小腿后侧远端蒂筋膜皮瓣修复踝足部皮肤缺损

小腿下端及足跟部等近踝处皮肤菲薄,血运差,缺损易导致骨骼、肌腱外露。该处软组织缺损的治疗较为棘手1998年9月～2006年6月,我院共收治此类患者60例,采用小腿后侧远端蒂筋膜皮瓣修复此处皮肤缺损,均取得良好效果．报道如下。     

Isolated partial tear of extensor digitorum longus tendon with overlying muscle herniation in acute ankle sports injury: role of high resolution musculoskeletal ultrasound

Lateral Ankle sprain is a common sports-related trauma with the mechanism of injury ranging from inversion to plantar flexion. These injuries commonly affect the ligaments but can also affect the associated soft tissue structures like the eversion muscles and tendons. Prompt and accurate diagnosis of such injuries is warranted so as to ensure early return to play and prevent long-term complications. Lateral ankle sprain injuries in sports may not always be associated with ligament injuries. We report a never before reported case of lateral ankle sprain injury in a soccer player with the unusual finding of isolated partial tear of Extensor digitorum longus muscle and its fascia leading to myo-fascial herniation. The lateral ankle ligaments were intact. The diagnosis was clinched on a high-frequency ultrasound scan supported by dynamic maneuvers which in fact proved to be superior to MRI as the latter failed to demonstrate the myo-fascial herniation in our case. We therefore propose that real-time ultrasound scanning with dynamic maneuvers should be the first line of investigation to assess sports injuries in anatomically complex joints like the ankle.     

电针配合中药熏洗治疗踝关节扭伤疗效观察

目的观察电针配合中药熏洗治疗陈旧性踝关节扭伤的临床疗效。方法将84例患者根据自愿分为A组、B组、C组,每组28例。A组采用电针配合中药熏洗治疗,B组采用单纯电针治疗,C组采用单纯中药熏洗治疗,治疗2个疗程后进行疗效评定和分析。结果 A组治愈率为71.4%,B组为42.9%,C组为28.6%,A组明显优于B组与C组,差异有统计学意义(P<0.05)结论电针配合中药熏洗治疗陈旧性踝关节扭伤能明显提高治愈率。     

大鼠视神经钳伤后外侧膝状体细胞损伤的研究

目的　探讨大鼠视神经钳伤后 ,外侧膝状体 (lateralgeniculatebody,LGB)细胞的损伤情况。方法　用 4 0g视神经损伤钳 ,压迫Sprague Dawley(SD)大鼠双侧视神经 30s,制成视神经部分定量损伤的动物模型。对LGB连续梯度切片 ,7d后用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法 (teriminaldeoxynucleotidyltransferase mediateddUTPnickend labeling ,TUNEL)对LGB细胞进行凋亡检测。 1个月后通过免疫组化染色技术 ,用兔抗鼠神经丝 (neurofilament,NF)单克隆抗体对LGB的神经元进行检测。同时经视觉中枢注入荧光染料颗粒蓝 ,对LGB细胞进行逆行荧光标记 ,在 70 0nm波长荧光显微镜下对连续切片的LGB标记细胞进行平均密度计数 ,并与对照组比较。结果　TUNEL法染色证实LGB细胞发生凋亡。对照组神经丝免疫组化染色呈清晰的条索状 ,而实验组明显减少。对照组LGB细胞密度均值为 (5 172± 2 4 8)个 /mm2 ,而损伤组LGB细胞密度均值为 (414 4± 6 1)个 /mm2 ,两组比较差异有非常显著意义 (t=8 995 ,P <0 0 1)。结论　在大鼠视神经钳伤后 ,LGB细胞受损 ,其损伤机制与凋亡有关     

药物性阴茎双功能超声检测在外伤性勃起功能障碍中的应用

目的 探讨阴茎双功能超声诊断尿道外伤患者勃起功能障碍的价值.方法 尿道外伤后经IIEF-5评分诊断为勃起功能障碍的患者35例分别于注射罂粟碱及酚妥拉明前后应用多普勒超声测量阴茎背动脉和背深动脉的动脉血流收缩期峰速(peak systolic velocity ,PSV),舒张末期流速(end diastolic velocity,EDV),阻力指数(resistance index,RI);背深静脉流速(V),并进行组间分析.依据骨盆耻骨联合有无分离分为两组,分离组13例,未分离组22例.结果 35例勃起功能障碍的患者中,经超声诊断为血管性勃起功能障碍(erectile dysfunction,ED)的有11例,耻骨联合分离组与未分离组在注射血管活性药物后背深动脉收缩期流速有统计学意义(P《0.05).结论 阴茎血流超声检测在诊断尿道外伤患者勃起功能障碍时可对血管性ED作出诊断,后尿道损伤患者尤其是合并骨盆耻骨联合分离者可能存在较大的血管性ED的风险.     

N-甲基-D-天门冬氨酸受体亚型NR1、NR2A在大鼠视网膜缺血再灌注损伤模型中的表达

目的:研究N-甲基-D-天门冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)功能亚单位NMDAR1、NM-DAR2A在Wister大鼠视网膜缺血再灌注模型中的表达情况。方法:18只健康成年Wister大鼠分成6组,每组3只,都取其右眼行视神经周围血管结扎手术制备视网膜缺血再灌注模型,左眼作为对照组不行手术。60分钟后去除结扎缝线恢复血流,分别于再灌注后即刻、3、12、24、72、168小时处死大鼠,摘除眼球,做冰冻切片。用免疫组织化学方法观察NR1、NR2A在视网膜缺血再灌注后不同时刻的变化并进行图象分析及统计学处理。结果:(1)各实验组和对照组间及各实验组间NMDAR1的表达无统计学意义。(2)除即刻组外各实验组和对照组间及各实验组间NMDAR2A的表达均有统计学意义,从再灌注后3小时至168小时NMDR2A表达缓慢上升。结论:(1)NMDAR1与视网膜缺血再灌注损伤无关,不参与谷氨酸的兴奋性毒性作用。(2)NMDAR2A与视网膜缺血再灌注损伤有关,参与谷氨酸兴奋性毒性作用。     

早期集束化急救策略救治严重多发伤临床评价

目的 探究采用早期集束化急救策略治疗严重多发伤的运用情况.方法 整群选择该院2013年2月—2015年2月收治的严重多发伤患者122例,分为观察组、对照组,各61例. 对照组采取一般监护治疗措施,观察组采取早期集束化急救策略. 对比两组在入院时、入院后1 h以及入院后24 h的乳酸(Lac)、血红蛋白(Hb)和血气指标,并且比较两组检查花费时间、平均住ICU时间、急诊手术率、漏诊率以及病死率情况. 结果 观察组在入院后1 h和24 h的Lac、Hb以及血气指标均显著优于对照组, 差异有统计学意义 (P<0.05). 观察组病死率为13.11%(8/61), 漏诊率为4.92%(3/61),均显著低于对照组的病死率31.15%(19/61),漏诊率为13.11%(8/61),差异有统计学意义(P<0.05);观察组急诊手术率为83.61%(51/61),显著高于对照的70.49%(43/61),差异有统计学意义(P<0.05);观察组检查花费时间和平均住ICU时间均显著低于对照组,差异有统计学意义(P<0.05). 结论 对于严重多发伤患者采取早期集束化急救策略可显著提高抢救率,降低死亡率,值得临床推广.     

医原性输尿管损伤18例临床分析

目的探讨医原性输尿管损伤的早期诊断和最佳治疗方案,提高手术成功率,减少合并症的发生。方法对1990至2005年18例19侧医原性输尿管损伤病例进行回顾性研究。分析治疗方法和预后及并发症之间的关系。结果15例早期发现患者中13例一期修复输尿管损伤;2例先行尿流改道,3个月后行修复手术成功。3例发现晚患者,3~10个月后手术,1例行肾切除,2例行一期修复手术。12例获得随访6~24个月,10例肾积水缓解。结论医原性输尿管损伤患者一般情况较好时,无论确诊时间早晚,均可考虑一期手术修复。     

前尿道憩室合并结石5例报告

目的　总结前尿道憩室合并结石的诊断治疗体会。方法　对 5例前尿道憩室合并结石行手术治疗后进行回顾性分析。结果　 4例行尿道憩室切除尿道修补术 ,取出全部结石 ,1例行尿道憩室造口术 ,取出结石 ,3个月后行尿道成形术。结论　尿道平片 +尿道造影简单可靠。手术应视具体情况选择方法     

How to become Pediatric Orthopedic surgeon inEurope:a long journey offering a unique career,full of satisfactions

In most European countries,Pediatric Orthopedic (PO) surgeons graduated from an approved Orthopedic and Trauma surgery training program which lasts 5 or 6 years,depending on the country.Upon completion of the Orthopedic and Trauma surgery program,the future PO surgeon must complete an additional subspecialty training (one to two years,depending on the country) in PO surgery.The possibility to become a certified PO surgeon through the specialization in Pediatric Surgery (option Orthopedics) or through a dedicated PO surgery training program only exists in France and in Romania,respectively.Credit as active and fully responsible PO surgeon can only be claimed when the trainee has actively participated in all phases of treatment,from diagnosis to treatment,without forgetting the management of complications and the setting up of an adequate follow-up of children and adolescents with musculoskeletal disorders.