切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折

目的探讨切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折的疗效。方法1999年10月-2005年4月，对62例平均年龄7．5岁的患儿，应用切开复位克氏针固定治疗Gartland Ⅲ型肱骨髁上骨折。其中伸直尺偏型41例，伸直桡偏型18例，伸直中间型3例；无伴发血管、神经损伤和筋膜室间隔综合征。闭合性骨折47例，开放性骨折15例。结果术后56例获得随访，随访时间为6～15个月，平均11．5个月。所有骨折均获得愈合。根据Flynn标准进行疗效评价，其中优22例（占39．3％），良21例（37．5％），可9例（16．1％），差4例（7．1％）。伤后8h内手术的优良率为89．7％，伤后8h后手术的优良率为63．0％。直接手术治疗的优良率为90．1％，曾接受手法复位的优良率为67．7％。结论切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折可取得满意的疗效，是安全、有效的治疗方法。     

New sonographic techniques for the diagnosis and treatment of hepatocellular carcinoma

Ultrasound (US) contrast agents such as Levovist and Sonazoid are now commercially available in Japan. Innovative contrast agents and ultrasound technologies have dramatically changed both diagnostic and treatment strategies for hepatocellular carcinoma (HCC). Contrast-enhanced US is extremely useful in the differential diagnosis of hepatic tumors as well as in evaluation of post-treatment response of HCC after lipiodol transarterial chemoembolization and radio frequency ablation. Harmonic US sensitively detects residual cancer cells in HCC patients after treatment, to facilitate accurate guidance for needle insertion for US monitoring; no other imaging modalities, including computed tomography (CT) or magnetic resonance imaging (MRI), have such capability. In 2005, the breakthrough technology of pure arterial phase imaging, which depicts only intranodular arterial accumulated maximum intensity projection images, was developed from advanced raw data storing and accumulation technologies. This technique can clearly identify whether blood supplyin the tumor is of arterial or portal origin, to facilitate the non-invasive characterization of nodular lesions associated with liver cirrhosis. Again, CT or MRI do not have such capabilities. This innovative technique can help differentiate premalignant lesions from overt HCC. Concurrent real-time imaging of multi-detector CT and US, known as real-time virtual sonography, has recently become available. This technique greatly facilitates the treatment guidance for HCC. These newly introduced sonographic techniques are dramatically changing the diagnostic and therapeutic strategies for HCC, which are expected to improve the prognosis of HCC patients.     

Proposed diagnostic thresholds for gestational diabetes mellitus according to a 75-g oral glucose tolerance test. Maternal and perinatal outcomes in 3260 Danish women.

AIMS: To study if established diagnostic threshold values for gestational diabetes based on a 75-g, 2-h oral glucose tolerance test can be supported by maternal and perinatal outcomes. METHODS: Historical cohort study of 3260 pregnant women examined for gestational diabetes on the basis of risk indicators. Information on oral glucose tolerance test results and clinical outcomes were collected from medical records. RESULTS: There was an increased risk of delivering a macrosomic infant in women with 2-h capillary blood glucose of 7.8-8.9 mmol/l compared with women with 2-h glucose < 7.8 mmol/l. Despite treatment, 2-h glucose of 9.0-11.0 mmol/l and > or = 11.1 mmol/l were both associated with increased rates of macrosomia, spontaneous preterm delivery, hypertensive complications, and neonatal hypoglycaemia. Adverse outcomes tended to be more frequent in women with 2-h glucose > or = 11.1 mmol/l than in women with 2-h glucose of 9.0-11.0 mmol/l. CONCLUSIONS: The risk for several maternal and perinatal complications increased with the diagnostic threshold for 2-h glucose. Large-scale blinded studies are needed to clarify the question of a clinically meaningful diagnosis of gestational diabetes mellitus. Until these results are available, a 2-h threshold level of 9.0 mmol/l after a 75-g oral glucose tolerance test seems acceptable.     

马来酸桂哌齐特在颅脑损伤患者的治疗效果观察

目的通过随机分组对照观察探讨马来酸桂哌齐特对颅脑损伤患者的治疗效果。方法100例急性闭合性颅脑损伤患者，分为对照组和用药组，各50例病人。分析对比治疗后对照组和用药组的实验室各项检查指标：血液流变学，TCD检查结果等变化情况。并且对出院后3—6个月随访调查结果进行比较分析。结果治疗后血液流变学检查中，用药组（马来酸桂哌齐特组）各项指标均低于对照组（P〈0．05）。经颅多普勒检测结果显示：用药组的脑血流速度与对照组相比明显减慢（P〈0．05），血管痉挛得到缓解。对比两组出院后随访结果可以看出，用药组的GOS评分、KPS评分及Barthel指数预后明显好于对照组（P〈0.05）。结论初步证明急性颅脑损伤早期应用马来酸桂哌齐特可增加病变区的脑血流，改善微循环，改善颅脑损伤患者的预后。值得推广和进一步研究。     

Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia

For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO2 <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38 degrees C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO2 <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.     

手部皮肤套脱伤的治疗

目的探讨手部皮肤套脱伤的治疗方法。方法2002年4月-2004年11月，治疗22例手部皮肤套脱伤患者，其中19例分别通过吻合血管、套脱皮肤修薄回植及多切口引流等方法进行修复。另有3例，因无法行套脱皮肤回植而采用腹部带蒂皮瓣修复。结果术后随访3个月-1年。19例套脱皮肤原位回植患者中，13例皮肤完全成活，4例有部分皮缘坏死，经中药换药后愈合，2例行切痂植皮术后治愈。手功能按ATN功能评分评定：优9例，良7例，中3例，优良率为84％，患者对手外形及功能满意。3例腹部皮瓣修复者，皮瓣全部成活。术后随访5个月-1年，手外形及功能明显差于皮肤原位回植者。结论尽可能地回植手部套脱皮肤，对手功能及外形的恢复具有重要意义。     

计算机导航辅助下人工全膝关节置换术

目的通过分析计算机导航辅助下人工全膝关节置换术中定位与软组织平衡的辅助检测作用,与传统手术进行疗效差异的比较,探讨计算机导航辅助手术的安全性、可靠性及其优势与不足。方法自2004年10月至2005年10月行计算机辅助人工全膝关节置换术18例22膝(导航组),男7例8膝,女11例14膝;年龄35～74岁,平均67岁。导航组采用计算机辅助下行人工全膝关节置换手术。从2003年10月至2004年10月用传统手术的52例中随机抽取17例22膝(非导航组),男5例6膝,女12例16膝;年龄56～78岁,平均65岁。非导航组采用髓内定位杆(股骨)、髓外定位杆(胫骨)定位,常规手术行人工全膝关节置换。全部44膝均为初次置换,两组患者的原始疾病、年龄、HSS评分行配对t检验,差异无统计学意义(P>0.05)。对比两组术前、术后的力线、软组织平衡、并发症、出血量、手术时间及随访情况,进行统计学处理。结果全部病例随访3～12个月,平均10个月。导航组力线误差大多在2°～3°,非导航组3°～6°。软组织平衡角度变量导航组大多在2°以内,非导航组2°～4°;软组织平衡分离变量导航组大多在2～4mm,非导航组5～7mm。导航组出血量大多在550～700ml,非导航组700～900ml;导航组手术时间大多在75～100min,非导航组45～60min。经SPSS10.0统计软件处理,两组在术后力线、软组织平衡角度变量和分离变量、出血量、手术时间,其差异均有统计学意义(P<0.05)。结论计算机导航辅助人工全膝关节置换术,使假体的植入位置更为准确,术后下肢力线和软组织平衡更佳,并能减少出血量,早期疗效满意,但延长了手术时间。     

交锁髓内钉治疗下肢长管状骨骨折的效果

①目的 探讨交锁髓内钉治疗下肢长管状骨骨折的效果。②方法 应用交锁髓内钉治疗下肢长管状骨骨折56例，随访8～26个月，观察治疗结果。③结果 56例病人术后对位、对线均满意，股骨骨折平均愈合时间为19．9周，胫骨骨折平均愈合时间为17．7周，2例延迟愈合。无主钉或锁钉断裂．无肢体短缩、功能障碍发生。④结论 交锁髓内钉是治疗下肢长管状骨骨折的一种理想、可靠的内固定方法，其疗效满意，值得临床推广应用。     

腕关节融合钢板内固定术的临床疗效

目的评价腕关节融合钢板内固定术的临床疗效。方法2000年7月-2004年12月，采用腕关节融合钢板内固定术治疗创伤性腕关节炎21例。随访内容包括腕关节疼痛程度、手指关节活动度、握力和x线片。根据Buck—Gramcko／Lohrnanrm评分表评价腕关节总体功能，DASH调查表评价腕关节融合术对患者日常活动及生活质量的影响。结果术后21例获得随访，平均随访时间为20个月。术后患侧腕部疼痛值平均为1．5（术前4．5），12例掌指关节和lO例拇指指间关节出现轻微背伸功能障碍，腕部握力为30kg（健侧为38kg）。x线片示腕关节全部骨性融合。Buck—Gramcko／Lohmanrm评分值为8．7，其中优5例、良10例，中6例。DASH值为32，DASH调查表结果表明腕关节融合术后部分日常活动受限。结论腕关节融合钢板内固定成功率高，腕关节疼痛明显减轻，但术后腕关节部分功能丧失。     

精神分裂症患者的记忆功能障碍与精神症状和疗效的关系

目的　探讨精神分裂症记忆功能与精神症状和疗效的关系。方法　对 88例精神分裂症患者分别给予奎的平、舒必利、维思通治疗。采用PANSS量表评定精神症状 ,修订韦氏成人记忆量表 (WMS -RC)测查记忆功能(治疗前用甲式 ,治疗后用乙式 )分别于治疗前、治疗后第 6周末各评一次 ,并采用Pearson相关分析和多元逐步回归进行分析。结果　治疗前记忆商数与阴性症状、一般病理性症状、PANSS总分呈显著负相关 ,与阳性症状无相关性 ;多元逐步回归分析显示治疗前记忆商数与阴性症状关系最密切 ;治疗后记忆商数增加值与阴性症状的减分值呈显著正相关 (r=0 337,P <0 0 1,88例 ) ;治疗前记忆商数与治疗第 6周末的阴性症状减分值、一般病理性症状减分值呈显著负相关 (r =- 0 2 6 5 ,P <0 0 5 ;r =- 0 2 35 ,P <0 0 5 ,88例 )。结论　本研究支持精神分裂症记忆损害与阴性症状存在相似的病理机制假说。