AN UNUSUAL CAUSE OF STRESS FRACTURE OF THE FIRST RIB

An unusual case of stress fracture of the first rib that occurred in a young male as a result of the constant loading due to carrying a heavy schoolbag is reported. This case demonstrates the difficulty in diagnosis and highlights the need for awareness of this condition, thus avoiding invasive investigation.     

第一、二鳃弓综合征畸形8例报告

由第一、二鳃弓发育障碍引起的综合征,波及范围广泛,所致畸形明显。本文介绍了我院近年收治的8例患者,经行面横裂修复,半侧颜面部充填,全耳再造后取得较为满意效果。对其修复时间及硅胶充填半侧颜面发育不全之可行性加以初步讨论。     

加压多钉钢板的应力测试及治疗股骨转子间骨折的初步体会

我院自1992年以来使用加压多钉钢板治疗股骨转子间骨折15例,并通过生物力学测试,证实其对股骨转子间骨折的固定强度大于国产“麦氏”鹅头钉约4倍。经临床应用表明这种固定方式操作简便、骨折复位率高、固定可靠,尤其对粉碎性不稳定性骨折有良好的复位固定作用。     

INTERTROCHANTERIC FRACTURES OF THE FEMUR: A RANDOMIZED PROSPECTIVE COMPARISON OF THE GAMMA NAIL AND THE AMBl HIP SCREW

Background: The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented. Methods: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern. Results: Those treated with the Gamma nail had a significantly longer image intensifier screening time (P <0.05), greater blood loss (P<0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre-existing medical conditions. Conclusions: The Gamma nail proved technically more demanding with higher intra-operative complications and inferior return of mobility.     

三维立体腹腔镜下胆囊三角区胆囊动脉解剖结构观察及其临床意义

目的：了解胆囊三角区有关胆囊动脉的解剖,为LC安全入路提供形态学依据。方法：全麻下310例LC患者,用三维立体腹腔镜对胆囊动脉在胆囊三角区解剖进行三维形态学观察。记录胆囊动脉数目,行经与毗邻结构的关系。结果：胆囊动脉在三角区内型：1支208例,2支58例,3支32例。三角区外型：三角区内看不到明确血管3例,胆囊动脉在胆囊管下方进入胆囊5例,2例胆囊动脉从左至右横跨在胆总管前方进入肿囊,1例在肿囊管下粗大血管不能识别。炎症疤痕肿囊三角形态失常不能判断型：3例。结论：胆囊三角区说实的肿囊动脉解剖特点及定位规律,提示后入路手术可行性,顺行性切除胆囊的优点在于准确辩认组织层次,对肝面潜在的出血危险有重要防治意义。     

急性坏死性胰腺炎大鼠血浆内皮素的改变及其意义

为了解急性坏死性胰腺炎（ａｃｕｔｅ ｎｅｃｒｏｔｉｚｉｎ ｐａｎｃｒｅａｔｉｔｉｓ,ＡＮＰ）时血浆内皮素（ｅｎｄｏｔｈｅｌｉｎ,ＥＴ）的变化及其病理意义,进行了前瞻性动物实验。即将ＳＤ大鼠随机分为３组：急性坏死性胰腺炎组（ＡＮＰ组,ｎ＝２）,组胆胰管注入５％牛磺胆酸钠（ＳＴＣ １ｍｌ／ｋｇ）制造ＡＮＰ模型,假手术组（ＳＯ组,ｎ＝２４）和血小板激活因子拮抗剂ＢＮ５０７３９组（ＢＮ组,ｎ＝２４）。测定     

掌背动脉逆行岛状皮瓣瓦合修复中环指脱套伤

目的:寻求修复中、环指脱套伤的新方法。方法:选择8只新鲜的成人手标本灌注红色乳胶后在显微镜下解剖观察第二、三、四掌背动脉的分支及吻合情况。结果:血液供应主要依靠各掌背动脉在远、近侧轴点处发出的粗大皮支,皮支之间在筋膜层构成丰富的网状血管结构,在指蹼处与指掌侧总动脉或分支之间有恒定的吻合支。设计以此吻合支为蒂两个逆行岛状皮瓣瓦合修复中、环指脱套伤,临床应用8例,获得了满意效果。结论:此皮瓣质地好,血供恒定,适宜于修复中、环指脱套伤。     

THE ROLE AND TIMING OF SURGERY FOR CRYPTORCHIDISM*

The higher the testis resides above the scrotum, the more dysgenetic the morphology is likely to be. High testes are rarely responsive to HCG and should be treated by orchidopexy by the age of 2–3 years. The undescended testis does not mature normally after the age of 2 years and may produce adverse effects on the contralateral descended testis, possibly by an auto-immune mechanism. A course of HCG for boys with low-lying undescended testes, both unilateral and bilateral, may produce descent in as many as 15% of patients and may make the technical aspects of orchidopexy easier in those who do not respond. Unilateral cryptorchid testes that are dysplastic or located high should generally be removed before adolescence.     

血栓素前列环素在大鼠轻症急性胰腺炎向重症急性胰腺炎转变中的变化和意义

目的 本实验旨在探讨血栓素、前列环素在轻症急性胰腺炎(MAP)向重症急性胰腺炎(SAP)转变中的变化和意义.方法 将SD大鼠40只按编号法随机分为假手术组(n=8)、MAP组(n=8)、SAP组(n=24).经胆胰管逆行加压注入2.5%牛磺胆酸钠建立大鼠MAP模型,在此基础上通过暂时阻断脾下动脉引发缺血再灌注损伤微循环障碍以产生SAP模型.术后6h剖杀各组大鼠,检测各组大鼠血液中血栓素(TXA2)、前列环素(PGI2)的含量,并观察其病理改变.结果 MAP组大鼠较假手术组胰腺病理组织学评分显著增高(P＜0.05),血栓素与前列腺环素的比值(T/P)值则无明显差异;而SAP组(钳夹脾下动脉15、30、60 min)较MAP组T/P值、胰腺病理组织学评分均有显著增高(P＜0.05).结论 胰腺微循环障碍作为持续和加剧损害因素贯穿于SAP发展的全过程,是MAP向SAP转化的重要因素.     

大肠癌组织雌激素受体的测定及意义

本文对３０例大肠癌细胞的胞浆和胞核部分作了雌激素受体（ＥＲ）测定，结合临床和病理分析，对肠癌组织中雌激素受体存在的意义进行了讨论，结果显示：在大肠癌组织中，存在ＥＲ，其中胞浆ＥＲ（ＥｃＲ）含量为６．０６９±４．７７６ｍｏｌ／ｍｇ蛋白；胞核ＥＲ（ＥｎＲ）含量为４２．７９±８·５７ｆｍｏｌ／ｍｇ蛋白，两者比较有明显差异（ｐ＜０．００５）。ＥＲ在胞浆中的阳性率为２６．６７％，胞核的阳性率为６６．６７％；女性ＥｎＲ阳性率为（８０％）高于男性（４０％）（Ｐ＜０．０５）；ＥＲ在胞浆及胞核中分布呈“异质性”二者表达相符率为４０％，不相符率为６０％（Ｐ＜０．０５）。大肠癌在组织学分级与ＥｎＲ阳性率有明显关系，分化好的肿瘤（Ⅰ、Ⅱ级），ＥｎＲ阳性率有高于分化差者（Ⅲ级）（Ｐ＜０．０５），而ＥｎＲ的含量亦随着分化程度降低而降低（Ｐ＞０．０５）。     

不同手术时机治疗胸腰段椎体骨折脱位伴脊髓损伤的疗效比较

目的比较不同手术时机治疗胸腰段椎体骨折脱位伴脊髓损伤的临床疗效。方法 2003年6月-2008年6月,收治80例胸腰段椎体骨折脱位伴脊髓损伤患者,其中男52例,女28例;年龄28～49岁,平均37.6岁。患者分为2组,A组伤后24h内手术(39例),骨折脱位按Meyerding分类:Ⅰ～Ⅱ度23例(A1组),Ⅲ～Ⅴ度16例(A2组);Frankel分级:A级17例,B级7例,C级9例,D级6例。B组伤后3～7d手术(41例),骨折脱位Ⅰ～Ⅱ度21例(B1组),Ⅲ～Ⅴ度20例(B2组);Frankel分级:A级20例,B级7例,C级11例,D级3例。对80例患者经后路行椎管减压、复位,椎弓根钉棒系统内固定、经椎间孔椎体间植骨治疗。结果 A1组患者失血量(407.4±24.3)mL,B1组(397.4±8.2)mL,差异无统计学意义(t=1.804,P=0.078);A2组失血量(1046.9±128.6)mL,B2组(494.4±97.7)mL,差异有统计学意义(t=14.660,P=0.000)。80例均获随访,随访时间2～2年6个月,平均2年3个月;所有患者椎管减压、复位内固定满意,术后12个月椎间植骨均达骨性融合。A、B组手术前后各时间点椎管容积、伤椎前缘高度及Cobb角比较差异均无统计学意义(P>0.05)。随访期间椎弓根螺钉无松动、脱落或断裂,后凸畸形无明显加重。A1组术后12个月脊髓损伤好转率为47.83%(11/23),B1组为19.05%(4/21),比较差异有统计学意义(χ2=4.046,P=0.044);A2组脊髓损伤好转率为12.50%(2/16),B2组为10.00%(2/20),比较差异无统计学意义(χ2=0.056,P=0.813)。A组术前Frankel分级为A、B级者术后脊髓损伤好转率为12.50%(3/24),B组为11.11%(3/27),差异无统计学意义(χ2=0.024,P=0.878);A组术前Frankel分级为C、D级者术后脊髓损伤好转率为66.67%(10/15),B组为21.43%(3/14),差异有统计学意义(χ2=5.992,P=0.014)。结论伤后24h内行后路椎弓根钉棒系统治疗胸腰段椎体骨折脱位复位良好、固定牢固、融合率高,是一种安全有效的治疗方法,但应注意对患者的选择。