闭合性阴囊及睾丸损伤的高频超声诊断

目的探讨高频超声对阴囊、睾丸损伤的诊断价值。方法回顾性分析46例阴囊、睾丸损伤患者（年龄8～82岁，平均年龄35．6岁）的超声表现及手术发现。结果46例患者据阴囊、睾丸的声像图表现可分为：阴囊壁挫伤32例，阴囊壁血肿14例，睾丸挫伤5例，睾丸血肿7例，睾丸破裂27例等五种类型。阴囊、睾丸损伤的超声诊断与临床符合率为100％，而阴囊、睾丸损伤的超声分型与术后诊断符合率仅为93．5％。结论高频超声能准确诊断阴囊、睾丸的损伤，且能对大多数阴囊、睾丸损伤的程度进行分型，为临床选择治疗方案提供可靠依据。     

创伤性腰5椎体完全性前脱位一例及文献复习

目的 报道1例少见的创伤性L₅椎体完全性前脱位病例,并结合文献探讨其临床特点、发生机制及治疗策略。方法 回顾性分析1例52岁女性创伤性L₅椎体完全性前脱位患者的临床资料。在中国知网、万方数据、维普及PubMed等数据库中,以“创伤性腰骶椎完全性脱位”“创伤性腰骶椎完全性滑脱”和“traumatic complete lumbosacral dislocation”“traumatic lumbosacral spondyloptosis”为中英文关键词,检索2019年1月前有关L₅椎体创伤性完全性前脱位的相关文献,共纳入10篇10例L₅椎体创伤性完全性前脱位的英文文献报道。结合本例诊治过程,总结该损伤的临床及影像学表现、损伤原因及治疗方法。结果 本文1例成年女性因交通事故致L₅椎体完全性前脱位伴神经损伤,行单纯后路减压、复位及椎间植骨融合术,术后完全复位,随访6个月复位无丢失,内固定物无松动,患者神经功能基本恢复正常。结合文献报道的10例,共11例创伤性L₅椎体完全性前脱位,男9例、女2例,年龄18~57岁,多由高能量暴力伤导致腰骶部肿胀、疼痛、活动受限及不同程度神经功能损伤;影像学提示L₅椎体相对于骶骨椎体前移超过100%,多合并脊柱后方附属结构破坏;治疗多提倡早期手术减压、复位、内固定植骨融合术以重建腰骶段稳定性及改善神经功能状态。结论 急性创伤性L₅椎体完全性前脱位临床较为罕见,生物力学极不稳定,且多合并神经损伤。其发生机制尚存争议。早期采取手术减压、复位及融合有助于改善预后。尽管需根据具体情况采取具体手术方式,但单纯后路减压复位椎间植骨融合内固定术是处理创伤性L₅椎体完全性前脱位的一种安全、有效术式。     

睾丸外伤40例诊治分析

目的 提高睾丸外伤的诊断治疗水平。方法 分析比较睾丸外伤手术及保守治疗的效果。结果 手术修补睾丸29例中阴囊坠痛感超过3月消失者仅3例，睾丸萎缩3例（10％），其中2例血睾酮下降，精液检查正常，1例双侧睾丸外伤精子量减少。保守治疗组8例中阴囊坠痛感3月后方减轻或消失者6例，4例睾丸萎缩（50．0％），其中3例检查无精子，1例精子量减少。结论 早期手术探查，清除血肿，切除修整突出白膜外的睾丸组织，缝合白膜，放置有效引流，能有效消除症状，降低睾丸萎缩及睾丸切除可能性。     

下尺桡关节脱位的治疗进展

目的：总结下尺桡关节（DRUJ）脱位治疗的研究进展。方法：在PubMed、中国知网及医知网数据库查阅近年国内外关于DRUJ脱位治疗的文献,进行综合分析。结果：单纯DRUJ脱位多采用手法复位石膏外固定治疗;合并桡骨远端骨折的早期DRUJ脱位可采用空心螺钉内固定治疗;陈旧性DRUJ脱位采用改良Sauve-kapandji手术及改良Milch手术;而软组织修复重建手术可稳定DRUJ,术后恢复快。结论：早期诊断和早期治疗有利于DRUJ脱位患者关节功能的恢复。DRUJ脱位的治疗方法各有优劣,应根据患者的损伤程度选择适合的治疗方法。     

距下关节脱位伴距骨后突骨折一例及文献复习

目的 报道1例少见的距下关节内侧脱位伴距骨后突骨折病例的诊断和治疗,探讨距骨后突周围解剖、距下关节内侧脱位伴距骨后突骨折发生机制、诊断及治疗。方法 回顾性分析1例25岁男性距下关节内侧脱位伴距骨后突骨折患者的临床资料。在PubMed、中国知网、万方数据及维普数据库中,以“距下关节脱位/subtalar dislocation”和“距骨后突骨折/posterior process fracture of talus”为关键词,检索2017年10月前有关距下关节脱位伴距骨后突骨折的相关文献,共纳入6篇6例距下关节脱位伴距骨后突骨折的英文文献报道和1篇1例中文文献报道;结合本例诊治过程,总结该损伤临床及影像学表现、损伤机制、诊断及治疗方法。结果 本文1例青年男性因车祸伤致右足内翻畸形、疼痛、肿胀、活动受限,正侧位X线平片示右距下关节内侧脱位伴后踝游离骨块,急诊行右距下关节脱位闭合复位石膏固定术。急诊术后X线片示距骨外旋,CT平扫示距跟关节间隙增宽、距骨后突骨折、足舟骨撕脱骨折,择期行右距下关节脱位伴距骨后突骨折切开复位内固定术;择期手术后距下关节及距骨后突复位良好,随访6个月患者踝关节活动可,未诉疼痛。结合文献报道的7例,共8例距下关节脱位伴距骨后突骨折,男7例、女1例,年龄17~52岁,均表现为伤后足内翻畸形、肿胀、疼痛、活动受限;X线示距胫关节稳定,足内翻、距下关节内侧脱位,后踝存在游离骨折块;治疗以切开或闭合复位内固定为主要手术方式;距骨后突解剖复位并石膏固定者术后功能恢复好,无关节不稳、创伤性关节炎等相关并发症。结论 当足遭受跖屈内翻暴力时距下关节可发生内侧脱位,同时距骨后突遭受距跟韧带的牵拉暴力形成撕脱骨折。距下关节脱位合并无移位或移位≤2 mm的距骨后突骨折可保守治疗,合并距骨后突骨折移位＞2 mm应手术治疗,有症状的陈旧性骨折可在关节镜下切除骨折块。     

睾丸扭转的诊断和治疗（附28例报告）

目的：探讨睾丸扭转的早期诊断及治疗。方法：回顾总结28例睾丸扭转患者的诊治资料。结果：28例均行手术治疗，7例行睾丸固定术，21例行睾丸切除；7例睾丸固定术后随访6月～2a，其中2例睾丸萎缩。结论：疑为睾丸扭转时，应首选彩色多普勒检查，治疗上应尽快手术探查，避免睾丸切除的发生。     

睾丸扭转14例临床诊断与治疗

目的：探讨提高睾丸扭转诊断及治疗水平的临床措施。方法：结合临床症状和体征确诊14例睾丸扭转；13例手术治疗，1例手法复位；结合献对临床资料进行分析。结果：14例中13例行急诊睾丸探查术，1例行手法复位；8例行睾丸切除术，6例保留睾丸，睾丸切除率达57.1％；随访3～12月，复位睾丸及对侧睾丸形态和功能正常。结论：对于睾丸扭转，早期诊断及早期开放手术是提高睾丸保留率的有效方法。     

外伤性睾丸脱位的手术治疗

外伤性睾丸脱位较少见。作者在临床工作中遇到2例,现报道如下: 临床资料 例1 男,19岁。因外伤后右睾丸下降不全2月入院。2月前因车祸致会部开放性损伤,当时无血尿、休克症状。在院外行清创缝合术。术后1月余发现右侧腹股沟内侧有一包块。查体:双侧阴囊不对称,右侧阴囊空虚,于耻骨联合外侧可触及一光滑包块,约3cm×2cm×2cm大小,边缘清楚。左侧阴囊内睾丸大小、形态正常。B超示右侧睾丸移位。1991年1月在腰麻下行右侧睾丸复位固定术。术中见右侧睾丸位于耻骨联合外侧皮下,睾丸形态、大小正常,睾丸、精索与周围组织粘连。遂     

46，XY，dir dup（6）一例

４６，ＸＹ，ｄｉｒｄｕｐ（６）一例王文臣，王秀岩，吴晓林，张志敏，刘庆仁，罗振国患者男，生后即发现其双侧阴囊内无睾丸，５年后来我院诊断为双侧隐睾症。当时即给予绒毛膜促性腺激素治疗，至今仍未发现睾丸进入阴囊。患者系足月顺产，否认家族遗传病史，父母无烟、...     

创伤性腕骨轴向脱位10例临床分析

目的 探讨创伤性腕骨轴向脱位的手术方式和术后的疗效.方法 2007年9月至2011年10月在潍坊市益都中心医院手足外科采用切开复位克氏针内固定手术治疗创伤性腕骨轴向脱位患者10例,采用Cooney评分法评价治疗效果.结果 术后随访5个月～4年,平均2年,10例患者腕关节诸骨序列良好,经功能锻炼后,腕关节功能满意.采用Cooney评分法评价治疗效果:优9例,良1例,无一例出现骨折畸形愈合、腕关节不稳定及创伤性关节炎等并发症.结论 创伤性腕骨轴向脱位虽然治疗困难,预后差,但是及早诊断,尽可能恢复骨性及软组织解剖结构,早期功能锻炼,仍可达到满意效果.     

Transverse testicular ectopia found by preoperative ultrasonography.

Transverse testicular ectopia, an extremely rare anomaly, is a deviation of testicular descent resulting in unilateral location of both testes, usually associated with an inguinal hernia, with the spermatic cord of the ectopic testes originating from the appropriate side. In most reported cases, the correct diagnosis was not made preoperatively. But we made a diagnosis of transverse testicular ectopia preoperatively by using the ultrasonography in patient with right-side inguinal hernia and left-side cryptorchism. Left testis was found on the right inguinal area and right testis was found in the right scrotum by ultrasonography, so we could make a diagnosis of transverse testicular ectopia. After right inguinal hemiorraphy, both testes were easily brought down sequentially through the right groin into the scrotum. Left testis was placed in the left hemoscrotum through transceptal incision to the scrotal subdartous pouch.     

Congenital testicular lymphangiectasis

Summary Testicular lymphangiectasis are described for the first time in a patient with bilateral inguinal cryptorchidism. A great number of irregular lymphatic channels was observed within the parenchyma and the tunica vasculosa in both testes. Large and numerous anastomosis between the lymphatic vessels of these two areas could also be seen. The MTD and the TFI of the left testis were normal. Both parameters were very low in the right testis. The association of this fact with the greater development of the lymphatic vessels in this testis strongly supports the idea that testicular lymphangiectasis interfere mechanically with the testis tubular development.Profesor Agregado de Histología y EmbriologíaProfesor Adjunto de Histología y Embriología     

Hemangioma of the testis: report of unusual occurrences of cavernous hemangioma in a fetus and capillary hemangioma in an older man

We report two cases of hemangiomata of the testes which occurred in a 17-week-old fetus and a 73-year-old man. To our knowledge, these are the first reported cases of cavernous hemangioma of the testis in a fetus and capillary hemangioma of the testis in an older man. Although a hemangioma of the testis is rare, it should be considered in the differential diagnosis of a testicular tumor. Ann Diagn Pathol 5:80-83, 2001.     

Intratubular malignant germ cells in testicular biopsies: clinical course and identification by staining for placental alkaline phosphatase

This study was undertaken to determine the clinical course of patients with intratubular malignant germ cells (ITMGCs) and to evaluate the reliability of placental alkaline phosphatase (PLAP) for detection of these cells. Eight patients with ITMGCs in testicular biopsy were followed. Four patients received no further immediate treatment. Two of these showed no evidence of disease after 190 and 132 mo; one developed seminoma at 38 mo, and one developed seminoma of the contralateral testis in 61 mo. The remaining four patients underwent immediate orchiectomy. Orchiectomy findings were invasive seminoma in three testes, intratubular seminoma in one, and residual ITMGCs in one testis (one patient had bilateral orchiectomy). Also studied were two testicular biopsies from patients with known retroperitoneal germ cell tumors, respectively, seminoma and teratoma. Both had ITMGCs in their testes. Immunoperoxidase stains for PLAP gave a positive result in all biopsies showing intratubular malignant germ cells. PLAP was not demonstrated in spermatogonia in 471 control biopsies which did not show germ cell neoplasia. Two other patients with incidental seminoma on biopsy for infertility are discussed. These results show that ITMGCs show a high rate of progression to invasive disease, but can show an indolent course. PLAP is a sensitive and specific marker for ITMGC, facilitating diagnosis.     

Involvement of calpain for apoptosis in dysfunction of the unaffected testis in rats with experimental testicular torsion

PROBLEM: The dynamics of calpain and involvement of apoptosis in sperm formation disorder of the unaffected testis in rats with experimental testicular torsion were investigated. METHODS OF STUDY: Using 6-week-old Wistar rats, an experimental unilateral testicular torsion model was prepared. The bilateral testes were excised 1, 3, 5, 7, 14, 35, and 70 days after the left testis was twisted, and the unaffected testes were subjected to immunohistological staining, sodium dodecyl sulfate polyacrilamide gel electrophoresis and Western blotting using anti-calpain antibodies. Apoptosis was detected by the TdT-mediated dUTP biotin nick end-labeling (TUNEL) method. RESULTS: By immunohistological staining, positive immunostaining by anti-pro mu-calpain antibody was observed in the spermatocyte nucleus, but not with anti-pro m-calpain antibody. The staining was increased until 7 days after testicular torsion, then decreased with progression of sperm formation disorder. By Western blotting, the intensity of staining with anti-pro mu-calpain antibody was increased until 7 days after torsion of the testis. Apoptosis expression in the unaffected testis was significantly inhibited by addition of a calpain inhibitor. CONCLUSIONS: It was suggested that mu-calpain may be involved in apoptosis expression in sperm formation disorder of the unaffected testis in unilateral testicular torsion.     

青少年疲劳性颈椎脱位与后凸畸形的诊断与治疗

目的：探讨青少年疲劳性颈椎脱位与后凸畸形的诊断与治疗.方法：回顾性分析2002年3月-2009年3月本院治疗青少年疲劳性颈椎脱位与后凸畸形患者20例,其中寰枢椎半脱位1例,后凸畸形19例 保守治疗16例,手术治疗4例.结果：全部患者治疗后VAS评分均得到显著改善,由治疗前平均7.9分下降至治疗后1个月平均2.8分,最终随访平均1.2分.经平均24.1个月 （12～84个月） 随访,17例患者一期治愈（半年以上无复发） 另3例保守治疗者分别于治愈后6～17个月复发,其中2例再次牵引后支具固定而治愈,1例支具固定半年后治愈.结论：有长期低头学习、玩电脑游戏或工作病史的青少年,出现颈部疼痛不适、头痛头晕、恶心等症状,X线有颈椎失稳或畸形表现者,即可诊断 早期牵引等保守治疗有效,对症状严重牵引治疗无效者应积极手术治疗.     

Iliac-Vena Caval Fistula: An Uncommon Acute Traumatic Arteriovenous Fistula

Acute traumatic arteriovenous fistulas in major abdominal vessels are relatively rare. They are often difficult to detect without arteriography in a patient with multiple injuries, without a nonexpanding hematoma. To the authors'' knowledge this is the first report of an acute traumatic iliac-vena caval fistula. The value of arteriography in diagnosis and the need for early recognition and operation of these lesions are stressed. Definitive arterial and venous reconstruction should be performed whenever feasible.     

The influence of vasovasostomy on testicular alterations after vasectomy in Lewis rats

The occurrence of alterations in testicular weight and morphology after vasectomy and vasectomy reversal by vasovasostomy was studied in Lewis rats. Animals were studied 3, 4, and 7 months after bilateral vasectomy or a vasectomy followed 3 months later by vasovasostomy. Other rats served as sham-operated controls. The weights of the testes in vasectomy and vasovasostomy animals fell into two groups-small testes weighing less than 0.88 g and normal-sized testes of 1.2 g or more. When the extent of testicular alterations was estimated in sections for light microscopy by use of a semiquantitative testicular biopsy score count (TBSC), the morphology of the testes corresponded closely to the testis weight (r = .94), small testes having correspondingly low TBSC scores. In severely altered small testes, the seminiferous tubules were narrower than in sham-operated rats, and numbers of germ cells were greatly depleted. Many tubules contained only Sertoli cells and spermatogonia, although spermatocytes were present in a minority of tubules. A few seminiferous tubules contained multinucleate spermatids. Electron microscopy of severely altered tubules revealed closely apposed processes of Sertoli cells, which contained filaments, microtubules, and endoplasmic reticulum. In contrast, testes with normal weight in vasectomy and vasovasostomy groups resembled those of the sham-operated animals. Comparison of distributions of testicular biopsy score counts demonstrated differences between vasectomy and vasovasostomy groups as time after operation increased. At the 3-4-month intervals, approximately one-third of the testes were severely altered in both vasectomy and vasovasostomy groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

高压氧对精索静脉曲张大鼠睾丸组织缺氧诱导因子1α、 脂质过氧化物、血管紧张素转化酶的影响及其作用机制*

目的：分析高压氧对精索静脉曲张大鼠睾丸组织缺氧诱导因子1α（HIF-1α）、脂质过氧化物（LPO）、血管 紧张素转化酶（ACE）表达的影响及其机制。方法：将雄性SD大鼠随机分为假手术组、模型组和高压氧组;模 型组和高压氧组行精索静脉曲张手术造模,假手术组仅手术而不造模;假手术组和模型组大鼠手术或造模成功后 正常饲养,高压氧组采用高压氧进行干预治疗;取睾丸计重,行TUNEL法检测睾丸生精细胞凋亡;用免疫印迹 和实时荧光定量PCR法检测睾丸组织中HIF-1α、LPO、ACE及其mRNA表达;用ELISA 检测试剂盒测定睾丸组 织LPO、超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、ACE表达水平。结果：高压氧组大鼠左侧、右侧和两侧 睾丸质量均明显高于模型组;高压氧组大鼠睾丸细胞凋亡率均明显低于模型组,睾丸组织LPO表达水平明显低于 模型组,而SOD、CAT、ACE表达水平均明显高于模型组;高压氧组大鼠睾丸组织HIF-1α、LPO蛋白和mRNA 表达均明显低于模型组,ACE蛋白和mRNA水平明显高于模型组。结论：高压氧对雄性SD大鼠精索静脉曲张干 预后可有效调节大鼠睾丸组织中HIF-1α、LPO和ACE的表达,进而减少睾丸细胞凋亡。     

Bilateral gonadoblastomas in a dog with mixed gonadal dysgenesis

Gonadoblastomas are rare mixed germ cell neoplasms, which are frequently diagnosed in testes excised for other reasons. In human patients these tumours are usually associated with undescended testes or dysgenetic gonads. This report describes a 10-year-old male dog with mixed gonadal dysgenesis ("streak testis" on the right side and testis on the left side) and bilateral gonadoblastomas. Immunohistochemical analysis revealed an atypical and mitotically active germ cell population which co-expressed placental alkaline phosphatase and c-kit oncogene, admixed with inhibin- and S-100 protein-positive sex cord cells. The findings were generally consistent with previous reports of the dual population of neoplastic cells in gonadoblastomas affecting human patients, and closely resembled the findings in the only other case reported in dogs. Moreover, the findings further support the proposal that gonadoblastomas should be considered a special form of in-situ germ cell neoplasia.