老年股骨粗隆间骨折的分类与手术方法的选择

回顾性分析1990年1月-2001年12月手术治疗219例老年股骨粗隆间骨折患者的诊治情况,探讨其骨折分类与治疗方法的选择.……     

改良Hardinge入路在非骨水泥全髋置换术中的应用

目的：对改良Hardinge入路行全髋置换进行评价。方法：对经改良Hardinge入路行非骨水泥全髋置换（THR－CL）术并获术后6个月以上随访的32例病人进行总结。结果：优良28例（88％），很好4例（12％），其中轻度跛行6例（19％），下肢不等长＞2cm1例（3％），改良Trendelenburg试验阳性3例（10％）。结论：此入路创伤小，暴露好，利于假体定位，易于控制下肢长度，术后外展肌功能恢复快。     

Ⅱ型浮膝损伤术后膝关节功能康复

目的:总结Ⅱ型浮膝损伤患者的治疗方法和手术后膝关节功能康复疗效。方法:回顾分析经治的68例患者,男57例,女11例;年龄17~60岁。68例共74侧肢体的Ⅱ型浮膝损伤-膝关节内骨折病例,其中双侧肢体Ⅱ型浮膝骨折6例。根据患者骨折类型、是否存在开放性损伤、软组织损伤程度分别采用内固定(髓内钉、解剖钢板)和支架外固定方法,术后均采用统一、系统的康复治疗。术后对治疗结果采用Karlstrom和Olerud的浮膝损伤治疗标准进行评价;使用χ2检验对两种固定方法治疗后膝关节功能康复效果差别进行显著性分析。结果:所有病例均得到1~4年的随访,平均24个月。内固定组优良率64.29%,支架外固定组优良率80.43%。内固定组与支架外固定组比较,膝关节活动受限度指标有统计学差异(P<0.05),说明Ⅱ型浮膝损伤应当注重对关节内骨折的复位和减少对膝关节周围软组织的破坏。结论:①早期功能恢复期支架组优于内固定组;②牵引后及术后早期系统的康复治疗有利于膝关节功能恢复和减少并发症;③伸膝功能锻炼应当在牵引治疗后即开始,膝关节屈伸功能锻炼在手术后3d进行。     

脑干区占位病变的手术入路

本文报告了1990年5月以来脑干区大型、复杂占位病变15例.其中,位于脑干内3例,脚间窝2例,岩尖部4例,全岩骨区1例,全斜坡区2例,第四脑室内3例.本组采用以扩大了的岩骨入路为主的联合入路,行肿瘤全切除8例,次全切除5例.2例仅作了活检加减压术.除1例死亡外,均恢复良好.本文结合文献,对脑干区手术入路进行了讨论.     

嗜铬细胞瘤手术治疗(附120例报告)

９７３年９月至１９９５年６月手术治疗嗜铬细胞瘤１２０例，其中良性１１３例（９４０％），恶性７例（５９％）。Ｂ超、ＣＴ对肾上腺嗜铬细胞瘤的诊断率分别为８９０％、９７０％。强调充分的术前准备，严密的术中及术后监测是手术治疗的三个重要环节。本组无症状嗜铬细胞瘤占７５％。恶性嗜铬细胞瘤的治疗仍以手术治疗为主。     

耳脑医用粘合剂修补脑脊液漏

耳脑医用粘合剂是α－氰基丙烯酸正辛酯和α－氰基丙烯酸正丁酯及少量添加剂配伍而成的复合性医用粘合剂。应用此粘合剂粘合修补脑脊液漏２７例，其中外伤性脑脊液鼻漏５例，经鼻蝶入路垂体瘤切除术脑脊液漏６例，开颅手术后手术切口脑脊液漏１１例，脊膜膨出修补术后脑脊液漏５例。成功２５例，成功率９３％。应用此粘合剂修补脑脊液漏具有简便、迅速、有效的特点。     

Enhanced stimulus-reward learning by intra-amygdala administration of a D3 dopamine receptor agonist

The amygdala is considered to be a critical neural substrate underlying the formation of stimulus-reward associations, and is known to receive substantial innervation from dopaminergic neurons located within the ventral mesencephalon. However, relat- ively little is known about the function of the mesoamygdaloid dopamine projection in stimulus-reward learning. Recently, we have found post-session intra-amygdala microinjections of d-amphetamine to enhance appetitive Pavlovian conditioning as assessed in a discriminative approach task. In the present study, we have examined the effects of dopamine receptor agonists possessing relative selectivity for the D₁, D₂ and D₃ receptor subtypes in order to examine more fully the role of the mesoamygdaloid dopamine projection in stimulus-reward learning. Thus, subjects were trained to associate an initially neutral stimulus (CS⁺) with 10% sucrose reward (US). A second, control stimulus (CS⁻) was also presented but never paired with sucrose reward. In order to measure specifically the conditioned response to CS⁺/CS⁻ presentation, responding during CS and US presentations was measured separately. Immediately following each training session, subjects received bilateral intra-amygdala infusion of 0.1, 1 or 10 nmol/side of SKF-38393, quinpirole or 7-OH-DPAT. Infusions of SKF-38393 or quinpirole were without effect on CS⁺ approach. However, post-session intra-amygdala infusions of 7-OH-DPAT enhanced selectively CS⁺ approach in a dose-dependent fashion. No dose of any drug affected CS⁻approach, US behaviours, or measures of extraneous behaviour. Subsequent acquisition of a novel conditioned instrumental response was also unaffected. Thus, the present data indicate a selective involvement of the D₃ dopamine receptor subtype in the modulation of stimulus-reward learning by the mesoamygdaloid dopamine projection. Received: 12 December 1996 / Final version: 9 April 1997     

Staple penetration and staple histological response for attaching an epimysial electrode onto the abdominal surface of the diaphragm using a laparoscopic approach

Background: Laparoscopic stapling was found to be a viable option for attaching epimysial electrodes onto the abdominal surface of the diaphragm. Stapling was preferable to suturing due to its simplicity and speed. Methods: Of the two staplers tested in this study, the Ethicon Endopath was preferred over the Autosuture Endo Hernia because the staples did not penetrate the diaphragm when an electrode tab thickness greater than 0.75 mm was used. Results: The thickness of the electrode tab was an important factor in determining staple penetration but large variation in penetration depth indicated that other factors may also play a role. An electrode tab thickness of 1.0–1.25 mm was suggested to minimize the risk of diaphragm perforation. Conclusions: The histological reaction to staples implanted up to 14 months was unremarkable, reflecting the safety of laparoscopic staples for permanently anchoring electrodes on the diaphragm. Received: 2 April 1996/Accepted: 12 June 1996     

(足母)趾跖趾关节滑膜性骨软骨瘤病1例报告

患者,女,32岁,因左(足 母)趾内侧疼痛8年,加重伴(足 母)趾肿胀1个月入院。入院前曾行血尿酸、抗O、RF未见异常,ESR28mm/L。入院查体:疼痛性跛行,左(足 母)趾跖趾关节周围红肿,有压痛,第一跖趾关节活动度检查:跖屈与背伸均为30°。X线示左(足 母)趾第一跖趾关节跖内侧可见多数散在的、大小相仿的高密度钙化影(图1)。入院诊断:左(足 母)趾跖趾关节滑膜性骨软骨瘤病。完善术前各项准备后,于2001年7月24日在连续硬膜外麻醉下行左(足 母)趾跖趾关节滑膜性骨软骨瘤切除术。     

A transcrista galli, translamina terminalis approach for highly placed basilar bifurcation aneurysms

Summary Surgery for highly placed basilar bifurcation aneurysms is one of the most difficult operations in neurosurgery. Specific surgical techniques have been developed including the temporopolar, zygomatic, transzygomatic subtemporal, transclinoid trans-sellar transcavernous, and trans third ventricular approaches. The authors present some technical advances which have been developed for the transcristagalli translamina terminalis approach for the treatment of this aneurysm.