肋骨骨折合并血气胸的临床护理分析

目的分析肋骨骨折合并血气胸的临床护理方法,以提高患者抢救率和改善预后。方法对我院49例肋骨骨折合并血气胸患者的临床护理资料进行回顾性分析。结果经过及时有效的抢救和精心的临床护理,49例患者均于1个月内治愈,平均住院21d。出院后随访6个月,患者均恢复良好,无并发症出现。结论对肋骨骨折合并血气胸患者实施及时有效的抢救同时采取精心的临床护理,对抢救患者生命,改善疾病预后,提高疾病治愈率具有重要的意义。     

同种异体冻干骨内固定治疗多发肋骨骨折28例

多根多处肋骨骨折所致的连枷胸是胸部创伤患者早期死亡的原因之一,其治疗较为棘手,治疗原则主要包括镇痛、清理呼吸道分泌物、固定胸廓和防治并发症,临床上已逐渐采用内固定术进行治疗。目前有多种内固定材料用于多发肋骨骨折的固定治疗,如钢丝、有机玻璃条、钢板、钛板等。     

内固定治疗多发肋骨骨折临床观察

多发性肋骨骨折是一种严重创伤,因浮动胸壁、连枷胸导致呼吸、循环功能障碍的发生,病情凶险,可致呼吸窘迫综合征的发生。我院采用切开复位内固定手术对12例多发性肋骨骨折患者进行治疗,取得较好疗效,现报道如下。     

切开复位内固定治疗肋骨骨折25例的体会

目的了解肋骨骨折切开内固定手术治疗的效果。方法对25例肋骨骨折患者行肋骨切开复位和爪形肋骨接骨板内固定,判断其疗效。结果术后胸廓牢固稳定,肋骨断端错位、胸廓塌陷等畸形得到矫正,患者疼痛缓解,肺功能恢复正常,疗效满意。结论采用爪形肋骨接骨板对错位严重的部分肋骨骨折进行切开复位内固定是一种有效的方法。     

切开复位内固定与非手术方法治疗多发性肋骨骨折的疗效对比分析

目的对比分析切开复位内固定与非手术方法治疗多发性肋骨骨折的临床疗效。方法将2012-02~2017-10该院收治的126例多发性肋骨骨折患者分为内固定组(n=65)和非手术组(n=61),分别采用切开复位内固定手术和非手术方法进行治疗,比较两组患者的住院时间、下床功能锻炼时间、骨折愈合时间、治疗费用及治疗前后疼痛程度、肺功能及并发症发生情况。结果内固定组住院时间、下床功能锻炼时间、骨折愈合时间均明显短于非手术组,住院费用明显高于非手术组,差异均有统计学意义(P 0. 05)。治疗前两组视觉模拟评分法(VAS)评分比较差异无统计学意义(P 0. 05),治疗后1、7、14 d内固定组VAS评分均明显低于非手术组,差异均有统计学意义(P 0. 05)。治疗后3个月,内固定组肺功能指标均明显优于非手术组,差异均有统计学意义(P 0. 05)。内固定组术后主要并发症发生率为6. 15%(4/65),非手术组为18. 03%(11/61),差异有统计学意义(P 0. 05)。结论切开复位内固定手术能明显促进患者康复、减少痛苦及降低并发症发生率,疗效满意。     

手术内固定对老年多发性肋骨骨折患者肺功能的影响

<正>肋骨骨折是常见的胸部创伤,当超过2根肋骨发生骨折,则被称为多发性肋骨骨折〔1〕。多发性肋骨骨折一般是由外界作用力而产生的,常合并失血性休克、肺挫伤等。情况严重可引起纵隔摆动和反常呼吸,会对患者呼吸循环系统造成严重影响,从而引发急性呼吸窘迫综合征〔2〕。研究报道〔3〕,手术内固定治疗多发性肋骨骨折具有较佳疗效。本研究观察内固定手术治疗对老年多发性肋骨骨折患者肺功能的影响。1资料与方法     

纯钛肋骨爪形接骨板内固定治疗多发肋骨骨折疗效观察

目的 观察纯钛肋骨爪形接骨板内固定治疗多发肋骨骨折的疗效.方法 用纯钛肋骨爪形接骨内固定治疗80例多发肋骨骨折患者.术前均经胸片或CT三维肋骨重建检查明确肋骨骨折部位及其移位的情况,术后定期随访,观察胸廓恢复及并发症发生情况.结果 80例患者治疗后疼痛、呼吸困难等症状明显改善.术后随访患者胸痛完全缓解,胸廓完整性良好,均未发生错位现象.无并发症和后遗症发生.结论 纯钛肋骨爪形接骨板内固定术治疗多发肋骨骨折固定效果可靠,手术操作简单快捷、创伤小,术后不需取出,疗效满意.     

微型钛板内固定治疗多发性肋骨骨折12例临床观察

1999～2004年,我院共收治多发性肋骨骨折74例,对其中12例进行了微型钛板内固定手术治疗,效果满意。现报告如下。     

超声引导胸椎旁间隙置管镇痛在多发肋骨骨折患者治疗中的应用

目的：观察超声引导胸椎旁间隙置管镇痛在多发肋骨骨折患者治疗中的应用效果。方法拟保守治疗的单侧多发肋骨骨折患者25例,超声引导下行胸椎旁间隙成功置管后,给予含0．5μg/mL肾上腺素的0．15％罗哌卡因和0．25μg/mL舒芬太尼以0．1 mL/（kg· h）持续滴入;同时口服塞来昔布200 mg,2次/d。观察VAS和Bar-thel指数,并记录术中循环状态及不良反应情况。结果25例均成功行胸椎旁间隙置管;与治疗前比较,治疗后静息和咳嗽咳痰状态下的VAS、Barthel指数均下降（P均＜0．05）;无呼吸抑制、恶心呕吐等不良反应。结论多发肋骨骨折患者超声引导下行胸椎旁间隙置管镇痛效果好,不良反应少。     

Analysis of high-frequency rotational angioplasty-induced echo contrast

During high-frequency rotational angioplasty (HFRA), myocardial contrast enhancement (echo contrast) was observed by means of two-dimensional echocardiography. In order to evaluate the echo contrast produced by HFRA, an in vitro experimental model was built using a cylinder with the HFRA catheter scanned in a water bath. The cylinder was filled with blood, mineral water, and distilled water. With a 2.5-MHz transducer, echograms were recorded and analyzed by video intensitometer, and the maximum intensity IUmax and persistence time P were calculated. Rotation frequencies of 20,000-200,000 rpm with 2.0--mm burrs and times of 10 s were tested. In another model, hyperbaric conditions for the same media were produced. The influence of debris from arterioscleroic plaque and of hematocrit on echo contrast intensity were also analyzed. The effect of HFRA on hemolysis (LDH, free hemoglobin) within 10 s and temperature were also measured. The contrast effect was transient, depending on the rotation frequency. In blood, it appeared at 20,000 rpm (IUmax at 200,000 rpm: 237 IU), in mineral water at 40,000 rpm (IUmax 165 IU), and in distilled water at 80,000 rpm (IUmax 72 IU). Persistence time was measured up to about a half-minute. Echo contrast production was reduced at 0.5 bar and fully suppressed at 2.5 bar. Debris increased contrast intensity from about 219 IU to 225 IU (at 160,000 rpm). In blood IUmax decreased from 227 IU to 97 IU by lowering the hematocrit from 44.2% to 3.6%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pneumocystis carinii pneumonia complicated by lymphadenopathy and pneumothorax

A case of generalized Pneumocystis carinii infection presented as hilar and mediastinal lymphadenopathy and was complicated by spontaneous pneumothorax. Extrapulmonary P carinii infection in patients with acquired immunodeficiency syndrome is rare, and pneumothorax is even rarer. The purpose of this report is to call attention to these atypical features of P carinii infection in patients with the acquired immunodeficiency syndrome.     

Treatment of multiple rib fractures. Randomized controlled trial comparing ventilatory with nonventilatory management

We studied the treatment of multiple rib fractures in NIC, comparing ventilatory with nonventilatory methods in 69 patients who were randomly allocated to one of the following two treatments: (1) a CPAP mask combined with regional analgesia (n = 36); or (2) endotracheal intubation and mechanical ventilation with PEEP (n = 33). Clinical outcome was as follows: mean duration of treatment, 4.5 +/- 2.3 days for the group with CPAP and 7.3 +/- 3.7 days for the intubated group (p = 0.0003); mean number of days spent in intensive care, 5.3 +/- 2.9 days and 9.5 +/- 4.4 days, respectively (p = less than 0.0001); mean period of hospitalization, 8.4 +/- 7.1 days and 14.6 +/- 8.6 days, respectively (p = 0.0019); and patients developing complications: 28 percent (10/36) and 73 percent (24/33), respectively. Infections caused the difference in complications, primarily pneumonias, which occurred in 14 percent (5/36) of the group with CPAP but in 48 percent (16/33) of the intubated group. We conclude that treatment with a CPAP mask combined with regional analgesia can shorten and simplify treatment in these patients, mainly through a decreased infection rate, when compared with intubation and mechanical ventilation, and we recommend this treatment in patients similar to our sample.     

电视胸腔镜辅助下钛镍合金接骨板内固定治疗多发肋骨骨折的临床研究

目的分析电视胸腔镜辅助下钛镍合金肋骨接骨板治疗多发肋骨骨折的临床疗效及优点。方法总结83例多发肋骨骨折患者的临床资料,比较电视胸腔镜辅助下（VATS组）与传统开胸（对照组）钛镍合金肋骨接骨板治疗多发肋骨骨折的手术时间、术中出血量、住院天数、疗效评价及呼吸功能改善情况。结果 83例患者均痊愈出院;VATS组患者手术时间、术中出血量、住院时间、疗效评价及呼吸功能改善情况均优于对照组（P〈0.05）。结论 VATS辅助下钛镍合金肋骨接骨板技术治疗多发肋骨骨折是一种安全、便捷、有效、创伤小的方法,术后患者痛苦小、恢复快,明显改善患者的生活质量。     

内固定治疗股骨粗隆间骨折失败原因分析及翻修手术策略

目的分析股骨粗隆间骨折患者的临床资料和内固定治疗失败原因,分享翻修手术策略。方法回顾性分析2012年9月至2014年9月期间解放军总医院骨科收治的8例内固定治疗失败并接受翻修手术的股骨粗隆间骨折患者的临床资料。通过病历、手术记录、术后随访及X线片等临床资料,分析骨折内固定失败的原因,并针对性提出翻修手术策略。结果 2例钢板治疗患者中,断板和骨折不愈合各1例。6例股骨近端(防旋)髓内钉(PFN/PFNA)治疗患者中,头钉切出3例,穿凿1例,退钉1例,断钉1例。内固定失败原因:头钉位置不良(5/6),股骨内侧壁或外侧壁失支撑(6/8),未能解剖复位(6/8),软组织过度剥离(1/8),感染(2/8)。针对失败原因,翻修手术方式包括全髋关节置换术(5/8)、钢板固定(1/8)、PFNA固定(1/8)、PFN固定(1/8)。2例患者因骨感染一期行抗生素骨水泥占位器治疗,1例患者因骨质较差,辅以自体松质骨植骨。结论股骨粗隆间骨折内固定失败均为多种危险因素造成,主要为头钉位置不理想、复位不良及内外侧壁失支撑等。因此,解剖复位、内置物正确选择和良好放置是防止内固定失败的重要举措。应针对患者一般情况和失败原因,为其选择恰当的翻修手术方式。     

尺骨鹰嘴骨折两种内固定治疗方法的比较

目的比较克氏针钢丝张力带内固定和尺骨鹰嘴解剖钢板内固定两种治疗方法治疗尺骨鹰嘴骨折的疗效。方法选取2006-01～2010-09收治的75例尺骨鹰嘴骨折患者随机分为钢板组(n=40)和张力带组(n=35),钢板组接受尺骨鹰嘴解剖钢板并加压螺钉治疗,张力带组接受普通克氏针钢丝张力带固定手术治疗,以美国特种外科医院(hospital of special surgery,HSS)肘关节功能评价标准评估两种方法的疗效。结果钢板组优秀25例,良好7例,优良率为80.0%;张力带组优秀20例,良好9例,优良率为82.9%。两组患者的术后优良率比较,差异无统计学意义(χ~2=0.66,P=0.417)。结论克氏针钢丝张力带内固定和尺骨鹰嘴解剖钢板内固定治疗尺骨鹰嘴骨折均可取得良好疗效。