肱骨近端骨折的手术治疗策略

目的探讨不同类型肱骨近端有移位骨折的最佳手术治疗方案。方法对肱骨近端骨折有移位的174例患者,进行Neer分类,122例二部分骨折和8例三部分骨折行三叶草钢板内固定,30例三部分骨折和3例四部分骨折行肱骨近端加压锁定钢板（10cking proximal hunerus plate,LPHP）内固定,而5例三部分骨折和6例四部分骨折行人工肱骨头置换术（humeral head replacement,HHR）。结果内固定术后所有骨折均愈合,无畸形。愈合时间为8—12周,平均10周。肱骨头置换术后,假体未出现松动、脱位等现象。所有病例均无感染、神经、血管损伤等并发症发生。结论对肱骨近端骨折采用手术治疗可取得较为满意的效果。Neer二部分骨折、多数三部分骨折及一些四部分骨折可采用钢板内固定,而部分三部分骨折、多数四部分骨折可根据情况一期行人工肱骨头置换术。     

铅单围蔽式防护减少X线对非检部位辐射危害的研究

目的探讨在X线检查中非检部位防护的重要性,减少非检部位X线辐射危害。方法使用移动式0.6 mm铅当量橡胶复合软质铅单在X线检查中对非检部位进行管状围蔽式防护以减少X线辐射的危害。结果使用移动式0.6 mm铅当量橡胶复合软质铅单具有很强的防辐射能力,能阻挡X射线、γ射线、C射线对非检部位的辐射。结论使用移动式0.6 mm铅当量橡胶复合软质铅单在X线检查中对非检部位进行管状围蔽式防护可以很大程度减少射线对被检者辐射的危害,是X线防护用品中又一更新、更好、更简单防护品,具有很好的防护作用。     

Some effects of knee angle and foot placement in bicycle ergometer

The aim of this study was to examine the effect on heart rate, blood pressure and RPE on a bicycle ergometer performed with three different ways, i.e. with the anterior part of the foot, the posterior part of the foot and at saddle height with a knee angle of 120 degrees-125 degrees of submaximal and maximal work load. Untrained female (age X = 22 +/- 2.10 years, weight X = 56 +/- 5.4 kg, height X = 162 +/- 5.25 cm) volunteered as subjects. Heart rate and RPE at work load of 100 Watts were significantly lower in cycling with anterior part of the foot than with posterior part of the foot, while RPE in cycling with the posterior part of the foot was significantly lower in comparison to cycling with a knee angle of 120 degrees-125 degrees. Thirty three subjects were able to complete cycling on the load of 125 W with the anterior part of the foot; 28 with the posterior part of the foot and 22 with a knee angle of 120 degrees-125 degrees. It was concluded that cycling, (a) with the anterior part of the foot and the knee almost fully extended, is perceived easier and is more effective; (b) with the posterior part of the foot is tiring and ineffective and (c) with a low height of the saddle affects muscular work negatively.     

CT扫描对十二指肠壁血肿的诊断价值

目的探讨十二指肠壁血肿的CT表现及其诊断价值。方法回顾性分析7例十二指肠壁血肿患者的CT表现,4例经手术证实,3例经内科治疗后CT随访证实。结果7例患者中,血肿同时累及水平段和降段1例,同时累及水平段和升段2例,单纯累及水平段4例。7例CT扫描显示均有肠壁增厚,管腔受压变窄。CT平扫示壁内有高密度或等密度肿块,增强后无强化,十二指肠壁血肿的并发症包括：1例合并胰头钩突肿块,2例合并胰腺弥漫肿大且边缘模糊,1例合并胆总管轻度扩张,2例合并腹腔少量积液。3例内科保守治疗患者CT复查血肿有缩小。结论CT能对十二指肠壁血肿作出准确诊断,并为临床治疗方案的选择和随访提供可靠依据。     

Estimation of fetal age at death from the basilar part of the occipital bone

The purposes of this study are to examine documented fetal skeletal remains of Japanese, to measure the basilar part of the occipital bone, and to develop diagnostic standards for estimating fetal age at death which can be applied to poorly preserved skeletons. The sample is composed of 272 Japanese individuals of the early to middle twentieth century, whose ages were recorded in months from gestations of 5 to 11?months. The measurement items used here are the length, breadth, and index of the basilar part. The regression equations of gestational age in months for one or two variables were calculated. The results indicated that it is possible to use the regression equations to estimate the age at death of fetuses directly from the basilar part measurements. Another indicator for estimating age at death from the basilar part is the ratio of the width to the length, which was here expressed as the index of the basilar part. The width exceeded the length at 7?months and the basilar part changed with age from an anteriorly posteriorly long shape to a bilaterally wide one. It is concluded that the basilar part is a good indicator for estimating the fetal age at death.     

小脑血管母细胞瘤的MRI表现及其病理探讨

目的 分析小脑血管母细胞瘤的MRI表现与病理特点,探讨二者之间的关系.方法 回顾性分析经手术病理证实的32例小脑血管母细胞瘤,探讨其MRI表现和病理特点.结果 MRI表现大囊小结节型21例,实质型9例,囊性型2例.T1 WI上肿瘤囊性部分呈均一低信号,实性部分或瘤结节呈稍低或等信号;T2WI及FLAIR上肿瘤囊性部分呈均一高信号,实性部分或瘤结节呈稍高信号;增强后实性部分或瘤结节明显强化.病理表现实性部分或瘤结节主要由基质细胞构成,囊性部分主要由毛细血管网构成.结论 小脑血管母细胞瘤具有典型的MRI表现,且与其病理基础密切相关.MRI是诊断小脑血管母细胞瘤的有效检查方法.     

不同暴力下胸腰椎损伤的生物力学因素

目的探讨不同类型胸腰椎损伤的生物力学背景，为临床正确的诊断及治疗提供理论基础与科学依据。方法用三维有限元方法建立人体胸腰椎活动节段的力学模型，并对其在垂直压缩、压缩屈曲、分离屈曲三种外加载荷下的应力进行分析。结果垂直压缩载荷下，胸椎上、下终板的中央及松质骨邻近终板的中央部位应力值最高，同时椎间盘纤维环的后外侧、胸腰椎体的前后部、密质骨的椎弓根、峡部及小关节也存在应力集中区；压缩屈曲载荷下，终板前方及椎体前下方应力集中；分离屈曲载荷下，椎体后部结构的棘突上缘、后纵韧带、棘上、棘间韧带、椎间盘纤维环后部均是应力集中的部位。结论生物力学因素在胸腰椎脊柱损伤的发生机制中占有重要地位，其损伤类型与所受外载荷力的方式有密切关系     

颞骨鼓部发育不良所致外耳道畸形的CT分析

目的 分析84耳外耳道畸形的高分辨率CT（HRCT）表现，探讨颞骨鼓部发育畸形与外耳道畸形的关系。资料与方法 临床诊断84耳外、中耳畸形患者均行HRCT检查，重点观察骨性外耳道鼓部发育的形态。结果 鼓部完全未发育、骨性外耳道未形成43耳(43／84)；鼓部重度发育不良、鼓部为不规则形态、未形成骨性外耳道27耳(27／84)；鼓部中度发育不良、鼓部形成不典型的“U”结构、外耳道形态不良14耳(14／84)。结论 骨性外耳道发育不良与颞骨鼓部发育不全有重要关系。     

顶叶不同部位在计算任务中作用的fMRI研究

目的用功能MRI探讨顶叶的不同部位在计算时的活动情况。方法对18例正常青年受试者进行简单及复杂任务的功能MRI扫描,采用SPM2软件进行数据分析和脑功能区定位。结果简单及复杂计算时主要可见额前区、顶叶、小脑及枕叶的激活,顶叶的激活以顶下区为主;随着计算难度的增大,可见顶上区的激活增加。结论顶下区是计算任务的主要部位,随着计算难度的增大,顶上区的作用明显增加。     

Sinochoanal polyp and its variant, the angiomatous polyp: MRI findings

The angiomatous polyp corresponds to the vascular compromised nasochoanal part of a sinochoanal polyp. We describe the MRI characteristics of such lesions in four patients. All patients had an angiomatous polyp, in three cases as part of an antrochoanal polyp, and in one case as part of a sphenochoanal polyp. The unenhanced MR images depicted the typical appearance of a sinochoanal polyp, hypointense on T1-weighted and hyperintense on T2-weighted images. On gadolinium-enhanced MR images, the sinusal part showed little or no peripheral enhancement; however, the nasochoanal part, corresponding to the angiomatous polyp, showed strong enhancement. An angiomatous polyp mimics a hypervascular mass lesion on enhanced MR studies. The anatomic location and association with a sinusal polyp allows the correct diagnosis. Received: 7 September 1999 Revised: 8 June 2000 Accepted: 9 June 2000     

交锁髓内钉治疗股骨多段骨折

目的　探讨使用交锁髓内钉治疗股骨多段骨折的疗效。方法　收集我院 1997年 2月— 2 0 0 2年 12月应用交锁髓内钉治疗股骨多段骨折 2 8例 ,进行分析评估。结果　 2 8例患者全部愈合 ,愈合率 10 0 %。结论　交锁髓内钉治疗股骨多段骨折 ,具有固定牢靠、骨折愈合好、患肢功能恢复好的特点     

利多卡因宫颈注射在人工流产术中的应用

目的：旨在观察2％利多卡因宫颈注射在人工流产术中的应用效果。方法：400例病人随机分为A（实验组）,B（对照组）两组,A组术前宫颈注射2％利多卡因;B组按常规人工流产操作手术,结果;A组手术效果优于B组,术中术后患者痛苦,并发症少于B组,结论：2％利多卡因宫颈注射可广泛推广使用人工流产术中。     

Blood flow in the menisci of anaesthetized dogs

The distribution of blood flow in the menisci was investigated in 23 anaesthetized mongrel dogs. The blood flow was determined by means of radioactive microspheres injected intracordially and reference samples were taken from the aorta at a constant rate of 2.5 ml/min. The menisci were dissected in separate parts and the gamma radiation of the specimens was counted in a scintillation counter to assess the blood flow. The rate of blood flow in the medial meniscus was 5.55 ml per 100 g per min in the peripheral part and 2.51 ml per 100 g per min in the inner part. The corresponding figures were 3.09 and 2.33 for the lateral meniscus. No significant differences between the anterior horn, the middle section and the posterior horn were demonstrated. In the medial meniscus the rate of blood flow was 9 times lower in the central part (0.30) than in the surface-near part (2.78). In the lateral meniscus the rate of blood flow was 16 times lower in the central part (0.12) than in the surface-near part (1.88).     

腓肠神经营养血管皮瓣的临床应用

目的　探讨腓肠神经营养血管皮瓣的优越性。方法　用逆行腓肠神经营养血管皮瓣对 1 5例患者的足背、内外踝、小腿中下段、胫前部皮肤缺损进行修复 ,同时观察腓肠神经及营养血管的走行特点。结果　 1 5例完全成活 ,无 1例坏死或部分坏死。转移的皮瓣均于术后 6个月恢复感觉。结论　腓肠神经营养血管皮瓣切取简便 ,成功率高 ,最远可达足前中部 ,是修复足跟、足背、内外踝、及小腿中下段软组织缺损的理想供区。     

烧伤创面内Notch信号因子变化临床研究

目的探讨Notch信号在创面愈合中的作用,为临床治疗提供依据。方法选取2015年5月至2016年5月西京医院烧伤外科收治的中重度烧伤患者25例为研究对象。分别切取烧伤创面不同部位标本行ABC免疫复合物法免疫组织化学染色,观察判断组织中Notch1、Jagged1、NICD蛋白的含量和分布情况。结果受体Notch1、配体Jagged1、活化信号NICD在烧伤创面内有明显的一致表达。在创面上皮愈合边缘部位,三者均表达最强;在创面中心肉芽部位,三者表达较弱;正常皮肤组织三者无明显的表达。结论烧伤创面内不同部位受体Notch1、配体Jagged1、活化信号NICD的表达强度和分布情况不同,其变化与创面愈合密切相关,在促进创面愈合方面有很重要的作用。     

Percutaneous transluminal treatment of varicoceles: where to occlude the internal spermatic vein

Percutaneous transluminal sclerotherapy is an accepted treatment for varicoceles. It is administered by applying a liquid sclerosing agent to the internal spermatic vein. However, the optimal site for the placement of the occlusive material has not been evaluated previously. Therefore, the success rate of sclerotherapy was determined in two groups of patients. In the first group (34 patients), the liquid agent was applied in the cranial part of the internal spermatic vein; in the second group (113 patients), the agent was applied in the caudal part of the vessel at the level of the inguinal ring. The success rate determined 3 months after therapy by telethermography was significantly higher after treatment in the caudal part (82%) than in the cranial part (68%) of the vessel. Sclerotherapy at the level of the inguinal ring appears to be superior to therapy in the cranial part of the internal spermatic vein.     

磺胺嘧啶银治疗的烧伤创面转换湿润暴露疗法的临床观察

目的：探讨由磺胺嘧啶银（SD—Ag）治疗创面转换为湿润暴露疗法（MEBT）的可行性。方法：对2006年2月～2007年2月收治的14例院外使用磺胺嘧啶银处理的烧伤创面，分别采用立即、分区及延迟转换为湿润暴露疗法治疗，对伤后48h的创面，清洗磺胺嘧啶银后立即完成治疗方法的转换，对已成痂、溶痂的创面根据创面大小、炎症程度、创面深度分为立即转换、分区转换及延迟转换处理。结果：立即转换者11例，9例在伤后48h内入院，2例伤后1周入院，清洗磺胺嘧啶银后立即转为MEBT处理创面，浅Ⅱ度在7d～10d愈合，深Ⅱ度在14d～21d愈合，Ⅲ度创面28d～35d愈合，愈合后无明显瘢痕增生，色素沉着轻；分区转换者1例，在伤后1周入院，创面溶痂、创周炎症明显，浅Ⅱ度、深Ⅱ度立即转换，Ⅲ度创面延迟转换，深度创面经耕耘、薄化处理后21d～35d愈合；延迟转换者2例，在一周内完全过度到MEBT治疗，深Ⅱ度耕耘、薄化处理后皮岛稀疏，1个月自愈，Ⅲ度创面耕耘、薄化处理后无明显皮岛，1个月后植皮封闭创面，愈合后瘢痕增生明显。结论：湿润暴露疗法对经磺胺嘧啶银治疗的烧伤创面仍能发挥其有效的治疗作用，浅度创面能以MEBT治疗方式愈合，深度创面宜早期实施耕耘、薄化技术处理，以利于创面愈合。     

骨间前神经分支受压及手术松解的解剖学基础

目的　阐明骨间前神经 (AIN)分支起点、行程受压因素及为手术治疗提供解剖学基础。方法　解剖观测 4 0例成人上肢标本 ,将骨间前神经分为 2段 ,即旋前圆肌段和指浅屈肌段。观测骨间前神经各分支的分出位置及行程的毗邻关系。结果　骨间前神经从旋前圆肌段发出到 :旋前圆肌 36例、拇长屈肌 19例、指深屈肌 16例、指浅屈肌 7例 ,没发现旋前方肌支 ;骨间前神经从指浅屈肌段发出到 :旋前圆肌 3例、拇长屈肌 2 0例、指深屈肌 18例、指浅屈肌 2 7例、旋前方肌 39例。结论　前臂旋前功能减弱伴屈腕屈指功能下降 ,提示卡压部位在旋前圆肌段 ;前臂旋前功能正常 ,仅出现屈腕屈指功能下降 ,提示卡压部位在指浅屈肌段     

十二指肠血管压迹的影像学观察

目的探讨胃肠钡餐造影检查中十二指肠横部血管压迹的来源.材料和方法对比研究50例钡餐造影所见的十二指肠横部血管压迹与相应CT层面上十二指肠横部、腹主动脉、肠系膜上动、静脉及下腔静脉之间的关系;3例血管造影与钡餐造影联合检查,证实该压迹的来源.结果所有病例十二指肠横部血管压迹均与腹主动脉相吻合;肠系膜上动脉等血管与该压迹的位置及宽度不符;下腔静脉偶可导致另一压迹.结论十二指肠横部血管压迹,为腹主动脉压迫所致,称其为"十二指肠腹主动脉压迹”较为准确.     

A case of tubulocystic carcinoma of the kidney with aggressive features

Tubulocystic carcinoma of the kidney is rare and typically indolent. Our case involved an aggressive tubulocystic carcinoma as well as the radiological confirmation of its relation to papillary renal cell carcinoma. A 46-year-old male presented with renal multiloculated cysts with a solid part. On computed tomography and magnetic resonance imaging, the solid part showed the characteristics of papillary renal cell carcinoma. Contrast enhancement of the solid part was fluffy and sparse because of the coexistence of cysts. Perirenal fat invasion resulted in exophytic cysts, and renal-hilar cystic lymph node metastasis existed. The histopathological diagnosis was tubulocystic carcinoma associated with areas of papillary renal cell carcinoma and poorly differentiated carcinoma with metastasis. Our case suggests that the solid part enhancement of tubulocystic carcinoma tends to be fluffy and sparse, and exophytic cysts and cystic lymph nodes may show radiologically aggressive findings.