特殊运动致腓总神经损伤一例

患者 男，21岁，体育专业学员，7个月前在一次三级跳远运动后，自觉右小腿外侧及足背麻木，右踝背伸、外翻不能，于当地诊断为“右腓总神经损伤”，行腓骨颈部腓总神经探查松解术，术后半年无明显恢复。于2002年11月入院，检查：右小腿腓骨颈部见陈旧刀口瘢痕，右小腿远端外侧及足背皮肤感觉缺如，右足下垂，不能主动背伸、外翻，小腿前群及外侧群肌力为0级。肌电图：右腓总神经损伤。     

腓总神经火器伤延期修复一例

患者 男,21岁。火药枪弹丸从左大腿下段正中击入,腘窝外侧穿出,伤后足下垂28天入院。检查:左小腿外侧皮肤感觉迟缓,皮温降低,足背感觉消失,足下垂。诊断左腓总神经伤,行左腓总神经探查术。术中见腓总神经缺损2.5cm,分离松解两断     

双腓总神经急性卡压征1例

1　临床资料患者,女,26岁,农民,汉族。因双膝关节连续屈曲蹲位劳动12ｈ,出现双小腿麻木、足及足趾背伸障碍,逐渐加重,8天入院。体检:患者行走呈跨越步态,双小腿及足背外侧触觉、痛觉减退,双侧腓骨颈部Ｔｉｎｅｌ征阳性,双侧拇长伸肌、趾长伸肌、胫前肌、腓骨长短肌的肌力均为Ⅲ级,双侧屈趾肌及小腿三头肌的肌力正常。临床诊断:双腓总神经急性卡压征。手术探查发现,右腓总神经在腓管内有4ｃｍ长明显充血、水肿、灰暗无光泽、柔软性不良,左腓总神经在腓管内有3ｃｍ长轻度充血、水肿,伴行血管淤滞、扩张。为证明此病理改变的病因,模拟下蹲的姿…     

股动脉损伤伴同侧胫前和胫后动脉损伤一例

患者 男，33岁。驾车时翻车，右腹股沟部被方向盘挤压，右膝部被车厢压伤后10h转我院，检查：右股动脉、腘动脉多普勒检查未闻及血管音，右足伸屈、内外旋活动障碍，右足背、足底及右小腿皮肤感觉减退。右膝外侧见淤血斑，外侧应力试验（＋）。右小腿肿胀，皮温低，被动屈伸踝时右小腿轻疼痛。X线片见：骨盆、右下肢骨质未见异常。诊断：右股动脉损伤，右膝外侧副韧带损伤，右胫神经、腓总神经损伤，右小腿骨筋膜室综合征。手术切开右小腿骨筋膜室减压，探查股动脉见于腹股沟韧带下4cm处局部破损，栓塞约3cm，取对侧大隐静脉移植，伤后15h通血。小腿皮缘迅速渗血，色红润，甲床充盈。右腘动脉、右胫后动脉搏动好，右足背动脉无搏动。术后给予“三抗”等治疗。术后12h，右腘动脉搏动好，右胫后动脉搏动减弱，右足背动脉多普勒听诊未闻及血管音。给予溶栓、扩容等治疗。术后24h小腿渗出较多，见小腿深层部分肌肉钳夹无收缩，无明显动脉出血。术后48h，二次手术见右腘动脉仍搏动好，胫前动脉于腘动脉分支处断裂，近端栓塞。     

手术治疗带状疱疹后腓总神经麻痹1例

正患者,男,69岁,因右侧小腿疼痛8周、右踝关节背伸无力6周,于2017年7月3日入院。患者8周前出现右侧腘窝外侧及右侧小腿前外侧、足背、足底皮疹和水疱,皮疹区阵发性电击样疼痛,在当地医院诊断为"带状疱疹"。接受抗病毒及对症治疗,2周后皮疹逐渐消退。但仍有腓总神经分布区皮肤持续烧灼样疼痛,并出现右侧踝关节背伸无力,行走不利。神经电图提示:腓总神经损伤。     

腘窝火器伤5例的临床治疗

目的 探讨腘窝火器伤的治疗及效果.方法 采用早期血管神经探查修复、自体血管移植、小腿切开减压、二期减压切口植皮治疗胭窝火器伤5例.结果 5例患者保肢均成功,4例患肢功能恢复良好,1例合并腓总神经损伤致足下垂,功能恢复欠佳.结论 腘窝火器伤患者应争取时间,早期行血管神经探查及小腿筋膜间室预防性切开减压,二期覆盖减压切口创面,保肢成功率高,效果较为满意.     

腰5神经根纤维瘤误诊腰5骶1椎间盘突出症1例报告

1　病例介绍患者 ,男 ,41岁。主因腰骶部疼痛伴右下肢疼痛麻木 1月入院。入院前 1月患者无任何诱因出现腰骶部疼痛 ,并放射至右小腿、右足拇趾、示趾 ,疼痛剧烈 ,坐卧不安 ,跛行 ,疼痛持续无缓解。无潮热 ,盗汗等病史。查体右侧腰5棘突有深压痛及叩击痛 ,右小腿下段外侧及足背内侧拇趾、示趾感觉减退 ,拇指背伸肌力减退 ,拇趾、示趾活动疼痛加重。直腿抬高试验 ( ) ,加强试验 ( -) ,跟腱反射、膝反射及肛门反射均可引出。CT提示 :腰5骶1 椎间盘突出症。积极完善术前检查准备手术 ,术中见 :骶1 神经根轻度受压、侧隐窝无明显狭窄 ,腰5神经…     

腘窝囊肿压迫致腓总神经损伤一例

患者 女性,52岁,因左腘窝肿块4个月伴小腿麻木1个月入院.患者4个月前发现左侧腘窝内侧有一直径约5 mm肿块,主诉无疼痛及其他特殊不适.于当地医院就诊时行彩超检查示左腘窝囊肿,未行特殊处理.后肿块逐渐增大,入院前1个月以来感觉左小腿外侧及左足背皮肤麻木.入院后查体:左侧腘窝内侧扪及一约3 cm×2 cm肿块,质中、张力较大、活动可、边界清、无压痛.左侧小腿外侧、左足背皮肤感觉减退.左腓骨颈部Tinal征(+).我院肌电图检查示左侧腓总神经部分损伤.     

背阔肌-脐旁联合巨大皮瓣游离移植修复小腿严重创伤一例

患者　男 ,2 1岁。车祸致右小腿热压伤后 9d,入我院。右侧小腿下 2 / 3及足背严重毁损 ,在面积皮肤缺损 ,创面外覆异种皮 ,部分发黑 ,脓性分泌物多 ,味臭。去除异种皮后 ,见腓深、浅神经及部分肌肉、肌腱坏死 ,胫前及腓动、静脉、大隐静脉栓塞 ;胫、腓骨中、下段粉碎性骨折 ;第 1～ 5趾发黑。诊断 :热压伤后右小腿毁损。 (1)右小腿大面积软组织缺损 ;(2 )右胫、腓骨开放性、粉碎性骨折 ;(3)伸肌腱、胫前血管、腓血管、腓总神经坏死 :(4 )第 1～ 5趾缺血性坏死 ;(5 )继发性毒血症。治疗方法 :纠正毒血症 ,加强全身支持疗法 ,去除异体皮 ,加强…     

手术治疗腓深神经出口卡压综合征1例

<正>笔者于2014-05手术治疗腓深神经出口卡压综合征1例,报道如下。1病例报告患者,男,56岁,因"反复右足第1趾蹼区麻木1年,加重2周"入院。1年前无诱因下出现右足第1趾蹼区麻木,足在跖屈位、行走后症状加重,休息后好转,夜间偶有电击样感觉。最近2周上述症状加重。入院时专科查体:腓深神经出口处Tinel征(+),第1、2趾趾蹼及第1、2跖骨间皮肤浅感觉减退,趾短肌肌力减弱。足背动脉搏动正常。辅助检查:肌电图示腓深神经出     

Sagittal plane analysis of the open and closed methods in children with displaced supracondylar fractures of the humerus (a radiological study)

OBJECTIVES: The aim of this study was to compare the radiological outcome of open and close reduction and osteosynthesis methods in the treatment of type II and III supracondylar humerus fractures in childhood with respect to the immediate post-operative reduction quality in sagittal plane. METHOD: One hundred and forty four-pediatric patients with type IIb and III supracondylar humerus fractures treated at two centers between 1995 and 2005 were evaluated radiologically within a retrospective study. Seventy-six patients (54 boys, 22 girls, mean age 7.6, range 2-12) were treated by closed reduction and cross percutaneous pinning while 68 (49 boys, 19 girls, mean age 7.3, range 2-13) were treated by open reduction. The reduction quality of the open and closed groups was compared on immediate post-operative lateral radiographs by measuring of lateral humerocapitellar angle, anterior humeral line and anterior coronoid line criteria. The reduction quality was classified excellent, good, fair and poor according to the achievement of three, two, one or none of the criteria, respectively. Reductions classified as excellent and good were introduced as acceptable results. RESULTS: At least one criterion was achieved in all the patients of both the groups. The mean humerocapitellar angle was 30.1 degrees in closed reduction group while the mean of it was 29.8 degrees in open reduced group. Radiograph of 48 (63.1%) patients with closed reduction were found to display the anterior humeral line intersecting the middle one-third of capitellum while this criteria was 45 (66%) in open reduction group. The anterior coronoid line was disturbed in three patients in each of both the groups. The reduction quality was evaluated to be excellent in 32 patients, good in 31, fair in 13 at the closed reduction group while these evaluations were 31, 20 and 17 in open reduction group, respectively. Successful reduction was achieved in 74.9% of the patients in closed reduction group and 75% of the patients in open reduction group. CONCLUSION: It is concluded that there was no significant difference between closed and open reductions of pediatric displaced supracondylar fractures with regard to the radiological criteria of reduction quality in sagittal plane.     

Comprehensive review of post–organ transplant hematologic cancers

A higher risk for a variety of cancers is among the major complications of posttransplantation immunosuppression. In this part of a continuing series on cancers posttransplantation, this review focuses on the hematologic cancers after solid organ transplantation. Posttransplantation lymphoproliferative disorders (PTLDs), which comprise the great majority of hematologic cancers, represent a spectrum of conditions that include, but are not limited to, the Hodgkin and non‐Hodgkin lymphomas. The oncogenic Epstein‐Barr virus is a key pathogenic driver in many PTLD cases, through known and unknown mechanisms. The other hematologic cancers include leukemias and plasma cell neoplasms (multiple myeloma and plasmacytoma). Clinical features vary across malignancies and location. Preventive screening strategies have been attempted mainly for PTLDs. Treatments include the chemotherapy regimens for the specific cancers, but also include reduction of immunosuppression, rituximab, and other therapies.     

Decreasing incidence of cancer after liver transplantation—A Nordic population‐based study over 3 decades

Cancer remains one of the most serious long‐term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer‐registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age‐specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6‐year follow‐up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02‐2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10 years post‐LT was observed from the 1980s: 4.53 (95%CI, 2.47‐7.60), the 1990s: 3.17 (95%CI, 2.70‐3.71), to the 2000s: 1.76 (95%CI, 1.51‐2.05). This was observed across age‐ and indication‐groups. The sequential decrease for the SIR of non‐Hodgkin lymphoma was 25.0‐12.9‐7.53, and for nonmelanoma skin cancer 80.0‐29.7‐10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study.     

Risk of lip cancer after solid organ transplantation in the United States

Solid organ transplant recipients have an increased risk of lip cancer, but the reasons are uncertain. Using data from the Transplant Cancer Match Study, we describe the epidemiology of lip cancer among 261 500 transplant recipients in the United States. Two hundred thirty‐one lip cancers were identified, corresponding to elevated risks for both invasive and in situ lip cancers (standardized incidence ratios of 15.3 and 26.2, respectively). Invasive lip cancer incidence was associated with male sex (adjusted incidence rate ratio [aIRR] 2.01, 95% CI 1.44‐2.82), transplanted organ (0.33, 0.20‐0.57, for liver transplants and 3.07, 1.96‐4.81, for lung transplants, compared with kidney transplants), and racial/ethnic groups other than non‐Hispanic whites (0.09, 0.04‐0.2). In addition, incidence increased with age and during the first 3 years following transplant, and was higher in recipients prescribed cyclosporine/azathioprine maintenance therapy (aIRR 1.79, 95% CI 1.09‐2.93, compared with use of tacrolimus/mycophenolate mofetil) and following a diagnosis of cutaneous squamous cell carcinoma (4.21, 2.69‐0.94). The elevation in lip cancer incidence is consistent with an effect of immunosuppression. Notably, the very strong associations with white race and history of prior skin cancer point to an important role for ultraviolet radiation exposure, and cyclosporine and azathioprine may contribute as photosensitizing or DNA damaging agents.     

梗阻性黄疸患者血浆可溶性P-选择素与内毒素、D-二聚体的关系及其意义

目的　研究梗阻性黄疸 (梗黄 )患者血浆可溶性P -选择素 (sP selectin ,sP s)与内毒素 (ET )及D -二聚体 (D d)的关系及其意义。方法　应用ELISA和鲎试剂比色法测定梗黄组、急性胆囊炎组和健康人组血浆sP s ,D d和ET含量。结果　健康人组血浆sP s含量为 (93 .43± 17.65 )ng/ml ,ET (0 .0 0 3 0± 0 .0 0 0 4)EU /ml ,D d(0 .3 9± 0 .2 1)mg/L ;急性胆囊炎组血浆sP s含量为 (2 3 3 .3 2± 82 .12 )ng/ml ,ET (0 .40 12± 0 .15 0 6)EU /ml ,D d(0 .76± 0 .2 7)mg/L ;梗黄组血浆sP s含量为 (3 5 1.90± 93 .83 )ng/ml ,ET(0 .3 814± 0 .14 3 0 )EU /ml ,D d(2 .14± 0 .3 7)mg/L。急性胆囊炎组和梗黄组sP s ,D d及ET均高于健康人组 (P <0 .0 1) ;梗黄组ET与急性胆囊组差异无显著性 ,但梗黄组sP s和D d较急性胆囊炎组高 (P <0 .0 1) ,梗黄组的以上二物质含量呈正相关性 (P <0 .0 1) ;急性胆囊炎组sP s与ET呈正相关性 (P <0 .0 1)。协方差分析表明 ,在相同ET含量时 ,梗黄组sP s高于急性胆囊炎组 (P <0 .0 1) ,且与D d有相关性 ,二者有相同变化趋势。结论　胆道梗阻是ET致血管内皮细胞损伤和血小板活化的敏感性因素 ,梗黄患者血液高凝状态与继发性纤溶反应处于动态平衡 ,提示动态监测血浆sP s和D d变化 ,     

胆囊炎患者胆汁中内皮素浓度的意义

目的探讨胆囊炎患者胆汁中内皮素浓度及其意义。方法采用放射免疫分析法测定了４０４例单纯型、４８例化脓型和２７例坏疽型结石性胆囊炎患者胆汁中内皮素浓度。结果三型胆囊炎患者胆汁内皮素浓度分别为２７４±８３ｐｇ／ｍｌ,４２３±１１１ｐｇ／ｍｌ和６７５±１３８ｐｇ／ｍｌ,与对照组测值１９４±４７ｐｇ／ｍｌ比较,具有显著性差异（Ｐ＜０．０５～０．０１）。结论胆汁中内皮素参与了胆囊炎的病理过程,其作用机制尚需深入研究。     

肾脏黏液样小管状和梭形细胞癌(附2例报道及文献复习)

目的 探讨肾脏黏液样小管状和梭形细胞癌(Mucinous tubular and spindle cell carcinoma,MTSCC)的临床及病理学特点.方法 对本院收治的2例肾脏黏液样小管状和梭形细胞癌患者临床及病理特点进行观察和讨论并结合相关文献复习.结果 2例患者术后诊断:肾脏黏液样小管状和梭形细胞癌.临床及病理特征符合相关文献对该型肾癌的报道,术后长期严密随访无复发.结论 MTSCC是罕见的肾癌分型,症状隐匿,具有独特的病理学特征,早期手术是最佳治疗方法,预后良好,罕见预后较差报道.     

Epidemiologic perspectives on immunosuppressed populations and the immunosurveillance and immunocontainment of cancer

The advent in the last several years of effective immunotherapy for cancer has renewed interest in the role of the immune system in controlling cancer. The idea that the immune system can help control cancer has a long history. Solid organ transplant recipients (SOTRs) as well as human immunodeficiency virus (HIV)–infected people are affected by cell‐mediated immune dysfunction. Epidemiologic studies of these populations reveal a pattern characterized by a strongly increased incidence of virus‐related cancers (eg, Kaposi sarcoma, non‐Hodgkin lymphoma, and anogenital cancers). In addition, recent epidemiologic studies have evaluated cancer‐specific mortality among SOTRs and HIV‐infected people following a cancer diagnosis. For a wider range of cancers—not limited to those caused by viruses, and including melanoma and cancers of the colorectum, lung, and breast— these immunosuppressed cancer patients have higher cancer‐specific mortality than other cancer patients. This latter group of cancers somewhat mirrors those for which immunotherapy with checkpoint inhibitors is approved. These epidemiologic observations suggest that there are 2 distinct immune selection processes in humans: immunosurveillance directed against premalignant cells before cancer diagnosis (most relevant for preventing virus‐related cancers), and “immunocontainment” directed against established cancers. These processes thus appear relevant for different groups of malignancies and may have different mechanisms.     

胃切除术后应用改良Braun术式重建胃肠道预防返流性胃炎

目的探讨预防胃十二指肠溃疡术后碱性返流性胃炎的发生和逆转原残胃粘膜的炎性病变的新手术治疗方法。方法采用胃部分切除术后改良Ｂｒａｕｎ术式对胃十二指肠球部溃疡病急性穿孔并弥漫性腹膜炎２３例病人进行治疗。术后１～２年随访２２例，其中１９例行胃镜复查及残胃液甘胆酸（ＣＧ）测定、幽门螺杆菌（ＨＰ）检查。９例钡餐透视观察残胃排空情况。结果所有病人术后恢复好，Ｖｉｓｉｃｋ分级优良率为９５７％；残胃炎消除率为７３７％；ＨＰ感染率由术前的５８％降至２１％；胃镜及钡餐检查无１例出现胆汁返流，仅１例残胃排空延迟钡餐检查为输出袢粘连。结论改良Ｂｒａｕｎ术式的应用可有效地减少残胃炎发生，对预防残胃炎及残胃癌发生有积极意义