平行双接骨板内固定治疗老年肱骨远端粉碎性骨折

Objective To summarize our experience of treating distal humeral fractures of AO/OTA type C with parallel-plate fixation in the aged. Methods From January 2007 to September 2008, we treated 22 cases of type C distal humeral fractures by parallel-plating. They were 6 males and 16 females, with a mean age of 70. 2 (range, 60 to 81 ) years, including 3 open fractures (Gustilo type Ⅰ) and 19 close fractures. According to AO classification, there were 5 cases of type C1, 10 cases of type C2 and 7 cases of type C3. The posterior midline approach was selected. After the articular surface of the distal humerus was exposed through the olecranon osteotomy or the liguliform flap of triceps brachii muscle, parallel-plate fixation was performed to fix fractures internally. All patients began functional exercise of the elbow joint from 3 days after operation. Results All patients were followed up for a mean of 18 (range, 13 to 35) months. All fractures achieved complete union. The mean degrees of the elbow movement were as follows: extension was 16°(range, 0 to 50°), flexion 125° (range, 95° to 140°), supination 65° (range, 40° to 90°) and pronation 67°(range, 40° to 90°). According to Mayo elbow performance score (MEPS), 11 cases were graded as excellent, 8 as good, 2 as fair and one as poor. 86. 4% of the patients had an excellent or good functional result. Two cases reported transient ulnar nerve paralysis, 2 heterotopic ossification, one delayed union and elbow stiffness,3 slight symptoms of traumatic arthritis, and 2 slight malformation of cubitus varus. Conclusions Parallel-plate fixation is a preferred treatment for AO type C distal humeral fractures in the aged because of satisfactory bone healing, early mobilization and recovery of joint function. However, more attention should be paid to the complexity of the fracture which may influence the therapeutic effects of the operation.     

Foxo3a和p27kip1在大鼠坐骨神经损伤后背根神经节中的表达

Objective To investigate the expression of Foxo3a and p27kip1 in lumbar dorsal root ganglia (DRG) after injury of sciatic nerve in rats. Methods Adult rats were randomly divided into control group and experimental group. The rats in experimental group were subjected to sciatic nerve clamp.Expression and distribution of Foxo3a and p27kip1 and cellular proliferation and axon regeneration in DRG was detected by western blot and immunohistochemistry. Results Foxo3a protein levels begined to reduce at 1 day (7.0 ± 3.5), reached valley at 2 day (6.0 ± 3.8) after injury, and following Foxo3a downregulation, p27kip1 protein levels begined to decrease at 2 day (29.0 ± 3.5), reached valley at 7 day (21.0± 3.0) after injury. Down-regulation of Foxo3a and p27kip1 was expressed predominantly in neurons and glial cells by double immunolabelling. Foxo3a and p27kip1 were expressed in neurons [(37.8 ± 5.7)%, (43.3 ±4.3)%] and glial [(22.4 ± 3.9)%, (13.8 ± 3.2)%] cells in sections of DRG at 2 day after injury less than neurons [(73.6 ± 2.5)%, (84.1 ± 3.7)%] and glial [(61.3 ± 4.4)%, (68.7 ± 5.6)%] cells in sections of normal DRG. Proliferating cell nuclear antigen (PCNA) and GAP-43 were up-regulation from 2 day, and PCNA reached peak at 7 day after injury.The glial cells were the main type of cellular proliferation.Conclusion Down-regulation of Foxo3a and p27kip1 in lumbar DRG is correlated with the proliferation of glial cells and axonal regeneration after sciatic nerve injury.     

急性肺不张1例报告

1　病历报告患者 ,女 ,45岁 ,主因腹痛、腹胀伴恶心、呕吐 1ｄ于 2 0 0 0年 4月 17日入院。该患者 5年前曾因外伤至右肾切除。1997、1998年分别因肠扭转和肠梗阻行腹部手术 ,无肿瘤病史。查体 :心肺未见异常 ,腹部膨隆 ,腹软 ,压痛 ,可见肠型和蠕动波 ,听诊肠鸣音减弱。入院第 2ｄＸ线透视腹腔可见多个大小不等阶梯状液平。 4月 2 1日患者出现鼻腔流血 ,量多、胸痛、咳痰时带有血丝。拍正侧位Ｘ线胸片示右肺上叶后段见 3ｃｍ× 3.6ｃｍ大小 ,密度均匀、边缘清楚类圆形影。 4月 2 4日患者咯血 70ｍｌ,色鲜红 ,内有少量痰液 ,胸闷、胸痛、气急…     

介入化疗治疗乳腺癌继发上肢肿胀疗效分析

研究介入化疗治疗乳腺癌继发的上肢肿胀的疗效。采用Seldinger技术对6例乳腺癌继发上肢肿胀患者行锁骨下动脉灌注化疗，随访观测患肢症状的变化。6例患者共治疗12例次，上肢肿胀症状短期内均显著减轻．治疗前后患侧与健侧上臂中份周径的差值分别为6～13cm、1～7cm，平均差值分别为8．7、3．5cm。毒副反应少。锁骨下动脉灌注化疗是治疗乳腺癌继发上肢肿胀的最有效方法之一。     

多发性骨髓瘤浸润胸膜致胸水1例

多发性骨髓瘤浸润胸膜致胸水１例沈阳市变压器厂职工医院（１１００２４）张元元徐大伟沈阳职工医学院临床医院（１１００２４）李春耀患者男性，４５岁，因胸闷气短２０天，发热７天入院。２０天前无明显诱因出现胸部闷痛，活动后心悸气短。咳嗽，咯白色粘液痰，消瘦乏力...     

带蒂甲片转移结合 V－Y 推进皮瓣治疗指端缺损的临床应用探讨

目的：探讨应用带蒂甲床转移结合 V－Y 推进皮瓣治疗指端缺损在临床中的效果。方法对30例端缺损伴有甲床部分缺损的患者行带蒂甲片转移结合 V－Y 推进皮瓣治疗。结果术后30例患者甲床均能修复,外观良好,伤指指腹饱满,无功能障碍。结论该术式操作简便,疗效满意,并发症少,是治疗指端缺损的理想选择。     

巨大肝囊肿经皮穿刺引流硬化治疗

目的:评价经皮穿刺引流硬化治疗巨大肝囊肿的疗效.方法:21例21个巨大肝囊肿(直径＞10cm)经皮穿刺引流无水乙醇硬化治疗,随访6个月.结果:该组随访21例,有效率100%,囊肿消失率47.6%,一次治愈率85.8%,无严重并发症.结论:经皮穿刺引流硬化剂治疗巨大肝囊肿创伤小、治愈率高,是一种非常有价值方法.     

类风湿性关节炎患者滑膜组织中β1,4-半乳糖基转移酶-Ⅰ的表达

目的研究β1,4-半乳糖基转移酶-Ⅰ(β1,4-GalT-Ⅰ)在类风湿性关节炎(RA)患者膝关节滑膜组织中表达水平及细胞定位。方法选择12例RA患者(A组)和8例健康人(B组)滑膜组织,采用Western blot检测β1,4-GalT-Ⅰ、E-选择素的蛋白表达水平,免疫组化检测β1,4-GalT-Ⅰ的表达和分布情况,免疫荧光检测β1,4-GalT-Ⅰ与滑膜组织中炎症细胞以及E-选择素的共定位情况。结果与B组相比,A组滑膜组织中β1,4-GalT-Ⅰ和E-选择素蛋白表达明显增加(P<0.01或P<0.05)。在RA滑膜炎症过程中,β1,4-GalT-Ⅰ主要表达于巨噬样滑膜细胞、成纤维样滑膜细胞、活性T细胞和中性粒细胞。E-选择素与β1,4-GalT-Ⅰ存在共定位。结论β1,4-GalT-Ⅰ可能参与调节RA滑膜组织的炎症反应过程。