 edited by Song Hua homemade micro-spring embolization spermatic vein treatment of varicocele Song Huazhi Wang Ping Tian Jialin Xiaoxu Huang Weibing varicocele It is the cause of male infertility, accounting for 4 of infertility patients. The clinical symptoms include scrotal swelling and pain, which can affect work and life. In our hospital from 1999042000, in February, 25 cases of varicocele were treated with self-made micro-spring embolization of the internal spermatic vein, and the results were satisfactory.
1 Method and data received date 2000075 25 patients aged 2026 years, the median age of 21 years. All are left varicocele. One example is postoperative recurrence. 25 cases of clinical grade = grade 4 cases, grade 2.25 cases of all patients used 8 method, pulse puncture intubation, 22 cases of success, 3 cases of success, after the catheter was inserted into the left renal vein, push the ground plug Misong used 30 compound diatrizoate 1015,8, total 3, 虬 pressure 350 lbs, left renal vein angiography, to understand the position of the spermatic vein opening, the catheter tip close to the fine internal vein opening, inserted into the catheter The super-sliding guide wire is guided into the internal vein of the spermatic cord. Under the guidance of the super-sliding guide wire, the catheter is inserted into the internal vein of the spermatic cord at the level of the waist 3, and the internal spermatic vein is compared. Contrast condition 41 pressure below 150, total 161. According to the angiography, the catheter is placed in a suitable position. A tungsten wire microspring with a length of 2.5 and a diameter of 0.5, 1 is placed over the thin steel wire, fed into the 31-tube, and the thin steel wire is withdrawn, and the micro-spring is pushed out of the catheter with the hard end of the butt-shaped guide wire. The amount of micro springs was 23 times. After the embolization is completed, the catheter is withdrawn and the puncture site is pressurized and bandaged. Antibiotics were used for 3 days after surgery. Three patients had mild left-middle-abdominal pain after surgery, and were treated without treatment. No other discomfort or complications.
2 The results disappeared, and the scrotum was palpated without varicose veins. 9 cases were effective, that is, the symptoms were alleviated and the degree of varicocele was lightened. No recurrence and ineffective cases. Seven patients were treated with spermatic vein venography at the distal end of the resection of the varicocele, and no new collaterals were found.
3 Discussion 3.1 Physicochemical properties and characteristics of homemade tungsten filament microsprings The treatment of varicocele by internal veins of sputum spermatic cord has been widely used in clinical practice. Commonly used embolic materials are spring steel detachable ball, 31 and hardener. In 199904, we used self-made tungsten wire as the spring embolization spermatic vein for the treatment of varicocele. In addition to the same embolization effect as the above materials, the main advantages It is easy to obtain and low in price. Tungsten wire has stable spring performance and no obvious toxic side effects on the tissue. 5 Tungsten wire microspring has been used for embolization of intracranial aneurysms and venous leakage. 7. No complications were found by embolization with tungsten wire microsprings.
3.2 The treatment of spermatic vein embolization for the treatment of varicocele, there are many mature experiences. Some authors have suggested that the internal spermatic vein and the lumbar vein have traffic branches or traffic veins with the vena cava, and can not be embolized. 8. Some people have suggested that the contrast agent from the venous vein to the renal vein is not suitable for embolization. 9. We think Embedding with a micro-spring, as long as avoiding the traffic branch, will not cause embolization of the lumbar vein and vena cava. When the micro-spring is plugged, the effect of complete embolization can be achieved without the need to add a hardener, and it is not necessary to consider the reflux problem. In order to prevent recurrence after embolization, it is necessary to master the site of embolization. In each case, the location of the embolization was determined according to the venous angiography of the spermatic cord. It was suggested that if the proximal end of the spermatic vein was changed, the embolization site should be below. For example, there are 23 branches at the distal end of the internal spermatic vein, which should be embolized above all branch points. Our experience is basically the same as above, but if there is a side branch, it is best to give the embolism up and down separately.
The intubation procedure must be light and avoid rough movements to avoid damage to the renal veins or to cause varicocele. When the catheter is close to the opening of the internal vein of the spermatic cord, the surgeon fixes the catheter and the assistant inserts the super-sliding guide wire through the catheter. After the super-sliding guide wire is inserted into the internal spermatic vein, the catheter is then sent to the internal spermatic vein to reach the level of 123, and the guide wire is withdrawn. An anatomical variation should be considered if the catheter is close to the internal spermatic vein opening, but the superslip guide wire cannot be inserted into the internal spermatic vein. This group has this case. After careful analysis of the contrast and smoke observation, it is found that the spermatic vein opening is above the renal vein. Therefore, the tip of the catheter is turned upside down to the internal vein of the spermatic vein, and guided by the super-sliding guide wire. The intubation was successful. In the case of embolization, if a spring is used, it is not necessary to use a hardener or gelatin sponge. The embolization can be achieved by the spring plug. When gelatin sponge or hardener is added, gelatin sponge and hardener can enter the scrotum. After surgery, the patient's scrotum is red and swollen, the pain is obvious, and there is obvious left lower abdomen pain. This phenomenon was first seen in 2 patients in this group. The gelatin sponge and hardener were not used in the future, and the above situation did not occur. In addition, the intubation time should not be too long, otherwise it may cause vasospasm and the intubation fails. If the intubation is unsuccessful, you don't have to be stubborn. You can intubate the tube for the next week or so, so as to avoid vascular damage caused by impatience. Although it has been reported that renal vein perforation has no adverse consequences, the value is best not to occur.
The self-made tungsten wire micro-spring embolization of the spermatic vein for the treatment of varicocele, the patient has little pain, good effect, easy to take, low price, easy to promote and apply.
2 Li Baochi, Mu Lianbi, Luo Zemin and so on. Intravenous venous embolization for the treatment of varicocele in 20 cases reported to the Chinese Journal of Urology, 988, 9 5 brother Zuoquan, Ma Lianting, Zhang Lun and so on. The development of tungsten filament micro-coil and its observation of embolization effect. Chinese Journal of Experimental Surgery, 1994, 6369 6 Wu Xue. Wang Zhongcheng, Zhang Youping. Self-made micro-coil to embolize intracranial posterior circulation aneurysms. Chinese Journal of Radiology, 1996.309587 7 Song Huazhi, He Jiangang, Liu Qinzhen and so on. Treatment of 40 cases of venous leakage and impotence through deep penile vein embolization. Chinese Journal of Urology, 1996, 17 of Urology, 1984, 56739 Li Shenqin, Ge Hongfa, Cheng Jiyi and so on. Treatment of varicocele with spermatic vein embolization. Chinese Journal of Urology, 1988, 94243, edited by Song Hua's small incision for the treatment of 22 cases of middle-aged and elderly pituitary adenomas Luo Chaowei Tian Yingde, Quyou straight pituitary adenoma is the most common tumor in the sellar region, accounting for about the intracranial tumor year, but in the middle There are also many elderly patients, and the clinical treatment is mainly surgery.
There are two types of traditional surgical methods: transcranial surgery and transsphenoidal surgery. The former is divided into the forehead and the pterional approach. In the transurethral approach, the incision is usually located in the hairline. The wound has a large wound. Since December 1993, we have used 22 patients with middle-aged and elderly patients with pituitary adenoma to remove the tumor with a small frontal craniotomy, which has achieved satisfactory results. The report is as follows.
1 Materials and Methods 1.1 General Information This group of 22 patients, 13 males and 9 females, aged 4769 years, mean 61.2 years old. The course of disease is as short as 4 months and the longest is 5 years, with an average of 2.7 years. Clinically, there were 22 cases of visual field changes, 16 cases of increased intracranial pressure such as headache and vomiting, and 7 cases of endocrine changes such as acromegaly and cardiac dysfunction. Imaging features and or 1 saddle tumor developed to the saddle, tumor position internal view cross-type or retrograde posterior type. In the skull, the sphenoidal saddle is enlarged, the double saddle is changed, the saddle bone is not damaged, and the frontal sinus is relatively small.
1.2 + method before the operation of Du Leng Ding and stability of the static pain, the operation of the middle of the static drop stability, if necessary, add a small amount of Du Lengding, in order to maintain a light sleep state for routine oxygen, monitor blood oxygen saturation. The patient was placed in the supine position, and the incision was made in the direction of the frontal line of the right eyebrow. The length of about 4, if the tumor is obviously to the left, the left incision can also be taken. After local anesthesia, the skin subcutaneous tissue and periosteum were completely cut, the periosteum was slightly peeled off, the skull was drilled and the bone window was enlarged about 3,7!3, the lower edge reached the upper edge of the iliac crest, and the bone window edge was coated with bone wax to stop bleeding. Open the dura mater in the arc, tear the frontal arachnoid membrane in the sulcus, slowly suck out the cerebrospinal fluid, and after the brain tissue collapses, gently lift the frontal lobe into the saddle area, and open the visual cross-cell to release the cerebrospinal fluid to facilitate the tumor. Exposure and surgical procedures. After the tumor is revealed, the tumor is puncture and aspiration is taken before the optic chiasm, the vascular tumor is excluded, the tumor capsule is electrocoagulated and the tumor is incision, and the tumor is resected; for the tumor capsule, it is not necessary to peel off, and the electrocoagulation can be made back. Shrink, to achieve adequate decompression of the optic nerve. After careful hemostasis, the dura mater is tightly sutured. The skull defect was repaired with plexiglass, and the incision skin was sutured.
2 treatment results 22 patients were removed 7 days after surgery, except for 2 cases of incision subcutaneous hemorrhage, physical therapy for blood absorption, the other patients without any complications, and the visual field began to gradually recover from the first day after surgery . There were no deaths in this group.
3 Discussion 3.1 The advantages of this procedure through the amount of the pituitary adenoma surgery in order to make the patient's appearance unacceptable date 2000 Department of Military Medical University Affiliated Hospital Neurosurgery
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