同种异体骨移植治疗胫骨长段缺损一例

患者　男 ,2 1岁。 1996年 7月 2 5日因车祸致左胫腓骨开放性粉碎性骨折 ,当地医院急诊行清创缝合 ,腓骨克氏针内固定术。 2天后转入我院 ,检查 :左小腿内后侧中段横行伤口长约 10 cm,已缝合 ,有血性液渗出 ,胫前 10 cm× 18cm皮肤暗红、大部分呈黑色坏死 ;足部严重肿胀 ,剧痛 ,皮肤呈暗紫色 ,足背动脉搏动消失 ,足趾活动消失 ;左小腿中段呈假关节活动。立刻拆除伤口缝线 ,渗出血性及脓性液约 10 0 m l,骨折远端从伤口外露 ,足趾血运好转 ,5分钟后足背动脉可触及搏动。X线片 :左胫骨中段缺损约 16 cm,有 4块小碎骨片游离状 ,腓骨克氏针内固…     

跟腱骨化1例

1病例资料 患者,男,42岁,农民.因左跟部疼痛2年就诊,无明显外伤史,长时间行走时足跟部疼痛明显,乏力,曾在当地医院服用止痛药物,效果不明显.查体:左小腿无外伤瘢痕,下段后侧可见7 cm×2.5 cm×2 cm肿物,质硬,不活动,边界清楚,无明显压痕;左足中立位,内外翻功能正常,足背伸及跖屈略受限,左小腿无明显肌萎缩,肌力Ⅴ级.左小腿皮温正常,感觉正常.X线片:正位片示胫骨下段外缘、跟骨上部宽约2.5 cm,长约6cm,侧位片示左胫腓骨后侧3 cm处跟骨上部可见长约6 cm、宽约2 cm、稍低于皮质骨密度阴影,边界清楚.见图1.诊断为左侧跟腱骨化.因功能影响不大,给予对症处理,观察治疗.     

胫骨干骺端骨膜下截骨延长1例

患者，男，21岁。被叉车叉伤致左小腿断裂、出血不止1h，急救中心现场急救包扎后送入院。入院时查体：脉搏140次／min，呼吸28次／分，血压90／50mmHg。左小腿中段断裂，呈向后翻转畸形，仅小腿后侧约5cm长皮肤相连，伤口内肌肉严重挫裂伤，呈暗紫色，无弹性，刺激无收缩，骨断端外露，胫腓骨中段严重粉碎性骨折，有部分骨缺损。左     

同种异体骨移植治疗胫骨大段缺损1例

患者,男性,21岁,住院号:56016。该患者1996年7月25日因车祸致左小腿流血,肿胀、疼痛、畸形,功能障碍在肇事当地医院急诊治疗,行清创缝合术,石膏外固定,7月27日家属要求转到我院医治而收住我科治疗。查体:左小腿内后侧中部横行伤口长约10cm,已缝合,伤口有血性渗出,胫前10×18cm皮肤暗红,大部分呈黑色坏死,足部严重肿胀,剧痛,皮肤呈暗红,紫色,足背动脉搏动消失,足趾血运差,活动消失,解除石膏外固定后,左小腿中段呈假关节活动。立刻拆除伤口皮肤缝合线,渗出血性及脓性液约100ml,胫骨骨折远端从伤口外露,足趾血运好转,5分钟后足背动脉可触及搏动。摄X线片示:左胫腓骨中段粉碎性骨折,胫骨中段缺损约16cm,有4块游离状小碎骨片,腓骨中段骨折,已行克氏针内固定。入院后应用多联抗菌素加强抗感染。8月7日行左小腿清创术,摘除感染的游离骨碎片,切除坏死的软组织及皮肤,创面约20×18cm。8月16日创面肉芽生长良好,行右大腿取皮,左小腿创面植皮术,术后予石膏托外固定。创面植皮生长愈合后于9月2日行左小腿AO外固定架固定术,以维持左小腿长度及正常生理轴线,也便于肢体护理,伤口换药。11月中旬左小腿感染     

左小腿骨外骨瘤一例报告

患者男,13岁.因发现左小腿后侧肿块,逐渐增大,伴肿胀、酸痛3年余人院.查体:左小腿后侧中下段有一条索状色素沉着带(约1.5 cm×5.0 cm),皮肤表面有散在丘疹样结节,质硬、不活动.软组织内可触及边缘不规则硬性肿块,大小约3.0 cm×4.5 cm,质硬,活动度好,有轻微触痛,无下肢功能障碍.实验室检查各项指标正常.     

左腕部合并左小腿毁损性离断伤再植1例

1病例资料 患者男,38岁.因左腕及左小腿煤石砸伤后肢体离断4h入院.查体：一般情况差,眼睑及甲床苍白,左腕部见皮肤环形碾挫伤,仅掌侧约2cm皮肤与部分指深屈肌腱相连,碎裂的数块腕骨外露,创缘不规则,撕裂并挫灭的肌腱（肌肉）、血管、神经组织外翻,伤口出血明显;左小腿下1/3处离断,仅有后侧宽约2cm皮条与近端肢体相连,伤处肌腱、肌肉组织挫灭,胫腓骨断端外露,伤口内布满煤灰等异物,重度污染.     

组合皮瓣一期修复小腿爆炸伤一例

1 病例介绍 患者男,39岁.哑炮炸伤左小腿.伤后1小时入院.检查:左小腿前侧膝关节下10 cm始,胫前方皮肤及软组织缺损10 cm×25 cm.胫骨骨折端外露.仅余踝前5 cm宽的皮肤完好.左足背8 cm×10 cm皮肤及软组织缺损,跗骨及跖骨外露.第1跖骨骨折伴骨缺损.胫前后动脉血管完整.伤口及组织内较多碎石.     

烧伤伴多发开放伤一例救治体会

1病例介绍患者,女性,32岁,在室内被液化气火焰烧伤并被刀砍伤后1h收入湖北医药学院附属人民医院.体检:意识模糊,体温不升,脉搏145次/min,呼吸32 次/min,血压74/52 mm Hg(1mm Hg =0.133 kPa),口唇略紫绀,四肢厥冷,面颈胸部创面皮革样焦痂;双上肢创面苍白,腐皮脱落,可见明显栓塞血管枝;双足底皮肤脱套;头部可见多处刀砍伤,皮肤裂开,额颞顶部伤口明显,长约12.0 cm;右侧面部皮肤裂开,长约6.0 cm;右耳垂斜行砍伤,长约2.0 cm;左下颈部伤口长约2.0 cm;皮肤表面黑色焦痂状;右侧胸廓稍饱满,背部2处刀砍伤,伤口分别为2.0cm×3.0cm～2.1 cm ×3.0 cm;右胸长伤口为3.0 cm,深达胸腔,可见气体溢出;右肺呼吸音低弱,左肺呼吸音粗糙,呼吸急促,清理呼吸道(吸痰),痰液呈炭末样物.     

健侧骶1为动力源神经移位修复骶丛撕脱伤病例报告及文献回顾

目的 探讨健侧S1作为动力源神经修复1例骶丛撕脱伤的安全性与有效性.方法 2007年11月收治1例骨盆骨折伴左下肢功能障碍3个月患者,男性,10岁.术前检查:左臀部、大腿后侧、小腿外侧及足部皮肤感觉麻木或缺失,左髋外展、左膝屈曲和足踝部活动丧失.X线片示左骶髂关节分离术后、左耻骨上下支骨折.椎管照影显示左侧L4～S1根部假性硬膜囊肿.肌电图检查提示骶丛神经损伤.在全身麻醉下行左侧骶丛神经探查+健侧S1移位、腓总神经移植修复臀上神经和股二头肌肌支,左侧闭孔神经移位、腓总神经移植修复部分胫神经术.结果 该患者手术时间为5h,术中出血量约2000 mL,输血量为1600 mL.术后患者伤口一期愈合.术后4d右侧下肢髋外展、后伸、屈膝与踝关节跖屈、背伸活动基本无影响,踝关节外翻稍减弱;足底、足趾外侧部分皮肤感觉减退,面积约4cm×12 cm;术后20 d,皮肤感觉减退面积约为2 cm×6 cm.术后18个月随访,右足底皮肤感觉减退区消失,感觉恢复正常,右下肢感觉、运动功能恢复正常;左侧髋关节外展、膝关节屈曲肌力达3级,踝关节功能无恢复.结论 利用S1作为新动力源神经移位修复骶丛撕脱伤可能是一种安全而有效的手术术式.     

动脉化静脉复合组织瓣应对桡动脉掌浅支组织瓣血管变异一例

<正>1病例介绍患者男,35岁。因电锯伤致左示、中、环指出血、活动受限1 h于2014年5月入院。入院检查:左示、中、环指呈屈曲位;示指中节背侧横形伤口,长约1.5 cm,可见指伸肌腱断端;环指中节背侧横形伤口,长约1.0 cm,可见指伸肌腱部分断裂;中指中节背侧存在大小为4.5 cm×2.0 cm皮肤软组织缺损,伴指伸肌腱缺损长约4.0 cm,指骨骨折端外露,患指运动障碍(图1)。X线片示左中指中节指骨基底骨     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

不同方法重建指尖离断静脉回流的疗效分析

目的：探讨不同方法重建指尖离断静脉回流的疗效。方法：2008年3月-2013年2月收治指尖离断患者80例,38例吻合指侧方静脉重建回流,术中吻合动静脉比例1：1或1：2或2：2,平均1：2;22例吻合指腹静脉重建回流,术中吻合动静脉比例1：1;20例未吻合静脉,术中仅吻合1条动脉,行侧切口或甲床放血。观察各组治疗效果。结果：吻合指侧方静脉组手指全部成活,无一例发生回流障碍;吻合指腹静脉组19例发生静脉危象,其中4例手指坏死;未吻合静脉组20例均发生回流障碍,其中6例手指坏死。58例获随访,随访时间6~28个月。吻合指侧方静脉组32例,指尖外形佳、指腹饱满;吻合指腹静脉组14例,指体轻度萎缩,指甲生长不平整;未吻合静脉组12例,指体萎缩明显。吻合指侧方静脉组指甲生长近平整,长度长于其他两组[（14.4±3.2）mm比（12.5±2.3）mm和（12.2±2.2）mm],远侧指间关节活动度大于其他两组[（63±5）°比（48±3）°和（45±7）°],两点分辨觉小于其他两组[（4.6±0.4）mm比（7.1±1.2）mm和（7.3±0.6）mm],感觉级别高于其他两组[S（3.45±0.39）级比S（2.57±0.42）级和S（2.55±0.49）级],差异均具有显著性（P〈0.05）。吻合指腹静脉组和未吻合静脉组在指甲长度、运动和感觉方面差异无统计学意义（P〉0.05）。结论：吻合指侧方静脉能有效解决指尖再植静脉回流问题,可避免回流障碍,成活率高,促进指甲生长,可恢复 DIPJ 活动度及感觉。     

Frequency of complications of manipulation of the spine

Summary A survey of all members of the Swiss Medical Association of Manual Medicine was undertaken for the year 1989. Informative data were given by 425 respondents on the frequency of complications of manipulation as related to the spine. The number of thoraco-lumbar manipulations during 1989 (225 working days) was 805 for each respondent, and the number manipulations of the cervical spine 354. Thus, the total number of thoraco-lumbar manipulations was 342 125, and the total number of cervical manipulations was 150 450. The overall incidence of side-effects of transient complications due to cervical spine manipulation such as disturbance of consciousness or radicular signs was 1: 16716. Seventeen patients (ratio 1: 20 125) after manipulation of the lumbar spine presented, in addition to increased pain, a transient sensorimotor deficit with precise radicular distribution. Nine of the 17 patients (ratio 1: 38013) developed a progressive radicular syndrome with sensorimotor defict and radiologically verified disc herniation and had to be referred for surgery. Side effects and complications of cervical and lumbar spine manipulation are rare. Taking in to account the yearly number of manipulations performed by a single physician in Switzerland and the rate of complications, it can be calculated that a physician practicing manual medicine will encoutner one complication due to manipulation of the cervical spine in 47 years and one complication due to lumbar spine manipulation in 38 years of practice. However, it is important that a careful clinical assessment is carried out to avoid complications due to manipulation carried out on the basis of inappropriate indications. Furthermore, the decision as to which technique is indicated for any particular functional disorder of the spine should be made on the basis of rational criteria resting on a knowledge of clinical biomechanics, functional anatomy and neurophysiology. The authors recommend a prospective morbidity study to be carried out among physicians, chiropractors, osteopaths and physiotherapists, taking into account the different indications and therapeutic techniques in relation to complications.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7–, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20–, MUC2–). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

静脉皮瓣成活过程的实验研究

我们以兔为实验动物，通过微循环观察及血管内灌注填充剂，研究静脉皮瓣的成活过程。这一过程可分为２个阶段。第一阶段（术后７２小时内）为静脉血营养期：静脉血由静脉干通过小静脉吻合支、微静脉干间吻合支及终末微静脉吻合支回流至另一静脉。术后４８小时内毛细血管内无血液运动。第二阶段（术后７２小时～６周）为动脉血营养及血管改造期：术后７２小时新生血管开始向皮瓣内生长。术后７２无皮瓣动脉同主要来自皮瓣周围正常组织内的新生血管吻合使动脉血分布于整个皮瓣，这是静脉皮瓣成活的关键     

Oddi括约肌肌电活动实验模型的建立

目的建立研究Oddi括约肌肌电活动的动物模型和实验方法。方法将双极金属钩状电极通过浆膜层置入Oddi括约肌，记录不同条件干预下家兔的Oddi括约肌肌电活动信号，调整电生理实验参数并经放大、滤波及计算机处理后，对其大小、波形、幅度进行分析。结果不同条件干预下的家兔Oddi括约肌的肌电活动在波形、频率、幅度等方面均有明显的不同，具有明显的规律性。重复实验可得到相似的结果。结论使用双极金属钩状电极配以合理的电生理实验参数调整可以稳定地采集到在体的家兔Oddi括约肌肌电活动信号。这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。     

骨盆骨折的治疗进展

对于骨盆骨折的治疗 ,传统方法以卧硬板床 ,股骨髁上持续骨牵引 ,骨盆兜等保守治疗为主 ,常常引起下肢不等长 ,骶髋痛 ,步态失常等而严重影响生活质量 ,同时长期卧床易引发肺部感染、褥疮、应激性溃疡、泌尿系统结石等并发症而危及生命。下面就骨盆骨折的治疗进展作一综述。1     

Management of sequelae of septic arthritis of hip

A nine years old boy, who had suffered septic arthritis at the age of two years and presented now with a limp, hip instability, leg length discrepancy. The patient was treated by adductor tenotomy and upper tibial pin traction. When head remnant reached the level of the acetabulum, open reduction and Pemberton osteotomy was done to achieve cover of the femoral head. The purpose of this report is to highlight the six years followup of reconstruction of sequale of septic arthritis of hip joint.     

Catamnestic study of childless patients of the Department of Andrology of Hamburg-Eppendorf University Hosptal

By means of a questionnaire, we carried out a catamnestic study of 1419 patients with a complaint of infertility. 27 per cent of the replying patients reported about the birth of children. 343 patients (38%) reported about one or more conceptions. Compared with previous studies, this investigation shows better results of therapies. We interprete this to be caused in better possibilities of therapy, esp. the Kallikrein therapy.     

主动脉窦瘤破裂外科治疗的临床研究

目的　探讨主动脉窦瘤破裂局部病理改变及其合并主动脉瓣关闭不全的手术方法。方法　 3 6例主动脉窦瘤破裂 (RASV)合并主动脉瓣关闭不全 (AI) 15例、室间隔缺损 (VSD) 2 6例。补片修补 3 5例 ,其中合并VSD的均以一片法修补 ,合并AI的主动脉瓣置换 (AVR) 6例 ,主动脉瓣成形 4例。手术取材作病理检查 5例。结果　本组 3 6例中手术死亡 2例 ( 5 .6% )。存活的 3 4例病人均经门诊复查或通信随访 0 .3～ 18年 ,其中 2例死亡。病理检查见RASV合并VSD的瘤壁为纤维素样坏死或玻璃样变性。结论　主动脉窦壁纤维素样或玻璃样变性可能是其形成的病理基础。合并主动脉瓣关闭不全时应探查其病变程度 ,酌情一期矫正 ,瓣膜损伤明显时宜行主动脉瓣置换 ,对主动脉瓣环细小的病例 ,可借修补VSD和RASV的补片扩大主动脉瓣环。