加压滑动鹅头钉治疗股骨粗隆间骨折并发症探讨

由于加压滑动鹅头钉具有加压滑动、稳定内固定作用，病人术后可早期活动、减少并发症、降低死亡率，早已广泛应用于临床。但如手术不当可发生不良结局。自１９８３年３月～１９９２年１２月应用加压滑动鹅头钉治疗股骨粗隆间骨折１１０例，发生手术并发症１６例，占１４．...     

80岁以上老年人股骨转子间骨折的手术治疗

目的探讨治疗老年人股骨转子间骨折的疗效。方法回顾性分析23例80～93岁老年股骨转子间骨折患者的临床资料。结果23例中,股骨转子间稳定型骨折6例,不稳定型17例;患有不同程度并存疾病12例。术后约14～18周完全负重。本组无手术死亡。平均随访32月,术后优良率为82。6%(优8例,良11例)。结论动力加压螺纹钉（DHS）固定牢固,在患者早期康复、减少并发症方面优于L-角钢板及中空加压螺纹钉。     

特制加压滑动鹅头钉治疗股骨转子下骨折

特制加压滑动鹅头钉治疗股骨转子下骨折１０００９１北京解放军第３０９医院常青黄迅悟范玉山荆海赵大庆朱文忠曲文春关键词骨折固定术，内；股骨骨折中国图书资料分类号Ｒ６８７．３２转子下骨折是髋部骨折中最难处理的创伤。１９９２～１９９４年，作者用特制加压滑动鹅...     

加长加压滑动鹅头钉在股骨转子下骨折治疗中的应用

介绍加长加压滑动鹅头钉的结构、原理及在股骨转子下骨折治疗中的应用.该器械抗内翻弯曲强度大,放置方便,固定可靠,术后活动早、愈合快.适用于转子下骨折、波及转子下的转子间骨折的治疗.     

股骨粗隆间骨折内固定材料的选择

对股骨转子间骨折尽量采用内固定治疗方法的见解已趋一致。内固定方法很多 ,如何根据不同类型的骨折 ,选用最佳的内固定方式 ,是提高治疗效果 ,减少并发症的关键。我科 1 991年 3月～ 1 998年 6月共手术治疗股骨粗隆间骨折 1 58例 ,分别选用多根斯氏针、加压螺纹钉、麦氏鹅头三翼钉、1 3 0°角钢板、加压滑动鹅头钉作为内固定材料 ,报告如下。1　临床资料1 .1　一般资料　本组共 1 58例 ,男 97例 ,女 61例 ,年龄 2 1～ 86岁 ,平均年龄 53 .5岁。55岁以上者 1 0 2例 ,占本组病例的 64 .6%。损伤原因 :车祸 4 4例 ,骑自行车摔倒 3 5例 ,平地摔…     

股骨转子间骨折动力髋螺钉内固定失败的危险因素

目的 探讨导致股骨转子间骨折动力髋螺钉（DHS）内固定失败的危险因素。方法 分析2000年11月～2003年5月应用DHS治疗的137例股骨转子间骨折患者，男42例，女95例；平均年龄68岁（43～83岁）。平均随访13个月（8～34个月）。其中跌倒等低能量创伤98例，交通伤等高能量创伤39例。选择股骨颈螺钉切出指数、骨质疏松程度及骨折类型作为变量，应用COX模型分析其导致DHS内固定失败的风险比率。结果 本组中15例内固定失败。随切出指数增大，DHS内固定失败发生率增加。骨折分型、骨质疏松程度均与DHS内固定失败相关，转子间骨折不稳定型并伴有骨质疏松者易发生DHS内固定失败。COX模型行多因素分析后发现，切出指数、骨折类型、骨质疏松是转子问骨折DHS内固定失败的独立预后因素。结论 沿股骨头中轴较深地拧入股骨颈螺钉，可减少切出指数，降低内固定失败率。术前应用Singh法评价骨质疏松程度，并根据改良Evans转子间骨折分型确定骨折类型，能够预测术后内固定失败的风险。对于不稳定型且伴有严重骨质疏松的转子间骨折患者，不宜应用DHS内固定治疗。     

AO股骨近端髓内钉在股骨转子间骨折治疗中的应用

目的讨论应用国际内固定研究学会（AO）股骨近端髓内钉（PFN）治疗股骨转子间骨折的临床疗效。方法应用AO产PFN治疗股骨转子间骨折35例，并随访疗效。结果34例获得随访，时间6—24个月，平均14个月，骨折全部愈合，髋关节功能优良31例（91．2％）。结论AO股骨近端髓内钉治疗股骨转子间骨折具有手术创伤小、微创、固定牢靠、病人可早期进行功能活动，并发症少等优点，是目前治疗股骨转子间骨折较理想的内固定物。     

双颈滑动加压螺纹钉设计及转子间骨折治疗

目的：研究治疗股骨转子间骨折的最佳手段．方法：设计双颈滑动加压螺纹钉．该钉由一个双套筒钢板、２枚粗螺纹钉、２枚尾部扣锁和骨皮质螺丝钉四部分组成．对该钉及Ｒｉｃｈａｒｄｓ钉进行了生物力学测试，临床使用３１例．结果：双颈滑动加压螺纹钉的抗旋转强度为（３０．８７±５．４９）Ｎ／ｍ２，而Ｒｉｃｈａｒｄｓ钉仅（７．４５±１．５７）Ｎ／ｍ２．两者差异有统计学意义（Ｐ＜０．０１）．而且，该钉有较强的抗弯强度，其最大一次性载荷为（３４６９．２±５５８．６）Ｎ，Ｒｉｃｈａｒｄｓ钉仅（２０３８．４±４７０．４）Ｎ．两者差异有统计学意义（Ｐ＜０．０１）．临床效果满意．结论：双颈滑动加压螺纹钉具有较强的抗弯和抗旋转强度，患者使用该钉后可早期扶拐下地活动．     

股骨粗隆间骨折内固定失效原因分析及对策

目的探讨股骨粗隆间骨折内固定失效原因及治疗对策。方法回顾总结我院2003～2009年行手术治疗的123例股骨粗隆间骨折病例,按Evans分型,分析各型骨折内固定失效原因,内固定方式与内固定失效类型及发生率情况。结果 123例均得到随访,有23例骨折内固定失效,其中稳定型骨折内固定失效5例,不稳定型骨折内固定失效18例;发生率为18.69%。失效类型：髋内翻、股骨颈短缩、内固定物断裂导致骨折畸形。不稳定型骨折内固定失效发生率远高于稳定性骨折,而钉板系统内固定失效发生率远高于髓内系统。钉板系统中近端解剖钢板内固定失效发生率高于动力髋螺钉（DHS）。结论对各类型骨折特点认识不够从而导致内固定方式选择不当;骨质疏松症患者术后过早负重;术者操作不当。     

微创DHS内固定治疗老年股骨粗隆间骨折体会

采用C臂X线机辅助微创加压滑动鹅头钉(DHS)内固定方法治疗老年股骨粗隆间骨折24例,此方法减少了手术创伤出血以及局部循环的破坏,利于骨折的愈合。     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

Staging and surgical management of pancreatic and biliary cancer and inflammation

Management of benign and malignant diseases of the pancreas, liver, and biliary tract has made remarkable progress in the last two decades. Advances in minimally invasive surgery, interventional radiology, and diagnostic and therapeutic endoscopy have changed the treatment of common diseases such as cholelithiasis and more serious diseases such as pancreatic adenocarcinoma. Advances in biliary tract and pancreatic surgery have paralleled the advances in ultrasonographic imaging, CT, and MR imaging. This article outlines the surgeon's perspective on radiologic imaging and preoperative staging of benign and malignant biliary and pancreatic disease.     

细胞自噬与肿瘤发生发展

自噬是真核生物中一种高度保守的胞内降解途径.其主要通过溶酶体或液泡进行饥饿状态下的营养动员,清除受损蛋白质、细胞器和胞内病原体.自噬主要包括巨自噬、分子伴侣介导自噬(CMA)和微自噬.自噬已被证实与多种人类疾病相关,其在肿瘤发生发展中具有重要意义.近年研究中,对于自噬和肿瘤关系有了进一步的认识,该文就自噬分子机制、调控...     

The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings

Thyroid imaging approach is based on the preliminary clinical evaluation. Lesions that are smaller than 2 cm should be assessed with US, which is capable of discriminating masses as small as 2 mm and distinguishing solid from cystic nodules. US-guided FNAB provides tissue for cytologic examination of thyroid nodules. CT and MR imaging are indicated for larger tumors (greater than 3 cm diameter) that extend outside the gland to adjoining structures, including the mediastinum, and retropharyngeal region. Metastatic lymph nodes in the neck and invasion of the aerodigestive tract are also in the realm of CT and MR imaging. Thyroid nodules are categorized on scintigraphy as hot or cold nodules. Hot nodules are rarely malignant, whereas cold nodules have an incidence of 10% to 20% of malignancy. Calcifications (amorphous, globular, nodular, and linear) occur in adenomas and carcinomas and have no differential diagnostic features except for psammomatous calcifications, which are a pathognomonic finding in papillary carcinomas and a small percentage of medullary carcinomas. Papillary carcinoma is the most common malignant tumor (80%) followed by follicular (20% to 25%); medullary (5%); undifferentiated; anaplastic carcinomas (< 5%); lymphoma (5%); and metastases. Lymph node metastases are common in papillary carcinoma, 50% at presentation, and less common in follicular carcinomas. The metastatic nodes in papillary carcinoma may enhance markedly (hypervascular); show increased signal intensity on T1-weighted images (increased thyroglobulin content or hemorrhage); and reveal punctate calcifications. Localized invasion of the larynx, trachea, and esophagus occurs predominantly in papillary and follicular carcinomas; the incidence is less than 5%. Ectopic thyroid tissue may be encountered in the tongue (foramen cecum); along the midline between posterior tongue and isthmus of thyroid gland; lateral neck; mediastinum; and oral cavity. Goiter and malignant tumors, notably papillary carcinoma, may develop in ectopic thyroid tissue. Carcinomas may also arise in thyroglossal duct cysts, which develop from duct remnants between the foramen cecum and thyroid isthmus. Infectious disease of the thyroid gland is not common and the CT and MR imaging findings are similar as described under neck infection. Other types of inflammatory disorders including Hashimoto's thyroiditis, granulomatous thyroiditis, and Riedel's struma display no specific imaging features. Imaging studies may, however, be indicated to confirm a suspected clinical diagnosis and assess compromise of the airway (Riedel's struma). HPT is a clinical diagnosis in which hypercalcemia is the most important finding. Parathyroid hyperplasia, adenoma, and carcinoma represent underlying lesions. To relieve the patient's symptoms surgical extirpation is indicated. The surgical success rate without imaging is 95%. The indications for imaging studies vary but it is generally agreed that reoperation after a previous failed surgical attempt and suspicion of an ectopic parathyroid adenoma should be investigated by imaging. These consist of US, nuclear medicine studies, CT and MR imaging. US and technetium sestamibi scanning have the highest accuracy rate for localizing an adenomatous gland at and near the thyroid gland. Ectopic adenomas, particularly if they are located in the mediastinum, are preferrably investigated with CT and MR imaging with gadolinium and fat suppression. Carcinomas and parathyroid cysts are optimally evaluated by CT and MR imaging. On MR imaging adenomas are low in signal intensity on T1-weighted images, high in signal intensity on T2-weighted images, and enhance post introduction of gadolinium.