克氏针丝线张力带治疗拇指掌指关节尺侧副韧带撕脱骨折

目的探讨克氏针丝线张力带治疗拇指掌指关节尺侧副韧带撕脱骨折的临床疗效。方法 2008年9月-2011年10月,收治14例拇指掌指关节尺侧副韧带撕脱骨折患者。男8例,女6例;年龄23～55岁,平均40.8岁。致伤原因:机器扭转伤5例,人力扭转伤4例,跌伤4例,运动伤1例。受伤至手术时间2 h～14 d。患者拇指掌指关节疼痛,活动受限,掌指关节尺侧侧方应力试验阳性。采用克氏针丝线张力带固定骨折,2周后开始功能锻炼。结果术后切口均Ⅰ期愈合,拇指掌指关节尺侧侧方应力试验阴性。患者均获随访,随访时间6～18个月,平均13.1个月。X线片检查示骨折复位、愈合良好,愈合时间为4～10周,平均7周。末次随访时,患指掌指关节屈伸活动稳定,对指功能正常,手指抓捏功能正常。按照Saetta等标准评价术后功能,获优11例,良3例,优良率达100%。结论克氏针丝线张力带具有手术操作简便、术后功能锻炼早、功能恢复满意的优点,是治疗拇指掌指关节尺侧副韧带撕脱骨折的有效方法之一。     

侧副韧带和跖板对跖趾关节屈曲功能的影响

目的探讨侧副韧带、跖板对跖趾关节屈曲功能的影响. 方法取成人尸体第2～4足趾,共24趾.按切断双侧侧副韧带和跖板的不同顺序均分为A、B两组(n=12),A组先切断双侧侧副韧带,再切断跖板薄弱部分,B组按相反顺序切断,观察不同顺序切断前后相同负荷下跖趾关节屈曲角度的变化.并于1994年5月～2000年7月,应用第2足趾游离跖趾关节复合组织移植重建第2和第3掌指关节11例,其中2例行跖板切除术,另9例行跖板 双侧侧副韧带切除术. 结果 A组,术前跖趾关节屈曲角度为37.30±5.42°,切断双侧侧副韧带后屈曲角度增加11.29±2.36°,达48.60±2.98°,与切断前比较差异有统计学意义(P<0.01);再次切断跖板后,屈曲角度增加5.30±1.59°,达53.35±2.76°,与切断前比较差异有统计学意义(P<0.01).B组,术前跖趾关节屈曲角度为34.59±5.32°,切断跖板后屈曲角度增加6.29±2.98°,达40.89±2.36°,与切断前比较差异有统计学意义(P<0.01);再次切断双侧侧副韧带后,屈曲角度增加9.71±1.94°,达50.60±2.01°,与切断前比较差异有统计学意义(P<0.01).切断双侧侧副韧带与切断跖板比较,前者更能增加跖趾关节的屈曲角度(P<0.01),二者切断的先后顺序对总屈曲角度改变影响无统计学意义(P>0.05).临床应用后随访显示,仅切断跖板者经2个月随访,屈曲角度为15～45°;切断跖板 双侧侧副韧带者经26.3个月随访,屈曲角度为10.3～58.4°. 结论切断双侧侧副韧带及跖板可增加跖趾关节屈曲角度.     

膝关节内侧副韧带急性损伤诊治方法的探讨

目的探讨膝关节内侧副韧带急性损伤的诊治方法. 方法 1998年8月～2003年8月,对收治的87例膝关节内侧副韧带急性损伤均进行膝关节功能及MRI检查.其中35例Ⅰ、Ⅱ度损伤者行保守治疗;52例Ⅲ度损伤者行关节镜探查术,修复内侧副韧带,其中有21例应用前半部的股薄肌肌腱加强. 结果 32例Ⅰ、Ⅱ度损伤患者获6～24个月随访,平均13个月,按Lysholm评分标准,优良率达93.7%;50例Ⅲ度损伤患者术后获随访7～72个月,平均16个月,优良率达90%. 结论 MRI是确诊内侧副韧带Ⅰ、Ⅱ度损伤的重要手段,膝伸直位外翻应力时的直向不稳定是确诊Ⅲ度损伤的主要方法.Ⅰ、Ⅱ度损伤以保守治疗效果好,Ⅲ度损伤宜选择手术治疗.     

带尺侧下副动脉尺神经松解前置术治疗肘管综合征

目的 总结带尺侧下副动脉尺神经松解前置术治疗肘管综合征的手术方法及临床效果.方法 2005年9月-2006年5月,采用保留尺侧下副动脉在尺神经上的吻合支,行带血供尺神经松解前置术治疗25例肘管综合征.男19例,女6例:年龄20～72岁,平均60岁.发病至手术时间2个月～3年,平均6.7个月.发病原因:骨性关节炎23例,肘管内囊肿及尺神经滑脱各1例.术前按Pasque肘管综合征评分系统评定:可19例,差6例.电生理检查:肘关节周围尺神经运动神经传导速度<42 m/s.结果 术后切口均1期愈合,无手术并发症及复发患者.25例术后均获随访,随访时间1年～2年半,平均13.9个月.按Pasque肘管综合征评分系统评定:优15例,良9例,可1例,优良率96%;与术前评定结果比较,差异有统计学意义(P＜0.05).电生理检查;肘关节周围尺神经运动神经传导速度>42m/s.结论 带尺侧下副动脉尺神经松解前置术是治疗肘管综合征的安全有效方法之一.     

NON-OPERATIVE TREATMENT OF DISPLACED AVULSION FRACTURES OF THE ULNAR BASE OF THE PROXIMAL PHALANX OF THE THUMB

Treatment of displaced or rotated avulsion fractures of the ulnar base of the proximal phalanx of the thumb remains controversial. There is limited information on the outcome of management of these injuries by non-surgical means. We undertook a retrospective follow-up study of the non-operative treatment of these fractures. The study included 28 thumbs that were stable to lateral stress testing at the time of initial investigation. The patients were treated by immobilisation of the thumb in a spica cast. The mean follow-up interval was 2.5 years (range 1-4). None of the patients changed their permanent employment or was unable to participate in their usual sporting activities. Twenty-six patients (93%) reported no pain on movement of the thumb. At follow-up, grip and pinch strengths did not differ significantly on the injured and non-injured sides. No thumbs showed instability on stress testing. The fractures had a 40% rate of bony union and 60% rate of fibrous non-union. All the patients were satisfied with their outcome. None of the patients was operated on after treatment. Non-operative treatment is recommended in cases of displaced or rotated avulsion fractures provided that there is no lateral instability of the metacarpophalangeal joint. Patients with unstable thumbs should always be treated surgically.     

INSURANCE AND THE RISK OF RUPTURED APPENDIX IN THE ADULT

Background : Disparities in medical care related to the insurance status of patients have been reported. A retrospective analysis was performed to examine the insurance-related differences in the risk of appendiceal perforation in the Prince of Wales Hospital (POWH), New South Wales. Methods : Computerized data of 1179 patient years who had a diagnosis of appendicitis and were admitted to the POWH over the preceding 10 years were examined. The outcome measure was appendiceal perforation. Patient variables examined were insurance status, sex, age, and socio-economic status (SES). Three hundred patients over the same period were identified who had an appendicectomy but not appendicitis. Multiple logistic regression and Fisher’s exact test were used for statistical analysis. Results : The overall perforation rate in 1179 patients was 17%. The only factor that was related to an increased risk of perforation was age over 50 years (odds ratio (OR)1.57; 95% confidence interval (CI) 1.04–2.53). Sex, insurance status or SES were not associated with a higher risk of perforation. The overall rate of negative appendicectomy was 20% (300 of 1479 patients), and the rate was higher in the uninsured patients (22 vs 17%, P = 0.014, Fisher’s exact test). Conclusions : Lack of health insurance was not associated with an increased incidence of appendiceal perforation at the POWH. Age over 50 years was identified as the only risk factor for appendiceal perforation. The lower negative appendicectomy rate in the insured group may be because of better diagnostic ability of consultants compared to registrars.     

原发性肝癌破裂出血的诊断和治疗

目的 探讨原发性肝癌破裂出血的诊断和治疗。方法 回顾性分析21例原发性肝癌破裂出血的诊断及治疗结果。结果 21例患者中,8例行保守治疗,其院内病死率为75％(6／8),13例行手术治疗,手术方法有不规则肝切除手术,肝动脉结扎加网膜填塞缝扎术,单纯网膜填塞缝扎术、其病死率分别为20％(1／5)、50％(3／6)、50％(1／2)。结论 原发性肝癌破裂出血的确诊和治疗对预后有重要意义,早期肝癌破裂肝功能良好者应争取急诊手术探查并争取行肝切除术,如病情不许可,可先行保守治疗,再争取行Ⅱ期或延期肝切除术。     

原发性肝癌自发性破裂的诊断和治疗

目的 探讨原发性肝癌自发破裂出血的诊断和治疗,尤其对保守治疗的评估。方法 回顾性总结原发性肝癌自发性破裂出血的诊断和治疗结果。对各种治疗方法和应注意的一些问题进行讨论。结果 27例患者中,6例行保守治疗,术后病死率为66．6％（4／6）。21例行手术治疗,手术方法有不规则肝切除术,肝动脉结扎＋填塞缝扎术,单纯填塞缝扎术。其病死率分别为25．0％（1／4）,44．4％（4／9）,75．0％（6／8）。结论 原发性肝癌自发性破裂出血的患者采用肝切除术是安全的可行的和有效的,保守治疗的患者选择方面还需进一步探讨。     

经直肠B超在慢性前列腺炎诊断中的价值

用经直肠B超对73例前列腺进行了探测,其中43例为慢性前列腺炎患者,30例为正常人.检查发现慢性前列腺炎组前列腺声像图具有一定的特征,其中36例(84%)内部回声不均,周边区有低回声晕,5例(12%)发现有结节样强回声团,6例(14%)前列腺部尿道呈串珠样改变,3例发现有前列腺囊肿.在测得前列腺各径中,前列腺炎组的长径、横径明显大于正常组,差异显著(P<0.01),前后径无显著性差异(P>0.05).我们认为经直肠B超对前列腺内部结构显示清晰,对了解前列腺炎的发展程度和发现并发疾病、指导治疗有着重要的意义.     

离断拇指复合组织回植皮瓣包埋再造拇指

目的 介绍一种非显微手术行离断拇指再造的良好方法。方法 离断拇指复合组织回植、腹部真皮下血管网皮瓣包埋再造拇指。结果 ５例５指皮瓣及回植的断指复合组织均成活,再造拇指有指甲生长,外形美观,功能良好。感觉略为迟钝。结论 离断拇指,在丧失再植条件,病人拒行足趾移植,并要求重建恢复拇指外形、功能时,采用此法可获较好效果。     

HIGH-RESOLUTION ULTRASONOGRAPHY IN DETECTION AND FOLLOW-UP OF A TUMOUR OF THE FOREARM

A 39-year-old man had a mass in his right flexor medial mid-forearm of unknown aetiology for two years. Preoperative high-resolution ultrasonography showed a well-defined solid mass with reduced echogenicity. The mass was excised and histopathological examination showed neurilemmoma. There had been no recurrence of the tumour six months after operation.     

彩超辅助下的皮下深部软组织内海绵状血管瘤的诊治

目的　准确、有效地对皮下深部软组织内海绵状血管瘤进行诊治。方法　 1996年以来对 15例海绵状血管瘤患者采用彩色多普勒超声仪 (CD)确定血管瘤的诊断、定位 ;并在直接引导下行铜针栓塞治疗或者手术切除治疗。术后 2周～ 1年再以 CD对治疗效果进行判定与监测。结果　 10例患者行直接引导下铜针穿刺 ,2例在 CD引导下直接铜针穿刺进行栓塞治疗 ,3例患者经手术切除 ,均取得满意效果。结论　在非创伤性的 CD辅助下 ,皮下深部软组织内的海绵状血管瘤可以明确诊断 ,采用铜针栓塞治疗或切除术可以达到更准确而有效的治疗效果     

THE USE OF MAMMOGRAPHY IN DIAGNOSIS AND SCREENING

Up to nine per cent of women are destined to have breast cancer. Of these 25% are likely to be occult lesions only detectable on mammography.¹ Early detection is important. Ten year survivals of over 65% can be expected in patients without axillary node Involvement, compared to 25% with nodes.² Apart from biopsy, mammography is the most sensitive method of cancer detection and is therefore of considerable help to the surgeon in evaluation of breast disease     

THE DEVELOPMENT AND ENHANCEMENT OF THE COLLATERAL CIRCULATION IN AN ANIMAL MODEL OF LOWER LIMB ISCHAEMIA

In an animal model of hind limb ischaemia we documented the levels of endogenous basic fibroblast growth factor (bFGF) in control and ischaemic hind limbs, and evaluated the response to the administration of exogenous recombinant bFGF and heparin, Variations in this model were tested for their ability to alter the development of the collateral circulation. Recovery after acute arterial occlusion was significantly delayed by immediate bilateral mirror-image arterial ligations, when compared with either unilateral arterial ligation or delayed contralateral ligations performed after 2 months. If the major veins were also occluded all limbs developed gangrene, tissue loss and a marked delay in the recovery of blood flow, while none of the animals with unilateral arterial ligations developed gangrene. This indicates that the recovery in blood flow during the acute phase in this model is dependent on collateral vessels from the contralateral iliac artery and that major venous occlusion impedes the development of collateral vessels. Lumbar sympathectomy did not alter the recovery of blood flow after arterial occlusion, suggesting that collateral blood flow is not significantly influenced by autonomic neural supply. Following arterial occlusion there was a ten-fold increase in the levels of endogenous bFGF in all ischaemic muscle groups. Intramuscular implantation of bFGF in heparin-sepharose pellets at the time of arterial ligation markedly enhanced the blood flow for 3 weeks compared with untreated ischaemic limbs. A further increment in blood flow occurred if an additional dose of bFGF was administered 4 weeks after ligation. Administration of heparin for 1 week during either the acute or chronic phases of collateral development significantly improved the blood flow in ischaemic limbs. This was neither as profound nor as prolonged as that observed for bFGF. Treatment with heparin for 4 weeks following arterial ligation provide an increased blood flow for the first 3 weeks. These results indicate that tissues respond to ischaemia by an increased release of bFGF and that the evolution of collateral vessels can be enhanced by the administration of both exogenous recombinant bFGF and heparin. We conclude that bFGF is an important biochemical mediator in the development of the collateral circulation.     

ALLEN'S TEST AND SYSTOLIC ARTERIAL PRESSURE IN THE THUMB

The result of Allen's test for arterial patency was comparedwith systolic arterial pressure in the thumb following manualocclusion of the radial artery in 118 patients aged 11–72yr undergoing cardiovascular surgery. In 19 of 235 hands (8.1%),manual compression of the radial artery reduced the systolicarterial pressure in the thumb to less than 40mm Hg, indicatinginadequacy of the collateral ulnar arterial supply. The predictivevalue of a negative Allen's test was 0.992. Thus, in only 0.8%of cases would a negative Allen's test falsely indicate adequacyof the collateral ulnar supply. These results justify generalapplic of Allen's test before radial artery cannulation.     

DIAGNOSIS AND SURVIVAL IN CARCINOMA OF THE LARGE BOWEL

Diagnostic delay was measured in 455 consecutive patients who had large bowel cancer and it was found to be less pronounced than in a previous study in the same hospitals. However overall corrected live year survival remained the same. The duration of symptoms was not correlated with the stage of the disease, nor with five year survival. The pattern of disease resembled other Western series, with an overall corrected five year survival rate of 33.2%. Prognosis was significantly better in women and worse in patients with an elevated ESR on presentation. Intestinal obstruction due to carcinoma did not adversely affect prognosis.     

乳腺癌诊治的进展

早在 1 757年法国ＬｅＤｒａｎ即说过有希望“治愈”乳腺癌 ,历经三个多世纪 ,乳腺癌的诊治虽已发生很大的变化 ,但依然是危害女性的重要疾病之一 ,至今尚未能解释乳腺癌的全部生物行为 ,也无统一的理想治疗方案。现将乳腺癌诊治进展介绍如下。1　分子生物学研究1 .1　端粒酶 (ｔｅｌｏｍｅｒａｓｅ)端粒是真核细胞染色体末端一段重复的ＴＴＡＧＧＧ序列。自 1 978年Ｂｌａｋｂｕｒｎ、Ｇａｌｌ测定第一个端粒序列以来 ,发现多数肿瘤细胞可测出端粒酶活性 ,并将端粒和端粒酶引入至肿瘤的研究中。现证实 ,经 1 ,2 5(ＯＨ) 2 Ｄ3 诱导的雌激素…