Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.     

纳洛酮治疗原发性脑干损伤

目的 :观察纳洛酮治疗原发性脑干损伤的疗效。方法 :83例原发性脑干损伤病人分为纳洛酮组 38例 ,在常规治疗基础上加用纳洛酮 0 .3mg·kg- 1加入氯化钠注射液 5 0 0mL中静脉滴注 ,qd× 3d ,3d后减为 4 .8mg·d- 1,qd× 7d ,10d为一个疗程 ;常规治疗组 4 5例 ,单用常规治疗。按格拉斯哥昏迷评分标准观察病人症状。结果 :常规治疗组和纳洛酮组的昏迷时间分别为 (30±s 4 )d和 (2 0±4 )d ,死亡分别为 16例和 6例 ,恢复良好分别为 12例和 2 3例 ,中残分别为 7例和 6例 ,重残分别为 10例和 3例、植物生存各 1例 ;2组昏迷时间及疗效比较 ,P <0 .0 1。结论 :纳洛酮在原发性脑干损伤的治疗中能降低死亡率 ,缩短昏迷时间 ,减少残存率。     

Multi‐center Retrospective Study of Factors Affecting Perioperative Transfusion of Packed Red Blood Cells for Pelvic Fracture Patients

ObjectiveTo analyze the use of packed red blood cells (PRBCs) for patients with pelvic fracture and evaluate factors associated with PRBC transfusion for patients with pelvic fracture.MethodsThis retrospective cohort study collected 551 patients with pelvic fractures from six hospitals between September 1, 2012, and June 31, 2019. The age span of patients varied from 10 to 95 years old, and they were classified into two groups based on high‐energy pelvic fractures (HE‐PFs) or low‐energy pelvic fractures (LE‐PFs). The study''s outcome was the use of PRBCs, fresh frozen plasma (FFP), and albumin. Demographic data, characteristics, laboratory tests, clinical treatment details, and clinical outcomes were compared between the two groups. Factors that were statistically associated with perioperative PRBCs in univariate analyses were included to conduct an optimal scale regression to determine the independent factors for perioperative PRBCs.ResultsA total of 551 patients were screened from six hospitals, and after inclusion and exclusion, 319 were finally included and finished the follow‐up from admission to discharge, while four patients died during hospitalization. Three hundred and nineteen patients were classified into two groups by their injury mechanisms. A total of 230/319 (72.1%) patients were classified into the HE‐PF group, and 89/319 (27.8%) patients were classified into the LE‐PF group. Patients in the HE‐PF group were transfused with 4.5 (3–8) units of PRBCs, 300 (0–600) ml of FFP, and 0 (0–30) g of albumin, while patients in the LE‐PF group were transfused with 3.5 (2–4.5) units of PRBCs, 0 (0–295) ml of FFP, and 0 (0–0) g of albumin (all P < 0.001). There were higher proportions of male patients and patients under 65 in the HE‐PF group (all P < 0.001). HE‐PF group patients were more severely injured and likely to take external fixation. The optimal scale regression revealed four significant factors associated with perioperative transfused PRBCs, which were patients on admission with hemorrhagic shock (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.283, P = 0.004), followed by fracture types identified by Tile classification (importance = 0.156, P < 0.001), hemoglobin levels below 70 g/L on admission (importance = 0.148, P = 0.039), and methods of pelvic fixation (importance = 0.008, P = 0.026), ranked by the importance.ConclusionPatients with HE‐PFs had increased transfusions of PRBCs, FFP, and albumin, and hemorrhagic shock on admission, Tile classification, Hb levels, and stabilization methods were found to be associated with perioperative PRBCs.     

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。     

儿童腹部损伤的诊断与治疗

目的 探讨儿童腹部损伤的保守治疗及手术探查的指征,提高儿童腹部损伤的诊疗水平.方法 回顾性分析我院89例腹部损伤患儿的临床资料,根据损伤部位情况进行分类,并逐一对其进行分析.结果 (1)89例腹部损伤患儿中,25例肝损伤,1例行剖腹探查;48例脾损伤,46例保守治疗,1例行脾切除术,1例予修补;14例胃肠道损伤,4例急诊剖腹探查,1例住院4 d后出现迟发穿孔;8例胰腺损伤,6例肾、肾上腺挫伤,予保守治疗;1例子宫、膀胱损伤,急诊手术治疗.(2)与成人不同,肝脾损伤患儿绝大多数经保守治疗能治愈,静脉补液后输血仍超过40 ml/kg,且血压不稳定者应及时手术探查.(3)CT检查对怀疑有胃肠道损伤,而不宜行腹部X线立位平片者有重要临床意义,合并气腹或腹胀明显加重,或出现腹膜炎表现的患儿,应及时手术探查,尤其注意迟发消化道穿孔的可能.(4)排除有胰腺横断的患儿,胰腺损伤多应保守治疗.(5)膀胱及子宫损伤患儿,外伤多较严重,需及时剖腹探查.结论 基层医院儿童腹部损伤应高度重视,实质脏器损伤导致的内出血是患儿死亡的最主要原因,空腔脏器损伤延误诊治是导致患儿死亡的另一重要原因,因此,早期准确诊断,积极治疗,以及综合处理其他严重的合并伤、并发症是成功救治该类患儿的关键.     

间接视神经损伤的治疗和视力预后分析

目的探讨间接视神经损伤患者视力预后的影响因素,评价单纯药物治疗（糖皮质激素为主,能量合剂、神经营养、脱水、改善血管微循环等常规药物为辅）与联合治疗（视神经减压术加上述药物）的临床效果。方法回顾性研究186例间接视神经损伤患者的临床资料,对影响视力预后的多种因素进行分析,比较其药物治疗和联合治疗的临床效果。结果186例患者中,67例（36．02％）视力有好转,51例恢复中心视力,经治疗最终视力优于伤后视力（P〈0．01）。136例无光感眼视力好转率仅为25．74％,比残留视力眼的好转率低42．26％（P〈0．01）。联合治疗与单纯药物治疗的疗效差异有统计学意义（P〈0．01）。Logistic回归法分析,显示手术治疗对于伤后残留视力眼的视力好转有意义（P〈0．01）,伤后昏迷是影响视神经损伤眼预后的危险因素（P〈0．05）。伤后残留视力眼,视神经管骨折、颅脑伤、年龄偏高、视力首次好转时间延迟均为影响患者视力预后的危险因素,而视神经损伤后及时的手术治疗则是保护视力的有利措施,伤后残留视力值分别与最终视力和视力恢复值呈直线正相关。结论视力为无光感、昏迷、视神经管骨折、颅脑伤、年龄偏高、视力首次好转时间延迟均为间接视神经损伤患者视力预后的危险因素,而伤后残留视力情况直接关系到患者的视力预后;视神经管减压术有利于伤后残留视力眼的预后,联合治疗的效果优于单纯药物治疗。     

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     

3种保肝药物治疗艾滋病人的药物性肝损伤的成本—效果分析

目的:评价3种保肝药物治疗艾滋病人的药物性肝损伤的成本—效果。方法:166例患者随机分为3组,分别给予还原型谷胱甘肽(A组)、复方甘草酸苷(B组)、硫普罗宁(C组),治疗28d后观察(A、B、C组)3组治疗效果,并进行成本—效果分析。结果:A组疗效显著>B、C组(P<0.05),且A组成本/效果比为3组中最低。结论:还原型谷胱甘肽(A组)为艾滋病人的药物性肝损伤的较佳治疗药物。