锁定钢板内固定治疗肱骨上段复杂骨折

目的]评价门静脉、下腔静脉磁共振血管成像腹部肿瘤血管侵犯的影像特征及诊断价值.方法]收集47例肝脏、胰腺及腹膜后等肿瘤患者门腔静脉增强磁共振血管成像（CE-MRA）原始数据,用最大密度投影（MIP）及薄层多平面重组（MPR）两种方法重建血管影像对血管是否存在侵犯进行术前评估.评估结果与手术结果对照,并总结血管受侵的相关影像学表现.结果]27例存在血管侵犯,门静脉侵犯18例、肝静脉侵犯4例、下腔静脉侵犯5例.CE-MRA成像技术对门静脉系统血管侵犯判断的特异性和敏感性分别为：90.1%,94.4%,阳性预测值为：89.4%,阴性预测值为95.2%;对下腔静脉-肝静脉系统血管侵犯判断的特异性和敏感性分别为：93.5%,88.9%,阳性预测值为：80%,阴性预测值为96.6%.血管受累主要表现为：血管腔的突然狭窄中断、狭窄,远侧血管不显影;血管壁缺损;血管腔内向心和偏心性充盈缺损;侧支循环形成.结论]3T磁共振CE-MRA多种方法血管重建能清晰显示门静脉、肝静脉及下腔静脉,在腹部肿瘤术前血管评估中起重要作用.

Locking Plate Internal Fixation for Treating Complex Proximal Humeral Fractures

Objective] to explore the efficacy of locking proximal humeral plat（LPHP） in treating complex proximal humeral fractures. Methods] Fifty two patients with complex proximal humeral fractures undergo- ing open reduction and LPHP in our hospital from 2005 to 2009 were analyzed retrospectively. According to Neer system, all of them were three-part or four-part fractures. Twenty five patients receive LPHP treatment and 27 patients received traditional T-type plate or general proximal humeral plate treatment. The operation time, bone healing time and good and excellent rate of postoperative function by Constant-Murley absolute value rating system were evaluated and used to compare the efficacy of two fixation methods. Results] The operating time of LPHP group and traditional plate group were 89.0± 15.6 minutes and 120.6±21.9 minutes, respectively, and the difference had statistical significance（ P 〈0.05）. The bone healing time of LPHP group and traditional plate group were 13.0±2. 10 weeks and 15.5±2.67 weeks, respectively, and the difference had statistical significance（ P 〈0.05）. The good and excellent rate in LPHP group and traditional plate group by Constant-Murley absolute value rating system were 92.0% and 66. 7%, respectively, and the difference had statistical significance（ P 〈0.05）. Conclusion] Compared with the traditional plate, LPHP for treating complex proximal humeral fractures has shorter operation time, faster bone healing, firmer fixation and better functional recovery, so it is worthy to be extended in clinic.