经腘静脉穿刺介入治疗髂股静脉阻塞

目的 探讨经腘静脉穿刺介入治疗髂股静脉阻塞的临床应用价值。方法 对58例髂股静脉阻塞经腘静脉穿刺行综合性介入治疗，其中经导管接触性溶栓术42例，经导管血栓抽吸术25例，机械性血栓清除术49例，球囊扩张腔内成形术41例，支架置入术35例，52例预先放置下腔静脉滤器。平均每人接受5．2项介入治疗。根据造影复查和体征将疗效分为优、良、中、差。出院后继续抗凝治疗1个月，抗血小板治疗6个月。门诊随访6个月时作造影复查。结果腘静脉穿刺技术成功率为96．7％（58／60）。2例腘静脉穿刺失败均为盲穿者。出院时介入治疗疗效：优19例；良30例；中8例；差1例。42例取得6个月随访资料，其中优18例；良20例；中1例；差3例。结论经腘静脉穿刺介入治疗髂股静脉阻塞安全有效。     

经腘静脉顺行穿刺治疗下肢静脉血栓的探讨

目的：探讨经腘静脉顺行穿刺治疗下肢静脉血栓的可行性及优越性。方法：下肢静脉血栓患者19例，经对侧股静脉放置下腔静脉滤器后，使用骨科止血带加压成功穿刺腘静脉，15例顺行插管抽血栓，4例使用Amplatz血栓清除器（ATD）。结果：19例均获成功，栓塞血管复通达100％。临床症状消失，无症状性复发。结论：下肢静脉血栓中使用骨科止血带后可有效地提高顺行穿刺腘静脉成功率，是下肢静脉溶栓治疗的有效方法。     

Anatomic relationship between the popliteal artery and vein: a guide to accurate angiographic puncture

The anatomic relationship between the popliteal artery and vein means that an arteriovenous fistula can be created when a popliteal artery approach is used for endovascular interventions. To determine the best site for retrograde puncture of the popliteal artery, we studied six cadaveric specimens, CT scans of 31 patients at 280 levels, and 30 plain radiographs of the knee. In the cadaveric specimens, the vessels were enclosed in a common sheath. In 92% of all levels studied on CT, the artery was anterior to the vein (anterolateral in 9%, anteromedial in 43%, strictly anterior in 40%), and more than 25% of the diameter of the artery overlapped the vein in 87% of these levels. However, at the most cranial level analyzed (64 mm above the femorotibial joint space level), such an overlap occurred in only 60%, and the artery was medial in 25%, resulting in a relationship between the artery and the vein that involved less risk of fistula. On radiographic study, the popliteal crease was located above the level of the joint space (considered the most reliable landmark of the popliteal fossa anatomy) in 97% of cases, although the values were scattered (mean, 2.9 +/- 1.5 cm). In order to minimize the risk of creating an arteriovenous fistula, we recommend a skin incision be located 3-4 cm above the joint level as determined by fluoroscopy, and a puncture directed obliquely from caudal to cranial and from medial to lateral.     

髁间棘骨折的诊断与微创治疗

目的 探讨不同影像学检查在髁间棘骨折诊断中的价值及微创治疗的疗效.方法 2004年7月-2007年12月共收治43例髁间棘骨折患者,不同影像学进行检查及微创治疗.收集术前、术后影像学资料进行对比分析及手术前后功能评分对比.结果 骨折检出率:X线片为95 %,CT三维重建为100 %,MRI为90 %.术后40例获得1～8个月随访,所有骨折均Ⅰ期愈合,膝关节功能采用美国特种外科医院(HISS)膝关节百分评分系统进行评价,优25例,良10例,中3例,差2例.结论 传统的X线为髁间棘骨折诊断中首选的经济实用的方法,CT三维重建可提高诊断率,而MRI检查则可帮助诊断交叉韧带损伤情况.关节镜下及小切口微创治疗损伤小,有利于膝关节功能的恢复,但关节镜下技术操作要求高;采取张力带的方法较其他固定方法简单可靠,不易导致骨折块碎裂,可用于任何骨折类型.     

CT导引下穿刺治疗肾囊肿的护理体会

1 临床资料 2003年3月～2006年6月共收治60例肾囊肿患者,其中男36例,女24例,年龄19～65岁,平均56岁.单发性48例,多发性12例,囊肿直径4～14 cm,全部病例均经B超和CT检查明确诊断.其中39例有肾区明显胀痛不适感,21例无症状,仅在检查时发现.     

Leiomyosarcoma of the popliteal vein

Primary vascular leiomyosarcomas are rare tumors arising from the media of vessel walls, involving the extremities in about one third of reported cases, and the popliteal vein even less frequently. We report a case of popliteal vein leiomyosarcoma in a 62-year old man who presented with leg pain and edema 4 weeks following spine surgery. Findings on ultrasound, MRI and CT angiography are reviewed, with particular emphasis on the value of CT angiography in fully evaluating the extent of the mass and in assisting percutaneous biopsy.     

Thrombosis of the popliteal vein

Among 3,307 consecutive patients (3,556 legs) with deep venous thrombosis, 54 (1.5%) showed an isolated thrombus of the popliteal vein on phlebography. The majority of those had a history of “effort” or long lasting flexion during air or bus travel. Forty-four percent suffered from pulmonary embolism as the first sign of deep venous thrombosis. Functional phlebography demonstrated the primary site of thrombosis at folds forming in the vein wall at flexion. In order to further elucidate the pathogenetic mechanism, 158 popliteal veins were examined phlebographically in different functional states revealing age-related characteristic wall patterns of rings and folds in flexion causing transient impairment of flow. Complementary morphological studies of 120 popliteal veins during autopsy showed a transverse rippling of the vein wall caused by intimal fibrosis and partial atrophy of the media corresponding to the phlebographic findings. It is concluded that microtrauma during effort in combination with impaired venous backflow and fibrotic transformation of the venous wall can lead to thrombus formation in the popliteal vein.     

交通伤后胫骨髁间棘撕脱性骨折关节镜下治疗

目的 探讨交通伤后胫骨髁间棘撕脱骨折在关节镜下复位、PDS-Ⅱ线固定的治疗方法.方法 在2005年2月～2009年12月间,我科共治疗36例交通伤后急性胫骨髁间棘撕脱骨折.男性25例,女性7例;平均年龄27.5岁(11～55岁).其中Ⅱ型9例(25%),Ⅲ型20例(56%),Ⅳ型7例(19%).手术采用关节镜下骨折复位...