钝性创伤性膈疝12例诊断与治疗

目的：探讨钝性创伤性膈疝的诊断治疗方法。方法：2008年9月-2011年12月我科收治钝性创伤性膈疝12例,对其临床资料进行旧顾性分析。结果：本组12例,术前胸部X线片检查确诊3例,胸部Crr检查确诊7例,手术中探查确诊2例。12例均手术修复破损膈肌,还纳移位脏器,其中1例合并有左下肺实变,予以左下肺叶切除;2例因降结肠、结肠脾曲嵌顿坏死,行坏死结肠切除,结肠外置。术后肺部感染2例,所有患者切口均愈合良好,均治愈出院。术后随访无复发,无一例死亡。结论：钝性创伤性膈疝可通过详细了解受伤原因、部位,全面细致的体格检查,以及X线、胸部CT等辅助检查及早明确诊断。钝性创伤性膈疝一旦确诊,应立即手术治疗,以修复破损膈肌,还纳移位脏器,减轻胸腔压迫,恢复循环、呼吸和消化功能。     

重症超声在多发伤合并胸部损伤诊断中的应用价值分析

目的重症超声在多发伤合并胸部损伤诊断中的应用价值。方法选择2017年11月～2019年11月入住我院的198例多发伤疑似合并胸部损伤重症患者作为研究对象,所有患者均接受早期床旁超声、胸部X线片诊断,并以最终临床诊断结果为金标准,比较两种诊断方法与金标准诊断符合率、诊断平均耗时、诊断灵敏度、特异度、准确率、漏诊率、误诊率差异。结果床旁超声对多发伤患者气胸、胸腔积液、肺挫伤、心包积液的诊断符合率以及诊断灵敏度、特异度、准确率均明显高于胸部X线片(P0.05);床旁超声诊断平均耗时、漏诊率、误诊率明显低于胸部X线片(P0.05)。两种诊断方式对创伤性膈疝的诊断符合率无明显差异(P0.05)。结论床旁超声在多发伤合并胸部损伤的诊断中诊断效能更为理想,临床应用价值更突出。     

胸部损伤的早期处理

本文收集我院于1998年7月至2001年7月收治的胸部损伤21例,现就救治经验进行总结分析如下。 一、临床资料 1.一般资料:本组21例,单纯肋骨骨折8例,占38.1％;血气胸13例,占61.9％;其中心脏损伤1例,横膈肌破裂1例,胸腹联合伤3例。①致伤原因:交通及建筑事故7例,刀器伤9例,其它打击、摔伤、挤压伤等5例。②合并症:合并休克者10例,合并颅脑、肝、脾、肾及四肢伤者8例,胃肠破裂1例。     

肺挫伤33例治疗体会

肺挫伤在胸部损伤中很常见，胸部挤压、撞击或毒性气体引起，多与肋骨骨折、血气胸、肺出血、连枷胸等共存，对呼吸、循环功能有极大影响。现将我院2001年7月到2002年12月收治肺挫伤33例诊治情况分析如下。     

肾脏钝性撞击损伤影响因素的有限元方法研究

目的 采用有限元方法研究肾脏钝性撞击损伤的影响因素。方法 基于肾脏CT图像构建不同年龄人群肾脏有限元模型,重构肾脏钝性撞击实验,分析肾脏材料本构参数、肾脏组织结构、肾脏大小、撞击位置和撞击速度等参数对肾脏损伤的影响。结果 相同撞击工况下,肾皮质应力随肾脏质量的增加有所减少,随撞锤撞击速度的增加而增加;肾包膜具有一定的吸能效果,从而降低肾脏的应力;肾脏受到撞击时,侧面撞击的肾皮质应力明显高于正面撞击。结论 相比黏弹性本构模型,Mooney Rivlin材料本构模型更适合用于肾脏损伤的有限元评价;肾脏损伤随肾脏质量的增加有所减少;撞锤撞击速度的增加会加剧肾脏损伤;肾包膜会一定程度上减轻肾脏损伤,故在进行肾脏有限元建模时,必须考虑肾包膜结构的存在;相比正面和背面撞击,肾脏侧面受到撞击时损伤相对更严重。     

腹腔镜技术在创伤性膈肌损伤诊治中的应用

<正>膈肌损伤在胸腹部外伤是罕见的,但创伤患者容易漏诊,严重地威胁到患者生命。虽然距第1例创伤性膈肌损伤的报道已有400余年[1],但是到目前为止其具体发病率仍不明确。由于缺乏典型的临床表现和确切的诊断方法,在胸腹部创伤中,膈肌的损伤常容易漏诊。据统计,创伤性膈肌损伤术前诊断正确率不到50%[2]。随着腹腔镜技术的不断进步,腹腔镜技术以其创伤小、恢复快的优势,得到了广泛的应用[3],然而其在膈肌损伤诊治中的应用目前尚存在争议。在此背景下,本文就腹腔镜技     

儿童钝性腹部创伤超声显像高度准确和特异

据Tas F[Eur J Radiol，2004，51(1)：91—96]报道，儿童钝性腹部创伤(BAT)超声显像(US)高度准确和特异，对肝、脾和肾损害高度敏感。US对胃肠道(GIT)和胰腺损伤诊断敏感度适宜。     

闭合性腘动静脉损伤2例治疗分析

目的 探讨闭合性胭动静脉钝性损伤的诊治方法。方法 本院近期收治闭合性胭动静脉钝性损伤2例，两例患者均有膝关节周围骨折，脑动静脉均系钝性损伤。结合受伤情况及临床检查以及多普勒超声检查，早期诊断，早期仔细修复损伤的血管，术中、术后抗凝治疗，以及术中预防性筋膜切开减压、预防感染等综合治疗。结果 1例截肢，1例发生缺血性肌坏死虽保住了肢体，但遗留有严重的肢体功能障碍。结论 闭合性胭动静脉钝性损伤应早期诊断，积极采取手术等综合治疗，降低并发症发生率和截肢率。     

闭合性胭动静脉损伤2例治疗分析

目的 探讨闭合性胭动静脉钝性损伤的诊治方法。方法 本院近期收治闭合性胭动静脉钝性损伤2例，两例患者均有膝关节周围骨折，脑动静脉均系钝性损伤。结合受伤情况及临床检查以及多普勒超声检查，早期诊断，早期仔细修复损伤的血管，术中、术后抗凝治疗，以及术中预防性筋膜切开减压、预防感染等综合治疗。结果 1例截肢，1例发生缺血性肌坏死虽保住了肢体，但遗留有严重的肢体功能障碍。结论 闭合性胭动静脉钝性损伤应早期诊断，积极采取手术等综合治疗，降低并发症发生率和截肢率。     

腰肋三角的应用解剖

对33具(64侧)成人及儿童尸体的腰肋三角作了解剖观察,对特例摄影记录。腰肋三角出现率左侧84.84±6.24％,右侧54.84±8.94％,左右对比P<0.01。三角的位置(以两斜边起点表示)左右侧均以腰方肌外缘——第12肋尖多见。三角底边最长者为自L1横突至第11肋尖,最短者为自腰方肌外缘附近至第12肋尖附近,总体看左侧三角底边长者明显多于右侧。三角底边长与高度之间无相关,双斜边绝大多数以锐角相交,外斜边叠压内斜边,然后移行为腱膜,以钝角相交者属底边最长者,64例中见3例,占4.69±2.64％。交角内有弧形肌片遮被共5例,占7.81±3.35％,有纵行肌片自交角或斜边附至底边共4例,占6.25±3.03％。根据调查数字,本文提供了经第11肋骨床或第11肋间入路进行脊柱上腰段或肾脏手术时切断膈肌的发生率。本文还讨论了腰肋三角与膈疝的关系。     

闭合性胰腺损伤的诊治（附18例报告）

目的探讨腹部闭合性胰腺损伤的诊治方法。方法回顾性分析1999至2006年18例闭合性胰腺损伤的临床资料。结果16例治愈,治愈率88.9%;2例死亡,病死率11.1%;发生胰瘘、腹腔脓肿、胰腺假性囊肿等并发症7例,发生率38.9%。结论腹部闭合性胰腺损伤早期诊断困难,早期诊断、及时手术和恰当的治疗方式是决定预后的关键。     

Thyroid implants after surgery and blunt trauma

The differential diagnosis of thyroid tissue found laterally in the neck includes several conditions: lymph node deposits of thyroid carcinoma, "benign metastatic thyroidosis," detached thyroid nodules, and true ectopic thyroid tissue. We have studied nine cases with thyroid deposits in the soft tissues of the neck that do not conform to these diagnoses. We present evidence that they represent surgical or traumatic implantation of thyroid neoplasms. Eight of the nine cases presented one to 26 years after initial surgery. Adequate information of the operative procedure was available in seven cases, one patient underwent subtotal lobectomy and six subtotal thyroidectomy for a nodular gland. The nodules occurred within the operation field with no evidence that they were within lymph nodes. In six cases, birefringent particles consistent with talc from the earlier operation were found adjacent to the nodules. Three cases showed implants of colloid nodules, three of follicular adenoma, one of oncocytic (Hürthle) cell adenoma and one of follicular carcinoma. In the ninth case, infiltrating thyroid tissue in muscle and fibrous tissue presented 3 years after major blunt trauma to the neck. The tissue resembled that in a disrupted thyroid nodule present in the gland itself and was regarded as traumatically implanted. The observation that surgery or trauma to a nodular thyroid can occasionally lead to multiple subcutaneous thyroid implants has implication for management of thyroid disease. Therapy may be difficult; recurrence followed surgical removal of the nodules in three cases, and radioiodine may be a more effective therapy. Recognition of this entity is important for accurate pathologic diagnosis. It is apparently limited to implantation of tumor. The absence of implantation of normal or hyperplastic thyroid, despite the high frequency of partial thyroidectomy in Graves' disease, has pathobiological implications. These findings also support the generally held view that lobectomy rather than nodulectomy is the operation of choice for a solitary nodule.     

Black-white disparities in blunt trauma.

To uncover causes of increased mortality rates in black accident victims, patterns of injury and access to trauma care were compared between black and white patients. Over a 41-month period (February 1985 to June 1988), 2120 white and 468 black patients, each with an Injury Severity Score (ISS) > 14 as a result of blunt trauma, were admitted to a Level I regional trauma center, part of a statewide trauma system. Blacks were significantly older and more of them had premorbid illnesses. Although vehicular crashes accounted for the majority of injuries in both groups, blacks had significantly more injuries resulting from falls, pedestrian accidents, and assaults. Whereas 70.6% of whites were transported from the scene and 73% were transported by helicopter, 52.7% of blacks were transported from the scene and 44% by helicopter. Blacks made up 18% of the study group and accounted for 20% of deaths (mortality rate 17.3% for blacks and 14.9% for whites). Mortality was significantly increased for black patients admitted with a Glasgow Coma Scale (GCS) score > or = 13. Private medical insurance, available for 46.3% of black patients, accounted for 78% of payments for all trauma admissions. Increased mortality of black trauma patients may be related to risk factors (age, premorbid illness), increased rates of pedestrian accidents and falls, and disparities in access to Level I trauma centers.     

胸部创伤的临床治疗分析（附482例报告）

目的分析胸部创伤病人的临床特点和治疗。方法对482例胸部创伤患者者的致伤原因、损伤类型及治疗方法的选择进行回顾性分析。结果全组治愈465例(96.5%),死亡17例(4.5%)。结论大多数胸部创伤患者给予保守及胸腔闭式引流治疗可治愈,对并发其他器官损伤者应给予积极的手术治疗,防治急性呼吸窘迫症等严重并发症。     

Emergency management of blunt trauma in children

Apart from the trend to nonoperative treatment of blunt abdominal injuries, based on accurate CT diagnosis, most of the recent and anticipated changes in pediatric trauma are organizational. They include resuscitation and triage before hospitalization, the use of designated trauma centers, resuscitation by trauma teams, noninvasive diagnosis and monitoring, comprehensive pediatric intensive care, the use of objective measures of outcome, and improved rehabilitation programs (Templeton JM: personal communication). The treatment of individual cases is based on simple but well-established principles. The key steps in management are to recognize children with life-threatening injuries (on the basis of the mechanism of injury or a Pediatric Trauma Score less than or equal to 8 or a Revised Trauma Score less than or equal to 11), to support the function of vital organs by establishing and maintaining adequate respiratory gas exchange and circulation, and to identify all important injuries by thorough and ongoing assessment.     

泪小管炎的诊断和治疗进展

泪小管炎是一种少见的感染性泪道疾病,其症状、体征与慢性结膜炎、睑板腺囊肿、慢性泪囊炎等疾病相似,临床误诊率高,治疗方法仍存在争议。随着技术的发展,超声生物显微镜、泪道内镜等技术的应用为泪小管炎的精准诊疗提供了可能。本文就泪小管炎诊断和治疗方面的研究现状及进展进行综述,以期增加临床对该病的认识和重视。     

胸廓内动脉及其穿支的解剖与临床应用研究进展

<正>形态丰满良好的乳房是女性形体审美的标准之一。乳房整形与重建外科应用广泛,手术方式有单纯隆乳术、巨乳缩小术、乳房重建术等。防止术中出血、术后血肿以及保证乳头乳晕的血供等问题备受整形外科医生关注。胸廓内动脉是乳房最主要血供来源,掌握其解剖特点对于提高隆胸手术、巨乳缩小术的安全性及其术后效果具有重要意义;以胸廓内动脉或其穿支作为受体血管进行游离皮瓣移植,是乳房重建的重要