尺桡骨骨折合并上、下尺桡关节及肘关节脱位1例

正笔者于2018-01-30诊治1例尺桡骨骨折合并上、下尺桡关节脱位及肘关节脱位,报道如下。1病例报道患者,男,46岁,因"机器绞伤致右前臂出血、疼痛、畸形0.5 h"急诊入院,入院检查:右肘关节畸形,右肘关节前桡侧见一长约4 cm伤口,创缘整齐,伤口出血;右前臂畸形,肿胀明显,有骨擦感,右前臂中段后侧见一长约2 cm伤口;右腕掌侧见一长约6 cm开     

外伤性无名动脉损伤一例

患者男,4 7岁,被铁质锐器刺伤颈部流血不止2h ,于2 0 0 3年6月19日由外院转入我院,外科医生用手压迫止血直接入手术室抢救,查体:测血压4 0 /2 0mmHg ,立即输同型血2 0 0 0ml,血压升至110 /6 0mmHg ,患者意识清楚,呼吸困难,无大小便失禁,伴大汗,颈部右侧锁骨上有一长10cm探查手术切口,伤口未缝合,用纱布填塞,左胸锁关节处有一0 5cm×0 5cm创口,创缘不整齐,无出血。辅助检查:当地医院行胸部CT示:右侧胸腔积血,纵膈右侧积血。手术探查:沿原切口入路,截断右锁骨,右侧第1、2、3前肋,清除纵膈右侧血肿,血肿量约5 0 0ml,出血量约5 0 0 0ml,见无…     

颈动脉损伤二例报告

例1 女，23岁，被刀刺伤颈部、双季肋部、双肩及双上臂15min急诊人院。检查：神志恍惚，精神差，贫血貌，血压60／30mmHg，心率130次／min．右颈部可见2处1．5cm长伤口，右耳后、喉结下各有1cm长伤口，左右季肋部各有1．5cm长伤口，双肩及双上臂各有6～7处1．5cm长伤口。入院后立即补液，配血，急送手术室探查.见右颈部巨大血肿，气管明显左移，气管破裂出血，右颈总动脉贯通伤，内、外侧壁均可见1．3cm长裂口。手术解剖分离出颈总动脉，用血管夹夹闭伤口两端，     

头部巨大纤维脂肪瘤继发血肿一例

病例男,25岁。右头部肿物进行性增长10年,1周前碰伤后增大迅速,严重影响外观和头部活动入院治疗。查体:右侧头部肿物基底约20cm×16cm,有波动感。右耳廓受压变形向下移位,左耳位置也较正常为低。右颧颊部皮肤松弛形成皱襞(图1)。手术取沿右侧发际上、下的弧形切口,切除肿物。术中见肿物中央有陈旧性积血约500ml。同期按原切口行右颜面皮肤提     

腹壁切口包块为子宫内膜异位症二例报道

例1:女性,35岁.因阑尾切除术后腹壁切口包块形成半年入院.病人8月前于月经期因患"急性化脓性阑尾炎"急诊行阑尾切除术.术后3月,切口处形成一包块,逐渐增大,呈周期性疼痛.体检:右下腹切口处有一包块,约2.5 cm×2.0 cm大小,呈暗紫色,质硬,移动性差,有压痛.     

双阑尾畸形

例1.患者女,30岁,住院号2319。以转移性右下腹痛15小时,1980年10月15日入院。体温37.4℃,右下腹有肌紧张、压痛及反跳痛,腰大肌及闭孔内肌试验阳性,肠音活跃。化验:WBC11,700,中性86%,诊为急性阑尾炎。在局麻下急诊行阑尾切除术。经麦氏切口进入腹腔。腹腔内有脓汁溢出,探查发现盲肠后位有两个条索状物,一个长约4cm,粗1.5cm,表面有脓苔,尖端发黑,已坏死穿孔。另一个在其近端,相距约0.5cm,阑尾长约2.5cm,粗约0.9cm,有轻度出血、水肿现象。两个索状物均有系膜附着。术中诊为双阑尾,行阑尾切除,术后解剖标本均有腔。病理证实双阑尾。例2.患者男,39岁,1981年10月1日入院。3天前开始右下腹疼痛,1天后疼痛扩散全腹,伴恶心、呕吐,吐出暗褐色水样物,既往无类似史。入院检查,体温36.9℃,血压90/60mmHg。腹部膨隆,     

动物咬伤致大腿高位截肢的教训

患者,男,45岁,农民,因右大腿被马咬伤四小时入院。患者在劳动中被受惊的马咬住右大腿上段,持续约5分钟。入院查体:右大腿上段可见五处皮肤撕裂伤,内侧三处,长分别为4cm、5cm、3cm,外侧二处分别长4cm、6cm,深部肌肉组织断裂,外露,有一斜行伤口位于腹股     

鞭虫性阑尾炎术后盲肠外瘘1例报告

患者，男，20岁。因急性阑尾炎在外院行阑尾切除后第10天于手术切口中点处出现一皮肤破溃口，并有少许脓液渗出，渗液中偶见一条或数条蠕动的白色小虫。经外院治疗3月无效以“阑尾术后瘘”入院。查体：生命体征平稳，一般情况差。右下腹见一长约6cm的手术疤痕，其中点见一约0．5cm长皮肤破溃口，有少许脓性渗液，触之切口下有一约5．0cm×6．0cm边界不清的肿块，质硬，不活动，轻触痛，肠鸣音正常。白细胞总数及分类计数均正常。腹部B超检查示回盲部有一约4．0cm×5．0cm大肿块。瘘管造影示右下腹麦氏手术切口疤痕中点皮肤破溃下有一宽约1…     

小儿股直肌断裂误诊1例报告

患儿张× ,男 ,11岁。因碰伤右大腿后肿痛并出现肿物2 0天而于 1999年 4月 10日来我院。查体 :一般情况可 ,心肺无异常 ,肝脾肋下未及。右大腿中段前正中部可见一肿物 ,约5× 4× 3cm3大小 ,质软 ,活动度可 ,无触痛 ,距肿物下约 5 cm处可见一横形皮肤伤痕 ,长约 10 cm。双侧对照 ,患侧伸膝力量差。以“股直肌疝”收入院。入院第二天 ,采用连续硬膜外麻醉 ,常规消毒术区 ,铺无菌中单及大洞巾。以肿物为中心行纵行切口 ,长约 10 cm,依次切开皮肤及皮下组织 ,结扎止血、护皮 ,仔细分离 ,见深筋膜完整无损 ,遂排除肌疝的可能性。纵行切开深筋膜…     

预构耳支架游离移植全耳再造一例

患者　男性 ,2 6岁。因硫酸烧伤后右耳缺失 ,右颞顶秃发及右面部瘢痕影响美观 3个月于 1998年 6月 5日入院。检查 :右耳郭缺损 ,右颞顶部及面部约 2 0 cm× 10 cm红褐色增生性瘢痕区。手术先将膨体聚四氟乙烯材料组合拼接成耳支架待用。然后于脐到左腹股沟中点连接中 1/3部位设计“S”型切口 ,长约 2 0 cm,皮下分离出略大于耳支架的腔隙 ,植入支架。找到腹壁下动、静脉 ,向上游离约 10 cm长 ,远端结扎切断将其引出置于支架中段的浅面 ,放置负压引流 ,缝合切口。经预构耳延迟手术后 ,由远端紧贴支架下方向近端掀起 ,见支架有明显的出血点 ,…     

Management of Pancreaticoduodenal Injuries

The nature of the pancreatic or duodenal injury itself influences mortality, and is co-dependent on the presence of multiple other injuries, which account for most of the early mortality. Intra-abdominal sepsis leading to multiple organ failure accounts for most of the late deaths, indicating the importance of early haemodynamic stabilization, adequate debridement of devitalized tissue and wide drainage. Most duodenal injuries can be adequately managed with primary repair or resection and anastomosis. The presence of a pancreatic injury certainly increases the likelihood of an anastomic leak from a duodenal repair. With a significant associated pancreatic injury a more conservative initial approach to the duodenal injury may be more appropriate. Pancreatic injuries should be treated by debridement and simple drainage unless there is clinically obvious duct involvement. For distal injuries with duct involvement, a distal pancreatectomy is indicated. In injuries to the pancreatic head with clinical duct involvement, complex procedures such as pancreaticoduodenectomy should not be performed in the unstable patient with multiple injuries. Debridement and wide external drainage may be implemented and the resulting fistula dealt with at a later operation, if necessary. Large, complex, combined pancreaticoduodenal injuries may require temporary duodenal ligation or a pancreaticoduodenectomy and subsequent reconstruction.     

腕部切割伤72例分析

目的总结腕部切割伤治疗的经验和教训. 方法对72例腕部切割伤进行回顾分析. 结果 72例患者中随访58例.手术效果: 优49例(占85%),良6例(占10%),可2例(占3.4%),差1例(占1.6%);臂丛麻醉意外死亡1例. 结论保证腕部切割伤疗效的关键是:处理及时,清创彻底,争取血管、肌腱、神经无创Ⅰ期吻合.     

中指及无名指指伸肌腱的疲劳性损伤

目的 探讨指伸肌腱疲劳性损伤的诊断治疗方法。方法 39例指伸肌腱疲劳性损伤严格按照Ⅲ区以远和Ⅲ区以近的分型、完全断裂和部分断裂的不同而区别治疗。结果 系统治疗35例，随诊33例，30例患指功能正常。结论 指伸肌腱疲劳性损伤，发病时间集中，病史雷同，应早期诊断，严格按分型治疗。     

前臂肌腱刀伤早期处理的体会

目的探讨前臂肌腱切割伤一期缝合与二期缝合效果差异。方法 分析１２００例前臂肌腱切割伤患者的治疗及愈合情况。结果 一期缝合功能恢复优良９６９例，差５１例，二期缝合功能恢复优良１４４例。差３６例。结论一期缝全治愈率明显高于二期缝合；一期缝合以１２ｈ为参考时间。     

复杂断肢再植临床分析(附5例报告)

目的探讨断肢再植术的处理方法,提高断肢再植成活率及患肢功能。方法5例断肢患者,包括断上臂中段、腕、大腿中下段、小腿中上段及断掌并多个断指各1例,断端污染严重,均予再植。离断至吻合时间约4~7 h。所有病例均以8-0显微丝线吻合主要动静脉及神经。结果随访12~36月,断掌功能良好;再植上臂、大腿均成活;断上臂术后8月,肘关节活动范围约5°,其他关节无功能,感觉无恢复;断大腿者能行走,小腿中段以上感觉恢复;腕、小腿再植者失活。结论复杂断肢再植应妥善行术前处理,彻底清创,行断肢再灌注和血管吻合,重视围术期处理和功能重建,以提高断肢再植成活率和功能恢复。     

Particularities of hand and wrist complex injuries in polytrauma management

Hand and wrist lesions are relatively common in polytraumatised patients. These subjects sustain a wide range of potential life-threatening conditions and hand and wrist injuries incurred are often not diagnosed or are insufficiently treated. Closed lesions are the most frequently missed diagnosis, but even severe open lesions may be incorrectly treated. Most of these hand and wrist injuries can have a strong negative impact on long-term quality of life, particularly when treatment of these injuries is poor or delayed. Orthopaedic and hand surgeons should be vigilant in their assessment and treatment of patients with multiple injuries and a global approach, based on the advanced trauma life support (ATLS)-protocol, must be applied. The very common association of head, chest, abdomen, bone and soft-tissue lesions in the polytraumatised patient requires a multidisciplinary team approach from the beginning. The energy of trauma in these patients often causes complex injuries to the wrist and hand; these require correct treatment in terms of both timing and techniques. It is not possible to create a practical, useful guideline with a “one lesion-one solution” approach, because every case is different; therefore, this paper describes a spectrum of indications and techniques that may be useful in managing hand and wrist injuries, particularly in polytraumatised patients.     

创伤性踝关节不稳定的治疗体会

造成踝关节失稳的因素是多种复合应力作用的结果，恢复正常解剖、重建稳定性是日后减少创伤性关节炎发生的关键。自2000—2005年，收治踝关节损伤后关节不稳定31例，治疗效果满意，现总结报告如下。     

创伤性上升性脊髓缺血损伤

脊椎损伤后,脊髓损伤平面上升较为少见。作者报告了５例,其中Ｔ１０－１１骨折脱位２例：１例于伤后２周内,截竣平面上升至Ｃ２,呼吸麻痹死亡,１例上升至颈部脊髓,双上肢无力;另３例为Ｔ１２骨折２例,Ｌ３骨折１例：其中截竣平面上升至Ｔ９至１例,Ｔ８者２例。５例患者双下肢皆呈软竣,１例死亡患者尸检见脊髓完整,Ｔ９－１０段脊髓前后动静脉血栓,其向上至Ｃ３,向下至Ｓ１,脊髓前血管、中央血管、髓内小血管多处 栓,     

前臂区屈肌腱切割伤的类型及治疗

目的 探讨前臂区屈肌腱切割伤的类型及特点,以利于规范选择确切的治疗方法。方法 总结和分析122例前臂区屈肌腱切割伤病人,按受伤时腕指的位置、术中腱组织损伤的部位和程度进行临床分型,根据不同的类型来选择相应合理的治疗方法。结果 前臂区屈肌腱切割伤按受伤时腕指的位置分为背伸型和屈曲型,按损伤的部位分为腱区、移行区和肌区,按损伤的程度可分为I－Ⅳ种类型。用TAM系统评定法作为评定标准,优69例,良45例,可6例,差2例,优良率为93％。结论 根据不同类型的特点来选择相应合理的治疗方法是获得满意疗效的前提。     

Frequency and strategy of treatment of chondral lesions in cases of anterior instability: a summary of 500 ACL reconstructions

Abstract Cartilage injuries are frequent arthroscopic findings in the course of anterior cruciate ligament (ACL) reconstruction. Various therapeutic options are available to restore integrity to the joint, including new surgical methodologies aimed at the restoration of hyaline cartilage. The observation and classification of cartilage injuries during arthroscopic evaluation represent the crucial moment for any choice of treatment: we use the classification the International Cartilage Repair Society (ICRS). The degree of injury of the cartilage, determines the treatment of choice: shaving, coblation, microfracture, osteochondral grafts, or autologous chondrocyte grafts. From 1 July 2000 to 30 June 2002 we carried out 500 ACL reconstructions: in 118 knees (23.6%) we found no cartilage injury; in 270 (54%) we found injuries which did not require any treatment; finally, in 112 (22.4%) cartilage repair was performed. We carried out 33 shavings, 60 coblations, 21 microfractures, 2 osteochondral grafts, and 5 autologous chondrocyte grafts. This analysis confirms the high frequency of cartilage injury in the presence of ACL lesions. Not all the injuries need to be treated; on the contrary, most of them do not require surgical treatment.