周围神经端侧缝合与端端缝合疗效比较的实验研究

目的比较周围神经损伤后端侧缝合与端端缝合方法疗效的优劣。方法ＳＤ大鼠１２只,按手术先后随机分成Ａ,Ｂ两个时间组。左侧腓总神经切断后作端端缝合。右侧腓总神经切断后,远断端与近断端上方０．５ｃｍ束外膜开窗处作自身端侧缝合。分别于术后１、３个月时作肌电图后取材,测肌湿重及作组织学检查。结果Ａ、Ｂ两组,端侧缝合与端端缝合比较,肌电图中诱发电位潜伏期延长、波幅降低。胫前肌肌湿重减轻。肌纤维截面积、有髓神经纤维数均减少。经配对ｔ检验,Ｐ值均＜０．０５。结论周围神经断伤作端侧缝合后,其神经再生质量不及端端缝合优良。     

Excision of urethral stricture and end to end anastomosis

Thirteen patients with bulbar urethral strictures were treated by excision of the stricture and end to end anastomosis of the urethra with uniformly good results.     

Fractures of the distal end of the radius

Attitudes to the treatment of distal radial fracture are now more critical than previously, especially where intraarticular fracture is concerned. Inadequate primary reduction and such complications as redislocation or dystrophic problems lead to poor results. Quantification of fracture instability is becoming increasingly important in fracture classification, determination of the indications for the different treatment modalities and management. Accurate anatomical reduction also improves later function. The quality of alignment attained during the treatment depends on the quality of reduction. Closed reduction by means of traction should be achieved by pulling on fingers I, II and IV. The radial dislocation should be corrected first and then the dorsal dislocation; a cast applied to the lower arm is sufficient for immobilization. Primary surgery is indicated more urgently and the type of surgery in more detail, for example, when there are steps in the articular surface or when there is more than one factor in instability. Pin fixation should be applied sooner and more frequently with either primary or early secondary indications. Plate fixation is mostly achieved from the volar surface; it is indicated in flexion fractures and sometimes in extension fractures, but only in combination with rigid screw fixation with or without bone grafting. We are finding increasingly more indications for external fixation, not only in the case of open fractures with soft tissue damage but also with multiple fragments or comminuted fractures, sometimes in combination with bone grafting.     

Fractures of the medial end of the clavicle

Much is known regarding the epidemiology of clavicle fractures, particularly those of the middle-third and distal clavicle. Medial clavicle fractures are uncommon, and as a result, there is little information available. The purpose of this study is to review retrospectively a case series of medial clavicle fractures treated at a tertiary trauma center. All clavicle fractures treated at our institution over a 5-year period were reviewed by use of all available radiographic studies and medical records. These data were evaluated with respect to several epidemiologic points, including mechanism of injury, associated injuries, fracture orientation, fracture displacement, treatment, and associated injuries. Follow-up data were gathered in 32 of 44 available patients with chart review and telephone survey. We evaluated 57 medial fractures in 55 patients. Patients were typically men in the fifth decade injured as a result of vehicular trauma. Fractures were occasionally missed on chest radiographs but were always identifiable by computed tomography scan. Injuries were most often closed and without neurovascular injury. However, patients almost always had multisystem trauma. Operative treatment was rarely performed, and patients typically had little or no pain at the time of follow-up. Finally, it was found that 11 patients died within 1 month of their injuries, indicating that 20% (11/55) of patients with medial clavicle fractures died as a result of the trauma associated with their injury. Medial clavicle fractures remain a relatively uncommon injury compared with other clavicular fractures. However, they typically are accompanied by significant multisystem trauma and have a high associated mortality rate.