创伤早期肺特异性相关蛋白测定对识别和量化肺挫伤的价值初探

目的通过分析创伤早期肺特异性相关蛋白——克拉拉蛋白（CCl6）、表面活性蛋白D（sP—D）、高级糖基化终末产物可溶性性受体（sRAGE）的血清浓度与肺挫伤和挫伤体积的相关关系,以探讨其对诊断和量化肺挫伤的价值。方法以无吸烟史健康受试者为对照组（15例）,根据急诊初次胸部CT结果,将多发伤患者分为肺挫伤组（31例）和无肺挫伤组（15例）,同时采集静脉血样,检测血清CCl6、SP—D和sRAGE的浓度,比较3组问3种肺特异性相关蛋白的差异性,并对其与肺挫伤和挫伤体积进行相关分析,得出敏感指标的ROC曲线。结果3种肺特异性相关蛋白中,只有CCl6的血清浓度在3组间有明显统计学差异,并与肺挫伤体积正相关,肺挫伤是血清CCl6浓度升高的独立影响因素。CCl6的ROC的曲线下面积为0．890,诊断灵敏度为0．935,特异度为0．800。结论CCl6有望成为辅助临床诊断肺挫伤的生物学标志物。     

心肌挫伤后心肌标志物测定的临床意义

目的 观察心肌挫伤患者在48h内心肌标志物含量的变化及判断心肌挫伤的程度。方法 对28例心肌挫伤患者在48h内不同时间分别采集静脉血,测定肌红蛋白(Myo)和肌酸激酶同功酶质量(CK-MB)、肌钙蛋白I(c Tnl)及心肌酶谱(LDH、AST)等心肌标志物含量。结果 伤后8h血清中Myo、CK-MB、eTn-I及LDH、AST含量均升高,其中Myo、CK-MB及LDH、AST在伤后8h升高明显(P<0.01):在伤后24hcTn I升高最为明显,而Myo、CK-MB和LDH、AST含量有所下降,但仍高于正常参考值。结论心肌标志物的联合测定在判断心肌挫伤中具有重要意义,cTnI的特异性高于Myo、CK-MB和LDH、AST。     

单侧入路大脑镰切开清除双额底脑挫伤手术探讨

目的：探讨一侧入路清除双侧额底脑挫裂伤伴局部血肿的可行性及临床疗效。方法对我院2011年6月-2013年1月年共15例经损伤较重的一侧入路清除双额底脑挫伤的患者进行回顾性研究。结果术中均直视下清除双侧额底脑内血肿及挫伤坏死脑组织,其中左侧9例,右侧6例,术后 CT 检查提示脑挫伤血肿清除满意。伤后随访3个月,根据 GOS分级标准评定,恢复良好11例,中残2例,重残1例,死亡1例。结论经单侧入路清除双额底脑挫伤可行,能显著降低重型颅脑损伤患者的死亡率和致残率。     

鼠神经生长因子联合葛根素治疗视神经挫伤的临床观察

目的观察在常规治疗基础上应用鼠神经生长因子（mNGF）联合葛根素治疗视神经挫伤的临床疗效。方法随机将视神经挫伤患者78例（78只眼）分为治疗组40例（40只眼）,对照组38例（38只眼）,2组常规给予脱水、改善微循环及糖皮质激素药物治疗,治疗组另外加用mNGF、葛根素。治疗后随访6～12个月,比较各组患者视力恢复情况,并观察mNGF、葛根素的安全性。结果治疗组总有效率为87．5％,对照组为52．6％,2组差异有统计学意义（P=0．003）。结论mNGF联合葛根素治疗视神经挫伤疗效好、安全性高。     

MRI在膝关节急性骨挫伤诊断中的临床应用价值

目的探讨MRI在膝关节急性骨挫伤诊断中的临床应用价值。方法对2010年3月～2012年3月1来我院就诊且MRI检查诊断为骨挫伤的120例患者进行回顾性分析。观察指标包括骨挫伤部位、形态、信号以及半月板、韧带、关节囊及关节周围软组织改变情况。结果 120例急性骨挫伤患者中共有279处病灶均伴有不同程度的关节腔积液、周围软组织肿胀;T1WI序列上表现为骨皮质下髄质区低或略低信号区,T2WI序列骨挫伤区可见不均匀稍高信号区;31例合并软骨损伤,MRI表现为"对吻"征;合并隐性骨折25例,T1WI和T2WI呈细线状、条带状、网状低信号带;合并韧带损伤55例,合并半月板损伤59例。结论 MRI可以准确显示急性骨挫伤部位、形态、信号及附属结构的损伤情况,对该病变的诊断和治疗具有重要的临床意义。     

双额叶脑挫裂伤的临床特点及治疗

目的:探讨双额叶脑挫裂伤的临床特点与治疗方法以改善预后.方法:回顾性分析2006年3月至2010年3月我科收治的急性双额叶脑挫裂伤患者42例的临床资料.结果:恢复良好26例,中度残疾7例,重度残疾4例,死亡5例.结论:急性双额叶脑挫裂伤病情易出现突变,创伤的严重性较其他部位有潜在发展的特点,必须动态严密观察生命体征及头颅CT变化,对病情恶化者及时手术治疗,消除颅内高压可改善患者预后.     

Nasal OEC transplantation promotes respiratory recovery in a subchronic rat model of cervical spinal cord contusion

Engraftment of nasal olfactory ensheathing cells (OEC) is considered as a promising therapeutic strategy for spinal cord repair and one clinical trial has already been initiated. However, while the vast majority of fundamental studies were focused on the recovery of locomotor function, the efficiency of this cellular tool for repairing respiratory motor dysfunction, which affects more than half of paraplegic/tetraplegic patients, remains unknown. Using a rat model that mimics the mechanisms encountered after a cervical contusion that induces a persistent hemi-diaphragmatic paralysis, we assessed the therapeutic efficiency of a delayed transplantation (2 weeks post-contusion) of nasal OECs within the injured spinal cord. Functional recovery was quantified with respiratory behavior tests, diaphragmatic electromyography and neuro-electrophysiological recording of the phrenic motoneurons while axogenesis was evaluated using immunohistochemistry. We show that 3 months post-transplantation, nasal OECs improve i) breathing movements, ii) activities of the ipsilateral diaphragm and corresponding phrenic nerve, and iii) axonal sprouting in the injury site. We also demonstrate that this functional partial recovery is mediated by the restoration of ipsilateral supraspinal command. Our study brings further evidence that olfactory ensheathing cells could have clinical application especially in tetraplegic patients with impaired breathing movements. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.     

Time-course of recovery of gastric emptying and motility in rats with experimental spinal cord injury

Abstract  We have shown recently that spinal cord injury (SCI) decreases basal gastric contractions 3 days after injury. In the present study we used the [¹³C]-octanoic acid breath test and gastric strain gauges with the aim to investigate the time-course of recovery from postinjury gastric stasis in rats that underwent experimental SCI at the level of the third thoracic (T3) vertebra. Following verification of the [¹³C]-breath test sensitivity in uninjured rats, we conducted our experiments in rats that underwent T3- spinal contusion injury (T3-CI), T3-spinal transection (T3-TX) or laminectomy (control) surgery at 3 days, 1, 3 or 6 weeks postinjury. Our data show that compared to rats that underwent laminectomy, rats that received SCI showed a significant reduction in the cumulative per cent [¹³C] recovery. Although more marked in T3-TX rats, the delayed gastric emptying in T3-CI and T3-TX rats was comparable in the 3 days to 3 weeks period postinjury. At 6 weeks postinjury, the gastric emptying in T3-CI rats recovered to baseline values. Conversely animals in the T3-TX group still show a significantly reduced gastric emptying. Interestingly, the almost complete functional recovery observed in T3-CI rats using the [¹³C]-breath test was not reflected by analysis of spontaneous gastric contractions after SCI. These data indicate that T3-SCI produces a significant reduction in gastric emptying independent of injury severity (T3-CI vs T3-TX) that persists for at least 3 weeks after injury. However, 6 weeks postinjury T3-CI, but not T3-TX, rats begin to demonstrate functional recovery of gastric emptying.     

肋骨接骨板置入内固定治疗肋骨骨折39例：同一机构2年资料回顾

背景：肋骨骨折是否需要植入物内固定治疗,何种情况下需要植入物固定及固定技术达成共识均不多。 目的：回顾性分析过去2年中39例胸部钝性创伤患者采用肋骨接骨板置入内固定治疗肋骨骨折的必要性和可行性。 方法：选择胸部钝性创伤患者39例,男32例,女7例,平均年龄(47.8±13.8)岁;其中有连枷胸无肺挫伤4例,有连枷胸有肺挫伤10例,无连枷胸无肺挫伤15例,无连枷胸有肺挫伤10例。根据患者临床状况,可首先保守治疗,待病情稳定后再行肋骨接骨板置入内固定治疗,或急症剖胸同时行肋骨接骨板置入内固定。 结果与结论：患者经置入内固定治疗后胸壁稳定,胸壁塌陷畸形接近矫正,疗效满意。然而,1例68岁有连枷胸有肺挫伤患者,因肺炎、脓毒症,进而出现感染性休克于术后26 d死亡。其余患者胸壁塌陷、胸廓畸形在置入内固定治疗后都得到满意矫正。术后胸片或胸部CT复查肋骨接骨板内固定区肋骨复位好,无松脱移位,双侧胸廓大致对称,患侧与固定前相比胸廓塌陷畸形消失,基本恢复正常。因此,肋骨接骨板置入内固定治疗肋骨骨折,不论是否连枷胸及有无伴发肺挫伤患者均能达到满意的效果。     

视诱发电位在眼外伤视神经挫伤中的应用

目的通过检测视诱发电位（VEP）,探讨其在眼外伤视神经挫伤中的应用价值。方法对49例眼外伤视神经挫伤患者行棋盘格翻转刺激VEP检查,并与健侧眼或正常对照组相比较。结果49例（55眼）患中者P100波幅降低40例（45眼）,P100潜伏期延长11例（14眼）,P100潜伏期延长并波幅降低3例（5眼）,视神经挫伤眼P100波幅较健侧眼、对照组差异有统计学意义,而P100潜伏期与健侧眼比较差异无统计学意义,与对照组比较差异有统计学意义。结论VEP对眼外伤后视神经损伤检出有较高敏感性,能客观、定量评定视功能,对早期诊断、预后评价有重要价值。