Craniofacial penetration by a wooden stick

IntroductionPenetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity.Case summaryWe describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3 cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain.DiscussionPenetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.     

经迷路径路听神经瘤手术中对颈静脉球的处理

目的探讨经迷路径路听神经瘤手术中处理颈静脉球的方法和临床疗效。方法回顾性分析上海交通大学医学院附属第九人民医院耳鼻咽喉科2016年1月~2017年6月由同一术者经迷路径路手术治疗的72例听神经瘤患者的临床资料,包括术中对颈静脉球的处理和效果。结果72例患者中颈静脉球高位的出现率为29.2%（21例）。术中所有颈静脉球均予清楚暴露。为充分显露桥小脑角,降低50例颈静脉球的高度,其中颈静脉球破裂4例,均为高位颈静脉球（3例使用双极电凝止血,1例通过止血纱布和骨蜡填塞止血）。肿瘤直径为（2.4±1.5）cm,手术全切70例,次全切除2例。术后面神经解剖及功能保留72例,均未出现后组脑神经功能异常。术后一年随访复查MRI未见肿瘤复发,面神经功能HB-I~II 66例（91.7%）,HB-III~IV 6例（8.3%）。结论经迷路径路手术中恰当处理颈静脉球,可充分显露桥小脑角,同时降低颈静脉球破裂和误伤后组脑神经的风险。     

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach: A prospective case-control study

Background:The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach.Methods:This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score.Results:A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049).Conclusion:The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.     

经岩乙状窦前入路的相关影像学研究

目的:为该入路提供影像解剖依据,减少术后并发症。方法:对10例成人头颅标本先行高分辨率CT岩骨薄层扫描,后用磨钻对标本轮廓化骨迷路,分别测量与该入路有关的后半规管及乙状窦沟与周围骨质的距离。结果:CT扫描测量乙状窦沟宽是11.44±1.79mm,深是5.27±1.93mm,乙状窦沟底到乳突外表面的距离是10.38±3.90mm,乙状窦沟前壁到外耳道后壁的距离是13.66±2.18mm。后半规管最外侧至乳突外表面的最近距离是13.44±1.86mm,至乙状窦沟前缘的距离是9.65±1.76mm,其最后部至岩骨后壁的距离是2.92±0.98mm。对应的解剖测量结果分别是11.26±1.58mm、5.12±1.88mm、10.26±3.78mm、13.74±1.96mm、13.86±1.98mm、9.82±1.91mm和3.12±1.08mm。CT扫描测量与解剖测量结果统计学上无显著性差异(P>0.05)。结论:CT扫描测量结果可代表实际的相关解剖结构的距离,CT岩骨薄层扫描可指导经岩乙状窦前入路中岩骨后外侧壁的安全磨除。     

双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎的临床疗效

目的:探讨双入路小切口坏死组织清除术联合持续灌注引流治疗感染性坏死性胰腺炎（INP）的临床疗效。方法:采用回顾性描述性研究方法。收集2016年4月至2019年7月陆军军医大学大坪医院收治的20例INP病人的临床资料;男11例,女9例;年龄为（42 ±9）岁。20例病人均行双入路小切口坏死组织清除术,联合术后...     

Motivation to Consent and Adhere to the FORT Randomized Controlled Trial

The aim of this qualitative study was to identify the motivational factors that influence cancer survivors to participate and adhere to the fear of cancer recurrence (FCR) FORT randomized controlled trial (RCT). Fifteen women diagnosed with breast and gynecological cancer who took part in the FORT RCT were interviewed about their experience to consent and adhere to the trial. The transcribed interviews were content analyzed within a relational autonomy framework. The analysis revealed that the participants’ motivation to consent and adhere to the FORT RCT was structured around thirteen subthemes grouped into four overarching themes: (1) Personal Influential Factors; (2) Societal Motivations; (3) Structural Influences; and (4) Gains in Emotional Support. The unique structures of the trial such as the group format, the friendships formed with other participants in their group and with the group leaders, and the right timing of the trial within their cancer survivorship trajectory all contributed to their motivation to consent and adhere to the FORT RCT. While their initial motivation to participate was mostly altruistic, it was their personal gains obtained over the course of the trial that contributed to their adherence. Potential gains in emotional and social support from psycho-oncology trials should be capitalized when approaching future participants as a mean to improve on motivations to consent and adhere.     

神经内镜辅助夹闭颅内动脉瘤临床研究

目的 探讨神经内镜辅助夹闭颅内动脉瘤的价值。方法 2000年2月至2002年12月，神经内镜辅助颅内动脉瘤手术夹闭78例患79个动脉瘤，前循环系统动脉瘤72例(73个动脉瘤)，后循环系统动脉瘤6例。动脉瘤体直径5—40mm，平均12．5mm。术前分级：Hunt—Hess分级0级8例，Ⅰ级32例，Ⅱ级33例，Ⅲ级5例。结果 本组无手术死亡，手术后出现并发症6例(7．7％)，其中肢体偏瘫4例(1例合并语言障碍)，伪膜性肠炎及视力下降各1例。本组未出现与内镜有关的并发症。结论 神经内镜辅助动脉瘤外科提高了手术效果，但神经内镜设备仍有待改进。     

耳后小切口入路手术治疗三叉神经痛1100例临床分析

本文报告自１９８４年１月至１９９３年４月，对诊断为原发性三叉神经痛久治不愈者１１００例，采用局麻、耳后小切口入路行桥小脑角探查术。据术中发现不同病因采用神经血管减压术、肿瘤切除术等治疗。本组死亡２例，近期总有效率为９９．５％。对本病的治疗方法、术式的选择、并发症和副反应的防治等问题，进行了讨论。     

翼点入路经终板切除鞍区肿瘤的显微外科技术

目的 探索利用终板切开更好地显露肿瘤,争取对颅咽管瘤和巨大垂体瘤、胚胎瘤、脑膜瘤实施全切手术。方法 自1994年至1998年所施行的347例鞍区肿瘤中,有44例需切开终板行肿瘤切除。视交叉前置和侵及三脑室前部的肿瘤是施行终板切开的适应证,此种情况可在术前MR片上获取有益信息。终板切开前,仔细地解剖侧裂池、颈动脉池、视交叉池,分离切断蛛网膜连结是暴露终板的前提条件。沿同侧视束切开终板、注意辨识和保护视交叉及对侧视束是防止术后视力下降、视野缺失的关键。肿瘤的囊内分块切除,联合间隙1、间隙2,牵引剥离肿瘤是既能全切肿瘤,又能防止术后下丘脑、丘脑受损的有效方法。结果终板切开结合间隙1、间隙2切除鞍区肿瘤,全切率达84％(37/44),其中颅咽管瘤全切率为94％(29/31),垂体瘤为89％(8/9)。术后死亡率为14.6％,死因多为癫痫大发作或持续癫痫。结论 终板附近有下丘脑等重要神经结构,此区手术如方法得当不会损伤上述重要结构,并能达到全切肿瘤的目的。