探讨后内侧入路治疗胫骨平台后髁骨折的临床效果

目的探讨后内侧入路治疗胫骨平台后髁骨折的临床效果。方法自2006年5月~2011年8月,我科收治胫骨平台后髁骨折的患者19例,在罗从凤三柱分型中均为后侧柱骨折,其中右膝12例,左膝7例,单纯后内侧髁骨折10例,后内侧髁骨折伴膝关节半脱位者2例,单纯后外侧髁骨折3例,后外侧髁骨折伴膝关节半脱位者1例,后侧双髁骨折3例;19例患者均采用后内侧入路进行复位、内固定。结果随访10~40.8个月,平均17个月,骨折全部愈合,愈合时间为3~6个月。随访第12个月本组平均屈膝(107.42±2.6)°(95~120°),平均伸膝(3.7±1.02)°(0~8°);根据Hass膝关节功能评定,本组中优10例,良7例,可2例,优良率89.47%。膝关节HSS评分平均为87.8分(78~94分)。术中解剖清晰,操作简单、安全,术后并发症少。结论采用后内侧入路治疗胫骨平台后髁骨折能充分显露胫骨平台的后髁,能为骨折的复位和内固定提供较好的操作空间,手术操作简单、安全、固定可靠。     

膝前后联合入路治疗胫骨平台后侧柱骨折

目的：探讨累及胫骨平台后侧柱骨折的手术治疗方法。方法胫骨平台后侧柱骨折30例,进行手术治疗并进行随访观察。结果随访30例,手术后患者的膝关节功能优良评分为86.7%。结论膝后内侧倒"L"入路通过T形钢板适度预弯后进行支撑固定,结合前外侧锁定钢板手术治疗胫骨平台后侧柱骨折有很好的临床疗效,是治疗胫骨平台后柱骨折的一种有效方法。     

手术治疗胫骨平台（III型）骨折20例临床分析

目的探讨手术治疗胫骨平台(I I型)骨折的临床疗效。方法回顾性分析我科近5年收治胫骨平台(I I型)骨折患者20例,完全采用采用双切口入路,微创LCP钢板内固定手术治疗。结果本组20例患者,平均随访时间1年6个月。6个月内骨折均骨性愈台,平均愈合时间4.8个月。疗效评定为优6例,良9例,可3例,差2例。结论采用双切口入路,微创LCP钢板内固定,可获得内外侧平台更加准确的复位,对胫骨结节周围的软组织影响较小,可减少术后并发症,利于切口和骨折愈合。     

肘前、外侧两种手术入路治疗桡骨头骨折的比较

目的探讨显露桡骨头骨折的有效手术入路。方法采用肘前侧手术入路显露桡骨头并结合微型空心螺钉固定治疗桡骨头骨折12例,其中2例MasonⅢ型骨折的骨折块于前臂完全旋后时位于桡骨头的前侧。采用传统的肘外侧手术入路10例,显露桡骨头骨折并用微型空心螺钉埋头固定。结果前侧手术入路显露骨折时间平均为20．7分,外侧入路显露骨折时间平均为11．6分。按照Broberg和Morrey肘关节评分标准评定手术疗效：前侧入路组优良率为92％,外侧入路组优良率为90％,两组间无明显差异。结论肘前侧入路可有效显露并固定桡骨头骨折,降低桡神经深支损伤的可能性,尤其适用于治疗前臂完全旋后时桡骨头前侧骨折这一特殊类型骨折。两种入路可视具体情况加以选用。     

膝关节前外侧入路联合后内侧入路治疗胫骨后外侧平台骨折的近期疗效观察

目的探讨膝关节前外侧入路联合后内侧入路治疗胫骨后外侧平台骨折的近期疗效。方法回顾性分析2013年1月至2017年8月在我院治疗的胫骨后外侧平台骨折患者共21例,均采用前外侧入路联合后内侧入路进行手术治疗。其中男性12例,女性9例;平均年龄(45.8±4.3)岁。根据骨折AO分型,均为B型骨折,其中B1.1型8例、B2.1型6例、B2.2型4例、B3.1型3例;按三柱分型则均为外侧柱+后柱骨折。术后进行随访,并采用美国特种外侧医院(HSS)膝关节评分评价患者关节功能情况。结果 21例病例手术平均时间为(141±10.2) min,术中平均出血量(391±13.4)mL。术后随访6～8个月。按HSS膝关节功能评分标准,优12例,良6例,可2例,差1例,优良率85.7%。2例患者出现前外侧伤口感染,经积极抗炎治疗后好转,并发症率9.52%。结论膝关节前外侧入路结合后内侧入路治疗胫骨后外侧平台骨折手术视野清晰,内固定可靠且符合生物力学,术后关节功能满意。     

胫骨外侧平台骨折合并后外侧劈裂的手术治疗

目的探讨胫骨外侧平台并后外侧劈裂塌陷骨折的治疗方法和临床疗效。方法 2008年1月~2011年12月间,收治胫骨外侧平台骨折并后外侧劈裂塌陷骨折患者8例,其中男5例,女3例,年龄33~49岁(平均38.5岁)。骨折按AO分型为B3型,CT扫描和三维重建见外侧和后外侧平台劈裂塌陷。采用前外侧联合后外侧入路治疗4例,采用外侧腓骨近端截骨入路治疗4例,骨折复位后均采用外侧和后外侧支撑钢板内固定。采用DeCoster评定标准评定骨折复位情况和HSS法行膝关节功能评定。结果术后X线片检查示所有患者均达到解剖复位,8例患者经过6~24月(平均11.8月)随访,随访3个月时X线片示骨折均已愈合,未见高度丢失,膝关节功能HSS评分为85~96分,平均89.3分。1例术后出现腓总神经麻痹,2月后神经功能恢复,无血管损伤、伤口感染和皮缘坏死等并发症。结论前外侧联合后外侧入路或外侧腓骨近端截骨入路能直视下对胫骨外侧平台并后外侧劈裂骨折进行复位和内固定,是治疗这种类型骨折较为理想的手术入路。     

一种新型胫骨下端后侧接骨板治疗后踝骨折的初步疗效观察

目的总结一种新型胫骨下端后侧接骨板治疗后踝骨折的临床效果。方法应用小腿下端后外侧入路,胫骨下端后侧接骨板内固定手术治疗后踝骨折12例,按Haraquchi法分型：I型6例,II型4例,III型2例。结果 12例随访3-8个月,骨折愈合,伤口愈合良好,无伤口感染和皮肤坏死等并发症。按Leeds治疗结果标准：优8例,良3例,差1例。结论该胫骨下端后侧接骨板符合胫骨下端后外侧解剖形态,起到一种压板作用,固定确切可靠,对后踝骨折治疗有良好作用。     

胫骨远端外侧解剖形钢板治疗成人肱骨中下段骨折

目的探索应用胫骨远端外侧解剖形钢板治疗成人肱骨中下段骨折的临床效果。方法 2010年~2013年,应用胫骨远端外侧解剖形钢板治疗成人肱骨中下段骨折18例,根据AO分型,其中A型6例,B型5例,C型7例。采用患肢同侧胫骨远端解剖钢板,前外侧入路,显露桡神经,骨折复位后钢板放置于肱骨中下段前外侧固定。结果 18例患者均获得随访,全部患者骨性愈合,未见内固定物松动断裂、切口感染及神经损伤等并发症发生。肩、肘关节功能优良率100%。结论胫骨远端外侧解剖型钢板是一种治疗成年人肱骨近中下段骨折可靠有效的方法。     

双切口3块钢板置入内固定治疗合并复杂后侧骨折的胫骨平台三柱骨折

背景：胫骨平台3柱骨折多为高能量暴力引起,一般为粉碎性骨折,伴随关节面破裂、塌陷,合并严重软组织损伤,并发症多,是创伤骨科的难点。 目的：观察前后联合双切口3块钢板固定治疗合并复杂后侧骨折的胫骨平台3柱骨折的临床效果。 方法：采用前外侧联合后内侧双切口3块钢板固定治疗12例复杂胫骨平台3柱患者,前外侧切口采用一块高尔夫棒型钢板固定,后内侧用一块长钢板加一块短“T”型钢板固定。 结果与结论：12例患者内固定后均获得12个月以上随访,骨折均获愈合。X射线愈合时间为(14.0±1.1)周,完全负重时间为(15.1±1.7)周。内固定后即刻Rasmussen评分为(16.8±0.6)分。内固定后12个月膝关节活动度屈126.3°,伸-1.3°,膝关节HSS评分为(89.1±2.5)分。内固定后即刻,3,12个月胫骨平台内翻角及胫骨平台后倾角度数比较,差异无显著性意义(均P > 0.05)。患者内固定均未发生切口皮肤坏死、感染、内固定松动及断裂。结果表明,对于合并复杂后侧骨折的胫骨平台3柱骨折,双切口3钢板固定方法兼顾到了骨折的复杂性和胫骨平台后侧的解剖学形态特殊性,疗效确切可靠。     

累及胫骨平台后内侧柱复杂骨折:“竹筏”型及后内侧支撑钢板的置入

背景:累及胫骨平台后内侧骨折多为高能量损伤所致复杂型骨折,如不能选择合适时机、采用合理的固定入路及固定方式,则易出现局部皮肤坏死、骨折延迟愈合或不愈合、内固定失败及膝关节功能障碍等不良并发症。目的:探讨累及胫骨平台后内侧柱的复杂胫骨平台骨折的固定方法及效果。方法:以CT三维重建为基础和胫骨平台的三柱分型理论为依据,回顾性分析复杂胫骨平台骨折累及后内侧柱的患者37例资料。所有病例施行固定治疗,采用前外侧切口及后内侧切口固定入路,外侧利用国际内固定研究学会"竹筏"型解剖锁定接骨板固定,后内侧柱根据骨折情况选择此锁定支撑钢板固定,并行骨诱导人工骨植骨,按Merchant评分标准膝关节功能恢复情况。结果与结论:患者均获得平均12.8个月随访。骨折均达到临床愈合标准,无并发症出现。膝关节功能恢复情况:优25例,良9例,可2例,差1例,优良率92%。结果证实,前外侧切口结合后内侧切口+胫骨外侧"竹筏"型钢板及后内侧支撑钢板内固定,并应用骨诱导人工骨植骨治疗累及胫骨平台后内侧柱的胫骨平台骨折可以取得良好的治疗效果。     

Familial neuromuscular disease with "myotubes"

Van Wijngaarden et al. (1969) described a "myotubular myopathy" in a Dutch family, of which six male members were affected, indicating a recessive X-linked mode of transmission. They also thought that the morphology of a case reported by Engel et al. (1968) resembled that seen in their family.
The present case is a male sib of the patient reported by Engel and colleagues, who has similar clinical and morphologic features to his brother, and who died at 7 months of age. Muscle enzyme histochemistry of a quadriceps biopsy revealed that most type I fibers were small and had central pale areas or plump nuclei. A smaller percentage of type II fibers also showed the same features. Biopsies of muscle from the mother and father were histologically normal including fiber type composition. Karyotypic analyses, not reported in earlier cases, were performed on the family and showed no abnormalities in modal number or of individual chromosome structure. Pedigree analysis suggests an X-linked recessive inheritance pattern in this family.     

Solid variant of mammary "adenoid cystic carcinoma with basaloid features" merging with "small cell carcinoma"

We describe a rare case of a solid variant of a mammary adenoid cystic carcinoma with basaloid features (sbACC) and its coexistence with a "small cell" carcinoma (SCC), identified and confirmed by histological and immunohistochemical observations: the absence of glandular structures and PAS-positive globules, positivity for neuroendocrine markers (NSE, synaptophysin and chromogranin), and negativity for 34betaE12 and SMA actin were the aspects suggesting the presence of SCC. Furthermore, positivity for CD10 was found both in sbACC and in SCC, supporting the hypothesis that the two components share the same histogenetic myoepithelial origin and represent an example of dedifferentiation along neuroendocrine phenotype lines occurring in a multipotential neoplastic stem line, already committed towards a myoepithelial phenotype. To our knowledge, this is the first reported case of a solid basaloid adenoid cystic carcinoma merging with an SCC carcinoma. Furthermore, it is the first study in which CD10 was used to investigate the histogenesis of the two neoplastic components.     

A "pulseless" woman with proteinuria!

Takayasu arteritis, also called pulseless women disease, is a chronic vasculitis of unknown aetiology, which primarily involves the aorta, its branches and coronary and pulmonary arteries. It is an uncommon disease with a variety of presentations and most frequently found in Asia than in Europe. We report a case of a 52-year-old woman, suffering from Takayasu arteritis for 19 years. She was admitted to the hospital for diffuse pain and oedema. Biological tests pointed out proteinuria with renal failure, which was confirmed by a renal biopsy. The association of Takayasu arteritis and renal failure is unusual. This review focuses on the biological manifestations of Takayasu arteritis and on the link between this disease and the renal failure observed in this case.     

The future of telepathology. An Internet "distributed system" with "open standards"

With the availability of Internet, the interest in the possibilities of telepathology has increased considerably. In the foreground is thereby the need of the non-expert to bring in the opinions of experts on morphological findings by means of a fast and simple procedure. The new telepathology system iPath is in compliance with these needs. The system is based on small, but when possible independently working modules. This concept allows a simple adaptation of the system to the individual environment of the user (e.g. for different cameras, frame-grabbers, microscope steering tables etc.) and for individual needs. iPath has been in use for 6 months with various working groups. In telepathology a distinction is made between "passive" and "active" consultations but for both forms a non-expert brings in the opinion of an expert. In an active consultation both are in direct connection with each other (orally or via a chat-function), this is however not the case with a passive consultation. An active consultation can include the interactive discussion of the expert with the non-expert on images in an image database or the direct interpretation of images from a microscope by the expert. Four software modules are available for a free and as fast as possible application: (1) the module "Microscope control", (2) the module "Connector" (insertion of images directly from the microscope without a motorized microscope), (3) the module "Client-application" via the web-browser and (4) the module "Server" with a database. The server is placed in the internet and not behind a firewall. The server permanently receives information from the periphery and returns the information to the periphery on request. The only thing which the expert, the non-expert and the microscope have to know is how contact can made with the server.     

Successive bacteremias with "Campylobacter cinaedi" and "Campylobacter fennelliae" in a bisexual male

A bisexual human immunodeficiency virus-seropositive male had successive bacteremias with "Campylobacter cinaedi" and "Campylobacter fennelliae." Because final identification of both isolates was not completed until 1 month after the last admission of the patient, a novel and nonstandardized antimicrobial susceptibility testing method was useful in guiding timely antimicrobial therapy.     

具有"灰区"特征的不能分类的B细胞淋巴瘤

WHO(2008版)造血与淋巴组织肿瘤分类反映了近年来淋巴造血领域研究的新进展,根据疾病的临床、形态学、免疫表型和遗传学特征更好地介定了病变实体的不同分类,并对不能明确归入一种病变的病例提出了暂定的交界性分类(borderline categories)[1].