目的:探讨外伤性颅内迟发性血肿CT表现特点和规律,为临床即时诊治提供可靠依据。方法:对136例外伤性颅内迟发性血肿患者首次CT及伤后迟发性血肿发生时间进行分析。结果:外伤性颅内迟发性血肿患者多数首次CT检查,可仅表现为蛛网膜下腔出血、脑肿胀、脑挫裂伤和颅骨骨折;颅内迟发性血肿发生的高峰期为伤后24～72小时。结论:外伤性颅内迟发性血肿首次CT检查多有异常,但无颅内血肿者,应在24~72小时内进行CT复查,以发现颅内迟发性血肿,方不至贻误诊治。
Objective To investigate the effect of combined types in treating cases with 2 to 5 tissues transplantation. Methods 305 cases treated from December 1989 to December 2002 were analyzed and summarized. 214 cases were constructed with 2 combined tissues transplantation, the combined types were:toe combined flap,the second toe at both sides transplanted,2 flaps combined transferred; 75 cases were constructed with 3 combined tissues transplantation,the combined types were:the second toe at both sides combined flap,2 flaps combined toe,3 flaps combined transferred;11 cases were constructed with 4 combined tissues transplantation, the combined typeswere:2 flaps combined 2 toes,1 toes combined 3 flaps,4 flaps combined transferred; 5 cases were constructed with 5 combined tissues transplantation, the combined type was:the wrap flap and the second toe with 1 vascular pedicle and another second toe combined bilateral femoris anterior flaps were transferred.The principles of repair were:the thumb was reconstructed first,the wrap round flap was used for the thumb’s skin,the second toe transplantation was used for the thumb defect.The opposite toe was transferred to finger to reconstruct the pinch function.1 or 2 flaps were selected for repair according to the area of damage. The anterolateral thigh flaps were used for the large areas and the lateral arm flaps were usedfor the small areas in selecting the donor area. Results Of the 722 tissues in 305 cases, 14 of them were necrosis, in which the toe were 6 and the flap were 8,and other transferred tissues all survived, the survival rate of tissue transplantation was 98.1%.251 cases were followed up for 1 year to7 years(2.6 years in average).All the patients could care themselves in daily life. The pinch and oppositionfunctions of the constructed thumbs and fingers were recovered,the two-point discrimination was 6 to 14 mm,but 2 cases recovered adduction function only because the thumb was 6 degree defect without the thenar muscle and did not fix the reconstructed thumb in opposite side in operation.All transplanted flaps recovered protecting sensory with S2,56 flaps required plastical operation because of their swelling appearance.The donor areas gained primary stage heal in 285 cases,20 cases gained secondary stage heal, in which part grafted skin necrosis in donor of wrap round flap were 12 cases,the distal of donor big toe necrosis were 2 cases and grafted skin necrosis in donorofanterolateral thigh flap were 8 cases and skin grafted were sucessful. Conclusion Different combined types can be used according to the traumatic situation. Surgical operation and early rehabilitation is conducive to the final function.Combined tissue transplantation is the best way to repair complicated hand injuries.
目的:分析汶川8.0级大地震致腹部外伤的患者的心理问题并探索其护理对策。方法:以汶川8.0级大地震致腹部外伤的19名患者为暴露组,普通患者20名和医务人员19名作为对照组。由3名医护人员运用汉密顿抑郁量表进行调查和分析。结果:地震伤员在睡眠质量、精神焦虑、抑郁情绪等3个方面与普通患者及医务人员比较有明显异常。结论:地震致腹部外伤患者的心理影响明显大于普通患者及医务人员,应进行及时有效的心理干预护理,以控制和减缓其心理问题。
Objective To evaluate a modified anterolateral thigh fascial flap designed for the treatment of the soft tissue defects in the forearmsand hands. Methods From September 2000 to December 2003, a modified anterolateral thigh fascial flap combined with the intermediate split thickness skin graft was applied to the treatment of 13 patients with the soft tissue defects in the forearms or the hands. There were 8 males and 5 females, aged 19-43 years (average, 27.6 years). Three patients had a mangled injury, 4 had a belt injury, and 6 had a crush injury; 6 patients had their tissue defects on the palm side of the forearm, 6 had their tissue defects on the dorsal side of thehand, and 1 had the defect in the index finger (dorsal side of the hand). The tissue defects ranged in size from 17.5 cm×7.7 cm to 4.6 cm×3.4 cm.In addition, 4 of the patients had an accompanying fracture in the forearm or the hand,and the remaining 9 had an extenor tendon injury. All the patients underwent emergency debridement and reposition with an internal fixation for the fracture; 3-5 days after the repair of the injured nerves, muscle tendons and blood vessels, the tissue defects were repaired with the anterolateral thigh fascial flap combined with the intermediate split thickness skin graft. Results No vascular crisis developed after operation. All the flaps survived except one flap that developed a parial skin necrosis (2.0 cm ×1.0 cm) in the hand, but the skin survived after another skingrafting. The follow-up for 3-12 months revealed that all the flaps and skin grafts had a good appearance with no contracture of the skin. According to the evaluation criteria for the upper limbs recommended by the Hand Society of Chinese Medical Association, 9 patients had an excellent result, 2 had a good result, 1 had a fair result, and 1 had a poor result, with a good/excellence rate of 85%. Conclusion The modified anterolateral thigh fascial flap combined with the skin graft is one of the best methods for the treatment of the soft tissue defects in the forearms and the hands. This method has advantages of no requirement for a further flap reconstruction, no skin scar or contracture in the future, easy management for the donor site, and less wound formation.
目的 探讨外伤性脾破裂手术适应证和方法。方法 对77例外伤性脾破裂进行保脾手术治疗，按姜洪池脾损伤四级分类法： Ⅰ级8例，Ⅱ级41例，Ⅲ级18例，Ⅳ级10例。附加脾动脉结扎术6例。结果 死亡4例； 2例并粘连性肠梗阻。获随访45例，随访时间3个月至3年，仅4例儿童有反复上呼吸道感染，无1例发生脾切除后凶险感染(OPSI)。结论 根据脾损伤的部位和程度，可采用两种以上的联合保脾术式，对控制伤脾出血及保留脾脏功能有重要价值。
目的探讨腹腔镜在腹部外伤并胃肠道损伤中的诊治作用。 方法对我院2005年1月至2010年6月期间60例行腹腔镜手术治疗的腹部外伤并胃肠道损伤患者的临床资料，以及腹腔镜手术入路及术中处理情况进行回顾性分析。 结果60例患者均经腹腔镜手术证实为胃肠道损伤，根据损伤的具体情况，行完全腹腔镜手术20例、腹腔镜下辅助手术40例，其中行胃肠穿孔修补术45例,肠段切除术15例。 所有患者均顺利完成手术，无术后胃肠道瘘和腹腔出血情况，有2例患者术后出现切口感染，经换药后治愈。 结论 腹腔镜在腹部外伤并胃肠道损伤方面的诊断价值确切，治疗效果满意，避免了不必要的剖腹手术，且创伤小，是一种安全、合理的手术方式。
Emergency treatment of ocular trauma is a systematic and complicated work. Rapid and correct diagnosis and treatment are needed to maximize the recovery of ocular structure and function. In recent years, China has made remarkable progress in the emergency treatment of ocular trauma, including the development of Expert consensus on the norms of emergency treatment of ocular trauma in China (2019), the establishment of a national ocular trauma database, and the development of VisionGo Artificial Intelligence prediction system for ocular trauma. These measures improve the treatment level of ocular trauma and provide support for the prediction of postoperative visual acuity in severe traumatic eyes. However, with the development of economy and society, the characteristics of ocular trauma in our country have changed. For example, the majority of hospitalized patients were open ocular injuries, farmers and workers were the main occupational groups, and the proportion of eye injuries caused by traffic injuries increased year by year, and the proportion of women and minors increased. Although the annual loss of life of ocular trauma disability in China has decreased faster than the world average, the emergency treatment of ocular trauma still faces many challenges, such as regional differences, insufficient primary medical resources, lack of standardized training, and insufficient promotion of emergency treatment standards. In order to cope with these challenges, it is necessary to further strengthen the popularization of science and technology for the prevention and treatment of ocular trauma, standardize the emergency treatment process, strengthen the training of grass-roots medical personnel, strengthen the safety of emergency surgery, and pay special attention to the particularity of children's ocular trauma. In addition, relevant research has been actively carried out to establish a complete database of emergency patients with ocular trauma to promote the accurate prevention and treatment of ocular trauma.
Objectives To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.