带血管蒂大转子骨瓣治疗股骨骨折17例

1993年以来,我们采用同侧带旋股外侧血管横支的大转子骨瓣,治疗股骨颈陈旧性骨折13例,股骨中上段骨不连、骨缺损4例,取得满意疗效。1　临床资料1.1　一般情况　本组男11例,女6例;年龄21～45岁,平均31岁。股骨颈陈旧性骨折13例,股骨中上段骨不连、骨缺损4例。交通伤7例,坠落伤4例,其它伤6例。取同侧带旋股外侧血管横支的大转子前外侧骨瓣嵌植于骨槽内,骨瓣为3.5cm×3cm×2cm～4.5cm×2cm×2cm。术后石膏固定2个月。随访3～6个月,均获骨性愈合。1.2　手术方法　在髂前上棘和髌骨外缘联线上,取S形切口,切断缝匠肌及股直肌起始部,翻向远侧。解…     

股骨颈骨巨细胞瘤1例

患者 ,女性 ,汉族 ,2 3岁。从约 1ｍ高处摔下后左髋关节疼痛、畸形、活动受限 3ｈ后于 1999- 0 8- 12入院。左髋关节呈轻度屈髋、屈膝及外旋畸形 ,关节处扪及明显骨擦感轴向叩击痛 ( ) ,患肢短缩 1ｃｍ ,大粗隆在Ｎｅｌａｔｏｎ线之上 ,Ｂｒｙａｎｔ三角底边缩短。Ｘ线片示左股骨颈骨折 ,骨折线处骨质变薄 ,有溶骨性病灶 ,呈皂泡样改变。经胫骨结节牵引 5ｄ后手术。见左股骨颈内瘤组织呈红褐色 ,有囊性变 ,刮除后温盐水反复冲洗 ,5 0 %氯化锌烧灼骨腔三遍 ,直视下复位骨折断端 ,三枚空心螺钉固定 ,取带股方肌骨瓣约 1.5ｃｍ× 4ｃｍ× 2ｃｍ…     

老虎咬伤五例治疗体会

我院自 1998年以来 ,共收治野生动物园老虎严重咬伤患者 5例。临床资料　 (1)一般资料 :本组男 4例 ,女 1例 ;年龄 2 0～ 3 3岁 ,平均 2 5 .8岁。受伤部位 :左膝部咬伤 1例 ,伤口深达股骨内外髁 ,股直肌内外侧头部分断裂 ,外髁有一小块骨皮质游离 ,未达膝关节 ;左前臂咬伤 1例 ,伤口深达桡骨 ,伸屈肌肌腹部分断裂 ,有 3ｃｍ× 4ｃｍ皮肤缺损 ;右上臂咬伤 1例 ,伤口深达肱骨 ,肱二头肌及三头肌部分断裂 ,桡神经挫伤 ;右小腿咬伤 2例 ,伤口深达胫骨后方 ,腓肠肌及腓骨长短肌部分断裂。 (2 )治疗方法 :左膝部咬伤患者 ,行局麻下清创Ⅰ期缝合伤…     

右大腿脂肪瘤并神经鞘瘤1例报告

患者　女性,31岁,右大腿肿块伴麻木感3年余,自觉胀痛,肿块逐渐增大。体查:右大腿中后侧触及2ｃｍ×1.5ｃｍ肿块,质尚软,边界清而光滑,轻度压痛,余无殊。实验室检查:肝功能、血、尿、大便常规均正常。Ｂ超:右窝内上方探及4.8ｃｍ×2.4ｃｍ低回声区,边界清(图1)。Ｘ片示:下肢顺行静脉造影见股静脉,交通支,浅静脉功能良好,于中下部后侧交通支呈蛛网状,并有一交通支弧形后突,下方密度较低区,股静脉中后方见3.5ｃｍ×7ｃｍ大小椭圆形中度致密影,后缘为一交通支包绕。初诊为右股中后方软组织良性肿瘤(图2)。手术:右大腿中段背侧切开分离,见包膜…     

应用足底内侧岛状皮瓣肌皮瓣修复足跟软组织缺损10例

1　临床资料11　一般资料　男7例,女3例,年龄14～68岁,足跟部软组织缺损面积最小3ｃｍ×4ｃｍ,最大6ｃｍ×8ｃｍ。其中3例合并跟骨慢性骨髓炎,跟骨部分缺损。12　治疗方法　首先全身应用敏感抗生素。术前3ｄ给予12000洗必泰溶液清洗并湿敷创面。最大限度减少脓性分泌物。7例跟骨完整者应用足底内侧岛状皮瓣修复,3例合并跟骨损者应用外层肌肌皮瓣修复。术后继续应用抗生素。13　结果　本组10例皮瓣,肌皮瓣全部成活,创面Ⅰ期愈合。随访1～6ａ,皮瓣愈合良好,温痛觉恢复,负重好,无溃疡形成,不影响行走。2　讨论足跟部因创伤引起的皮肤缺损,跟…     

He-Ne激光联合康宁克通A治疗瘢痕疙瘩

目的 :比较单纯康宁克通Ａ局部注射与Ｈｅ Ｎｅ激光照射联合康宁克通Ａ注射治疗瘢痕的疗效。方法 :单纯康宁克通Ａ治疗 40例患者 ,平均年龄 35岁 ,瘢痕面积 0 2ｃｍ× 0 2ｃｍ～ 5 0ｃｍ× 1 7ｃｍ ;Ｈｅ Ｎｅ激光照射联合康宁克通Ａ治疗共 81例患者 ,平均年龄 31岁 ,瘢痕面积 0 3ｃｍ× 0 3ｃｍ～ 7 0ｃｍ× 3 5ｃｍ。Ｈｅ Ｎｅ激光原光束散焦照射瘢痕疙瘩 ,功率≤ 2 5ｍＷ ,每次 15～ 2 0ｍｉｎ ,每日 1次 ,10天一疗程。Ｈｅ Ｎｅ激光照射后 ,将康宁克通Ａ缓慢均匀注入瘢痕组织中。结果 :单纯康宁克通Ａ治愈 2 3例 ,好转 15例 ,Ｈｅ …     

腺泡状软组织肉瘤颅骨肺转移1例

患者　女 ,2 9岁 ,右股部外侧逐渐增大无痛性包块 8年 ,近 3个月包块处出现胀痛及压痛 ,并发现左侧颅顶部及左颌下包块就诊。查体 :右股部外侧距膝关节 10ｃｍ处触及约10ｃｍ× 15ｃｍ× 15ｃｍ质韧包块 ,尚活动 ,局部压痛 ,肤色及皮温正常 ,无波动感。实验室检查 :Ｈｂ80ｇ/Ｌ ,ＡＫＰ0 .10 92ｕｋａｔ/Ｌ。Ｘ线表现 :右股部内侧巨大软组织肿块影 ,边界模糊 ,密度均匀 ,右股骨骨质结构正常 (图 1)。左侧颅顶骨一 5ｃｍ×5ｃｍ溶骨性骨质破坏区 ,边缘呈虫蚀状 ,局部有 3ｃｍ× 6ｃｍ大软组织肿块 (图 2 )。左下颌骨体部 4ｃｍ× 5ｃｍ溶骨性…     

睾丸卵黄囊瘤5例

睾丸卵黄囊瘤少见 ,治疗方法各异。 1988～2 0 0 1年 ,我院采用手术和 (或 )化疗方法共收治此病5例 ,成活 4例。1　临床资料1 1　一般情况　年龄 1～ 17岁 ,平均 4岁。左侧 2例 ,右侧 3例。主要表现均为睾丸进行性肿大 ,从出现症状至就诊 2～ 6个月 ,平均 4 2个月。睾丸肿块2 5ｃｍ× 2ｃｍ× 2ｃｍ～ 5ｃｍ× 4 5ｃｍ× 4ｃｍ ,平均3 8ｃｍ× 3ｃｍ× 2 5ｃｍ ,质硬伴触痛。腹股沟淋巴结肿大 1例。1 2　治疗方法　均行病灶侧根治性睾丸切除术 ,精索高位结扎。术后行ＰＶＢ方案化疗 (顺铂、长春新碱、博来霉素 ) 1例 ,共 4个疗程 ,另 4…     

脑膜瘤术后张力性皮下积液1例

患者男 ,2 3岁 ,因头痛伴左下肢麻木乏力 1周 ,加重 2ｄ入院。查体生命体征平稳 ,心、肺、腹无异常。双眼底视乳头边界欠清 ,左侧肢体肌力 4级伴下肢病理反射弱阳性。头颅ＣＴ示右顶枕窦镰旁脑膜瘤 ,5 .2ｃｍ× 4.7ｃｍ×7ｃｍ。入院后在全麻插管下行右顶开颅肿瘤切除术 ,皮骨瓣翻向颞侧 ,硬膜翻向中线 ,肿瘤与硬膜有 3ｃｍ× 4ｃｍ侵润 ,连同肿瘤一并切除 ,肿瘤呈紫褐色 ,来源于矢状窦 ,止血后瘤腔放引流管 ,脑组织较塌陷 ,硬膜未缝逐层关颅。术后患者清醒、四肢无瘫、如期拆线 ,术后 10ｄ骨瓣高于正常骨缘并有波动感 ,局部不红患者体温正…     

手术切口癌瘤种植2例

例 1,女 ,49岁。 1999- 0 8以宫颈癌术后 1年左股内侧疼痛入院。查体见腹壁陈旧切口旁有一界限不清坚硬结节 ,不规则 ,7ｃｍ× 5ｃｍ× 4ｃｍ大小。病理巨检 :腹壁组织一块 ,3ｃｍ× 2ｃｍ× 2ｃｍ ,切面灰白、质脆。镜下所见 :肌组织间见条索状、巢状分布的癌细胞 ,细胞卵圆或梭形 ,瘤组织有片状坏死。病理诊断 :腹壁鳞状细胞癌 ,Ⅱ级。Ｘ线、Ｂ超检查示主要脏器未见肿瘤。经询问既往史知 ,患者曾于 1998年 9月因阴道流血 ,在外院行子宫全切术 ,术后病理诊断 :宫颈鳞状细胞癌 ,Ⅰ级。例 2 ,男 ,70岁。 1999- 0 9因食管癌术后 4个月 ,切口下…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.