肘关节分裂脱位一例

正1病例介绍患者男,37岁。因"摔伤致左肘关节、左前臂肿痛、畸形、活动受限1 d"入院。伤后于当地医院就诊,摄X线片示左肘关节脱位,左尺骨骨折,予以手法复位石膏固定后来我院。查体:左肘关节石膏固定,肿胀明显,压痛,左手各指可屈伸运动,感觉轻微麻木,桡动脉搏动可触及。入院后行左肘关节CT平扫及三维重建检查进一步了解脱位情况,消肿治疗。入院4 d肿胀消退,根据肘关节X线片及CT三维重建制定手术方案。患者于全麻下取仰卧位,     

肘关节分裂脱位一例北大核心CSCD

1病例介绍患者男,37岁。因“摔伤致左肘关节、左前臂肿痛、畸形、活动受限1 d”入院。伤后于当地医院就诊,摄X线片示左肘关节脱位,左尺骨骨折,予以手法复位石膏固定后来我院。查体：左肘关节石膏固定,肿胀明显,压痛,左手各指可屈伸运动,感觉轻微麻木,桡动脉搏动可触及。入院后行左肘关节CT平扫及三维重建检查进一步了解脱位情况,消肿治疗。入院4 d肿胀消退,根据肘关节X线片及CT三维重建制定手术方案。     

同侧肱骨和尺桡骨骨折并肘关节脱位一例

患者男,35岁。因翻车后扔出车外,右上肢撞击石块致右上肢肿痛、活动受限,急诊入院。查体:右上臂中下段明显肿胀、压痛,有反常活动和骨擦感,右肘关节畸形,活动障碍,右前臂中段成角畸形,肿胀压痛,桡尺动脉搏动正常。Ⅹ线片示:右肱骨中下1/3横形骨折、右肘关节后脱位,右尺桡骨中段骨折。     

尺骨不愈合继发上、下尺桡关节脱位一例报告

男,19岁,因左前臂外伤后畸形4年伴肘关节活动受限、左手乏力入院.患者4年前摔伤致左尺、桡骨中段骨折,于当地医院手术(术式不详).数月后出现左肘关节活动受限,并逐渐出现畸形及左手乏力,未行治疗.     

后内侧入路钢板内固定治疗胫骨中段骨折并前方软组织损伤1例

笔者于2019-01诊治1例胫骨中段骨折并前方软组织广泛损伤,行后内侧入路钢板螺钉内固定手术治疗,报道如下。1病例报道患者,男,28岁,因"车祸导致左小腿肿痛、畸形、活动受限3 h"入院。专科查体:左小腿肿胀、畸形,前侧、外侧皮肤广泛挫伤,少量渗血,局部压痛明显,可触及骨擦感,膝关节、踝关节因疼痛活动受限,左下肢末梢血运、皮肤感觉可。     

Essex-lopresti损伤1例报告

1 病例简介 1.1 临床资料 女性患者,18岁,因左肘部跌伤后疼痛、活动受限1d人院.查体:头颅五官端正无畸形,心、肺、肝、脾未见异常.专科检查:左肘关节外侧略肿胀,内侧可见面积4.0 cm×5.0 cm的皮下瘀斑,左桡骨小头处压痛明显,左前臂旋转活动受限,左肘关节侧方应力试验阳性.     

克氏针结合强生缝线治疗单纯性肱骨远端关节面粉碎性骨折一例

笔者于2005年9月收治肱骨远端关节面粉碎性骨折1例,采用非典型内固定(克氏针、强生缝线结合内固定),获得满意疗效,报告如下。1病例报告患者,男性,39岁,因暴力外伤致左肘部疼痛、畸形、活动受限,伤后3h入院。专科情况:左上肢纵轴叩击痛,局部可触及骨擦感,肘关节屈伸活动明显受限     

成人病毒性脑膜炎并发左肘部异位骨化1例

1病例资料 患者，女，21岁。因左肘关节活动受限6个月，关节僵直伴左环指尺侧、小指麻木1个月入院。患者于2006年2月无明显诱因出现头疼、昏迷，在当地医院行脑脊液穿刺检查，诊断为病毒性脑膜炎（CBV6、HSV1两种病毒抗体阳性），抗病毒治疗4个月后清醒。醒后左肘关节肿痛不适，活动受限，摄X线片检查未见异常，自服中药后左肘部疼痛消失，但活动受限逐渐加重。于同年11月出现关节僵直及左环指尺侧、小指麻木来我院就诊，诊断为：“左肘关节异位骨化，左肘管综合征”。既往体健，无肘部、脑部外伤史。查体：生命体征平稳，神志清楚，检查合作。左肘部无红肿，皮温不高，     

股骨下段骨梗死1例报道

患者．女．62岁．左膝关节肿痛活动受限1周入院，1周前无明显诱因出现左膝关节的肿痛．活动受限．偶伴午后发热，无盗汗、消瘦等症状，体检左膝关节肿胀明显．浮髌征阳性．左股骨下段压痛．扣击痛．关节活动明显受限．     

肱骨下端T型骨折并桡神经损伤1例

1 病例资料 患者男性,42岁,因车祸致左肘关节肿痛、畸形、功能障碍1h,于2008年11月2日入院。患者1h前骑摩托车不慎摔倒,左手先撑地,随即左肘撞击地面,伤后即感左肘剧痛,外观畸彤,活动功能障碍。查体：左腕下垂,左肘后三角关系增宽,左上臂及肘关节可扪及骨擦感及异常活动;局部压痛剧烈;     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.