带锁髓内钉治疗股骨干骨折不愈合与延迟愈合

股骨干骨折是骨科临床上最常见的骨折之一。目前，其治疗有多种方法，但基本原则不变，仍是复位、固定和功能练习。目前，国内外学者主张股骨干骨折选择带锁髓内钉固定治疗。     

全面部骨折手术治疗的临床研究

目的 探讨全面部骨折及并发症的诊治要点，摸索适合于口腔颌面部骨折治疗的生物学固定原则。方法 采用X线头影测量分析、模型外科、骨切开复位等技术，结合生物学固定的原则矫治48例全面部骨折所致牙颌面畸形和咬袷紊乱。结果 本组患者均获得满意的功能和形态效果。结论 全面部骨折必须通过术前精确的设计，有组织、有步骤地达到功能与形态并举的治疗效果。同时，骨折治疗必须重视骨的生物学特性，如选择恰当的接骨板和螺钉系统以及正确的复位固定方法，坚强固定和弹性固定相结合，复位固定要修复骨缺损。     

解剖型钢板内固定加撬拨复位治疗跟骨骨折

采用撬拨复位加解剖型钢板内固定治疗跟骨关节内骨折47足。本组全部骨性愈合,治疗优良率91%。认为撬拨复位加解剖型钢板内固定是治疗跟骨骨折较为理想的方法,临床效果与骨折类型、手术时机的选择密切相关。     

61例Pilon骨折的临床治疗及分析

目的：探讨胫骨闭合性Pilon骨折的治疗方法及影响临床效果的因素。方法：分析我科治疗的61例Pilon骨折的患者，根据治疗前后的X片资料和随访结果，对不同类型（Ruedi-Allgower分型）的骨折，比较保守治疗、有限内固定、有限内固定结合外固定架、坚强内固定4种治疗方法的临床疗效。结果：参照Helfet提出的标准判断，保守治疗临床疗效差，手术治疗优良率为80％。胫距关节面达到解剖复位的骨折疗效优良率为90％。对II型和III型骨折，坚持内固定组应用胫腓骨钢板，其内支撑作用能够更有效地恢复肢体长度和达到关节内骨折解剖复位，临床疗效优良率高于其他手术组。结论：临床治疗效果与骨折类型、治疗方法有关。应根据骨折的具体情况具体分析，采用不同治疗方法，手术治疗的效果优于保守治疗。对II型和III型骨折，当局部皮肤条件较好时，首选切开复位坚强内固定；当局部皮肤条件不好时，宜选择有限内固定结合外固定架治疗。早期牢固的胫距关节面的解剖复位和恢复肢体长度是治疗的关键。     

下颌骨髁突骨折的内固定治疗

目的探讨内窥镜下微型钛板坚固内固定治疗下颌骨髁突骨折的方法。方法在内窥镜下对22例下颌骨髁突骨折患者进行骨折复位，经皮穿刺行微型钛板坚固内固定治疗。结果22例均恢复良好的面部外形，骨折愈合好，21例下颌运动正常，20例咬合关系良好。结论内窥镜下复位坚固内固定治疗下颌骨髁突骨折，手术创伤小，复位固定可靠有效，无并发症发生，适用于下颌骨髁突颈及颈下骨折的治疗。     

钛板坚强内固定在颌面部骨折中的应用

目的提高颌面部骨折复位后固定的可靠性，观察和评价钛板坚强内固定技术治疗颌面部骨折的临来效果。方法采用钛扳坚强内固定技术对25例领面部骨折患者进行固定与重建。结果25例骨折患者均明显缩短了领面部骨折固定的时间，运到良好的复位与固定，术后面容及功能恢复良好，半年随访复查无一例发生咬合错乱等术后并发症。结论该技术操作简便、效果良好、并发症少、颌间固定时间短，是一种较好的颌面部骨折治疗方法。     

闭合复位加空心钉固定治疗股骨颈骨折回顾性分析

目的：探讨股骨颈骨折采用闭合复位加空心钉固定与切开复位空心钉固定加骨瓣移植的临床效果。方法：对1996年9月－2002年1月收治的304例股骨颈骨折患者进行回顾性分析。其中随访资料完整的138例中，Garden II型49例，Ⅲ型68例，Ⅳ型21例。平均随访时间25个月。结果：138例中，17例出现股骨头坏死，坏死率为12．3％，其中采用闭合复位加空心钉固定患者81例，5例出现股骨头坏死，坏死率为6．2％，采用切开复位空心钉固定加骨瓣移植57例，12例出现股骨头坏死，坏死率为21．1％。结论：股骨颈骨折所致股骨头坏死和骨不连的发生与治疗方法的选择有关。良好的闭合复位加空心钉固定可达理想的治疗效果。股骨颈骨折在切开复位内固定的同时，不必同时采用骨瓣移植用以防止股骨头坏死或骨不连的发生，对于老年股骨颈骨折患者，如果全身健康状态好，闭合复位加空心钉固定仍然是临床可供选择的有效方法。     

螺栓内固定治疗胫骨平台塌陷骨折（附7例报告）

胫骨平台塌陷骨折处理较困难，治疗方法的选择是否适当，直接影响膝关节的功能。1980年以来我们采用开放复位，螺栓内固定治疗7例，疗效满意，介绍如下．     

股骨干骨折内固定失败的原因分析

目的 分析股骨干骨折内固定失败的原因并提出预防措施。方法 对36例股骨干骨折内固定失败的病例进行生物力学分析和总结。结果 36例中采用钢板内固定21例，梅花钉9例，“V”形针3例，国产带锁髓内钉3例。其中内固定物选择错误16例，骨折复位不良或有明显骨缺损18例，术后过早负重22例。所有病例经过再次手术内固定、植骨后全部愈合。结论 股骨干骨折内固定失败的主要原因是未遵循生物力学原则。根据骨折部位选择适当的内固定物、在良好复位的同时尽量保护骨折处的血运、有明显骨缺损时应一期植骨，术后功能锻炼应根据骨折复位、固定情况循序渐进，避免术后过早负重是预防股骨干骨折内固定失败的有效措施。     

组合式骨外固定器治疗胫骨干复杂骨折33例

目的：研究治疗Ｃ２型（多段骨折）、Ｃ３型（不规则骨折）胫骨干复杂骨折合理有效的方法．方法：使用自行研制的组合式骨外固定器治疗胫骨干复杂骨折３３例（Ｃ２型１３例，Ｃ３型２０例）．结果：本组骨愈合率９３％．骨外固定器可为胫骨干复杂骨折提供长跨度固定系统，并随机组成不同力学构型，穿针位置随骨块位置和多少而定，使骨折达到复位和固定，可对诸骨折端分别施力，骨折固定中后期可实施弹性固定，固定后可早期治疗关节，功能恢复快．结论：骨外固定器是治疗胫骨干复杂骨折的可供选择的优良方法     

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.