肾创伤的生物力学性质及其临床特点

目的总结肾创伤生物力学性质及其临床特点。方法回顾本院2000年1月至2006年1月间收治的326例肾创伤病例,分析创伤过程中生物力学因素发挥的临床效应。结果随着暴力动量的增大,肾创伤等级、肾切除率及死亡率均随之增高,有统计学意义(P＜0．05)。钝性暴力相对于锐性更容易造成闭合伤和合并伤,且肾切除率低,差异有统计学意义(P＜0．01)。后腰着力的肾伤情重于腹部正面或侧面着力,且合并伤发生率低(P＜0．05)。创伤瞬间速度变化的趋向对伤情等级、肾切除率及死亡率无明显影响(P＞0．05)。结论肾创伤过程中暴力的生物力学性质与其临床表现紧密相关。     

米诺环素对压力作用下体外培养视网膜神经细胞凋亡的抑制

目的 观察米诺环素对压力系统作用下大鼠视网膜神经细胞(RNs)的活性及凋亡的影响，探讨其对受损RNs保护的可能机制。 方法 制备大鼠RNs体外加压培养模型，通过细胞形态学观察、四唑盐（MTT）比色法测定细胞活力、吖啶橙/溴化乙锭（AO/EB）染色法检测细胞凋亡率等方法观察不同浓度的米诺环素对上述损伤细胞的保护作用，并用免疫细胞化学法观察iNOS和caspase 3表达的改变。 结果 加压培养后RNs与对照组相比形态改变较明显，细胞活力降低，5393%的细胞发生凋亡。20000 μmol/L的米诺环素治疗组则细胞形态改善，活力显著增高，1729%的细胞发生凋亡；免疫细胞化学法显示细胞内iNOS和caspase-3表达较加压损伤组减少。 结论 一定剂量的米诺环素在体外可有效抑制压力引起的大鼠RNs损伤及凋亡；抑制iNOS和caspase-3的表达可能是其潜在作用机制。     

创伤性颈动脉海绵窦瘘的可脱性球囊栓塞治疗技术

目的探讨创伤性颈动脉海绵窦瘘的临床表现和血管内介入栓塞治疗效果。方法回顾性分析本组共32例创伤性颈动脉海绵窦瘘的临床表现,采用可脱性球囊微导管技术经股动脉途径闭塞颈内动脉破口处或破口处患侧颈内动脉主干。结果28例一次性治愈;4例术后16~48h因球囊发生早泄移位复发,经再次以可脱性球囊栓塞后治愈。本组有28例(87.5%)闭塞了瘘口,颈内动脉主干保持通畅;4例同时闭塞了瘘口及颈内动脉主干。27例获随访(术后6个月~5.2年),无复发。结论采用可脱性球囊栓塞技术是治疗创伤性颈动脉海绵窦瘘的首选方法。     

螺旋CT多功能重建在骨关节外伤中的应用

目的 探讨螺旋cT功能重建在骨与关节外伤中的应用，提高重建技术的使用能力和诊断水平。方法 对使用双层螺旋CT，SSD，MPR，MIP等多种方式重建检查的49例复杂的骨与关节外伤病例进行回顾性分析。结果 49例骨关节外伤重建成像，其中，颅底3例，颌面部7例，颈、胸、腰、骶椎共17例，肩胛骨3例，髋关节8例，膝关节11例。SSD在显示碎骨片明显移位的空间关系方面较MIP，MPR为佳，它可以直观地、立体地、清晰地、多角度显示骨关节损伤，而MIP在显示骨折细节方面较优，尤其在外伤中颅窝观察有关神经孔方面。结论 螺旋CT的SSD，MPR和MIP技术的综合应用，对复杂的骨折、关节损伤的显示效果良好，具有较高的临床应用价值。     

急性重度眼烧伤135例临床分析

目的了解急性重度眼烧伤的临床特点、预后及并发症发生情况。方法对笔者单位病案室保存的1977--2002年住院眼烧伤患者135例（155只眼）的病历进行回顾性统计分析。分析不同深度、原因眼烧伤的眼表修复率、修复时间、致盲情况及并发症。结果治疗后Ⅲ度眼烧伤的修复时间短于Ⅳ度眼烧伤，其修复率也明显高于Ⅳ度眼烧伤（P〈0．01）；在不能修复的Ⅳ度眼烧伤中，酸烧伤致角膜穿孔6只眼，显著高于碱烧伤（1只眼，P〈0．05）。Ⅲ度眼烧伤视力≥0．05者有38只眼，〈0．05者51只眼；Ⅳ度眼烧伤视力≥0．05者0只眼，〈0．05着66只眼。78只酸、碱烧伤眼中，52只眼致盲，致盲率为66．7％；77只热烧伤眼中，65只眼致盲，致盲率为84．4％。Ⅲ度眼烧伤的并发症发生率低于Ⅳ度眼烧伤。其中Ⅲ度眼烧伤角膜穿孔、睑球粘连的发生率（1．1％、36．O％）均显著低于Ⅳ度眼烧伤（27．3％、59．1％，P〈0．01）。在酸烧伤患者中，角膜穿孔及睑外翻的发生率（29．2％、37．5％）较高。而热烧伤患者中眼睑球粘连的发生率（53．2％）较高。结论Ⅳ度眼烧伤伤后的预后差，致盲率高。目前的治疗方法尚不能完全改善其视功能及预后，有待进一步研究。     

Value of spiral CT in hemodynamically stable patients following blunt chest trauma

Introduction: Features of spiral CT (SCT) — fast scanning, dynamic injection of contrast allowing optimal vessel opacification, and supplemental multiplanar imaging — promises to provide increased accuracy in the diagnosis of acute and non acute thoracic vascular disease. Recent work demonstrating the cost effective triage of hemodynamically stable patients after blunt chest trauma for angiography based on dynamic CT findings has prompted an investigation into the accuracy of SCT in this clinical setting. Methods: A retrospective review of all patients seen in the emergency department over the period of one year for aortic, thoracic, or blunt chest trauma evaluation was performed (74 patients) and all SCT scans available were reviewed and data reformatted for optimal delineation of pathology using maximum intensity projection and multiplanar reformation. The accuracy and predictive positive and negative values of SCT were calculated with respect to angiography, surgical, and/or clinical follow up evaluation. Results: Twenty three (31%) patients went directly to angiography owing to mediastinal widening on chest film and hemodynamic instability, of which four were positive and required emergent surgery. Seven hemodynamically stable patients (9%) had noncontrast SCT owing to mediastinal widening on chest film, all of which had angiography with none having great vessel trauma. Fourty four hemodynamically stable patients (60%) had contrast enhanced SCT (ceSCT), of which five (11%) were abnormal and underwent angiography, four of these were positive for aortic damage, one for a subclavian artery laceration. Of the remaining 39 patients who had normal ceSCT; five had angiography, all of which were normal. Of the remaining 34 patients that had normal ceSCT none had adverse outcome on clinical follow-up, minimum of 12 months. Conclusion: The predictive positive value for aortic trauma of ceSCT in blunt trauma is 80%, with a predictive negative value of 100%, indicating that it is feasible for SCT to be a first line exam in blunt chest trauma in the future.     

Features of pediatric head injury in Hong Kong

Head injury in children causes special concern in most communities. From 1989 to 1994, 2,785 children younger than 16 years old were admitted to our neurosurgical service because of head injury. Fall from a height was the major cause of head injury leading to admission in infants and children in preschool age groups, whereas traffic-related or bicycle-related accidents were more likely to be the cause of head injury for those aged 11–15 years. In all age groups there was a male preponderance. The overall mortality was 0.6%. Traffic-ralated accidents caused more severe injury and accounted for 67% of all fatalities. For patients under 6 years old, about 40% of head injuries occurred at home. Preventive measures for pediatric head injury in Hong Kong are suggested.     

创伤骨科中责任制护理初探

本文复习了有关责任制护理的理论，从创伤骨科的角度，介绍了这一护理技术在创伤骨科中具体应用方法。通过对创伤骨科病人心理及临床特点的分析，提出了针对创伤病人的护理问题，订出护理计划，在阐述了责任制护理具体实施的优点时，对现存的问题也进行了分析，提出了改进措施。     

IL－2LAK细胞局部治疗眼部恶性肿瘤的临床效果

应用γＩＬ－２体外诱导自身ＬＡＫ细胞（ｌｙｍｐｈｏｋｉｎｅａｃｔｉｖａｔｅｄｋｉｌｌｉｎｇｃｅｌｌ），对眼部早、中期恶性肿瘤病人进行瘤区注射，取得较好效果。２５例恶性肿瘤中，ＩＬ－２ＬＡＫ细胞治疗１０例；肿瘤完全消退９例，部分消退１例。手术＋ＩＬ－２ＬＡＫ细胞治疗１５例，肿瘤完全消退。随访中除１例肿瘤部分消退失访外，其他２４例经１～５年观察均未见复发。以上结果表明，自身ＬＡＫ细胞局部治疗是一种有效的肿瘤免疫治疗方法。