阔筋膜瓣移植结合Ⅱ期植皮修复手、足创面缺损的临床应用

随着交通和机械产业的发展,临床上出现了相当比例的手、足创伤患者,其中组织缺损发生较为普遍。对于该类创面的修复,从最早的腹部带蒂皮瓣修复到后期的多种类型游离皮瓣修复,修复的方式取得了极大的发展。其中股前外侧皮瓣由于血管蒂解剖位置稳定,质地较好,临床上运用广泛[1]。但是对于手背、足背这些外观美容的区域,它又有不可忽视的缺点:外观的臃肿,后期局部的毛发密集,这些给美容要求高的患者带来了很大的烦恼。自2008年起,我们在临床上选择14例患者,采用游离阔筋膜瓣移植结合Ⅱ期植皮修复,取得了满意的临床效果。     

闭合性锤状指切口改良与缝线排异

2006年2月～2009年12月,我们对9例闭合性锤状指患者进行切口改良手术,报道如下.     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

64层螺旋CT在主动脉夹层支架置入术前及术后的应用与评价

目的：评价64层螺旋CT血管造影对主动脉夹层术前诊断及介入术后评估的价值。方法：回顾性分析我院行腔内隔绝术的14例主动脉夹层的术前及术后64层螺旋CT血管造影征象,并与DSA结果进行比较,分析2种方法对主动脉夹层的术前诊断及支架置入术后疗效评估的价值。结果：64层螺旋CT、DSA均对14例患者做出主动脉夹层的诊断和正确分型;2种方法均能清晰显示主动脉夹层真假腔及内膜片。64层螺旋CT共显示14例患者破口共27个,覆膜支架破口封堵术后内漏2个;DSA显示破口19个,介入术后内漏1个;两者在显示破口方面有明显差异（χ2=4.926,P=0.026）。结论：64层螺旋CT血管造影对主动脉夹层的诊断及介入术前及术后评估的价值优于DSA。     

组织胚胎学网页教材制作与应用

采用计算机多媒体教育技术进行教学 ,是实现以教师为主导 ,学生为主体转变的有效方法 ,本文简要介绍用Frontpage 2 0 0 0软件制作网页教材 ,实现组织学与胚胎学校园网络教学 ,包括网上课堂、网上实验、网上讨论、自测练习及考试等内容的组胚网页教材制作的一些体会     

一蒂双足趾组织组合移植修复复合性手创伤

目的探讨一种简便、有效的治疗复合性手创伤的方法。方法1995年始,对12例复合手外伤均采用一蒂双足趾组织移植修复;其中用改良甲瓣加第二足趾移植再造手4例,指、第二足趾双趾腹皮瓣移植修复6例,足背皮瓣加趾趾腹皮瓣移植修复2例。急诊一期修复5例,延迟修复4例,二期修复3例。术后均经系统的康复治疗。结果12例的皮瓣及再造指全部成活。2例(足趾、皮瓣各1例)在术后发生动脉危象,手术探查、处理后成活。术后1年随访,再造指外观良好,TAM平均为140°,指腹二点分辨觉平均为8mm。再造指对掌、对指正常3例,轻度受限1例。移植皮瓣无明显臃肿,二点分辨觉平均为12mm。结论一蒂双足趾组织移植只吻合一套血管系统,供养两块组织,手术简便、安全、实用。保证移植组织的双套供血回流系统,及保持虎口、指蹼间的正常跨度是手术成功的关键。     

16层螺旋CT血管成像在胸部大动脉急症诊断中的应用价值

急性肺动脉栓塞、急性主动脉夹层是常见的胸部大动脉急症,二者临床症状及生化指标多有重叠,早期明确诊断对降低死亡率、选择合理的治疗方案有重要意义。16层螺旋CT由于其更快的扫描速度、更薄的扫描层面为临床胸部大动脉急症的诊断提供了快速准确的检查手段。     

高龄肺癌患者手术的护理

高龄肺癌患者一般是指年龄在 65岁以上的病人 ,由于非特异性免疫力下降及各器官的退行性改变 ,心肺功能绝大多数存在不同程度的功能衰退和减弱 ,手术治疗危险性大 ,并发症多 ,死亡率相对较高。故认真做好手术前后的护理是提高高龄患者手术成功的关键。湖北省肿瘤医院于 1995年1月～ 1998年 1月行手术治疗及护理 65岁以上高龄肺癌患者 38例。现报告如下。1　临床资料38例高龄肺癌手术患者中 ,男 2 8例 ,女 10例 ,年龄65～ 69岁 2 7例 ,70岁以上 11例 ,手术行肺癌切除 34例 ,其中肺叶切除 30例 ,全肺切除 2例 ,右下肺楔形切除 2例 ,4例行肺动…     

泽菲联合顺铂治疗晚期非小细胞肺癌近期疗效观察

联合化疗是治疗中晚期肺癌的主要手段之一。20世纪90年代以来，新一代抗肿瘤药不断推出，其中：Shepherd等报告吉西他滨单药治疗非小细胞肺癌（NSCLC）缓解率达20％，引起人们的关注。2003年1月至2005年7月，我们采用联合泽菲顺铂治疗晚期NSCLC患3l例。取得较好疗效，总结报道如下。