后尿道损伤的早期,亚早期手术治疗

１９７３－１９９４年５月共收治骨盆骨折所致的后尿道断裂５４例，其中行早期尿道吻合３３例，亚早期尿道吻合９例，占７７．８％（４２．５４），均取得满意效果，尿道断早期组织弹性好，无粘连，无瘢痕，可以达到解剖对位。手术同时可以清除血肿及外渗尿液，减少感染及狭窄机会，对合并休克的病人在休克纠正后，处理其他复合伤的同时急尽早行尿道对端吻合术。对伤严重的的病人经抢救休克处理复合伤，生命指标平稳后行亚早期手术仍     

移植于脊髓的断离肋间神经重发新支至原去神经肋间肌的实验观察

将15只大鼠左侧第11或12肋间神经从根部向外,自周围组织完全分离出20～35mm,并于此处剪断。再将其近端改向植入脊髓左侧半 L_(1～2) 之间的髓节内。在存活57～413天后解剖观察,发现自移植神经的干上发出1～3条新分支,分布于原去神经的肋间肌。经光、电镜观察证实是成活的再生神经纤维。于移植神经干注射 CB-HRP 后,发现这些神经纤维来源于原肋间神经髓节的前角和移植部髓节内的神经细胞。故认为外周神经缺损,不作神经对接或桥接,不经断离神经的远段,在一定条件下可以由近段发出再生纤维组成新支,分布于去神经的靶组织。     

中度视网膜冲击伤后血视网膜屏障改变兔模型的评价

应用ＢＳＴ－Ⅲ型生物激波管致伤建立的中度视网膜冲击伤兔模型，研究视网膜冲击伤后血视网膜屏障（ＢＲＢ）的改变，结果显示，中度视网膜冲击后除有炎症性反应外，可致视网膜细胞部分变性和坏死，ＢＲＢ轻度损害和视网膜电图（ＥＲＧ）ｂ波波幅下降４０％。由于受损细胞在某些因素如自由基的作用下可进一步导致ＢＲＢ严重继发性损害。如早期进行正确处理，可能阻止这种“不稳定”受损细胞的继发性损害。因此，该模型可用于研究视网     

Ultrasound for diagnosis of apophyseal injuries

Avulsion injuries of the apophysis is a problem in young athletes. A correct diagnosis is necessary for establishing the appropriate treatment and the rehabilitation program. However, it is often difficult to distinguish between a simple muscle strain and an avulsion fracture. The X-ray examination is helpful only when an ossification center of the apophysis exists. Ultrasonography is considered the suitable diagnostic tool for these cases. From June 1988 to June 1993, 243 young athletes were seen with an anamnestic and clinically suspected apophyseal injury of the lower extremity. In all cases X-ray examination and ultrasound examination were performed. In 80 cases the diagnosis was confirmed by X-ray examination and in 97 by ultrasonography. Four criteria were defined for the sonographic examination: (a) a hypoechogenic zone, (b) increased distance to the apophysis, (c) dislocation of the apophysis, and (d) mobility of the apophysis on dynamic examination. These criteria are correlated to (a) edema, (b) lysis, (c) avulsion, and (d) unstable avulsion of the apophysis. Ultrasonography is a proven technique for the detection of apophyseal injuries. In comparison to X-ray examination, it has the advantages of no radiation exposure, early detection even without ossification center, and dynamic examination.     

月骨周围进行性不稳定的腕运动力学研究

目的探索腕月骨周围进行性不稳定的运动力学变化。方法对１４具新鲜冷冻尸体腕关节，用计算机辅助测量了正常腕和各阶段月骨周围不稳定时腕动力肌腱在腕屈伸、尺桡偏时滑动幅度，根据肌腱滑动幅度和关节运动范围计算动力肌腱力臂。结果月骨周围进行性不稳定时屈腕肌腱力臂明显增大，屈指肌腱力臂减小；桡侧腕动力肌腱力臂以增大为主，尺侧肌腱力臂以减小为主。桡侧腕屈肌腱在腕屈伸或尺桡偏时均显著增大。结论腕运动力学变化对月骨周围不稳定的形成、运动力学变化、腕部塌陷起重要起动作用。     

sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情转归关系探究

目的 探讨可溶性白细胞分化抗原14（soluble cluster of differentiation antigen 14,sCD14）、血管生成素2（angiopoietin 2,Ang2）、C反应蛋白（C-reactive protein,CRP）与急诊创伤骨折伴多发伤患者病情转归的关系及意义。 方法 选取创伤骨折伴多发伤患者324例,根据患者出院时病情转归情况分为良好组（275例）、不良组（49例）,比较2组一般资料、sCD14、Ang2、CRP水平,应用Pearson分析sCD14、Ang2、CRP与损伤严重程度评分（injury severity score,ISS）关系,采用Cox回归分析急诊创伤骨折伴多发伤患者病情转归的相关影响因素,采用受试者工作特征曲线（receiver operating characteristic,ROC）分析sCD14、Ang2、CRP对病情转归预测价值。 结果 不良组ISS评分高于良好组（P＜0.05）;不良组sCD14、Ang2、CRP高于良好组（P＜0.05）;sCD14（r=0.785）、Ang2（r=0.778）、CRP（r=0.842）与ISS评分呈正相关（P＜0.05）;sCD14、Ang2、CRP均是预后相关独立危险因素（P＜0.05）;sCD14、Ang2、CRP预测病情转归的ROC下面积（area under the curve,AUC）依次为0.813、0.757、0.749;挑选出预测敏感度最高（sCD14）、特异度最高（Ang2）的两个指标进行sCD14+Ang2的联合ROC分析显示,两者联合预测病情转归的AUC为0.935,大于任一单一指标（P＜0.05）。 结论 sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情严重程度及病情转归有关,均可作为预测病情转归的标志物,但联合检测sCD14、Ang2能提高预测可靠性,为临床诊疗及护理提供更准确的参考信息。     

Absence of the left inferior thyroid artery: clinical implications

Dissection of an adult male cadaver revealed an absence of the left inferior thyroid artery; its usual area of distribution to the thyroid gland was supplied by the right inferior thyroid artery. Absence of the left inferior thyroid artery occurs in 1-6% of cases. The inferior thyroid artery arises commonly from the thyrocervical trunk, passes posterior to the carotid sheath and supplies the inferior pole of the corresponding lobe of the thyroid gland; its branches can course anterior or posterior to or between branches of the recurrent laryngeal nerve. During thyroid surgery it is imperative to identify the relationship of the inferior thyroid artery to the recurrent laryngeal nerve or to establish its absence because injury to the nerve can be a major complication; awareness of significant variations of the surgical anatomy of the thyroid gland is vital for preserving the integrity of important structures.     

Pediatric head injuries caused by traffic accidents

In an unselected series of 488 patients with head injuries referred to a general surgical department, there were 126 children aged 0–19 years whose head injuries were a result of traffic accidents. In age group 0–4 years, only 23% of the head injuries were due to traffic accidents. In age groups 5–9, 10–14, and 15–19 years, however, traffic accidents were the main cause of the injuries, being responsible for 47%, 65% and 82% of the cases respectively. Both age groups 5–9 and 10–14 years had an unusually high proportion of bicycle injuries, while motorcycle and automobile accidents were the leading causes of injury in age group 15–19 years. Eight children (6%) died as a result of head trauma. Furthermore, among the survivors there were 8 children with severe head injuries (post-traumatic amnesia lasting 24 h), the rest being minor head injuries. All the survivors but one returned to school and achieved reasonable performances. Repeated follow-up studies at 3 months, 1 and 5 years, including interviews with the parents, disclosed that several of the children had headache, dizziness and other complaints. These subjective complaints subsided with time, but with different patterns, in the younger and older age groups. It is concluded that the postconcussional syndrome is not uncommon in children, but it may be better tolerated and resolves more completely with time than in adults. Eight children (7%) had one seizure or more during the 5-year follow-up period.     

Bilateral brain abscesses complicating the use of crutchfield tongs

The case of a 4-year-old girl who developed bilateral brain abscesses complicating skull traction is reported. Crutchfield tongs were used to reduce a fracture dislocation at C2–3. Presenting symptoms consisted of headaches and focal seizures. Surgical treatment and antibiotics using serial CT led to a satisfactory outcome. This is the first reported case of this complication in a child. The current literature is reviewed.To whom offprint requests should be addressed at Avda. Pio Baroja 4, 30011 Murcia, Spain     

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning

Summary This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with negative angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.Our series amounts to a data bank of cases both contemporary to and in good agreement with that collected by Jennett and his associates in their 1977 multinational study; and it affords a useful reference in the assessment of epidemiological variations and alternative management in relation to outcome.