成人齿状突骨折的治疗策略

对于齿状突骨折的治疗目前无一致意见，且尚无充分证据支持骨折的非手术或手术治疗选择。影响骨折愈合的因素包括骨折平面、是否移位和移位程度以及患者的年龄，笔者建议的手术适应证包括明显移位或成角、年龄〉50岁、ⅡA型骨折、非手术治疗不能维持骨折稳定和陈旧性骨折。手术治疗应尽量选择前路螺钉内固定而避免融合。     

中空加压螺钉内固定治疗枢椎齿状突骨折

目的探讨中空加压螺钉内固定治疗枢椎齿状突骨折的疗效。方法从2004年4月至2007年3月应用颈前路中空加压螺钉内固定治疗齿状突骨折24例，其中Ⅱ型13例，Ⅲ例11例。所有患者术前均行颅骨牵引，受伤后平均6d内行前路齿状突螺钉内固定手术，术后颈围保护6周，进行定期临床和X线检查。结果所有患者均得到随访，平均为28个月，骨折全部骨性愈合，无术中及术后并发症，无内固定螺钉松动、移位或断裂。结论采用中空加压螺钉内固定治疗枢椎齿状突骨折，骨折愈合率高，并发症少，是治疗齿状突骨折较好的选择。     

Pilon骨折的治疗体会

28例Pilon骨折采用切开复位内固定术治疗。选择恰当手术时机,根据骨折类型及移位情况选择合适的内固定材料、正确的手术方法,术后早锻炼、晚负重等综合治疗方法,可减少局部并发症,获得较好的临床疗效。     

枢椎齿状突骨折临床治疗分析

目的 探讨牵引和手术治疗枢椎齿状突骨折的疗效。方法 应用颅骨或枕颌带牵引，头颈胸石膏外固定治疗Ⅰ型8例，Ⅱ型2例，Ⅲ型5例，后路寰枢椎融合术治疗Ⅱ型2例，Ⅲ型1例。结果 随访1．5～3．0年，骨折全部愈合，均无复发和颈椎不稳表现。结论 头面部有创伤，颈痛伴活动受限，应注意检查颈椎有无损伤，对伤后无明显严重的颈脊髓损伤临床症状和体征的颈椎齿状突骨折病人急时牵引或手术治疗，远近期疗效好。     

移位髋骨折的手术治疗

探讨手术复位内固定治疗移位髋骨折的临床疗效,处理髋骨折应其他关节内骨折一样,应尽可能使骨折达到剖复位或近似解部复位     

手术治疗18例肩峰骨折的体会

对18例肩峰骨折患者手术治疗的效果进行回顾分析,认为当肩峰骨折发生向下移位导致肩峰下间隙变窄时,应手术治疗。对OgawaⅠ型骨折选用直径3.5mm空心拉力螺钉固定,对OgawaⅡ型及Ⅲ型骨折选用重建钢板内固定是良好的选择。     

移位关节内骨折的手术治疗进展

移位关节内骨折的手术治疗是骨科医生面临的挑战之一。其治疗原则是解剖复位,有效固定骨折,重建关节的完整性与肢体的解剖力线,早期进行功能锻炼。本文从伤情评估、手术时机与手术方法确立、术后康复方案制订等方面介绍了近年来移位关节内骨折的手术治疗进展,旨在进一步提高关节内骨折的临床治疗水平,加强相关的基础研究。     

移位髋臼骨折的手术汉字

探讨手术复位内固定治疗移位髋臼骨折的临床疗效。处理髋臼骨折应像其他关节内骨折一样，应尽可能使骨折达到解剖复位或近似解剖复位。     

手术治疗桡骨远端复杂骨折的体会

29例桡骨远端骨折伴关节面明显移位患者实行手术治疗,术后指导其功能锻炼,随访其手术效果及晚期并发症。25例效果良好,恢复正常功能,4例出现腕关节疼痛,原因为不正确功能锻炼。桡骨远端骨折伴关节面明显移位患者行手术治疗,恢复关节平整及桡骨远端的解剖与功能锻炼非常重要。     

克氏针钢丝张力带内固定治疗陈旧性肱骨外髁骨折23例

我们于1986年6月～1992年12月采用克氏针钢丝张力带内固定治疗陈旧性肽骨外髁骨折23例，骨折愈合率100％，肘关节功能恢复满意率91．3％。报告如下。临床资料本组男18例，女5例；年龄3～12岁。左侧15例，左侧8例。好发年龄5～7岁，共13例，占总数56％。骨折类型：骨折块明显向外后侧移位7例。骨折块向外侧同时向后下翻转移位13例；肋骨外髁骨骺骨折伴尺桡骨近端问后外侧移位，骨折块保留在桡骨头上面不旋转3例。受伤至手术时间：20～30d12例，31～90d9例，90d以上2例。术前伤肢功能：本组病例伤后均行手法复位，夹板或石膏外固定4周以上，肘…     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].     

U50,488H对正常及缺氧心肌细胞L型钙电流的作用

目的 探讨心脏阿片受体和β-受体相互作用的机制。方法 采用全细胞膜片钳技术，观察U50，488H(β-阿片受体选择性激动剂)对正常和缺氧心肌细胞L型钙电流的作用。结果 U50，488H剂量依赖性(0．1～100μmol／L)抑制正常心肌细胞的L型钙电流及异丙肾上腺素(0．1μmol／L)激动的钙电流，而细胞缺氧后，这一抑制作用减弱；U50，488H对Forskolin(10μmol／L)激动的L型钙电流无明显影响。结论 β-阿片受体对β-受体信号的负性调节作用在细胞缺氧后减弱，其作用位点可能发生于β-受体与腺苷酸环化酶环节之间。     

Overtraining syndrome : la piste de la suractivité ?

Introduction

Overtraining is clearly a multifactorial disturbance. We aimed at evaluating the relative importance of overactivity and nutritional imbalances.

Methods

A comparison of 17 footballers with seven subjects with a diagnosis of overtraining evidenced that the two groups differ by energy expenditure resulting from physical activity (1573 ± 378.6 kcal/d from 804.7 ± 184.7 kcal/d) while food intake does not exhibit significant differences.

Conclusion

In this sample of subjects, inadequate food intake is found in both groups, so that overtraining appears rather characterized by a higher level of physical activity. Therefore, a relative energy deficit resulting from overactivity rather than dietary mistakes appears to explain the syndrome in these athletes, who are thus truly “overtrained”.     

Prenatal detection of brain anomalies with ultrasonography

Ultrasound is the first-line imaging study of the fetal brain performed at 12, 22 and 32 weeks of gestation. The very structured evaluation of biometric and morphological data, facilitated by the use of a checklist, ensures a high quality examination. All patients where an anomaly of any key element is suspected should be referred to a center dedicated to prenatal diagnosis for confirmation irrespective of the gestational age. Prenatal diagnosis plays a significant role in France since medical interruption of pregnancy until term is authorized.