胸骨骨折的外科治疗

目的 总结分析胸骨骨折的外科处理方法。方法 31例胸骨骨折患者中，17例经非手术保守治疗，14例手术行胸骨固定，同时治疗合并症。结果 2例死于严重的脑外伤和呼吸衰竭，29例治愈。其中1例钢丝断裂和1例胸骨被切割开，需再次手术，3例并发肺部并发症，经相应处理后治愈。结论 胸骨骨折是危及患者生命的严重外伤，及时诊断、评价伤情和正确的处理是减轻患者并发症，降低死亡的关键。     

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection （DSWI） following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males （73.7%） and 5 females （26.3%）, aged 55±13 （18-78） years. According to the Pairolero classification of infected median sternotomies, 3 （15.8%） patients were type II, and the other 16 （84.2%） were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients （78.9%）, bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients （21.0%） needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients （10.5%） presented with subcutaneous infection, and 3 patients （15.8%） had hematoma. They recovered following local debridement and medication. 17 patients （89.5%） were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.     

Diagnostic Lumbar Puncture

Diagnostic Lumbar Puncture is one of the most commonly performed invasive tests in clinical medicine. Evaluation of an acute headache and investigation of inflammatory or infectious disease of the nervous system are the most common indications. Serious complications are rare, and correct technique will minimise diagnostic error and maximise patient comfort. We review the technique of diagnostic Lumbar Puncture including anatomy, needle selection, needle insertion, measurement of opening pressure, Cerebrospinal Fluid (CSF) specimen handling and after care. We also make some quality improvement suggestions for those designing services incorporating diagnostic Lumbar Puncture.     

卵巢囊肿超声引导穿刺术

目的探讨卵巢囊肿超声引导穿刺术的疗效。方法应用超声引导卵巢囊肿穿刺,抽吸囊液后,随后注入无水酒精,观察、检测囊肿变化并准确记录。结果 70例卵巢囊肿中,治愈63例(90.4%),显效4例(5.71%),无效3例(4.29%),总有效率(95.71%)。结论卵巢囊肿超声引导穿刺术疗效显著。     

改良胸骨抬举术治疗小儿漏斗胸

目的探讨采用改良胸骨抬举术治疗小儿漏斗胸的疗效及经验。方法回顾性分析1999年7月-2008年8月期间采用缝合已切除畸形病变肋软骨的断段、将肋软骨膜包绕肋软骨断段缝线使之呈管状的改良胸骨抬举术治疗42例小儿漏斗胸的临床资料,术后随访14个月-10年,随访内容包括胸廓外形、临床症状、X线胸部正侧位片。结果均顺利完成手术,无手术死亡,手术后38例患者得到随访,矫形效果满意,活动耐力及反复呼吸道感染症状明显好转,X线胸片心影左移情况消失。结论改良胸骨抬举术治疗小儿漏斗胸并发症少,操作简单方便,效果满意,值得推广。     

浅静脉穿刺困难老年患者2种穿刺方法的比较

目的探讨2种不同的穿刺方法对浅静脉穿刺困难的老年患者穿刺成功率的影响。方法将300例老年患者随机分为对照组和试验组，对照组给予传统的静脉穿刺方法，试验组给予改进后的静脉穿刺方法，即穿刺前热敷浅静脉15～30min，手臂下垂扎止血带，穿刺时不握拳。结果改进后的静脉穿刺方法，大大提高了浅静脉穿刺困难的老年患者穿刺成功率。结论这种方法更有利于浅静脉充盈，更能提高一次性穿刺成功率。     

深部胸骨切口感染的研究进展

深部胸骨后感染(DSWI)是接受胸骨正中切口术后患者可怕的、灾难性的一种并发症。流行病学资料显示,近5年来DSWI的发生率为0.6%².0%,而其住院病死率或者30 d病死率却高达10.25%2.0%,而其住院病死率或者30 d病死率却高达10.25%²5.8%。围术期预防措施在降低DSWI发生率方面至关重要。真空辅助闭合装置治疗是一种优于其他传统方法有效的过渡治疗方案。胸廓重建术在治疗DSWI中起着决定性作用。多学科协作能够降低DSWI的发生率,在DSWI防治过程中值得提倡。     

核素骨显像胸骨单发浓聚灶特点分析

目的探讨核素全身骨显像胸骨单发浓聚灶的特点及联合CT诊断的临床意义。方法收集本院近7个月全身骨显像中发现的胸骨单发浓聚灶42例,并行胸骨局部CT检查。按核素浓聚灶位置、形状及CT影像表现进行诊断分析。结果 42例胸骨单发浓聚灶患者中有骨转移瘤37例(占88.1%),退行性变3例,手术创伤2例。胸骨单发浓聚灶胸骨体多见(28处),其次是胸骨柄(16处)和诸切迹(5处),形状以团块状为主。结论核素骨显像胸骨单发浓聚灶联合CT有助于对胸骨病变明确诊断,具有重要临床价值,值得推广应用。     

由恶性刺伤事件透视AIDS

近日,在北京及其周边地区不断发生年轻女性被人用锐器扎伤的恶性事件,更有甚者利用“注射器针头”进行恶意攻击。在人们普遍缺乏防范意识的情况下,一时间引起了一定范围内的恐慌。令广大群众更为焦虑的是,如果万一被染有艾滋病毒的针头扎伤,被传染的可能性有多大?被扎后应该怎样采取措施自我保护?让我们一起聆听专家的解释—     

腹膜后肿瘤穿刺技术探讨

目的腹膜后肿瘤CT及DSA双重导引下穿刺的安全性、准确性和手术技巧探讨.方法穿刺前CT增强扫描,三维重建,并分别在下腔静脉及腹主动脉插入血管导管作为标志,术中实时CT扫描监视。结果穿刺成功率100%,无严重并发症发生。结论术前术中措施提高了成功率,安全性及准确性。     

胸骨畸形／血管发育不良综合征伴线状色素减退

作者报道1例7岁男孩面部有血管瘤、胸骨局部凹陷、主动脉缩窄、室间隔缺损及脑动脉发育不良引起急性梗塞。这些临床特征被总称为胸骨畸形／血管发育不良综合征或PHACES综合征。在5岁时，患儿右臂、右手和背部沿Blaschko线出现线状色素减退，发病前无炎症史，皮损持续不变。之前报道的此综合征不伴发上述色素改变。