创伤性膈疝误诊漏诊原因分析（附8例报告）

目的：探讨创伤性膈疝误诊漏诊的原因,方法：回顾性分析１９７６～１９９６年８例创伤性膈疝并结合有关文献进行探讨。结果：全组患者术前确诊５例,术前未明确膈肌破裂,因其它原因手术而确诊３例,结论：创俐性膈疝的诊断主要依靠临床动脉观察和Ｘ线的特异表现为追踪观察。     

International comparison of the treatment of polytraumatized patients

Summary Worldwide there will be an increase in polytraumatized patients. The number of death after trauma will increase from 5,1 Mill. to 8,4 Mill. The reason is the technical progress in the third world. In western countries there was a decrease in trauma death, in Germany below 8.000 due to traffic accidents in 1998. In most countries the paramedic system and ATLS are established (USA, South Africa). Long rescue times and inadequate shock treatment preclinically are the bigest problems in Russia and Greece. Worldwide the institution of trauma centers (Level I, II, III) has brought much better results comparing to nontrauma centers but is economically expensive. The annual number of polytraumatized patients (Level I 600–1.000 severe trauma, > 65 personal experience) is essential for the success rate. Infrastrucure, Algorithmus and the personal experience of the trauma leader are the keys for optimal results. One parameter for Quality measurement is the number of potentially preventable deaths. Retrospective analysis of treatment protocols and pathological results by an expert team is the best practical way. The results of level I trauma teams reach between 1 and 2 % preventable deaths. A further instrument of quality improvement are Trauma registers like in US and England (MTOS) and the German Trauma register of the German Society of Trauma. The Trauma register in Germany contents till now 2.069 polytraumatized patients.The lethality is 18,6 % (ISS 21 ± 13), comparing to MTOS (ISS 12,8 ± 11,3, lethality 9,2 %). The differences in injury pattern show in the US three times more penetrating injuries than in the German Traumaregister (21,1 % versus 7,2 %).      

Therapy-resistant unilateral chronic blepharokeratoconjunctivitis as the main finding in autoaggression syndrome. Clinicohistopathological findings

Summary Autoaggressive syndromes as causes of diseases underlying chronic blepharitis and keratoconjunctivitis that are refractory to treatment are often difficult to recognize. Patients: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4 × ) or left-(1 × ) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2 ,11 and 30 months prior to admission. In each case more than 5 ophthalmologists and 2–6 eye hospitals had been consulted, and extraocular surgery had been performed 1–4 times. Results: Patients presented with a visual acuity of 0.3 p (1 × ), 0.1 (1 × ), FC (1 × ), HM (1 × ). In three patients contact eczema of the facial skin and lids and a corneal pannus were observed; in two patients we saw purulent pseudomembranous and in two patients chronic cicatrizing keratoconjunctivitis. Conjunctival smears grew P. aeruginosa, and S. aureus; impression cytology showed infiltration with neutrophils and epithelial keratinization; histopathology indicated chronic inflammatory, partly purulent subepithelial and stromal conjunctival infiltrate with hyper- and parakeratosis fibrous strands and epithelial cell loss; the lower lids showed parakeratosis, focal necrosis, intercellular edema and a lymphohistiocytic round-cell infiltrate. Furthermore, multiple allergies to antibiotics and preservatives (4 × ), lacerations of the arms and legs (2 × ) and an irritative-toxic dermatitis (1 × ) were substantiated. In the patients who agreed to a psychiatric consultation, somatized-agitated longing for care combined with a dependent and infantile personality (1 × ) and reactive depression (2 × ) were verified. Conclusions: In patients suffering from treatment-refractory unilateral chronic blepharokeratoconjunctivitis correlated with the hand, one must take into consideration the fact that other factors may be involved: possible exacerbation prior to examinations; multiple inpatient diagnostic and surgical procedures in different locations; histopathological mixed inflammatory patterns; and psychiatric syndromes.      

Post-traumatic avascular necrosis of the humeral head

Summary A study of nine cases of post-traumatic avascular necrosis of the head of the humerus is presented with a review of 60 cases previously published. Onset of symptoms begins between one and two years after fracture. Pain and stiffness are the principal features. The clinical picture eventually stabilises with decreasing pain and variable loss of movement. The chief radiological changes are sclerosis and a snow-cap appearance of the head or a characteristic spanner-shaped deformity. The possible causative factors are listed and the importance of associated vascular damage emphasised. Conservative treatment is usually adequate but prosthetic replacement of the head may be indicated.

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Résumé Les auteurs analysent 60 cas de nécrose post-traumatique de la tête humérale publiés dans la littérature, auxquels ils ajoutent neuf cas personnels.Ils soulignent le rôle des facteurs combinés dans la pathogénie parmi lesquels le facteur vasculaire est le plus important. Après 1 à 2 ans de latence, les manifestations cliniques apparaissent et vont évoluer lentement vers une certaine stabilisation, en particulier des phénomènes douloureux, souvent intenses au début, mais au prix d'une raideur résiduelle quasi constante. La radiologie reconnaît deux types principaux d'image:condensation en calotte de neige;déformation en clé anglaise de la tête humérale;la glène restant très longtemps indemne.Le traitement, le plus souvent médical, devrait peut-être ressortir de la chirurgie par prothèse type Neer, qui pourrait dans les types les plus graves, être placée préventivement.

     

中西医结合对重症脑外伤昏迷病人促苏醒疗效观察

目的 :探讨醒脑开窍疗法对治疗重症颅脑损伤患者促苏醒作用以及对预后的影响。方法 :将 80例颅脑损伤患者 (GCS≤ 8)随机分成 2组 ,治疗组 4 0例 (在常规治疗基础上加用中药针刺疗法 ) ;对照组 4 0例。两组于伤后 1月按GCS预后评分评定预后 ,两组在促醒后 1月内意识好转率作一比较。结果 :治疗组预后恢复良好为 87 5 % ,显著高于对照组 6 2 5 % ,P <0 0 1;两组病死率差异无显著性意义 (P >0 0 5 )。治疗组 1月内清醒 32例 ,对照组 2 0例 ,P <0 0 1。结论 :中西医结合疗法在治疗重症脑外伤昏迷患者时 ,能加速促醒和提高生存质量。     

创伤性气管支气管断裂的诊断及治疗

目的　分析创伤性气管、支气管断裂的诊断及治疗 ,总结早期急诊及晚期诊断 (1周后 )依据 ,探讨误诊原因 ,分析治疗效果。方法　本组1 1例 ,伤后距手术时间 72小时 8例 ,6周至 3个月 3例。气管、支气管断端吻合 8例 ,修补成形 3例。结果　治愈 1 0例 ,死亡 1例。结论　早期诊断、早期治疗及应用生物蛋白胶可提高治愈率 ,减少术后并发症 ,有利于肺功能恢复     

外伤性肝破裂术后再出血诊疗体会

目的 提高外伤性肝破裂的外科治疗水平。方法 1993年9月～2003年9月收治的230例外伤性肝破裂中有7例术后再出血病人，对再出血诊断、原因、手术方法及治疗结果进行回顾性分析。结果 7例病人中再手术5例，保守治疗1例，均治愈，1例死亡。结论 提高医务人员对肝外伤的治疗水平，选择正确的方法，发现再出血情况及时诊断治疗可提高治愈率。     

Post-traumatic recto-spinal fistula

Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. Received: 7 December 1998; Revised: 10 May 1999; Accepted: 10 May 1999     

十二指肠损伤的临床特点及诊治

目的探讨十二指肠损伤的临床特点及手术方法,以提高十二指肠损伤的诊治水平。方法回顾性分析1993-10～2003-11我科收治的30例十二指肠损伤患者的临床特点、诊治方法、手术方式及治疗效果。结果腹部X线透视、诊断性腹腔穿刺阳性率分别为24%(6/25)、30%(6/20)。单纯十二指肠损伤占20%(6/30),合并其他腹腔内脏器损伤占80%(24/30)。损伤部位以降部多见占46.67%(14/30),水平部次之占30%(9/30)。术后并发症发生率60%(18/30),病死率20%(6/30)。结论十二指肠损伤具有术前确诊率低、术中漏诊率高、合并损伤多的特点,故并发症发生率及病死率较高。因而掌握其特点,注重早期诊断、早期手术,根据术中具体情况选择简单而合理的手术方式是提高治愈率、降低病死率的关键。     

外伤性脾破裂保脾手术的探讨

目的 探讨脾破裂保脾手术方式，以提高脾破裂的诊治水平。方法 回顾性分析25例外伤性脾破裂患者的临床资料，分别采用脾破裂修补术、部分脾切除术、自体脾移植术治疗脾破裂。结果 本组25例，全部治愈。术后经B超或CT检查证实脾脏或脾片成活。结论 创伤性脾破裂在确保伤者生命安全的前提下，应尽可能保留脾脏，尤其是儿童。保脾手术治愈率高，术后感染率低。