颅骨钻孔应用尿激酶引流治疗硬膜外血肿

我院于1999~2005年对19例急性外伤性硬膜下血肿采用CT定位,局麻下行颅骨钻孔,尿激酶注入引流的方法取得良好的效果。现报告如下。1临床资料1·1一般资料本组19例,男14例,女5例。年龄18~59岁,平均33.4岁。1·2临床表现有一过性昏迷的6例,无昏迷的13例,头痛19例,伴有恶心呕吐的11例。受伤至手术时间12~24小时者3例,24~72小时者9例,3~7天者7例。GCS评分8~15分,其中8~10分6例,10~13分9例,13~15分4例。有颅盖骨骨折15例,中颅窝骨折4例。19例患者术前均经CT检查,血肿量计算公式T=1/2×L(长轴)×S(短轴)×Slice(层面厚度)计算,血肿量在20~30m …     

改良型根管糊剂在根管充填治疗中的应用

目的 观察改良型根管糊剂在根管治疗中的临床疗效.方法 选择需要作根管充填的248颗患牙随机分为实验组和对照组两组,每组124颗患牙,比较改良型根管糊剂与传统型根管糊剂在充填后3天、及2年后的疗效.结果 改良型根管糊剂在根管充填术后近远期效果均优于传统型糊剂,两者差异有显著性.结论 改良型根管糊剂在根管治疗中优于传统根管糊剂,术后反应轻微,远期疗效稳定.     

创伤性脑损伤病人术中低血压的危险因素分析

创伤性脑损伤(traumaticbraininjury,TBI)如脑挫伤、硬脑膜外血肿和硬脑膜下血肿的病人,在开颅血肿清除和去骨瓣减压手术过程中可能发生术中低血压(intraoperativehypotension,IHT)。低血压可加重脑缺血性损伤,并能使颅内压(ICP)进一步的升高乃至死亡。而低血压发生以后,采取容     

左旋布比卡因腰-硬联合阻滞在下肢手术的应用

目的探讨0.75%左旋布比卡因用于蛛网膜下隙阻滞的临床效果及安全性。方法随机选择ASAⅠ～Ⅱ级的40例骨科下肢手术患者(股骨干及髋关节大手术的患者),随机均分成两组:L组腰麻用药为0.75%左旋布比卡因15mg,容量为2.5ml;B组腰麻用药为0.75%布比卡因,剂量及容量同L组。术中必要时经硬膜外导管注入2%利多卡因。术中监测BP、HR、SpO2、RR的变化并观察围术期不良反应的发生。结果两组最高阻滞平面及到达时间、麻醉持续时间、肌松效果及达到最大肌松效果时间差异均无显著意义。两组均无神经系统的不良反应。结论0.75%左旋布比卡因用于腰-硬联合麻醉骨科下肢手术安全有效,效果与0.75%布比卡因相比差异无显著意义。     

Pediatric intracranial aneurysms——clinical characteristics and therapeutic strategies

Objective To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in children. Methods From our dedicated neurovascular databank of patients, we reviewed 23 consecutive children who had 24 intracranial aneurysms. There were 14 boys and 9 girls with a mean age of 9.09 years ( range 1 - 14 years ). Results Intracranial aneurysms in children ≤ 14 years constituted 1.3% of all intracranial aneurysms. Internal Carotid artery (ICA) and middle cerebral artery (MCA) were the most frequent sites for aneurysms. About 58.3% of the aneurysms were complex, including dissecting, pseudoaneurysm, giant and fusiform aneurysm. 1/3 of all aneurysms were located in posterior circulation. Only 1 case had multiple aneurysms in this case series. Almost half of all cases presented with subarachnoid hemorrhage and others presented with mass effect. 14 cases underwent endovascular treatment. 4 patients received microsurgical therapy. 5 cases did not receive microsurgical or endovascular therapy, 2 of them whose aneurysms spontaneously thrombosed during follow up. One boy with left vertebral artery giant aneurysm died after endovascular therapy owing to gradual thrombosis in basilar artery. Another child had poor outcome because of rerupture of aneurysm before operation. Whereas the majority had a favorable outcome. Conclusions Intracranial aneurysms in children had many clinical and radiological characteristics different from those in adults : ( 1 ) remarkable male predominance; ( 2 ) ICA and MCA were the most common sites for aneurysms; (3) high incidence of large, traumatic, infectious, dissecting and fusiform aneurysms. (4)For pediatric intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. Endovaacular therapy was the best choice for complex aneurysms.     

上胸椎前方手术入路

上胸椎前方解剖关系复杂，由浅及深为肌层：颈阔肌，胸锁乳突肌；骨性结构：胸骨柄，胸锁关节；血管性结构：左、右颈总动脉，主动脉弓，无名动脉，左无名静脉，左、右头臂静脉，甲状腺下动脉，胸导管；神经组织：喉返神经，交感神经链；其他深层组织：食管，气管，甲状腺，胸腺。这些器官和组织相互交错，互为邻里，错综复杂。此处椎体或脊髓前方病变时，前方入路可直接暴露病变部位，术野清晰，手术直接，效果明确，但易损伤以上相邻组织，严重者损伤胸髓，导致患者高位截瘫。     

脑室置管和腰椎穿刺行脑脊液置换治疗严重蛛网膜下腔出血44例报告

自1997年1月至2004年8月,我们应用侧脑室外引流和腰椎穿刺放液、脑脊液置换治疗严重自发性蛛网膜下腔出血(SAH)44例,效果良好。现报道如下。1临床资料1.1一般资料本组男24例,女20例;年龄18岁~74岁,平均58岁,其中60岁以上20例,占45.4%。全部病人均行多次脑CT检查,均有广泛蛛网膜     

上颈椎手术翻修原因分析及对策

上颈椎处于颅颈交接区，由于其解剖位置特殊、毗邻关系复杂，历来被视为脊柱外科手术的“禁区”。然而在过去的20多年里，上颈椎手术得到了更大范围的普及，但同时也出现了一些并发症，造成不良预后，一定程度上阻碍了上颈椎手术技术的发展。本文参阅国内外文献就上颈椎翻修术原因进行综述如下。     

肌筋膜缝线悬吊法下睑袋整复术

下睑袋整复术作为常见的面部美容手术，虽然术式众多，但术后并发症仍时有发生。自2002年以来，我们用了新的肌筋膜缝线悬吊法，行下睑袋整复手术40例。它主要针对重度睑袋，下睑缘外露，下睑松弛，下睑退缩，外眦下移，或下睑外翻需要再次手术的病例，经临床观察满意，报道如下。     

乙字汤运用心得

乙字汤是治疗肛肠疾病的著名方剂,出处无从考证,因结肠形似“乙”字而得名。该方由柴胡10g、黄芩10g、当归12g、升麻6g、大黄6g、生甘草10g组成,其中柴胡、甘草需等量,其因不得而知。忆在大学讲堂先师尹质明讲授湿热肠风下血一证时,对该方之功效大加赞赏,随师临证观其效,如鼓应