微创穿刺术在急诊抢救外伤性颅内血肿中的应用

目的探讨微创穿刺术在急诊抢救外伤性颅内血肿的应用价值。方法回顾性分析1995年1月到2005年12月于我院应用微创穿刺术抢救脑疝阶段的外伤性颅内血肿患者126例的临床资料,以术前凹片为依据,确定穿刺点、置管方向及深度,在急诊手术室局麻下行微创穿刺并置管引流的方法。结果本组穿刺成功率100％。瞳孔散大患者经引流后瞳孔均有不同程度缩小,单侧瞳孔散大组79／95例（83．1％）;双侧瞳孔散大组17／31（54．8％）,以临床即时效果评价的总有效率76．2％。根据COS结果分级：良好48例,中残26例,重残18例,植物生存16例,死亡18例。结论微创穿刺术可快速改善脑疝症状,缩短脑疝时限,延长开颅手术的时间窗,是一种有效的抢救手段,同是也是创伤急救医生有必要掌握的一种确定性救命手术技术。     

颅脑外伤并发脑梗塞的临床分析

目的分析颅脑外伤后并发脑梗死的发生机制,探讨早期预防、救治的措施。方法 总结自1997年1 月至2003年1月收治颅脑外伤并发脑梗塞39例临床经验。结果按格拉斯哥结果分级判断预后的标准,治 愈17例,中残5例,重残5例,植物生存3例,死亡9例。结论认为提高对颅脑外伤并发大面积脑梗塞的 认识,早期诊断和早期治疗是提高疗效的保证,及时手术、术中、术后进行正确预防和治疗,将有助于改善 患者的预后和提高生存质量。     

固位纤维树脂夹板在青少年前牙外伤的临床应用

目的:探讨固位纤维树脂夹板在青少年前牙外伤的临床应用效果。方法:选择13-18岁青少年前牙外伤患者50例,共71颗患牙,使用固位纤维树脂夹板固定。结果:固位3-4周临床复查,成功50颗,显效16颗,总有效率为92.96％;患者满意度调查各项结果均在90％以上。随访疗效评定,3个月复查,成功45颗,显效16颗,总有效率为...     

β-七叶皂甙钠治疗创伤性肿胀疗效观察

目的:研究β-七叶皂甙钠治疗创伤性肿胀的疗效。方法:将100例创伤性肿胀病人的损伤部位及损伤性质基本相同的病人配对,分为治疗组50例,男34例,女16例,年龄30±8岁,给予β-七叶皂甙钠10mg溶于250ml生理盐水中静滴,并予常规治疗(切开复位内固定和抗感染);对照组50例,男32例,女18例,年龄32±10岁,仅予常规治疗。疗程均为14d。结果:治疗组治愈率96％,高于对照组(48％),经t检验,治愈率有显著性差异(P<0.05)。治疗组水肿消失明显快于对照组。结论:β-七叶皂甙钠治疗创伤性肿胀有效。     

2072例颅脑创伤患者用血状况调查

目的掌握华东六省一市颅脑创伤(TBI)患者用血状况,为临床合理输血和及时救治患者提供理论依据。方法组织华东六省一市77家医院神经外科医生对经治的14948例颅脑创伤患者严格填写《颅脑创伤流行病学调查表》,收集2004年颅脑创伤住院患者输血与疾病的诊断、治疗及预后等相关因素的信息,获得的数据用SPSS13.0进行统计分析。结果14948例患者中经输血治疗2072例,其中男性1663例(80.26%),女性409例(19.74%),平均年龄(41.56±17.36)岁,15～44岁的占56.00%。平均每人输血1114.03ml,54%的患者输血量在400～800ml。术中输血(70.08%)和失血性休克(23.75%)为输血主要原因。合并伤越重、颅内受损越重、颅脑手术越复杂者输血概率越大;颅脑损伤程度越重,输血量越多(χ2=103.44,P<0.005);输血越多,引起感染等并发症的概率越大(χ2=1593.98,P<0.001),预后越差(χ2=62.42,P<0.005)。结论对颅脑患者早期应积极控制出血性休克,预防各种感染、休克等并发症,术中严格控制出血,术后及时纠正贫血。     

Long-term expression of heme oxygenase-1 (HO-1, HSP-32) following focal cerebral infarctions and traumatic brain injury in humans

Extracellular heme derived from hemoglobin following hemorrhage or released from dying cells induces the expression of heme oxygenase-1 (HO-1, HSP-32) which metabolizes heme to the gaseous mediator carbon monoxide (CO), iron (Fe) and biliverdin. Biliverdin and its product bilirubin are powerful antioxidants. Thus, expression of HO-1 is considered to be a protective mechanism against oxidative stress and has been described in microglia, astrocytes and neurons following distinct experimental models of pathological alterations to the brain such as subarachnoidal hemorrhage, ischemia and traumatic brain injury (TBI) and in human neurodegenerative diseases. We have now analyzed the expression of HO-1 in human brains following TBI (n = 28; survival times: few minutes up to 6 months) and focal cerebral infarctions (FCI; n = 17; survival time: < 1 day up to months) by immunohistochemistry. Follwing TBI, accumulation of HO-1+ microglia/macrophages at the hemorrhagic lesion was detected as early as 6 h post trauma and was still pronounced after 6 months. In contrast, after FCI HO-1+ microglia/macrophages accumulated within focal hemorrhages only and were absent in non-hemorrhagic regions. Further, HO-1 was weakly expressed in astrocytes in the perifocal penumbra. In contrast to experimental data derived from rat focal ischemia, these results indicate a prolonged HO-1 expression in humans after brain injury.     

Six-year course and prognosis of traumatic knee symptoms in general practice: Cohort study

Background Traumatic knee symptoms are frequently seen, however, evidence about the course and prognostic factors are scarce.

Objectives To describe the one and six-year course of traumatic knee symptoms presenting in general practice, and to identify prognostic factors for persistent knee symptoms.

Methods Adolescents (≥12 years) and adults with traumatic knee symptoms (n?=?328) from general practice were followed for six years with self-report questionnaires and physical examination.

Results Persistent knee symptoms were reported by 27% of the patients at one year and by 33% at six years. There was a strong relationship (OR: 11.0, 95% CI: 5.0–24.2) between having persistent knee symptoms at one year and at six-year follow-up. Prognostic factors associated with persistent knee symptoms at one year were age, poor general health, history of non-traumatic knee symptoms, absence floating patella and laxity on the anterior drawer test (AUC: 0.72). At six-year follow-up, age, body mass index?>?27, non-skeletal co-morbidity, self-reported crepitus of the knee, history of non-traumatic knee symptoms, and laxity on the anterior drawer test were associated with persistent knee symptoms (AUC: 0.82).

Conclusion Traumatic knee symptoms in general practice seem to become a chronic disorder in one out of three patients. Several prognostic factors assessed at baseline were associated with persistent knee symptoms at one and six-year follow-up.