显微外科手术治疗矢状窦镰旁脑膜瘤的研究

目的:研究显微外科手术治疗矢状窦镰旁脑膜瘤的手术技巧和效果。方法:我院自1996年1月至2011年1月共收治66例矢状窦镰旁脑膜瘤患者,2005年1月前收治的34例采用常规手术治疗(设为常规手术组,2005年1月后收治的32例采用显微外科手术治疗(设为显微外科组),比较两组的疗效。结果:常规开颅手术组34例,肿瘤全切除率61.8%,平均输血量(1120±415)mL,恢复良好率79.4%。显微外科手术32例,肿瘤全切除率90.6%,平均输血量(356±220)mL,恢复良好率96.9%。与常规手术组比较,3项指标均有统计学意义(P<0.05)。结论:显微外科手术能明显减少术中出血量,提高肿瘤的全切除率,降低术后病残率。     

神经内镜下治疗基底节区高血压脑出血的效果研究

目的探讨传统开颅手术与神经内镜手术在治疗基底节区高血压脑出血(HICH)患者中的疗效与安全性,为其临床治疗提供一定依据。方法 86例基底节区HICH患者,根据手术方式不同将患者分为神经内镜组(40例)和开颅手术组(46例),开颅手术组采用开颅血肿清除手术治疗,神经内镜组采用神经内镜微创血肿清除手术治疗,对比两组基底节区HICH患者皮肤切口大小、骨窗大小、皮层切口大小、手术时间、术中出血量、血肿清除率、术后并发症、近期与远期疗效和病死率。结果神经内镜组患者的皮肤切口大小、骨窗大小、皮层切口大小、手术时间、术中出血量均明显低于开颅手术组(P 0.01);两组患者血肿清除率差异无统计学意义(P0.05);神经内镜组患者术后并发症发生率为10.0%,明显低于开颅手术组的28.3%(P 0.05);神经内镜组患者近期疗效良好率为90.0%明显高于开颅手术组的60.9%(P 0.01);神经内镜组患者远期疗效良好率为92.5%明显高于开颅手术组的63.0%(P 0.01);开颅手术组患者死亡3例,病死率6.5%;神经内镜组患者死亡2例,病死率5.0%;两组患者病死率差异无统计学意义(P0.05)。结论神经内镜手术治疗基底节区HICH可以减小手术创伤,缩短手术时间,降低出血量,提升近期与远期疗效,降低并发症发生率。     

腹腔镜下胃肠道穿孔修补术与传统开腹术的临床疗效比较

目的观察比较腹腔镜下胃十二指肠溃疡穿孔修补术与传统开腹手术之间临床治疗效果。方法选取2015年1月~2017年1月我院普外科收治的60例胃十二指肠溃疡穿孔患者。随机分为腹腔镜组和开腹手术组各30例。腹腔镜组采用腹腔镜行胃十二指肠溃疡穿孔修补术,开腹手术组患者采用传统开腹手术进行治疗。观察比较两组患者手术时间,术后下床活动的时间,胃肠道功能恢复的时间;手术中的出血量,切口长度,术后镇痛药物的使用以及术后并发症的发生率。结果腹腔镜手术组患者手术时间,术后下床活动的时间,胃肠道功能恢复的时间均显著优于开腹手术组(P0.05);腹腔镜组患者手术中的出血量,切口长度以及术后镇痛药物的使用均显著优于开腹手术组(P0.05);腹腔镜手术组术后并发症发生率为3%,显著低于开腹手术组的20%(P0.05),差异具有统计学意义。结论腹腔镜下的胃肠道穿孔修补术用于急性胃十二指肠溃疡穿孔的治疗具有手术时间短,伤口小,术后恢复时间短,出血量以及并发症少的特点,是治疗胃十二指肠溃疡的首选治疗方式。     

负压引流联合换药预防肥胖患者腹部Ⅱ类切口术后感染

目的 观察多侧孔硅胶引流管负压引流联合外科换药预防肥胖患者腹部Ⅱ类切口术后感染的临床效果.方法 选择行胃肠道等腹部手术并符合肥胖标准的60例,随机分为治疗组和对照组,每组30例.术后切口治疗组采用多侧孔硅胶引流管负压引流联合外科换药治疗,对照组仅采用外科换药治疗.观察比较两组术后切口感染率、切口二次缝合率、切口愈合分级及切口愈合时间.结果 术后切口感染率治疗组为3.3％,对照组为16.7％,差异有统计学意义(P＜0.05);治疗组无切口二次缝合病例,对照组切口二次缝合3例(10.0％),差异有统计学意义(P＜0.05).切口愈合分级治疗组甲级96.7％、乙级3.3％,对照组甲级83.3％、乙级6.7％、丙级10.0％,两组甲级、丙级切口愈合率比较差异均有统计学意义(P＜0.05),乙级切口愈合率比较差异无统计学意义(P＞0.05).切口愈合时间治疗组为(8.0±1.4)d,对照组为(12.0 ±1.3)d,两组比较差异有统计学意义(P＜0.05).结论 多侧孔硅胶引流管负压引流联合外科换药可减少肥胖患者腹部Ⅱ类切口术后感染率及二次缝合率,且可缩短切口愈合时间.     

经皮微创松解术治疗儿童狭窄性腱鞘炎效果分析

目的探讨儿童狭窄性腱鞘炎经皮微创松解术治疗的临床效果。方法 47例(51指)狭窄性腱鞘炎患儿,按手术方式分为传统手术组25例(28指)和微创手术组22例(23指),分别行腱鞘炎松解术。术后随访3~6个月,采用Quinnell分级标准比较2组手术指功能和术后切口美观情况等。结果术后2组患儿均痊愈,无不良反应;微创手术组单指手术时间[(9.42±1.00)min]短于传统手术组[(13.23±2.66)min](P<0.05);微创手术组术后指功能优20指,良3指,优良率100%;传统手术组优24指,良4指,优良率100%,2组治疗后指功能疗效比较差异无统计学意义(P>0.05);微创手术组术后指功能恢复时间[(1.29±0.39)d]短于传统手术组[(4.32±1.52)d](P<0.05),术区瘢痕发生率(4.54%)低于传统手术组(36.00%)(P<0.05)。结论经皮微创松解术治疗儿童狭窄性腱鞘炎手术时间短,指功能恢复好,切口美观。     

腹腔镜阑尾切除术与开腹手术的疗效比较

【目的】对比分析腹腔镜与开腹手术对治疗阑尾炎的临床疗效。【方法】452例急性阑尾炎患者分为腹腔镜手术组(198例)与开腹手术组(254例),对比两组手术情况及疗效。【结果】开腹组与腹腔镜组手术时间相比差异无显著性(P>0.05);开腹组术中出血量及切口感染率高于腹腔镜组(P<0.05);开腹组术后胃肠功能恢复时间及住院时间均长于腹腔镜组(P<0.05)。开腹组住院总费用低于腹腔镜组(P<0.05);腹腔镜手术组发现有不同程度的腹腔粘连30例(15%)。开腹手术组45例(17.7%),两组相比较差异无显著性(P>0.05)。【结论】腹腔镜阑尾切除术,具有切口小、创伤小、胃肠功能恢复快、出血少、切口感染率低、并发症少和平均住院时间短、较好的美观效果等优点,是一种疗效确切、安全的手术方式。     

腹腔镜及开腹手术在直肠癌患者临床治疗中的效果对比

目的对比腹腔镜及开腹手术在直肠癌患者临床治疗中的效果。方法选取该院胃肠肿瘤外科2008年5月-2013年5月收治的直肠癌患者80例,随机将这些患者分为腹腔镜手术组(n=40)和开腹手术组(n=40)两组,对两组患者的手术时间、术中出血量、切口长度、淋巴结清扫数量、首次通气时间、下床活动时间、住院时间、住院费用、术后并发症发生情况和治疗满意度进行统计分析。结果腹腔镜手术组患者的手术时间明显长于开腹手术组(P0.05),术中出血量明显少于开腹手术组(P0.05),切口长度明显短于开腹手术组(P0.05),首次通气时间、下床活动时间、住院时间均明显短于开腹手术组(P0.05),住院费用明显高于开腹手术组(P0.05),术后并发症发生率15.0%(6/40)明显低于开腹手术组35.0%(14/40)(P0.05),治疗满意度97.5%(39/40)明显高于开腹手术组67.5%(27/40)(P0.05)。结论腹腔镜手术在直肠癌患者临床治疗中的效果较开腹好。     

小骨窗微创手术治疗脑出血的疗效及患者满意度分析

目的分析小骨窗微创手术治疗脑出血的疗效、并发症发生情况及患者满意度。方法选取该院2014年5月至2016年5月收治的脑出血患者80例,按照随机数字表法将患者分为小骨窗微创手术组(40例)和传统开颅手术组(40例)两组,对两组患者的临床疗效、术后并发症发生情况、疾病复发及死亡情况、治疗满意度进行分析。结果小骨窗微创手术组患者治疗的总有效率为87.5%(35/40),显著高于传统开颅手术组的65.0%(26/40),差异有统计学意义(P0.05);小骨窗微创手术组术后并发症发生率、复发率、病死率分别为10.0%、0、5.0%,显著低于传统开颅手术组的17.5%、10.0%、20.0%,差异有统计学意义(P0.05);小骨窗微创手术组治疗满意度为87.5%(35/40),显著高于传统开颅手术组的70.0%(28/40),差异有统计学意义(P0.05)。结论小骨窗微创手术治疗脑出血的疗效较传统开颅手术显著,同时具有较少并发症及较高的患者满意度,值得在临床推广使用。     

肝癌破裂出血的肝动脉化疗栓塞术与手术治疗疗效对比

回顾性分析收治的50例肝癌破裂出血患者的临床资料,分为手术组(24例,采用手术切除治疗)和TACE组(26例,采用TACE治疗),随访1年,比较两组疗效、并发症情况及生存时间。TACE组止血成功率为100%,优于手术组的83.3%(P0.05);TACE组并发症发生率为7.7%,低于手术组的37.5%(P0.05),治疗后TACE组生命体征很快稳定,复查肿瘤均减小,手术组出现术后因循环功能衰竭死亡1例,其他患者全部恢复出院;TACE组术后1年生存率为46.2%,高于手术组的16.7%(P0.05)。对于病情危重的肝癌破裂出血患者,TACE是一种控制出血、挽救生命的非常有效的治疗手段,可显著降低患者肿瘤腹腔种植转移率,提高生存率。     

腹腔镜治疗52例卵巢子宫内膜异位囊肿治疗的临床疗效观察

选取104例需手术治疗的卵巢子宫内膜异位囊肿患者,分别采用腹腔镜手术和开腹手术治疗。结果与开腹手术相比,腹腔镜手术组手术时间短,术中出血量少,术后排气时间短,术后下床时间短,平均住院时间短,各项指标比较差异显著,具有统计学意义(P0.05)。腹腔镜手术组总治疗有效率为100.0%,明显高于传统开腹手术组(88.5%),两组比较差异显著(P0.05);腹腔镜手术组术后1年复发率为0,低于传统开腹手术组(7.69%),两组比较差异显著(P0.05)。腹腔镜手术治疗卵巢子宫内膜异位囊肿疗效确切,创伤小、疼痛轻、恢复快、术后并发症少,是治疗该病的理想术式。     

Effect of self-selected handgrip position on maximal handgrip strength

OBJECTIVE: To assess whether participants were able to select the handgrip position on a Jamar hand dynamometer with which the maximal handgrip strength could be delivered, while sitting and while standing. DESIGN: A criterion standard comparison study. SETTING: A university campus in the Netherlands. PARTICIPANTS: Fifty-six healthy subjects (30 men, 26 women; mean age, 30 y; range, 19-60 y) voluntarily participated. Interventions Not applicable. MAIN OUTCOME MEASURES: Maximal handgrip strength for the self-selected and non-self-selected handgrip position of the hand dynamometer (positions 2 or 3), while sitting and while standing. RESULTS: The self-selected handgrip position resulted in the highest mean maximal grip strength compared with the non-self-selected handgrip strength, both for sitting (mean difference, 2.3 kg; P 相似文献   

手卫生培训对社区医护人员手部带菌含量的效果研究

目的:探讨手卫生培训对减少社区医护人员手部带菌含量的效果.方法:选择沙园社区卫生服务中心作为手卫生培训干预组,昌岗社区卫生服务中心作为对照组,每中心随机抽选医护人员各60名,对干预组的医护人员进行手卫生强化培训,培训前对两组医护人员在接触病人或操作后进行手微生物采样.在培训后分别对对照组和干预组进行手微生物采样进行追踪,比较分析、并提出对策,检查干预组成员手卫生的依从性及效果.结果:经过强化培训后,干预组与对照组相比,每平方厘米手部所含细菌菌落明显减少,医护人员洗手依从性增加,P＜0.05,差异有统计学意义.结论:手卫生培训能使社区医护人员掌握正确手卫生的方法,提高手卫生的依从性,有效降低社区医护人员手部细菌的含量,降低社区医院感染的发生率.     

Hand hygiene education of Greek medical and nursing students: A cross-sectional study

AimTo investigate medical and nursing students’ education on hand hygiene, their attitude on hand hygiene education and how this education influences their hand hygiene knowledge and practices.BackgroundHospital-acquired infections are associated with prolonged hospitalisation and mortality. The most effective measure for their control is healthcare workers’ hand hygiene compliance. Since medical and nursing students constitute the future healthcare workers, our study focuses on them.DesignCross-sectional studyMethodsThis study was conducted during the academic year 2016–2017, using a modified World Health Organisation questionnaire. Our sample consisted of 132 medical and 111 nursing students from National and Kapodistrian University of Athens, Greece. In data analysis, the Mann-Whitney and Fisher’s exact tests were applied to compare differences in continuous variables and proportions in categorical variables, respectively. Knowledge and practices overall scores were calculated per student group. Multiple linear regression analyses were performed to assess the influence of potential confounders on these scores.ResultsWe found that 73.1% of medical and 98.2% of nursing students had received relevant education, which was reported as “only theoretical” by 77.4% of the former and as “hands-on and theoretical” by 88.1% of the latter group. Besides the risk of infection, knowledge acquired in lectures and trainer’s behaviour were also considered very influential factors shaping hand hygiene attitude in both groups. Overall, medical students reported better hand hygiene practices than nursing ones (69.9% and 59.7%, respectively; p < 0.001). The opposite finding was observed regarding their overall knowledge on hand hygiene (57.2% of medical versus 60.4% of nursing students, p = 0.04). The majority of students (86.6% of all participants; p < 0.001) supported the inclusion of compulsory hand hygiene education in their curriculum. Compulsory education and seminars were assessed as the most effective measures to increase hand hygiene compliance (71.4% of all students).ConclusionIn our study, medical students scored better in practices questions than nursing students; this did not apply for the knowledge score. The majority of students supported the inclusion of compulsory education on hand hygiene principles in their Departments’ curricula, highlighting compulsory education and seminars as the most effective measures to increase compliance with hand hygiene.     

手消毒剂支领量纳入科室考核对手卫生效果的影响

目的通过对科室每月手消毒剂支领量的考核,监督手消液的临床使用量,确保手卫生效果。方法从2010年1月实施每月检查库房各科室手消毒剂支领数量,将医务人员手卫生监测不合格复查率作为观察指标,将2008～2009年监测数据作为对照组,2010～2011年监测数据作为观察组。结果2008年不合格复查率为3.4%,2009年为2.2%,对照组平均复查率2.8%;2010年为0.5%,2011年为0.4%,观察组平均复查率0.49%,实施前后不合格复查率明显降低。结论将手消毒剂支领量纳入科室考核后,支领量明显增加,手卫生不合格复查率降低,此管理方法能够明显提高手卫生效果。     

Upper extremity transplantation: current concepts and challenges in an emerging field

Loss of an isolated upper limb is an emotionally and physically devastating event that results in significant impairment. Patients who lose both upper extremities experience profound disability that affects nearly every aspect of their lives. While prosthetics and surgery can eventually provide the single limb amputee with a suitable assisting hand, limited utility, minimal haptic feedback, weight, and discomfort are persistent problems with these techniques that contribute to high rates of prosthetic rejection. Moreover, despite ongoing advances in prosthetic technology, bilateral amputees continue to experience high levels of dependency, disability, and distress. Hand and upper extremity transplantation holds several advantages over prosthetic rehabilitation. The missing limb is replaced with one of similar skin color and size. Sensibility, voluntary motor control, and proprioception are restored to a greater degree, and afford better dexterity and function than prosthetics. The main shortcomings of transplantation include the hazards of immunosuppression, the complications of rejection and its treatment, and high cost. Hand and upper limb transplantation represents the most commonly performed surgery in the growing field of Vascularized Composite Allotransplantation (VCA). As upper limb transplantation and VCA have become more widespread, several important challenges and controversies have emerged. These include: refining indications for transplantation, optimizing immunosuppression, establishing reliable criteria for monitoring, diagnosing, and treating rejection, and standardizing outcome measures. This article will summarize the historical background of hand transplantation and review the current literature and concepts surrounding it.     

新型洁芙柔消毒凝胶在手部消毒中效果评价

目的 探讨新型洁芙柔消毒凝胶手部消毒的效果.方法 随机抽取我院各临床科室的医师52人,护士132人,随机分为实验组和对照组,每组92人.实验组使用洁芙柔消毒凝胶洗手,对照组使用肥皂和碘伏刷手.洗手前后均采样测定菌落数,计算除菌率,同时观察不良反应及接受度.结果 实验组平均菌落数低于对照组,除菌率实验组(97.87％)高于对照组(82.22％);实验组洗手合格率(92.39％)明显高于对照组(72.83％);实验组洗手法的接受度显著高于对照组洗手法(P＜0.05);实验组皮肤不良反应明显少于对照组(P＜0.05).结论 洁芙柔消毒凝胶能有效减少手部细菌,使用便捷,消毒效果好,是一种较为理想的快速手消毒剂,值得临床推广和使用.     

利用指背部皮瓣修复手指软组织缺损

目的：总结应用手指背部皮瓣修复外伤后手指软组织缺损的经验。方法：对128例外伤后手指软组织缺损分别采用侧方蒂邻指皮瓣（78例）、近端蒂邻指皮瓣（34例）、示指近节背侧皮瓣（5例）及其它近节指背皮瓣（4例）、指背推进皮瓣（2例）与指背旗形皮瓣（5例）进行修复。结果：除2例皮瓣远端有小部分坏死外,其余皮瓣均成活良好。结论：多种指背部皮瓣修复手指软组织缺损其方法简便、皮瓣成活可靠,治疗费用较低。     

深度手烧伤早期切痂植皮治疗及功能康复

目的：为了防止手部深度烧伤后形成瘢痕挛缩畸形，以达到恢复手功能。方法：对深Ⅱ度或Ⅲ度于烧伤，于伤后2～10d，采用切痂植皮、大张厚中厚自体皮片覆盖创面，术后早期进行功能锻炼及持续弹力手套压迫。结果：对116只手(68例)用该方法治疗，均取得了满意的手术效果，手功能及外形良好者达到95％以上。结论：早期切痂时间以伤后1周以内为佳。手深度烧伤采用早期切痂植皮不但可防止手瘢痕挛缩，恢复手功能，而且又可缩短疗程，减轻病人精神痛苦和经济负担。     

Using Grasping Tasks to Evaluate Hand Force Coordination in Children With Hemiplegic Cerebral Palsy

Mackenzie SJ, Getchell N, Modlesky CM, Miller F, Jaric S. Using grasping tasks to evaluate hand force coordination in children with hemiplegic cerebral palsy.

Objective

To assess force coordination in children with hemiplegic cerebral palsy (CP) using a device that allows for testing both unimanual and bimanual manipulation tasks performed under static and dynamic conditions.

Design

Nonequivalent groups design.

Setting

University research laboratory for motor control.

Participants

Six children with hemiplegic CP (age, mean ± SD, 11.6±1.8y) and 6 typically developing controls (11.6±1.6y).

Interventions

Not applicable.

Main Outcome Measures

Children performed simple lifting and force-matching static ramp tasks by way of both unimanual and bimanual pulling using a device that measures grip force (force acting perpendicularly at the digits-device contact area) and load force (tangential force). Main outcome measures were grip/load force ratios (grip force scaling) and correlation coefficients (force coupling).

Results

CP subjects showed significantly higher grip/load force ratios (P<.05) and slightly lower correlation coefficients than the control group, with more pronounced differences for most tasks when using their involved hand. For subjects with CP, switching from unimanual to bimanual conditions did not bring changes in scaling or coupling for the involved hand (P>.05).

Conclusions

Compared with healthy children, the impaired hand function in the hemiplegic CP pediatric population could be reflected in excessive grip force that is also decoupled from ongoing changes in load force. Therefore, the bimanual grip load device used in this study could provide a sensitive measure of grip force coordination in CP, although nonmotor deficits should be taken into account when asking children to perform more complex tasks.     

Patients' perceptions of the treatment and management of hand osteoarthritis: a focus group enquiry

Purpose.?Osteoarthritis (OA) is the commonest reason for a musculoskeletal consultation in primary care in older adults. There is evidence that appropriate advice and management is sub-optimal. The aim of this study was to explore perceptions and experiences of the treatment and management of hand OA in older adults.

Methods.?Four focus groups were conducted with primary (n == 15) and secondary (n == 14) care participants aged 50–84 years (mean age 64.9 years; 3 males, 14 females) with a clinical diagnosis of hand OA. Data were tape-recorded, transcribed and analysed using thematic analysis and constant comparison method.

Results.?Participants described a lack of help and information with regards to management of their hand OA and also a perceived lack of understanding of the impact of hand OA on the individual. Some received contradictory advice about its management. Beliefs about treatment efficacy were balanced against perceived and actual side-effects and tolerance, and such perceptions appeared to influence the use of alternative therapies.

Conclusions.?The study identified a perceived unmet need in people with hand OA presenting in primary and secondary care. This may be due to the clinical uncertainty of treatment, lack of high-quality randomised controlled trials evaluating therapeutic options, and the limited written information available incorporating the patient experience. The study emphasised the need to understand patient illness and treatment beliefs. A better understanding of illness and treatment beliefs will facilitate the use of evidence-based approaches in the management of hand OA.