碳—钛组合式人工股骨头临床应用15年随访

自1980年4月至1995年4月,应用碳—钛组合式人工股骨头治疗髋关节疾患319例。随访最短1年,最长15年。随访结果:股骨颈骨折组优良率93％,股骨头无菌性坏死组优良率89.8％。余者2例失败,4例髋关节周围钙化,2例碳质头略大,3例假体下沉,1例类风湿性髋关节强直,术后关节再强直。1例髋臼硬化,4例6髋关节明显疼痛。4例死于心血管疾病。我们体会到碳质材料具有良好的物理、化学性能和生物相容性,是一种优良的人工关节材料。碳—钛组合式人工股骨头是目前优良的人工假体之一。     

Hyperaemia prior to acute cerebral swelling in severe head injuries: The role of transcranial doppler monitoring

Summary Acute cerebrovascular congestion after a closed head injury is significantly related to intracranial hypertension. As an indirect method of cerebral blood flow measurement, transcranial doppler sonography (TCD) provides a rapid and noninvasive assessment of cerebral haemodynamics, including hyperaemic conditions.TCD examinations was serially performed in 35 patients with severe head injury with intact cerebral circulation; i.e. the mean flow velocity (MFV) patterns of the middle cerebral artery (MCA) did not show signs of cerebral circulatory arrest such as systolic spike, to and fro, or no flow. The results showed that the MFV of the MCAs and ipsilateral extracranial internal carotid arteries (ICAs) in 9 of these patients increased sharply and pulsatility index (PI) decreased during 48–96 hours after the injury. This was soon followed by patterns of high intracranial resistance, consistent with elevated intracranial pressure (ICP) in monitored patients and acute brain swelling on repeated computed tomographic (CT) scans. The correlation between increased MFVs, decreased PIs, and cerebral haemodynamic changes leading to acute brain swelling is discussed.The number of patients who ended with severe disability, vegetative state, or death was 66% in this group of 9 patients, compared to only 34% for the 35 patients overall with severe head injury. Though the morbidity and mortality rates largely depend on the primary injury, the presence of acute cerebral swelling aggravate the grave course in these patients. And the ability of TCD to monitor the hyperaemic state prior to oedema should lead us to adjust the therapy in order to minimize the secondary insult related to intracranial hypertension.     

Short-term lack of cerebral perfusion with good outcome. Advantages of early intracranial pressure monitoring

A 21-year-old man was injured by a tailboard of a truck. He suffered a severe head injury with bilateral depressed skull fractures necessitating surgical decompression. On admission to the hospital the patient showed bending to pain stimuli (Glasgow Coma Score 5). Anisocoria was noticed from the beginning. Initial intracranial pressure (ICP), measured 3 hours after injury, was 30 mm Hg, and the cerebral perfusion pressure (CPP) was 70 mm Hg. During surgical elevation of the skull fracture on the right side an unexplainable rise of ICP to values of 100 mm Hg occurred, which corresponded to the mean arterial blood pressure (MAP). At the same time both pupils were dilated and fixed indicating a lack of cerebral perfusion. Due to immediate trephination of the opposite side, the ICP was lowered to values below 20 mm Hg, and sufficient cerebral perfusion (above 50 mm Hg) was regained. The patient showed a good recovery and was transferred to a rehabilitation center 5 weeks after injury.This case report emphasizes the importance of early and continuous intracranial pressure monitoring for adequate therapy in neurosurgical emergencies.     

头低位限制活动对家兔主要脏器微血管壁通透性的影响

本文报导了用40只白色短毛家兔所做的动物模拟失重实验,得出各脏器微血管通透性的动态反应曲线。并用微循环研究方法,分析了模拟失重时各脏器微血管功能状态与微血管通透性之间的关系;阐述了各脏器微循环功能变化特点;并对变化机理作了初步探讨。     

Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 Cases

Summary 115 traumatic extradural haematoma cases who were treated surgically at Cerrahpasa Medical Faculty Neurosurgery Department between 1987 and 1992 are evaluated.When factors affecting the outcome were examined, a strong correlation was found between the result andGlasgow coma scale (GCS) (p<0.00001). The existence of a fracture, the interval between onset of haematoma symptoms and intervention and the existence of an intracerebral haematoma together with contusion accompanying intradural haematoma, affect the outcome in a negative direction. There was no statistical correlation between the outcome and the age of patient, localization of the haematoma and aetiology.     

带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损

目的：介绍带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损的应用解剖、手术方法及临床效果。方法：在２０侧成人上肢标本上，观测前臂后皮神经及桡侧副动脉的行程及外径，设计以桡侧副动脉为蒂的前臂后皮神经电缆式移植修复上臂桡神经缺损的新术式并应用于临床。结果：前臂后皮神经与桡侧副动脉伴行关系密切，具有形成带血管蒂前臂后皮神经转移的解剖学条件；前臂后皮神经横径２．０ｃｍ左右，可切取长度１５．０ｃｍ左右，折叠后可以修复７．０ｃｍ左右的桡神经缺损。同时，术中发现神经供体断端出血活跃，说明带血供的前臂后皮神经移植的血供是可靠的。临床应用８例，神经缺损３．５～６．０ｃｍ，随访１０个月～３年，效果满意。按陆裕朴介绍的评定标准：优４例，良３例，可１例。结论：该术式转移灵活，操作简单、安全、可靠，对供区影响小，是修复上臂桡神经缺损的一种有用的方法。     

胰头静脉弓的16层CT研究

目的探讨16层CT的各种血管成像方法对胰头静脉弓的正常表现及显示率方法对40例非腹部疾病患者行胰腺静脉期扫描,使用轴位图像、薄层最大密度投影(TSMIP)和容积再现(VR)图像分别评价胰头静脉弓的表现及显示率结果轴位图像、TSMIP和VR显示胃网膜右静脉均为100%,胃结肠干均为80%,右结肠上静脉分别为100%、87.5%、80%;胰十二指肠上后静脉分别为92.5%、65%、40%;胰十二指肠上前静脉分别为92.5%、62.5%、45%结论使用16层CT,联合轴位、TSMIP和VR图像可以清楚显示胰头静脉弓     

颈淋巴结清除改进术138例

探讨颈淋巴结清除术的手术改进方法及其临床效果.方法:回顾性总结138例颈淋巴结清除术患者的手术改进方法和临床效果的临床资料.结果:病理证实有淋巴结转移102例,淋巴结转移数为1～36枚,平均手术时间为2 h,术中出血量为130 ml,手术并发症为2.2%.2年、3年生存率分别为85.6%和8 2.1%.结论:改进后的颈淋巴结清除术具有快速、安全、有效、术中出血少等优点,值得推广应用.     

A method to quantitate axonal injury

The quantitation of diffuse axonal injury provides a more objective approach to the assessment of tissue damage in head injuries. The method designed in this study takes into account the anisotropy and structural inhomogeneity of the brain, and the distribution of lesions in diffuse axonal injury. The number of counts required for the statistical analysis is inversely proportional to the square of the desired accuracy, specified as the percentage of the mean value of the axonal balloons since the true mean is unknown from the outset. The number of fields are examined using an indexed-squares graticule in 10 different areas of the brain. Silver-stained sections from the brains of head injured patients that survived longer than 12 h must be used with this method. Difficulties may arise when patients of different survival times are compared since it takes some time for the axonal balloons to develop. A correlation with the survival time can be established with the quantitative data collected. The morphometric principles and the statistical rationale on which this methodology is based are briefly presented.