眼部主要战伤伤谱初步研究

目的　研究现代常规战争中眼部战伤的发生规律和特点 ,了解现代眼战伤伤谱 ,以更好地加强平战时眼部伤的救治。方法　调研有关现代战争的眼战伤资料 ,对所收集的数据进行统计分析。结果　初步总结出现代战争眼部战伤的主要发生规律、特点以及致伤因素。结论　现代战争眼部主要战伤伤谱为 :(1 )眼球穿通伤 ;(2 )眼球穿通合并眼球异物伤 ;(3)眼球钝挫伤 ;(4 )眼附属器的外伤 ;(5 )眼烧伤。     

现代战争中眼创伤的伤情特点与防治

现代战争中 ,高速、高能、高精确度武器的应用使眼创伤的比率增大 ,伤情严重 ,救治困难。其中 ,眼爆炸伤、穿通伤和异物伤多见 ,复合伤和多发伤增多。头盔及护目镜等防护器具的研制和装备 ,正确的急救原则 ,完善的后送程序是防治眼创伤的主要措施     

眼外伤后玻璃体手术的适应证及禁忌证是什么?

解答：适应证：（1）眼球穿通伤：眼前段穿通伤：外伤性白内障,各种穿通伤引起的后期并发症如白内障、瞳孔区机化膜、浅前房或无前房、上皮植入性囊肿与玻璃体黏连;眼后段穿通伤：无吸收趋势的玻璃体出血,伤后玻璃体形成牵拉条索,引起视网膜裂孔,前部PVR致视网膜脱离。（2）球内异物：非磁性异物：玻璃体内的铜、铅、铝、玻璃、塑料、石块等。     

眼球穿通伤的临床特征与预后

近年来,显微眼外科的进展为降低眼球穿通伤的致盲率提供了新的技术和措施。本文回顾性研究了148例眼球穿通伤患者的临床表现及预后因素,以期有助于眼球穿通伤的进一步处理。     

玻璃体腔穿刺注药治疗细菌性眼内炎

细菌性眼内炎是眼球穿通伤和内眼术后破坏性最大的、最棘手的并发症，一旦感染发生，将严重损害患者的视力，甚至需作眼球摘除术。而且由于玻璃体内无血管及血眼屏障的存在，严重限制了玻璃体腔内的药物浓度，导致玻璃体一旦感染，抗炎效果不显著，眼内感染时间稍久就会严重损害视网膜的功能，预后不佳。所以，早期玻璃体腔给药在现有医疗条件下是提高玻璃体内药物浓度的首选方法。     

复杂眼球穿通伤二期玻璃体手术临床分析

目的 分析复杂性眼球穿通伤救治过程中各手术阶段的特点，强调伤眼救治的时序性。方法 对我院1998年1月～2002年1月间收治的开放性眼外伤二期进行玻璃体切割手术的56例(58眼)进行回顾性分析。结果 伤眼经二期玻璃体手术后，最终视力提高44眼(75．9％)，视力保持不变9(15．5％)，视力下降5眼(8．6％)；伤眼一期伤口修复满意的视力预后明显好于不满意的；伤后2周左右实施玻璃体切割手术的视力预后明显好于其他时间段，伤后超过1月进行玻璃体切割手术的伤眼视力预后最差。结论 复杂性眼球穿通伤显微手术的一期修复水平决定着伤眼的命运，准确把握二期玻璃体切割手术时机，使外伤眼的救治具有系统性，对伤眼的预后至关重要。     

外伤性青光眼

眼球挫伤或眼球穿通伤后引起眼压升高称为外伤性青光眼，是眼外伤的严重并发症和眼外伤失明的重要原因。一、单纯性挫伤后青光眼1．病因：眼球顿挫伤后，未发生限内组织明显损伤，但眼球局部血管神经控制失调，毛细血管扩张，渗透性增加，房角小梁水肿，房水外流阻力增加，引起伤眼或由于神经反射作用同时伴健侧眼压升高。2．临床特点：伤后1周内出现眼病、恶心、呕吐、瞳孔扩大，眼压可达5．33～8．00hP。，房角检查多无异常。眼压升高一般持续数天至3个月，对视功能一般不造成危害。3，治疗：一般不需特殊治疗，可口服醋氨酸胺，给予镇静…     

腹部钝性伤的早期救治

腹部钝性伤是意外伤害及交通事故中最常发生的事件之一,是临床常见的创伤性疾病,其伤情复杂,发展迅速,严重者可出现出血性休克等并发症危及患者生命。及时正确的早期救治是影响患者预后甚至挽救生命的关键。因此,加强早期救治对提高腹部钝性伤的救治水平至关重要。     

机械性眼外伤治疗

发生机械性眼外伤后,对伤情及时、准确的判断和治疗,对挽救患者眼球及恢复视功能至关重要。机械性眼外伤一般分为钝挫伤、穿通伤和异物伤等。对于不同类型及不同部位的机械性眼外伤,须采取不同的     

眼球穿通伤显微手术治疗体会

我科自1993年以来采用眼科显微手术,对36例眼球穿通伤病例进行探查、清理、修补缝合处理,疗效显著提高,现报告如下。临床资料本组36例,男29例,女7例,年龄2～73岁,均为单眼外伤。其中角膜穿通伤19例,巩膜穿通伤5例,角巩膜穿通伤12例,其中3例伤口延至赤道后,2例伤口贯     

军人眼外伤113例临床分析

目的　研究军人眼外伤的相关因素 ,探讨相应的防治措施。方法　对 1 1 3例 ( 1 3 7眼 )眼外伤住院军人的年龄、职别、致伤环境、致伤原因、就诊时间、主要致伤类型、受累组织、并发症及预后等进行总结和分析。结果　眼外伤患者占同期眼科总住院军人的 41 .85 %,均为男性 ,士兵居多 ,受伤地点多在工作训练场所 ,致伤原因以打击伤、钝器挫伤为主 ,就诊时间1/2h至 1 0d不等 ,致伤类型主要是睑裂伤、眼球钝挫伤、前房积血、视网膜震荡等 ,致盲率 2 0 .44%,眼球摘除 1眼。结论　眼外伤是军人主要致盲眼病之一 ,积极预防和采取及时治疗是关键。     

Loss of visual function as the result of gunshot injuries of the eye

The article presents the clinical-and-statistical analysis of causes of visual function loss occurred after the gunshot injuries of eyes. The main cause of sight loss is the eye destruction as the result of gunshot injury (61.1%). Because of the unsuccessful treatment of posttraumatic changes in eyeball the injured eyes were removed in 38.9% of the casualties. In most cases the fragmentation and mine-explosive trauma were the cause of eye destruction. In the cases of eyeball destruction enucleation and evisceration were the main surgical interventions. In the therapy of posttraumatic changes in the injured eye (flaccid inflammatory process without tendency towards its resolution, painful syndrome as well as eyeball atrophy and subatrophy) enucleation was performed. Improvement of conservative methods in therapy of posttraumatic complications could contribute to decrease in the number of casualties with sight loss after the eye gunshot injures.     

Uterine perforation resulting in bowel infarction: sharp traumatic bowel and mesenteric injury at the time of pregnancy termination

BACKGROUND: By law, elective terminations of pregnancy are not performed in U.S. military institutions. However, in the civilian sector, more than a million abortions are performed each year, some of which are on military beneficiaries. Although complications are relatively rare, patients not uncommonly present for follow-up care to their military installation. We report the case of a patient who presented after a second-trimester elective abortion and was found to have suffered uterine perforation with mesenteric and bowel injury that required bowel resection. CASE: An 18-year-old gravida 1 para 0 female presented from an outlying facility 1 week after elective termination at 18 weeks of gestation with complaints of severe abdominal pain, nausea, and vomiting. Exploratory laparotomy for presumed bowel obstruction revealed uterine perforation and bowel devitalization and necrosis, which required small bowel resection. Fetal bones were discovered within the surgical specimen. CONCLUSION: Morbid, even potentially fatal, complications can occur as a result of pregnancy termination. With second-trimester procedures, perforation can result in injury to abdominal viscera from the perforating instruments or even from sharp fetal bony structures. Military gynecologic surgeons, who are not in abortion practice, must nevertheless be cognizant of the potential for perforation leading to serious visceral injury.     

Spontaneous foreign body extrusion following perforating eye injury

A structured approach to the management of a perforating ballistic eye injury is illustrated in this case, where initial treatment was limited to simple corneal wound closure and antibiotic prophylaxis. A pellet had passed completely through the globe but the retina remained attached, and it was decided to manage the case conservatively. Two retained foreign bodies were extruded spontaneously some months after the injury when suture removal and delayed cataract surgery led to a virtually perfect visual outcome. The patient has had no further complications at least three years after initial injury. The management of this civilian case illustrates some basic concepts in treating ballistic eye injuries that may be applicable in a military setting.     

玻璃体切除术联合多波长激光光凝治疗增殖型糖尿病视网膜病变

目的探讨玻璃体切除术联合多波长激光光凝治疗增殖型糖尿病视网膜病变的临床效果。方法对102例(118只眼)增殖型糖尿病视网膜病变患者行玻璃体切除术治疗,多数病例术后1周内开始行多波长激光光凝治疗,并在术后1个月内完成全视网膜光凝。术后随访为1～15个月,观察视力、眼底等。结果 118只眼中视力≥0.02的眼数由治疗前的49只眼(41.5%)增加到治疗后的86只眼(72.9%),其中,≥0.1的的眼数由治疗前的18只眼(15.3%)增加到治疗后的54只眼(45.8%)。玻璃体手术中未造成新的视网膜脱离,术前已有视网膜脱离的46只眼,术后视网膜均得到复位,其中35只眼填充硅油,22只眼已于随访期间取出硅油,视网膜脱离未复发。并发症主要有:手术后持续较浓密的玻璃体积血11只眼,其中5只眼接受了再手术;光凝期间玻璃体再出血6只眼,2只眼接受了再次手术;虹膜红变及新生血管性青光眼5只眼,眼球萎缩2只眼。结论玻璃体切除术能够有效治疗严重的增殖型糖尿病视网膜病变,通过联合应用多波长激光全视网膜光凝治疗,能显著改善手术预后,降低手术并发症的发生,提高或保留患者的视力,减少失明率。     

Treatment of nerve injuries in the multiple-ligament-injured knee

Dislocation of the knee is a serious and potentially limb-threatening injury. Associated ligamentous injuries,fractures, and vascular and nerve injuries are common. Prompt recognition of a knee dislocation and appropriate treatment of associated injuries is necessary to minimize the complications of this severe and potentially devastating injury. Peroneal nerve injury occurs in about 28% of knee dislocations and cases of multiple-ligament injury. Despite numerous advances in nerve repair techniques, the prognosis for nerve injuries after knee dislocation remains poor, with an overall recovery rate of 40%. This article provides a review of current recommendations for evaluation, treatment, and management of complications associated with nerve injury in knee dislocation, as well as areas for future study to improve prognosis and treatment.     

Experience in rendering ophthalmological care to the wounded]

Medical losses from ophthalmological injuries inflicted by small arms were from 2.2 to 4.5%, and taking into account concomitant injuries--up to 5.6%. Frequently there were binocular lesions, perforating wounds and destructions of eyeballs. Complicated ophthalmological operations were performed on patients who simultaneously had severe injuries of extremities, chest, abdomen, etc. Vitrectomy was a basic stage in the treatment of eye-penetrating wounds. Application of active measures for management of ophthalmological wounds at the stages of medical care made it possible to improve the outcome of treatment, diminish the frequency of purulent complications, for example endophthalmitis by 2 times.     

腹膜透析治疗重型颅脑损伤并发症疗效分析

目的探讨腹膜透析治疗重型脑损伤并发症的临床效果。方法应用腹膜透析(PD)治疗重型颅脑损伤30例,以甘露醇脱水,静脉补充电解质治疗同类病员29例为对照组,比较两组的临床效果。结果PD治疗组:1例因脑伤过重死亡,其余治疗情况良好,无严重水电解质紊乱,对有严重脑水肿脑肿胀者,脱水效果良好;3月后GOS评定:痊愈:9例,中残:16例,重残:4例,植物生存:0例,死亡1例。对照组:4例死于急性肾功衰;2例死于弥漫性脑水肿;23例合并有不同程度的水电争质紊乱;3月后GOS评定:痊愈3例,中残14例,重残4例,植物生存2例。结论PD治疗重型颅脑损伤并发脑水肿脑肿胀,纠正严重水电解质紊乱,防止急性肾功衰等,均有良好的临床效果。腹膜透析可作为重型颅脑损伤并发症的有效治疗措施。     

腹腔开放合并肠空气瘘的防治

腹腔开放能够减轻腹腔内压力,便于清除感染坏死组织,及时止血,及时发现肠外瘘等并发症,目前腹腔开放疗法已成为应用损害控制理念救治严重创伤、重度腹腔感染、腹腔间隙综合征的重要治疗手段。但腹腔开放仍有一些并发症,尤其是继发肠空气瘘,一旦发生肠空气瘘,则需要调整治疗思路,建议采用阶段性治疗策略,同时重视此过程中肠内营养的应用。     

Complications associated with treatment of multiple ligament injured (dislocated) knee

Multiple ligament injured knee is a heterogenous group of injuries, which remains a challenging entity for physicians to manage. Complications that are associated with this severe injury can occur from the injury itself or can arise from emergency or definitive treatment. The development of these complications can alter management options and compromise patient outcomes.