肺挫伤的救治经验

目的总结肺挫伤的诊断及治疗经验。方法回顾分析2001年1月～2007年6月收治的188例肺挫伤的诊断、治疗方法及治疗效果。结果治愈181例,死亡7例;其中死于创伤性失血性休克2例,重型颅脑损伤2例,急性呼吸窘迫综合征（ARDS）3例。结论严重创伤患者肺挫伤的诊断首选CT检查,治疗后复查宜选胸部X线片。严重的合并伤和肺部并发症是肺挫伤的主要死亡原因,积极治疗合并伤,预防和治疗肺炎、肺不张及ARDS等是治疗肺挫伤的关键。     

准静态下颞部撞击致颅脑伤的有限元模拟分析及其临床意义

目的建立准静态下颞部撞击致颅脑伤的虚拟模型，研究准静态下颞部撞击所致的应力分布以及应力波的传播，探讨颞部撞击致颅脑伤的生物力学机制。方法在Hypermesh软件中建立准静态颞部撞击伤的有限元模型，用Ls-Dyna软件对该有限元模型进行数值模拟计算，最后用Ls-Prepost软件进行后处理。结果撞击点处颞骨VonMises应力以及颅内压力随撞击速度的提高而增大；应力波在颅骨表面的传播以撞击点为圆心的径向上传播，在颅骨一脑组织耦合处急剧衰减；颅底有应力集中区域。该数值模拟的结果与生物试验结果较吻合。结论本研究对颞部撞击致颅脑损伤的诊断和防护有重要意义。     

穿透性心脏损伤临床救治进展

探讨穿透性心脏损伤及时准确地定性,定位诊断以及早期治疗的重要性。熟练掌握穿透性心脏损伤的诊治原则,手术方式及围手术期处理方法,对降低病死率和改善预后具有极其重要的意义。     

确立重度肺爆震伤救治中体外膜肺氧合的地位

随着经济全球化和世界格局的极不稳定,局部范围内各类爆炸不断,肺爆震伤患者逐渐增多。重度肺爆震伤伤情复杂、临床救治难度大、并发症多,能否早期、有效地维持呼吸、循环功能稳定,是提高救治率、降低病死率的关键。而体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)已成为救治各种重症肺部疾病不可或缺的方法。笔者采用ECMO救治重度肺爆震伤动物模型的早期试验以及临床救治重度肺爆震伤患者均取得了满意的效果。因ECMO具有强大的心肺辅助支持功能,从而为重度肺爆震伤的救治提供一条新途径。     

准静态下颞部撞击致颅脑伤的有限元模拟分析及其临床意义

目的 建立准静态下颞部撞击致颅脑伤的虚拟模型,研究准静态下颞部撞击所致的应力分布以及应力波的传播,探讨颞部撞击致颅脑伤的生物力学机制.方法 在Hypermesh软件中建立准静态颞部撞击伤的有限元模型,用Ls-Dyna软件对该有限元模型进行数值模拟计算,最后用Ls-Prepost软件进行后处理.结果 撞击点处颞骨Von Mises应力以及颅内压力随撞击速度的提高而增大;应力波在颅骨表面的传播以撞击点为圆心的径向上传播,在颅骨-脑组织耦合处急剧衰减;颅底有应力集中区域.该数值模拟的结果与生物试验结果较吻合.结论 本研究对颞部撞击致颅脑损伤的诊断和防护有重要意义.     

胸部闭合性肺实质损伤的X线诊断：附200例分析

本文报告肺实质损伤２００例，将其Ｘ线表现主要归纳为：（１）肺内表现，创伤性湿肺，肺挫伤，肺撕裂伤，肺内血肿四种类型。（２）肺外表现，单纯性气胸，单纯性血胸，血气胸，皮下气肿或纵隔气肿四种类型，并就其Ｘ线表现及病理基础做了简要分析，指出对于肺实质损伤患者，进行动态胸部Ｘ线摄片检查的必要性。     

233例胸部创伤的X线分析

本文对２３３例胸部创伤患者的Ｘ线表现进行了分析。其中钝挫伤１４０例，刀刺伤９３例。钝挫伤中肋骨骨折，特别是多根肋骨骨折和肺挫伤多见，刀刺伤以血气胸为多。结合文献讨论了肺挫伤和创伤性湿肺的发生及其病理基础，发现肺挫伤多发生在直接致伤部位，伤后立即出现；创伤性湿肺一般出现较晚，且多不在直接致伤处。注意到延迟性血气胸在胸部创伤中的临床意义。     

兔眼冲击伤后视网膜损伤的病理学变化

目的 探讨冲击伤导致视网膜损伤的病理学改变特点。方法 采用兔眼局部冲击伤模型,对伤前和伤后各时相点进行常规眼科检查,并取视网 膜组织做常规HE染色光镜检查和环氧树脂618包埋电镜观察。结果 眼部冲击伤后即刻见球结膜充血、水肿,脉络膜出血和玻璃体出血,视网膜损伤重于眼前节损伤,以眼底改变为主,有明显的视网膜血管改变,组织水肿、渗出、出血等改变。结论 眼部气体冲击伤以视网膜损伤最为突出,可导致视功能障碍。     

Timing of cortical contusion

Summary One hundred and sixteen cases with known intervals between the time of brain injury and the time of death were systematically examined for selected histologic alterations in an attempt to facilitate the timing of histomorphologic alterations in cortical contusions following closed brain injury. The following criteria were considered: erythrocytes, polymorphonuclear leukocytes, scavenger cells, hemosiderophages, lymphocytes, hematoidin, degenerating neurons, neuronophagy, axonal swelling, protoplasmic astrocytes, piloid astrocytes, siderin-containing astrocytes, edema, increase of vessels, fibroblasts/fibrocytes, and collagenous fibers. The post-traumatic interval ranged between 0 min and 58 years.Following routine staining, the paraffin sections were evaluated, and the presence of the selected histomorphologic criteria was determined (i.e., the time at which the criteria were demonstrable for the first and the last time during the post-traumatic interval in cases with different times of post-traumatic survival). The relative frequency of those cases with positive findings was calculated for each criterium in each observation period. The limits of confidence for the respective relative frequency was estimated with a statistical reliability of 95% according to Clopper and Pearson (1934) in the cases with demonstrated individual histomorphologic criteria. The distribution-free tolerance intervals with which each histomorphologic criterium is to be expected with 95% reliability within the observation period were established. The statistical data were compared with some of the data presented in the literature.     

肺挫伤研究现状及治疗

肺挫伤是主要的胸部钝性伤,严重肺挫伤死亡率较高,是胸部创伤的主要死亡原因之一。笔者收集了近几年有关肺挫伤基础研究及临床救治的文献报道,对肺挫伤后的病理生理、影像学研究及治疗进展作了重点介绍。     

肺挫伤的诊治进展

探讨肺挫伤的发生机制、病理生理改变、临床表现、诊断及治疗方法的最新进展。熟练掌握肺挫伤的诊治原则,对降低病死率及改善预后具有极其重要的意义。     

Eye injuries in sports

In a retrospective study from 1988 to 1998, eye injuries were found in 553 patients. Seventy-six (13.7%) of these injuries were associated with sport. The mechanism of trauma was for the most part a ball (71.1%) or a club (13.2%). Most eye injuries occurred in soccer (35.5%), which is, by far, the most widespread sport in this region of Norway. A disproportionately high number of the injuries occurred in floorball (17.1%), bandy (13.2%), and squash (10.5%). The rules in these sports may, in theory, be strict enough to prevent eye injuries in most cases. However, these rules are often neglected in informal activities. Strategies for educating the general public about the potentially serious effect of eye injuries in sports exposed to such risk are of great importance.     

隐性骨与软骨损伤的MRI诊断

目的探讨隐性骨与软骨损伤的MRI特点,分析骨挫伤、隐性骨折和关节软骨损伤间的关系。方法回顾性分析了101例隐性骨与软骨损伤,其中骨挫伤70例,隐性骨折13例,关节软骨损伤18例。观察病变的MRI特点、分布,检出骨挫伤的序列敏感性。结果T1WI,STIR或PDWI(f/s)检出骨挫伤的敏感性为95.7%及100%。骨挫伤病变在关节主要分布于骨骼的边缘,脊椎主要分布于椎体上缘终板下。隐性骨折骨折线走行方向不定,平均宽度为1.8 mm,邻近区域的骨挫伤是其重要的间接征象。关节软骨损伤MRI表现为关节软骨变薄、断裂或缺损,软骨下骨挫伤出现率为100%。结论隐性骨折和关节软骨损伤均合并有骨挫伤,MRI是诊断隐性骨与软骨损伤的敏感方法。     

美宝创疡贴治疗皮肤挫擦伤35例临床观察

目的 观察美宝创疡贴对皮肤挫擦伤的临床疗效.方法 创面简单清创后采用美宝创疡贴换药治疗.结果 应用美宝创疡贴换药治疗时创面无疼痛、创面愈合快、愈合后无色素沉着.结论 美宝创疡贴治疗皮肤挫擦伤创面疗效显著,具有疼痛轻、愈合快、无瘢痕等优点.     

Efficacy and safety assessment of acute sports-related traumatic soft tissue injuries using a new ibuprofen medicated plaster: results from a randomized controlled clinical trial

Objective: To investigate the efficacy and safety of a recently developed ibuprofen medicated plaster in the treatment of acute sports impact injuries/contusions.

Methods: In this double-blind, multi-center, placebo-controlled, parallel group, phase 3 study (EudraCT Number: 2012–003257-2) patients (n = 132; ages 18 to 60 years) diagnosed with acute sports-related traumatic blunt soft tissue injury/contusion to the upper or lower limbs were randomized to receive either ibuprofen 200 mg plaster (n = 64) or placebo plaster (n = 68). Plasters were administered once daily for five consecutive days. The primary assessment was the area under the curve (AUC) of the visual analogue scale (VAS) of pain on movement (POM) over 0 to 72 h (VAS_0-72).

Results: The ibuprofen medicated plaster was associated with a reduction in pain on movement (POM) based on lower VAS AUC_0-72h (2399.4 mm*h) compared with placebo (4078.9 mm*h) (least squares mean difference: – 1679.5 mm*h; P < 0.0001). The reduction in AUC of POM was also significantly greater for the ibuprofen medicated plaster compared with placebo at 12, 48, 24, and 120 h (P < 0.0001). Algometry/tenderness measurements found that the ibuprofen medicated plaster was associated with greater reduction in tenderness/pain than placebo at each timepoint (P values <0.0001). Seven patients experienced drug-related adverse events (n = 1 [1.6%] for the ibuprofen plaster, and n = 6 [8.8%] for placebo). All drug-related AEs were administration site reactions and were mild in intensity.

Conclusions: The results of this study indicate that ibuprofen medicated plaster results in rapid and clinically relevant reduction of pain in patients suffering from blunt musculoskeletal injuries or recurrent pain. The ibuprofen medicated plaster was well tolerated.     

A quantitative immunohistochemical study on the time-dependent course of acute inflammatory cellular response to human brain injury

The time-dependent inflammatory cell reaction in human cortical contusions has been investigated during the first 30 weeks after blunt head injury. Immunohistochemical staining was carried out using CD 15 for granulocytes and LCA, CD 3 and UCHL-1 for mononuclear leucocytes. In order to provide reliable data for a forensic wound age estimation, the intensity of the cellular reaction was evaluated with a quantitative image analysis system. CD 15-labelled granulocytes were detectable earliest 10 min after brain injury, whereas significantly increased numbers of mononuclear leucocytes occurred in cortical contusions after a postinfliction interval of at least 1.1 days (LCA), 2 days (CD 3) or 3.7 days (UCHL-1), respectively. Received: 15 June 1998 / Received in revised form: 6 October 1998     

The time course of the vascular response to human brain injury – an immunohistochemical study

In a total of 104 individuals who had sustained traumatic brain injury (TBI), the time-dependent vascular response was investigated at the injured cortical area during the first 30 weeks after the trauma. The immunohistochemical staining of the cerebral blood vessels was performed with antibodies against laminin, type IV collagen, tenascin, thrombomodulin and factor VIII associated antigen. Compared to the immunoreactivity in unaltered control tissue, a significantly increased vascular expression could be detected in cortical contusions after a postinfliction interval of at least 3 h for factor VIII, after 1.6 days for tenascin or after 6.8 days for thrombomodulin, whereas the immunostaining for laminin and type IV collagen was regularly positive even in the vascular endothelium of uninjured brain tissue. Received: 22 April 1999 / Received in revised form: 7 October 1999     

Immunohistochemical investigations on the course of astroglial GFAP expression following human brain injury

The course of GFAP expression by astrocytes has been immunohistochemically investigated during the first 30 weeks after human brain injury. In order to provide reliable data for a forensic wound age estimation, a quantitative morphometric analysis was performed considering the different topographic regions of the cortex as well as of the white matter. Compared to the GFAP immunoreactivity in unaltered control tissue, significantly increased numbers of GFAP positive astroglial cells could be detected adjacent to the cortical contusion from 1 day up to 4 weeks after brain injury. Received: 10 November 1998 / Received in revised form: 26 February 1999     

创疡贴治疗皮肤挫擦伤60例临床疗效观察

目的　观察创疡贴应用于皮肤挫擦伤创面的临床疗效。 方法　 对60例患者的146处皮肤挫擦伤创面进行分级,在简单清创后,采用创疡贴换药治疗, 观察治疗效果。 结果　 60例患者146处创面全部临床治愈,其中Ⅰ度创面平均愈合时间约为7 d,Ⅱ度创面平均愈合时间约为10 d,Ⅲ度创面平均愈合时间约为21 d。 结论　创疡贴适用于不同深度的皮肤软组织挫擦伤创面,操作简便,疗效满意,值得临床推广应用。