Treatment of 39 cases of tibiofibular fracture with percutaneous lag screw internal fixation

21%, 51 strains of Klebsiella pneumoniae, 24 strains of ESBLs positive strains, accounting for 47%. The ESBLs strains in 2001 increased significantly compared with 2000, P<0.05, and the increase of Klebsiella pneumoniae was more obvious.

The lactamase gene mutation is mainly manifested in Escherichia coli and Klebsiella pneumoniae. The results of this study indicate that the infection rate of ESBLs strains is getting higher and higher, especially Klebsiella pneumoniae. This situation can easily lead to outbreaks. As long as it is determined to be a positive ESBLs strain, regardless of the sensitivity of the in vitro susceptibility test, it should be reported clinically to avoid the use of penicillins and first, second and third generation cephalosporins and aztreonam. Carbapenems, 3 lactamases containing enzyme inhibitors, and the prevention of nursing errors can be analyzed by the production of Escherichia coli and Klebsiella pneumoniae ESBLs such as aminoglycosides and fluoroquinolones. Xie Xiuyan Liu Jinyan Wang Lina (Changyi People's Hospital Wang Xiuli Zhao Hui Yang Changchun Shen Yanna (Shengli Petroleum Administration Central Hospital Lu Yanzeng in recent years, with the wide application and unreasonable use of 3 lactamase (ESBLS) antibiotics, resistant The drug strains increase rapidly. ESBLs produced by drug-resistant strains can hydrolyze most of the 3-lactamases and monoamide antibiotics, which brings great difficulties to clinical treatment. In order to prevent drug-resistant strains from causing hospital outbreaks and out-of-hospital drug-resistant strains Transmission, the detection of ESBLs-producing strains is extremely important. We use the paper diffusion method and the VITEK32 susceptibility card method to separate Escherichia coli isolated from the blood, urine, sputum, drainage fluid, secretions and prostatic fluid samples. Klebsiella pneumoniae was tested for ESBLs and is reported below.

Blood, urine, sputum, drainage fluid, secretions and prostatic fluid samples were collected from outpatients and inpatients of our hospital, and identified by VITEK32. The quality control strain was Escherichia coli. According to the standard paper diffusion recommended by NCCLS in January 1999. Confirmation of ESBLs for confirmation, using ceftazidime (CAZ, 3Qig) and ceftazidime/clavulanic acid (CAZ/CA, 3Wg/1Cfig) combination, cefotaxime (CTX, 3Wg) and cefotaxime clavulanic acid (CTX/CA) , 30g/10g) combination, when the antibacterial diameter difference of any group of drugs is 5mm, it is judged that the ESBLs positive strain is used in our hospital. The micro-automatic analyzer VITEK32 and the drug-sensitive tablet GNS506 can also be purchased from Beijing, and the hydrolyzed casein is purchased from Shanghai. Medical Institute, the drug sensitive card GNS506 identification card GNf is a French Mérieux product.

RESULTS: From February to December 2000, 162 strains of Escherichia coli were identified from the collected specimens, 36 strains of ESBLs positive strains, accounting for 22.5%; 61 strains of Klebsiella pneumoniae and 8 strains of ESBLs positive strains, accounting for 14 From January to June 2001, 53 strains of Escherichia coli and 11 strains of ESBLs-positive strains were identified, which accounted for the occurrence of nursing errors and directly affected the rehabilitation of patients and the reputation of hospitals, in order to reduce nursing errors and prevent medical accidents or Disputes, improve the quality of care, we summarize 30 years of work experience, introduce the preventive measures of nursing errors as follows: Common causes of nursing errors are not serious, lack of responsibility, unskilled technology, poor sterility, and patients Lack of feelings and so on. To this end, the following precautions can be taken: 1 Improve the system: In the nursing work, not only the nurses are required to strictly abide by the application, such as the medical examination system, the handover system, the disease registration system, the disinfection and isolation system, and the nurses' error registration and discussion system. 2 Strengthen the responsibility of training: Regularly carry out medical ethics and professional ethics education for nursing staff. Arouse the compassion and responsibility of the caregiver through role exchange activities. 3 Improve professional level: nursing work requires scientific, safe and reliable nurses should not simply perform medical orders, injections and medicines, but plan comprehensive holistic care for patients. A qualified nurse must have the ability to work independently. High professional theoretical knowledge, skilled nursing operation technology, and advanced medical equipment. Improving the level of business technology is a reliable guarantee for doing a good job in nursing work and preventing accidents.

Percutaneous lag screw internal fixation for the treatment of tibiofibular fractures in 39 cases Peng Jianlin Wen Yuling Zhao Hui Zhang Lei (Shandong Qiaolian Hospital Xu Defeng 耿侃 1999, we used percutaneous lag screw internal fixation for the treatment of 39 cases of tibiofibular fractures, the effect is better, the report is as follows.

Clinical data: 29 males in this group. 10 females, aged 21-52 years old. The fractures were classified according to AO: A, 16 cases, A213 cases, B, 7 cases, and 3 cases.

Surgical method: For displaced humeral fractures, the manipulative reduction was performed under C-arm X-ray monitoring, and the anatomical reduction or near anatomical reduction was achieved (the anterior or posterior tibial epiphysis was close to the anatomical reduction) according to the preoperative X-ray. The film and the preoperative design, cut the 1~15cm incision at the predetermined marking point, and then separate to the bone surface; insert the self-designed working sleeve; enter the first by the working sleeve according to the AO lag screw technology A lag screw with a diameter of 4.5 mm is inserted into the second screw in the same manner as the predetermined entry point perpendicular to the long axis of the humerus. According to the type of fracture, the number of screws can be selected. The AiA2 type can be generally 2 pieces, and the Bi and B2 types can be used for more than 3 cases. The clinical data: 14 males and 4 females, aged 39-74 years, average 56.5 years old, with a course of half a year to 22 In the year, the average of 4.9 years, 18 cases had intermittent claudication, intractable low back pain and radioactive numbness in the lower extremities. The symptoms of supine rest were not alleviated or even aggravated; the straight leg raising test strengthened the test positive in 16 cases and sphincter dysfunction in 5 cases. The Kemp test was positive in 16 cases. 5 cases of simple lumbar CT examination and 13 cases of myelography CT showed lumbar spinal stenosis, lateral recess stenosis and intervertebral disc herniation. The lateral recess stenosis was unilateral in 13 cases and bilateral in 5 cases. One of the 3 cases of 2Bh3B>3 should restore the integrity of the tibia. In this combination, 21 cases of tibiofibular fractures were treated with DCP, and all were treated with external sinus needles. The wounds were sutured for 2 weeks. After the operation, the long-legged plaster was used for 4 weeks, then the short-legged plaster was replaced, and the y-class was removed for 6-8 weeks. The clinical and X-ray follow-up was performed at 61016 weeks.

RESULTS: The fracture line of this type of A fracture was almost disappeared. The fracture line of the B-type fracture was blurred or disappeared after 8-16 weeks without delayed healing or non-healing.

The skin and the extremely thin subcutaneous tissue are covered, and the bony marks are obvious, which is an advantageous condition for the closure of the fracture. The nourishing vascular hole of the humerus is mainly located in the upper part of the humeral shaft, and there is no muscle adhesion in the lower part. Therefore, the lower part of the fracture is prone to delayed healing or non-healing due to poor local blood supply, so the residual blood supply should be protected as much as possible. Fracture healing and reduce complications.

Percutaneous lag screw internal fixation has the following advantages: 1 A small incision is required for percutaneous nailing, and the trauma is small. 2 There is no need to peel off the periosteum and other tissues, which can protect the blood supply of periosteum and soft tissue to the greatest extent, which is beneficial to fracture healing. 3 As long as the strict implementation of AO surgical operation specifications can also achieve the effect of open reset internal fixation 4 operation is fast and simple. 5 Generally, it is not necessary to take out the screws twice. The following should be noted when applying percutaneous lag screws: 1 This method is only suitable for A1 and B1B2 spiral and oblique fractures of AO classification. It only provides stability between fractures and does not provide great strength, so it should be fixed with plaster after surgery. 2 Before the operation, under the surveillance of C-arm or X-ray machine, the fracture is brought to or close to the anatomical reduction by the manual reduction. The position of the first lag screw is at right angle to the fracture surface, and the second is fixed perpendicular to the long axis of the backbone. The fracture should use 3-4 screws. The central lag screw is at right angles to the longitudinal axis of the bone. The screws at both ends are at right angles to the fracture surface.

Percutaneous lag screw internal fixation for the treatment of tibiofibular fractures maximizes the protection of local blood supply, with less trauma and simple operation, and overcomes the shortcomings of open reduction DCP fixation. This group was cured by lumbar spine plate osteotomy and posterior lumbar spinal canal enlargement for the treatment of lumbar degenerative triplet disease in 18 cases Zhao Qinghui Zhang Liming Li Jianmin (Donga County People's Hospital 252201) (Shandong University Qilu Hospital) March 1996 to 1999 In January of the year, we used lumbar plate osteotomy and posterior replantation and spinal canal enlargement for the treatment of lumbar degenerative triad (lumbar spinal stenosis, lateral recess stenosis, intervertebral disc herniation) in 18 cases, the results are satisfactory, the report is as follows.

Narrow, 1 case of 4 stenosis surgery: the patient was in prone position, taking the posterior median incision. The spinous process, the lamina and the bilateral facet joints at the site of the spinal canal are exposed, and the supraspinous and interspinous ligaments between the adjacent superior and inferior spinous processes are cut. Use a thin bone knife or an electric oscillating saw to open the lamina of the segment of the spinal canal on both sides of the facet joint and the sagittal plane of the spine at 45*. The vertebral lamina was splayed with a periosteal stripper, and the ligaments of the ligamentum and fibrosis were separated by a nerve stripper and a sharp knife to completely open the narrow spinal canal. Excision of the intervertebral disc to remove the hyperplastic epiphysis and hypertrophic cohesive part of the articular process, enlarge the narrow lateral recess. Flatten or thin the inner surface of the lamina. The lamina is then implanted to shape the spinal canal. If the sagittal diameter of the spinal canal is less than 9.5 mm, the base of the spinous process is split longitudinally with a chainsaw, and splits on both sides, and then fixed to enlarge the interspinous and supraspinous ligaments of the sagittal diameter of the spinal canal. , place the drainage tube. Resting in the supine position for about 10 weeks, you can take the waist to get out of bed.

RESULTS: Seven patients were followed up for 6 months to 3 years and 6 months. Excellent (pre-operative symptoms disappeared, return to normal work) 11 cases, good (symptoms disappeared, but walking more than 2.5km, mild back and leg pain) 6 cases, can (symptoms relieved, there are still mild low back pain and intermittent claudication 1 case, excellent and good rate was 94.1%, 5 cases underwent CT spinal canal scan, the transverse diameter was enlarged by 3.9mm, and the sagittal diameter was expanded by 5.5mm. There was no signs of dural sac and nerve root compression, although the decompression was thorough, but far The effect is not ideal, because total laminectomy can lead to lumbar instability and intractable low back pain, and the lamina is removed. The spinal canal loses the smooth back wall to protect the dura mater, and the dense scar tissue is compressed and the hard ridge is pulled. Membrane and nerve roots can produce secondary spinal stenosis. Due to the limitations of surgical exposure, the removal of the posterior margin of the vertebral body and the enlargement of the lateral recess are difficult, so that the decompression is not complete and the symptoms are easily left. Lumbar spinal decompression, "H*-shaped bone graft fusion, although the expansion of the spinal canal and reconstruction of the posterior lumbar spine structure, but the surgical lumbar posterior column" H*-shaped bone graft fusion, is not a physiological fusion. Lumbar spine single-door laminoplasty is still open to the spinal canal rather than tubular shape, the dura mater on the open side is exposed, and the hinge side is difficult to decompress thoroughly. Although the artificial lamina made of a variety of hard materials can restore the tubular structure of the spinal canal, the fusion with the body and the prevention of adhesion are worse than that of the autologous bone. After the osteotomy of the lumbar spine is removed, the spinal canal is expanded and the spinal canal is completely opened, so as to eliminate the pressure and completely decompress the under direct vision. After the lamina was moved back to the plant, the tubular structure and ligament structure of the posterior column of the lumbar spine were restored, the physiological activity of the lumbar spine was preserved, and complications such as lumbar instability and dural adhesion were avoided. However, the technique of vertebral plate osteotomy is relatively high. The dural and nerve roots should be avoided during the operation. The osteotomy must be fixed accurately and firmly, and the supraspinous ligament should be suspended on the lumbar fascia. Eliminate lamellar sag and laminar non-healing. The follow-up of this group showed that the excellent rate of the treatment of lumbar degenerative triad was 94.1%, and the narrow spinal canal was obviously enlarged without serious complications. It is believed that this procedure can be promoted and applied.

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