内外同时固定治疗重度不稳定骨盆骨折

骨盆骨折是一种较严重的损伤,约占创伤患者人数的15%~([1]).其中约半数为不稳定骨盆骨折,病死率高达40%~([2,3]),若治疗不当造成畸形愈合,则影响患者生活.笔者i999年1月-2005年12月对33例不稳定型骨盆骨折进行内固定结合骨盆外固定治疗,效果良好.现报告如下.     

经皮骶髂关节空心螺钉联合骨盆外固定架治疗C型骨盆骨折48例

17%骨盆骨折属不稳定型~([1-3]),TileC型骨盆骨折是同时存在旋转和垂直两个方向不稳定的骨盆骨折.近年经皮骶髂螺钉固定技术得到广泛应用~([2-5]).2001年3月-2007年7月,笔者采用经皮骶髂螺钉固定技术联合骨盆外固定架治疗48例Tile c型骨瓮骨折患者(经皮组),疗效满意.现报告如下.     

单齿钩在颧骨复合体骨折中的应用

颧骨复合体骨折(zygomatic complexfracture,ZCF)是面中部最多见的颌面部损伤,其发生率占颌面部骨折的18%～40%~([1]).仪次于下颌骨骨折~([2]).此部位骨折常常可以引起相应的颧面部凹陷及张口受限等功能障碍.     

不稳定骨盆骨折急救的新进展

骨盆骨折是常见的损伤,仅次于四肢和脊柱骨折,并发症较多,有较高的病死率。高能损伤所致骨盆骨折逐年增多,且复杂而严重,临床处理困难。既往多采取非手术治疗,如骨牵引、骨盆悬吊、石膏固定等方法,但病死率高达5%～20%,致残率为1. 9%～36. 6%。随着对骨盆骨折认识的深入,近年来主张对不稳定性骨盆骨折,采取更加积极的治疗,早期评估、损害控制复苏、血管造影栓塞等新理念降低了病死率和致残率。     

大鼠放射性白内障氧化损伤机制的探讨

随着X射线在疾病诊断和治疗中的日益广泛应用,其生物学效应已引起人们的高度重视.研究表明,一定剂量的X射线照射对晶状体可产生辐射损伤效应,共至形成放射性白内障~([1-2]).放射性白内障的发病机制涉及射线的直接作用、晶体蛋白的氧化损伤、机体微循环改变、微量元素变化等方面,其中晶体蛋白的氧化损伤被认为是放射性白内障形成的主要机制~([3-5]).     

一体化损害控制救治模式在严重骨盆骨折患者中的应用效果

正骨盆骨折大部分是由高能量损伤导致的,占全身骨折的3%,患者病死率高,其中严重不稳定骨盆骨折患者的病死率达到29%,而开放性骨盆骨折患者的病死率则高达49%以上。多发伤合并严重骨盆骨折是所有骨盆骨折患者中发生率最高的,损伤严重度评分(ISS)高达15分及以上,其并发症可引起重要脏器功能障碍甚至脏器衰竭。本研究是笔者医院在运用损害控制骨科原理治疗多发并骨盆骨折患者的基础上,初步建立的一套严重骨盆骨折伴多发伤院前院内一     

严重骨盆骨折早期救治的外科技术

高能量损伤导致的严重骨盆骨折是创伤救治的重点和难点之一,病死率高,致残率高。导致死亡的主要原因是大量失血和严重合并损伤,而神经损伤及骨盆畸形则可能导致永久残疾。随着麻醉、外科手术技术、重症支持技术的发展及应用,严重骨盆骨折病死率有所下降。如何早期综合应用外科技术,有效止血,减少死亡,同时降低伤残率仍是临床创伤关注的重点。这些技术包括髂内动脉结扎和介入栓塞为主的髂内动脉断血技术、骨盆填塞止血、骨盆支架外固定稳定骨盆、血管探查修复、腹主动脉球囊阻断、骶神经探查、盆腔盆底毗邻脏器探查处理等。严重骨盆骨折后早期治疗按损害控制原则进行处理,重点是止血、稳定骨盆、识别神经及毗邻脏器损伤,为后期骨盆髋臼整复创造条件,以期达到降低病死率、伤残率的目的。     

重度骨盆骨折的现代救治

临床工作中通常将骨盆环失去稳定性的骨盆骨折称之为重度骨盆骨折。一百多年前 ,Ｍａｌａｇａｉｇｎｅ即描述了垂直分离型骨盆骨折 ,但时至今日重度骨盆骨折仍是一个尚未圆满解决的问题。骨盆骨折的发病率为 2 0～ 35.2 /10万 /年[1 4 ] ,占骨关节损伤的 1%～ 3% ,占住院骨折病人的 1.5%～ 4 .8% ,但休克发生率高达 19%～ 50 % ,合并伤较多 (膀胱伤 6%～11% ,尿道伤 4 %～ 14% ,直肠伤 1.2 %～ 3.4 % ,骨盆神经伤 10 %～ 15% ,血管伤 2 .4 %～ 2 0 % ,在女性生殖道伤为 13.6%～ 17% ) ,且常伴发颅脑、胸、腹或骨关节损伤[5] 。重度骨盆骨…     

颞肌筋膜蛛网膜开窗治疗外伤性硬膜下积液的疗效分析

颅脑外伤后引起脑脊液聚积在硬脑膜下腔,称为外伤性硬膜下积液,在颅脑损伤中此并发症约占3.7%～5.4%,多见于幕上,偶可见幕下,临床上分为进展型、稳定型和消退型~([1,2]).其中由于进展型硬膜下积液不断增多,导致颅内压增高,相应部位的神经系统受损,表现为轻瘫、嗜睡、淡漠及头痛呕吐等,还有转变成慢性硬膜下血肿的可能~([3]),需要手术干预.     

骨盆解锁复位架辅助闭合复位微创治疗Tile C3型骨盆骨折伴单侧骶髂关节前脱位1例

Tile C3型骨盆骨折伴单侧骶髂关节前脱位临床上少见, 常伴血流动力学不稳定及其他部位的严重损伤, 病情复杂, 治疗周期长, 病死率及致残率高。若患者未得到及时且合理的治疗, 将引起严重并发症, 甚至危及生命。骶髂关节前脱位的治疗多采用切开复位内固定, 而闭合复位微创治疗骶髂关节前脱位的报道较少。中国人民解放军总医院设计骨盆解锁复位架(UCRT), 扩宽了骨盆骨折闭合复位微创治疗的适应证。笔者报告1例Tile C3型骨盆骨折伴单侧骶髂关节前脱位损伤患者, 探讨UCRT辅助闭合复位微创治疗该类损伤的疗效。     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控...     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.