和平时期胸部火器穿透伤55例分析

本文报告和平时期胸部火器穿透伤55例,其中男性48例,女性7例。致伤原因以枪伤占多数(87.5％)。盲管伤30例(占54.5％);本组中血气胸34例(占62％),胸内异物存留18例(占32.7％),胸腹合并伤7例(占14.58％);截瘫6例(占12.5％)。治愈50例(91％),死亡5例(9％)。本文重点讨论了胸部火器穿透伤的早期伤情判断,开胸指征,胸腹联合伤、胸内异物存留的判断和处理。     

电视胸腔镜手术在胸部损伤中的合理应用

目的：探讨电视胸腔镜手术（VATS）在胸部损伤诊断、治疗中的应用价值。方法：选择2001年7月—2010年4月胸部损伤患者34例,应用电视胸腔镜进行探查、诊断,同时进行肺修补、心包修补、膈肌修补、止血等手术治疗。结果：34例经VATS探查以明确脏器损伤情况,肺裂伤10例,右心室穿透伤1例,左下肺静脉撕裂伤1例,胸内异物残留3例,2例可疑乳糜胸皆在VATS联合辅助小切口下完成。合并腹部伤5例行VATS及腹腔镜下修补术。VATS探查及治疗时间45~140 min。术后住院时间5~10d。34例术后半年随访,复查胸片或胸部CT均无胸腔积液、异物、肺不张及其他异常发现。结论：VATS的合理应用能使胸部损伤患者诊断更加及时、准确,在不延误治疗的情况下可使手术创伤尽可能达到最小。     

多层螺旋CT和同层动态CT电影扫描对小儿气管异物的诊断价值

目的 探讨螺旋CT和同层动态CT电影诊断小儿气管异物价值.方法 对51例疑诊气管异物的患儿行胸部X线、胸部CT扫描及硬支气管镜检查,其中12例加行同层动态CT电影扫描.比较硬支气管镜检查和CT扫描结果.结果 硬支气管镜检查发现42例异物在主支气管或支气管叉,胸部CT扫描显示相同位置异物;硬支气管镜诊断为阴性的9例中,胸部CT检查6例为真阴性而3例为假阳性.CT检查出气管异物的灵敏度、特异度、准确率、阳性和阴性预测值分别为100%(95%可信区间,91%～100%),66.67%(29%～92%),94.12%(64%～99%),93.33%(81%～98%),和100%(54%～100%).同层动态CT电影扫描正确诊断9例真阳性和3例真阴性,并可鉴别空气滞留与继发肺改变.结论 CT扫描可用于诊断小儿气管支气管异物,尤其是在诊断困难时.     

基层医院对胸部创伤的处理

本文报告胸部创伤51例的救治体会。男47例,女4例。年龄10～61岁。51例中开放伤8例(15.7％),闭合伤43例(84.3％),血气胸22例,肋骨折30例(其中连枷胸4例),支气管损伤3例。本组合并四肢脊柱伤9例,肾挫伤3伤,颅脑伤1例。本组治愈49例(96.08％),死亡2例(3.92％)。本文重点讨论了胸外伤的早期处理,肋骨折和血气胸的治疗原则。     

210例小儿颅脑损伤抢救与临床护理

小儿与成人的解剖生理有所不同,因而颅脑损伤后的临床表现、抢救及护理各有其一定的特殊性。本文仅对我科1986年至1991年收治的14岁以下小儿颅脑损伤210例分析总结如下。一、临床资料一般资料:本组210例中男153例(72.86％),女57例(27.14％),男:女为3:1。年龄分布以3～9岁为多,共112例(53.33％),伤因以坠落伤、车祸及踢(拖)伤为主142例(占68％),其次为跌倒伤、击伤、火器伤及产伤。210例中开放性颅脑损伤177例,(84.3％),各类型颅内血肿计81例,23例出现脑疝。     

闭合性外伤性支气管断裂的临床观察及护理

严重的闭合性胸部损伤中,支气管断裂发生率约为3%,死亡率高。拉克里瑞奥(Nac1erio)认为:在伴有气管、支气管断裂的闭合性胸部损伤患者,常于伤后3～6小时内死亡,其原因主要是大量血性分泌物造成呼吸道阻塞性室息,以致引起的循环功能障碍和严重休克所致〔1、2〕。因此这类病人入院后应及早诊断,及时手术治疗和精心护理是很重要的。我院自1980-1989年间收治严重闭合性胸部损伤患者中,发生支气管断裂共9例,报道如下。临床资料本组9例,其中男性6例,女性3例,年龄最小者7岁、最大者36岁。撞击伤2例(拖拉机撞击),挤压伤2例(钢板滑动及车祸)压榨伤2例(房屋倒塌)及摔伤3例。左侧支气管3例,右侧     

小儿颅脑损伤76例临床诊治体会

我院自1999年以来共收治14岁以下小儿颅脑损伤病人76例 ,由于小儿头部外伤的发生机制 ,颅骨及颅内容的反应及长期预后均与成人明显不同 ,且小儿的神经系统在成熟和快速记忆过程中有其不同特点 ,现就其颅脑损伤的临床特点、诊治及预后等方面进行探讨。1临床资料1.1一般资料本组共76例 ,男47例 ,女29例 ;2岁及2岁以下6例 ,3～6岁33例 ,7～14岁37例。受伤原因 :坠落伤38例 ,车祸伤22例 ,跌伤9例 ,砸伤6例 ,异物刺入伤1例。损伤类型 :脑震荡10例 ,帽状腱膜下血肿8例 ,硬膜外血肿15例(合并矢状窦损伤1例) ,硬膜下血肿14例 ,脑内血肿7例 ,脑挫伤13…     

胸部锐器穿透伤的救治：附53例报告

1985年1月至1995年1月我们共收治胸部锐器穿透伤53例,占同期胸部锐器伤58.9％(53/90)。占同期胸部外伤8.5％(53/620)。首诊明确为胸部穿透伤者45例(84.9％),有5例入院后进一步明确为胸部穿透伤,有3例按非穿透伤处理后,病情加重复诊明确为穿透伤。     

心脏及胸内大血管破裂伤的诊治探讨

目的：探讨心脏及胸内大血管破裂伤的损伤机制和救治原则。方法：对近20年心血管内外科和急诊科收治的32例病人进行了回顾性研究。结果：发现全组病人中男性占21例，女性11例，年龄36．81±11．87岁；按致伤原因分为直接穿通性损伤组9例，非穿通性损伤组7例，医源性损伤组16例；手术治疗29例，非手术治疗2例，死亡7例，其中死亡率以非穿通性损伤组为最高，达42．86％。结论：作者认为心脏及胸内大血管破裂伤的临床表现和凶险程度因其接受的损伤方式及机制形成等因素不同而表现各异，必须根据病情及危及生命的轻重缓急程度决定抢救的手段和形式，才能有效地降低死亡率。     

全麻下小儿食管异物取出术62例诊治体会

小儿食管异物是耳鼻咽喉科常见急诊 ,由于小儿食管的解剖因素 ,小儿不合作及异物的种类、性质、大小、形态、数目和停留的时间及部位不同 ,在食管镜下取出有时较为困难 ,容易造成小儿食管粘膜的损伤。我科自 1998年 1月～ 2 0 0 2年 10月采用全身静脉复合麻醉下气管插管后行小儿食管异物取出术 ,取得良好效果 ,报告如下 :1　临床资料1 1　一般资料 :本组 62例 ,其中男 3 9例 ,女 2 3例 ,年龄17个月～ 6岁 ,平均 4 5岁。异物为一元硬币 2 6例 ,一角硬币9例 ,枣核 9例 ,鸡骨 5例 ,方形铁片 5例 ,瓶盖 4例 ,玉挂件 4例。异物停留时间 1 2h～ 16…     

Multidetector CT findings of skeletal chest injuries secondary to cardiopulmonary resuscitation

Introduction

Rib and sternal fractures are frequent complications of cardiopulmonary resuscitation (CPR) in adults. This is the first study to evaluate the MDCT findings of chest injuries secondary to CPR, by comparing with the findings of radiography.

Methods

For 40 patients who underwent MDCT after CPR for a non-traumatic cause of cardiac arrest, we evaluated the MDCT findings of the CPR associated traumatic chest injuries and compared the diagnostic performance of chest radiography and MDCT for the evaluation of chest injuries.

Results

MDCT revealed that 26 patients (65%) had rib fractures and 12 patients (30%) had sternal fractures. However, radiography detected only 10 patients who had rib fractures. In 25 of the 26 cases, multiple ribs were fractured (ranging up to 13 rib fractures), and the rib fractures were bilateral in 18 of these cases. The majority of rib fractures were located in the anterior part of the thoracic cage. Six of the patients had fracture-related complications (pneumothorax = 1, subclavian vein injury = 1, chest wall hematoma = 4). The sternal fractures predominantly occurred in the middle and lower third of the sternal body (five each for the middle and lower third of the sternal body).

Conclusion

Rib and sternal fractures are frequent complications in patients who underwent CPR. MDCT is useful for the evaluation of chest injuries secondary to CPR as compared with that of radiography and also for the evaluation of the fracture-related complications.     

Clinical study in 11 cases of endobronchial foreign body

We report 11 cases of endobronchial foreign body. From January 1982 through December 1994, a total of 11 cases were diagnosed roentogenographically and bronchoscopically at our hospital. These patients consisted of 10 men and 1 woman with a mean age of 58.5 years (range 33 to 77 years). Symptoms on presenting were usually cough, sputum, or chest pain. The foreign bodies were inorganic in 10 cases and of organic origin in 1 case. Three patients were not aware that they had aspirated a foreign body. In 9 patients, the endobronchial foreign bodies were successfully removed endoscopically. One patient spontaneously expectorated the foreign body before bronchoscopy. One patient underwent thoracotomy because the foreign body could not be removed bronchoscopically. There were no severe complications during or after the endoscopic removal of the foreign bodies, but in one patient extraction of the foreign body caused pneumonia after bronchoscopy. In conclusion, flexible bronchoscopy is useful for the diagnosis and treatment of endobronchial foreign bodies.     

Chest pain: overlooked manifestation of unsuspected esophageal foreign body

Two cases of unsuspected esophageal foreign body ingestion with chest pain as the main symptom are reported. Both patients had extensive cardiac evaluation to rule out myocardial ischemia. They were discharged home with continuing chest pain and odynophagia. Both patients were denture wearers, and further questioning revealed the coincidence of chest pain with taking meals. Further evaluation revealed an impacted esophageal foreign body in one patient and an esophageal perforation with a mediastinal abscess in the other. These cases illustrate the importance of considering esophageal foreign bodies as factors in chest pain.     

上颈椎损伤的早期诊断与治疗

目的：探讨上颈椎损伤的早期诊断方法和治疗措施。方法：回顾分析2000年1月至2008年7月间收治住院的上颈椎损伤患者35例临床资料,其中寰椎骨折6例,枢椎骨折24例,无骨折的寰枢关节脱位5例。除3例陈旧性齿状突骨折和2例陈旧性寰枢关节脱位外,其余为新鲜损伤。评价其早期诊治方法及其预后。结果：早期漏诊6例,35例患者X线检查后均需结合CT或MRI检查完善诊断及分型。手术治疗18例,其中5例为齿状突骨折早期保守治疗后改手术治疗,2例为漏诊的陈旧性寰枢关节脱位。非手术治愈16例,其中3例齿状突骨折Ⅲ型畸形愈合。1例复合性损伤患者住院3月后诊断出寰枢关节脱位出院。33例得到4～38个月随访。随访的33例患者中,骨折患者均愈合,4例寰枢关节脱位患者脱位整复,上颈椎稳定性均维持良好,神经功能改善。结论：重视上颈椎损伤患者影像检查方法早期合理的分步选择与充分利用,避免漏诊。治疗上,积极地整复骨折与脱位,尽早恢复上颈椎的稳定性。     

Sledding injuries in the southeastern United States

BACKGROUND: Heavy ice and snow accumulation combined with record low temperatures in Chattanooga, Tennessee, from February 2-6, 1996, contributed to many sledding injuries. METHODS: We retrospectively reviewed medical records of emergency visits to seven area hospitals from February 2-6, 1996. We further reviewed sledding injury records. Sledding was defined as sliding on snow or ice using any device except skis. RESULTS: Of 2,134 emergency room visits, 241 patients had 310 sledding injuries. Ages of patients ranged from 3 to 53 years (mean, 18.9; median, 16). One hundred twenty-eight injuries were severe. These included extremity injuries (65), head injuries (28), chest injuries (10), intra-abdominal injuries (10), vertebral column fractures (11), and pelvic fractures (4). Thirty-six patients required inpatient hospitalization; 18 had surgery. The minimum healthcare costs associated with these injuries were estimated at $220,000. CONCLUSIONS: Major trauma potential is associated with sledding, especially where significant winter storms are uncommon. Level I trauma centers should seasonally incorporate sledding safety into community-wide injury prevention programs.     

肩胛骨骨折的分类及微创手术人路的应用疗效分析

目的：探讨微创切口治疗肩胛骨骨折的适应证及疗效。方法：2004-02-2012本院17例肩胛骨骨折的病例纳入本研究。17例患者中,男性15例．女忡2例．年龄范围为19～75岁,平均年龄为39岁。其中,肩胛孟骨折9例,肩胛骨突起部位骨折3例,肩胛骨体部骨折5例;车祸伤8例,高处坠落伤5例,直接暴力伤2例,刀砍伤2例;闭合性骨折14例,开放性骨折3例。卡艮据Hardegger的分型方法．体部骨折6处．肩胛骨骨折5例,肩胛颈骨折2处．盂缘骨折2处．盂窝骨折2处。其中混合型骨折10例,合并全身发伤5例。通过微创切口入路手术,对不同类型的肩胛骨骨折使用重建钢板或拉力螺钉和钢丝等固定。结果：17例患者获得随访,随访时间6月～3年,平均18个月。根据Rowe疗效评价标准。优11例,良2例,可2例,优良率83．7％。术后并发肩关节创伤性芙仃炎2例。结论：经微创切口入路内固定肩胛骨骨折操作简单,暴露较充分．效果可靠。除了肩胛骨体部粉粹性山脚折外及漂浮肩外．几乎各类犁的肩胛骨骨折均可通过微创切口入路完成,尤其通用于肩胛骨的体部骨折及肩胛骨骨折以及肩胛颈骨折盂缘骨折盂窝骨折。这是向胛骨骨折手术治疗的一种案例有效方法。     

胫骨平台骨折的MRI诊断与评价

目的:探讨MRI在胫骨平台骨折中的临床应用价值。方法:66例胫骨平台骨折病例经X线检查后作MRI扫描,MRI扫描序列包括SE序列T1WI、FSE序列T2WI及STIR序列,每例骨折按Schatzker分类法分类,比较胫骨平台骨折的平片与MRI诊断结果,分析骨折合并膝关节其他损伤的MRI表现。结果:66例胫骨平台骨折病例中X线检查60例阳性(81.8%)。MRI检查65例阳性(98.5%),I型7例(10.6%)、II型20例(30.3%)、III型6例(9.1%)、IV型18例(27.3%)、V型4例(6.1%)、VI型10例(15.2%)。其中合并半月板损伤57例、韧带损伤48例、关节软骨损伤58例、局部骨挫伤34例、关节囊积液或积血61例。结论:MRI检查是术前评价胫骨平台骨折的一种实用和有效的方法。     

胸部MSCT诊断高空坠落伤

目的 分析高空坠落伤的胸部MSCT表现,探讨年龄、坠落高度、性别对损伤的影响。方法 回顾性分析 235例高空坠落伤患者的临床及MSCT资料,分析各损伤类型的影响因素。结果 235例患者中,肋骨骨折104例(104/235,44.26%),脊柱骨折102例(102/235,43.40%),胸骨骨折13例(13/235,5.53%),肩胛骨骨折27例(27/235,11.49%),锁骨骨折10例(10/235,4.26%),肺实质损伤91例(91/235,38.72%),胸膜损伤63例(63/235,26.81%),纵隔损伤15例(15/235,6.38%),胸壁软组织损伤13例(13/235,5.53%)。年龄与肋骨骨折(OR=1.023,P=0.046)、脊柱骨折(OR=1.023,P=0.039)及锁骨骨折(OR=1.073,P=0.017)有关,坠落高度与肋骨骨折(OR=1.115,P=0.028)、脊柱骨折 (OR=1.127,P=0.016)、肺实质损伤(OR=1.101,P=0.041)、胸膜损伤 (OR=1.105,P=0.041)、胸壁软组织损伤 (OR=1.270,P<0.001)有关,性别与各种损伤均无明显关系。结论 MSCT显示高空坠落所致胸部损伤具有多部位、多器官累及的特点,患者年龄及坠落高度是影响损伤类型的危险因素。