解剖钢板治疗老年股骨粗隆间骨折52例临床分析

目的：评价解剖钢板治疗股骨粗隆间骨折的优越性,探讨此类骨折的治疗方法。方法：对52例股骨粗隆间骨折采用切开复位解剖钢板内固定,观察术中情况、愈合时间及疗效。结果：随访6～18月,术后骨折平均愈合时间5.8月,无钢板断裂、松动及骨折再移位情况发生,功能评价优良。结论：解剖钢板治疗股骨粗隆间骨折稳定性好、固定可靠、骨折愈合快的特点,是一种较好的治疗方法。     

梯形截骨双钢板治疗肱骨中下段骨不连

目的 探讨梯形截骨加双钢板治疗肱骨中下段骨不连的临床效果.方法 选取13例肱骨中下段骨不连患者,采用梯形截骨双钢板治疗,术后定期随访,观察骨折愈合时间、骨折愈合率、肢体短缩长度、肘关节功能,根据肘关节功能Mayo评分标准评分.结果 本组所有病例手术切口L/甲愈合,无尺神经损伤症状,骨折愈合率100％;平均愈合时间8.0月;上臂平均短缩2.7 cm;1例术后出现桡神经牵拉损伤,脱水消肿、口服营养神经药物后症状消失;1例术后桡神经瘢痕粘连、骨痂压迫,二期行桡神经松解术,神经功能恢复;肘关节功能优8例,良3例,中1例,差1例,1例屈肘0～90°,1例出现肘关节僵硬,行二期松解术后肘关节屈曲达80°;肘关节功能优良率85％.结论 梯形截骨双钢板治疗肱骨中下段骨不连具有良好的临床效果,梯形截骨极大增加骨折接触面积,肱骨远端锁定钢板保证断端垂直及侧方稳定,内侧辅助钢板增加旋转稳定,满足骨折愈合所需条件,是一种可靠的手术方法.     

锁骨钩钢板治疗锁骨外1/3Ⅱ型骨折

对6例锁骨外1/3Ⅱ型骨折手术切开复位、锁骨钩钢板内固定.随访1～2年,骨折全部愈合,认为锁骨钩钢板治疗锁骨外1/3Ⅱ型骨折具有固定牢固、手术操作简单、疗效好等优点.     

双锁定钢板加皮质剥离术植骨治疗股骨干骨折不愈合

目的 探讨双锁定钢板加皮质剥离术植骨治疗股骨干骨折不愈合的疗效.方法 本组患者19例,均为股骨干陈旧性骨折骨不连,在我院行手术切开复位内固定9例,在外院手术10例.再次手术均采用双锁定钢板加皮质剥离植骨术,术中不剥离骨折端的骨膜,将骨折端皮质骨连骨膜一同凿下,咬除骨折断端硬化骨,再通髓腔,采用自体髂骨移植修复骨缺损,双锁定钢板内固定治疗股骨干骨折不愈合,获得随访共19例.结果 所有病例均得到9～20个月的随访,19例均达到骨性愈合,愈合率为100%.所有病例无感染、断钉、断板、骨折不愈合等并发症发生.结论 双锁定钢板加皮质剥离术植骨治疗股骨干骨折不愈合,提供了坚强的内固定及良好的血供,疗效确切.     

点式接触解剖钢板内固定治疗不稳定性肱骨外科颈骨折

目的评价点式接触解剖钢板内固定治疗不稳定性肱骨外科颈骨折的疗效。方法采用点式接触解剖钢板内固定治疗不稳定性肱骨外科颈骨折15例。平均随访6．3个月(4—12个月)。结果术后无伤口感染、无骨折不愈合和骨折延迟愈合等并发症的发生。骨折愈合时间为术后1．5—4月(平均2．5个月)。按照Neer’S肩关节功能评定标准,肩关节功能优14例,良1例。结论点式接触解剖钢板对肱骨外科颈骨折固定牢稳,并发症少,具有保护板下血供和骨折愈合快等优点。     

克氏针与重建钢板治疗锁骨骨折的疗效比较

目的比较克氏针和重建钢板在内固定治疗锁骨中段骨折的临床疗效。方法回顾性分析比较克氏钢针内固定治疗锁骨中段骨折46例与重建钢板内固定治疗39例的治疗效果。结果85例经1～2年随访,克氏钢针内固定组：骨折平均愈合时间为4个月,其中1例骨折处分离、畸形、不愈合,1例发生断针,均重新手术外,余44例骨折全部愈合。参照韩平良等锁骨疗效标准：优35例、良9例、差2例、优良率95.7%。重建钢板内固定组：骨折平均愈合时间3个月,其中1例术后3周发生钢板翘起,螺钉被拔脱重新手术外,其余38例骨折全部愈合,优35例、良3例、差1例、优良率97.4%。对两组疗效比较作χ2检验（P〉0.005）,两组间优良率没有显著差异。结论重建钢板治疗锁骨中段骨折固定牢靠,能早期进行功能锻炼,为固定锁骨中段骨折之首选材料。克氏钢针治疗锁中段骨折只要术后制动患肢6～8周,仍可取得满意疗效,具有价格低廉的优势。     

记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折

目的探讨记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折的临床疗效。方法采用记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折28例,其中锁骨外侧1/3骨折17例,中1/3骨折8例,内侧1/3骨折3例。结果28例患者术后随访13个月,骨折全部临床愈合,平均临床愈合时间10周。结论记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折具有手术简单、固定牢靠、骨折端血运破坏少、手术安全、并发症少等优点,疗效满意。     

负压封闭吸引结合钢板内固定治疗Gustilo Ⅲ型尺桡骨开放性骨折

目的探讨应用负压封闭吸引结合钢板内固定治疗GustiloⅢ型尺桡骨开放性骨折的疗效。方法治疗GustiloⅢ型尺桡骨开放性骨折12例,受伤原因:机器碾压伤7例,车祸伤4例,重物砸伤1例。均采用负压封闭吸引技术一期结合钢板内固定治疗。结果 12例患者无感染发生,植皮及皮瓣均一期愈合。11例获得骨性愈合,1例出现尺骨不愈合,手术植骨后骨质愈合。结论在早期彻底清创的前提下,负压封闭吸引技术一期结合钢板内固定是治疗GustiloⅢ型尺桡骨开放性骨折一种有效的治疗方法。     

胫骨远端解剖型钢板内固定治疗胫骨远端骨折

目的:探讨胫骨远端解剖型钢板内固定结合非骨膜剥离技术治疗胫骨远端骨折的疗效.方法:对62例胫骨远端骨折的闭合及开放性骨折病人,在软组织条件允许下采用胫骨远端解剖型钢板,应用非骨膜剥离技术进行切开复位内固定手术.结果:57例随访病人均在术后12个月内实现骨折愈合,较传统骨膜剥离技术提前6个月以上,功能恢复优良率100%.结论:胫骨远端骨折采用胫骨远端解剖型钢板,应用非骨膜剥离技术进行手术可缩短骨折愈合时间,明显提高骨折愈合率,更好恢复患肢功能.     

股骨近端锁定钢板与动力髋螺钉治疗转子间骨折的分析

目的 比较股骨近端锁定钢板与动力髋螺钉(DHS)治疗股骨转子间骨折的临床效果.方法 收集2007年6月～2010年12月来我院就诊的股骨转予间骨折的患者87例,随机分成两组,分别采用股骨近端锁定钢板(47例)和DHS(40例)治疗,比较两组患者的手术时间、术中出血、骨折愈合时间、髋关节功能Harris评分及术后并发症.结果 87例患者均获得随访,平均随访时间为11.6个月.两组患者在手术时间上无明显差异(P＞0.05),但近端锁定钢板组术中出血多于DHS组(P＜0.01);两组患者骨折愈合时间及Harris评分无统计学差异(P＞0.05);近端锁定钢板组出现2例锁定螺钉进入髋关节的并发症,DHS组出现1例髋内翻、1例头钉拔出.结论 股骨近端锁定钢板治疗转子间骨折临床效果与DHS相似,是一种较为理想的手术方式.     

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.