腰椎结核手术治疗并发症的分析

目的探讨手术治疗腰椎结核的并发症及其预防措施。方法通过对我院2002年9月至2007年9月的5年时间内收治的行手术治疗的66例腰椎结核患者进行了回顾性分析,66例患者中男48例,女18例。结果术后3个月获得随访66例,术后6个月获得随访48例,术后1年或者更长时间获得随访37例,平均随访1.9年（3个月～4年）。本组共出现并发症14例,其中神经根牵拉损伤2例,脊髓损伤1例,硬膜撕裂2例,脑脊液漏1例,下肢深静脉血栓形成2例,伤口感染2例,钛网下沉移位或植骨块脱出2例,术后复发2例。对于脑脊液漏、神经牵拉损伤脊髓损伤、硬膜撕裂、下肢深静脉血栓形成等,经过及时治疗,均获得满意的疗效。结论标准化的手术操作、规范化的术前准备和术后处理是预防和治疗腰椎结核手术并发症的关键。     

手术治疗胫骨平台骨折48例临床分析

目的探讨手术治疗胫骨平台骨折的临床疗效。方法回顾性总结本院1998年1月—2008年1月收治的胫骨平台骨折48例的治疗效果。按Schatzker分类,Ⅰ型8例,Ⅱ型30例,Ⅲ型5例,Ⅳ型3例,Ⅴ型1例,Ⅵ型1例,均采用切开复位内固定治疗。结果42例获得随访,随访期1~5年,全部骨性愈合。结论手术是治疗胫骨平台骨折的有效方法,解剖复位、骨缺损植骨、稳定的固定和早期功能锻炼是减少并发症的关键。     

滑脱症原位与复位融合的临床研究

观察螺纹椎间融合器（TFC）、椎弓银钉加TFC、椎弓根钉加植骨治疗不稳定性腰椎滑脱的临床疗效。1995年5月－2000年8月，106例经过保守治疗（6－12个月）无效的腰椎滑脱患者接受手术治疗，按Meyerding分类Ⅰ度滑脱56例，Ⅱ度滑脱47例，Ⅲ度滑脱3例。术后平均随访3年2个月，对照比较手术前后临床症状改善和X线片复位程度。TFC组31例，获得随访22例，优良率95．5％。椎弓根钉加植骨组42例，解剖复位率83％，35例获得随访，优良率94．8％。椎弓根钉加TFC组33例，解剖复位率81％，28例获得随访，优良率96．4％。说明只要掌握好适应证，单纯使用TFC进行的原位融合和TFC加用椎弓根钉系统进行复位融合均可以获得较高的治愈率。     

甲状腺癌的分类及病理诊断——206例甲状腺癌的临床病理分析

当前,国内对甲状腺癌的病理学分类及诊断标准尚存在某些分歧,并给手术治疗造成了混乱。因此,我们对206例外科切除的甲状腺癌标本进行临床病理分析。并结合随访结果,对病理分类及其诊断标准进行探讨。 本组106例为长海医院1958～1975年6     

右心室双出口102例外科治疗

目的分析总结右心室双出口(DORV)外科治疗效果。方法 1997年1月—2012年6月,外科手术治疗DORV共102例,按照STS-EACTS制定的先心病数据库命名计划将DORV分型:法洛四联症型50例(49.0%)、室间隔缺损型28例(27.5%)、大动脉转位型16例(15.7%)、远离两大动脉VSD型8例(7.8%)。手术方式:双心室矫治术76例(74.5%),单心室功能矫治术19例(18.6%),其他姑息手术7例(6.9%)。结果全组住院死亡13例(死亡率12.7%),主要死亡原因是术后低心排血量综合征7例,早期再手术4例(3.9%)。随访67例,随访时间3～167(中位数50,四分位间距73)个月,需再次手术的患者共15例(15/67,22.4%),心室流出道梗阻是再次手术的主要原因。结论根据STS-EACTS制定的标准对DORV进行分类,更有利于选择手术指征和分析结果。随访期间需要再次手术的患者应及时采取治疗措施。DORV的外科治疗可获得良好的早中期效果。     

胸腰椎骨折手术入路选择及疗效分析

目的 探讨胸腰椎骨折的手术入路选择及临床疗效.方法对1995年1月-2009年1月手术治疗并获得随访的212例胸腰椎骨折进行回顾性分析,观察脊柱结构及神经功能的恢复情况.结果前路手术73例,后路手术139例,平均随访23.7个月(12～52个月),手术后的伤椎椎体高度、Cobb角及椎管容积明显改善(P<0.01),脊髓...     

早期胃癌63例内镜随访结果分析

我院自1974年1月～1991年3月经内镜检查发现,手术及病理证实早期胃癌共98例。其中获得内镜定期随访观察63例,其中男性57例,女性6例。年龄27～74岁,平均年龄为52.5岁。手术方式:Billroth Ⅰ式13例,Billroth Ⅱ式36例,全胃切除14例。98例早期胃癌获内镜随访者63例,占64.3％。63例手术后2年内每半年随访     

手术治疗32例髋臼骨折的疗效分析

目的探索髋臼骨折手术的治疗方法和治疗效果。方法对2003年1月至2008年8月之间进行的32例髋臼骨折手术治疗方法进行分析总结。结果本组病例全部获得随访,随访时间最长48个月,最短8个月。其中优11例,良13例,可6例、差2例。优良率为75％（24／32）。结论本组病例说明,正确分析骨折类型,选择合适的手术入路和早期的手术治疗是提高髋臼骨折治疗效果的关键。     

肛管直肠恶性黑色素瘤25例诊治体会

目的 探讨肛管直肠恶性黑色素瘤的生物学特性与治疗方法。方法 对1985年-2005年确诊并接受治疗的25例肛管直肠恶性黑色素瘤患者的临床资料和治疗结果进行回顾性分析。结果 本组25例患者中男10例,女15例,平均年龄59岁。手术治疗21例,其中根治性手术（Miles手术）18例。20例获得随访,随访时间4个月-6年。全组病例总5年生存率为12％,根治手术5年生存率16．7％。结论 肛管直肠恶性黑色素瘤恶性程度极高,区域淋巴结转移是影响预后的主要因素,治疗上应行手术根治及淋巴结清扫。提高生存率的关键是早期发现,早期治疗,根治性手术。     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折手术入路的选择及分析临床应用效果。方法从1997年7月—2009年1月对31例肩胛骨骨折患者采用三种不同的手术入路进行内固定,对比其临床适应证,分析治疗效果。结果 31例患者全部得到随访,按照Constant的评定标准:优22例,良6例,可3例,优良率为90.3%。结论肩胛骨骨折通过手术治疗可获得良好的疗效,不同的骨折类型应采用不同手术入路,可获得更好的治疗效果。     

颌面部骨折并颅颈交界区损伤的CT诊断

目的 探讨颌面部骨折合并颅颈交界区损伤的影像学特点及多层螺旋CT诊断。方法 收集10例颌面部外伤合并颅颈交界区损伤的螺旋CT重建扫描资料，比较常用影像学检查手段的诊断价值。结果 上、下颌骨双骨折并颧弓骨折者5例，下颌骨骨折5例。其中3例合并颞颌关节脱位，3例合并有轻、中度颅脑损伤。合并颅颈交界区损伤有：枕颈脱位2例，枕骨髁撕脱骨折2例，寰枢椎旋转性半脱位6例，结论 颌面部外伤骨折合并上颈椎损伤多为韧带型损伤，影像学特点为小片的撕脱性骨折及枕颈半脱位、寰枢椎旋转性半脱位；多层螺旋CT重建技术是诊断本病的最佳方式；提高对本病的警惕，重视颅颈交界区解剖标志间关系的画线测量是防止漏诊的关键。     

轻中型颅脑损伤合并无脊髓损伤的上颈椎骨折脱位的诊治

目的总结轻中型颅脑损伤合并无脊髓损伤的上颈椎骨折脱位的诊治经验,以提高对其的认识和疗效。方法回顾性分析2012年1月—2017年12月海军军医大学附属公利医院骨科收治的25例轻中型颅脑损伤合并无脊髓损伤的上颈椎骨折脱位患者临床资料,男性14例,女性11例;年龄20~71岁,平均48.2岁。颅脑损伤9例行手术治疗,16例行非手术治疗;颈椎骨折10例行非手术治疗,13例单独行颈椎手术,2例一期颅颈联合手术。出院时进行格拉斯哥预后评分(GOS评分),术后门诊随访X线片或CT片评价颈椎骨折愈合情况。结果出院时GOS V级20例,IV级4例,I级1例。随访12~48个月,平均24.5个月,复查颈椎X线片或CT示骨折愈合良好。结论颅脑损伤患者常规颈椎CT扫描有助于上颈椎损伤的早期诊断。上颈椎不稳定骨折在病情允许下尽早手术,可减少并发症的发生。     

眼眶骨折的CT表现及分型(附86例分析)

目的探讨CT对眼眶骨折的诊断价值及分型方法。方法回顾性分析86例共92只眼眶骨折的CT特征，根据眼眶骨折的部位、范围及其他部位受累的情况，将眼眶骨折分为单纯型、复杂型、复合型。结果在92只眼眶骨折中，单纯型57只（61．97％），复杂型10只（10．87％），复合型25只（27．17％）。结论cT检查可较全面地观察眼眶骨折的情况，为临床治疗提供重要依据，是眼眶骨折的首选检查方法。     

闭合性喉损伤的CT诊断

目的 搪塞闭合性喉损伤的ＣＴ表现及诊断价值。方法 对１６例闭合性喉损伤病人的ＣＴ和临床资料进行回顾性分析。结果 软组织损伤５例,杓会厌襞和真假声带肿胀、气道狭窄４例,左环杓关节脱位,声带麻痹１例;声门损伤２例;均有会咽软骨骨折伴榴府厌襞和下咽部撕裂;声门损伤４例;甲状软骨右翼部骨折１例,甲状软骨前联合部纵行或粉碎骨折３例,其中１例骨折片进入喉腔形成异物,两侧声带和前联合撕脱;声门下损伤（５例）：左     

CT在肾创伤诊断与分类中的价值

目的评价CT在肾损伤的诊断和分类中的价值。方法回顾性分析76例肾损伤的CT表现。结果76例中单纯性肾挫伤9例，单纯性肾内血肿7例，肾挫裂伤24例，单纯性肾包膜下血肿10例，肾撕裂伤21例，肾撕裂伴血肿及尿外渗2例，单纯性肾周血肿3例，合并腹内脏器伤41例，下位肋骨骨折18例。同时，所有患者的肾损伤是依据CT表现分为4大类型。结论螺旋CT能明确诊断肾损伤，并确定损伤类型，为临床制定治疗方案提供重要依据。     

创伤骨科急诊入院病人漏诊与误诊的分析

探讨创伤骨科急诊人院病人漏误诊原因及防止措施。方法根据１９９７年１１０４例创伤骨科急诊入院病人的病历记录,对５７例６４处损伤初诊被漏诊或误诊进行统计分析,寻找与漏诊发生的相关因素。结果１１０４例创伤骨科急诊入院病人中,５７例６４处损伤初诊被漏诊或误诊,漏误诊率为５．１％。     

Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs.

Although CT is widely recognized as an important adjunct to plain films in the evaluation of patients with acute pelvic trauma, accurate diagnosis of orthopedic injuries with plain films alone is often important to determine if immediate external fixation is necessary. The purpose of this study was to determine the efficacy of plain radiographs in the detection of pelvic fractures and dislocations in patients with acute pelvic trauma by using CT as the gold standard. CT scans and plain films collected prospectively in 50 patients with acute pelvic injuries were evaluated independently, and fractures and dislocations were identified and tabulated. Of a total of 162 fractures and dislocations seen on CT, only 14 (9%) were misdiagnosed on plain films. None of these misdiagnoses altered patients' management. Sixteen (80%) of 20 cases of intraarticular fragments in the hip joint associated with acetabular fractures were not identified on plain films. We conclude that plain film examination of the patient with pelvic trauma is sufficient to identify virtually all clinically important fractures and dislocations. Plain radiographs alone are not accurate in detecting fracture fragments within the hip joint.     

CT assessment of the prevalence of retinacular injuries associated with hindfoot fractures

Objective

To determine the incidence of injuries to the flexor and peroneal retinacula in hindfoot fractures as demonstrated on ankle computed tomography (CT).

Materials and methods

Study patients were identified via review of CT records at a single institution. CT scans were retrospectively reviewed and compared with surgical reports.

Results

Hindfoot fractures undergoing CT showed flexor retinacular injuries in 23.7% of cases and peroneal retinacular injuries in 10.2%. The posterior tibial tendon was partly torn in 4.2% of cases, and entrapped between fracture fragments in 16.1%. The peroneal tendon was rarely injured, being entrapped in 1.7% of cases. Pilon, distal tibial shaft, malleolar, talar, and calcaneal fractures were all associated with retinacular injuries. CT findings correlated well with surgical findings; there were no false-positive CT findings, and only 1 false-negative finding, a posterior tibial tendon that was entrapped at surgery, but in a normal position on the CT.

Conclusions

Retinacular injuries are commonly demonstrated on CT in patients with ankle fractures. The contribution of these injuries to fracture outcomes is unknown.     

Diagnostic value of 3 D CT surface reconstruction in spinal fractures

Our purpose was to evaluate the diagnostic value of three-dimensional (3 D) CT surface reconstruction in spinal fractures in comparison with axial and reformatted images. A total of 50 patients with different CT-proven spinal fractures were analysed retrospectively. Based on axial scans and reformatted images, the spinal fractures were classified according to several classifications as Magerl for the thoraco-lumbar and lower cervical spine by one radiologist. Another radiologist performed 3 D CT surface reconstructions with the aim of characterizing the different types of spinal fractures. A third radiologist classified the 3 D CT surface reconstruction according to the Magerl classification. The results of the blinded reading process were compared. It was checked to see in which type and subgroup 3 D surface reconstructions were helpful. Readers one and two obtained the same results in the classification. The 3 D surface reconstruction did not yield any additional diagnostic information concerning type A and B injuries. Indeed, the full extent of the fracture could be easier recognized with axial and reformatted images in all cases. In 10 cases of C injuries, the dislocation of parts of vertebrae could be better recognized with the help of 3 D reconstructions. A 3 D CT surface reconstruction is only useful in rotational and shear vertebral injuries (Magerl type C injury). Received: 29 May 1995; Accepted: 11 January 1996     

Radiological evaluation of temporal bone disease: high-resolution computed tomography versus conventional X-ray diagnosis

Sixty-two patients with different temporal bone lesions were prospectively examined by high-resolution computed tomography (CT) and conventional plain radiography, including pluridirectional tomography. High-resolution CT enabled a clear diagnosis in 80% of cases, conventional radiology in 63%; 1.6-times more bone information was recorded by high-resolution CT which is clearly superior for imaging cholesteatomas, metastases and inflammatory processes and for evaluating osseous destruction. With regard to pathological soft tissue or effusions filling the tympanic cavities, conventional radiology shows poor sensitivity (0.61). High-resolution CT is the most sensitive method for the imaging and classification of temporal bone fractures, including labyrinthine damage and ossicular chain injuries. Only in cases of atypical fractures with an unfavourable relationship to the CT planes, can carefully directed tomography be more effective. In most cases high-resolution CT replaces conventional radiology and should be the method of choice for comprehensive radiological examination of the temporal bone.