AO锁骨钩钢板治疗肩锁关节脱位

2002年5月-2005年12月,我院应用锁骨钩钢板治疗肩锁关节脱位,取得满意疗效。     

γ-氨基丁酸A受体在静脉麻醉药理学效应中的研究进展

背景 静脉麻醉药物通过对中枢神经递质及受体功能的影响,从而产生多种药理学效应,其中对γ-氨基丁酸A受体(γ-aminobutyric acid subtype A receptor,GABAA)功能的调节是目前全麻药理学效应机制研究的热点.目的 阐述GABAA受体可能是静脉麻醉药物产生多种临床药理学效应的潜在分子靶点....     

应用穿支皮瓣治疗下肢远端慢性骨髓炎并皮肤缺损

目的 探讨游离或带蒂穿支皮瓣在治疗下肢远端慢性骨髓炎并皮肤缺损创面修复中的应用价值.方法 应用穿支皮瓣游离或带蒂移位修复胫前及足踝部慢性骨髓炎并皮肤缺损28例.游离移植13例:采用股前外侧穿支皮瓣修复胫前2例,踝前3例,足背2例,足跟2例;小腿外侧腓动脉穿支皮瓣修复足背4例.带蒂移位15例:胫后动脉穿支皮瓣修复胫前4例,修复内踝2例;腓动脉外踝后上穿支皮瓣修复足跟6例,外踝及足背各1例;第1跖背动脉穿支皮瓣修复近节(足母)趾背侧1例.抗生素液灌流伤口7例,万古霉素明胶海绵残腔填塞8例.结果 1例胫后动脉穿支皮瓣出现静脉回流不足,表浅坏死,自行愈合,其余皮瓣无坏死.随访6个月～2年,2例复发,分别经1次和2次手术后愈合,其余均一期愈合,皮瓣外形满意.3例行二期骨移植.最后一次随访时,患者可行走,患肢完全负重,按足部疾患治疗效果标准评定平均为84.5分.结论 游离或带蒂穿支皮瓣血供良好,可用于治疗残腔不大的慢性骨髓炎并皮肤缺损.     

全麻诱导期急性超容量液体填充对非体外循环冠状动脉旁路移植术患者血液动力学的影响

目的 研究全麻诱导期急性超容量液体填充(acute hypervolemic fluid infusion,AHFI)对冠状动脉粥样硬化性心脏病患者行非体外循环冠脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)血液动力学的影响.方法 40例患者按随机数字表法随机分为6％羟乙基淀粉130/0.4 (6％ hydroxyethyl starch 130/0.4,HES 130/0.4)组和乳酸林格液(lactated ringer's solution,RL)组,每组20例.全麻诱导前5 min开始,30 min内分别输注HES 130/0.4或RL10 ml/kg.在麻醉诱导前5min(T0),诱导后即刻(T1),插管后即刻(T2),插管后5 min(T3)及AHFI结束后(T4)分别记录心率(HR),血压(BP),中心静脉压(central venous pressure,CVP),心脏指数(cardiac index,CI),每搏输出量(stroke volume,SV)及每搏变异指数(stroke volume variation,SVV). 结果 与T0时HR[(66.2±9.5)次/min、平均动脉压(mean arterial pressure,MAP)[(98.6±12.5) mm Hg(1 mm Hg=0.133 kPa)]、CI[(2.7±0.4)L·min-1·m-2]、SV [(82.5±17.4) ml]及SVV[(8.6±4.3)％]比较,HES130/0.4组患者T1时MAP[(82.3±10.8) mm Hg]、CI[(2.3±0.3)L·min-1·m-2]及SV [(73.4±15.5) nl]均下降;在T3和T4时HR[(57.8±6.2)次/min和(56.4±6.9)次/min ]下降;T4时CI[(3.2±0.4)L·min-1· m-2]升高,但是SVV[(6.3±3.2)％]降低(P＜0.05);而RL对照组在T1、T3及T4时MAP[ (78.8±12.1) 、(82.7±12.9)、(79.2±10.1) mm Hg]和SV[(71.3±16.2)、(73.6±15.9)、(74.4±16.3)ml]均降低(P＜0.05或P＜0.01).在T3时与RL对照组CI[(2.5±0.4)L·min-1·m-2]和SV[( 73.6± 15.9) ml]比较,HES 130/0.4组CI[(3.0±0.5)L·min-1·m-2]和SV [(91.2±18.6) ml]均升高(P＜0.05).在T4时与RL对照组MAP[ (79.2±10.1) mm Hg] 、CI[(2.6±0.4)L·min-1· m-2] 、SV[ (74.4±16.3) ml]和SVV[(10.6±4.5)％)]比较,HES130/0.4组MAP[(88.2±9.4)mm Hg]、CI[(3.2±0.4)L·min-1·m-2]和SV[(91.2±18.6)％]均升高,但SVV[(6.3±3.2)％]明显降低(P＜0.05).结论 OPCABG全麻诱导期行AHFI安全有效,使用HES130/0.4比RL能更好地维持全麻诱导期间的血液动力学稳定.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

膝关节骨性关节炎的非手术疗法

膝关节骨性关节炎是常见的骨骼肌肉系统疾病之一 ,其发病原因为多方面。主要表现为关节功能减退、关节疼痛。尽管手术治疗方法和技巧较以前有了较大提高 ,但并不是每个患者都适合于手术。非手术疗法越来越受到重视 ,但实行连续、规律的治疗计划是困难的 ,本文只对与本病有关的主要非手术疗法作一简介。一、药物疗法　药物治疗在膝关节骨性关节炎治疗中占有重要地位 ,常用药物有以下几种 :1止痛剂 ;2非甾体类消炎药 ;3软骨营养类药物 ;4甾体类消炎药。给药途径有口服、外用和关节灌洗。最常用的止痛药物是扑热息痛 (对乙酰氨基酚 ) ,2 0 0 0…     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

硝普钠、艾司洛尔用于嗜铬细胞瘤手术病人的血液动力学观察

嗜铬细胞瘤患者因肿瘤分泌的内源性儿茶酚胺不同，其临床表现、术前准备、术中肿瘤摘除前后血液动力学变化及麻醉处理均有差异…。血管扩张药硝普钠(SNP)和β1肾上腺素能受体阻滞剂艾司洛尔(Esmolol)已成功用于该手术。本文拟观察两种药物对嗜铬细胞瘤术中血液动力学的影响及肿瘤摘除后血液动力学的变化特点。     

干扰素、转移因子防治反复呼吸道感染的疗效观察

我院 1998年 1月～ 2 0 0 1年 6月符合反复呼吸道感染(ＲＲＴＩ)诊断标准的门诊患儿 2 40例 ,对 12 0例采用干扰素、转移因子治疗 ,效果较好 ,现报告如下。对象与方法一、对象及分组　均符合 1987年 4月成都会议制定的ＲＲＴＩ诊断标准[1] 。随机分为两组 ,应用干扰素、转移因子治疗的 12 0例为观察组 ,常规方法治疗的 12 0例为对照组。ＲＲＴＩ每年 7～ 2 0次以上。两组年龄、性别、症状和体征、感染疾病、合并症及ＲＲＴＩ次数等临床资料相比 ,具有可比性。二、治疗方法　观察组给干扰素 (深圳科兴生物制品有限公司生产 ,批号 :19970 711)…     

足底内侧皮瓣修复手小鱼际部软组织缺损

目的探讨足底内侧皮瓣修复手小鱼际部软组织缺损的临床疗效。方法 2006年4月-2010年12月,采用带血管神经蒂的足底内侧皮瓣修复6例手小鱼际部软组织缺损。男4例,女2例;年龄15～46岁,平均31.5岁。挤压伤4例,热压伤1例,受伤至手术时间3～8 h;神经纤维瘤切除后1例。软组织缺损范围为4 cm×3 cm～6 cm×5 cm。合并小指屈指深、浅肌腱断裂1例,掌骨骨折2例,小鱼际部肌肉缺失4例。皮瓣切取范围为4.5 cm×3.5 cm～6.5 cm×5.5 cm。供区游离植皮修复。结果术后皮瓣及植皮均顺利成活,创面Ⅰ期愈合。术后患者均获随访,随访时间6～8个月。皮瓣外形无臃肿,质地优良,痛、温、触觉存在,术后6个月两点辨别觉为8～11 mm,平均8.6 mm。结论足底内侧皮瓣质地与小鱼际皮肤相似,修复后外观及耐磨度良好,皮瓣切取后对供区功能影响小,血管走行恒定,口径粗大易于吻合,是修复手小鱼际部软组织缺损较好方法之一。