OBJECTIVE: To explore a better surgical mode to treat gluteal muscle contracture. METHODS: In 98 cases, superior cross incision of large tuberosity was performed in 20 cases, posterosuperior curve incision of large tuberosity was performed in 20 cases, and exteroinferior cross incision of iliac spine in the other 58 cases. The patients were observed after operation and followed up. RESULTS: The patients who received exteroinferior cross incision of iliac spine recovered soon without bleeding and infection after operation, which indicated the lowest incidental rate of postoperative complication. CONCLUSION: Exteroinferior cross incision of iliac spine is a safe and effective surgical operation to loosen the gluteal muscle contracture.
Objective To expolre the factors which affect the size of diabetic,macular fobeal avascss scular zone(FAZ). Methods Making ten years of duration of diabetes a limit,79 nonproliferative and early proliferative diabetic patients were divided into 2 groups.Diabetic retinopathy severity level was diveided into 4 stages,and the macular edema was subdivided into focal、diffuse and cystoid according to fluorescein leakage of foveomacular region.All patients were measured FAZ with Heidelberg scanning laser fluoresceion angiography system and then compaired the size of FAZ of patients with different duration of diabetes、diabetic retinopathy severity level and macular edema status.The results were performed analysis of variance and t test. ResultsThe study shown the size of FAZ was not directly related to the duration of diabetes(t=1.3854,Pgt;0.1);There were significant differences about the size of FAZ of patients with different diabetic retinopathy severity level(F=7.6251,P＜0.01)and macular edema status(F=5.4369,P＜0.01)． Conclusion The size of FAZ was significantly increased in diabetic patients.It was enlarged with the development of diabetic retinopathy severity level,but it was not related to duration of diabetes. (Chin J Ocul Fundus Dis,2000,16:155-156)
ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.
Objective To explore the application of multi-disciplinary team (MDT) clinics in fetal developmental abnormalities. Methods A retrospective analysis method was used to collect case data of fetal developmental abnormalities and completion of prenatal MDT clinics diagnosis and treatment in pregnant women who were registered in the Department of Obstetrics of West China Second Hospital, Sichuan University between December 2021 and November 2022. The situation of pregnant women and fetuses was summarized and analyzed. Results There were 19362 registered pregnant women, of which 1125 (5.8%) had abnormal fetal development. Among them, 272 (24.2%) received prenatal MDT clinics diagnosis and treatment. Fetal developmental abnormalities were mainly characterized by structural abnormalities (208 cases, 76.5%), with the top three being central nervous system abnormalities, circulatory system abnormalities, and multiple malformations. There were 202 pregnant women who continue to conceive, and 70 cases had undergone induced labor, with an induced labor rate of 25.7%. The top three main causes of induced abortion were multiple malformations, central nervous system abnormalities, and circulatory system abnormalities. After prenatal MDT clinics diagnosis and treatment, the diagnosis of fetal developmental abnormalities in 46 pregnant women were corrected. Conclusion Prenatal MDT clinics are helpful for the early comprehensive evaluation of fetal developmental abnormalities and the determination of diagnosis and treatment plans.
Multi-disciplinary team (MDT) is a leading diagnosis and treatment model widely respected in modern international medical field, which plays an important role in clarifying disease diagnosis, determining treatment direction, and reducing patient time and labor cost. In recent years, China has issued relevant policies to encourage hospitals to vigorously develop MDT. West China Hospital of Sichuan University established a MDT clinic in 2013. Through continuous innovation and bold breakthrough in terms of experience accumulation, clinical resource integration, disciplinary collaboration and other aspects, the hospital breaks the barriers of MDT, timely helps complex severe diseases patients to solve the diagnosis and treatment needs, provides patients with the best personalized treatment plan, and continuously improves the medical experience of patients. Therefore, this article introduces and summarizes the implementation process and experience of MDT outpatient clinic in West China Hospital of Sichuan University.
Objective To observe the cl inical results of treatment of Schatzker V/VI tibial plateau fracture involved posteromedial condyle through combined posteromedial and anterolateral approach and fixed with two or three plates. Methods From April 2005 to April 2008, 18 cases of tibial plateau fracture involved posteromedial condyle were treated, including 14 males and 4 females with an average age of 38.5 years old (range, 18-62 years old). According to Schatzker classification, there were 12 cases of type V and 6 cases of type VI. The posteromedial condyle were involved in 13 cases and bilateral posterior condyle in 5 cases. All patients were given posteromedial fragment and medial condyle fracture reduction through posteromedial approach firstly, and then lateral condyle fracture reduction through anterolateral approach, and injury of meniscuses and cruciate l igaments were treated at the same time. Three plates (lateral, medial, posterior) were used in 10 cases and two plates (lateral, posteromedial) in 8 cases. Results All wounds achieved heal ing by first intention without compl ications such as infection, flap necrosis, osteofascial compartment syndrome, chronic osteomyel itis, nonunion. All patients were followed up for 12 to 48 months with an average of 24.4 months. The mean flexion of the knee was 118.4° (range, 100-130°) 1 year after operation. According to Iowa evaluation system, 12 patients got excellent results, 4 good, and 2 fair; the excellent and good rate was 88.9%. Conclusion Combined posteromedial and anterolateral approach and fixed with two or three plates is effective in treatment of the Schatzker V/VI tibial plateau fracture involved posteromedial condyle. Anatomical reduction and rigid internal fixation of the posteromedial fragment are critical to successful operation.
Objective To discuss the strategies for building the framework of team culture of multi-disciplinary team (MDT) for colorectal cancer. Methods By comprehending the traditional concept of volunteer and probing into the value of traditional team culture, combining the needs of MDT for colorectal cancer, build appropriate team culture and core idea of MDT for colorectal cancer. Results Confirm that building of volunteers groups and the volunteers culture is the core of the team culture of MDT for colorectal cancer. Analyze characters of volunteers groups and the operation strategies, and find the way of maintaining the volunteers culture. Conclusion With the development of volunteers groups and increased participants, the team culture of MDT for colorectal cancer will show more sociality and extent. And it is also the important idea and direction for development in future. As team culture, organization structure and personnel structure supplements each other, adjusting and perfecting the team culture in practice continually is a long-term work for MDT.
The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.
Medical simulation teaching is a bridge course from theoretical knowledge to clinical practice. At present, the medical simulation teaching is facing many problems. The iSIM is a systematic method to optimize medical simulation teaching. It aims to maximize the effect of medical simulation teaching by various teaching methods and assistant technologies. The combination of iSIM and medical simulation teaching can develop the correct clinical thinking, improve the clinical skills and strengthen the communication skills, so as to improve the medical quality in the real clinical environment. Based on experience Center of Experimental Teaching on Clinical Skills of West China Hospital , this paper introduces how to use iSIM to optimize medical simulation teaching.