目的 总结腹部闭合性损伤的诊治体会。方法 回顾性分析我院78例腹部闭合性损伤患者的临床资料。结果 78例中67例手术治疗，4例行肾动脉栓塞术，7例保守治疗； 除1例死亡外，余均治愈。结论 及时诊断和治疗是救治腹部闭合性损伤患者的关键，腹腔穿刺、B超、CT及X线检查的合理应用对诊断有重要价值。
Because of the complicated causes and variable clinical signs, closed injury of tendons at wrist is difficult to diagnosis and treat. Twenty-six cases of tendon ruptur were reported. Among them, 11 cases were caused by bone fracture or dislocation, 8 cases were caused by rheumatoid synovitis, 5 cases were caused by synovial tuberculosis, and 2 cases caused by other. The pathogenesis and clinical signs were analyzed. Twenty-three cases were treated by tendon transfer and 3 cases were treated by tendon transplantation. By average follow-up of 16 months (ranged 6 months to 4 years), the results were as follows: the clip strength and both active and positive motion of fingers were restored in 19 caese, 75% of those were restored in 7 cases and 50% of those were restored in 2 cases. It was suggested that diagnosis, treatment and function rehabilitation should be carried out early, and tendon transfer or tendon transplatation were the method on priority.
Objective To compare the effectiveness of the 3 methods (traditional open Achilles tendon anastomosis, minimally invasive percutaneous Achilles tendon anastomosis, and Achilles tendon anastomosis limited incision) for acuteAchilles tendon rupture so as to provide a reference for the choice of cl inical treatment plans. Methods Between December 2007 and March 2010, 69 cases of acute Achilles tendon rupture were treated by traditional open Achilles tendon anastomosis (traditional group, n=23), by minimally invasive percutaneous Achilles tendon anastomosis (minimally invasive group, n=23), and by Achilles tendon anastomosis l imited incision (l imited incision group,n=23). There was no significant difference in gender, age, mechanism of injury, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 3 groups (P gt; 0.05). Results Minimally invasive group and limited incision group were significantly better than traditional group in hospital ization days and blood loss (P lt; 0.01). Incision infection occurred in 2 cases of traditional group, and healing of incision by first intention was achieved in all patients of the other 2 groups, showing significant difference in the complication rate (P lt; 0.05). Re-rupture of Achilles tendon occurred in 1 case (4.3%) of minimally invasive group and limited incision group respectively; no re-rupture was found in traditional group (0), showing significant difference when compared with the other 2 groups (P lt; 0.05). All cases were followed up 12-18 months with an average of 14.9 months. The function of the joint was restored. The AOFAS score was more than 90 points in 3 groups at 12 months after operation, showing no significant difference among 3 groups (P gt; 0.05). Conclusion The above 3 procedures can be used to treat acute Achilles tendon rupture. However, minimally invasive percutaneous Achilles tendon anastomosis and Achilles tendon anastomosis limited incision have the advantages of less invasion, good heal ing, short hospital ization days, and less postoperative complication, and have the disadvantage of increased risk for re-rupture of Achilles tendon after operations.
目的探讨诊治闭合性肝外伤的有效方法。方法回顾分析了1990～2000年收治的168例闭合性肝外伤的临床资料。结果均行腹腔穿刺，阳性率为94.6%（159/168），B超检查92例，阳性率为95.7%（88/92），CT检查33例，阳性率为93.9%（31/33），术前确诊率为98.2%。168例中，行非手术治疗37例（22.0%），手术治疗131例（78.0%）。治愈161例（95.8%），其中非手术治疗37例均痊愈； 手术治疗131例中痊愈124例，死亡7例（4.2%）。结论外伤史、体征、腹腔穿刺、B超和CT检查是诊断肝外伤的重要依据，及时手术治疗是降低严重肝外伤病死率的关键。
Objective To explore the early diagnostic value of single photon emission computed tomography(SPECT), thoracic computed tomography(CT),and chest X-ray for closed chest trauma. Methods To establish the animal model of unilateral chest impact trauma,to adopt SPECT, thoracic CT, and chest X-ray for early diagnosis of closed chest trauma,and to compare these findings with postmortem examination. Results Thirty minutes after blunt chest trauma, the region of interesting (ROI) between traumatized lung and the heart (ROI2/ROI1) immediately increased to the peak six hours after trauma; on the contralateral lung, the ratio (ROI3/ROI1) increased slowly and reached the peak after six hours, these ratio was still smaller than that of the traumatized lung. These differences were significant (Plt;0.01). Conclusions Chest X-ray is still the most fundamental diagnostic method of chest trauma,but it was thought that the patients of severe chest trauma and multiple injuries should be examined early by thoracic CT. Radionuclide imaging have more diagnostic value than chest X-ray on pulmonary contusion. The diagnostic sensibility to pulmonary contusion of thoracic CT is superior to conventional radiograph,but thoracic CT is inferior to SPECT on exploring exudation and edema of pulmonary contusion. Thoracic CT is superior to conventional radiograph on diagnosis of chest trauma,therefore patients of severe chest trauma and multiple injuries should be adopted to thoracic CT examination at emergency room in order to be diagnosed as soon as possible.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
OBJECTIVE: To study the management of extensive closed internal degloving injury (CIDI). METHODS: From September 1987 to October 1999, 18 cases of CIDI were retrospectively reviewed. Of 18 cases, there were 7 cases in thigh, 6 cases in legs and 5 cases in pelvis, ranging from 15 cm x 12 cm to 38 cm x 25 cm in size. Various managements were adopted according to the severity of the injury, including vacuum drainage and adjuvant compression in 5 cases, regrafting of defatting fenestrated full-thickness skin by non-resection in 8 cases, and skin grafting with transfer of myocutaneous flap in 5 cases. Among them, there were 11 cases of bone and articular fixation or repair, 4 cases of principal vessels repair. All of the cases were evaluated clinically and followed up for 6 months to 3 years. RESULTS: In the 8 cases repaired by regrafting of defatting fenestrated full-thickness skin, only one case of skin necrosis, 5 cm x 2 cm in size, recovered after skin grafting; the others healed well. All of the patients recovered normal life and had normal limbs. CONCLUSION: It’s crucial to make a careful assessment about the injury severity of CIDI, to stress on importance of management of both CIDI and deep injury, and to choose proper options after comprehensive assessment of the injury.
目的 探讨腹腔镜技术在闭合性腹外伤病例中诊断、治疗的价值。方法 对1999年8月至2004年12月期间26例闭合性腹外伤患者应用腹腔镜进行探查及治疗。结果 26例中肝破裂3例，脾破裂6例，腹膜后血肿2例，肠系膜破裂3例，小肠破裂穿孔8例，结肠破裂穿孔1例，膀胱破裂1例，肠管挫伤2例。14例经腹腔镜顺利完成探查及治疗，另12例中转开腹手术。全部病例未发生术后并发症。结论 腹腔镜技术在闭合性腹外伤患者的探查及治疗过程中是一种有临床应用价值的有效方法。
Objective To evaluate the role of CT in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma. MethodsTwenty preoperative CT scans and clinical data were obtained in 20 patients who subsequently had bowel ruptures verified surgically. CT findings were analyzed retrospectively in these patients. Retrospective interpretation was made by consensus of at least two radiologists. ResultsTwenty cases of CT scan showed intraperitoneal fluid (18 cases), pneumoperitoneum (18 cases), extravasations of gastrointestinal tract contents (2 cases), bowel wall findings (14 cases) and mesenteric injury (15 cases). Conclusion CT is fast, sensitive and noninvasive in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma.