烧伤合并骨折病人的护理

目的：探讨烧伤合并骨折病人的护理经验。方法：总结7例烧伤合并骨折病人的临床资料及护理体会。结果：烧伤合并骨折的病人，休克期更易发生休克，应充分估计烧伤渗出和创面出血导致的血容量丢失；注意创面和骨折的护理，预防骨感染；加强功能煅炼，早期以被动为主；加强心理护理。结论：落实以上护理措施，有助于提高烧伤合并骨折伤员的临床疗效和康复质量。     

胫骨下1/3螺旋形骨折合并后踝骨折的致伤机制及漏诊原因分析

胫骨下1／3螺旋形骨折较为常见，但合并胫骨后踝骨折较为罕见，国内尚未有报道，国外偶有报道。胫骨下1／3螺旋形骨折合并后踝骨折有其特殊的致伤机制，与常见的Pilon骨折受伤机制有明显的区别，而后踝骨折多为裂纹骨折，往往被忽略，临床中常漏诊后踝骨折，导致踝关节创伤性关节炎的发生。我院自2004年11月至2005年11月收治胫骨远端闭合性骨折合并踝关节损伤7例，其中5例漏诊后踝骨折。     

老年髋部骨折合并糖尿病患者的康复护理

目的促进老年髋部骨折合并糖尿病患者顺利康复，减少并发症，提高生活质量。方法根据老年髋部骨折合并糖尿病患者特点加强护理，有效控制血糖，积极预防并发症，合理营养，正确指导功能锻炼。结果本组40例患者顺利康复，随访1—2年，无骨折不愈合、畸形及假体松动。结论通过对老年髋部骨折合并糖尿病患者精心护理，有效地促进机体康复，减少并发症，提高生活质量。     

复杂上颌骨骨折的诊治体会

上颌骨骨折合并周围颅面骨骨折，包括眶上颌颧骨复合体骨折、鼻额筛眶复合体骨折、合并腭中缝骨折和眶底爆裂等。如处理不当或延误治疗，将会导致面部畸型和不同程度的功能障碍。我科自1991年2月至2002年2月诊治153例，现报告如下。     

GH水平变化对四肢骨折合并脑外伤患者骨折愈合的影响

目的：分析四肢骨折合并脑外伤患者GH水平的变化对骨折愈合的影响。方法：采用对比分析法对2010—04—2013—02收治的骨折患者进行资料分析，并按照骨折的程度将其分为对照组与观察组，其中观察组患者为四肢骨折合并脑外伤，对照组患者为单纯的骨折患者，对患者的血清GH水平以及各时间点的GH水平变化进行测定分析，从而对比两组对骨折愈合的影响效果。结果：以两周为测量界定，观察组患者GH水平相较于对照组升高比较明显，两组在不同时间点的GH水平具有差异性。结论：四肢骨折合并脑外伤能够使骨折愈合加速，其血清中存在的生长因子相较于单纯骨折者要多，且增加了骨折处的骨痂量，缩短了愈合时间，提高了治愈效果。     

颈椎骨折脱位合并瘫痪的手术治疗

颈椎骨折或骨折脱位合并脊髓损伤的处理，目前仍有很大的争论。对晚期脊髓损伤，则一般持消极的态度。我院自1980年5月～1985年12月对16例颈椎骨折或骨折脱位合并脊髓损伤的患者，行前路减压椎体间植骨融合术，取得了较好的效果，现报告如下．     

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。     

重型颅脑伤合并伤的救治体会

本科1972．～1994．共收治重型颅脑损伤320例。其中重症合并伤16例，含8例颅内血肿，5例严重脑挫裂伤，2例脑干损伤和1例硬膜下积液。合并伤中5例脾破裂，5例多处性长骨骨折，2例胸椎压缩性骨折，2例多发性肋骨骨折并发血气胸，骨盆骨折并发腹膜后血肿和下颌骨骨折各1例。13例合并两种以上损伤，11例合并休克。救治结果：11例治愈，5例死亡．     

眼眶内侧壁骨折的CT诊断

目的：探讨眼眶内侧壁骨折的CT表现及诊断价值。方法回顾38例眼眶内侧壁骨折患者的CT表现，所有病例均行常规横断位薄层扫描，必要时加扫冠状位。结果：显示骨折线14例，筛窦积血24例，筛板内陷24例，同时合并内直肌肿胀13例，筛板内陷24例，同时合并内直肌肿胀13例，眶内及眼睑积气4例，球内出血1例，眶内血肿1例，玻璃体脱位1例，球内异物1例，合并其他骨折17例。结论：CT不仅能发现眼眶内侧壁骨折，并可显示其内情况，周围软组织及邻近骨折的改变，是日前诊断眶内侧壁骨折最有效的方法。     

髋臼骨折合并股神经损伤相关因素分析

目的 分析髋臼骨折合并股神经损伤的原因，以期进一步提高临床诊治水平。方法 1996年1月-2004年11月，共手术治疗髋臼骨折146例，其中6例合并股神经损伤，根据临床表现、CT及三维重建分析股神经损伤的原因。按Letournel和Judet的髋臼骨折分类法进行分类，双柱骨折2例，横形伴后壁骨折1例，因骨折形成的巨大血肿压迫股神经，致股神经损伤；前壁骨折伴股骨头前脱位1例，髋臼前柱陈旧性骨折合并耻骨上支骨折1例，骨折端直接挫伤股神经；前柱骨折合并髂骨翼骨折1例，因术中牵拉损伤股神经。5例患者给予血肿清除、神经束减压、神经外膜松解去除病因，1例行保守治疗。结果本组6例患者随访1—3年，平均随访1．8年。5例患者股四头肌肌力从术前1—2级恢复至4—5级，1例从伤后2—3级恢复至5级，伸膝功能正常，可正常行走。4例患者感觉功能完全恢复，1例患者随访2年后仍有大腿下2／3前方及小腿内侧感觉减退；另有1例牵拉伤患者肌力恢复正常，随访1．2年后仍存在感觉障碍。结论 髋臼骨折合并股神经损伤临床上少见，复杂髋臼骨折应高度警惕有无股神经损伤；髂腰肌周围血肿形成及骨折块直接损伤是髋臼骨折合并股神经损伤的常见原因；医源性损伤需引起重视。     

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.