臂丛神经闭合性损伤和肿瘤的超声诊断

目的探讨高频超声在诊断臂丛神经闭合性损伤和肿瘤中的价值。方法用高频超声检查和诊断6例创伤性臂丛神经损伤与3例臂丛神经肿瘤，随机选择12例健康成年人作为正常对照组，观察臂丛神经的正常超声图像。结果高频超声显示斜角肌间隙和锁骨下动脉是臂丛神经检查的重要解剖标志，正常臂丛神经长轴显示多条线性平行回声，短轴呈圆形中等回声，内有点状弱回声，C5-7和上、中干显示率为100％（12／12），C8、T1和下干显示率为83．3％（10／12）。6例臂丛神经损伤显示神经增粗水肿，部分正常束状回声消失或不连续，内部点线回声不清，呈略低回声与周围软组织粘连。3例臂丛神经肿瘤显示为实性瘤样低回声与臂丛神经相连续，其内有血流信号，其中2例为超声检查最早诊断。结论高频超声可作为检查臂丛神经闭合性损伤和肿瘤的首选方法，值得临床推广应用。     

膝前框形钢丝内固定治疗髌骨骨折

目的　总结采用钢丝环扎 +膝前方框形张力带钢丝内固定法治疗髌骨骨折的经验和临床效果。方法　对 3 5例髌骨骨折应用此方法治疗 ,其中男性 2 4例 ,女性 11例 ,3 0例获得 3～ 2 4个月随访。结果　优 19例 ,良 10例 ,可1例 ,优良率 96 7%。术后未出现骨折再移位 ,无伤口感染。愈合时间 6～ 12周。结论　该方法符合生物力学原理 ,操作简便 ,适应证广 ,能早期关节活动 ,是治疗髌骨骨折的理想方法之一。     

无张力阴道吊带术治疗女性压力性尿失禁

目的：探讨无张力阴道吊带术(TVT)治疗女性压力性尿失禁的初步疗效和手术安全性。方法：对20例经过临床和尿动力学检查诊断为压力性或混合性尿失禁的女性患者进行TVT手术治疗，并对手术效果和并发症进行初步的随访研究。结果：平均手术时间40min(25—100min)，平均术后住院3．2d(1—28d)。18例单纯性压力性尿失禁患者16例治愈，治愈率为88．89％(16／18)，另2例显效(11．1％)。2例混合性尿失禁患者中1例显效，另1例无效。术后发生尿潴留3例，2例作松解术，1例延长导尿管留置时间后缓解。发生局部血肿1例经保守治疗后康复。结论：TVT手术是一种治疗压力性尿失禁的安全有效的方法，具有手术简单、创伤小、并发症少、患者康复快等优点。     

Effect of environment on extremely severe road traffic crashes：retrospective epidemic analysis during 2000-2001

Objective: To make an epidemiological analysis of the effect of environment on extremely severe road traffic crashes (RTCs). Methods: Epidemiologic data of extremely severe RTCs associated with environmental factors, including weather, topography, road conditions and other traffic conditions in Mainland China during 2000-2001, were collected and analyzed. Results: ( 1 ) During 2000-2001, there were 3 365 extremely severe RTCs with 13 666 deaths, 12 204 injuries and a direct economical loss of 136 million RMB. ( 2 ) Most extremely severe RTCs occurred in fine weather days and in the daytime. The high occurrence sites were plain areas, horizontal and straight roads, Grade B and C roads, ordinary road segment, and asphalt, smooth and mixed roads. (3) Compared with other RTCs, extremely severe RTCs were more likely to happen under following conditions: on cloudy, snowing, misty and blustering days; in hill and mountainous areas; on crooked and sloping roads; on freeway, Grade A, B, and C roads; mixed roads; ordinary, bridge, narrow and transitional roads; sand and dirt-roads; without traffic control measures; night without lighting. (4) Extremely severe RTCs of mountainous area or crooked and sloping roads were most severe in terms of deaths and injures per crash. Conclusions: Extremely severe RTCs are closely related with environmental factors. Rational road programming, enhancing road establishment and improving road conditions are probably effective measures to reduce the road traffic injuries.     

Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation

Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radioscapholunate (RSL) ligament. This malposition should be called rotatory palmar subluxation of the lunate (RPSL), by analogy to rotatory subluxation of the scaphoid (RSS). In contrast to dorsiflexed intercalated segment instability (DISI), in RPSL the RSL ligament is ruptured and, in the majority of cases, the scapholunate ligament remains intact. A prompt diagnosis should lead to successful treatment.     

应用张力带固定法治疗锁骨远端骨折

目的：评价张力带固定法治疗锁骨远端骨折的临床效果。方法：对20例锁骨远端骨折行切开复位后张力带固定法治疗。术后随诊分析。结果：所有骨折均在半年内愈合。患侧肩关节功能恢复良好。无一例出现伤口感染。结论：张力带固定治疗锁骨远端骨折是一种简单可靠的手术方法。     

肝外伤157例临床治疗分析

目的 提高对不同类型肝外伤的诊断和治疗水平。方法 回顾性总结1990年9月至2002年1月我中心收治的157例肝外伤患者，包括非手术治疗32例，手术治疗125例。结果 非手术治疗32例，完全治愈28例，4例死亡。手术治疗125例，完全治愈107例，死亡18例，总治愈率85．9％(135／157)，病死率14．1％(22／157)，其中9例死于多发性创伤合并多器官功能衰竭(MOF)，8例死于肝内大血管损伤引起的出血，5例死于术后并发症。结论肝外伤病情危重，临床表现复杂，早期正确诊断、及时和合理的手术治疗是减少死亡率提高救治水平的关键，积极抗休克，实行重症监护和防治并发症等非常重要。血流动力学稳定的患者可行非手术治疗。     

踢伤至臀筋膜室综合征1例报告

骨筋膜室综合征是骨科创伤常见的并发症 ,如治疗不及时、处理不当会造成神经肌肉缺血变性、坏死甚至危急生命 ,给患者带来伤残和严重的后遗症。现将 1例踢伤致右侧臀筋膜室综合征的病例报道如下 :患儿 ,男 ,12岁 ,以踢伤右臀部伴右下肢活动障碍 10ｄ为主诉。患儿 10ｄ前被足踢伤右臀部 ,当时自觉疼痛 ,走路跛行 ,没有重视 ,也未作任何治疗。伤后 7ｄ ,又被踢伤右臀部 ,当时自觉疼难忍 ,逐渐发现右臀部肿胀加重、皮肤发亮 ,在当地县医院就诊住院对症治疗 ,未能缓解症状 ,故来我院就诊 ,门诊以右侧臀筋膜室综合征收住院。入院检查 :Ｔ 38 5℃…