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创伤性浮动膝是指同侧股骨干和胫骨干(或骨骺部)同时骨折所形成的连枷膝。我科自1975~1995年共收治四肢骨折814例,其中浮动膝15例,占1.8%。现报告如下。1临床资料1.1一般情况男9例、女6例,年龄11~58岁。致伤原因:车祸12例,砸伤3例。合并颅脑伤6例,肩关节脱位2例,多发性肋骨骨折4例,脾破裂3例,对侧小腿开放骨折5例,骨盆骨折2例。1.2治疗和结果本组有11例(15个骨折部位)于伤后2周内行骨折切开复位、内固定。内固定方法包括加压钢板13处,螺丝钉1处,克氏针2处。4例(8个骨折部位)因合并伤严重,行跟骨结节加股骨髁上牵引… 相似文献
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我科1988年以来收治胸腰椎骨折108例,其中平移骨折9例,占8.3%。1临床资料1.1一般情况男7例,女2例。年龄18~53岁,平均29.3岁。致伤原因:个部为交通伤。损伤X段:I。17例,T;22例。损伤类型:经椎体一椎体水个切割1例,经前纵韧带、椎间盘一椎板一韧带8例。脱位程度:全部病例均有脱位(前后脱位),其中1度1例,I度2例,回度5例,IV度1例。截瘫程度:个瘫6例,部分瘫3例。1.2治疗全部病例均在入院后72h内手术,切开复位,椎板减压或侧前方减压水,tuque棒内固定。结果:全瘫1例完全恢复,5例感觉障碍个面稍有卜降,伤员可早期… 相似文献
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意外损伤住院儿童损伤类型与原因分析 总被引:9,自引:0,他引:9
目的:了解儿童意外损伤的发生情况,为儿童意外损伤的预防提供依据。方法:对收住院的2960例意外损伤儿童的病案首页进行统计,分析不同年龄,性别和地区的损伤类型及原因构成。结果:2960例意外损伤住院儿童中,骨折991例(占33.5%),烧伤,烫伤609例(占20.6%),内脏及颅内损伤536例(占18.1%),开放性损伤291例(占9.8),男女比例为2.2:1。各类意外损伤年龄特点:烧伤/烫伤多发生了3岁以下儿童(占51.2%,312/509),0-1岁儿童是发病高峰年龄段(占33.7%,205/609),骨折多发生了3岁以上儿童(占91.6%,908/991),而以6-14岁儿童为最多(占69.3%,687/991),交通伤多发年龄段为6-14岁(占66.7,478/717),跌落伤多发年龄段为6岁以上(占65.1%,576/885),年龄跨度最大。各类损伤住院总费用为3938583.4元,人均1330.6,总住院日为50778d,人均17.2d。结论:各类损伤的发生在不同年龄,性别和地区间有着明显特点,可根据具体情况采取相应的防范措施,减少其发病率是完全可能的。 相似文献
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全面部骨折38例临床分析 总被引:2,自引:0,他引:2
目的探讨全面部骨折的临床特点及治疗方法。方法收集我院2003年10月~2008年10月收治的38例全面部骨折患者病历资料,对致伤原因、伤情特点、治疗方法进行分析。结果致伤原因以交通伤为主,占全部骨折的86.8%,其中摩托车伤占交通伤比例的57.6%,骨折类型除上下颌骨骨折外,鼻骨是最常见的骨折部位,多成粉碎性,其次为颧骨。下颌骨多呈线形骨折,单处多见,上颌骨以双侧骨折、颧上颌缝分离、上颌窦前壁粉碎性骨折、双侧上颌骨中缝分离为主要的骨折类型。手术方法遵循从下到上,从外到内的骨折复位固定顺序,重建咬合关系和恢复面部外形,手术效果良好。结论目前全面部骨折以上颌骨、鼻骨、颧骨、下颌骨多发骨折为主,遵循建议的治疗方法可获得良好的效果。 相似文献
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弥漫性脑损伤的诊断与救治 总被引:18,自引:1,他引:17
目的:探讨弥漫性脑损伤(DBI)的发生机制、影像学表现、诊断与处理方法,以提高治愈率,降低残、死率。方法:回顾性总结871例弥漫性脑损伤的致伤原因、损伤类型、救治措施及预后状况。结果:致伤原因主要为交通伤和坠落伤;损伤类型多为弥漫性轴索损伤、弥漫性脑肿胀,可合并有蛛网膜下腔出血、脑挫裂伤、脑内出血和血肿等;入院时格拉斯哥昏迷评分(GCS)≤8分660例(75.8%),其中3-5分365例(41.9%);本组治愈好转率达75.4%(657/871),死亡率为19.7%(172/871),其中GCS≤5分的死亡率高达39.2%(143/365)。结论:DBI的诊断主要是临床表现与CT、MRI影像学的结合。治疗上应采取综合疗法,注意保持生命体征稳定,及时手术解除脑受压,加强手术前后的监护和开展亚低温疗法,这些是促使患者获得康复的重要手段。 相似文献
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影响移位髋臼骨折手术复位质量的若干因素 总被引:48,自引:12,他引:48
目的:探讨影响移位髋臼骨手术复位质量的相关因素。方法:1990年3月-1999年7月共手术治疗移位髋臼骨折189例,年龄8-53岁,平均32岁,根据可能影响骨折复位质量的常见原因进行分组,并分析其临床疗效。结果:解剖复位率在最近和最初的4.5年手术组分别是89.7(105/117)和63.9%(46/72);在简单和复杂型骨折组分别是97.8%(89/91)和63.3%(62/98);在伤后手术时间<3间和≥3周组分别是88.6%(101/114)和66.7%(50/75);在复杂型骨折组,由双入路和前后方单一入路手术获得的解剖复位率分别是84.8%(28/75),在复杂型骨折组,由双入路和前后方单一入路手术获得的解剖复位率分别是84.4%(28/33)和51.0%(25/49);获2-10年远期随访的136例中,解剖和非解部复位组的功能优良率分别是83.6%(92/110)和38.5%(10/26)。以上各因素分组间比较,差异具有非常显著性意义(P<0.01)。结论;医师经验,骨折类型,伤后手术时间以及入路选择均有骨折复位质量和临床疗效产生显著影响,克服这些因素的负面影响将有利提高复位质量和临床疗效。 相似文献
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作者总结了33例均采用带锁髓内钉内固定的不同类型的胫骨骨折,其中扩髓16例,不扩髓17例闭合骨折22例,开放骨折11例,除6例失访外,其余27例平均随访时间17.9个月(4-31个月),22例在半年内愈合,1例延迟愈合,1例远端锁钉断钉,3例随访时间不足半年,闭合骨折从致伤到手术平均时间为3.55天(入院当天-27天),开放骨折均在当天手术。闭合骨折扩髓12例,占54.5%(12/22);开放骨扩扩髓4例,占36.3%(4/11),术后均未发生骨筋膜室综合征或感染。提示带锁髓内钉适用于治疗胫骨骨折,非扩髓带锁髓内钉适于开放骨折和多发伤,早期手术并不影响预后,且可减少并发症。 相似文献
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髋臼骨折外科治疗近期效果分析 总被引:1,自引:0,他引:1
目的 探讨提高髋臼骨折切开复位内固定的治疗效果和减少其并发症的方法。方法 对我科34例髋臼骨折行切开复位内固定术患者的近期随访资料进行回顾性分析。结果本组随访时间6。28个月(平均13.6个月),根据Matta评分方法,治疗后优19例(55.9%),良6例(17.6%),一般5例(14.7%),差4例(11.8%);并发异位性骨化4例(11.8%),股骨头坏死2例(5.9%)。结论 手术治疗效果与骨折程度和伤后手术时间有关,骨块数≥4块和伤后≥10天行手术者愈后欠佳(P〈0.01)。骨折的类型和内固定物种类的应用与疗效关系不大(P〉0.05)。早期切开复位内固定,恰当的手术路径、稳固的固定手法和关节准确对位是手术成功的关键。 相似文献
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肾脏损伤分型在诊治中的作用 总被引:4,自引:1,他引:3
目的:探讨肾脏损伤分型在诊治中的作用。方法;回顾分析自1990年8月至2001年2月收治的98例肾脏损伤资料,其中男78例,女20例;年龄11-80岁,其中<40岁66例,占67.3%。本组挫伤60例,血肿16例,裂伤6例,粉碎伤16例;以直接打击伤、坠落伤和交通伤为多,分别为50例(51.0%)、27例(27.6%)和14例(14.3%);血尿96例,其中肉眼血尿52例(53.1%),镜下血尿44例(44.9%)。本组均按美国创伤外科学会器官损伤标准委员会 制定的肾脏损伤 标准分型。结果:I型60例,Ⅱ例16例,Ⅲ型3例,Ⅳ型3例,Ⅴ型16例。Ⅰ-Ⅲ型肾脏损伤均为保守,Ⅳ型行肾脏修补术,V型行肾脏切除术。98例全部治愈。结论:肾脏损伤分型与患者的年龄、致伤原因、合并伤、血尿程度以及治疗方式均有关,临床可根据分型情况指导治疗。 相似文献
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为探讨颞骨骨折及其并发症的特点及救治方法,作者对1989年1月-1999年11月收治的48例颞骨骨折临床资料进行了回顾性分析。结果显示,48例颞骨骨折患者中交通事故所致的占66.7%,存活43例(89.6%),死亡5例(10.4%);中、内耳或颅脑损伤占77.1%,听力下降或耳鸣占48%;纵行骨折的脑脊液耳漏占36.7%,面瘫占3%;横行骨折的面瘫占37.5%,脑脊液耳漏则占25%。研究结果表明,交通事故伤是造成颞骨骨折的首要高危因素,其严重并发症为颅脑损伤,合并多脏器伤常是致死性并发症;其常用并发症为听力下降或耳鸣等中、内耳损伤;纵行骨折以脑脊液耳漏多见,横行骨折易造成面瘫。 相似文献
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Usher EJ 《Air medical journal》2001,20(5):40-42
In the past, blast injuries were associated strictly with war and catastrophic industrial accidents. Unfortunately, these injuries are on the front lines of each ED and EMS system in the form of pipe bombs and terrorist plots. Domestically and internationally, the incidence of blast injuries is sporadic and infrequent. The injuries often are the result of fireworks--10,000-12,000 ED visits annually for this reason.(1) 相似文献
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Sternoclavicular joint subluxation/dislocation injuries in the athlete are uncommon. They can be organised by degree (subluxation, dislocation), timing (acute, chronic, recurrent, congenital), direction (anterior, posterior), and cause (traumatic, atraumatic). The unusual case reported is an adolescent butterfly swimmer with recurrent bilateral sternoclavicular subluxation associated with pain and discomfort. The condition was treated and resolved with conservative management. The diagnosis, investigations, and treatment options are discussed. 相似文献
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Long-term outcome of knee and ankle injuries in elite football 总被引:4,自引:0,他引:4
E. Larsen P. K. Jensen P. R. Jensen 《Scandinavian journal of medicine & science in sports》1999,9(5):285-289
To estimate the risk and evaluate the long-term outcome of knee and ankle injuries in former national team elite football, 69 players were randomly selected, followed by clinical and stress radiographic examinations. Thirty-nine players (49 knees) had had knee injuries and 29 ankle injuries (35 ankles). The median time from injury until study examination was 25 years. The knee injuries were tears of the medial collateral ligament (MCL) in 24 cases combined with rupture of the anterior cruciate ligament (ACL) and meniscus lesions in three. Meniscus lesions had occurred in 17 cases including three combined with ACL and MCL and another two with ACL ruptures. Isolated rupture of the ACL had occurred in four cases. The ankle lesions were in 26 of 35 cases ruptures of the lateral ligaments. In all, 12 players had completely stopped football and three had changed occupation. Signs of arthritis were present in 63% of the injured knees and in 33% of the injured ankles. The incidence of arthritis in the group of 17 uninjured players was 26% in the knee and 18% the ankle. In elite football players knee and ankle injuries seem to have a serious long-term outcome, but also uninjured players have a higher risk of developing arthritis than the normal population. 相似文献
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ObjectivesPrevalence, clinical characteristics and severity of gradual onset injuries (GOIs) in cyclists are poorly documented. We determine the prevalence, anatomical regions/sites affected and severity of GOIs among entrants in a community-based mass participation event.DesignCross-sectional study;SettingCape Town Cycle Tour;ParticipantsRace entrants.Main outcome measuresOf 35,914 entrants, 27,349 completed pre-race medical questionnaires. We studied 21,824 consenting cyclists (60.8% of entrants). Crude lifetime prevalence, retrospective annual incidence, anatomical region/sites, specific GOI, tissue type and GOI severity is reported.ResultsThe lifetime prevalence of GOIs was 2.8%, with an annual incidence of 2.5%. More common anatomical regions affected by GOIs were lower limb (43.4%), upper limb (19.8%), and lower back (11.5%). The knee (26.3%), shoulder (13%), and lower back (11.5%) regions were mostly affected. The most common GOI was anterior knee pain (14.2%). Of the GOIs, 55% were in soft tissue. 50% of cyclists reported symptom duration >12 months, and 37.3% of GOIs were severe enough to reduce/prevent cycling.Conclusion2.5% recreational cyclists report a GOI annually. >50% of GOIs affect the knee, lower back and shoulder. GOIs negatively affect cycling. Risk factors related to GOIs in cyclists need to be determined to develop and implement prevention programs. 相似文献
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目的 观察单核吞噬细胞在创伤性非断离轴索损伤(NDAI)继发断离的作用,探讨NDAI继发断离的机制。方法 液压冲击脑损伤SD大鼠55只,采用全鼠脑连续矢状冰冻切片去磷酸化神经丝蛋白轻链(NF68)和单核吞噬细胞标记抗原(ED1)组化双标及NF68组化电镜染色,光镜电镜观察,计数肿胀轴索及轴索球。结果 伴有血管损伤的冲击区皮质及部分胼胝体主要是断离性轴索损伤,轴索碎片呈NF68杂染,早期即有ED1阳性细胞浸润;远离冲击区的基底节区、脑干、小脑无血管损伤,主要是NDAI,伤后3~12h出现NF68阳性反应的肿胀轴索和轴索球,7~14d毛细血管周边出现ED1阳性细胞,21~28d除肿胀轴索和轴索球外,部分神经元NF68阳性反应,ED阳性细胞广泛浸润。结论 延迟的NDAI继发断离与中枢吞噬细胞免疫反应密切相关。 相似文献
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目的 利用磁共振波谱技术探讨颅脑爆震伤后不同时间段脑局部代谢变化.方法 新西兰大白兔45只采用随机数字表法分为对照组(10只)和创伤组(35只),采用600 mgTNT当量纸雷管在创伤组兔脑上方约6.5 cm垂直距离爆炸,于伤后1,6,12,24 h、3,7,14 d用磁共振波谱技术观测动物存活情况,并检测脑损伤区病理及磁共振波谱表现,观察乙酰天门冬氨酸(N-acetylaspartate,NAA)/肌酸(creatine,Cr)、胆碱(choline,Cho)/Cr在爆震伤后随时间发展的演变过程.结果 创伤组兔存活时间在7 d以上,病理及常规MRI示脑挫伤病灶;NAA/Cr均值在损伤后1 h明显下降,持续至伤后24 h,24 h后义上升,7 d后再次下降.Cho/Cr均值在损伤1 h后即明显升高,12 h后下降,3 d后义逐渐升高.结论 磁共振波谱技术可反映兔颅脑爆炸伤不同时间段局部组织的代谢变化,为了解爆雀伤后局部组织变化情况及判断组织损伤类型提供理论依据.Abstract: Objective To evaluate the regional cerebral metabolic changes in different episodes by magnetic resonance spectroscopy (MRS) after explosive brain injury in rabbits. Methods Fortyfive New Zealand white rabbits were randomly divided into eight groups, ie, normal control group( 10 rabbits) and trauma group (35 rabbits). The explosive injury in trauma group was induced by explosion of 600 mg TNT equivalent of paper detonators at 6.5 cm above the rabbit brain. The rabbits in trauma group was divided into 1,6, 12, 24 hours, 3, 7, 14 days subgroups (6 rabbits per group). The survival rate was observed at different time points after explosive injury. The MRS was used to detect the regional cerebral metabolic changes including N-acetylaspartate (NAA)/creatine (Cr) ratio and choline(Cho)/Cr ratio as well as evolution of blast injuries over time. Results The rabbits survived for overseven days in the trauma groups, with typical brain contusion manifested by pathological and conventional MRI. Compared with the normal control group, the NAA/Cr ratio was markedly decreased at one hour after injury, slightly rose again at 24 hours and fell again after seven days. The Cho/Cr ratio was markedly increased at one hour after injury, slightly fell again at 12 hours and rose again at three days after injury.Conclusions MRS can manifest the regional cerebral metabolic changes of rabbits with explosive injury at different time points and hence provide a theoretical basis for understanding the local tissue changes and determining the type of tissue damage after blast injury. 相似文献
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92例胸腹联合伤临床分析 总被引:42,自引:1,他引:42
目的 探讨胸腹联合伤的诊断及治疗特点。方法 总结经手术证实的胸腹联合伤92例,其中开放性损伤41例(44.57%),以锐器刺伤为主;闭合性损伤51例(55.43%),以交通伤多见。分析不同原因的损伤类别及不同临床症状与手术方式。结果 92例中,术前明确有膈肌破裂42例(45.65%);88例在第一次手术中发现膈肌破裂,并予以修补(95.65%),4例未探查膈肌而漏诊(4.35%);死亡13例(14.13%)。结论 胸腹联合伤是一种特殊类型的损伤,伤情复杂、严重,死亡率高。诊断应根据受伤机制和出血量判断,特别注意避免漏诊膈肌损伤。治疗原则为先处理胸部损伤,后处理腹内脏器损伤。 相似文献
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Calpain抑制剂Ⅰ对大鼠脑非断离性轴索损伤继发断离的影响 总被引:2,自引:1,他引:1
目的 研究Calpain抑制剂Ⅰ对非断离性轴索损伤 (NDAI)继发断离的影响 ,探讨NDAI的治疗途径。 方法 将 16只雄性SD大鼠随机分为Calpain抑制剂Ⅰ组和对照组各 8只 ,液压冲击致大鼠脑弥漫性损伤 ,比较两组伤后 2 4 ,72h胼胝体区、间脑中脑区、桥脑延脑区和小脑区肿胀轴索及轴索球最大密度变化。 结果 大鼠致伤后 ,NF6 8免疫组化显示肿胀的轴索及轴索球。伤后 2 4h ,Calpain抑制剂Ⅰ组桥脑延脑区、小脑区肿胀轴索及轴索球最大密度明显减少 (P <0 .0 1) ;伤后 72h ,Calpain抑制剂Ⅰ组小脑肿胀轴索及轴索球减少 (P <0 .0 5 ) ,而胼胝体区、间脑中脑区、桥脑延脑区变化不明显 (P >0 .0 5 )。 结论 Calpain抑制剂Ⅰ可减轻NDAI的继发断离 ,主要是减少损伤较轻的NDAI的继发断离。 相似文献