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甲状腺癌术后乳糜瘘的观察与护理

【摘要】　目的　总结甲状腺癌行颈廓清术并发乳糜瘘的治疗及护理方法。　方法　2008年8月-2009年10月，对8例甲状腺癌行颈廓清术发生乳糜瘘患者，采用局部加压包扎，引流管接负压器充分引流或手术缝扎乳糜管等治疗，并进行心理护理、营养指导、引流管监护、并发症的预防等专科护理和基础护理。　结果　4例患者经保守治疗、4例患者采用手术缝扎乳糜管，治愈出院。　结论　对甲状腺癌颈廓清术后并发乳糜瘘患者，采取适当的治疗方法及正确的护理措施，能促进患者尽快早日康复出院，缩短住院时间和减少经济负担。

CERVICAL LATERAL MASS PLATE WITH ITS CLINICAL APPLICATION

Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.

带旋髂深血管束髂骨骨膜移植治疗中青年股骨颈骨折

THE PROBLEMS IN THE USE OF SUPERFICIAL CERVICAL ARTERY SKIN FLAP AND IT’S RELEVANT SOLUTION

Superficial cervical artery skin flap is widely used in clinical practice. In order to inprove the outcome of the flap in clinic, eleven cases of skin defect of scalp who were treated with the flap was discussed. After operation, the donor area healed but there was no hair growth on recipient area. Among them, six cases occurred partial necrosis of skin flaps. In order to avoid these problen, the relevant solution discussed as follows: 1. Handle well the pedicle of the skin flap to prevent the interference with venous returm. 2. Adhere strictly to indications. 3. Apply skin expander to obtain "extra" skin, then carryout the tranfer of skin flap and 4. Better use the skin flap with residual hair.

人工双极股骨头置换术治疗老年股骨颈骨折

【摘要】目的观察人工双极股骨头置换术治疗老年股骨颈骨折的临床疗效。方法2004年4月2007年10月,采用人工双极股骨头置换术治疗21例老年股骨颈骨折。男8例,女13例;年龄68～80岁,平均年龄726岁。致伤原因:摔伤16例,车祸伤5例。骨折类型:头下型11例,经颈型8例,基底型2例。合并骨质疏松17例,内科疾病31例。伤后至入院时间2～22 h,平均16 h。结果平均手术时间70 min,平均输血量300 mL,手术后引流量平均40 mL。手术后切口均I期愈合。并发尿路感染3例,肺部感染1例,均经抗生素治疗后痊愈。21例均获随访,随访时间6个月～4年,平均28年。X线片检查示髋关节间隙正常。末次随访时按Harris评分标准评定髋关节功能:优14例,良5例,可1例,差1例,优良率90%。结论人工双极股骨头置换术治疗老年股骨颈骨折具有能及时解除患者疼痛、恢复关节功能、防止并发症等优点。

Significance of LCT Joint HighRisk HPV Testing for Followup after CIN Treatment

摘要:目的: 探讨联合LCT和高危型HPV检测对CIN宫颈治疗后的随访意义。 方法 :对200例LCT异常,高危型HPV阳性,阴道镜活检证实为CIN1~3的患者行LEEP治疗或宫颈冷刀锥切,治疗后进行严格随访,包括LCT和高危型HPV检测,阳性病例行组织学检查。 结果 :(1)所有病例经治疗后均无病变残留,其治愈率为100%。(2)从治疗后3个月起,CIN1组高危型HPV转阴率为100%。在随访的第3个月和6个月,CIN2~3组高危型HPV转阴率分别为7317%和9085%,显著低于CIN1组,差异有统计学意义(〖WTBX〗P ＜005)。(3)从随访12个月起,一直有2例病例持续HPV阳性,均为CIN3患者,但LCT和阴道镜检查未发现细胞学异常,继续随访。 结论 :CIN治疗后高危型HPV的转阴时间及转阴率与CIN的级别有关;高危型HPV持续阳性,但LCT和阴道镜检查无异常者可继续严格随访;LCT联合高危型HPV检测是CIN治疗后临床追踪随访的有效手段。Abstract: Objective: To investigate the Significance of LCT joint highrisk HPV testing for followup after CIN treatment. Methods : 200 cases that highrisk HPV infection were tested by realtime PCR and CIN1~3 were confirmed with LCT and colposcopy biopsy were considered. The patients were treated with LEEP treatment or cold knife conization. After treatment, all cases were strictly followed up with LCT and HPV test, and the patients with positive results were examined by histology. Results : 1) After treatment, there was no residual disease in all cases, the cure rate was 100%. 2) From 3 months after treatment, highrisk HPV negative rate was 100% in CIN1 cases. While at 3rd and 6th month after treatment, highrisk HPV negative rate in CIN2~3 cases were 7317% and 9085%, which were significantly lower than those in CIN1 cases,the difference was statistically significant. 3) From the 12th monthafter treatment, there are still two cases of sustained highrisk HPV positive but normal with LCT and colposcopy biopsy. All cases are still strictly followedup. Conclusion : After treatment, the negative rate and time of highrisk HPV concerned with the grade of the CIN; the patients with persistent positive highrisk HPV, but without abnormalities detected by LCT and colposcopy biopsy could continue to strictly follow up; LCT joint highrisk HPV detection is an effective clinical means for followup after CIN treatment.

TREATMENT OF FEMORAL NECK FRACTURE WITH CANNULATED SCREW FIXATION IN YOUNG ADULTS

Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.

Clinical Application of CCRS in Anterior Cervical Spine Surgery

目的:探讨CCRS拉钩在颈椎前路手术中的应用方法及结果。方法:回顾分析2007~2008年在我院完成的97例颈椎前路手术中,应用CCRS拉钩来显露切口者的临床资料,并观察平均手术时间、术中出血量、周围软组织突入手术野的次数、术者术中调整撑开器的次数、患者术后咽部不适时间和医生满意度等指标。结果:该组病例平均手术时间103min,平均术中出血量110 mL,每台次软组织突入术野的次数为0~2次,术者术中调整CCRS 1~2次,患者术后咽部不适1~4 d,医生满意度为95.88%。结论:CCRS拉钩撑开切口后颈前方显露清晰,避免了周围软组织突入颈前操作区,从而提高了手术安全性和术者满意度。

带旋髂深血管蒂髂骨及髂骨膜瓣移位治疗中青年股骨颈骨折

目的 总结带旋髂深血管蒂髂骨及髂骨膜瓣移位治疗中青年股骨颈骨折的手术方法及临床疗效。 方法 2003 年4 月－ 2007 年3 月，收治22 例中青年股骨颈骨折患者。男12 例，女10 例；年龄25 ～ 53 岁，平均42 岁。均为闭合性骨折。致伤原因：交通事故伤18 例，高处坠落伤4 例。受伤至手术时间5 h ～ 43 d。新鲜骨折20 例，陈旧性骨折2 例。骨折部位分型：头下型10 例，经颈型12 例。骨折Garden 分型：Ⅲ型6 例，Ⅳ型16 例。术前Harris 髋关节功能评分（22.80 ± 8.75）分。采用带旋髂深血管蒂髂骨及髂骨膜瓣移位加空心加压螺钉治疗。 结果 术后1 例供区伤口伴液化渗出，经换药治愈；其余切口均Ⅰ期愈合。术后患者均获随访，随访时间20 ～ 60 个月，平均42 个月。21 例股骨颈骨折愈合，愈合时间3 ～ 6 个月，平均3.5 个月；1 例骨折不愈合并股骨头缺血性坏死，于术后6 个月行人工全髋关节置换术。术后14 个月Harris 评分为（86.40 ± 7.95）分，与术前比较差异有统计学意义（P lt; 0.05）。 结论 带旋髂深血管蒂髂骨及髂骨膜瓣治疗中青年股骨颈骨折可改善骨折端血运，促进骨折愈合，减少股骨头坏死的发生。

The Clinical Study of Projection Position of Cervical Particular Facet

摘要:目的:研究一种能够显示颈椎关节突关节及关节间隙的最佳投照摄影位置的方法。方法:观察50例非脊柱疾病患者,在透视下利用传统颈椎斜位的基础上,继续增大角度20°～25°,使人体冠状面与床面的夹角逐渐增大至65°～70°角的范围,此时颈椎(C3～C7)关节突关节在电视上显示最佳时,然后进行点片获取C3~C7关节突关节X线照片。结果: 经透视点片获取422个关节突关节,其中C3显示48个,C4 为96个,C5 为98个,C6 为98个,C7为82个;经统计学χ2检验,颈C3~C7关节突关节在同一椎体的不同侧面及性别间显示率无差异(Pgt;0.05)。在摄影时,笔者设计将躯干冠状面与胶片成65°～70°角的范围,颈椎略呈屈曲位,头部略向对侧外旋,使头部冠状面与胶片成45°角,中心线下移至第五椎体下缘平行射入,经透视确定位置后点片,可得到清晰的关节突关节影像,此摄影位置称可视颈椎关节突关节投照位。结论:可视的颈椎节突关节投照位置能清晰显示颈椎关节突关节及关节间隙。Abstract: Objective: To study the best projection position of cervical articular facet. Methods:The cervical facet angle which was the join angle between sagittal plane of body and the continual line of cervical facet was measured on cervical Xrayed images showed and to the film in 50 healthy people. Results: The facet angle was 65°70°,during projection, the coronal plane of body in the form of 65°70° to the film, this projection position was called cervical facet position. Conclusion: seeingredients cervical facet and its interspaces of join can be showed clearly in the cervical facet position of projection.