外伤性鼓膜穿孔的诊断和治疗—附264例分析报告

目的 探讨外伤性鼓膜穿孔准确的诊断方法和最佳的治疗方法。方法 对２６４例创伤患者的鼓膜穿孔,其中双耳３６例,单耳２２８例的诊断标准及治疗进行分析。患者均采用保守治疗。结果 ２６２例治疗满意,２例不佳。结论 采用保守疗法取得了比较好的疗效,保守治疗简单方便,经济实惠,但诊断外伤性鼓膜穿孔要有两位耳科专科医师在场,以增加诊断的准确度和可靠性。     

临床诊断困难急腹症的分析报告（附三例病历报告）

急腹症是一类以急性腹疼为突出表现,需要早期诊断和及时处理的腹部疾病,其特点是发病急,进展快,变化多,病情重,一旦诊断延误,治疗方法不当,将会给患者带来严重危害甚至死亡[1]。     

甘露醇在四肢骨折中的应用（附80例报告）

目的观察甘露醇在四肢骨折中的应用的疗效。方法本组共80例骨折病人，在骨折早期及骨折术后早期使用甘露醇进行脱水治疗，观察用药后的疗效。结果术后无一例发生骨筋膜室综合症(OCS)及严重伤口感染，早期未肿胀病例经预防治疗后无一例发生张力性水泡，未见有严重药物毒副作用发生。结论甘露孵可作为四肢骨折的临床辅助用药，该方法具有简单、安全和经济的特点。     

睾丸扭转的诊断和治疗（附28例报告）

目的：探讨睾丸扭转的早期诊断及治疗。方法：回顾总结28例睾丸扭转患者的诊治资料。结果：28例均行手术治疗，7例行睾丸固定术，21例行睾丸切除；7例睾丸固定术后随访6月～2a，其中2例睾丸萎缩。结论：疑为睾丸扭转时，应首选彩色多普勒检查，治疗上应尽快手术探查，避免睾丸切除的发生。     

外伤性颞浅动脉假性动脉瘤的诊断与治疗（附1例报告）

目的探讨卵巢甲状腺肿的临床和病理学特征。方法回顾性分析1990年1月至2009年12月收治的卵巢甲状腺肿13例临床及病理资料。结果卵巢甲状腺肿发病年龄19～67岁,平均40.6岁。临床无症状症状或表现为腹部包块和腹部不适,均为良性,大体呈囊性、实性、囊实性,囊内为黄褐色胶样物和淡黄褐色液体。组织学类型有单纯型或混合型。结论卵巢甲状腺肿是一种高度特异性卵巢畸胎瘤,多为良性,预后良好,具有发病率低、临床表现不特异、术前诊断困难等特点,术后病理检查方能确诊。     

甘露醇在四肢骨折中的应用（附80例报告）

目的观察甘露醇在四肢骨折中的应用的疗效.方法本组共80例骨折病人,在骨折早期及骨折术后早期使用甘露醇进行脱水治疗,观察用药后的疗效.结果术后无一例发生骨筋膜室综合症(OCS)及严重伤口感染,早期未肿胀病例经预防治疗后无一例发生张力性水泡,未见有严重药物毒副作用发生.结论甘露醇可作为四肢骨折的临床辅助用药,该方法具有简单、安全和经济的特点.     

外伤性大脑纵裂血肿的诊疗体会（附14例报告）

目的：研究外伤性大脑纵裂血肿的发生机制、临床表现和治疗方法。方法：回顾性分析2002年12月～2008年12月收治的14例外伤性大脑纵裂血肿患者的临床特点和救治情况。结果：按格拉斯哥预后（GOS）评分,14例中,11例恢复良好（其中2例手术治疗,9例保守治疗）,1例轻度残疾,1例重度残疾,1例术后5h死于脑中心疝。结论：本病早期症状和体征不严重,早期发现,早期诊断,无论手术还是保守治疗效果均良好。     

闭合性肾损伤的CT诊断（附20例报告）

肾损伤较为常见,本文报告20例我院1997年1月～11月经CT和临床证实的闭合性肾损伤病例,就其CT表现总结分析如下: 1资料和方法 20例中,男13例、女7例。年龄7～50岁。左肾损伤8例,右肾损伤12例,病程1天～2月。均有腰部、腹部外伤史,临床上有肉眼血尿18例、2例合并腰椎骨折。全部病例采用GE640CT扫描机检查,常规平扫,其     

椎弓根内固定器对胸腰椎爆裂骨折解剖复位的力学机理──附48例治疗结果分析

本文总结了４８例胸腰椎爆裂骨折应用Ｄｉｃｋ或改良ＲＦ器手术治疗结果，从生物力学角度分析爆裂骨折解剖复位的可能性、椎弓根螺钉的抗弯强度和恢复生理前凸对椎弓根螺钉抗弯能力的影响。结果表明：足够的轴向撑开力是爆裂骨折解剖复位的基础，复位方法则是影响复位效果的关键，在维持脊柱生理前凸条件下，均匀而同时撑开三柱，是最理想的复位方法。     

Nasal bone to nasal tip length ratio for describing nasal bone hypoplasia and predicting trisomy 21

IntroductionFetal nasal bone hypoplasia has been proven to be a strong marker for trisomy 21 during second trimester ultrasonography. Rather than evaluating the nasal bone hypoplasia according to the nomograms, it may be possible to evaluate it with a more practical and specific method.Material and methodsRetrospectively collected data were provided from the saved and stored patient data between 2012 and 2017. Nasal bone length and nasal tip length were measured and the ratio was calculated. The ratio ≤ 1/3 was defined as the threshold ratio for the definition of the marker. Nasal bone nasal tip length (NB/NL) ratio values were compared among groups with trisomy 21 and euploid fetuses.ResultsA total of 59 fetuses had trisomy 21 and 2304 euploid fetuses were included in the study. The ratio of nasal bone to nasal tip length was 1/3 and below in 21/59 (35.5%) of fetuses with trisomy 21 whereas this ratio was 31/2304 (1.3%) in euploid fetuses. The difference was statistically significant (p < 0.001). Sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of nasal bone/nasal tip ratio ≤ 1/3 were 35.5%, 98.6%, 26.4 and 0.6 for Down syndrome, respectively.ConclusionsThis study suggested that the nasal bone to nasal tip length ratio may be a new promising and practical sonographic marker in the second trimester genetic sonography. Although its sensitivity is not high, it seems to be more practical and specific than the evaluation of fetal nasal bone length.     

产前超声在胎儿鼻骨缺失与鼻骨短小中的诊断效果及与预后的相关性研究

目的研究产前超声在胎儿鼻骨缺失与鼻骨短小中的诊断效果及与预后的相关性。方法随机选取2016年8月至2018年8月我院中孕期孕妇的鼻骨发育异常胎儿138例,采用彩色多普勒超声诊断仪对其进行产前超声检查,然后统计分析鼻骨缺失和鼻骨短小胎儿合并畸形情况、单纯和合并畸形鼻骨发育异常胎儿的染色体异常发生情况、单纯鼻骨缺失和鼻骨短小胎儿的染色体异常发生情况。结果 138例鼻骨发育异常胎儿中,48例鼻骨缺失,14例合并畸形,合并畸形率为29.2%;90例鼻骨短小,26例合并畸形,合并畸形率为28.9%。鼻骨缺失和鼻骨短小胎儿合并畸形率之间的差异不显著(P>0.05)。接受染色体检查82例,其中64例为单纯鼻骨发育异常,8例染色体异常,染色体异常发生率为12.5%;18例为鼻骨发育异常合并畸形,14例染色体异常,染色体异常发生率为77.8%。鼻骨发育异常合并畸形胎儿的染色体异常发生率显著高于单纯鼻骨发育异常胎儿(P<0.05)。单纯鼻骨发育异常胎儿64例中,18例单纯鼻骨缺失,其中1例染色体异常,染色体异常发生率为5.6%;46例单纯鼻骨短小,其中6例染色体异常,染色体异常发生率为13.0%。单纯鼻骨缺失和鼻骨短小胎儿的染色体异常发生率之间的差异不显著(P>0.05)。结论产前超声在胎儿鼻骨缺失与鼻骨短小中的诊断效果好,能够将有效依据提供给临床治疗,从而有效改善患者预后,值得推广。     

鼻内镜下鼻中隔术中穿破的及时修复

目的探讨鼻内镜下及时修复鼻中隔术中对穿性破损的方法及临床效果。方法2001年6月～2005年6月在荆州市第一人民医院就诊的20例鼻中隔偏曲合并鼻窦炎、鼻息肉的病人，其中男性14例，女性6例，年龄22～58岁，平均年龄28岁。行鼻窦手术和鼻中隔手术，术中出现鼻中隔黏骨膜对穿性破损，17例立即采用鼻内镜下鼻中隔破损修补术，术中取自体鼻中隔或者鼻甲薄骨片封闭穿孔，复位破损黏骨膜进行修复，采用指套凡士林纱条填塞；2例在头灯照明下常规手术以鼻中隔软骨进行修复，1例未作处理。结果17例立即在鼻内镜下进行修复的病人，随访6个月，术后没有出现鼻中隔穿孔；2例在头灯照明下修复的病人于术后7、10d发现鼻中隔穿孔；1例未处理的病人于术后5周发现鼻中隔穿孔。结论鼻内镜下及时修复鼻中隔手术中出现的对穿性破损，视野清晰，修补可靠；术后局部应慎用激素或者开始使用激素的时间应当延迟。     

经鼻内窥镜选择性鼻中隔粘膜下切除术

目的：探讨经鼻内窥镜选择性鼻中隔粘膜下切除术的意义及手术方法。方法：根据不同的手术目的对204例需要行鼻中隔手术的病人，经鼻内窥镜实施选择性鼻中隔粘膜下切除术。结果：采用该技术对单纯性鼻中隔偏曲患者手术临床治愈率100％，其手术有效治愈头痛、鼻阻及鼻出血等鼻中隔偏曲临床症状，达到临床治疗目的。未出现鼻腔粘连、鼻中隔穿孔等并发症。有2例形成鼻中隔血肿，经放置引流管处理后治愈。对于解除高位鼻中隔偏曲解剖异常引发的鼻窦炎，手术后效果良好。取鼻中隔软骨做为修补材料手术效果满意。结论：经鼻内镜选择性鼻中隔粘膜下切除术目的性强、方法灵活、创伤小、并发症少、手术效果确切。     

宽鼻缩窄截骨术的临床应用解剖

目的为更好地开展鼻背缩窄截骨术并减少其并发症提供解剖学基础。方法10例20侧防腐成人头部标本用局部解剖的方法观察鼻背骨结构与周围组织的比邻关系。结果鼻背骨结构由鼻骨、上颌骨鼻突、额骨鼻突组成。其中:(1)鼻骨间缝合长度(25.2±2.91)mm;(2)鼻颌缝合长度(29.2±2.51)mm;(3)上颌骨鼻突厚度①梨状孔起点处(1.86±0.22)mm,②眶下缘平面(2.18±0.22)mm,③内眦平面(2.78±0.10)mm;⑷鼻颌沟到鼻泪管之间的距离①顶部(3.52±1.22)mm,②中部(5.10±1.48)mm,③底部(5.62±1.26)mm;⑸内眦韧带止点与鼻颌缝的距离(2.87±0.08)mm。结论鼻背缩窄的侧鼻安全截骨线为:截骨术要从下鼻甲上部的附着部位开始,于骨膜下沿鼻颌沟进行,避开鼻外侧静脉,于眼窝内下方大约相距3.5mm左右,到鼻根点部位于内侧截骨线相遇。     

Mixed-mode fracture of human cortical bone

Although the mode I (tensile opening) fracture toughness has been the focus of most fracture mechanics studies of human cortical bone, bones in vivo are invariably loaded multiaxially. Consequently, an understanding of mixed-mode fracture is necessary to determine whether a mode I fracture toughness test provides the appropriate information to accurately quantify fracture risk. In this study, we examine the mixed-mode fracture of human cortical bone by characterizing the crack-initiation fracture toughness in the transverse (breaking) orientation under combined mode I (tensile opening) plus mode II (shear) loading using samples loaded in symmetric and asymmetric four-point bending. Whereas in most structural materials, the fracture toughness is increased with increasing mode-mixity (i.e., where the shear loading component gets larger), in the transverse orientation of bone the situation is quite different. Indeed, the competition between the maximum applied mechanical mixed-mode driving force and the weakest microstructural paths in bone results in a behavior that is distinctly different to most homogeneous brittle materials. Specifically, in this orientation, the fracture toughness of bone is markedly decreased with increasing mode-mixity.     

带血管蒂趾长伸肌瓣及肌骨瓣的临床应用

目的:探讨带血管蒂肌(骨)瓣的临床应用;方法:应用带血管蒂趾长伸肌(骨)瓣逆行转位修复22例小腿中下1/3胫腓骨开放性骨折并软组织缺损;结果:均获得成活;结论:实践证明该术式是修复小腿骨皮缺损的比较理想的手术方法。     

锁骨干部骨折及接骨板与其解剖分型的匹配性研究

目的　改进现有锁骨接骨板,为锁骨骨折的临床治疗提供解剖学基础。 方法　对115根锁骨干标本及115例成人锁骨骨折影像学资料进行相关数据测量并总结;将市面上两种常用锁骨接骨板分别与锁骨干标本进行匹配。 结果　115根锁骨干标本中I、II、III型锁骨分别占45.2%、45.2%、9.6%;115例锁骨骨折影像学资料中3型锁骨分别占14.8%、57.4%、27.8%,锁骨干部骨折最多,占73.9%;改进后锁骨接骨板模型与两种常用锁骨接骨板对115根锁骨干标本贴合匹配程度的Kappa值分别为：0.38、0.51。 结论　新型锁骨接骨板模型与各型锁骨的匹配贴合程度较前有明显提升,对临床应用具有一定的指导意义。     

Gender differences in fracture risk and bone mineral density

We have investigated gender-related differences of bone mineral density and fracture threshold in 136 males (age, 60.7±9.3 years) and 337 females (age, 59.7±7.8 years) without evidence of secondary osteoporosis. Women and men were examined for total amount of spine fractures and bone mineral density by quantitative computed tomography (QCT) of three non-fractured vertebral bodies L1–L5. Females with lumbar fractures (n=96) when compared with non-fracture women (n=241) were older and had lower bone density at their vertebral sites. Males with vertebral fractures (n=52) were older and had a significantly reduced bone mineral density of the spine when compared with healthy males (n=84). When we compared gender-related vertebral fracture rates, we observed a significantly higher prevalence of vertebral fractures in the male population. After matching males and females for age and bone mineral density to exclude an influence of either variable, we compared the prevalence of vertebral fracture risk in both sexes with logistic regression analysis. Data of estimated fracture risk, differed very significantly for sex and bone density at the vertebral site, indicating that men present fracture at a higher bone density level compared with females; in 10% of study population fractures occurred at a QCT level of 105 mg/cm³ in women and 120 mg/cm³ in men. The estimated odds ratio for sex of 3.1 (95% CI) means a three-fold increased risk for vertebral fractures compared to males at a given density level. These results underline that a decreased bone mineral density leads to the occurrence of spine fractures in females and males as well.     

基于骨折端骨痂分级的下肢骨干骨折术后钢板断裂并原位骨折的治疗策略

目的 探讨下肢骨干骨折术后钢板断裂并原位骨折的治疗策略。方法 回顾性分析2015年3月至2021年3月就诊于江西省信丰县人民医院下肢骨干骨折术后钢板断裂的26例患者临床资料、翻修手术信息及临床疗效。依据原始骨折部位的位置以及骨痂生长选择髓内钉或者解剖型锁定加压接骨板固定。在植骨与否的选择上原始骨折部位骨痂为Fernadez-esteve骨痂Ⅰ级、Ⅱ级一期行自体髂骨植骨手术,Fernadez-esteve骨痂Ⅲ级、Ⅳ级、Ⅴ级不给予植骨治疗。术后评价患者的骨折愈合时间、患肢临床疗效及髂骨供区并发症情况。结果 所有患者随访至骨折愈合,所有患者获得临床愈合,愈合率100%,平均愈合时间5.92个月。所有患者随访期间均未出现内固定物再次断裂、松动等内固定物失效情况。按照Tohner-Wrnch标准,优16例,良10例,差0例,优良率100%。自体髂骨供区并发症达25.00%。结论 下肢骨干内固定失败行翻修手术可根据患者原始骨折部位及骨痂生长情况综合考虑选择手术方式。Fernadez-esteve骨痂Ⅰ级、Ⅱ级原始骨折位于股骨干中段、上段患者建议采用顺行髓内钉行翻修手术,原始骨折位于股骨下段的患者...