久治不愈儿童期肢体骨折术后感染所致长段骨缺损的重建治疗

目的探讨儿童期骨折术后感染致长段骨缺损、骨骺损害的成因及其预防和修复手段.方法对2例儿童期肢体骨折（胫腓骨、肱骨各1例）术后感染性骨缺损,经过1年和10年反复治疗失败形成的骨感染、骨缺损、骨外露和肢体短缩、假关节畸形肢体,进行一次性病灶清除、骨畸形矫正,并以游离腓骨皮瓣移植完成一次性骨结构重建修复创面.结果移植骨皮瓣一次性成活,伤肢于手术后半年达到骨性愈合并恢复持重和行走功能.结论游离腓骨皮瓣移植是治疗儿童期骨折术后感染所致长段骨缺损的理想方法,骨折术后感染早期合理救治对于避免继发骨及骨骺损害有着重要的临床意义.     

非手术综合治疗胫腓骨骨折68例报告

目的：探讨非手术综合治疗胫腓骨骨折的临床效果。方法选取收治的68胫腓骨骨折患者,通过非手术方式进行综合治疗,随访半年至1年半随访,了解骨折愈合情况。结果68例其中56例半年－1年半随访,骨折全部愈合,根据胫腓骨骨折愈合标准,早期功能恢复优良率96.4％（54／56）,全部病例无深部感染及骨感染和骨不莲发生。平均住院时间25天。骨折愈合时间最短1.5月,最长5月,平均2.5月。结论针对胫腓骨骨折患者情况,采用非手术方式进行综合治疗,疗效肯定,可减少患者负担,适合于基层医院。     

湿润烧伤膏治疗胫腓骨骨折术后骨外露41例

目的：寻求简要方法应用湿润烧伤膏治疗胫腓骨骨折术后骨外露的简便治疗方法。方法：本组41例病人全部采用早期清创钻孔引髓湿润烧伤膏外敷，形成肉芽覆盖外露骨质。结果：本组41例采用此方法全部治愈，骨质覆盖满意。结论：早期清创钻孔引髓应用湿润烧伤膏是治疗胫腓骨骨折术后骨外露的一种良好方法，值得推广。     

外固定架治疗胫腓骨骨折48例报告

笔者从1996年～2000年底用单边及半环槽外固定架治疗胫腓骨骨折48例,其中单边外固定治疗32例,半环槽16例;47例愈合,1例术后骨不连,改行其它术式后愈合.该术式用于严重开放性、粉碎性、伴有大范围软组织伤的胫腓骨骨折治疗可收到其他手术方法难以达到的效果.     

分期治疗胫腓骨远端开放骨折的疗效分析

对收治的胫腓骨远端开放骨折患者35例急诊行胫骨外固定架固定＋伤口清创缝合/伤口清创负压封闭引流（ VSD）覆盖创面,恢复胫骨长度及下肢基本力线,术后使用抗生素预防感染,伤口情况稳定后Ⅱ期拆除外固定,行胫腓骨骨折内固定治疗,术后踝关节功能锻炼。随访15～27个月（平均20个月）,伤口均无感染,6例伤口局部皮肤坏死,经清创VSD治疗均获得愈合。     

单臂外固定架治疗儿童胫腓骨远端骨折

目的探讨单臂外固定器固定在儿童胫腓骨远端骨折治疗中的可行性及其并发症的防治,提高对儿童该类骨折的治疗水平。方法采用单臂外固定器固定治疗儿童胫骨或胫腓骨远端骨折23例,其中男性17例,女性6例;年龄2～13岁,平均年龄5岁7个月。开放性骨折8例。结果随访2～4年。23例均未见骨折不愈合及畸形愈合。按照Paley骨折愈合标准评分:优13例,良7例,中3例;优良率87%。其中发生延迟愈合5例,6例有针道感染征象,5例有螺钉部分松动,4例行超踝关节固定患儿术后踝关节功能受限,恢复较差。结论采用单臂外固定器固定治疗儿童胫腓骨远端骨折是一种安全、简便的固定方法,软组织损伤轻,骨折端血运破坏少,骨折临床愈合快,并允许早期关节活动及负重练习,减少了关节功能障碍的发生,适用于几乎所有类型的儿童胫腓骨骨折,尤其是合并严重软组织损伤修复后需长期换药或合并血管、神经损伤者;但对于合并有严重骨质疏松、广泛皮肤病变,及因为年龄或其他因素不能配合术后管理的患儿应慎用。     

腓骨内固定治疗Ⅲ°开放性胫腓骨骨折20例疗效分析

探讨腓骨内固定治疗Ⅲ°开放性胫腓骨骨折的疗效.对20例采用腓骨内固定及术后管型石膏外固定治疗Ⅲ°开放性胫腓骨骨折的资料进行回顾性分析,优良率为85%.     

有限内固定结合外固定架在地震伤员四肢开放性骨折早期救治中的应用

目的：探讨有限内固定结合外固定架在地震伤员四肢开放性骨折早期救治中的应用。方法：采用有限内固定结合单臂外固定架早期治疗5·12地震四肢开放性骨折27例，其中肱骨开放性骨折1例，尺桡骨开放性骨折3例，胫腓骨开放性骨折22例，股骨髁间伴胫骨平台开放性骨折1例。GustiloⅡ型3例、ⅢA型10例、ⅢB型14例。结果：术后随访6w，开放性伤口均闭合。术后无骨折成角畸形，无针道松动、感染等并发症。结论：有限内固定结合外固定架，操作方便、可调整、拆除方便、固定可靠、创伤小、方便创面二期处理、不影响早期功能康复训练，是对地震造成的四肢开放性骨折早期救治的理想方法。     

高海拔地区微创结合高压氧治疗胫腓骨骨折

目的:探讨高海拔地区微创髓内钉结合高压氧治疗胫腓骨骨折的疗效.方法:对我院近三年收治的121例胫腓骨骨折行微创髓内钉治疗,术后常规高压氧治疗,取得了满意的疗效.结果:本组患者随访时间平均13个月.全部获一期愈合,无1例成角畸形及双下肢不等长,优良率97.5％.结论:高海拔地区微创髓内钉结合高压氧治疗胫腓骨骨折是一种很有...     

分期外固定支架结合交锁钉治疗胫腓骨开放性骨折

目的探讨分期外固定支架结合交锁钉治疗胫腓骨性开放骨折的疗效。方法早期运用外围定支架治疗胫腓骨开放骨折，待伤口软组织情况稳定后，再二期行交锁钉内固定治疗。Gustilo分类I度16例，Ⅱ度30例，Ⅲ度12例；近端5例，中段36例，远端17例。结果58例伤口愈合良好，57例术后平均12个月获得骨性愈合；1例发生延迟愈合，将髓内钉及锁钉由静力性固定改为动力性固定及植骨后，骨折愈合，无不愈合及畸形愈合。结论外固定支架结合交锁钉是治疗胫腓骨开放性骨折的一种较理想方法，操作简便，固定牢靠，感染率低，骨折愈合快，并发症少。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…