骨盆生物力学性能与交通事故骨盆损伤机制

高能量交通伤所致骨盆骨折多为高危性创伤,常伴有合并伤和多发伤。国内外学者对骨盆的生物力学性能、骨盆骨折的损伤机制、分类及合并伤等做了大量的研究工作,并取得一定成果。本文就骨盆生物力学性能与交通事故骨盆损伤机制作-综述。     

进一步提高骨关节创伤的治疗水平

骨关节创伤是最常见的创伤，我国近20-30年来就其治疗取得了巨大的进步，主要有：（1）脊柱脊髓损伤的预防宣传和院前急救运送技术的提高，早期使用大剂量的甲基强的松龙治疗方案，脊柱三柱学说和影响学诊断水平的提高，脊柱骨折固定技术的提高；（2）尽早固定不稳定骨盆骨折以控制出血和休克，多学科协同救治伴有重度骨盆骨折的多发伤，手术复位和固定有明显移位的不稳定型骨盆环骨折；（3）四肢骨关节损伤治疗从“AO”到“BO”的转变，骨外固定技术的发展，多发骨折救治的损害控制性处理。     

Orthofix外固定支架治疗儿童不稳定骨盆骨折

骨盆骨折是一种较严重的高能量损伤,占全身骨折的5%～10%[1].近年来,随着我国交通事业的发展和居民住房条件的改善,交通伤和高处坠落伤逐年增多,骨盆骨折随之增加.由于该类骨折常常合并其他组织器官损伤,患儿就诊时一般情况差,部分患者生命体征不稳定,治疗困难,死亡率可高达5%～25%[2].     

血管造影栓塞术治疗骨盆骨折出血的现状

骨盆骨折是骨科常见的一种严重损伤。随着交通业的迅速发展、生活节奏的加快，交通事故和工业事故的创伤增多，其发生率随之增加且占相当大的比例。据统计．交通事故引起的严重创伤中，骨盆骨折紧随中枢神经系统损伤和胸部损伤，成为第三大致死因素。因为常常伴有严重的内脏并发伤和腹膜后出血，骨盆骨折对创伤外科医生来说是一个较大的挑战，高发病率（40％-50％）和高死亡率（5％-30％）的部分原因归咎于不能通过合适的外科手段控制骨盆后腹膜出血。自从1973年Ring等首次报道介入治疗外伤性骨盆骨折出血获得成功以来，血管造影栓塞术（angiographic emblization．AE）成为治疗骨盆骨折出血的主要手段。     

封面故事

正骨盆骨折占所有骨折类型的3%,常由交通事故、高处坠落等所致,21%、17%、8%和7.8%伴随胸伤、脑伤、腹伤和长骨骨折,13%有大出血,是创伤中心面临的严峻挑战。休克复苏成功血流动力学稳定后,骨盆骨折的及时精确复位和早期固定能降低不良预后的发生率。传统的切开复位钢板内固定术常需长切口和深度剥离,创伤较大,对复苏要求较高,手术并发症发生率高。骨盆复位架系统可以在微创的前提下实现骨盆骨折的多平面复位并维持复位进行固定,手术时间窗提前。本期华中科技大学附属同济医院创伤外科易成腊教授团队论文《骨盆复位架在骨盆骨折闭合复位和微创固定的初步临床应用》回顾性分析了41例应用骨盆复位架治疗不同类型骨盆骨折,结果显示该方法创伤小、切口相关百分之发生率低。     

骨盆前环骨折微创内固定技术研究进展

骨盆、髋臼骨折占所有骨折的3％～8％,常伴有膀胱、直肠和重要神经、血管等损伤,致死率、致残率高达18％.其治疗先后经历了非手术治疗、手术治疗、微创治疗三个发展阶段.近年来,以微创为代表的骨盆骨折内固定术式在临床上普遍开展.骨盆前环是骨盆重要的张力弓.在不稳定骨盆骨折中,骨盆前环骨折约占3/4.笔者对用于骨盆前环骨折的几...     

不稳定型骨盆骨折骨外固定技术的应用

目的 探讨不稳定型骨盆骨折外固定架固定术的可行性。方法 根据骨盆不稳定型骨折的Ｔｉｌｅ创伤分类,对不同的创伤类型应用相对应的作用力进行固定,达到消除骨盆骨折移位、稳定骨盆环的目的。结果 本组１６例,１你合并多发肋骨骨折、血气胸、术后死亡;１例未随访;１４例获得平均１０．１个月随访,总优良率为８５．７％（１２／１４）。结论 外固定术具有创伤小,操作简单,不增加副损伤等优点。对于骨盆后侧韧带保持完整的     

血流动力学不稳定骨盆骨折急诊综合救治策略进展

骨盆骨折是交通伤与高处坠落伤等高能量损伤导致死亡的主要损伤之一,伤后24 h内的主要死亡原因是急性失血[1,2].随着损伤程度的增高,死亡率不断升高,可达18％～40％[3,4].钝性伤导致骨盆骨折血流动力学不稳定的定义为低血压≤90 mm Hg(1 mmHg=0.133 kPa),并伴有需要大量输血(伤后6h内需要输注4～6U或以上浓缩红细胞)、显著的碱缺失(≤-6 mmol/L)或两者兼有[5].其处理充满挑战,也存在争议.处理的关键在于要明确出血部位并控制出血.处理血流动力学不稳定的骨盆骨折需要一个多学科的团队,急诊综合救治策略包括救命性手术、损伤控制复苏、早期骨盆稳定等关键性决定等内容.笔者根据临床开展的工作并结合相关文献进行综述.     

不稳定骨盆骨折的治疗

随着经济和交通的不断发展,高能量损伤的患者越来越多,骨盆骨折属于高能量损伤中较严重的骨折类型,其发生率在逐年增加.而骨盆骨折导致的死亡率和致残率很高,Sathy等[1]分析63 000例创伤患者,发现如果存在骨盆骨折会使死亡率明显升高.     

重度骨盆骨折的现代救治

临床工作中通常将骨盆环失去稳定性的骨盆骨折称之为重度骨盆骨折。一百多年前 ,Ｍａｌａｇａｉｇｎｅ即描述了垂直分离型骨盆骨折 ,但时至今日重度骨盆骨折仍是一个尚未圆满解决的问题。骨盆骨折的发病率为 2 0～ 35.2 /10万 /年[1 4 ] ,占骨关节损伤的 1%～ 3% ,占住院骨折病人的 1.5%～ 4 .8% ,但休克发生率高达 19%～ 50 % ,合并伤较多 (膀胱伤 6%～11% ,尿道伤 4 %～ 14% ,直肠伤 1.2 %～ 3.4 % ,骨盆神经伤 10 %～ 15% ,血管伤 2 .4 %～ 2 0 % ,在女性生殖道伤为 13.6%～ 17% ) ,且常伴发颅脑、胸、腹或骨关节损伤[5] 。重度骨盆骨…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.