Interposition Ankle Arthroplasty Using Acellular Dermal Matrix: A Small Series

Although ankle arthrodesis is the reference standard for end-stage ankle arthritis, loss of mobility and adjacent joint arthritis are consequences that alternatives to arthrodesis attempt to avoid. The purpose of the present study was to report the clinical results of interpositional arthroplasty using acellular dermal matrix in 4 patients (age 32 to 42 years) for the treatment of advanced ankle osteoarthritis. The primary findings included relief of pain, with improvement in tibiotalar joint range of motion from a mean of 16.5° (range 0° to 24°) preoperatively to a mean of 31° (range 25° to 40°) postoperatively. All 4 patients underwent open arthrotomy of the anterior and posterior tibiotalar capsule with plafond exostectomy and debridement of all deleterious tissue within the ankle capsule. The articular surface of the talar dome was denuded down to smooth subchondral bone, and microfracture was performed. Autologous calcaneal bone marrow aspirate was applied, and talar resurfacing was achieved using an acellular dermal matrix. Knotless anchors placed medially and laterally within the anterior and posterior dome were used to affix the dermal matrix. The follow-up period ranged from 12 to 18 (mean 14) months. The mean pre- and 12-month postoperative Association of Orthopaedic Foot and Ankle Society hindfoot-ankle scale scores were 35 and 88.5, respectively. These outcomes suggest that interpositional tibiotalar arthroplasty using an acellular dermal matrix is successful in improving function and range of motion and decreasing pain. As an alternative to tibiotalar arthrodesis, interpositional tibiotalar arthroplasty might be the procedure of choice for young patients with end-stage ankle arthritis. Longer follow-up periods, histologic testing, and arthroscopic evaluations would be advantageous to further assess the durability of this procedure.     

颅内巨大动脉瘤的手术治疗

目的：颅内巨大动脉瘤虽然少见,但手术治疗困难,手术病死率和致废率仍较高。本对我院1980年以来手术治疗的30例颅内巨大动脉瘤作一回顾性分析。方法：动脉瘤瘤颈夹闭术13例,动脉瘤孤立后切除术11例;动脉瘤切除或孤立后载瘤动脉重建术2例;颈部颈内动脉结扎术2例;动脉瘤包裹术2例。结果 术后早期恢复良好为73．3％,中、重残为20％,死亡2例,病死率6．6％。动脉瘤瘤颈夹闭组的13例病人中、除1例术前Ⅳ级的前交通动脉瘤病人术后重残外,均恢复顺利。动脉瘤孤立或孤立后切除的11例病人中,4例术后早期出现不同程度的对侧肢体瘫痪,其中2例在术后3周内恢复正常,另2例分别在术后3个月和28个月恢复正常;1例大脑中动脉（MCA）动脉瘤术后因术野血肿再次手术清除血肿后,病人出院时能独立行走。单纯行颈部颈动脉结扎的2例病人出院时病情无明显变化。而仅行动脉瘤包裹术的2例病人均在术后因再出血死亡。结论 为消除巨大动脉瘤的占位效应和出血的潜在性,对颅内巨大动脉瘤提倡积极的直接手术治疗。动脉瘤瘤颈直接夹闭并保留载瘤动脉通畅是首选治疗,对必需行动瘤孤立且交叉循环不良的病例,应尽可能重建载瘤动脉。     

Assessment of pancreatic enzyme secretory capacity by a modified Lundh test

Summary Background. The Lundh test is a usual means of estimating the enzyme secretory capacity of the gland. During this procedure, however, a major proportion of the test meal is removed from the duodenum together with the gastric, duodenal, and pancreatic secretions and the bile. This study was undertaken to compare the pancreatic enzyme secretion induced by the Lundh procedure with that resulting from stimulation of the normal digestive process, by reinfusion of the aspirated duodenal juice. Methods. Nine men (mean age: 46.7, range 42–55 yr) free from pancreatic disease were studied. Pancreatic secretion was measured via a multiple lumen tube by aspiration of the duodenal juice. After a basal period the Lundh test meal was placed in the stomach and the duodenal juice was completely aspirated. On a separate day, the procedure was repeated, but the aspirated duodenal juice was reinfused into the upper jejunum. Results. In the first 30 min of the test period, the enzyme outputs were the same on both test days. In the 30–60-min period, the lipase output, and in the 75–90-min period, the amylase output was significantly lower during the Lundh test compared with the jejunal reinfusion test. The CCK levels were significantly above the basal level at 20 and 40 min, but the increase was significantly lower during the traditional Lundh test. No significant difference in gastrin release was observed during either the Lundh or the reinfusion test. Conclusions. In the traditional Lundh test, the trypsin secretory capacities of the gland are measured appropriately, but the lipase and amylase secretory capacity and the CCK release are not fully represented compared with the reinfusion test. An association between the lower CCK release and lipase amylase secretion is suggested.     

间置空肠消化道重建术对患者营养状况的影响

目的　评估间置空肠法(JIP)是否是一种理想的全胃切除后消化道重建术。方法　对 20 例 JIP组术后3~6个月的营养指标,肠道功能进行测评,同时与23例Roux-en-Y消化道重建术(RYP)组进行比较。结果　两组患者术后营养状况明显优于术前(P<0 01),JIP组较RYP组改善更明显(P<0 01)。结论　JIP法是全胃切除术后较为理想的消化道重建手术方式。     

肠内营养对重症急性胰腺炎的治疗作用

目的探讨肠内营养在重症急性胰腺炎(SAP)非手术治疗中的作用和疗效。方法对36例SAP患者采用肠内营养支持治疗。结果35例患者空肠内营养平均维持时间19(7~38)d,未出现全身感染或多脏器功能衰竭等严重并发症。1例因假性囊肿形成于第4周行外科手术治疗。结论在SAP非手术治疗期间,适时和尽快由肠外营养过渡到肠内营养,有助于维持肠道屏障功能,改善患者的营养状况,降低感染等并发症的发生,对改善SAP患者的预后有重要意义。