临床病例讨论——同侧骨盆、髋臼及股骨颈骨折的术前计划讨论

病历摘要 患者,女性,23岁,高处坠落致全身多处受伤,右髋关节活动受限9 d于2007年7月11日入院.患者9 d前从五层楼坠落,致胸部、腹部、髋关节多处受伤.受伤当时胸部疼痛,呼吸困难.在当地医院诊断为:右侧胸腔积液、右侧肾挫伤及包膜下血肿、骨盆骨折、右髋臼骨折、右股骨颈骨折.     

消息

病历摘要患者,女性,23岁,高处坠落致全身多处受伤,右髋关节活动受限9 d于2007年7月11日入院.患者9 d前从五层楼坠落,致胸部、腹部、髋关节多处受伤.受伤当时胸部疼痛,呼吸困难.在当地医院诊断为:右侧胸腔积液、右侧肾挫伤及包膜下血肿、骨盆骨折、右髋臼骨折、右股骨颈骨折.     

多发骨折术后发生脂肪栓塞综合征一例

笔者于2012年4月收治1例多发骨折术后脂肪栓塞综合征,报告如下。1病例报告患者,男,19岁,因"车祸致全身多处疼痛、活动受限4 h"入院。入院诊断:右股骨中段粉碎骨折;骨盆多发骨折;左外踝骨折。入院后积极完善检查,急诊全身麻醉下行右股骨骨折切开复位钢板内固定术、左外踝骨折切开复位空心螺钉内固定术。手术顺利,术后出现发热,最高体温达41.2℃,予以物理降     

Ilizarov外固定架治疗膝关节屈曲受限伴足下垂1例

1临床资料 患者女性,18岁,主因＂车祸致髋部及双下肢疼痛、肿胀、活动受限5 h余＂,于2009年8月30日入院。患者于入院前5 h被货车撞倒致髋部及双下肢疼痛、肿胀、活动受限,送至我院急诊就诊,X线片示：骨盆骨折、右股骨髁上骨折、左内踝骨折。为进一步治疗,急诊收入院。     

超选择性肾动脉栓塞治疗儿童重度闭合性多处肾碎裂伤一例并文献复习

目的评价超选择性肾动脉栓塞治疗儿童重度闭合性多处肾碎裂伤伴活动性出血的有效性。 方法回顾性分析于2020年9月1日在我科经肾动脉超选择性栓塞等综合治疗重度闭合性多处肾碎裂伤伴活动性出血1例的儿童临床资料。 结果该儿童经超选择性肾动脉栓塞等综合治疗后出血完全停止,患肾的绝大部分组织和功能得以保存,最终治愈出院。术后3个月随访该儿童患肾功能良好,肾周血肿基本吸收,无血尿复发及尿性囊肿等并发症。 结论超选择性肾动脉栓塞治疗重度闭合性多处肾碎裂伤伴活动性出血的儿童具有显著的临床疗效,避免不必要的医源性肾切除术,最大程度地保护肾脏实质与肾功能。     

经肾动脉超选择栓塞治疗肾挫裂伤疗效观察

目的探讨经肾动脉高选择栓塞治疗肾挫裂伤致出血的安全性及疗效观察。方法回顾性分析13例肾挫裂伤经肾动脉高选择栓塞治疗肾动脉出血患者的临床资料。本组共13例,男10例,女3例,年龄11岁～56岁,平均28.7岁;左肾7例,右肾6例,经肾动脉造影明确诊断,并用明胶海绵栓塞治疗,术中见栓塞确实,出血停止。1例5d后再次出血,二次栓塞成功。结果 13例患者经超选择栓塞治疗均治愈出院。随访12例患者肾功能良好（1例因其他原因未随诊）。结论经肾动脉超选择栓塞治疗肾挫裂伤出血,避免手术切除肾脏,最大限度保护肾功能,取得确实疗效。     

肾性骨病致双侧股骨多次骨折1例报道

正肾性骨病致全身多处骨折的文献报道国内外并不少见[1-2],但对于导致双侧股骨骨折的报道少见,尤其是多次股骨骨折更是罕见,值得分析和探讨。现就我科收治的1例肾性骨病致双侧股骨多次骨折的患儿做一简单报道。1患者资料患者,男,13岁,以"抽搐致右大腿肿痛伴活动受限2 d"为主诉,于2015年12月30日入院。现病史:2 d前因抽搐再次发作,随后感右侧大腿疼痛、肿胀伴活动受限,无皮肤破损     

齿状突骨折合并C5～6脱位1例

齿状突骨折和下颈椎骨折脱位在临床上多见,但同一个患者同时出现比较少见,现报告1例如下。1临床资料患者,男,35岁,主因车祸致颈部疼痛,四肢无力,左臂麻木2个月余入院。患者于入院前2个月因车祸致伤颈、胸、骨盆,当时患者昏迷约5 m in,清醒后觉颈、肩、胸、骨盆等多处疼痛难忍,四肢不能活动,当地医院诊断为“颈部软组织损伤,锁骨骨折,肋骨骨折,骨盆骨折”,住院治疗10 d,四肢恢复活动,回家康复锻炼。2个月后复查,四肢肌力差、僵硬感、不能做精细动作。遂拍X线片,发现有齿状突骨折和颈椎脱位,收入院。患者受伤后曾有大小便失禁,入院时正常。查…     

隐匿性髋臼骨折一例漏诊的经验教训

笔者于2006年11月,收治了1例外院漏诊的隐匿性髋臼骨折,报告如下. 1病例报告 患者,男,49岁,因"车祸致全身多处疼痛、活动受限21 d"入院.当地医院摄X线片示右锁骨骨折、右胫骨近端骨折,摄骨盆X线平片未见有明显的髋部骨折征象,予行右锁骨骨折、右胫骨近端骨折切开复位.出院后仍感右髋部疼痛,其他医院CT扫描示右髋臼骨折(横行加后壁骨折).笔者收治后,予股骨髁上骨牵引,全身麻醉下行右髋臼骨折切开复位内固定术,术中显示右髋臼骨折前柱骨折断端有较多纤维骨痂生长,后柱、后壁移位明显,后壁骨折块有压缩伴骨缺损,予以行内固定并行后壁骨缺损植骨治疗.     

肾部分切除术后肾动脉假性动脉瘤一例并文献复习

目的 探讨肾部分切除术后少见但危重的肾动脉假性动脉瘤(RAP)的临床表现、诊断与处理方法。方法 报告2019年8月我科诊疗的1例腹腔镜左肾部分切除术后出现RAP患者的临床资料,并复习相关文献对RAP的临床特征、诊断与治疗进行分析总结。结果 患者男,77岁,因“发现左肾占位1个月”入院,术前诊断为“左肾占位:肾癌可能性大”。行腹腔镜下左肾部分切除术,术后病理结果示左肾透明细胞癌,包膜完整。术后第8天出现无痛性肉眼血尿,超声造影提示左肾RAP,介入下肾动脉造影再次确诊并同时行超选择性肾动脉栓塞,成功栓塞动脉后患者无再发血尿,顺利出院。结论 RAP是肾部分切除术后少见但严重的并发症,可疑患者应尽早行超声造影检查,超选择性肾动脉栓塞治疗安全有效。     

Continuous renal replacement therapy improves renal recovery from acute renal failure

BACKGROUND: Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. METHODS: We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate. RESULTS: 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial. CONCLUSIONS: Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.     

Influences of renal stone surgeries on renal function--evaluation of renal function with 99mTc-DMSA renal scintigraphy]

From 1984 to 1990, 99mTc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94 +/- 5.60%) was significantly lower than that of PNL (-0.06 +/- 3.92%), pyelolithotomy (-4.08 +/- 4.79%) (p less than 0.01) and ESWL (-7.72 +/- 3.87%) (p less than 0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80 +/- 4.21% nephrolithotomy 4.67 +/- 4.73%, pyelolithotomy -1.46 +/- 5.39% and ESWL -2.02 +/- 4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possivility of deterioration of renal function after ESWL was suggested.     

Reversible renal hypertension due to renal hygroma

A hygroma of the left kidney was found at surgery in a thirty-five-year-old woman, who presented with anemia, hypertension, and a left abdominal mass. There was a very high sedimentation rate and fine needle aspiration yielded bizarre cells which raised the possibility of malignancy. Compression of the kidney by the cystic structure probably interfered with renal blood flow and was responsible for the elevated blood pressure which receded to normal after removal of the cyst and the left kidney.     

Extensive renal involvement by renal cell carcinoma

Experience with the management of 3 cases of bilateral renal adenocarcinoma and 1 case of unilateral carcinoma in the solitary kidney is presented. Two patients died of metastases six and thirteen months postoperatively, while one is alive with metastases at fourteen months and another is alive without metastases at four months. The literature is reviewed, and the various treatments are discussed.     

Abnormal renal arteriography after renal trauma.

Angiograms following renal trauma in a ten-year-old girl were highly suggestive of renal neoplasm, especially Wilms' tumor. There are striking similarities between arteriograms after renal trauma and those showing neovascularity.