附加钢板与交锁髓内钉治疗下肢长骨干骨折后肥大性骨不连22例

交锁髓内钉已成为治疗长骨干骨折的金标准，与以往的钢板固定相比，其骨折愈合率明显提高，而各种并发症大大降低。但在临床中仍有部分患者在应用交锁髓内钉固定后会出现骨不连。笔者对下肢长骨骨折髓内钉治疗术后肥大性骨不连患者，分别给予附加钢板治疗和交锁髓内钉治疗，均取得良好的疗效。现报告如下。     

胫骨干骨折手术疗效分析

目的 探讨适合胫骨干骨折的手术治疗方法及并发症的预防措施。方法 回顾性分析手术治疗胫骨干骨折病例67例，根据选择手术方式不同，将病例分为交锁髓内钉、加压钢板和外固定支架3组，临床观察结合X线片评价骨折愈合、延迟愈合、不愈合作为判断临床疗效标准。结果 髓内钉组的骨折愈合率明显高于加压钢板和外固定支架组，外固定组的骨折延迟愈合率高于其他两组；并发症包括骨不连、关节僵硬及畸形愈合，发生率为22．4％，其中骨不连发生率为13．4％。结论 髓内钉内固定治疗胫骨干骨折的临床疗效优于加压钢板和外固定支架；骨不连为胫骨骨折常见并发症，应严格掌握适应证、规范手术操作。     

股骨交锁髓内钉应用的并发症及防治

随访本院１９８７年４月￣１９９９年５月,用交锁髓内钉固定股骨患者３５２例,对治疗中的并发症,处理及预后作研究。３３１例得到随访（５－１４５个月）,共发生明确的并发症１６例;断钉８例（合并骨不连３例）畸形愈合２例,会阴神经损伤１例,感染２例,股骨颈骨折１便,退钉２例。经及时处理,２例功能差,其余优良。对严重创伤２,骨折早期交锁髓内钉固定,不增另并发症。Ⅰ度或Ⅱ度开放骨折可在清创彻底的情况下作一期交锁     

带锁髓内钉治疗股骨中下段骨折术后骨不连的临床效果

目的观察带锁髓内钉+锁定钢板+植骨治疗股骨中下段骨折术后骨不连的临床效果。方法选取2008年1月—2013年2月股骨中下段骨折治疗后骨不连患者50例作为研究对象,根据入院时间分组,前25例列入对照组,后25例列入研究组。两组患者均进行再手术治疗,研究组行带锁髓内钉+锁定钢板+植骨治疗,对照组仅清除骨折断端粘附的纤维组织,原手术钢板重新固定。结果研究组患者骨折均愈合,愈合率为100%,膝关节活动良好者24例,占96%;对照组患者17例愈合,8例未愈合,愈合率68%,膝关节活动动良好者15例,占60%。研究组骨折愈合率和膝关节活动良好率高于对照组,差异有统计学意义(P<0.01)。结论应用带锁髓内钉+固定钢板+自体髂骨松质骨植骨治疗股骨中下段骨折术后骨不连疗效显著,膝关节活动性好,适合于临床应用。     

交锁髓内钉内固定术治疗尺骨骨折术后骨不连

目的评估交锁髓内钉内固定术治疗尺骨骨折术后骨不连的临床疗效。方法采用交锁髓内钉内固定术治疗11例尺骨骨折术后骨不连患者,其中4例萎缩型骨不连辅以自体髂骨植骨术。术后采用Meod标准评估骨折愈合情况及前臂功能。结果平均随访11．6个月（8～18个月）,11例骨折均愈合,前臂功能优7例,良3例,可1例。结论交锁髓内钉内固定术是治疗尺骨术后骨不连的可选择术式之一。     

开放性胫骨骨折的3种固定方法比较

目的 通过比较3种固定法治疗开放性胫骨骨折的疗效,从而寻找更有效的治疗开放性胫骨骨折的方法。方法 将收治的228例分为3组：分别用扩髓交锁髓内钉（A组）、非扩髓带锁髓内钉（B组）、分阶段多功能外固定架和石膏外固定（C组）进行治疗,比较疗效。结果 本组随访4～58个月,术后深部感染方面无明显差别;术后患肢延迟愈合及骨不连发生率A、B组较C组明显少;C组的关节活动优良率略低于A、B组。结论 两种髓内钉固定法治疗开放性胫骨骨折效果均佳,分阶段多功能外固定架和石膏外固定次之。     

交锁髓内钉治疗股骨干骨折的临床分析

目的　探讨交锁髓内钉在股骨干骨折中的应用。方法　回顾性分析 1996年 2月～ 2 0 0 3年 4月行交锁髓内钉内固定术的股骨干骨折患者 112例。结果　 112例患者中有 98例获得随访 ,均于术后 13～ 2 6周骨性愈合 (平均18 2周 )。所有患者到取内固定时髋、膝关节功能均接近正常 ,无 1例发生感染、断钉、骨不连、骨折畸形愈合等并发症。结论　使用交锁髓内钉治疗股骨干骨折疗效满意。     

空降兵股骨干骨折内固定疗效比较

目的评价空降兵股骨干骨折内固定方法的效果。方法对150例空降兵股骨干骨折的患者分别采用加压钢板、梅花钉、交锁髓内钉等内固定方法治疗,进行疗效分析。结果所有病例均获骨性愈合。平均愈合时间:交锁髓内钉组5.2个月,梅花钉组5.8个月,加压钢板组6.2个月。加压钢板组术后伤口感染4例,内固定断裂松动6例,梅花钉组没有术后伤口感染病例,内固定断裂1例;交锁髓内钉组无断裂、感染发生。结论利用交锁髓内钉治疗股骨干骨折是目前较合适的方法。     

高原地区交锁髓内钉配合高压氧治疗闭合性胫骨干骨折48例

目的：探讨高原地区交锁髓内钉配合高压氧治疗闭合性胫骨干骨折的治疗效果。方法2013年1月—2015年12月我科收治48例闭合性胫骨骨折患者,采用交锁髓内钉配合高压氧治疗,术后均获得随访。结果患者伤口均一期愈合,无感染、脂肪栓塞、骨筋膜室综合征、骨不连等并发症的发生,无膝、踝关节功能障碍。按照Johner-Wruhs评分标准评定,优25例,良19例,中4例。骨折平均愈合时间为3～7个月,平均4.2个月。结论在高原地区采用交锁髓内钉配合高压氧治疗胫骨干骨折,可避免因切开复位对骨断端的血供破坏,在一定程度上改善缺氧对骨折愈合的影响,促进骨断端骨痂生长,有效预防骨不连的发生,缩短治疗周期。     

交锁髓内钉治疗四肢长管状骨骨不连35例

人体四肢长管状骨骨折治疗方法很多 ,但仍存在骨折不愈合 (骨不连 )、延迟愈合的问题。对此 ,传统的方法仍然是行切开复位、凿通髓腔、植骨、钢板内固定术。近 4年来笔者应用交锁髓内钉治疗成人四肢长干骨骨折不愈合、延迟愈合 35例。现报告如下。临床资料　 ( 1)一般资料 :本组共 35例 ,男 2 1例 ,女 14例 ;年龄 19～ 6 4岁。肱骨 6例 ,股骨 11例 ,胫骨 18例。从受伤至交锁髓内钉固定平均时间 37周。受伤原因 :车祸伤 2 1例 ,摔伤 8例 ,重物或塌方砸伤 6例。受伤后前期处理 :闭合复位石膏外固定 4例 ,切开复位钢板(加压钢板及普通钢板 )内…     

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.