小夹板治疗闭合性骨折致肢体坏死2例

自 1998年 12月以来 ,我院共收治闭合性骨折因使用小夹板固定不当致气性坏疽及肢体坏死而截肢患者 2例 ,为引起重视 ,现报道如下。1　病例资料2例均为男性。 1例 34岁 ,为左胫腓骨上段骨折 ;另 1例 12岁 ,为右股骨干下段骨折。均就诊于民间医生 ,采用手法复位后行小夹板外固定。于小夹板外固定后 3天出现肢体肿胀 ,剧烈疼痛 ,未引起重视及采取相应处理措施。继而出现持续高热 ,体温高达 40℃ ,烦躁不安。 3周后就诊我科 ,去除小夹板后 ,发现肢体高度肿胀 ,表面有水泡 ,大面积皮肤坏死 ,肢体恶臭 ,伴有渗液 ,伤肢可触及捻发音 ,有气泡随渗液…     

Intragenicular subchondral fracture. Report of 10 cases

10 cases of subchondral fracture of femoral condyle or tibial plateau with or without rupture of lateral meniscus were reported. All these fractures were compressive type and were treated by open poking reduction and filling of the remaining defect with cancellous bone. Follow-up for 5 to 9 years of the 10 patients showed that they regained painless stable knee and resumed their previous works. We purposely reviewed genicular radiograms of 100 cases who had knee joint injuries, and found that certain number of them showed depression on articular surfaces of femoral condyles, possibly compressive fractures, which should have been considered more seriously. The essential points of diagnosis and the operative keys of surgery for this kind of injury have been mentioned in the paper.     

Depressed skull fracture in the neonate. Report of three cases.

The authors describe three cases of neonatal depressed skull fracture that were elevated by means of an obstetrical vacuum extractor. In one case, a transparent breast pump shield replaced the metal vacuum extractor cup, permitting direct observation as the depression was elevated. Neonatal depressed skull fractures not associated with neurological signs may be safely elevated without surgery using the obstetrical vacuum extractor.     

Jefferson fracture of the atlas. Report of six cases.

Six cases of Jefferson fracture of the atlas are summarized. None had recognizable neurological signs that resulted from the injury when seen in the hospital. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. None of the patients underwent fusion of the cervical spine.     

移植肾肾盂输尿管并发症(附24例报告)

1979年10月～1996年11月施行尸体肾移植术613例(659次),术后发生肾盂输尿管并发症24例,发生率为3.6％。其中肾盂局限性坏死缺损漏尿1例,肾盂炎性肉芽肿伴结石1例,输尿管末端坏死漏尿4例,输尿管膀胱吻合口部分撕裂脱开漏尿10例,输尿管膀胱吻合口狭窄伴肾盂积水8例。本文着重探讨了发生肾盂输尿管并发症的各种原因,并根据其原因,类型提出不同的治疗方法,均取得良好效果。     

Absolute fracture risk varies with bone densitometry technique used. A theoretical and in vivo study of fracture cases.

The lack of consensus of how the results of peripheral bone mineral density (BMD) measurements should be interpreted is proving a barrier to the wider use of these devices. One approach is to interpret peripheral measurements using thresholds (so-called equivalent T-scores) defined to have the same absolute fracture risk as a femoral neck T-score of -2.5. For this concept to be valid, the estimates of fracture risk for a population should be the same irrespective of the measurement technique used. We tested this prediction both theoretically and in vivo using data for 63 postmenopausal women with Colles fracture and 191 control subjects. The theoretical analysis showed that if the normal population has a Gaussian BMD distribution and fracture risk varies exponentially with Z-score as exp(-beta Z) then patients who experience a low-trauma fracture have a fracture risk that is larger by a factor exp(beta(2)) compared with the fracture risk of the whole population. Using data from the in vivo study, fracture risk predictions were compared for seven different types of measurement (lumbar spine; femoral neck; total hip BMD; and speed of sound [SOS] at the radius, tibia, phalanx, and metatarsal). When quantitative estimates of fracture risk were made for individual subjects, the average risk of fracture for the Colles group varied between 1.03 times larger (for tibial SOS) and 2.77 times larger (for total hip BMD) than the average fracture risk for the whole population. As predicted by the theoretical study, fracture risk varied according to the odds ratio determined by logistic regression analysis. Therefore, estimates of fracture risk derived for the same group of patients varied almost threefold according to the type of measurement. It was concluded that equating estimates of absolute fracture risk for different types of scan should not be used as the basis of deriving equivalent T-scores for interpreting peripheral measurements.     

Surgical treatment of congenital horseshoe kidney. Report of 21 cases]

From 1984 to 1989, we treated surgically 21 patients with horseshoe kidney. Clinically, urinary tract calculi was a common problem. In this group, 14 patients were complicated by urinary tract calculi. Diagnosis of horseshoe kidney was established roentgenographically in most cases. Twenty-one patients underwent 25 operative procedures for removal of the urinary tract stone and division of the isthmus. Eight operations were performed by classical extraperitoneal horizontal flank incision and 17 were done transperitoneally. We consider that the latter is more superior than the former.     

极度背伸端提手法复位塑形夹板固定治疗Hawkins Ⅲ型距骨颈骨折23例

自1997年5月-2003年10月，采用极度背伸端提手法复位塑形夹板固定治疗Hawkins Ⅲ型距骨颈骨折患者23例，取得满意疗效，现报告如下。     

Breast repair using a silicone gel-filled prosthesis. Report of 21 cases

From March 1985 to May 1988, a total of 32 breast repairs in 21 patients following mastectomy were performed in our hospital. The operative procedures included: immediate prosthesis insertion following subcutaneous mastectomy in 16 patients; subsequent prosthesis implantation following simple mastectomy in 4 patients; a transfer of latissimus dorsi skin-muscle flap with submuscular placement of prosthesis subsequent to the radical mastectomy in 1 patient. The chief indications for mastectomy are: multiple fibroadenomas, giant fibroadenoma, severe fibrocystic mastopathy and cystosarcoma phyllodes and so on. After a period of 1-38 months follow-up postoperatively, the results were satisfactory with no significant complications. It is believed that the breast repair by utilizing silicone gel-filled implant following mastectomy is a safe, reliable and more effective procedure, and is reasonable to extend its indication in latter clinical application.     

Malignant tumors of the small intestine. Comments concerning 21 observed cases

Patients affected by malignant tumors of the small intestine observed by the Department of Clinical and Pathological Surgery at the University of Florence were studied from 1964 to 1989. The most important aspects of the disease were studied, on the one hand emphasising its low incidence and on the other the poor prognosis which accompanies it. Greater attention should be focused on these lesions in order to enable an early diagnosis to be made since this currently represents the sole possibility for carrying out an efficacious therapy.     

小肾癌的诊断方法比较(附40例报告)

目的：探讨小肾癌的较好诊断方法,比较B超检查、IVP和（或）逆行肾盂造影检查、CT扫描及选择性肾动脉造影诊断小肾癌的临床价值。方法：回顾性分析40例小肾癌患者的临床资料。结果：无任何临床症状而经体检偶然发现者26例（65．0％）,有血尿6例（15．0％）,腰痛5例（12．5％）,血尿并腰痛2例,因慢性肾功能不全经B超检查发现1例。40例接受B超检查,诊断准确率为87．55％;29例接受IVP或逆行肾盂造影检查,诊断准确率为44．83％;38例接受CT检查,诊断准确率为94．76％。结论：B超、CT及肾动脉造影综合影像诊断技术成为目前诊断小肾癌的主要手断。     

Treatment of Jefferson fracture with a halo apparatus. Report of two cases.

Two patients with bursting fractures of the atlas vertebra are presented. The use of a halo apparatus as an effective alternative to bedrest and cervical traction in these patients is discussed. Polytomography was helpful in establishing an accurate diagnosis.     

Transmission of pressure into the human limb from pneumatic splints

The anterior compartment of the leg of 4 volunteers was used to study the transmission of externally applied pressure into a limb. The pressure from a pneumatic splint was found to be transmitted directly into the leg and was found to be added to the resting intramuscular pressure. The median inflation pressure of such a splint applied by trained ambulance personnel was 25 mm Hg (range 15-36 mm Hg). When the resting intramuscular pressure was raised experimentally, either by voluntary muscular contraction or venous engorgement, numerical addition of externally applied pressure was again observed. A moderate rise in compartment pressure commonly occurs after injury. Due care should be taken in the use of pneumatic splints or compressive dressings as the total pressure generated within a limb may be sufficient to induce ischaemia.     

Late vertebral body fracture after lumbar transpedicular fixation. Report of three cases

Late-onset vertebral body (VB) fracture after lumbar transpedicular fixation has not been previously described in the literature. The authors present three cases in which VB fracture occurred several months after posterolateral fixation in patients with degenerative disease or traumatic injury. The authors suggest that postoperative osteopenia, modified load-sharing function, and intravertebral clefts were responsible for the fractures. Two women and one man were evaluated at a mean follow-up interval of 3 months. Two patients suffered recurrent lumbar pain. Radiography and magnetic resonance imaging revealed fracture of some of the instrumentation-treated VBs. These two patients underwent surgical superior or inferior extension of instrumentation. The third, an asymptomatic patient, received conservative management. The two patients who underwent reoperation made complete recoveries, and there was no evidence of further bone collapse in any case. The authors speculate that alterations in the VBs may occur following application of spinal instrumentation. In rare cases, the device can fracture and consequently lead to recurrent lumbar back pain. Recovery can be achieved by extending the instrumentation in the appropriate direction.     

Combined fracture of the distal radius and scaphoid in children. Report of 2 cases

The authors report 2 cases of concomitant scaphoid and distal radial fractures, a rare combination of lesions in children. The first case was in a 13-year-old boy who presented a transverse midscaphoid fracture associated with a Salter type II distal radial fracture. The second concerned a 10-year-old boy who presented a bilateral wrist injury. On the left side, a distal forearm fracture with anterior displacement was associated with a transverse midscaphoid fracture. On the right side, there was only a distal forearm fracture. Scaphoid fracture associated with distal radial fracture seems to have been more frequently reported in the literature during the last decade, probably because it is more frequently recognised. In fact, children with distal forearm injury should be well examined both clinically and radiologically in order to search for an associated scaphoid fracture. Reduction of the radius fracture should be done carefully to avoid possible displacement of the scaphoid fracture.