创伤性膈疝21例临床分析

我院自１９８９年３月至１９９５年１０月手术治疗２１例创伤性膈疝，２１例疝愈。 发病机理与胸腹腔压力差、腹腔脏器冲击膈肌及胸腔负压有关。同时简要介绍了创伤性膈疝的诊断和治疗。     

急性创伤性膈疝误漏诊的防范

目的：探讨急性创伤性膈疝救治中误漏诊的原因及防范措施。方法：回顾总结9例急性创伤性膈疝的临床资料，重点分析误漏诊率和诊治失误的原因。结果：本组患正确、及时诊断率为22．2％。全组治愈8例，死亡例。结论：造成急性创伤性膈疝误漏诊的危险因素是：1、对本病的警惕性不高；2、对膈疝形成、发展的机制缺乏认识；3、过细的外科分工影响综合抢救质量；4、部分急性开放性膈肌损伤腹部症状体征轻微或缺如。     

外踝骨折分型及治疗方式探讨

踝关节骨折在创伤骨科中发病率较高 ,处理不当易造成关节疼痛 ,甚至创伤性关节炎。此多因早期处理中对外踝骨折及下胫腓关节分离认识不足所致［１］。本院按Ｄｅｎｉｓ -Ｗｅｂｅｒ分型［２］治疗外踝骨折 ,取得了较好疗效 ,报告如下。１临床资料１．１一般资料１９９７年８月～１９９９年８月共有外踝骨折患者５３例 ,其中男３２例 ,女２１例。年龄２１～６７岁 ,平均４１岁。致伤原因为 :车祸３０例 ,摔倒扭伤１６例 ,高处坠下７例。就诊时间为伤后１周以内。按Ｄｅｎｉｓ-Ｗｅｂｅｒ分型 :Ａ型１２例 ,Ｂ型２１例 ,Ｃ１型１１例 ,Ｃ２型…     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

创伤性肾动静脉瘘一例报告

患者,女,30岁。右侧腰背部车祸伤2h于2005年4月16日入院。伤后无血尿。查体：血压120/80mm Hg,右腰背部肿胀,皮下淤血斑约6．0cm×5．0cm。局部触压痛,腹部未见异常。彩超示双肾大小、形态尚可,包膜连续,实质回声均匀,肾窦回声未见分离。右肾窦区可见2．2cm×1．4cm×1．6cm无回声区。彩色多普勒血流图像(CD- FI)右肾窦区可见五彩血流束,下方与右肾动脉相延续,肾门处肾动脉最大流速     

手术治疗创伤性浮膝损伤23例临床分析

浮膝损伤是指同侧肢体的股骨与胫骨骨折引起膝关节的相对漂浮状态，是一种高能量损伤，常见于多发伤患者。我院自1999年10月～2005年2月共手术治疗浮膝损伤23例，报告如下。     

膝交叉韧带重建术的护理配合

随着社会经济的不断发展，由于交通及运动损伤引起的膝关节损伤目趋增多。交叉韧带是维持膝关节稳定的重要结构，韧带的断裂会引起关节不稳，若时间长会发展成创伤性关节炎，严重影响病人的工作与生活。膝交叉韧带重建术，尤其在关节镜监视下重建是近年来发展起来的一项新技术，通过手术能有效地恢复关节的稳定与功能，但手术的效果优劣在很大程度上取决于手术技术及术中医护配合的好坏。2000年7月-2003年7月，我院共行膝交叉韧带重建术236例，现将护理配合报告如下。     

中西医结合治疗膝关节创伤性滑膜炎的体会

<正>膝关节创伤性滑膜炎是急性创伤或关节负重力线不均、关节畸形等因素所致膝关节滑囊的无菌性炎症。目前常用的方法是穿刺抽出积液或抗生素、激素等治疗,但往往治疗不全面而反复发作,手术治疗又增加损伤,患者痛苦大,关节功能恢复较慢。2006年5月至2008年5月我们采用中西医结合治疗本病82例,取得良好效果。现总结如下: