Y形钢板加松质骨螺钉固定和尺神经前置治疗肱骨髁间骨折

目的:评价Y形钢板加松质骨螺钉固定及常规尺神经前置治疗肱骨髁间骨折的疗效。方法:2003年7月～2006年6月,采用Y形钢板加松质骨螺钉固定及常规尺神经前置的方式手术治疗肱骨髁间骨折31例。随访资料完整27例,男21例,女6例;年龄16～72岁,平均39岁。肱骨髁间骨折按AO/ASIF分型:C1型17例,C2型8例,C3型2例。除3例合并尺骨鹰嘴骨折经后侧骨折端入路,其余均采用Campbell后侧入路。术后早期肘关节CPM功能练习。结果:随访6～27个月,平均11.8个月,按Cassebaum方法评价疗效:优16例,良8例,可3例。优良率88.9%。3例术前尺神经挫伤随访8个月,1例神经功能恢复不全,另2例均完全恢复。肘关节功能良好。结论:肱骨髁间骨折应尽早解剖复位,尺神经前置可有效减少神经麻痹的发生,对于术前有尺神经挫伤者也有利于神经功能恢复。坚强的固定便于早期功能锻炼,有助于肘关节功能恢复。     

应用大动脉转换术治疗完全性大动脉错位

目的 探讨Switch术(大动脉转换术)在完全性大动脉错位(D-TGA)中的应用.方法 2003年1月至2006年5月应用Switch术治疗完全性大动脉错位7例.手术平均年龄(3.14±4.56)个月,体重(4.12±9.45)kg.结果 手术死亡1例,其余随访2月～3年,胸片,心脏超均提示心脏能状况良好.1例患儿主肺动脉吻合口压差35mm Hg.结论 大动脉转换术在完全性大动脉错位中的应用可以取得良好的手术效果,术中保持肺动脉吻合的低张力和冠状动脉移植的通畅,是手术成功的关键.     

宫颈癌根治术中行卵巢移位的临床效果分析

目的探讨宫颈癌根治术中行卵巢移位术术后卵巢的功能状况。方法1999年1月至2003年12月江门市新会区人民医院等2家医院收治43例年龄26~40岁宫颈癌ⅠB~ⅡA期患者,其中22例在宫颈癌根治术中行卵巢移位术为观察组,21例行传统的宫颈癌根治术为对照组。术后应用血FSH、LH、E2及Kuppermann评分进行卵巢功能测定,随访1~4年。结果观察组术后4年内卵巢功能基本正常,对照组术后1个月卵巢功能丧失。两组记录生存质量的改良Kuppermann评分比较差异有非常显著性意义(P<0·01),而复发率和存活率比较差异无显著性意义(P>0·05)。结论宫颈癌患者在宫颈癌根治术时行卵巢移位术,可保留卵巢功能。     

Omental cysts: an unusual cause of abdominal distension in children

Congenital cystic lesions arising in the omentum are a rare finding in the paediatric age group. They are difficult to diagnose preoperatively as they have few distinct features; the diagnosis is often confirmed only at lalaparotomy. They are thought to arise due to a developmental abnormality of the lymphatic system. Two cases are presented and the literature reviewed. The treatment of choice is complete resection. Long-term follow-up is unnecessary due to their benign nature.     

动脉转位术的临床应用

目的 总结动脉转位术(arterial switch operation，ASO)治疗完全型大动脉转位(transposition of the great arteries，TGA)和右心室双出口伴肺动脉瓣下室间隔缺损(VSD)的临床经验。方法 采用ASO治疗小儿先天性心脏病32例，其中TGA22例，伴室间隔完整型(intact ventricular septum，IVS)9例，伴VSDl3例；右心室双出口伴肺动脉瓣下VSD(Taussig—Bing)10例。结果TGA／IVS9例中死亡1例，TGA／VSD13例中死亡4例，Taussig-Bing10例死亡3例，总手术死亡率25％(8／32)。术后随访3个月～2年，所有患者紫绀消失，活动能力明显增强。1例Taussig—Bing术前二尖瓣轻-中度反流，术后仍为中度反流；2例TGA主动脉和肺动脉瓣上狭窄，压差40mmHg(1kPa=7．5mmHg)，1例肺动脉瓣下狭窄和残余VSD，3个月后再次手术治愈。结论 ASO已广泛应用于TGA的纠治，手术效果满意；应用于右心室双出口肺动脉瓣下VSD的早期纠治，不但可防止发生肺血管阻塞性病变，而且避免了心内修补左心室流出道梗阻的远期并发症。     

The prevalence of hereditary neuropathy with liability to pressure palsies in patients with multiple surgically treated entrapment neuropathies

PURPOSE: Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant peripheral neuropathy that results from deletion of a 1.5-Megabase pair (Mb) segment of the short arm (p) of chromosome 17. Hereditary neuropathy with liability to pressure palsies increases susceptibility of peripheral nerves to pressure and trauma and can be associated with symptoms at multiple anatomic entrapment sites. Many patients present with multiple upper-extremity entrapment neuropathies and the etiology is uncertain. We hypothesized that some of these patients have an underlying hereditary neuropathy. The purpose of this study was to determine the prevalence of HNPP in patients with multiple surgically treated upper-extremity entrapment neuropathies. METHODS: The inclusion criterion for the study was history of more than 1 carpal tunnel release and/or ulnar nerve transposition. The exclusion criteria were history of diabetes or history of Charcot-Marie-Tooth neuropathy. Fifty-nine patients were in the study group. Two patients known to have the 17p11.2 deletion were used as controls. Genomic DNA was extracted from peripheral blood. Each sample was genotyped using polymerase chain reaction (PCR) amplification with short tandem repeat polymorphism markers within the 1.5-Mb region of 17p deleted in HNPP. Markers were scored as homozygous or heterozygous after resolution by polyacrylamide gel electrophoresis and silver staining. RESULTS: The 2 control patients were homozygous for 11 markers. None of the 59 study patients were homozygous for all markers tested in the deleted region. No study patient had the 17p deletion diagnostic for HNPP. Based on the sample size of 59 patients the 95% confidence interval for the prevalence of the 17p11.2 deletion in this population is 0% to 5%. CONCLUSIONS: We found no evidence for an association between HNPP and patients who have multiple surgical releases for upper-extremity entrapment neuropathies.     

Idiopathic Omental Bleeding: Report of a Case

We report a case of idiopathic omental bleeding in a 27-year-old man who was brought to our hospital after the sudden development of intermittent abdominal pain, nausea, and fainting. Computed tomography showed intra-abdominal fluid and emergency laparotomy revealed a hemorrhagic mass in the omental bursa, which was excised. The patient was successfully treated and a diagnosis of idiopathic omental bleeding was made.     

Ulnar nerve pathology at the elbow: the place of anterior transposition today

Summary A retrospective study is presented of 39 patients with ulnar nerve pathology at the elbow. All patients were treated by anterior transposition. Improvement to at least good functional recovery occurred in 46% of the patients. In the other 54% there was only slight or no improvement, or even deterioration. A further analysis of the results showed that in patients with objective signs of ulnar pathology, but without muscular atrophy, the results were good: 64% of these patients showed a good operative result. The most important factors in postoperative prognosis in the patients studied are the existence of muscular atrophy, age, and, in the moderately severe group, the length of history before operation. The aetiology was not important with respect to the outcome. On the basis of the recent literature and the results of this study suggestions are presented for a rational choice between the different possibilities of treatment for ulnar nerve pathology at the elbow.     

Mandibular lateral incisor-canine transposition associated with dental anomalies

Tooth transposition is a rare positional anomaly that may create many orthodontic problems. Its etiology is an enigma. The occurrence of mandibular canine/lateral incisor transposition is a relatively rare anomaly. Two rooted canine/rotated incisor transposition has not been reported previously in the clinical dental literature. We describe a case with transposition of a mandibular two rooted canine and a lateral incisor with 180 degrees rotation. Possible causes such as trauma and tooth agenesis were absent in this case. Due to the root anomaly, we consider that our case may have a genetic etiology. Although the mandibular lateral incisor and canine were not in their normal anatomic positions, there were no functional or esthetic problems.