成人股骨颈骨折诊治失误的临床分析与对策

目的 探讨股骨颈骨折诊治失误的原因和对策.方法 将我们近三年来收治的股骨颈骨折诊治失误的病例共10例进行回顾性分析.结果 漏诊5例,误治5例,经及时正确处理取得优良效果.结论 养成全面专科体检的习惯,结合临床表现及影像学资料,进行客观、仔细地分析,可避免或减少股骨颈骨折的漏诊;掌握股骨颈骨折的治疗原则和手术技巧,可提高股骨颈骨折的治愈率,降低股骨头坏死的发生率.     

浙江省肿瘤医院大肠癌外科

浙江省肿瘤医院大肠癌外科成立于1973年,是国内最早成立的大肠癌诊治专科.每年收治结、直肠癌病人700余例,是浙江省大肠癌临床诊治中心,也是国内主要的大肠癌临床治疗基地之一.     

Hemoptysis developing soon after use of sildenafil： an observation on two cases

Dear Sir,Our group from Pamukkale University Hospital wouldlike to present an observation on hemoptysis that was prob-ably associated with sildenafil usage in two patients.Sincehemoptysis occurred immediately the drug was taken andhas not recurred following the discontinuation of the drug.We think that after eliminating other risk factors,sildenafilmight be a probable cause of transient hemoptysis.Case 1A 70-year-old male patient presented to the ChestDiseases Department at the Pamukkale University Schoolof Medicine with a complaint of a bloody cough for2 days.There were no other symptoms.He had nochronic bronchitis or any other accompanying diseasesexcept benign prostatic hyperplasia.He had been a heavysmoker,and had a 50-pack/year hisory.His physical     

浅谈产后出血的临床分析和处理

产后出血是分娩期严重并发症,居我国产妇死亡原因的首位[1].严重的产后出血不仅可直接导致产妇死亡,而且部分病人可继发产褥感染、垂体功能低下、贫血等并发症,降低产妇的生活质量.本文对我院2001年～2010年69例产后出血病例进行回顾性分析,探讨产后出血的原因和正确的处理方法,从而采取最适当的处理,降低产后出血率,提高产科质量.     

Treatment of displaced radial head fractures by internal fixation with absorbable pins

Objective: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures. Methods: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason typesⅡandⅢ) were treated with internal fixation by absorbable pins. The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey. Results:All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15°(0°-35°), and pronation and supination decreased by 10°(0°-30°) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey. Conclusions: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.     

临床护理科研选题之我见

护理事业的发展,有赖于护理科学研究的普及,但广大护理人员忙于完成日常大量的治疗和护理工作,很少参与护理科研.除了工作忙之外,很大的障碍在于没有掌握科研选题的技巧.笔者就如何选择临床护理科研课题谈一点看法.     

阴茎假体的临床应用研究进展

自1936年Borgas首先肋软骨制作阴茎假体以来,许多学者对阴茎假体的结构、材料和植入方法进行了深入研究,七、八十年代,阴茎假体发展为两类,即半硬性或延展性假体和可胀性假体.前一类中最原始的Small-Carrion假体后来被Finney和Jonas改进;后一类最原始的假体首先由Timm介绍使用,后来经Broadly和Scott发展.继而出现了许多新型的阴茎假体.它们较以前的假体临床效果更为理想.目前,阴茎假体植入术已成为治疗阳萎患者的重要方法之一.本文就阴茎假体的应用研究进展情况作一综述.     

Operative strategy of acetabular fractures

Anatomic structure of acetabular fractures are complex and operative exposure and fixation are extremely difficult. For those obviously displaced acetabular fractures, close reduction is doomed to cause deformative healing. Open reduction with internal fixation (ORIF) not only results in anatomic reduction, but also brings complications. No matter which method will be adopted, traumatic arthritis or avascular necrosis of femoral head might occur. In order to treat acetabular fractures more effectively, orthopedic surgeons should be required to fully master the acetabular anatomy,biomechanics, classification and the necessary knowledge for complication prevention.     

支架式教学对实习护生临床沟通能力的影响

目的 探讨支架式教学对专科实习护生临床沟通能力的影响.方法 将90名护生随机分成两组各45名.对照组采用常规带教方法实习,观察组在常规带教方法上开展支架式教学.分别在实习1周和6个月时评价护生的临床沟通能力.结果 观察组在敏锐倾听、确认患者问题、验证感受、共同参与和建立和谐关系方面评分显著高于对照组（均P＜0.01）;但两组护生在传递有效信息方面无统计学差异（P＞0.05）.结论 支架式教学能较好地提高实习护生的临床沟通能力.     

高度致敏肾移植患者的围术期处理

目的 探讨高度致敏肾移植患者的围手术期处理.方法 对22例高度致敏肾移植患者术前组织配型及预处理,术后抗排异方案以及肾功恢复情况进行研究.结果 17例患者术前经血浆置换3～8次后群体反应性抗体(PRA)降至30%以下,5例患者术前PRA仍大于50%.术后发生超急性排斥反应(HAR)1例(9.9%),抗排异反应未能逆转,予以切除移植肾;急性排斥反应(AR)8例(36.3%),经甲强龙+ATG(ALG)冲击治疗后6例肾功恢复正常,2例转为肾功能延迟恢复(DGF);术后DGF5例(22.7%),予以血液透析+低剂量抗排异药物维持,肾功均恢复正常.结论 避开相应抗体进行良好的组织配型,是高度致敏患者肾移植成功的关键;术前行血浆置换降低高度致敏患者PRA,使用ATG或ALG可降低手术风险,提高排斥反应逆转率.     

Free iliac crest grafts with periosteum for treatment of old acetabular defects

Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects. Methods:From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum,which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws. Results:Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases,good in 4 cases and fair in 2 cases. Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.     

Induction of spermatogenesis in men with azoospermia or severe oligoteratoasthenospermia after antegrade internal spermatic vein sclerotherapy for the treatment of varicocele

Aim:To evaluate the treatment outcome of antegrade internal spermatic vein sclerotherapy in men with non-obstruc-tive azoospermia or severe oligoteratoasthenospermia(OTA)as a result of varicocele.Methods:Between September1995 and January 2004,47 patients(mean age 33.8±6.3 years)underwent antegrade internal spermatic vein sclero-therapy for the treatment of varicocele with azoospermia(14 patients)or severe OTA(33 patients).Testicular corebiopsy was also performed in complete azoospermic patients who provided informed consent.The outcome wasassessed in terms of improvement in semen parameters and conception rate.Results:Forty-two(89.4%)of 47patients had bilateral varicocele,Serum follicle stimulating hormone(FSH)did not differ between patients withazoospermia and severe OTA.After the follow-up of 24.8±9.2 months,significant improvement was noted in meansperm concentration,motility and morphology in 35 patients(74.5%).Comparison between groups during thefollow-up revealed significantly higher values of sperm concentration,motility and normal morphology in the severeOTA group.Pregnancy was achieved in 14 cases(29.8%).Testicular histopathology of the azoospermic patientswith postoperative induction of spermatogenesis revealed maturation arrest at spermatid stage,Sertoli-cell-only(SCO)with focal spermatogenesis or hypospermatogenesis.None of the patients with pure SCO pattern or maturation arrestat spermatocyte stage achieved spermatogenesis after the treatment.Preoperative serum FSH levels didn't relate totreatment outcome.Conclusion:Antegrade internal spermatic vein sclerotherapy is an easy and effective treatmentfor symptomatic varicocele.It can significantly reverse testicular dysfunction and improve spermatogenesis in menwith severe OTA,as well as induce sperm production in men with azoospermia,improving pregnancy rates insubfertile couples.(Asian J Androl 2006 Sep;8:613-619)     

Early total hip arthroplasty for severe displaced acetabular fractures

Objective ： To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures. Methods： Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years（ 1-6 years） and the average period from fracture to operation was 8 days （5-21 day）. The average age of the patients was 53 years （ 26-69 years）. Restdts： At the final follow-up the Harris hip score averaged 82（69-100） points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of lateloosening of the prosthesis. One patient had severe central displacement of the cup. Conclusions： In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.     

隐性乳癌4例误诊分析

本文分析了4例隐性乳癌临床误诊原因,探讨了隐性乳癌(OBC)临床诊断方法.强调了对腋窝孤立性肿决为首发症状的病人,应考虑到OBC 的诊断.乳房各种检查无阳性发现不能排除OBC.反之,若全身各系统检查未发现乳房外原发灶者,则OBC 诊断可基本确立.同侧乳房轻微胀大,触及边缘不清,质地偏韧的增厚腺体,更加提示OBC.腋窝肿块活检提供病理形态学依据,在OBC 诊断中有极高的价值.     

乳腺癌患者135例临床分析

目的:结合临床实践经验,探讨早期乳腺癌的临床特点及诊断治疗方法,为提高早期乳腺癌的诊断率和合理治疗提供参考依据.方法:选取我院乳腺癌患者135例作为研究对象,进行回顾性分析,分别研究其发病年龄,发病部位等因素.结果:老年人的发病率明显高于青年人的发病率,有明显差异(P＜0.05),差别有统计学意义.结论:高危年龄妇女乳腺增生伴症状加重、乳腺局限性增厚是早期乳腺癌的重要表现,合理治疗可以提高患者生存质量,值得临床进一步推广和研究.     

200例急诊病例动态心电图临床分析

目的:本文主要探讨动态心电图在心血管病急诊病例中的诊断价值.方法:选用经临床医生筛选的200例病情危急患者进行24h动态心电图检查和普通心电图检查对比.结果:200例病人异常检出率明显高于常规心电图.结论:动态心电图能明显提高心律失常的检出率,是危急重症病人较可靠的无创性诊断方法.     

骶骨临床解剖学新进展

骶骨螺钉及骶髂关节螺钉广泛应用于L5S1椎体滑脱、骶髂关节分离和骶骨骨折的治疗.由于骶骨的解剖结构既复杂又特殊,螺钉的置入常难以达到理想的位置,并且螺钉的穿出会导致重要血管神经的损伤,因此掌握骶骨的解剖对于骨科医生至关重要[1～3].本文对近年来骶骨的临床解剖学进展综述如下. 1 骶骨的底 第1骶椎的头侧表面代表了骶骨的底.S1椎体上终板前缘向前凸出,称为岬,是腰骶联合部位前路手术的重要解剖标志.S1椎体后面是三角形的骶管,2个上关节突位于骶管外侧,关节面朝向后内方向,同L5的下关节突相关节.     

Multiple-ligament injured knee

Objective: To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol, technique and outcome of treatment for the multipleligament injured knee. Methods: From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner (PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma,2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma, including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient. Results: No severe complications occurred at early stage after operation in the 9 patients. All of them were followed up for 10-39 months with an average of 23. 00 months±9. 46 months. Lysholm score was 70-95 with an average of 85.00±8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level. Conclusions:The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments simultaneously or in stages, have advantage of minimal trauma in surgery and satisfactory outcome.     

激光在关节镜外科中的应用进展

关节镜外科在20世纪70年代末迅猛发展,为激光的应用奠定了良好的基础.80年代初Smith最早将CO2激光应用于关节镜外科,因各种缺陷难以推广.80年代中期钕激光(Nd:YAG)和准分子激光(Excimer)得到一定程度的应用.90年代初Fonton率先将钬激光(Ho:YAG)应用于关节镜临床,由此掀开激光在关节镜外科应用的新篇章.这不仅拓宽了激光的应用范围,也推动了关节镜技术的发展.     

完善临床带教管理体系提高教学质量

我院是一所拥有 95 0张床位的综合性医院 ,每年接受 1 0 0多人次的中专、大专、本科护理专业学生(下称护生 )的实习任务。临床实习是护生从课堂走向社会的第一步 ,也是其适应角色多元化转变的开始。为了引导护生走好第一步 ,为今后从事临床工作打下坚实的基础 ,自 1 996年以来 ,我院对临床实习教学进行了一系列改革 ,形成了一整套教学管理体系 ,并在临床带教中取得了良好的效果。1　教学程序与方法1 .1　准备工作1 .1 .1　健全临床教学管理组织 :成立临床护理教研室 ,由 1 7位具有大专、本科学历及主管护师以上职称人员组成。护理部主任直接…