骨前康颗粒与加昧补中益气汤辅助防旋股骨近端髓内钉治疗老年股骨粗隆间骨折临床研究

目的:观察骨前康颗粒与加味补中益气汤辅助防旋股骨近端髓内钉(PFNA)对老年股骨粗隆间骨折的治疗效果。方法:选取老年股骨粗隆间骨折患者为观察对象,根据其治疗方式分为对照组和观察组,两组患者均接受PFNA治疗,对照组在术后给予常规西药治疗,观察组在此基础上给予骨前康颗粒与加味补中益气汤治疗。观察两组患者愈合时间,比较两组治疗前后炎症因子水平、功能恢复和并发症发生率的差异。结果:观察组患者下床活动时间和骨折愈合时间分别为(42.35±6.01)d、(3.35±0.97)月,均较对照组短(t=17.982、7.517,P<0.001);两组患者治疗前Harris评分无差别,治疗后,观察组患者Harris评分优于对照组(χ^2=8.635,P=0.035);观察组CRP、IL-6和TNF-α水平低于对照组(t=7.583、5.456、13.664,P<0.001);两组患者畸形愈合、伤口感染、骨不连和髋内翻发生率无差别(χ^2=0.346,P=0.556)。结论:骨前康颗粒与加味补中益气汤辅助PFNA可促进老年股骨粗隆间骨折患者的术后恢复。     

Clinical Outcomes after Apical Surgery on the Palatal Root of the Maxillary First Molar Using a Palatal Approach

IntroductionClinicians are often reluctant to use the palatal approach in apical surgery for the maxillary first molar. This study aimed to investigate the outcomes and complications associated with apical surgery on the palatal root of the maxillary first molar by using a palatal approach.MethodsWe searched for patients who underwent apical surgery with a palatal approach on the palatal root of the maxillary first molar between March 2010 and September 2017 by a single operator. A total of 46 teeth from 46 subjects were included, and they were examined at 6 and 12 months after surgery and annually thereafter. To evaluate whether there was nerve damage on the surgical side, a pinprick test and cotton swab test were used with a 0–10 numerical rating scale, and the results were statistically compared by using the Wilcoxon signed-rank test.ResultsOf the total 35 recall cases (recall rate, 76%; average follow-up time, 3.5 years), success was considered achieved in 32; 30 cases showed complete healing, and 2 had incomplete healing. Three cases resulted in failure, all occurring within 1 year after surgery. The pinprick test results showed that all the numerical rating scale scores were higher than 7, and the responses on the surgical site were not statistically different from those on the contralateral site (P = .109). All subjects showed normosensitivity to the cotton swab test.ConclusionsApical surgery on the palatal root of the maxillary first molar using a palatal approach was predictable and successful, and the number of complications resulting from artery and nerve damage was small.     

Endovascular Treatment of an Anatomically Complex Iliac Lesion and a Review of Variant Iliac Venous Anatomy

The diagnosis and treatment of pelvic venous disease is complicated by a number of potential venous anatomic variants. Stent-assisted recanalization of a chronically occluded left external iliac vein draining directly into the inferior vena cava, with absence of the left common iliac vein, is described here. Variant iliac venous anatomy is reviewed in 3 categories: additional iliac vessels, absence/shortening of iliac vessels, and deviations in the drainage pattern of iliac vessels. Additionally, variations of the ascending lumbar and iliolumbar veins, the identification of which can aid in the treatment of pelvic venous disease, are described.     

开放切除手术治疗股骨小转子部骨样骨瘤的疗效分析

目的：探讨股骨小转子部骨样骨瘤的影像学特点和开放切除术治疗的疗效。方法：回顾性分析2013年7月 至2015年8月在中南大学湘雅二医院接受开放切除手术治疗的股骨小转子部骨样骨瘤患者14例，男9例，女5例，年龄 9~44(平均20)岁，病程3~36(平均8)个月。术前完善X线、CT和MRI检查，术后3个月内避免剧烈运动。结果：14例患 者中皮质型骨样骨瘤9例，骨膜型5例。9例患者可在X线片发现瘤巢，14例患者CT均可发现瘤巢。14例患者术前未服 用非甾体抗炎药的情况下，视觉模拟评分(visual analogue scale，VAS)平均6.5分。随访9~34(平均20)个月。患者术后1个 月VAS平均0分，随访中无疼痛症状复发，无感染，无血管神经损伤和骨折等并发症发生。结论：开放切除手术治疗 股骨小转子部骨样骨瘤，术后复发率低，并发症少，是一种较好的治疗方法。     

用大网膜填塞治疗胸壁慢性炎症

应用带血管蒂大网膜填塞治疗5例胸壁慢性炎症,取得良好效果。利用大网膜填塞治疗胸壁慢性窦道时,应排除窦道形成的常见因素,否则,达不到治疗目的。找出了大网膜片的制取及填塞方法。     

带蒂大网膜在低位直肠癌根治术中应用的体会

腹会阴联合切口治疗低位直肠癌,留有巨大的骶前和会阴缺损,常使创口延期愈合,我们于1935年11月～1986年5月应用带蒂大网膜经左腹膜后作骶前间隙填塞术治疗低位直肠癌7例,使会阴创口一期愈合率为59%。带蒂大网膜吸收和抗感染能力强,易与周围组织迅速建立侧支循环,同时又保留胃网膜血管弓,可任意裁剪延长,是低位直肠癌根治术中消灭骶前和会阴残腔的理想自身填充材料。感染与血供障碍易影响本术的创口一期愈合。     

胸大肌肌皮瓣瓣体部的改良

目的：旨在克服传统胸大肌肌皮瓣的不足，使皮瓣更薄，更长，可供皮肤面积更大，血液循环更可靠，有利于被修复处的美观与功能，方法：改进胸大肌肌皮瓣瓣体部的设计。结果：应用经改良的胸大肌肌皮瓣修复口腔颌面部大范围软组织缺损28例，取得了满意的效果，皮瓣长度可增加4cm-6cm，皮肤面积可增加10cm^2-20cm^2，皮瓣无1例坏死或部分坏死，修复后，舌体，唇颊部的外形佳，被动运动好，颜面无明显凹陷畸形，结论：改良的胸大肌肌皮瓣具有更薄，更大，更长，血液循环更可靠的优点，是修复大范围组织缺损的良好修复材料。     

内脏大神经不同类型传入纤维兴奋的血压效应

19只猫,用α-氯醛醣麻醉、三碘季铵酚麻痹和人工呼吸。电刺激左侧内脏大神经中枢端。刺激A类纤维,其传导速度为40～60米/秒,引起血压降低或升高,这些反应取决于刺激频率,用频率1Hz刺激时,引起血压下降;频率20Hz刺激,则引起血压升高。阳极电流阻断A类传入纤维后,刺激C类纤维,其传导速度为0.5～2米/秒,则引起血压升高。这些结果表明,内脏大神经传入纤维兴奋的血压效应取决于纤维类型和刺激频率。     

The femoral neck lengthening osteotomy

Surgical Principles Premature closure of the epiphyseal plate can be a complication of hip dysplasia, Perthes disease, trauma or septic arthritis of the hip. As a result, the proximal femur may show a typical deformity with shortening of the neck of the femur and relative overgrowth of the greater trochanter. The femoral neck lengthening osteotomy aims at restoring the normal anatomy with restitution of the length of the femoral neck and leg length, and improving the lever arm of the abductors. The procedure includes three osteotomies parallel to the blade of a 130° or 120° blade plate. Lateralization of the shaft effectively lengthens the femoral neck. A part of the overgrown greater trochanter is used to fill the gap proximally to the lateralized shaft. The remaining trochanter is pulled distally and fixed to the femur. Revised Version from: Operat. Orthop. Traumatol. 1 (1989), 170–178 (German Edition).     

Tuberculous bursitis of the greater trochanter

A patient with tuberculous bursitis of the greater trochanter is reported. A 37-year-old woman had experienced persistent dull hip pain and noticed diffuse swelling over the greater trochanteric region. Plain radiograph revealed unremarkable osteopenic changes in the greater trochanter and faint mineralization in the vicinity of the trochanter. Computed tomogram showed erosion of the trochanter and a large soft tissue mass. Magnetic resonance imaging demonstrated a large multicystic mass. Histology of the cyst wall, showing chronic granulomatous tissue, and a positive culture of Mycobacterium tuberculosis confirmed the diagnosis of musculoskeletal tuberculosis. Complete excision of the lesion, followed by 6 months of antituberculous chemotherapy with rifampicin and isoniazid, cured the disease. There has been no sign of recurrent disease in 30 months of follow-up. Correct diagnosis was difficult because of its rarity, but modern imaging technology, magnetic resonance imaging, in particular, was extremely useful for showing the extent of the disease. Tuberculous infection should be considered as a differential diagnosis in patients with persistent hip pain. Received for publication on July 11, 1997; accepted on Nov. 6, 1997