带锁髓内钉治疗股骨干骨折96例

目的：探讨带锁髓内钉治疗股骨干骨折的临床疗效。方法：对应用有限开放复位带锁髓内钉内固定治疗股骨干骨折113例进行回顾性分析。结果：随访6～28个月,术后骨折愈合率94.7%,并发症少,患肢关节功能优良。结论：股骨带锁髓内钉是治疗股骨干骨折的首选内固定方法。     

闭合复位交锁髓内钉治疗成人胫骨干骨折

目的：评价闭合复位交锁髓内钉治疗胫骨骨折的临床疗效。方法：对90例成人胫骨干骨折患者采用闭合复位交锁髓内钉治疗。结果：本组病例随访6～24个月,平均12个月,骨折全部愈合,其中6例延迟愈合,愈合时间约5～12个月,平均6个月。无锁钉弯曲、断裂,无肢体短缩、旋转或成角畸形。按Johner-Wruhs评分标准,优48例,良36例,中6例,优良率93.3%。结论：闭合复位交锁髓内钉治疗胫骨骨折易操作,损伤小,并发症少,是治疗成人胫骨干骨折的有效方法。     

带锁髓内钉治疗股骨干骨折

目的:探讨带锁髓内钉治疗股骨干骨折的疗效。方法:自2002年6月至2005年6月使用带锁髓内钉治疗股骨干骨折67例,均取前外侧切口,扩髓、行静力型固定。结果:平均随访16个月(6-28个月)。切口均一期愈合。66例手术后4-8个月骨折骨性愈合,1例手术后6个月改为动力型固定,11个月愈合,无其他合并症。膝关节功能按Merchant评分标准评定,优良率92.5%。结论:带锁髓内钉治疗股骨干骨折可获得满意疗效。     

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。     

带锁髓内钉治疗股骨干骨折术后早期负重行关节肌肉功能训练的探讨

目的：总结带锁髓内钉治股骨干骨折的经验。方法：采用带锁髓内钉治疗股骨干骨折21例，其中新鲜粉碎骨折13例，陈旧性骨折不愈合7例，病理性骨折1例。结果：平均随访14月（4－30月），创伤性骨折20例中，骨折均获骨性愈合，优15例，良5例。结论：带锁髓内钉具有骨愈合率高，感染率低。再骨折率低。可以早期功能锻炼等优点，是治疗股骨干复杂骨折、全身多发骨折的良好选择。     

股骨干骨折不同内固定方法的疗效评价

目的：评价股骨干骨折最佳固定方法。方法：采用加压钢板,梅花钉,Ender钉,交锁髓内钉等不同内固定方法治疗的173例18－63岁股骨干骨折患者进行疗效分析。结果：本组病例均获骨性愈合。平均愈合时间：交锁髓内钉组5个月,梅花钉组5．5个月,Ender钉组6个月,加压钢板组7个月。加压钢板组术后感染3例,内固定断裂松动6例;梅花钉组术后感染2例,内固定断裂2例;Ender钉组内固定断裂1例,感染1例;交锁髓内钉组无断裂,感染发生。结论：交锁髓内钉是目前治疗股骨干骨折的合适手段,但软组织条件差者,以外固定支架为宜。     

一期与择期带锁髓内钉治疗股骨干开放性骨折比较

目 比较开放性股骨干骨折一期与择期带锁髓内钉治疗效果和并发症。方法 34例41侧开放性骨折，分别按急诊清创后直接行带锁髓内钉固定和急诊清创缝合开放伤口择期行带锁髓内钉固定两种方法进行治疗。结果 随访半年以上，骨折全部愈合，髋、膝关节活动良好。1例发生皮肤窦道不愈合，未发生进一步深部感染，10个月后取钉，皮肤窦道愈合。2例发生下肢短缩，未发生髓内钉断裂，1例远端锁钉断裂，1例远端锁钉松动，但未影响骨折愈合及关节功能。一期髓内钉内固定组在手术总时间、住院日、住院费用、抗生素用量、部分负重时间等方面明显优于择期手术，而在手术后的疗效、并发症方面无显著差异。结论 感染发生的危险性不是开放性股骨干骨折带锁髓内钉治疗的禁忌症，彻底清创，条件允许可以一期行手术治疗。     

带锁髓内钉加刻槽后钢丝固定治疗肱骨粉碎性骨折

目的探讨带锁髓内钉加刻槽后钢丝固定治疗肱骨粉碎性骨折的临床疗效。方法2002年1月—2007年1月,采用带锁髓内钉加刻槽后钢丝固定治疗肱骨粉碎性骨折患者32例,手术采用开放复位,骨块刻槽钢丝固定后顺行置入髓内钉,若骨块间隙>5 mm,采用自体骨条或冷冻干燥异体骨一期植骨。结果平均随访时间21.4个月,骨折全部愈合,平均愈合时间为4个月,所有患者肩肘关节功能恢复良好,无感染及医源性神经血管损伤。结论带锁髓内钉加刻槽后钢丝固定为治疗肱骨粉碎性骨折的有效方法。     

带锁髓内钉治疗178例长骨骨折疗效分析

目的探讨带锁髓内钉治疗股骨、胫骨和肱骨骨折的疗效.方法回顾性分析2001年1月至2007年6月我科收治的178例应用带锁髓内钉内固定治疗长骨骨折患者的临床资料.其中新鲜骨折153例(开放性40例,闭合性113例),陈旧性骨折25例;股骨骨折98例,胫骨骨折58例,肱骨骨折22例;男性142例,女性36例;年龄15～84(48.3±16.4)岁.术中应用"C"型臂或"G"型臂引导闭合复位,对部分闭合复位失败者采用切开复位内固定,陈旧性骨折和骨折粉碎严重的病例行断端植骨,取自体髂骨植骨或自体髂骨加固混合植骨.结果178例骨折均治愈,治愈率为100.0%;骨折平均愈合时间为(18.5±3.2)w,其中正常时间愈合167例(93.8%),延迟愈合9 例(5.1%),2例骨折9个月内不愈合(1.1%);内固定失败 6例,其中主钉断裂 2例,主钉合并远端锁钉断裂1例,远端锁钉退出1例,近端锁钉退出2例;感染2例(1.2%),外伤性骨折 2例(1.2%).结论 应用带锁髓内钉治疗股骨、胫骨和肱骨骨折愈合率高,并发症发生率低,是治疗骨干骨折的一种较为理想的内固定方法.     

股骨干骨折三种治疗方法的临床探讨

目的：比较钢板内固定术，外固定支架治疗及交锁髓内钉治疗股骨干骨折的优越性。方法：将119例股骨干骨折病例随机分为三组，A组53例行切开复住钢板内固定术：B组35例行外固定支架治疗；C组31例行交锁髓内钉治疗。治疗后对其疗效及并发症进行观察，比较和分析。结果：A组骨折愈合优良率81％，其并发症：浅表感染3例，深部感染1例，固定失败2例，迟延愈合5例。B组骨折愈合优良率73％，其并发症；浅表感染6例，固定失败2例，迟延愈合1例。C组骨折愈合优良率92％，其并发症：浅表感染1例，深部感染1例。结论：交锁髓内钉是治疗股骨干骨折较理想的方法。     

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.