混合型人工全髋关节置换术治疗老年股骨颈骨折

目的随访一组经混合型全髋关节置换术的股骨颈骨折老年的患者,了解骨水泥型股骨假体和非骨水泥型髋臼假体的组合应用于健康和骨质质量较差的老年患者的情况.方法 41名患者得到临床和影像学随访.随访内容包括老年患者的健康状况、手术方法、术后恢复情况以及对于骨形态、骨水泥固定质量和假体稳定性.结果未出现与骨水泥相关的术中和或术后死亡,各类全身性疾病在围手术期无加重表现.Harris评分为81.1分.股骨近端骨形态A型占20%,B型56%,C型24%.骨水泥固定质量分为A级37%,B级49%,C级4%.结论混合型人工关节置换术对老年股骨颈骨折患者较为适用.混合型人工关节的术后即时稳定性有利于老年患者的康复.在手术中必须应用现代骨水泥技术.

How To Become A Model Center of Medical Rehabilitation——The Experience of the Kessler Institute for Rehabilitation

In this article I will describe a model medical rehabilitation center in the United States based on my experience as the Medical Director of the Kessler Institute for Rehabilitation (KIR) located in West Orange,New Jersey.KIR has three integrated distinct missions:patient care,education,and research.It is a 336-inpatient bed facility (three separate locations) that runs at approximately 95％occupancy.In 2012,6896 individuals were admitted for care.The patient ages are from 18 to 109 with an average age of 69.Forty five percent of the patients were male and 55％ were female.KIR,West Orange,is a freestanding hospital that owns and operates its own X-ray and laboratory facilities.

静脉营养及生长激素联合应用在外科危重病人的临床效果

目的研究静脉营养及生长激素联合应用在外科危重病人的临床效果.方法1998年1月～1999年12月,对16例外科危重病人应用静脉营养联合生长激素治疗.其中,多器官功能衰竭4例,胰腺癌术后3例,结肠癌术后4例,卵巢癌伴肠粘连1例,脑出血2例,急性坏死性胰腺炎1例,淋巴瘤术后1例.男:女＝11:3,平均年龄65.86±12.4岁,生长激素4.5～8U/d,生长激素应用时间:8.07±4.5d.结果(1)16例患者中痊愈出院9例,7例因严重感染,多器官功能衰竭,呼吸衰竭死亡.(2)在14例肾功能正常组(血肌酐<115μmol/L),治疗前血浆BUN9.439±2.068μmol/L,治疗后BUN7.056±1.882μmol/L,二者差异有非常显著性(P<0.01).(3)2例肾功能不正常的病例,治疗前BUN分别为19.19及28.02μmol/L,治疗后为28.81及33.74μmol/L.(4)血浆总蛋白及白蛋白水平治疗前后差异无显著性(治疗前31.8±5.1g/L,治疗后32.47±6.43g/L,P>0.05).结论在肾功能正常的情况下,术后危重患者应用生长激素可以降低血浆尿素氮水平,其临床意义及机理有待于进一步研究探讨.

PICC在临床中的应用

目的了解PICC在临床应用中常见的并发症.方法回顾性总结1999年我院SICU收治病人中留置PICC的情况.结果1999年我院SICU收治病人中共有14人留置PICC,其中男12人,女2人,平均年龄72岁.均为术后不能经口进食而需行静脉营养的患者,经PICC主要输注静脉营养液,并同时应用抗生素.其中4例因PICC栓塞拔管,1例因静脉炎拔管,另有2例因高热怀疑PICC管感染而拔管,行PICC管培养为阴性.结论临床中应用PICA3所遇到的主要并发症为栓塞、静脉炎和感染.

Objective. To evaluate the results of TSRH instrumentation in the correction of coronal, sagittal and rotational deformity of scoliosis. Methods. From January 1998 to December 1999, thirty-two consecutive patients (6 males, 26 females) with scoliosis underwent anterior or posterior spinal instrumentation and fusion using TSRH instrumentation. Of these cases, 21 were idiopathic scoliosis and 11 were congenital scoliosis. The average age at surgery was 16.4 years (range, 11～ 45 years). The mean Cobb angle at surgery was 71 .2 (range, 44 ～ 125 ) in the coronal plane, and 49.2 ( range, 16 ～ 67 ) in the sagittal plane. Rotational deformity (Nash -Moe) ranged from I to III degree. Preoperative apical translation averaged 4.8 cm (range, 3～ 9 cm). Results. The average follow-up duration was 13.3 months (range, 10 ～ 24 months).At the final follow-up, the mean Cobb angle in the coronal plane was 26. 6 (range, 10 ～ 73 ),with a 63.8％ of improvement. Sagittal alignment was well maintained with a mean Cobb angle of 28 ( range, 10 ～ 45 ). The average correction of rotation of the apical vertebra was I degree. The average apical translation was 1.6 cm (range, 0.5～ 5.0 cm) representing a correction rate of 66,7％ . Complication was noted in two cases with an incidence of 3.1 ％ , one case had superficial infection and the other one had lower hook dislocation.There was no neurologic deficit and pseudoarthrodesis in this series. Conclusion. TSRH instrumentation is an effective and convenient three-dimensional correction system with a lower rate of complication, which can not only correct the coronal and rotational deformity, but maintain the sagittal alignment as well.

Objective． An internal fixation apparatus— — distraction reduction fixation system(DRFS) was designed to satisfy the clinical needs for spondylolisthesis. Methods. Since 1996, 53 patients were treated with DRFS. Among them, 35 had spondylolisthesis, 12 had lumbar canal stenosis accompanied with instability, 2 had vertebral tumors and 4 suffered from spinal fracture. The average age was 53.6 years old (ranged 24～ 72yrs). The mean time for follow-up was 30.6 months (16 ～ 44 months). Results． The slip rate was 0.15± 0.10 before operation, and decreased to 0.09± 0.07 after operation. Entire slip reposition was achieved in 19 cases (54.3％ ). The change in height of the intervertebral space within the fixation segments was 0.7± 0.17. Conclusion． DRFS achieved better results for spondylolisthesis less II degree and no other adverse effects were found. Compared with other foreign and domestic techniques, it had advantages in less implants, less operation gears required and ease to utilize in operation. It was proved to be an ideal internal fixation apparatus.

血管性痴呆的心理社会干预

INTRODUCTIONWith the increase of average age, number of senile dementia casesincrease. Vascular dementia is the most important reason of seniledementia (VD) . Many researches showed that VD are preventableand treatable. It includes preventive therapy, drug treatment, psy-chic treatment and social intervention.

医用智能控温仪对蛛网膜下腔出血患者神经功能恢复的疗效观察

1 Subject and method 1.1 Subject 121 SAH patients treated in our department from January 1996 to August 2001 were chosen, 93 male cases and 28 female cases with ages from 35 to 55 and the average age of (43.0± 3.2), they were all taken in hospital in 72 hours after first attack and they were all accorded with the standards set in the 2nd national cerebral vessels academic conference of 1996. the scores were 35～ 45 and they were conformed with CT or MRI, the cerebrospinal fluid showed positive result and there were no other severe compliments, the relatives were willing to take YZK treatment.

散发性类甲型非甲非乙型肝炎临床观察

非甲非乙型肝炎国外报告可分为类甲型和类乙型.本文对经血清学分型确定的急性非甲非乙型肝炎28例,进行临床观察,并随访1～2年.其临床特征、肝功能恢复时间、转归与甲型肝炎相似,现报告如下.

自体外周血造血干细胞移植治疗重症天疱疮三例

目的 探讨自体外周血造血干细胞移植治疗天疱疮的疗效及安全性.方法 选择经糖皮质激素、免疫抑制剂等治疗6个月以上病情仍难以控制或病情进展、且出现治疗相关并发症的3例寻常型天疱疮患者进行自体外周血造血干细胞移植治疗,并随访5年以上.3例中男1例,女2例,平均年龄27.3(21～39)岁.造血干细胞的动员方案为环磷酰胺4g/m2、重组人粒细胞集落刺激因子(G-CSF)、利妥昔单抗375 mg/m2;预处理方案为环磷酰胺50 mg·kg-1·d-1连用4d(移植前第6天到移植前第3天)、抗胸腺细胞球蛋白2.5 mg·kg-1·d-1连用4d(移植前第3天至移植当天)、利妥昔单抗600 mg/d于移植当天和移植后第7天静脉滴注.结果 3例天疱疮患者均获得成功植入,平均植活时间白细胞13.3 d(11 ～ 16d),血小板16.3 d(16～ 17d).监测各项免疫指标及相关抗体未见异常,免疫重建良好.随访期间,所有患者无严重并发症,生活质量较前明显提高.结论 自体外周血造血干细胞移植可能是治疗天疱疮有效且安全的新方法之一.

对称性肢端角化病九例分析

目的 探讨9例对称性肢端角化病患者的相关危险因素、临床表现、治疗及疗效.方法 门诊收集9例对称性肢端角化病患者的临床资料.对皮损进行拍照,真菌镜检、组织病理检查.予外用药治疗并随访.结果 男8例,女1例,平均年龄28.2岁,平均发病年龄24.6岁,病程2个月至16年；皮损对称分布,双手背、腕全部累及,踝次之；手腕部皮损分布呈圈状；夏季重、冬秋季多数自愈；大部分患者与塑胶或橡胶接触有关,部分合并寻常性鱼鳞病；真菌镜检均阴性,组织病理学表现为表皮角化过度,棘层肥厚,轻微乳头瘤样增生；尿素维E乳膏、丙酸氯倍他索乳膏按1∶1调用明显有效.结论 寻常性鱼鳞病患者存在对称性肢端角化病的易患因素,遇水变白可能是水、空气参与的一种物理现象.外用糖皮质激素可作为第一线药物选择.

婴儿腮腺毛细血管瘤的手术治疗

本文总结婴儿腮腺毛细血管瘤31例,按临床表现分为三型.详述了手术方法,提出颈外动脉中段结扎术,此法具有操作简单,不破坏颈动脉三角区,无误扎顼内动脉的危险,便于寻找面神经总干,缩短手术时间,减少出血等优点.

儿童贲门失弛症的诊断和治疗

我院自1964年4月至1982年6月,在对133例贲门失弛症的外科治疗中,发现年龄在儿童期者6例(4.5%).嗣后又为一名男童做了外科治疗,现将7例的诊治情况报告如下:临床资料本组7例中,男5例,女2例.年龄为2～12岁,平均10岁.病期为8个月～4年,平均2年.7例均有程度不同的发作性吞n因困难,4例体重明显下降,3例有呕吐,1例经常咳嗽、咳痰.

To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24～77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30～150min),blood loss was 10ml(3～50ml),and postoperative stay was 3 days(1～5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

Objective:　To analyze the causes of distal femoral nonunion and delayed union and assess the outcome of the corresponding treatment, retrograde intramedullary interlocking nail (RIIN).　　Methods:　From June 1995 to December 1998, 15 patients (9 males and 6 females) with distal femoral nonunion and delayed union were treated with RIIN. The average age of the patients was 34.5 years (23-46 years). Bone grafting was performed in 10 patients, closed reaming was done in the other 5 patients. Correction osteotomy was performed in 2 patients, and intra-articular release of knee adhesion in 11 patients. X-ray examination and knee society clinical rating system (KSS) were used to evaluate the results.　　Results:　All fractures were followed up for at least 9 months with average follow-up duration of 14.5 months (9-33 months). Solid union was documented in all patients at 6.4 months on average. There were no infections or malunions in this series. Based on the final follow-up data, acceptable functional range of motion (ROM) of over 90° was achieved in most patients. The average ROM was 93.5° with significant improvement of 28° (42.7%, P＜0.05) compared with the preoperative ROM. The average knee score was 96. Excellent ROM emerged in 13 patients. The knee function score was 90.5 on average.　　Conclusions:　The main causes of distal femoral nonunion and delayed union are improper indications and improper use of the implants. RIIN is an effective alternative for treatment of distal femoral nonunion and delayed union because it can provide a stable and reliable fixation which is beneficial for early functional exercise of knee. Bone grafting, closed reaming and intra-articular release of knee adhesion should be considered in order to enhance the bone healing and improve ROM and the knee function.