肘关节前内侧入路微创治疗尺骨冠状突骨折手术体会

目的探讨肘关节尺骨冠状突骨折后经前内侧手术入路微创内固定治疗的临床效果。方法对2011年9月—2016年10月笔者医院17例尺骨冠状突骨折患者采用肘关节前内侧入路进行手术内固定治疗。按照Regan-Morrey分型,Ⅱ型骨折10例,采用长度合适带线锚钉固定冠状突,再用锚钉的自带线修复关节囊及侧副韧带。Ⅲ型骨折7例,选用1~2枚Herbert螺钉固定冠状突后修复关节囊及副韧带结构。术后随访观察患者的肘关节功能,评分后进行总结分析。结果手术时长25~40min,平均36.7min。本组患者均获得随访6~14个月,平均10.3个月,按Broberg-Morrey评分,17例患者术后优良率93.4%。结论肘关节不稳定的尺骨冠状突骨折手术时采取前内侧入路操作安全可靠,易显露。根据骨块大小选择带线锚钉或者Herbert螺钉固定,手术时间短,创伤小,临床效果满意。     

Kocher入路治疗肘部损伤“三联征”

收治2例肘部损伤"三联征"。采用单一肘关节外侧Kocher入路,由深至浅依次修复冠状突骨折、桡骨头骨折或肱骨外髁骨折、外侧副韧带、伸肌总腱起点。随访8～12周,骨折已骨性愈合,Mayo肘关节功能评分(MEPS)94分(优)。     

肘关节“恐怖三联征”的治疗方法探讨

目的介绍肘关节"恐怖三联征"(后脱位合并桡骨头和冠状突骨折)的治疗体会及分析探讨。方法回顾了6例肘关节脱位合并桡骨头和冠状突骨折("恐怖三联征")病人的治疗结果。手术方法包括:传统方法(3例);新方法(3例):固定或置换桡骨头,尽可能的固定冠状突骨折,修复相关的关节囊和外侧韧带损伤,必要时修复内侧副韧带和辅助外固定。随访中对患者进行影像学和临床检查两项评估。结果术后平均随诊32周,患者肘关节活动度平均99±31,°M ayo肘关节评分平均得分72分(45~95分之间),其中1例优秀,3例良好,1例差。结论对肘关节"恐怖三联征"的损伤机制的充分认识,并重建其稳定性可以获得更好的术后功能。     

Hotchkiss入路治疗尺骨冠突骨折的手术疗效

采用Hotchkiss入路治疗19例尺骨冠突骨折患者。先采用Hotchkiss入路固定冠突骨折并修复内侧副韧带损伤,再处理其他合并损伤。随访时间12~36个月,平均18个月。末次随访时,患者肘关节屈伸及前臂旋转平均活动度分别为128°(100°~135°)和137°(98°~147°);Mayo肘关节评分(MEPS评分)为73~100分,平均96.5分。其中14例优,4例良,1例可。发生异位骨化2例,无临床症状,所有患者均无骨不连、关节不稳及创伤性关节炎等并发症。     

后路治疗尺骨冠状突骨折及软组织损伤的疗效分析

尺骨冠状突骨折是比较少见的疾病,常与肘关节脱位并发.张颖等[1]建议尺骨冠状突骨折需积极处理,重视软组织及韧带的检查及处理,尽量保留桡骨小头的完整性.由于损伤机制的不同,尺骨冠状突骨折可以有不同类型,并伴有肘关节其他损伤.     

后路治疗尺骨冠状突骨折及软组织损伤的疗效分析

尺骨冠状突骨折是比较少见的疾病,常与肘关节脱位并发.张颖等[1]建议尺骨冠状突骨折需积极处理,重视软组织及韧带的检查及处理,尽量保留桡骨小头的完整性.由于损伤机制的不同,尺骨冠状突骨折可以有不同类型,并伴有肘关节其他损伤.     

后路治疗尺骨冠状突骨折及软组织损伤的疗效分析

尺骨冠状突骨折是比较少见的疾病,常与肘关节脱位并发.张颖等[1]建议尺骨冠状突骨折需积极处理,重视软组织及韧带的检查及处理,尽量保留桡骨小头的完整性.由于损伤机制的不同,尺骨冠状突骨折可以有不同类型,并伴有肘关节其他损伤.     

后路治疗尺骨冠状突骨折及软组织损伤的疗效分析

尺骨冠状突骨折是比较少见的疾病,常与肘关节脱位并发.张颖等[1]建议尺骨冠状突骨折需积极处理,重视软组织及韧带的检查及处理,尽量保留桡骨小头的完整性.由于损伤机制的不同,尺骨冠状突骨折可以有不同类型,并伴有肘关节其他损伤.     

后路治疗尺骨冠状突骨折及软组织损伤的疗效分析

尺骨冠状突骨折是比较少见的疾病,常与肘关节脱位并发.张颖等[1]建议尺骨冠状突骨折需积极处理,重视软组织及韧带的检查及处理,尽量保留桡骨小头的完整性.由于损伤机制的不同,尺骨冠状突骨折可以有不同类型,并伴有肘关节其他损伤.     

后路治疗尺骨冠状突骨折及软组织损伤的疗效分析

尺骨冠状突骨折是比较少见的疾病,常与肘关节脱位并发.张颖等[1]建议尺骨冠状突骨折需积极处理,重视软组织及韧带的检查及处理,尽量保留桡骨小头的完整性.由于损伤机制的不同,尺骨冠状突骨折可以有不同类型,并伴有肘关节其他损伤.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.