手术治疗单下肢全长骨纤维异常增殖症1例报道

骨纤维异常增殖症(fibrous dysplasia of bones, FDB)又称骨纤维结构不良或骨纤维瘤,是一种先天性、非遗传性,以骨局限性突出、正常骨松质被增殖的异常骨纤维所替代为特征的良性骨病.本病最早在1922年被Wiel报道发现,其后在1937年及1938年Albright连续报道了7例相似病例.1942...     

高强度聚焦超声治疗子宫腺肌症合并四次开腹手术史患者1例报道

子宫腺肌症是一种严重影响女性健康的常见疾病,大量研究结果显示高强度聚焦超声治疗子宫腺肌症可取得良好的治疗效果。本文回顾分析了1例子宫腺肌症合并四次开腹手术史患者的诊治历程,并对相关文献进行复习,以期为该类患者的临床诊治提供参考。     

克罗恩病致肠梗阻行手术治疗1例报道

病例资料患者,女,24岁,因"腹泻、腹胀伴腹痛4个月"入院。入院前4个月出现腹泻,呈清水样便,7～8次/d,带少量黏液,脓血,在当地医院就诊,未作出明确诊断。因进食后腹胀、腹痛明显,患者惧怕进食,至消瘦明显,体重减轻约10 kg,故来我院就诊。查体:体重43 kg,一般情况差,腹部略凹陷,无胃形;于右下腹可见一肠形及蠕动波,腹肌柔软,脐周压痛,无反跳痛,肝脾未扪及,Murphy征(-),移动性浊音(-),叩诊呈鼓音,肠鸣音亢进。RBC 3.95×1012/L,     

Malignant hyperpyrexia and Duchenne muscular dystrophy: A case report

We report a patient with Duchenne muscular dystrophy who developed malignant hyperpyrexia during general anaesthesia. During anaesthesia bradycardia was followed by ventricular fibrillation, on which ventricular flutter supervened and a body temperature rise of 0.6 degrees C for 15 minutes, myoglobinuria and elevation of CPK level were observed. The caffeine sensitivity test of biopsied muscle fibers revealed an increase in sensitivity, although there was no sign of muscle rigidity during or after anaesthesia. Diagnosis of Duchenne muscular dystrophy was first established after the development of malignant hyperpyrexia in the present case as well as in previously reported cases. Determination of serum CPK is very important before general anaesthesia.     

Delay in diagnosing Duchenne muscular dystrophy in orthopaedic clinics

For clinical, psychological and social reasons the diagnosis of Duchenne muscular dystrophy should be established as early as possible. In a survey of 83 families with 93 affected boys, the diagnosis was missed in every case referred to an orthopaedic surgeon (37 patients). In the whole group there was a mean delay of 2.0 years (0 to 6 years) during which time inappropriate treatment, difficulties in communication with parents, much parental anxiety and further pregnancies occurred. A serum creatine kinase estimation is a simple outpatient test which should be carried out on any boy with clumsy or abnormal gait, with flat feet or with an unexplained equinus deformity.     

Nonoperative management of lower extremity claudication caused by a Baker's cyst: case report and review of the literature

A Baker's or popliteal cyst is a synovial cyst in the popliteal fossa arising from the knee joint. The majority of patients develop a popliteal mass that is asymptomatic, but in a small percentage of patients, complications and symptoms occur; these may not only encompass the popliteal veins and arteries but may also include cyst leakage, infection, hemorrhage, and compartment syndrome. Severe lower limb ischemia caused by a Baker's cyst is extremely rare, having been reported only six times since 1960; all patients were treated with surgical intervention. We report the case of a 29-year-old male presenting with right calf claudication caused by a Baker's cyst. The patient was managed nonoperatively with nonsteroidal anti-inflammatory agents, proper exercises, and close observation. His claudication improved progressively and had completely disappeared at 12 months of follow-up. A repeat duplex arterial study showed that increased blood flow to the right foot and the right ankle/brachial index improved to 0.97 from 0.67. Repeat ultrasonography demonstrated that the size of the cyst decreased from 4.5 x 1.5 cm to 2.8 x 0.9 cm. The patient had been followed for 20 months and remained asymptomatic in the last 8 months. We will continue to follow the patient to evaluate the long-term outcome. In summary, our own data and literature review suggest that the limb ischemia caused by Baker's cyst may be a transient condition and can be managed nonoperatively in selected patients.     

Reflex sympathetic dystrophy of the lower extremity

Reflex sympathetic dystrophy (RSD) is a complex syndrome of pain, trophic changes, and vasomotor instability secondary to an abnormal hyperactive state of the sympathetic nervous system following injury to an extremity. Numerous theories have been proposed to explain the pathophysiology. None is universally accepted. The diagnosis of RSD is complicated because some patients improve without treatment, whereas others develop intractable symptoms even after the injury has healed. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment, i.e., sympathetic blockade and physical therapy, provide the greatest opportunity for a successful outcome.     

Pediatric orthopaedic lower extremity trauma and venous thromboembolism

Purpose

Research on venous thromboembolism events (VTE), such as deep venous thrombosis (DVT) and pulmonary embolism (PE), in pediatric orthopaedic trauma patients is sparse. We describe the incidence in the USA of VTE associated with pediatric lower extremity orthopaedic trauma, and characterize injury patterns and VTE treatment methods.

Methods

The Pediatric Health Information System (PHIS) was queried from 2004 to 2013 using ICD-9 codes for lower extremity fractures (pelvis, femur, tibia, ankle, foot) and dislocations (hip, knee, ankle, subtalar) and VTE. Records were queried for age, diagnoses, and VTE treatment.

Results

During the study period 285,611 clinical encounters reported lower extremity trauma. Of those, 167 patients were simultaneously coded with VTE (99 DVT, 50 PE, 18 combined DVT/PE), to give an incidence of VTE associated with pediatric lower extremity trauma of 0.058 %. Patients were from 39 centers, with an average age of 12.9 years (range 0–19). There were 249 fractures and 21 dislocations, with 25 (15 %) patients sustaining more than one lower extremity injury. The most common fracture locations were the femur/femoral neck (95), tibia/ankle (92), and pelvis (44). 72 % (121/167) of patients were treated with anticoagulation medication, of which the most common was low-molecular-weight heparin (111/167, 66 %).

Conclusions

The incidence of VTE events associated with lower extremity orthopaedic trauma is 0.058 %. Adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis are more commonly affected. Low-molecular-weight heparin is commonly used to treat VTE in pediatric and adolescent patients.